Vaccination refusal increases risk of pertussis by 2,000%: Balancing the risks of vaccines and preventable diseases
Pertussis is a highly contagious and potentially deadly respiratory infection that affects mostly children in the developing world. The low prevalence of pertussis in industrialized nations is partly due to the effectiveness of the pertussis vaccine. However, several studies have indicated that the rates of pertussis in the US have significantly increased during the last decade, likely due to a parallel decrease in vaccinations, as parents have become increasingly worried about vaccine safety. But is this true? Are children of parents who decline the pertussis vaccine at higher risk for acquiring this disease?
The journal of the American Academy of Pediatrics recently published a study that examined the association between vaccination refusal and pertussis infections in Colorado. In this study, the authors conducted a case-control examination of children between 2 months and 18 years who were members of a large health plan (Kaiser Permanente Colorado). The study included 156 cases of pertussis and 595 control non-pertussis children.
The results:
- The authors found time trend in the cases of pertussis, with a large increase in cases of pertussis after the year 2000.
- Of the 156 children who acquired pertussis, 12% were children of parents who refused vaccination.
- In contrast, only 0.5% of the children who did not get pertussis were children of parents who refused vaccination.
- Among children of all ages, refusing vaccination increased the risk of pertussis infection by 2,280%!!!
And these numbers may actually be an underestimate of the real risk of vaccine refusal, since the authors found a possible bias in diagnostic practices. Specifically, parents who agreed to vaccinate their children were 2 times more likely than vaccine-refusing parents to visit the doctor for upper respiratory infections. One interpretation of this finding is that parents who accepted the vaccination are more likely to seek medical services when their kids are sick than parents who refused vaccination. If this is the case, it is likely that cases of pertussis in the unvaccinated kids may have been missed (as these kids were less likely to visit the doctor) so that the rate of pertussis among unvaccinated kids is actually higher than what was observed in this study.
In sum, this study indicated that children of parents who refused vaccination were over-represented among cases of pertussis in Colorado during the past decade and that vaccination refusal increased the risk of pertussis by more than 2000%
These findings made me think about the underlying reasons that drive some parents to refuse vaccination: the fear that by vaccinating their kids they are increasing their kids’ risk of having a severe side effect. But I’m wondering if these parents are properly weighting the risks. Specifically, I wonder how many of these parents have reliable information about both sides of the equation; so that the real and known risks of vaccination are properly weighted against the real and known risks of non-vaccination (such as a 2,000% increase in the risk of acquiring pertussis)?
Glanz, J., McClure, D., Magid, D., Daley, M., France, E., Salmon, D., & Hambidge, S. (2009). Parental Refusal of Pertussis Vaccination Is Associated With an Increased Risk of Pertussis Infection in Children PEDIATRICS, 123 (6), 1446-1451 DOI: 10.1542/peds.2008-2150
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Firesetting in childhood and adolescence: early sign of psychopathology?
This past week, police officers in Florida arrested an 18-year-old kid as prime suspect in a wave of cat killings and mutilations. The killing and torturing of animals for pleasure (excluding traditional hunting) is one of the strongest signs of serious psychopathology. Firesetting is likely a close second, with most adults and adolescents who engage in arson also have a history of childhood firesetting. But until now, most studies have not been able to accurately examine what type of firesetting is predictive of later problems? For example, some children who engage in firesetting do not engage in arson or have serious psychopathology. So what are the characteristics (severity, duration, etc) that are associated with such ‘transitional’ or ‘phase’ firesetting versus a firesetting behavior that is more chronic and potentially pathological?
In an upcoming issue of the Journal of Child Psychology and Psychiatry a team of researchers from the University of Toronto in Canada conducted a large epidemiological examination of firesetting among 3,965 Canadian children and adolescents in grades 7 to 12. The authors examined the correlates of 4 types of firesetters:
- No history of fire setting
- Desisters: History of firesetting but none during the past year
- Low frequency (1-2 during past year)
- High frequency (3+ times during the past year)
The authors then examined the following variables:
- sex
- age
- school level
- grades
- is family intact?
- welfare involvement?
- difficulty with peers
- daily smoking
- binge drinking
- cannabis use
- other illicit drug use
- delinquent behaviors
- Ritalin use
- high sensation seeking personality
- psychological distress
- suicidal ideation
The Results:
- 72% of the sample had either never engaged in fire setting (32%) or had engaged sometime during their lives but not during the past year (40.5%)
- 27% reported engaging in firesetting during the past 12 months.
- When compared to those with no history of firesetting, the “desisters” were were more likely to be male, older, smokers, cannabis users, high sensation seekers, and have high levels of psychological distress.
- When compared to those with no history of firesetting, the high frequency fire setters were more likely to be male, have low parental monitoring, be binge drinkers, cannabis users, illicit drug users, have a history of delinquent behaviors, be sensation seeking, have high levels of psychological distress, and have suicidal ideation. This profile was almost identical to the profile of low frequency firesetters.
While controlling for other variables:
One way to conceptualize these findings is to examine the factors that predicted high/low frequency firesetters but die no predict ‘desisters’. For example, low parental monitoring was associated with low/high frequency firesetters but not with desisters. This suggests that low parental monitor is a risk factor in more chronic firesetting behaviors and that parental monitoring may not have an impact on isolated events of firesetting that do not become chronic. Cannabis was associated with all groups, so it’s not that informative. This is not surprising given that cannabis use is very frequent among teens. However, other illicit drug use was associated with frequent fire setting only, likely reflecting the severity of behavior problems among these teens. This is supported by the finding that only the low and high frequency fire setters, and not the desisters, were more likely to have a history of delinquent behaviors.
The Reference: MacKay, S., Paglia-Boak, A., Henderson, J., Marton, P., & Adlaf, E. (2009). Epidemiology of firesetting in adolescents: mental health and substance use correlates Journal of Child Psychology and Psychiatry DOI: 10.1111/j.1469-7610.2009.02103.x
Thank you for subscribing to the RSS feed of Child-Psych.org. Please visit our website to join the conversation.
Firesetting in childhood and adolescence: early sign of psychopathology?
This past week, police officers in Florida arrested an 18-year-old kid as prime suspect in a wave of cat killings and mutilations. The killing and torturing of animals for pleasure (excluding traditional hunting) is one of the strongest signs of serious psychopathology. Firesetting is likely a close second, with most adults and adolescents who engage in arson also have a history of childhood firesetting. But until now, most studies have not been able to accurately examine what type of firesetting is predictive of later problems? For example, some children who engage in firesetting do not engage in arson or have serious psychopathology. So what are the characteristics (severity, duration, etc) that are associated with such ‘transitional’ or ‘phase’ firesetting versus a firesetting behavior that is more chronic and potentially pathological?
In an upcoming issue of the Journal of Child Psychology and Psychiatry a team of researchers from the University of Toronto in Canada conducted a large epidemiological examination of firesetting among 3,965 Canadian children and adolescents in grades 7 to 12. The authors examined the correlates of 4 types of firesetters:
- No history of fire setting
- Desisters: History of firesetting but none during the past year
- Low frequency (1-2 during past year)
- High frequency (3+ times during the past year)
The authors then examined the following variables:
- sex
- age
- school level
- grades
- is family intact?
- welfare involvement?
- difficulty with peers
- daily smoking
- binge drinking
- cannabis use
- other illicit drug use
- delinquent behaviors
- Ritalin use
- high sensation seeking personality
- psychological distress
- suicidal ideation
The Results:
- 72% of the sample had either never engaged in fire setting (32%) or had engaged sometime during their lives but not during the past year (40.5%)
- 27% reported engaging in firesetting during the past 12 months.
- When compared to those with no history of firesetting, the “desisters” were were more likely to be male, older, smokers, cannabis users, high sensation seekers, and have high levels of psychological distress.
- When compared to those with no history of firesetting, the high frequency fire setters were more likely to be male, have low parental monitoring, be binge drinkers, cannabis users, illicit drug users, have a history of delinquent behaviors, be sensation seeking, have high levels of psychological distress, and have suicidal ideation. This profile was almost identical to the profile of low frequency firesetters.
While controlling for other variables:
One way to conceptualize these findings is to examine the factors that predicted high/low frequency firesetters but die no predict ‘desisters’. For example, low parental monitoring was associated with low/high frequency firesetters but not with desisters. This suggests that low parental monitor is a risk factor in more chronic firesetting behaviors and that parental monitoring may not have an impact on isolated events of firesetting that do not become chronic. Cannabis was associated with all groups, so it’s not that informative. This is not surprising given that cannabis use is very frequent among teens. However, other illicit drug use was associated with frequent fire setting only, likely reflecting the severity of behavior problems among these teens. This is supported by the finding that only the low and high frequency fire setters, and not the desisters, were more likely to have a history of delinquent behaviors.
The Reference: MacKay, S., Paglia-Boak, A., Henderson, J., Marton, P., & Adlaf, E. (2009). Epidemiology of firesetting in adolescents: mental health and substance use correlates Journal of Child Psychology and Psychiatry DOI: 10.1111/j.1469-7610.2009.02103.x
Thank you for subscribing to the RSS feed of Child-Psych.org. Please visit our website to join the conversation.
