title: Vaccines, viruses, and voodoo.
abstract: Vaccinations are invaluable in protection from a wide variety of diseases that can cause substantial morbidity and mortality. Although a rare complication of vaccination, autoimmune disorders represent one of these morbidities. Recently, widespread public concern has arisen from case reports suggesting that--similar to what has been observed after natural viral infections--there might be an association between specific immunizations and autoimmune diseases. Herein we address the biological plausibility of such a connection, focusing particularly on the examples of hepatitis B, rubella, and measles-mumps-rubella (MMR) vaccinations, and the autoimmune diseases they are potentially associated with. Our review of the available data suggests that, for the general population, the risk: benefit ratio is overwhelmingly in favor of vaccinations. However, the possibility cannot be ruled out that, in genetically susceptible individuals, vaccination can result in the unmasking of an autoimmune disease triggered by the immunization. We also critically examine the existing data suggesting a link between immunization against MMR and autism, and briefly discuss the controversial evidence pointing to a possible relationship between mercury exposure from vaccines and autistic disorders. There is a continued urgent need for rigorously designed and executed studies addressing these potential associations, although the use of vaccinations remains a critical public health tool for protection against infectious disease.
authors.affiliation: Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA.
authors.forename: Andrea T
authors.initials: AT
authors.lastname: Borchers
authors.forename: Carl L
authors.initials: CL
authors.lastname: Keen
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Shoenfeld
authors.forename: Joseph
authors.initials: J
authors.lastname: Silva
authors.forename: M Eric
authors.initials: ME
authors.lastname: Gershwin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001321:Autistic Disorder / Q000209:etiology; D001327:Autoimmune Diseases / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D012411:Rubella Vaccine / Q000008:administration & dosage / Q000009:adverse effects*; D014611:Vaccination / Q000009:adverse effects; D014777:Virus Diseases / Q000517:prevention & control; D014780:Viruses / Q000276:immunology
chemical_list: D017325:Hepatitis B Vaccines; D022542:Measles-Mumps-Rubella Vaccine; D012411:Rubella Vaccine