"Imagine the Perfect Vaccine": Homeopathic Vaccine Alternatives and Vaccine Discourse in English Canada.

Advocates of homeopathic vaccines, also known as nosodes, reimagined the risks and benefits of vaccination from 1999 to 2015 by comparing "risky" vaccines to "risk-free" nosodes. I argue that nosodes allowed for a complementary argument to anti-vaccine discourse, fundamentally altering what had been framed as a choice between the risks of vaccination and the risks of vaccine-preventable disease. Despite evidence of their efficacy being flawed, advocates presented nosodes as an alternative to vaccines and a middle ground between anti-vaccination and vaccination. While a campaign from 2013 to 2015 tried to expose nosodes as ineffective, I argue that the campaign was unsuccessful. Instead, the mainstream media brought more attention to nosodes. The history of nosodes further complicates the history of vaccines and alternative medicine in Canada by adding vaccine alternatives to the growing literature on vaccine hesitancy.

Vaccination Attitudes and Practices of Integrative Medicine Physicians.

Context • The growth of Internet-based information and social networking has increased the accessibility and importance of antivaccine information. That information has led to a questioning of vaccination schedules and policies by many individuals. Although the attitudes of complementary and alternative practitioners, such as homeopaths and chiropractic students, toward vaccination have been assessed, despite the growth of integrative medicine, no assessment of the attitudes and practices regarding vaccination of these physicians has been performed. Objective • The study intended to evaluate the attitudes and practices regarding vaccination of members of the American Board of Integrative and Holistic Medicine (ABIHM). Design • The research team conducted a survey of practitioners. Setting • The administration and evaluation of the survey took place at San Diego State University (San Diego, CA, USA). Participants • Prospective participants were 1419 diplomats of the ABIHM on June 19, 2013. Outcome Measures • The survey assessed members' (1) use of and confidence in the vaccination recommendations of the Centers for Disease Control and Prevention (CDC) and of medical-specialty associations, (2) confidence in the manufacturing safety of vaccines and in manufacturer's surveillance of adverse events, and (3) attitudes toward vaccination mandates. The questionnaire included 33 items, with 5 open-ended questions that provided a space for comments. Results • The survey was completed by 290 of 1419 diplomats (20%). The survey showed a diversity of opinions in many vaccination issues. Integrative medicine physicians were less likely to administer vaccinations than physicians in traditional allopathic medicine. Among the 44% who provide vaccinations, 35% used alternative schedules regularly. Integrative medicine physicians showed a greater support of vaccination choice, were less concerned about maintaining herd immunity, and were less supportive of school, day care, and employment mandates. Toxic chemical and viral contaminants were of greater concern to a higher percentage of integrative medicine physicians. Integrative medicine physicians were also more likely to accept a connection between vaccinations and both autism and other chronic diseases. Overall, there was dissatisfaction with the Vaccine Adverse Event Reporting System as well as the vaccination recommendations of the CDC and their primary specialty. Conclusions • This survey documents significant variations in the vaccination attitudes and practices of integrative medicine physicians. This survey provides benchmark data for future surveys of this growing specialty and other practitioners. It is important for public health leaders and the vaccination industry to be aware that integrative medicine physicians have vaccination attitudes and practices that differ from the guidelines of the CDC and the Advisory Council on Immunization Practices.

What do homeopathic doctors think of vaccines? An international online survey.

BACKGROUND AND OBJECTIVES: Parental refusal to vaccinate is a cause of serious concern. Use of homeopathy is believed to be a relevant reason for parents to refuse to vaccinate. However, vaccination is one of the main gaps dividing between medically qualified or not homeopathic practitioners. The present study sought to investigate the attitude of homeopathic doctors towards vaccination and associated variables. METHODS: An international online survey was conducted with homeopathic doctors by means of an anonymous self-reported questionnaire in Portuguese or Spanish. Questions investigated sociodemographic and professional characteristics, overall opinion on vaccination and on some specific vaccines. RESULTS: A total of 512 responses were obtained, 77.5% of respondents were from Latin American countries, 16.8% from Spain, with small numbers from several other countries. About 75.6% of the respondents considered vaccination safe, effective and necessary, while 12.5% stated they would not recommend vaccination under any circumstance. The variables significantly correlated with positive attitude towards vaccination were: working in the public health system (p=0.04) and homeopathy not the main medical activity (p=0.005). Homeopaths from Brazil, where homeopathy is officially accredited, were more favorable to vaccination compared to respondents from countries where homeopathy has inferior status (p<0.001). CONCLUSION: The results show that there is no contradiction between homeopathy and primary prevention by means of vaccination.

Seasonal influenza self-vaccination behaviours and attitudes among nurses in Southeastern France.

BACKGROUND: Despite seasonal influenza vaccination (SIV) being recommended to healthcare professionals to protect themselves and their patients, uptake is low, especially among nurses. We sought to study self-vaccination behaviours, attitudes and knowledge about SIV among nurses in Southeastern France. METHODS: A cross-sectional survey with community and hospital-based hospital nurses was conducted with the same standardised questionnaire. Multi-model averaging approaches studied factors associated with the following dependent variables: self-reported SIV uptake; and considering SIV a professional responsibility. RESULTS: 1539 nurses completed the questionnaire (response rate: 85%). SIV was the most frequently cited vaccine (49%) regarding nurses' unfavourable opinions towards specific vaccines. Thirty-four percent of nurses reported being vaccinated at least once during the 2015-2016 or 2016-2017 seasons. A lack of perceived personal vulnerability to influenza, a fear of adverse effects, and a preference for homeopathy constituted the main deterrents of SIV. Nurses held various misconceptions about the SIV, but 69% considered its benefits to be greater than its risks. The multi-model averaging approach showed that considering SIV as a professional responsibility was the main factor associated with SIV uptake among nurses (Nagelkerke's partial R-squared: 15%). This sense of responsibility was strongly associated with trust in various vaccine information sources. CONCLUSION: Nurses had low SIV uptake rates and held various concerns and a lack of knowledge surrounding the vaccine. This is concerning considering the impact that these factors can have on nurses and patients' health, especially considering the increased role that nurses could have surrounding SIV in the near future.

Opinion about seasonal influenza vaccination among the general population 3 years after the A(H1N1)pdm2009 influenza pandemic.

OBJECTIVE: To assess the opinions of the French general population about seasonal influenza vaccination three years after the A(H1N1)pdm 09 pandemic and identify factors associated with a neutral or negative opinion about this vaccination. STUDY DESIGN: The study was conducted using data collected from 5374 participants during the 2012/2013 season of the GrippeNet.fr study. The opinion about seasonal influenza vaccination was studied on three levels ("positive", "negative" or "neutral"). The link between the participant's characteristics and their opinion regarding the seasonal influenza vaccination were studied using a multinomial logistic regression with categorical variables. The "positive" opinion was used as the reference for identifying individuals being at risk of having a "neutral" or a "negative" opinion. RESULTS: Among the participants, 39% reported having a positive opinion about seasonal influenza vaccine, 39% a neutral opinion, and 22% a negative opinion. Factors associated with a neutral or negative opinion were young age, low educational level, lack of contact with sick or elderly individuals, lack of treatment for a chronic disease and taking a homeopathic preventive treatment. CONCLUSIONS: These results show that an important part of the French population does not have a positive opinion about influenza vaccination in France. Furthermore, it allows outlining the profiles of particularly reluctant individuals who could be targeted by informative campaigns.

Cross-sectional survey: risk-averse French general practitioners are more favorable toward influenza vaccination.

OBJECTIVES: We tested the following hypotheses: (i) risk-averse general practitioners (GPs) are more likely to be vaccinated against influenza; (ii) and risk-averse GPs recommend influenza vaccination more often to their patients. In risk-averse GPs, the perceived benefits of the vaccine and/or the perceived risks of the infectious disease might indeed outweigh the perceived risks of the vaccine. PATIENTS/METHODS: In 2010-2012, we conducted a cross-sectional survey of a nationwide French representative sample of 1136 GPs. Multivariate analyses adjusted for four stratification variables (age, gender, urban/suburban/rural practice location and annual patient consultations) and for GPs' characteristics (group/solo practice, and occasional practice of alternative medicine, e.g., homeopathy) looked for associations between their risk attitudes and self-reported vaccination behavior. Individual risk attitudes were expressed as a continuous variable, from 0 (risk-tolerant) to 10 (risk-averse). RESULTS: Overall, 69% of GPs reported that they were very favorable toward vaccination in general. Self-reported vaccination coverage was 78% for 2009/2010 seasonal influenza and 62% for A/H1N1 pandemic influenza. Most GPs (72%) reported recommending the pandemic influenza vaccination to at-risk young adults in 2009, but few than half (42%) to young adults not at risk. In multivariate analyses, risk-averse GPs were more often vaccinated against seasonal (marginal effect=1.3%, P=0.02) and pandemic influenza (marginal effect=1.5%, P=0.02). Risk-averse GPs recommended the pandemic influenza vaccination more often than their more risk-tolerant colleagues to patients without risk factors (marginal effect=1.7%, P=0.01), but not to their at-risk patients and were more favorable toward vaccination in general (marginal effect=1.5%, P=0.04). CONCLUSION: Individual risk attitudes may influence GPs' practices regarding influenza vaccination, both for themselves and their patients. Our results suggest that risk-averse GPs may perceive the risks of influenza to outweigh the potential risks related to the vaccine.

[Lack of conviction about vaccination in certain Quebec vaccinators]. / Manque de conviction face à la vaccination chez certains vaccinateurs québécois.

A questionnaire was mailed to all vaccinators in Quebec in 1998. The objective of this survey was to document vaccinators' attitudes, knowledge, and practices related to vaccination. Vaccinators generally believe in the security, efficacy and usefulness of vaccines given to young children. However, 41% of nurses do not fully agree with these opinions. More than 94% of pediatricians completely disagree that "certain practices (homeopathy, good eating habits and a healthy lifestyle) can eliminate the need for vaccination", compared with 85% of general practitioners and only 60% of nurses. Less than 25% of doctors recall children who are late in getting their immunizations; approximately 45% of vaccinators are in complete agreement with simultaneous injections of two vaccines; many circumstances are incorrectly seen as contra indications for vaccination. Public health authorities should target systematic interventions towards vaccinators to improve this situation and to increase nurses' conviction regarding the benefits of vaccination.

[Evaluation of measles, mumps and rubella vaccine coverage in 3 year old children in twelve French counties. Time-trends and related factors]. / Evaluation de la couverture vaccinale rougeole-oreillons-rubéole chez les enfants de trois ans dans douze départements français. Evolution temporelle et facteur associés.

BACKGROUND: The aims of our study were to estimate the measle-mumps-rubella (MMR) vaccine coverage in 3 years old children in 12 French countees, to document the evolution between 1997 and 1999 in two groups of 6 countees (pilot group and control group) before and after the implementation of promotion programmes in the pilot group, and to identify factors related to measle-mumps-rubella vaccination. METHODS: Two telephone surveys were carried out in 1997 and 1999 among children randomly selected in the birth rolls of 12 French countees. Parents of 3 years old children were interviewed on measle-mumps-rubella vaccination, knowledge and opinions on vaccinations, utilisation of health care and socio-demographic characteristics. RESULTS: The participation rate was 97% in both surveys. Among the 7382 respondent parents, 98% had immediate access to the child's medical file and could document the vaccine status. The vaccine coverage did not increase significantly between 1997 and 1999 (86.7% versus 87.2%), both in control (89.3% vs. 90.2%) and pilot groups (84.3% vs. 84.3%). A logistic regression model showed that several factors were independently and significantly related to measle-mumps-rubella vaccination (utilisation of homeopathic medicines, mother's age, number of children, physician speciality (general practitioner or pediatrician) and opinion on vaccinations). CONCLUSION: Our study shows that there is a stagnation of vaccine coverage in several French countees, which makes unlikely the national objective of viruses eradication. This epidemiological situation makes very likely outbreaks of measles, mumps and rubella in these countees. National and local pilot programmes did not succeed to promote vaccination in countees with a low measle-mumps-rubella vaccine coverage. Our study identified sub-groups of parents who should be targeted by promotion programmes.

Characteristics of pediatric and adolescent patients attending a naturopathic college clinic in Canada.

OBJECTIVES: The use of complementary and alternative medicine (CAM) has grown substantially in North America and has drawn the attention of conventional-medicine practitioners. Conventional-medicine practitioners have expressed concern about the potential for unregulated CAM therapies to cause harm, the sometimes-uncertain cost-benefit ratios associated with these therapies, and the possibility that some CAM providers might advise against established conventional therapies, such as vaccination. These concerns are heightened with respect to the pediatric use of CAM products. To address this issue, we conducted a systematic audit of pediatric and adolescent case files at a large, college-based, Canadian naturopathic teaching clinic. We specifically sought to describe the demographic characteristics, reasons for presentation, use of CAM products, and vaccinations status of children presenting for naturopathic assessment. We also determined factors associated with the use of CAM products and vaccination status. METHODS: We identified all charts for children (<18 years of age) who presented to the Robert Schad Naturopathic Clinic, the teaching clinic of the Canadian College of Naturopathic Medicine, between February 1 and May 31, 2002. Data were abstracted directly from the standardized patient intake forms and from clinical notes recorded during the patient's initial visit to the clinic. The following data were obtained: age, gender, chief presenting complaints reported by parents, CAM product use at presentation, vaccination status, and reactions to vaccination. We conducted logistic regression analyses to identify factors associated with both CAM product use and vaccination status. RESULTS: A total of 482 charts were identified. The mean age of patients was 6.5 years (95% confidence interval [CI]: 1.6-11.4 years). The ratio of female subjects to male subjects was 1.09:1 (248:227). The most common reasons for presentation were skin disorders (23%), gastrointestinal complaints (17%), and psychiatric/behavioral disorders (15%). Thirty-five percent of children were using CAM products at presentation (21.2% when both vitamins and minerals were excluded). Vitamins were the most commonly used products (34.6%), followed by herbal remedies (14.9%), oil blends/fats (7.2%), minerals (5.6%), probiotics (4.5%), and homeopathic remedies (3.7%). Of charts with vaccination information, 8.9% indicated that children had not been vaccinated; possible vaccine-associated adverse events were reported for 27% of those who had been vaccinated. Partial or unvaccinated status was associated with younger age, attending the Canadian College of Naturopathic Medicine for advice regarding vaccination, and greater use of CAM products. CAM product use was associated with unvaccinated or partially vaccinated status (odds ratio [OR]: 2.86; 95% CI: 1.46-5.63), presenting with poor energy or fatigue (OR: 3.36; 95% CI: 1.00-11.26), or presenting with throat or sinus infections (OR: 4.06; 95% CI: 1.23-13.04). CONCLUSIONS: Children present for naturopathic assessment for diverse reasons, are high-level consumers of CAM products, and have lower rates of vaccination than population averages. The conventional-medicine community should work with naturopaths to address public health concerns in this population.

Attitudes of homoeopathic physicians towards vaccination.

Vaccinations are one of the most effective preventive procedures in modern medicine. However, earlier studies have indicated that homoeopathic physicians do not recommend or apply vaccinations as frequently as their allopathic colleagues. Few studies have been undertaken to clarify this question and most of these have not distinguished between medically and non-medically qualified homoeopathic practitioners. Therefore, misunderstandings have arisen concerning this question. In the study presented only medically qualified colleagues were included. In the course of this study, 219 medically qualified homoeopathic and 281 non-homoeopathic physicians in Germany (response rate 30.4%) returned a questionnaire about the application and recommendation of 17 different vaccinations in their practices. The answers show that the responding homoeopathic physicians do not generally refuse vaccines but rather view them with a specific hierarchy. The 'classical' vaccines against tetanus, diphtheria and poliomyelitis are applied to nearly the same degree as by non-homoeopathic colleagues. Vaccines against childhood diseases, risk group vaccinations and vaccinations judged as ineffective are applied and accepted with more restraint by homoeopathic physicians.

Vacina: agressao isopatica ou cura homeopatica por antecipacao? / Vaccine: isopathic agression or homeopathic cure in advance?

O preconceito de que a homeopatia e contraria a vacinaca moderna levou os autores a uma analise do problema, objetivando a formulacao de que um conceito doutrinario a partir dos principios estabelecidos por Hahnemann. Concluiram que a vacinacao e uma especie de cura homeopatica por antecipacao, explicada pela extrema semelhanca entre a vacina e seu respectivo agente infeccioso natural

Vacina: agressao isopatica ou cura homeopatica por antecipacao? / Vaccine: isopathic agression or homeopathic cure in advance?

O preconceito de que a homeopatia e contraria a vacinaca moderna levou os autores a uma analise do problema, objetivando a formulacao de que um conceito doutrinario a partir dos principios estabelecidos por Hahnemann. Concluiram que a vacinacao e uma especie de cura homeopatica por antecipacao, explicada pela extrema semelhanca entre a vacina e seu respectivo agente infeccioso natural