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Special Issue "Vaccination and Health Outcomes"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (15 July 2018)

Special Issue Editor

Guest Editor
Prof. Dr. Anthony R. Mawson

Department of Epidemiology and Biostatistics, School of Public Health, Jackson State University, 350 West Woodrow Wilson Avenue, Room 229, Jackson, MS 39213, USA
Website 1 | Website 2 | E-Mail
Phone: 601-991-3811
Interests: epidemiology; public health; pediatrics; injury; aggression; vaccines; health disparities; retinoids; violence; social determinants of health; behavior; asthma; autism; pregnancy-related conditions and birth outcomes and their influence on health in later life

Special Issue Information

Dear Colleagues,

About 95% of US children receive all of the recommended vaccines, and full vaccination is increasingly required for daycare and school attendance in the US and many other countries. New vaccines are also in development for children and adults. While vaccines have a strong safety profile, over $3 billion has been paid by the US Vaccine Injury Compensation Program for vaccine-associated injuries and deaths, and only about 1% of vaccine-associated injuries are officially reported to the Vaccine Adverse Events Reporting System. 

The long-term effects of vaccination on children’s health remain virtually unknown but are assumed to be limited solely to prevention of the targeted disease. Studies have been recommended by the Institute of Medicine to address this question. However, randomized controlled trials, the “gold standard” for such research, have been considered unethical because they normally involve depriving some children of the needed vaccines in order to create a control group. Vaccines also have a quasi-religious status as a “sacred cow” of medicine and public health, which has discouraged scientific inquiry, and critics are often attacked personally and pejoratively labeled as “anti-vaxxers”. Although it is well known that deaths from common infectious diseases declined dramatically before the advent of most vaccines due to improved environmental conditions (even diseases for which there were no vaccines), the worry is that criticism of vaccines could escalate to the point where parents become reluctant to vaccinate their children and once-dreaded diseases will return in full force. 

Yet it is in the public interest to determine the long-term outcomes of mass vaccination. In the absence of such data, potential harms from the schedule will remain unknown. For instance, research by Peter Aaby and associates has shown that common vaccines have non-specific effects in addition to prevention of targeted infections, and these effects depend in part on the order in which vaccines are administered. In some cases, the outcomes are beneficial; in others they can be harmful. During the same recent period in which the pediatric vaccination schedule has been greatly expanded and accelerated, there has been a parallel increase in childhood allergies and neurodevelopmental disorders (NDDs). It is unclear if these changes are related.

Although randomized controlled trials may not be feasible, other research designs are possible, such as comparative studies of vaccinated and unvaccinated children. In a recent study by the author and colleagues (Mawson et al., 2017a,b), the health outcomes of vaccinated and unvaccinated homeschool children were compared, based on mothers’ anonymous reports. Mothers were asked to complete an anonymous online questionnaire on their 6- to 12-year-old biological children with respect to pregnancy-related factors, birth history, vaccinations, physician-diagnosed illnesses, medications and the use of health services. A convenience sample of 666 children was obtained, of which 39% (261) were unvaccinated.  While the vaccinated were significantly less likely to have been diagnosed with chickenpox and whooping cough, they were significantly more likely than the unvaccinated to have been diagnosed with allergic rhinitis, eczema, attention deficit disorder, autism spectrum disorder, a learning disability, middle ear infection, and pneumonia. After adjustment, the factors of vaccination, male gender, and preterm birth remained significantly associated with neurodevelopmental disorders. However, in a final adjusted model with interaction, vaccination but not preterm birth remained associated with NDD, while the interaction of preterm birth and vaccination was associated with an apparent synergistic 6.6-fold increased odds of NDD (95% CI: 2.8, 15.5). Thus, vaccinated homeschool children were found to have a higher rate of allergies and NDD than unvaccinated homeschool children. Further research involving larger, independent samples is needed to verify and understand these unexpected findings in order to optimize the impact of vaccines on children’s health. Research is also focusing on vaccine ingredients that could be potential mechanisms of vaccine-associated injury, including mercury and aluminum. However, other voices claim that such findings, based on small samples and self-reports, are invalid; that alleged links between vaccines and NDDs are spurious; and increases in autism in particular are due to the widespread use of agricultural chemicals.

To encourage further research on the long-term health effects of vaccines, IJERPH is inviting contributions for a Special Issue titled, “Vaccination and Health Outcomes”.  A wide range of submissions are welcomed, including reports of new findings, reviews of the literature, commentaries on recent publications, and new hypotheses.

References

Mawson, A.R.; Ray, B.D.; Bhuiyan, A.R.; Jacob, B. Pilot comparative study on the health of vaccinated and unvaccinated 6- to 12-year-old U.S. children. J. Transl. Sci. 2017, 3(3), 1–12, doi: 10.15761/JTS.1000186. http://wwwNaNsri.org/wp-content/uploads/2017/05/MawsonStudyHealthOutcomes5.8.2017.pdf

Mawson, A.R.; Bhuiyan, A.Z.; Jacob, B.; Ray, B.D. Preterm birth, vaccination and neurodevelopmental disorders: A cross-sectional study of vaccinated and unvaccinated children. J. Transl. Sci. 2017, 3(3):1–8, doi: 10.15761/JTS.1000187. http://wwwNaNsri.org/wp-content/uploads/2017/05/MawsonStudyPretermBirth5.8.2017.pdf

Prof. Anthony R. Mawson
Guest Editor

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Keywords

  • chronic diseases
  • epidemiology
  • evaluation
  • health policy
  • immunization
  • vaccination
  • neurodevelopmental disorders
  • allergies
  • autism spectrum disorder
  • health disparities
  • genetics
  • pathogenesis
  • aluminum
  • mercury
  • health outcomes
  • birth outcomes
  • preterm birth

Published Papers (10 papers)

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Research

Jump to: Review, Other

Open AccessArticle Influenza Vaccinations for All Pregnant Women? Better Evidence Is Needed
Int. J. Environ. Res. Public Health 2018, 15(9), 2034; https://doi.org/10.3390/ijerph15092034
Received: 5 July 2018 / Revised: 23 August 2018 / Accepted: 14 September 2018 / Published: 18 September 2018
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Abstract
Pregnant women are a World Health Organization (WHO) priority group for influenza vaccination, but evidence of effectiveness and safety for pregnant women comes from observational studies, which are notoriously prone to confounding by indication and healthy-vaccinee bias. The latter type of bias leads
[...] Read more.
Pregnant women are a World Health Organization (WHO) priority group for influenza vaccination, but evidence of effectiveness and safety for pregnant women comes from observational studies, which are notoriously prone to confounding by indication and healthy-vaccinee bias. The latter type of bias leads to an overestimation of the effectiveness and safety of the vaccine, which may be what occurs in pregnant women. Indeed, better educated women with healthier behaviors and who seek better medical care may be more adherent to vaccinations recommended by doctors, scientific societies and health authorities. Therefore, it is fundamental to obtain information about vaccine effectiveness and safety from randomized controlled trials (RCTs). Cochrane reviews have identified only one RCT with “low risk of bias”. Its results were unclear in terms of maternal, perinatal, and infant deaths and hospitalization, and showed a Number Needed to Vaccine (NNV) of 55 for mothers, with an excess of local adverse effects. A Cochrane review concluded that the inactivated influenza vaccine provides pregnant women with uncertain or very limited protection against influenza-like illnesses and influenza. Some observational studies have suggested possible adverse effects of the inflammation following the vaccination. Consistent with the Cochrane reviewers’ conclusions, further trials for influenza vaccines with appropriate study designs and comparison groups are required before promoting universal seasonal influenza vaccinations of pregnant women. Meanwhile, vaccination in second to third trimester should be offered while communicating the uncertainties that still exist, promoting informed choices. Vaccination in the first trimester is debatable and debated. This does not mean leaving women defenseless; many other useful behavioral and environmental measures can reduce infectious disease. Full article
(This article belongs to the Special Issue Vaccination and Health Outcomes)
Open AccessArticle Correlation between Non-Polio Acute Flaccid Paralysis Rates with Pulse Polio Frequency in India
Int. J. Environ. Res. Public Health 2018, 15(8), 1755; https://doi.org/10.3390/ijerph15081755
Received: 6 July 2018 / Revised: 4 August 2018 / Accepted: 14 August 2018 / Published: 15 August 2018
Cited by 2 | PDF Full-text (766 KB) | HTML Full-text | XML Full-text
Abstract
The last case of polio from India was reported in 2011. That year, the non-polio acute flaccid paralysis (NPAFP) rate in India was 13.35/100,000, where the expected rate is 1–2/100,000. A previous study of data from 2000 to 2010 has detailed the NPAFP
[...] Read more.
The last case of polio from India was reported in 2011. That year, the non-polio acute flaccid paralysis (NPAFP) rate in India was 13.35/100,000, where the expected rate is 1–2/100,000. A previous study of data from 2000 to 2010 has detailed the NPAFP rate in a state correlated with the pulse polio rounds conducted there, and the strongest correlation with the NPAFP rate was found when the number of doses from the previous 4 years were used. However, a simple association being found with regression analysis does not prove a causal relationship. After publication of those findings, as the threat of polio had lessened, the number of rounds of OPV administration was brought down. The present study has been done to look at data till the end of 2017, to see if the incidence of NPAFP declined with this reduction in polio immunization rounds. We used polio surveillance data acquired by the Government of India from 2000–2017. Correlation of the NAFP rate to the number of polio rounds in the state was examined, and the cumulative effect of polio doses administered in previous years was sought. NPAFP rate correlated with the OPV pulse polio rounds in that year (R = 0.46; p < 0.001), and the NPAFP rate started to decrease from 2012 when the number of pulse polio rounds had decreased. NPAFP rates in the states of Uttar Pradesh (UP) and Bihar were the highest in the country. Looking at the high-NPAFP states of UP and Bihar, we found that the correlation coefficient was strongest when doses used over 5 years was considered (R = 0.76; p < 0.001). The response to the reduction in OPV rounds (de-challenging) adds credence to the assumption that OPV was responsible for the change in the NPAFP rate. Now that India has been polio-free for over 6 years, we propose that we may be able to reduce NPAFP by further reducing pulse polio rounds. Full article
(This article belongs to the Special Issue Vaccination and Health Outcomes)
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Open AccessArticle Tetanus Vaccination and Extra-Immunization among Adult Populations: Eight-Year Follow Up Cohort Study of 771,443 Adults in Taiwan, 2006–2013
Int. J. Environ. Res. Public Health 2018, 15(8), 1622; https://doi.org/10.3390/ijerph15081622
Received: 1 July 2018 / Revised: 22 July 2018 / Accepted: 31 July 2018 / Published: 1 August 2018
PDF Full-text (1016 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Under-and extra-immunization of tetanus boosters are important issues to consider in reducing the burden of vaccine-preventable disease in adults. The present study aimed to analyze the trend of vaccination coverage (VC) and risk factors associated with extra-immunization of tetanus during an 8-year period
[...] Read more.
Under-and extra-immunization of tetanus boosters are important issues to consider in reducing the burden of vaccine-preventable disease in adults. The present study aimed to analyze the trend of vaccination coverage (VC) and risk factors associated with extra-immunization of tetanus during an 8-year period using a national-scale cohort database. Taiwan’s one-million representative research database, the Longitudinal Health Insurance Database (LHID2005) was used. A total of 771,443 adults aged between 20 and 79 years were enrolled and followed from 1 January 2006 to 31 December 2013. VC at the beginning was as low as 35.1%, declining gradually and dropping to 33.9% at the end of follow-up. While a total of 303,480 tetanus boosters were used during the study period, more than half (55.5%) of these boosters were considered as extra-immunized. Both individual characteristics and visit characteristics were strongly associated with extra-immunization. Males, young and older adults, and those with a higher number of comorbidities were more likely to receive extra-immunization boosters, especially when they had more severe symptoms, visited an emergency room, or visited a hospital with lower accreditation levels located in a less urbanized area. This information could enhance implementation of evidence-based programs for tetanus boosters. Full article
(This article belongs to the Special Issue Vaccination and Health Outcomes)
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Open AccessArticle Prevalence of Vaccine Type Infections in Vaccinated and Non-Vaccinated Young Women: HPV-IMPACT, a Self-Sampling Study
Int. J. Environ. Res. Public Health 2018, 15(7), 1447; https://doi.org/10.3390/ijerph15071447
Received: 31 May 2018 / Revised: 2 July 2018 / Accepted: 5 July 2018 / Published: 9 July 2018
Cited by 1 | PDF Full-text (890 KB) | HTML Full-text | XML Full-text
Abstract
Background: The human papillomavirus (HPV) vaccination program for young girls aged 11–26 years was introduced in Switzerland in 2008. The objective of this study was to evaluate the prevalence of high- and low-risk HPV in a population of undergraduate students using self-sampling for
[...] Read more.
Background: The human papillomavirus (HPV) vaccination program for young girls aged 11–26 years was introduced in Switzerland in 2008. The objective of this study was to evaluate the prevalence of high- and low-risk HPV in a population of undergraduate students using self-sampling for monitoring the HPV vaccination program’s effect. Methods: Undergraduate women aged between 18–31 years, attending the Medical School and University of Applied Sciences in Geneva, were invited to participate in the study. Included women were asked to perform vaginal self-sampling for HPV testing using a dry cotton swab. Results: A total of 409 students participated in the study—aged 18–31 years—of which 69% of the participants were vaccinated with Gardasil HPV vaccine and 31% did not received the vaccine. About HPV prevalence, 7.2% of unvaccinated women were HPV 16 or 18 positive, while 1.1% of vaccinated women were infected by HPV 16 or 18 (p < 0.01). Prevalence of HPV 6 and 11 was 8.3% in non-vaccinated women versus 2.1% in vaccinated women (p < 0.02). We observed no cross-protection for the other HPV genotypes of a low- and high-risk strain. Conclusions: Prevalence of HPV 6/11/16/18 was lower in vaccinated women versus unvaccinated women. Continued assessment of HPV vaccine effectiveness in real population is needed. Full article
(This article belongs to the Special Issue Vaccination and Health Outcomes)
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Open AccessFeature PaperArticle Adverse Events Following Immunization in Brazil: Age of Child and Vaccine-Associated Risk Analysis Using Logistic Regression
Int. J. Environ. Res. Public Health 2018, 15(6), 1149; https://doi.org/10.3390/ijerph15061149
Received: 21 March 2018 / Revised: 25 May 2018 / Accepted: 29 May 2018 / Published: 1 June 2018
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Abstract
Objective: Vaccines are effective in controlling and eradicating infectious diseases. However, adverse events following immunization (AEFI) can occur in susceptible individuals. The objective of this study was to analyze the Brazilian AEFI database and compare eight vaccines in order to profile risks
[...] Read more.
Objective: Vaccines are effective in controlling and eradicating infectious diseases. However, adverse events following immunization (AEFI) can occur in susceptible individuals. The objective of this study was to analyze the Brazilian AEFI database and compare eight vaccines in order to profile risks of AEFIs related to the mandated pediatric schedule of immunization, considering the age and sex of the child, type of vaccine, and reported adverse events. Methods: We analyzed the Brazilian AEFI database integrating reports between 2005 and 2010 for children less than 10-years old immunized with eight mandated vaccines: diphtheria, pertussis, tetanus, Haemophilus influenzae type b (TETRA); diphtheria, tetanus, and pertussis (DTP); Bacillus Calmette–Guerin (BCG); oral poliovirus vaccine (OPV); measles, mumps, and rubella (MMR); oral rotavirus vaccine (ORV); hepatitis B (HB); and yellow fever (YF). We compared the children’s age regarding types of AEFI, evaluated AEFI factors associated with the chance of hospitalization of the child, and estimated the chance of notification of an AEFI as a function of the type of vaccine. In total, 47,105 AEFIs were observed for the mandated vaccines. Results: The highest AEFI rate was for the TETRA vaccine and the lowest was for the OPV vaccine, with 60.1 and 2.3 events per 100,000 inoculations, respectively. The TETRA vaccine showed the highest rate of hypotonic hyporesponsive episode, followed by convulsion and fever. The MMR and YF vaccines were associated with generalized rash. BCG was associated with enlarged lymph glands but showed the largest negative (protective) association with hyporesponsive events and seizures. Compared with children aged 5–9-years old, young children (<1 year) showed significantly higher odds of hospitalization. Conclusions: The Brazilian AEFI registry is useful to compare the magnitude and certain characteristics of adverse events associated with mandated pediatric vaccines. Full article
(This article belongs to the Special Issue Vaccination and Health Outcomes)
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Open AccessArticle Beliefs about Vaccinations: Comparing a Sample from a Medical School to That from the General Population
Int. J. Environ. Res. Public Health 2018, 15(4), 620; https://doi.org/10.3390/ijerph15040620
Received: 17 January 2018 / Revised: 13 March 2018 / Accepted: 20 March 2018 / Published: 28 March 2018
Cited by 1 | PDF Full-text (1146 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
The current study compares health care professionals’ beliefs about vaccination statements with the beliefs of a sample of individuals from the general population. Students and faculty within a medical school (n = 58) and a sample from the general population in the
[...] Read more.
The current study compares health care professionals’ beliefs about vaccination statements with the beliefs of a sample of individuals from the general population. Students and faculty within a medical school (n = 58) and a sample from the general population in the United States (n = 177) were surveyed regarding their beliefs about vaccinations. Participants evaluated statements about vaccinations (both supporting and opposing), and indicated whether they thought the general population would agree with them. Overall, it was found that subjects in both populations agreed with statements supporting vaccination over opposing statements, but the general population was more likely to categorize the supporting statements as beliefs rather than facts. Additionally, there was little consensus within each population as to which statements were considered facts versus beliefs. Both groups underestimated the number of people that would agree with them; however, the medical affiliates showed the effect significantly more. Implications for medical education and health communication are discussed. Full article
(This article belongs to the Special Issue Vaccination and Health Outcomes)
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Review

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Open AccessReview Gulf War Illness: Unifying Hypothesis for a Continuing Health Problem
Int. J. Environ. Res. Public Health 2019, 16(1), 111; https://doi.org/10.3390/ijerph16010111
Received: 20 September 2018 / Revised: 11 December 2018 / Accepted: 25 December 2018 / Published: 3 January 2019
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Abstract
An estimated 25%–32% of veterans of the 1991 Gulf War continue to experience multiple unexplained health problems known as Gulf War Illness (GWI). GWI encompasses chronic pain, musculoskeletal weakness, headache, fatigue, cognitive deficits, alterations in mood, and numerous multi-system complaints. Most potential exposures
[...] Read more.
An estimated 25%–32% of veterans of the 1991 Gulf War continue to experience multiple unexplained health problems known as Gulf War Illness (GWI). GWI encompasses chronic pain, musculoskeletal weakness, headache, fatigue, cognitive deficits, alterations in mood, and numerous multi-system complaints. Most potential exposures implicated in GWI were not well documented but included varying levels of several neurotoxicants as well as the anticholinergic drug pyridostigmine bromide (PB), which was routinely taken as prophylaxis against the nerve agent soman. While some veterans also took chloroquine as an antimalarial agent, the literature suggests an association between receipt of multiple vaccinations prior to or during the conflict (perhaps combined with other exposures), and GWI. In-theater exposures may account for any single individual veteran’s ill health but many veterans of the same era who were not deployed overseas also suffer the same or similar symptoms. The features of GWI also overlap with those of fibromyalgia, chronic fatigue syndrome and multiple chemical sensitivity, in all of which liver dysfunction has been documented, suggesting a unifying hypothesis. It is proposed that multiple vaccinations, with concurrent or subsequent exposure to PB or additional chemical insults of a liver-damaging nature, plausibly explain the pathogenesis and the observed chronicity of GWI. The suggested mechanism for GWI is thus a chemically-induced impaired liver function, with the spillage of stored vitamin A compounds (“retinoids”) into the circulation in toxic concentrations, resulting in an endogenous chronic form of hypervitaminosis A. Implications of the hypothesis are briefly reviewed. Full article
(This article belongs to the Special Issue Vaccination and Health Outcomes)
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Open AccessReview Mumps in the Vaccination Age: Global Epidemiology and the Situation in Germany
Int. J. Environ. Res. Public Health 2018, 15(8), 1618; https://doi.org/10.3390/ijerph15081618
Received: 9 July 2018 / Revised: 26 July 2018 / Accepted: 27 July 2018 / Published: 31 July 2018
Cited by 2 | PDF Full-text (898 KB) | HTML Full-text | XML Full-text
Abstract
Vaccination against mumps virus (MuV) (mostly measles-mumps-rubella) is routinely performed in more than 120 countries and has resulted in a distinct decrease of mumps incidence. However, alteration of mumps epidemiology has been observed in several countries after implementation of the vaccine but is
[...] Read more.
Vaccination against mumps virus (MuV) (mostly measles-mumps-rubella) is routinely performed in more than 120 countries and has resulted in a distinct decrease of mumps incidence. However, alteration of mumps epidemiology has been observed in several countries after implementation of the vaccine but is sparsely documented. Moreover, outbreaks have occurred after starting vaccination, even in highly vaccinated populations. In the former German Democratic Republic (DDR) mumps was a notifiable disease but vaccination against mumps was not implemented. In the five eastern German states forming the DDR until 1990, mumps was not notifiable until 2001. Except for the lack of reporting between 1990–2000, data from Eastern Germany allow analysis of mumps epidemiology after initiating the vaccination campaign. For the period from 2001 to 2016 the data show that the incidence of mumps dropped notably after initiating vaccines, and was accompanied by an increase of the median age of patients with mumps. In Eastern Germany, no outbreaks were noted, while several outbreaks occurred in Western Germany, possibly due to a lower vaccination rate. Further literature analysis revealed that outbreaks were facilitated by waning immunity and crowding. Nevertheless, although vaccination prevented infection, the course of illness, once infected, was sometimes more complicated. In comparison to non-vaccinated populations, high rates of complicated courses occurred and were marked by orchitis, due to higher age of mumps patients. Therefore, refusing vaccination against mumps increases the risk of severe courses when living in a vaccinated population. Full article
(This article belongs to the Special Issue Vaccination and Health Outcomes)
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Open AccessReview Aluminum Adjuvant-Containing Vaccines in the Context of the Hygiene Hypothesis: A Risk Factor for Eosinophilia and Allergy in a Genetically Susceptible Subpopulation?
Int. J. Environ. Res. Public Health 2018, 15(5), 901; https://doi.org/10.3390/ijerph15050901
Received: 28 March 2018 / Revised: 19 April 2018 / Accepted: 29 April 2018 / Published: 3 May 2018
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Abstract
There are similarities between the immune response following immunization with aluminum adjuvants and the immune response elicited by some helminthic parasites, including stimulation of immunoglobulin E (IgE) and eosinophilia. Immunization with aluminum adjuvants, as with helminth infection, induces a Th2 type cell mediated
[...] Read more.
There are similarities between the immune response following immunization with aluminum adjuvants and the immune response elicited by some helminthic parasites, including stimulation of immunoglobulin E (IgE) and eosinophilia. Immunization with aluminum adjuvants, as with helminth infection, induces a Th2 type cell mediated immune response, including eosinophilia, but does not induce an environment conducive to the induction of regulatory mechanisms. Helminths play a role in what is known as the hygiene hypothesis, which proposes that decreased exposure to microbes during a critical time in early life has resulted in the increased prevalence and morbidity of asthma and atopic disorders over the past few decades, especially in Western countries. In addition, gut and lung microbiome composition and their interaction with the immune system plays an important role in a properly regulated immune system. Disturbances in microbiome composition are a risk factor for asthma and allergies. We propose that immunization with aluminum adjuvants in general is not favorable for induction of regulatory mechanisms and, in the context of the hygiene hypothesis and microbiome theory, can be viewed as an amplifying factor and significant contributing risk factor for allergic diseases, especially in a genetically susceptible subpopulation. Full article
(This article belongs to the Special Issue Vaccination and Health Outcomes)
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Other

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Open AccessCase Report Post Vaccinal Temporary Sensorineural Hearing Loss
Int. J. Environ. Res. Public Health 2018, 15(8), 1780; https://doi.org/10.3390/ijerph15081780
Received: 11 July 2018 / Revised: 2 August 2018 / Accepted: 17 August 2018 / Published: 19 August 2018
Cited by 1 | PDF Full-text (259 KB) | HTML Full-text | XML Full-text
Abstract
In our systematic research we identified four studies concerning the onset of neurological adverse events following vaccination and two excluding this association. A 33-year-old Italian man, belonging to the Italian Army was hospitalized because he suffered from vertigo, nausea and sudden right hearing
[...] Read more.
In our systematic research we identified four studies concerning the onset of neurological adverse events following vaccination and two excluding this association. A 33-year-old Italian man, belonging to the Italian Army was hospitalized because he suffered from vertigo, nausea and sudden right hearing loss not classified (NDD), that set in 24 h after the administration of tetanus-diphtheria and meningococcal vaccines. Some neurological events arising after vaccination are very difficult to treat. In our case, the functional recovery on low and medium frequencies was possible about 6 months after the morbid event. Full article
(This article belongs to the Special Issue Vaccination and Health Outcomes)
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