group synthesis

Chuong, Dorno, Gomez, Thomas, & Vazquez

Group Synthesis on Developmental Delays, Disorders, and Autism in regards to Vaccinations among Children

Thai Chuong, Penalie Dorno, Rachel Gomez, Madison Thomas & Leisha Vazquez

Nursing Science: Research

NUR 3223

Dr. Phyllis King

Palm Beach Atlantic University

April 28, 2019

Developmental Delays, Disorders, and Autism in regards to Vaccinations among Children

With the increasing rise in children being diagnosed with autism spectrum disorder (ASD) parents and people are becoming concerned that ASD might be linked to vaccines children receive. While the institute of medicine stated that vaccines are very safe there is still some controversy between researchers and the media. The CDC determined that 1 in 59 children will be diagnosed with ASD, and autism can affect all ethnic and socioeconomic groups. The development of autism is unknown, but research has found that there is some genetic link involved among the clear majority of causes. While the development of ASD is on the rise, we believe that vaccines in children do not contribute to the development of autism spectrum disorder. Vaccines should not be viewed negatively, and it is important for the public to be informed on the importance of childhood vaccinations and the crucial role they play in prevention and promotion of health. Listed below are 10 articles that we reviewed which study the relationship between vaccines and autism in children. Shown in table 1 on pages 13 – 16 are each of the article’s title authors, study type, population of interest, and conclusion.

Review of Literature

Researchers, Becerra-Culqui, Getahun, Chiu, Sy, & Tseng were curious to see if there was any association between mothers who underwent prenatal tetanus, diphtheria, and acellular pertussis (Tdap) vaccination and development of autism spectrum disorder (ASD) in their children. This Retrospective cohort study examined mothers who received the Tdap vaccination during their pregnancy, and their offspring (Becerra-Culqui, Getahun, Chiu, Sy, & Tseng, 2018). The population of interest in this study was pregnant women who did not have assisted conceptions and gave birth to live infants between the ages of 22 to 45 week’s gestation, and their offspring (Becerra-Culqui,2018). The population of interest was then further reduced to mothers at the Kaiser Permanente Southern California Hospital (KPSC), who delivered children from 2011 through 2014 and received the Tdap vaccine. The mother’s offspring were then followed for several years until first ASD diagnosis, dropped out from the study, or the end of the follow up period on June 30, 2017 (Becerra-Culqui,2018). Overall the researchers found that the maternal Tdap vaccine affects immune trajectories protecting the infant from infections that would lead to neurodevelopment alterations (Becerra-Culqui,2018). Out of the 81,993 eligible children in the study, 1,341 children or 1.6% were diagnosed with ASD. Out of the 42,916 unvaccinated children, 772 were diagnosed with ASD during the study (Becerra-Culqui,2018). In the 39,077 vaccinated children, 569 had been diagnosed with ASD during the time of the study, thus showing a lower rate of ASD diagnoses in the vaccinated children (Becerra-Culqui,2018). To conclude the researchers found that getting the Tdap vaccination during pregnancy did not place the mother’s offspring at risk of developing ASD, and supports the recommendation to vaccinate pregnant women. (Becerra-Culqui,2018).

Racine, N., Gennis, H., Riddell, R. P., Greenberg, S., & Garfield, H. studied distress regulation during routine vaccinations in infancy and preschool as predictors of outcomes related to socioemotional competence in preschool. The development of a child’s distress regulation abilities not only come from the child, but also the parent’s behaviors associated with the child’s vaccination. This study seeks to examine the relationship between distress regulation during infancy and the predictive socioemotional development at the child’s preschool age. The population of interest in this study is infants receiving vaccinations at their 2, 4, or 6-month checkups and their caregivers. The study consisted of 172 parent-child dyads who agreed to participate in the study, and were then videotaped during vaccinations in infancy, and preschool, and subsequently participated in a full day psychological assessment as well. The videotapes were then coded for child pre- needle distress (baseline distress), immediate distress post needle (immediate reactivity), and pain related distress regulation (distress regulation). Parent sensitivity during the vaccination was coded as well to determine if there was a correlation between parent sensitivity and infant distress. The child and parent dyads were recruited between October 2007 and December 2015, from three pediatric clinics in Toronto, Canada. The psychological assessment took place at the Opportunities to Understand Childhood Hurt (OUCH) laboratory at York University. Each assessment was conducted by a doctoral trainee from a registered training program and was supervised by a registered psychologist. Two video cameras were used as well to capture both a close and a wide shot of the parents and child’s face throughout the vaccination procedure. During the vaccination procedure researchers reviewed videos and assessed the infants using The Modified Behavior Pain Scale (MBPS), and the preschool children were assessed based on The Face, Legs, Activity, Cry, and Consolability scale. Parent sensitivity was coded using The Maternal Behavior Q-Sort Short Version (MBQS). Data was then analyzed using the exploratory correlational analyses and regression analyses consisting of the MPlus 8.0 and the Statistical Package for the Social Sciences. Overall results showed that the child’s behavior to distress and socioemotional functioning at the time of vaccination could be a potential indicator of later difficulties with transitioning and emotions in later development. Results also showed that parent sensitivity was not associated with the child’s social. To conclude this research provides general and universal standardized paradigm to observe distress behaviors, and further studies are recommended to determine a child’s overall behavioral and distress problems.

Researchers Garg, Rahul., Meraya, Abdulkarim., Murray, J. Pamela., Kelly, Kimberly, Studied Parents’ illness representations regarding vaccine preventable diseases as a predictor of their willingness to vaccinate their children. Participants were women who could read and write in English, had at least one child under 3 years of age, and resided in West Virginia. Most of the mothers had a master’s degree, and health insurance access through work. Research has shown that mothers with health insurance and a higher education often have a higher level of vaccine worries, and thus their kids often have a lower vaccine immunization record. Studies have shown that these people worry and doubt the safety and effectiveness of the vaccines, and would rather manage the disease through medical treatment than rely on preventative measures. In this retrospective cohort study researchers randomly assigned mothers to different groups: Vaccine Worry and Vaccine Hassles, Cognitive Illness Representations of Pertussis, Child’s Receipt of Any Vaccine, and Child’s Up‐to‐date Vaccination Status. Within the groups mothers were given a survey which included a consent letter and a questionnaire to assess illness representations, vaccine hassles, worry, and behavior. Results showed that even though the participants reported a higher education and income for this region, more than one-tenth of participants’ children were not up-to date and had no future intention to follow the recommended vaccination schedule. Many diseases are preventable with vaccines and are proven scientifically to work, however participants agreed that it is still hard for them to change their view on vaccination even with all this information. This study shows there is a large correlation between the lack of understanding how vaccines as preventative measures work, and mothers lack of interest in vaccinating their children.

Researchers Lorton, F., Chalumeau, M., Assathiany, R., Martinot, A., Bucchia, M., Roue, J.M., Launay, E., studied morbidity and mortality in children with missing or incomplete meningococcal C (Men C) and pneumococcal conjugate vaccines (PCV). This study was a prospective, observational, population based study throughout France in 2009-2014, and included all children between the ages of 1 month to 16 years who died before admission or were admitted into an ICU for care for a community based bacterial infection. This study consisted of 262 both male and female children and researchers were looking for a proven infection in children admitted with incomplete PCV or no vaccines at all. Researchers were provided a medical record examined the number of children with no vaccine at all or children missing a dosage. Using descriptive statistics research showed that among the 124 children with serotyped meningococcal (n = 75) or pneumococcal (n = 49) severe infections included (median age 26 months), 20 (16%) died and 12 (10%) had severe sequelae. Vaccine-preventable infections accounted for 18/124 infections (15%, 95% CI 9, 22), 5/20 deaths (25%, 95% CI 9, 49), and 3/12 severe sequelae cases (25%, 95% CI 0, 54). One downfall to this study is out of the total 262 children, and 72 children were not documented. This leaves about roughly 27% of missing data for the population of interest. For 27% of the total population researchers are unsure what happened to them. To conclude results, prove that morbidity and mortality related to vaccine preventable Men C and PCV infections could be reduced by one quarter with better implementation of immunization programs. Better information on vaccines could help enhance parent’s perception of vaccine benefits and help parents hesitant about vaccinations. Overall, I would recommend that the same study to be done in different regions or even different countries at the same time. By doing so researchers can examine if the environment they live in could be an indicator as well for morbidity and mortality by comparing it to different regions or countries, this would also allow researchers to compare medical technology which can have a huge impact in saving life’s and reducing complications.

Researcher Jain, Anjali. studied if the MMR vaccine was associated with increased risk of autism, whether the child had an older sibling with Autism spectrum disorder. The population of interest in this study is the children with autism spectrum disorder born between January 1, 2001 to December 31, 2007 and have been continuously enrolled in a health plan from birth to at least 5 years of age and have an older sibling who was also enrolled in a health plan for at least 6 months between the beginning and end of the study frame (January 1, 1997- December 31, 2012). This was a retrospective cohort study that examined databases associated with a large commercial health plan consisting of more than 34 million individuals each year. There was no random sampling that was implemented into this study. This research was a retrospective study, therefore there was no reason to sample the population so long as they met the inclusion parameters. Those included were the index child and the older sibling. ASD status were determined using their entire enrollment time that fell within the study period. Index children had to have at least 1 older sibling with 2 claims with ASD diagnoses or all older siblings with no ASD diagnoses. The age of the first MMR dose administration is 12 to 15months, and 4 to 6 years for the second dose, relative risks (RRs) were estimated to compare ASD status in children receiving 1 dose of MMR at ages 2, 3, 4, and 5 years and 2 doses at age 5 years’ vs those who were unvaccinated at those ages. Out of 95 727 children in the cohort, 1929 had an older sibling with ASD, and among those who had an older sibling with ASD, 134 were diagnosed with ASD. While 860 were diagnosed with ASD that did not have a sibling with ASD. Researchers found no association between MMR vaccination and increased ASD risk among children. Researchers also found no evidence that receipt of either 1 or 2 doses of MMR vaccination was associated with an increased risk of ASD among children who had older siblings with ASD. This study suggests that as the prevalence of ASD increases, so does the number of children who have siblings with ASD increases. These findings indicate no harmful association between MMR vaccine receipt and ASD even among children already at higher risk for ASD.

Researchers Deisher, Theresa A, and Ngoc V. Doan B.S. studied change points in CA and U.S., to determine whether change points in time trends of AD rates temporally coincide with change points for the proposed causative sociologic and environmental factors. The objective of the study was to determine the validity of the social environmental causes of autism. The population of interest in this study is based upon People with Autism in the past three decades, and information was obtained from readily available authoritative sources that provided information on autism rates during change point years. This was an explorative study which evaluated medical records about autism rates from 1970-1997. Data was obtained from large populations within the given specified change points. Sociological factors were identified and quantified as increased professional awareness and increased parental awareness. Professional awareness was evaluated using the data obtained from the PubMed database. Parental awareness was evaluated using messages from Yahoo chat groups that discuss autism. Prediction of change points was based on the year and month that the FDA introduced, and approved certain vaccines. Change point analysis showed a limited relationship between autism rate trends and social environmental factors. Federal funding is a critical factor for autism diagnoses. It is also evident from the study that Thimerosal-Containing Vaccines have no effects on rates of autism. The use of such vaccines began as early as the 1940s, and there was no change in autism rates from then to now. To summarize, the author’s conclusion clears the existing doubts about why the rate of autism is on the rise. Although some scholars argue that social environmental factors have effects on autism rates, such arguments have limitations. The authors have supported in their study that there is no sufficient relationship between autism rates and autism change points of incidence.

Researchers Geier, D.A., Kern, J.K., & Geier, M.R. studied the relationship between an infant’s Hg exposure from Thimerosal-containing hepatitis b vaccines, and the long-term risk of a child being diagnosed with atypical autism. This was a hypothesis-testing, prospective longitudinal, case-control study approved by the CDC to evaluate the toxic effects from Thimerosal-containing childhood vaccines. After the cohort examined over 1 million children enrolled in the HMO database only those individuals diagnosed with atypical autism following the vaccines under study were included. After all inclusion and exclusion criteria the study consisted of 164 cases of atypical autism (138 males, and 26 females) born from 1991 to 1998. The researchers then used a set of statistical tests to examine individuals who were exposed to Hg that were age specific with individuals who were within six months old. In the second statistical test performed, the individuals that were analyzed remained at six months old (or younger), but it focused on the exposure of Hg from Thimerosal-containing hepatitis B vaccines that were given to the population of interest. Results suggest a significant role for Hg exposure from Thimerosal-containing hepatitis B vaccines administered to infants within the first six months of life and the long-term risk of being diagnosed with atypical autism. It was observed that cases diagnosed with atypical autism were significantly more likely to have received increased Hg exposure from Thimerosal-containing hepatitis B vaccines administered within the first month, first two months, and first six months of life, and were consistent when separated by gender. It was also observed using the logistic regression statistical testing that those that received higher doses of the Thimerosal- containing hepatitis B vaccine had an increased risk of developing atypical autism. In conclusion, routine childhood vaccinations are an important health tool to reduce morbidity and mortality of infectious diseases. The results of this study show a significant relationship between Thimerosal, found as a preservative in vaccines, and an increased risk of atypical autism. Thus, researchers recommend the removal of thimerosal from all vaccines, and to limit vaccines containing it.

Researchers Laure Fonteneau, Châtelet, I. D., Jean-Paul Guthmann, & Daniel Lévy-Bruhl, studied public concerns about Human Papillomavirus (HPV) vaccination safety and efficacy, and the relevance of using vaccines reimbursement data to assess the impact of those public concerns on vaccination coverage in France. In France vaccines are almost always exclusively administered through a private sector. Patients purchase the vaccine at pharmacies and typically 65 % of the price of the vaccine is covered, and a complementary insurance covers the remaining 35 % of the vaccine cost. This reimbursement data is then entered into a data base for the National Health Insurance Information System. Researchers were given access to this database to analyze vaccination data for girls born between 1995 and 1999 and aged 15 years between January 2010 and June 2014. Researchers extracted data related to HPV vaccines purchased between July 2007 and June 2014. For each selected individual from the database, researchers reviewed his/her vaccine history (number of doses reimbursed and age at delivery). Each of these individuals would have received their first HPV vaccination around 2011 once they became of age, although results showed that from 2011 to 2014 the coverage for complete vaccination among 16 years old girls decreased by 26.5%. researchers belive that the public media has put a negative sigma on the Human Papillomavirus (HPV) vaccination by putting testimonials of teenagers having developed neurological manifestations. The public is now concerned about the risks and controversy associated with this vaccine thus leading to lower vaccination coverage and higher public concerns on vaccination. The results from this study revealed that in 2011 for the French population, the HPV vaccination coverage was already low and decreasing because of media coverage regarding potential safety issues of the vaccine. Researchers in this study explored the relevance of using vaccines reimbursement data to assess the impact of those public concerns on vaccination coverage.

Researchers Jain, A., Marshall, J., Buikema, A., Bancroft, T., Kelly, J. P., & Newschaffer, C. J., studied the occurrence of autism spectrum disorder in children who also had an older sibling with or without autism spectrum disorder. The study was a retrospective cohort study using an administrative claims database associated with a large commercial health plan. Inclusion criteria for the study included children continuously enrolled in the health plan from birth to at least 5 years of age, born between January 1, 2001 and December 31, 2007, and had an older sibling continuously enrolled for at least 6 months between the beginning and end of the study period. The study was conducted using an administrative claims database associated with a large US health plan (the Optum research Database). This database includes more than34 million people each year. The people ranged from insured to noninsured. This database also included individuals from a geographically diverse US population, as well as the sex and age. The study consisted of 95,727 children with older siblings, and 994 were diagnosed with ASD, and 1929 children had an older sibling with ASD. From the children with older sibling with ASD only 134 were also diagnosed with ASD, while 860 were unaffected. Researchers concluded that children with older siblings, who received the MMR vaccine were not associated with increased risk of ASD, regardless of whether older siblings had ASD. These findings indicate no harmful association between MMR vaccine receipt and ASD even among children already at higher risk for ASD.

Researchers Goin-Kochel, R. P., Mire, S. S., Dempsey, A. G., Fein, R. H., Guffey, D., Minard, C., and Boom, J. A, studied whether the onset of regressive autism in children is triggered by vaccines. There is a belief held by parents that regressive onset of autism spectrum disorder (ASD) is caused by vaccines. This idea was introduced by Andrew Wakefield who published a paper proposing that certain vaccines such as measles, mumps and rubella vaccine can cause intestinal inflammation. Because of this inflammation, chemicals from the vaccines would be able to enter the blood stream, travel to the brain and cause autism. Though proven to be fraudulent information, people were already connecting their fear of autism with vaccination. This belief has cause parents to decline or delay vaccination for their children. Regression is usually noticed by parents and healthcare professionals at an average age pf 21.4 months. Because most vaccines are scheduled to be completed by the time a child is 2 years old, parents tend to correlate the two. This cohort study was done to evaluate whether parental report of child vaccination affects the onset of autism spectrum disorder. This study comprised of 2755 children ages 4 to 17 with the average of 9 years old. 33.5% of the children presented with early onset, 36.5% for plateau, 10% delay-plus- regression, and 20% with regression. Vaccination history was obtained from the parents through an extensive Medical History Interview. Participant information was gathered from the Simons Simplex Collection. This data contained information from families who have a single child diagnosed with ASD or suspected ASD. The results were then categorized into four groups, early onset, delay-plus- regression, plateau, and regression. Children with early onset developed symptoms of autism within the first year without skill loss, delay-plus-regression showed symptoms and some loss of language and/or social skills, plateau showed no symptoms or loss of skill within the first year, and finally children with regression showed no symptoms but had a loss of language and/or social skills. Researchers found that there is a lack of education and understanding of this disorder, however research does not support the assertions the regressive onset ASD is triggered by vaccines.

Table 1. Summary of review of literature

Authors	Study Type	Population of interest	Conclusion
Becerra-Culqui, T. A., Getahun, D., Chiu, V., Sy, L. S., & Tseng, H. F	Retrospective Cohort	Pregnant women who received the prenatal Tdap vaccine throughout Kaiser Permanente Southern California Hospitals (KPSC), who did not have assisted conceptions and gave birth to live infants between the ages of 22 to 45 week’s gestation, and their offspring.	Researchers found that getting the Tdap vaccination during pregnancy did not place the mother’s offspring at risk of developing ASD.
Racine, N., Gennis, H., Riddell, R. P., Greenberg, S., & Garfield, H.	Longitudinal Cohort	The population of interest in this study is infants receiving vaccinations at their 2, 4, or 6-month checkups and their caregivers.	Overall results showed that the child’s behavior to distress and socioemotional functioning at the time of vaccination could be a potential indicator of later difficulties with transitioning and emotions in later development. Results also showed that parent sensitivity was not associated with the child’s socioemotional development and competence.
Garg, Rahul., Meraya, Abdulkarim., Murray, J. Pamela., Kelly, Kimberly	Retrospective Cohort	The population of this study is mothers in West Virginia who could read and write English, and had at least one child less than 3 years old.	This study confirms that some children from higher educated parents often worry and doubt the effectiveness and safety of vaccinations. This results in lower child vaccinations and immunizations in the state of Virginia. This research also confirms that the enforcement of mandatory child vaccination in West Virginia is lowering the rate of vaccination in the study due to skepticism of parents.
Lorton, F., Chalumeau, M., Assathiany, R., Martinot, A., Bucchia, M., Roue, J.M., Launay, E.	Prospective, population based- observational	All children age 1 month to 16 years admitted to a pediatric intensive care unit (PICU) or who died before admission with a community-onset severe bacterial infection (COSBI), in France between August 2009 and January 2014.	Researchers found that mortality and morbidity rates related to preventable meningococcal or pneumococcal infection could be reduced by 25% through proper vaccinations. The researcher’s conclusion that without complete vaccination, the children will have a 25% chance of dying or have a severe complication once they get the infection. By increasing awareness of vaccination problems, it could help enhance the public’s perception on the benefits of vaccines.
Jain, Anjali.	Retrospective cohort	The population of interest in this study is the children with autism spectrum disorder born between January 1, 2001 to December 31, 2007, and have an older sibling diagnosed with autism spectrum disorder.	This research study in children diagnosed with autism spectrum disorder, who also have an older sibling diagnosed with autism spectrum disorder showed that the MMR vaccine was not associated with an increased risk of autism spectrum disorder. Regardless if the older sibling had autism spectrum disorder, the findings suggest no harmful association between the MMR vaccine and autsim spectrum disorder, even in children already at a high risk for autism spectrum disorder.
Deisher, Ph.D., Theresa A, and Ngoc V. Doan B.S.	Explorative study	The population of interest in this study is based upon People with Autism in the past three decades throughout California.	Change point analysis showed a limited relationship between autism rate trends and social environmental factors. The use of such vaccines began as early as the 1940s, and there was no change in autism rates. Vaccination of children happened at an early age and the quantity of mercury injected in the body is too little to cause any harm as supported in the charts. The authors have concluded that there is no sufficient relationship between autism rates and autism change points of incidence.
Geier, D. A., Kern, J. K., & Geier, M. R.	Hypothesis testing, prospective longitudinal, case control study.	All individuals with accessible medical records who were continuously HMO- enrolled from their date of birth and whose records specified their gender.	Results suggest that the mercurial component, thimerosal, used as a preservative in many multi-dose vaccines throughout the United States and worldwide, is significantly associated with a dose dependent increased risk for atypical autism disorder. As a results research suggest that thimerosal should be eliminated from all vaccine preparations.
Laure Fonteneau, Châtelet, I. D., Jean-Paul Guthmann, & Daniel Lévy-Bruhl.	Retrospective cohort	Vaccination history and data for the human papillomavirus (HPV), in girls born between 1995 and 1999 and aged 15 years between January 2010 and June 2014.	Researchers found that public media has put a negative stigma on the Human Papillomavirus (HPV) vaccination by putting testimonials of teenagers having developed neurological manifestations. Thus, HPV vaccination rates were very low, and still declining.
Jain, A., Marshall, J., Buikema, A., Bancroft, T., Kelly, J. P., & Newschaffer, C. J.	Retrospective cohort	The population of interest in this study were children with ASD. database born between January 1, 2001, and December 31, 2007, who were continuously enrolled in the health plan from birth to at least 5 years of age and who also had an older sibling continuously enrolled in the health plan for at least 6 months between the beginning and end of the study period.	This large retrospective sample study of privately insured children with older siblings diagnosed with ASD recipient of the MMR vaccine showed no increased risk of ASD. Regardless of whether older siblings had ASD, there was no increased risk that the other sibling would be diagnosed with ASD as well. These findings indicate no harmful association between MMR vaccine and ASD even among children already at higher risk for ASD.
Goin-Kochel, R. P., Mire, S. S., Dempsey, A. G., Fein, R. H., Guffey, D., Minard, C., Boom, J. A	Cohort study	The population of interest was families with vaccinated children with regressive autism, whose single child was diagnosed with ASD, and had no degree of relatives with ASD or suspected ASD.	Researchers stated that, “Overall, findings suggest that when parental description of ASD onset in children is examined against parent report of vaccine history, there is no association between patterns of onset of ASD and any types of vaccines.”

Synthesis

The ten research articles we studied all agreed that vaccines are not associated with the development of autism spectrum disorder in children. There was no contradicting information. It was shown throughout the articles that researchers found no connection between vaccines and autism. In fact, autism is a condition that affects the brain and the cause is unknown, but genetics, differences in brain anatomy, and toxic substances in the environment are thought to contribute to its development. Even with the overwhelming evidence that vaccines are safe and effective, some parents still decide not to have their children vaccinated or to even delay vaccinations. This is extremely risky because vaccine-preventable diseases like measles are still around, and if an unvaccinated child gets one of these preventable diseases they could get very sick or even die, as well as other people around them. Although autism rates have been increasing within the past 20 years, it is hard to pinpoint an exact cause. This can be contributed to whether rates of autism today are due to increased diagnosis and reporting, or an actual increase in development of ASD is unknown. This is likely because of the increase in knowledge and doctors within this area of medicine. From our research, we also concluded that vaccines do not contribute to developmental delays, disorders, and autism among children. Out of the ten articles we reviewed, majority of them were retrospective studies that followed the children over time. However, within retrospective studies, the data likely already exists or a survey is created which can sometimes not be the most reliable source.

Limitations

Some of the limitations that occurred in these studies included bias, sample size, time, and collection of data. Many of these studies interviewed parents who chose not to vaccinate their children, and likely are biased against vaccinations. Within these articles majority were retrospective studies that relied on subject’s information or data given to them, and this limits the researcher’s ability to control factors within their study. Some of the articles as well were not organized and lacked information obtained during the study. Parents often reported vaccine records, rather than obtaining them which creates room for error. The studies reviewed also took place throughout different countries and states where a diagnosis of ASD could differ, therefore some children may have been misdiagnosed or not diagnosed at all. However, the results found in the articles outweigh the limitations and provide good information on vaccines and autism.

Implications for Practice

We can conclude from these research articles that vaccines are not correlated with an increased risk of autism, developmental delays, and disorders in children, even those at risk. Vaccines are proven to be effective at preventing the development of morbid diseases, and are helpful in stimulating immune trajectories in children to prevent infection. Medical professionals including nurses should be aware about the effectiveness and safety of vaccines, and educate parents on the benefits of vaccines for their children. Parents should be made aware of possible outcomes to not vaccinating their children, along with benefits of vaccinations through valid research before making this decision.

Discussion

Questions and areas for further study

Some questions that remain unanswered from the research articles viewed are what directly causes autism. While it is still unknown the exact cause research has stated clearly that vaccines are not in correlation with autism and developmental delays in children. It has been predicted that autism is likely occurs even before the child is born while in the womb. We belive that one area for further study should include the benefits of vaccines, and questions regarding hesitancy to vaccines, and why some are opposed as they are shown to be helpful.

Considerations for research on this topic

The debate on the safety of vaccines has been going on since the introduction of vaccines. Within the past 20 years’ research has focused on vaccines effects on children and their development. It is important to consider that every individual is different, and everyone can react to a vaccination differently. It is important to inform parents and those receiving vaccines the benefits and side effects that can come with them. However, research shows there is no correlation to vaccines and developmental delays such as autism, and therefore parents should not be hesitant regarding them for these reasons. Another consideration is that as science and medical technology progresses so do vaccines, and ingredients that were once known as harmful are also removed and made safe through the CDC.

References

Becerra-Culqui, T. A., Getahun, D., Chiu, V., Sy, L. S., & Tseng, H. F. (2018). Prenatal Tetanus, Diphtheria, Acellular Pertussis Vaccination and Autism Spectrum Disorder. Pediatrics,142(3). doi:10.1542/peds.2018-0120

Deisher, Ph.D., Theresa A, and Ngoc V. Doan B.S. Sociological Environmental Causes Are Insufficient to Explain Autism Changepoints of Incidence. Issues in Law and Medicine, 2015.

Garg, Rahul., Meraya, Abdulkarim., Murray, J. Pamela., Kelly, Kimberly. (2018). Illness Representations of Pertussis and Predictors of Child Vaccination Among Mothers in a Strict Vaccination Exemption State. Matern Child Health Journal. Retrieved from http://web.b.ebscohost.com.proxy.pba.edu/ehost/pdfviewer/pdfviewer?vid=0&sid=7ffc95 95-ace9-4c84-84c2-4a56fb1703f0%40pdc-v-sessmgr06

Geier, D. A., Kern, J. K., & Geier, M. R. (2017, July). Increased risk for an atypical autism diagnosis following Thimerosal-containing vaccine exposure in the United States: A prospective longitudinal case-control study in the Vaccine Safety Datalink. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28595786

Goin-Kochel, R. P., Mire, S. S., Dempsey, A. G., Fein, R. H., Guffey, D., Minard, C. G., . . . Boom, J. A. (2016). Parental report of vaccine receipt in children with autism spectrum disorder: Do rates differ by pattern of ASD onset? (11), 1335-1342. doi:10.1016/j.vaccine.2016.02.008 Vaccine, 34

Jain, Anjali. “Autism Occurrence by MMR Vaccine Status Among US Children.” JAMA, American Medical Association, 21 Apr. 2015, jamanetwork.com/journals/Jama/full article/2275444? result Click=1.

Jain, A., Marshall, J., Buikema, A., Bancroft, T., Kelly, J. P., & Newschaffer, C. J. (2015). Autism Occurrence by MMR Vaccine Status Among US Children With Older Siblings With and Without Autism. Jama,313(15), 1534. doi:10.1001/jama.2015.3077

Laure Fonteneau, Châtelet, I. D., Jean-Paul Guthmann, & Daniel Lévy-Bruhl. (2015, December 12). The use of reimbursement data for timely monitoring of vaccination coverage: The example of human papillomavirus vaccine following public concerns about vaccine safety. Retrieved from https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-2575-7

Lorton, F., Chalumeau, M., Assathiany, R., Martinot, A., Bucchia, M., Roue, J.M., … Launay, E.

(2018). Vaccine-Preventable severe morbidity and mortality caused by meningococcus . and pneumococcus: A population-based study in France. Paediatric and Perinatal Epidemiology. https://onlinelibrary-wiley-com.proxy.pba.edu/doi/full/10.1111/ppe.12500

Racine, N., Gennis, H., Riddell, R. P., Greenberg, S., & Garfield, H. (2018). Distress

Responses in a Routine Vaccination Context: Relationships to Early Childhood Mental Health. Children,5(2), 29. doi:10.3390/children5020029