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OCR for page 82
82
IMMUNIZATION SAFETY RE VIE W
the differing guidelines for mercury exposure. The differences in the exposure
levels calculated by EPA, FDA, and ATSDR arise from use of different key
studies and different uncertainty factors. In addition, concerns about risks related
to thimerosal are difficult to convey, given the lack of direct evidence on the
toxic effects of low-level exposure to ethylmercury. Partly because of the differ-
ent exposure levels in the federal guidelines and the lack of evidence on ethyl-
mercury, the messages about the risks of using thimerosal-containing vaccines
have been complicated and not well understood by some professionals (Halsey
and Goldman, 2001~.
Second, finding information about thimerosal-containing vaccines on the
websites of federal agencies is difficult. Federal agencies with responsibilities
related to vaccines do not necessarily have pages on their websites devoted to
concerns about thimerosal-containing vaccines. In order to design websites that
respond more effectively to vaccine safety concerns, additional information is
needed about how parents access such information. Similarly, additional infor-
mation is needed about how clinicians (physicians, nurses, and others) access
vaccine safety information and the most successful communication strategies for
reaching them.
Third, information about vaccine risks on government websites contains
words that may be perceived as judgmental, such as "should." Using words that
are less directive and prescriptive is important in effectively communicating
vaccine risks (NRC, 1989~. For example, the message may be more effective if
it is stated as "CDC is confident that ... ." rather than, 'parents should feel cony
dent that...." Establishing trust is an important factor in communicating risk
effectively, but the message loses its effectiveness when the source of the infor-
mation is not considered credible and when the language is not understandable
(Carpenter, 1995, NRC, 1989~. Communication strategies need to be specific to
the intended audience and should ensure that language levels are appropriate for
that audience.
As the committee noted in its previous report (IOM, 2001), there are nu-
merous broad and recurring communication concerns in various vaccine safety
issues. The committee has not attempted to address these issues here, but will
examine them in a separate, more general context.
SUMMARY
Mercury is a known neurotoxicant. Little is known about ethylmercury (the
active component in thimerosal) compared to methylmercury. However, the
committee believes that the effort to remove thimerosal from vaccines was a
prudent measure in support of the public health goal to reduce the mercury ex-
posure of infants and children as much as possible. The committee urges, in fact,
that full consideration be given to removing thimerosal from any biological or
pharmaceutical product to which infants, children, and pregnant women are ex-
OCR for page 83
THIMEROSAL-CONTAINING VACCINES
83
posed. The committee concludes that although the hypothesis that exposure
to thimerosal-containing vaccines could be associated with neurodevelop-
mental disorders is not established and rests on indirect and incomplete
information, primarily from analogies with methylmercury and levels of
maximum mercury exposure from vaccines given in children, the hypothe-
sis is biologically plausible.
The committee also concludes that the evidence is inadequate to accept
or reject a causal relationship between thimerosal exposures from childhood
vaccines and the neurodevelopmental disorders of autism, ADHD, and
speech or language delay. The limited and unpublished epidemiological data
constitute weak and inconclusive evidence regarding causality. However, because
thimerosal remains in vaccines in other countries and in biological and pharma-
ceutical products in the United States, and because it is imperative to restore and
maintain trust in vaccines, the committee believes that continued public health
attention must be paid to this issue in the form of policy review and analysis,
public health and biomedical research, and improved communication strategies.
Box 5 summarizes the committee's conclusions and recommendations.
OCR for page 84
84
IMMUNIZATION SAFETY RE VIE W
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OCR for page 85
THIMEROSAL-CONTAINING VACCINES
85
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~ I E EE l~e E e om' e' os tUI E I E U a E $ I tlil I E e tl E
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::-:::::::::::::::::::::::::::::::::::::::::::::::::::
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~ 1--Ee ~mE Itt~e r~0oE EeE ~S EeSea~i to l~eEitl~ a $ate e~eCtive ai E
Representative terms from entire chapter:
mercury exposure
