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LEGISLATIVE
INTRODUCTION

consecutive but was in fact selective) and was
completely retracted by the Lancet in February
2010. Furthermore, Wakefield's motive was ques-
tioned because of possible financial gain working
for lawyers representing parents pursuing law-
suits against the pharmaceutical companies mak-
ing vaccines. Yet there still exists a belief that
there is a link between vaccines and autism.
New data published in 2018 points to a disrup-
tion of heavy metal metabolism that occurs in
utero in autistic children. They accomplished this
by using tooth-matrix biomarkers to measure
temporal profiles from the second trimester up
to approximately one year postnatally. Paul
Curtin, et al published findings of a disruption
of the fetal and postnatal zinc-copper rhythmic
metabolism in people with autism spectrum dis-
order. While metals have been implicated in
autism for many years, these authors found ab-
normal metal rhythmicity rather than concentra-
tion was associated with autism in a highly
predictive manner.
Presently, there are no federal vaccination laws, has its own recommendations for who should and shouldn't receive
but all 50 states have laws requiring children attending public school it. (See reference link for more details: https://www.cdc.gov/vac-
to be vaccinated against DTaP, polio (IPV), measles, mumps and cines/vpd/should-not-vacc.html.)
rubella (commonly in an MMR vaccine), and varicella (chickenpox). Now to answer my patients’ question, if a patient is on biologics
All 50 states allow for exemptions: 47 allow religious exemptions, such as Enbrel, Humira or others, live vaccines are contraindicated.
and 17 states allow philosophical exemptions. A review of disease If a patient is on methotrexate they should hold it for two weeks
emergence and vaccination refusal was published in JAMA March after receiving the flu vaccine in order to get a better immunological
2016. In 2000, measles was declared eradicated from the United response. The latter recommendation concerning methotrexate is
States, but by 2014, the CDC reported 23 measles outbreaks (total based on newer information published in 2018.
668 cases) since that time. This included the outbreak that originated As research like that of Curtin, et al continues to peel away the
in Disneyland in Anaheim, CA (111 cases, half of which were un- conundrum surrounding the etiology of autism, which concerns
vaccinated). Reviewing CDC data on the epidemic curve of measles, many of the anti-vaxxers, these issues will be better addressed. We,
outbreaks correlate with the resurgence of exemptions to vaccina- as healthcare providers should advocate for our patients by under-
tions among children. Moreover, states with less barriers to exemp- standing that our role is to provide the best possible advice while
tions have higher incidence rates of pertussis, which is endemic to remembering it is ultimately the patients’ choice and we should also
the United States. Of interest is a similar story that was reported in take their concerns into consideration. So, to those who refuse vac-
Italy where the Italian Parliament dropped mandatory vaccinations. cinations for themselves and their families, they must be properly
As a result, 5,000 cases of measles were reported in 2017, a six-fold informed of the increased risk of contracting and spreading a pre-
increase from previous years. It becomes clear that vaccinations help ventable disease. Although we learn quickly in our training how each
suppress the emergence of preventable diseases. So, returning back patient is unique, our responsibilities lie in the education of our pa-
to any patients' question, "Is it safe for me to get this vaccination?" tients and staying up-to-date on current findings and associations
A good rule of thumb on who should avoid a vaccine would be that may impact their or their loved one’s health.
if he or she is moderately or severely ill or has a history of a previ-
ous allergic reaction to the vaccine. However, the CDC has clear Rodolfo Molina, MD, is vice president of the Bexar County Medical
regulations on who should avoid vaccinations and each vaccination Society.

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