Things is gettin' worser - Pediatric Undervaccination

The typical trajectory of public health over the past several centuries has pointed upwards towards improvements including longer life-expectency. However, as we've entered the post-scientific era, where our country receives its medical advice from celebrities, it's not at all surprising that things can move in the wrong direction. Of course, vaccines are a victim of their own successes since absence of a terrible diseases like measles convinces people they don't need to vaccinate their children and also more susceptible to false claims of vaccine side-effects, but I digress.

Authors Jason Glanz and colleagues recently published a matched-cohort study of healthcare utilization in vaccinated vs. under-vaccinated children less than 3 years old. Their primary findings were that undervaccinated children had lower rates of outpatient visits but higher rates of inpatient admissions.  There are also some interesting findings about how parental choice in vaccination is associated with healthcare utilization. What was more interesting to me is how things have changed gotten worse in the birth cohorts over the 5 years studied (2004 to 2008).  In the figure below, time to first vaccination has increased greatly over the 5 years (solid shapes), as have the rates of 'no vaccination'. So things are moving upward, but in this case, that's the wrong direction.

Reference: Glanz JM, Newcomer SR, Narwaney KJ, et al. A Population-Based Cohort Study of Undervaccination in 8 Managed Care Organizations Across the United States. JAMA Pediatr. 2013;():1-8. doi:10.1001/jamapediatrics.2013.502.

"Young" doctors and vaccines

Vaccines these days can't catch a break.  Back in the day when people were dying from polio and measles, everyone (including physicians) could see the benefits of vaccines first hand. Now, with the success of vaccines in the bag, the ground has shifted against vaccines from "seeing is believing" to "what have you done for me lately." 

There is an abstract at IDSA that reports that young physicians are less supportive of vaccines. Sara Kliff at the Washington Post reports that Michelle Mergler (Emory) and Saad B. Omer (Johns Hopkins) found that recent medical school graduates were “more likely to believe immunizations do more harm than good" and were 15 percent less likely to believe vaccines work. Bummer.

see also: Shari Roan, LA Times 10/20/2011

IOM: 667 reasons why vaccines are generally safe

It's actually 667 pages.  The IOM has just released a report titled: "Adverse Effects of Vaccines: Evidence and Causality."  I've pasted a summary table (click to enlarge) of the major conclusions below, which you can also find, and read more easily, in the IOM Brief Report.  I hope this has an impact and convinces families that vaccines are safe, but somehow I get a feeling that it might have been better if instead of saying "favors rejection" for the vaccine link to autism, they might have said "nada" or "got nothing." I didn't realize this, but apparently the IOM has reviewed the safety of vaccines 11 times at the request of Congress since 1986. Well, should be a good read for my flight back from Seattle.

CLICK TO ENLARGE

Full IOM report (here)

WaPo article on the IOM Report 8/25/2011