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Myths and Mixed Messages: Championing the Benefits and Safety of Pediatric Vaccines

So, I'm going to take us into some myths and mixed messages here on championing the benefits and safety of pediatric vaccines.

A Child's Immune System Has the Capacity to Respond to Multiple Vaccines at Once

And I want to just talk about this for a second. As I said, I worked in immunology at children's for 35 years. ID and immunology. And I love talking to six-year-olds about how their immune system works. And believe it or not, you can do that. You know, have them imagine the fighter guys and their immune system, the army, that's they're always in the background ready to fight disease. It's amazing. They get all excited about it.

Mary Koslap-Petraco: Pac-Man chewing up things.

Patricia Stinchfield: That's right. Back when Pac-Man was good, was common, I did use that one for sure. We are dating ourselves there.

But - so I think one of the things is that vaccines use up a tiny - tiny part of our immune system less than 0.1%. It does not overwhelm the immune system. Whether you give one, two, four, five injections at the same visit your immune systems like bring it on. I can handle it.

Those newly licensed vaccines are tested alone and in combination with other vaccines. They’re tested in animals first, then a small group of people, then a larger group of people than the general population. So, even when vaccines come out, they are not new. They've been around for a long time and being studied intensely.

So, I think it's important people know that vaccines do not weaken your immune system. They do not overwhelm your immune system. They protect children from vaccine preventable diseases. And like our colleague and friend Paul Offit describes the immune system like an ocean. So, if you're talking to a parent about MMR, measles, mumps, rubella, that's three antigens or three germs. We're going to try to build up antibodies, the good guys, the fighter guys. And if you imagine your child's immune system like that ocean, and you want to put in a measles, mumps, and rubella antigen, it's like three spits in the ocean. It absolutely will not overwhelm it.

So, and combination vaccines, whether you give them individually or together, your immune system sees them as individual antigen. It's like a lock and key. It goes in as an antigen, it gets into that lock, turns it becomes that antibody, and fits one to one. So, you're not going to have any changes whether it's in combination or individually.,

Current Pediatric Vaccine Schedule Has More Vaccines but Fewer Antigens

And I think to that first question that was actually a myth. When you look back at the it's - I think it's about antigens versus pokes. All right. So as we say in Minnesota, pokes. And in 1980, there was fewer - there were fewer pokes for sure, but the number of antigens or those biological proteins that your immune system is recognizing and working with was about 3,000. Whereas in 2021, you can see the number of pokes has increased quite a bit, but the number of antigens has dropped substantially - thank you, science - down to around 320. So the protein chemistry, the purification, the recombination the realizing we don't need necessarily wholesale for some things we can use acellular vaccines. There's lots of reasons why we have more numbers of vaccines today, but less antigens. And I think it's really important.

What is this? You know, this number 72 kind of got in the - the misinformation/disinformation crew, and that's been going around with terrible looking memes of 72 needles poking in a child. That's getting at people's fear. And I do think it's getting at one of our biggest problems with immunization is pain. So, whether it's a baby or an adolescent, you've got to have your distraction that's going on at the time of injection. So, if it's an infant, they should be breastfeeding. If it's a toddler, they should be having bubbles or feathers that they're blowing. If it's a school age kid, let them look at an iPad. If it's a teenager, put on their headphones and rock out whatever it is that they have some distraction to that - that pain rub with a nice cold alcohol wipe really vigorously, and then your their brain picks up pressure and not pain.,

Myth: Vaccines Might Cause Autism

All right, so Mary Beth, I'm going to turn it over to you. This next myth.

Mary Koslap-Petraco: Okay. Thanks very much, Patsy. That was really a terrific explanation for that.,

MMR Vaccine Does Not Cause Autism

Okay, so MMR vaccine does not cause autism. So, there this is going to be a bit of a history lesson for you. In 1998, this was the original theory, and I'm old enough to remember this. It wasn't approved by any of scientific board. He just went and did this. And he was - and also always talk about the money. He was being paid money to do this by a group of parents whose children had autism. And he was also looking to discredit the currently licensed MMR vaccine because he was going to make his own.

So then, in 2004, 10 out of 13 co-authors pulled their names from the - the research study, and the Lancet published a retraction. But look how many years. And you know, like our good friend Dr. Paul Offit says, you cannot un-ring a bell. In 2010, Wakefield lost his license. I do not even ever refer to him as doctor. He doesn't deserve the title. So, he can't practice medicine in England or practice here. And he was reprimanded by the British Medical Board.

So, they did this large scale study in Denmark, and they had, oh, over 65 - 650,000 children, including those with factor - with risk factors for autism and siblings with autism. And they looked at their data. So, what they saw was that the MMR vaccine did not increase the autism link and didn't trigger autism in those who are susceptible, even - they weren't even associated with an increased risk of autism.

And now we have more studies coming out that say that there's a genetic link to autism and these developmental delays in children. We've also expanded the definition of autism. I'm a dinosaur. When I went to diploma school, children who had the - we consider the classical features of autism, the stimmers, nonverbal self-harm, that number of children with - with the classical autism has not increased. We've expanded the diagnosis, and those are some of the things we need to say as well.

So, we have repeated controlled, population-based studies that show no link between autism and the vaccine.

Vaccines Do Not Cause Autism

And like I said, I'm going to point to my own kids. My children got that old whole-cell DTP. And the kind of thinking that you use behind that is that parents are saying, well, that caused my child to get autism or developmental delay. What I'm going to say is, jeepers, that old wholesale autism must have made my kids really smart because one has a PhD in quantum mechanics, and the other one is a computer engineer who helps me make slides, by the way. So, that must have been that old whole-cell vaccine that did that. But that's the kind of thinking that we're - that these folks are using, and we need to explain that.

So, the Institute of Medicine has repeatedly reported there's no correlation between the thimerosal content and vaccines and in autism. And the cause of autism isn't known yet, but we're certainly getting more and more data that show that there is a genetic link there. We need to spend our money on other things, like to find those links to help these children to develop more interventions that can help these children.

And the epidemiological studies in different parts of the world have shown the same thing. There's no relationship between vaccines and autism. And the Vaccine Safety Datalink also did not show a relationship between vaccines and autism or any other neurodevelopmental disorders.

So, the take home message here is there's a temporal association between things is not the same as causation. We start seeing features of autism right around when we're giving vaccines. But quite frankly, every child I have ever cared for with autism, I saw things when they were infants. I have it in my own family. Lack of eye contact, social smiles, those kinds of things show up very early, and it never failed me in all my years of practice that when that child went on to have autism, I saw features at one to two months of age.

Patricia Stinchfield: And Mary Beth, can I add, I think, you know, we - when I said the CDC is - is been changed, they did take down a statement on the CDC website – yes - that said, you know, vaccines do not cause autism, and listed all those great studies that you just mentioned. And because the Secretary of Health and Human Services has a personal mission to you know, vilify vaccines, he made the CDC staff take that down. So, it's no longer on their website. Which is why, I mean - we are all encouraging people to use the NAPNAP website, use AAP for their vaccine guidance.

Mary Koslap-Petraco: Thank you so much for remembering to bring that in Patsy. Now with that, I'm going to turn it back over to Jen for the next myth.,

Myth: My child Doesn't Need This Vaccine Because This Disease Is Mostly Gone

Jennifer Walsh: Thank you, Mary Beth. Excellent - excellent comments by my colleagues.

So, another myth is my children doesn't need this vaccine because this disease is mostly gone. So, because vaccination has been so unbelievably successful in reducing and almost eliminating many of these diseases, it's made it difficult for the public to appreciate that, right? The public health has basically with vaccination created an invisible, pardon me - invisible shield against disease. So, we are needing to look at how can we make the invisible visible for our families?,

Perspective Is Needed

So, perspective is really needed. Again, overwhelming number of parents vaccinate their kids. And the majority of American children, over 70% follow that American Academy of Pediatrics vaccination schedule.

However, we do know that that number of completely unvaccinated is rising. So, in 2001, it was at 0.3%, rose to 0.9%, and then again in 2017, 1.3%. You might say this doesn't look that impressive. This - this is, you know, very close, right. But when you think about the fact that out of 3.9 million children, this number went from about 10,000 to over 50,000 American children - un - completely unvaccinated, right? And you think about how significant that number is when it comes to, you know, not just lowering or increasing their risk, but increasing everyone's risk. When we think about herd - herd immunity-

Mary Koslap-Petraco: I think we also need to point out, Jen, that this can be down - I mean, we always go down to the communities, and this can be community. I mean, look at Patsy's community. It was the Somali community. It wasn't the entire state. You know, in my - here in New York, it's - it's - we have our, our, our Hasidic religious community who've been scared to death about the vaccines. So, that's where these things start.

So, when we look at these numbers, they're very misleading because if you go and look in those - I mean, you saw the numbers that Patsy brought up about how low the numbers were in her community. And I could show you the same thing in New York with the how low the numbers are in some of our religious communities.

Patricia Stinchfield: And I think that's a great point. And it does tend to, you know, it's the Mennonites in Texas, the Hasidic Jews in New York, the Somali Muslims. And it is not the religion. That is - that is just what brings like-minded people together. They meet often. They - they're in close proximity. They spend a lot of time. So, if a disease gets into a closed community with low immunization rates, then it spreads within that community. So, it's not what their religion is because there aren't - aren't major religions that have any - any disagreement with vaccines. It's that like-minded-

Mary Koslap-Petraco: No religion is opposed to vaccinations. None of them.

Jennifer Walsh: Yeah, absolutely. Yeah, so important to remember that about the different pockets around, right? Where these numbers, you know, we're concerned about in general, the entire US, but even more so with those pockets of higher percentages of unvaccinated individuals. Excellent point to remember.,

Cumulative Measles Cases Reported in the United States by Yr

So, our cumulative measles report. We can see how this has been rising over time, particularly in the past couple of years we've seen a huge spike. And - and, you know, we - we do have to think about, you know, HHS and CDC and some of the information that came with that and how that impacted these numbers as well, as well as the misinformation and disinformation that we have going on right now. But look at 2026, we are on record for an absolutely devastating year for measles in the US and - and getting close every year to losing that.

Measles-free - measles elimination status. ,

Percentage of Reported Measles Cases in the US by Vaccination Status

So, and then we look at the, you know, percentage of reported measles cases in the US by vaccination status. And - and, you know, again, being a statistics kind of nerd, it's overwhelming about how - how at risk those unvaccinated or unknown are and how that is what's feeding the issue that we're having.,

Reemergence of Previously Eliminated Diseases

Patricia Stinchfield: So, let's just talk about a little bit about this elimination of diseases here. So, there was a simulation model built with data from the US Census Bureau and the National Center for Health predicting that declining vaccination could lead to millions of preventable infections. Well, we're there, people you know, three deaths from measles in the last year and a half, two in children. One in an unvaccinated adult who never sought care. Pertussis deaths across the country are increasing in young infants. And so. we are seeing these diseases re-emerge, and that parents and caregivers may not have that firsthand experience of the diseases.

But that is where a wonderful new organization has started grandparents for vaccines.org. You can go there, and you can join. You don't have to be a grandparent, but basically, you know, people like Mary Beth and I that remember having chickenpox, having influenza severely, having - I had hepatitis A, and so these stories are really important. That mix of the stories and the - the data that tells us that vaccines are safe and effective.

We have to make sure that we're reaching people in lots of different ways, but we've got to get our vaccine rates up and - and keep them up. Every day there's a new cohort born that we need to keep protecting. So, vaccination is never over. We will have to maintain that herd immunity and protect the people who can't be vaccinated, including infants too young for the vaccines, the immunocompromised people on chemotherapy, pregnant women. ,

Debunking Vaccine Myths

So, I think there's a lot to debunking vaccine myths. There is misinformation about vaccines that has proliferated on social media, and oh, if we could just get rid of the bots, there is so much misinformation and disinformation that is spread by - by not even humans, they're - they're bots. And so, we've got this misinformation online that we have got to be louder than.

And going back to Jen's point, most kids who enter kindergarten are fully vaccinated. They may have spread out their vaccines, but they're fully vaccinated. We need that group of parents to be louder. And so, if you've got parents in your clinics that want to participate, we're going to give you a slide in the end that there's some organizations that they can join and get their voices out there. But making sure that we're using evidence-based strategies, and trying to really get at those biases and misperceptions, and misinformation.,

Building Trust Is Important

And so, building trust is really the most important thing. And trust is earned. Trust doesn't happen in one visit. Trust doesn't happen because of the initials behind your name. Trust happens because you have spent time with them. And I always tell people – clinicians - to think of that Venn diagram. The - one circles you, the other circle is the parent. What is the part that overlaps? And really, it's mostly safety. You want their child to be safe. They want their child to be safe. It's just that you are approaching it differently. You want them to not get vaccine preventable diseases. They want to not have anything harmful from vaccines happening. And so, that's the part that you - you work on together.

But we know that we can be those trusted voices. We are the influencers. And I think the best thing is to never give up. Like if they say, I'm not doing that chickenpox shot, chicken pox, it's such a cute name, it can't be a bad disease. You know, it is a terrible disease. It can get into people's brains. I've seen patients that have lost limbs because of staph infection. And so yes, it's a very serious disease. It's one I saw a lot in my early career. And if you don't want to vaccinate today, let's talk about it next time. Here's some things between now and then to read. But the conversation should continue.

And then they're like, wow, she really cares. You know, she really is saying the same thing every time that trust gets built up over time, your credibility, your knowledge, your concern, your compassion, your listening. And nurses, as we know, are the most trusted of all professions. And we need to continue to - to use our power in those conversations. ,

Building Trust With Parents and Caregivers

So, building trust with parents and caregivers. Again, establishing that safe relationship. Understanding where they're coming from. We might just assume they think that MMR causes autism, and that's not on their mind at all. They might have had a relative who had a severe reaction. And is this going to happen - happen to my cousin? Is it going to happen to me and my kids? Offer that information to build their knowledge. And again, it's sort of the statistics and the stories combination that's really important, and trying to clarify and accept where they're coming from. And give those relationships time.,

Who and How to Debunk Vaccine Misinformation: Key Takeaways

So, who, and how to debunk those vaccine? The key takeaways are, again, use your trusted providers and health care, making sure that we're having facts alongside both what the long-term effects, what side effects may be, and what to expect. I think one of the most important things that we as clinicians can do is say, I'm giving you your MMR today. I want you to take out your calendar, and in about 10 to 14 days, put a little dot on there for rash and write it down. Because this is a live vaccine, it may cause a little mini version of measles that gives you a rash. It's not contagious. It doesn't - it's not going to be harmful. But they may develop a fever, and they even can have a rash with it.

And so, when that happens, it means the child's immune system has recognized this vaccine. It's seen it. It's building antibodies. And that's exactly what we expect. We expect some fever because that's your immune system's first response. We expect some redness. That's the inflammation and swelling. That's the immune system doing its job. So, when those things happen, they aren't afraid. They aren't like, oh, I'm never going to vaccinate again. They're like, oh, here's what they told me was going to happen. They think you're genius.

So, making sure that you describe in detail what they should expect for the next days. They're going to be sleepier. They're not going to eat as much. And so when those things happen, it's not that something bad happened, it's that their immune system is really working hard for their child. That's a good thing.

So, that effectiveness and debunking can fade over time. So, as I said, you're never done with immunizations by age. You're never done with them by visit. Every visit is a vaccine visit. Those conversations, if they come in with a broken thumb, you fix their thumb, and you look at their immunization record, and you make sure that they get caught up. So, continual efforts are always required.