Vaccine Adverse Events: Separating Myth from Reality

 

Vaccines are one of the most successful medical advances in modern times. Most vaccine-preventable illnesses are unfamiliar to modern parents. Because of this, parents are increasingly questioning the necessity of immunizing their children, especially because no vaccine is completely free of adverse effects or the risk of complications. Family physicians should be aware of the risks and benefits of recommended immunizations. Thimerosal is currently used only in multidose vials of influenza vaccine, and exposure through vaccines is not associated with adverse neurologic outcomes. The measles, mumps, and rubella vaccine is not associated with autism. Vaccines are associated with local reactions, such as pain and erythema. The rotavirus vaccine minimally increases the rate of intussusception, whereas other vaccines minimally increase the risk of syncope. Although immunization with the human papillomavirus vaccine is recommended for all boys and girls, vaccination rates remain low. Physicians should guide parents to credible resources if they are considering vaccine refusal. If a recommended vaccine is refused, proper documentation is essential. The Vaccine Adverse Event Reporting System and National Vaccine Injury Compensation Program track adverse events and allow compensation for documented harms from vaccinations.

With the success of vaccinations, many parents no longer have contact with children who have vaccine-preventable illnesses. Because of this, parents have difficulty balancing the potential harms and benefits of vaccines. Some parents express concern that physicians are not well educated on the adverse effects of vaccines or that physicians purposefully withhold information on adverse effects.1 Parents may seek out additional information from websites containing inaccurate information. Family physicians should gather accurate information about the harms and benefits of vaccines to advocate for vaccination and decrease the incidence of vaccine-preventable diseases.

WHAT IS NEW ON THIS TOPIC: VACCINE ADVERSE EVENTS

In 2012, the United States had its largest pertussis outbreak since 1955, including 48,277 cases and 20 pertussis-related deaths.

The most common adverse effects of the human papillomavirus vaccine are transient and similar to those of other vaccines, including mild pain and bruising at the injection site, headache, lightheadedness, and syncope.

The American Academy of Family Physicians does not support immunization exemption policies except in cases of allergic or medical contraindication.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

A 25-mm needle should be used instead of a 16-mm needle to reduce the risk of adverse reactions to vaccinations.

A

3

Antipyretics are not recommended for routine prophylaxis before immunizations.

A

6, 7

The measles, mumps, and rubella vaccine does not increase the risk of autism and should be routinely used.

C

35, 36

Parents who refuse a recommended vaccine should sign a refusal to vaccinate form.

C

7, 79, 82


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

A 25-mm needle should be used instead of a 16-mm needle to reduce the risk of adverse reactions to vaccinations.

A

3

Antipyretics are not recommended for routine prophylaxis before immunizations.

A

6, 7

The measles, mumps, and rubella vaccine does not increase the risk of autism and should be routinely used.

C

35, 36

Parents who refuse a recommended vaccine should sign a refusal to vaccinate form.

C

7, 79, 82


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

Vaccine Adverse Events

Common local reactions to vaccines include pain, swelling, and erythema at the injection site. Systemic reactions, including fever, irritability, drowsiness, and rash, may also occur.2 Use of a longer needle (25 mm vs. 16 mm) decreases injection site reactions.3 The fourth dose of the diphtheria and tetanus toxoids

The Authors

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JEANNE P. SPENCER, MD, is program director at Conemaugh Family Medicine Residency Program, Johnstown, Pa., and a clinical assistant professor of family and community medicine at Drexel University College of Medicine, Philadelphia, Pa....

RUTH H. TRONDSEN PAWLOWSKI, MD, is an assistant program director at Conemaugh Family Medicine Residency Program.

STEPHANIE THOMAS, PharmD, is an associate director of the pharmacy residency program at Conemaugh Family Medicine Residency Program.

Address correspondence to Jeanne P. Spencer, MD, Conemaugh Family Medicine Residency Program, 1086 Franklin St., Johnstown, PA 15905 (e-mail: jspence@conemaugh.org). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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