title: When science is not enough - a risk/benefit profile of thiomersal-containing vaccines.
abstract: Without a preservative, such as thiomersal (known as thimerosal in the US), multi-dose liquid presentations of vaccine are vulnerable to bacteriological contamination that can result in death or serious illness of the recipient. Concerns about levels of mercury exposure from thiomersal-containing vaccines were first raised in the US during 1999 in the context of Hepatitis B vaccine for newborns. Since then, a large body of evidence from animal and epidemiological studies has accumulated on the safety of thiomersal. Ironically, these data have become largely irrelevant in wealthy countries, where mono-dose, thiomersal-free vaccines have been introduced as a precautionary measure in almost all childhood vaccines, in part related to residual public scepticism. In poor countries, multi-dose vials remain important for vaccine delivery. There is a real danger that this controversy may result in the loss to the world of thiomersal as a preservative, simply from popular pressure. In reality, it would be impossible to cease overnight using thiomersal and maintain the supply of vital vaccines. This paper reviews and summarises the data available from published studies on mercury toxicity, and thiomersal in vaccines in particular, that overwhelmingly indicate continued use of thiomersal is safe in those countries where it is most needed.
authors.affiliation: Centre for International Health, The Macfarlane Burnet Institute for Medical Research and Public Health Ltd, GPO Box 2284, Commercial Road, Melbourne, VIC 3004, Australia. john@clem.com.au
authors.forename: C John
authors.initials: CJ
authors.lastname: Clements
authors.forename: Peter B
authors.initials: PB
authors.lastname: McIntyre
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D000818:Animals; D001321:Autistic Disorder / Q000139:chemically induced; D016021:Epidemiologic Studies; D005035:Ethylmercury Compounds / Q000633:toxicity; D000882:Haplorhini; D006801:Humans; D007223:Infant; D008628:Mercury / Q000633:toxicity*; D008767:Methylmercury Compounds / Q000633:toxicity; D009420:Nervous System / Q000254:growth & development; D011310:Preservatives, Pharmaceutical / Q000009:adverse effects* / Q000737:chemistry; D012307:Risk Factors; D013849:Thimerosal / Q000009:adverse effects* / Q000737:chemistry; D014612:Vaccines / Q000009:adverse effects*
chemical_list: D005035:Ethylmercury Compounds; D008767:Methylmercury Compounds; D011310:Preservatives, Pharmaceutical; D014612:Vaccines; D013849:Thimerosal; D008628:Mercury