Background Reading. 1. New York Times editorial from April 14, 2010: They Should Know Better

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1 Understanding Vaccines/Immunization Homework 2.5 pt F 10 Due at final exam, Monday 12/06/10 You can slide your assignment under my office door if all pages are stapled together. Do not !!! (To be clear: I will not accept or grade ed assignments.) CHM 109 started with a consideration (George Washington, R.I.P.) of the importance of using the scientific method to make medical decisions. The phrase evidence based medicine is sometimes used to describe this approach. This assignment revisits that notion on a topic that I hope is of some importance to you: vaccine use. Completion of this assignment requires you to read/scan 2 articles about immunization/vaccine use. These articles may not seem to be related (the editorial is about swine flu, while the literature review is about MMR vaccine and thimerosal containing vaccines not being linked to autism). However, I suspect the hostility some of our fellow citizens display toward immunization in general makes it more instructive to consider the articles together. Perhaps some of you will be able to help these fellow citizens make better informed health care decisions using the information from this assignment. Background Reading 1. New York Times editorial from April 14, 2010: They Should Know Better You can access this editorial through the Lexis-Nexis Academic electronic database available through the USC Upstate Library web site. Recall that you can access the various databases by clicking on the letters below Database & E-resources Index on the library s home page. I found the article by using the Easy Search mode (I believe that is the default setting.). I entered flu vaccine health care workers in the Search For box and put New York Times, The in the Or by Source Title box. When I did the search with these inputs the article you are after came up as the first hit. Read this editorial. It shouldn t take more than a few minutes. While an editorial is (by definition) giving an opinion, a well reasoned editorial supported by solid data can be quite educational. 2. From the Journal for Specialists in Pediatric Nursing 14 (3): (2009) read Autism and Vaccination-The Current Evidence by L. Miller and J. Reynolds. You can access this through CINAHL or directly through JOURNAL FINDER (TDNet), which is located on the upper left side of the USC Upstate library s home page. Read this article (It will take more than a few minutes.) and have paper and pencil handy so you can take notes as you read. Additional comment: While some of your professors might not be very fond of Wikipedia, I have found it to be useful when used in the proper context. It is often a good way to get a quick introduction to a topic, and there are a few areas here where it could be handy. 1

2 Write out all answers by hand. Do not use computer/word processor/cut and paste/etc. While you will be using information from the materials below, you are not allowed to quote their words directly (except as noted for specific questions). You are welcome to restate information, using your own language, when needed. If you need to give numbers or other data (example: 62%), it is permissible to copy that directly. Based on: They Should Know Better (Note: This article is based on information from the flu season (fall/winter/spring) of ) 1.(0.05 pt) According to the CDC and RAND Corporation, what percentage of health care workers received: seasonal flu vaccine swine flu (H1N1) vaccine 2. (0.05 pt) The editorial gave two reasons why health care workers should get vaccinated. What were these? 1) 2) 3. (0.05 pt) Among the most frequently cited reasons cited by health care workers for not getting vaccinated was I don t need it. I have been struggling to understand what that statement means. In four sentences or less, try to explain below what you think workers that gave that answer actually meant. If you cannot come up with an explanation, invent something that is humorous. 4. (0.05 pt) Was there a correlation between employers policy regarding vaccination and the rate at which health care workers complied with vaccination? If yes, elaborate briefly. 2

3 Based on Autism and Vaccination-The Current Evidence, by L. Miller & J. Reynolds 5. Define the following terms (0.4 pt). Some of these terms have a somewhat different meaning in a medical than a layman s context ( attenuated would be a good case in point). While I will accept a definition from either background as long as it is reasonably accurate, I hope you will try to find definitions for some of the terms that are more appropriate for the medical context used in this paper. etiology onset rigor validation attenuated regression cohort refuting 3

4 6. (0.1 pt) What are autism spectrum disorders (do the best you can regarding rewording vs. copying), and have they increased in frequency over the previous several decades? 7. (0.1 pt) When scientists make a direct assertion in their writing, they usually support that assertion with data they are presenting or by citing work and writings that other people have done. The authors make the assertion that Vaccines are a cornerstone in public health practice... How do they support this assertion? 8. (0.1 pt) Why do the authors state that some parents may be more concerned about the risks of taking a vaccine than the risks associated with not taking the vaccine? 9. (0.1 pt) Who is thought to have developed the first vaccine, and for what disease was this vaccine effective? 4

5 10. (0.05 pt) What health problem do the authors indicate was significant in the mid-1900's in the United States, and was among the most feared diseases? Name two individuals that worked on vaccine development for this disease. 11. (0.1 pt) The authors list approximately 23 different diseases for which vaccinations exist. Write the names of your favorite 8 diseases from their list in the space below. 12. (0.05 pt) Against how many diseases are pre-school children routinely vaccinated? 13. (0.1 pt) Why is it logical to immunize children relatively early in their life? 14. (0.1 pt) What is the goal of the immune system? 15. (0.05 pt) Are infant immune systems generally capable of responding to antigens by producing antibodies? yes no 16. (0.05 pt) Who plays a roll in monitoring the safety of vaccines? (In answering this question you may simply copy the appropriate words from the article.) 5

6 17. (0.05 pt) Why is it important to encourage parents to trust their instincts related to their children s health? (In answering this question you may simply copy the appropriate words from the article.) 18. (0.1 pt) What information are nurses and other healthcare providers required to record fo reach vaccine administered? (In answering this question you may simply copy the appropriate words from the article.) MMR section 19. (0.05 pt) What does MMR stand for? (In answering this question you may simply copy the appropriate words from the article.) 20. (0.1 pt) Has the MMR vaccine been effective in reducing the frequency of measles in the United States? (Indicate yes or no, and then supply some data to support your answer.) (In answering this question you may simply copy the appropriate words from the article.) The heart of this problem is the Wakefield et al article, which is the last entry in the References list: 21. (0.05 pt) Twelve children were described in a 1998 publication by a British researcher & 12 coauthors. Of these children, for how many was a diagnosis of autism given? For how many of these children was link between the developmental disorder and vaccination made? What types of people made this link? 22. (0.05 pt) In 2004 how many of Wakefield s coauthors asked to formally retract the interpretation placed upon these findings...? 23. (0.05 pt) You can access Wakefield s Lancet paper by going through TDNet via the USC Upstate library (use the British Lancet edition). What does it say, in what color, and roughly what size font across the first page of the article? 6

7 24. (0.05 pt) The authors cite a number of published studies that refute an association between MMR vaccine and autism. Give only the author s names part of the citation for two of these. 1) 2) 25. (0.05 pt) MMR immunization rates decreased somewhat in England (to a low of 80% in ). Was there a increase in the number of cases of measles in England between 1998 and 2008? If so, what was the number of cases in each year? Thimerosal section (This will be short.) 26. (0.1 pt) Write the structure of thimerosal in the space at right: (readily available on the www). 27. (0.05 pt) What element is present in thimerosal that you might expect would be dangerous to humans? 28. (0.05 pt) Have scientific studies shown there to be a link between use of thimerosal in vaccines and autism or other childhood development disorders? yes or no 29. (0.05 pt) List only the authors names for two of the citations given by Miller & Roberts to support the answer to Q# 28. 1) 2) 30. (0.1 pt) What did the U.S. Court of Federal Claims find (published 02/12/09) concerning MMR & thimerosal vaccines related to autism or ASD? extra credit (0.1 pt) What word from the article are you surprised that I did not ask you to define? Write the definition of that word. 7