Busting vaccines myths with Nurse Practitioner Sonja Elia

00:04 MVEC credits 

You’re listening to The Vaccine Coverage, an educational podcast where we talk about the basics of vaccination in Australia. Brought to you by MVEC, the Melbourne Vaccine Education Centre. The Vaccine Coverage is recorded and produced on the land of the Wurundjeri people. We acknowledge the traditional owners of the land and pay our respects to their elders, past, present and emerging.  

00:25 Rachael 

Hi everyone and welcome to The Vaccine Coverage, our podcast where we explore everything about vaccines and immunisation. My name is Rachel McGuire and today we’re going to be chatting about some myths relating to vaccines and not only setting the record straight on a few things, but also talking about where these misconceptions might begin and how to avoid getting caught up in them. So to do this, I’m going to be joined by a very special guest today, and someone who has a wealth of knowledge in immunisation, Sonja Elia. Welcome!  

00:54 Sonja Elia 

Thanks, Rachael.  

00:55 Rachael 

Are you able to share with us your background and your clinical experience?  

00:57 Sonja Elia 

Yeah. So, I’ve worked at the Children’s Hospital for just over 20 years and 20 of those years, being in the Immunisation Service and I became a Nurse Practitioner in 2017. And you know, been working as a Nurse Practitioner in the service and really enjoying what I do.  

01:12 Rachael 

Fantastic. I’m sure I speak for many people when I say that as a parent, one of the trickiest things can be navigating what the right thing to do for your child is. And I guess this can also be really felt when deciding to vaccinate. And I guess the same thing can also be said for adults as well, deciding if or what vaccines are important for them. So I wanted to ask you about how to navigate all of the information that’s out there. So, you know, there’s obviously websites, podcasts like this one, but social media and just general conversations that you’re having out in the public. How do people know what information is reliable?  

01:48 Sonja Elia 

I think that’s one of the biggest challenges in society today is because I think previously people would just go and speak with their local GP or an immunisation expert to get the advice. But now it seems there is so much information so readily available from the internet that you can just look up anything and it doesn’t necessarily mean that it’s always evidence based. So often when you go to some of these social media platforms, or you know websites that you think are about immunisation and providing a balanced view, they tend to be just opinion pieces. So they’re just someone’s opinions on vaccination and it might just be an anecdotal experience rather than actually being evidence-based practice. So, my advice to families is always to go to a reputable source. And how do you know that that’s a reputable source? Is that it is probably a bit more evidence based. That it’s usually recommended by your GP to some of these sources and some of those are the National Centre for Immunisation Research and Surveillance, so NCIRS, of course, Melbourne Vaccine Education Centre. As well as the Department of Health, Victoria or, you know, other states that all have Department of Health websites that have information about immunisation. And I think the most important thing really is to speak to an immunisation expert. And I think speaking to someone specifically who works in the field of immunisation, that’s really where you’re going to get your best answers from.  

03:07 Rachael 

Yeah, I think that’s a really good point. We do have this, I guess level of expectation of our healthcare professionals that they need to know about everything and that’s just not always the case. Immunisation can be quite a specific and unique area and especially when it comes to those sorts of very specific concerns that I guess we’re going to explore a little bit more today. So good to go to the people in the know. Now I imagine that myths about vaccines sort of come and go over time. What do you think triggers them in the first place?  

03:38 Sonja Elia 

So I guess the thing that I’ve noticed, certainly over 20 something years of working in immunisation: It really depends on what’s being talked about. So certainly through social media, so many, many years ago, one of the first myths was around MMR and autism. And so that was certainly in my career in the early, you know, year 2000s, that’s what parents were really wanting to know about, cause suddenly the seed was planted and maybe there are some concerns. But I certainly think after 20 odd years now of evidence suggesting there is absolutely no link between MMR and autism that that sort of myth has been debunked, if you like, and there’s less concerns about that. But what we hear now, of course, is concerns about new vaccines. So the vaccines haven’t been tested, they haven’t been out long enough. How do you know what the long-term side effects are? And so parents really worry about things that seem new. But it may actually just be that it’s new to them. So often some of us who’ve worked in immunisation, we’ve been along the journey of the clinical trials and other products. And so for us, it doesn’t really seem that new at all. So that sort of tends to be some of the myths, but also again, it could just be a person who’s suggested that there’s a link between a vaccine and a side effect that their child has had, and that’s generated some interest online or via social media platform. And then suddenly we sit there as immunisation providers going where did this come from, you know, because it’s not really a genuine, you know, myth, if you like, but it’s suddenly this concern that’s just gathering a bit of momentum.  

05:03 Rachael 

And I guess it really is that anecdotal conversation or this happened to me. It can be quite fear provoking obviously, but yeah, I guess it’s just so, so important that as healthcare providers and immunisation providers, we always take that myth back and compare any chance of those sorts of side effects happening, for example, with that burden of disease or the level of disease and what that disease can actually mean. And I always think that sometimes the success of a vaccine is actually a detriment to itself. Because when we have high rates of vaccine coverage, we see less disease which which is exactly what we want. But then you know, those doubts can creep in, I guess, do you have any thoughts on that?  

05:46 Sonja Elia 

Yeah, definitely. I think you’re absolutely right. Once you see reduction in the disease, then suddenly those fears or concerns about vaccinations becomes greater. Because, let’s say for example HPV. You know we’ve seen such a success with the vaccination program, that suddenly the fears about the vaccination causing allergies and causing, you know, menstrual problems. And these are all just myths and misconceptions that are purported. And there’s still some girls that haven’t gone and had the vaccination and some boys, for example. But the program has been shown to be really successful. And so rather than talking because there’s not much HPV around, let’s talk more about the side effects. And so yeah, once you see that it becomes a bit more of a challenge for us.  

06:27 Rachael 

And I guess that HPV one is a tricky one, because it’s that virus that can trigger cancers, but that cancer doesn’t happen till many, many years later. So it’s really tricky to see the benefit immediately. Another myth or misconception we often hear is that notion that too many vaccines can overwhelm the immune system. Obviously, on the immunisation schedule for children specifically, there’s multiple vaccines for each visit, each age group. Do you want to unpack that myth for us?  

06:59 Sonja Elia 

So I always answer families with, I think the best thing we can do is protect your child from as many things as we possibly can. So I don’t think there’s ever too many vaccines on the immunisation schedule, of course. But I think for families, they do worry that having too many injections can cause the child obviously more pain and discomfort. And that’s not entirely untrue. But in terms of the vaccinations themselves, the drug companies spend a lot of time and energy working out which antigens can go with which and what is therefore safe. And so a lot of families worry about having in particular the six-in-one vaccine that has diphtheria, tetanus, whooping cough, polio, haemophilus influenza type B and hepatitis B. But that’s worked out so that it is really protective in one injection, and the infant’s immune system is designed to actually cope with lots of different antigens in everyday life. And so in that vaccination, whilst it has six antigens, it has very, very small small amounts of those antigens. And so it doesn’t in any way overwhelm the child’s immune system. And certainly having, you know, other vaccinations. Again, while it may increase the pain and discomfort from having you know, 3 needles in one arm instead of 1, the actual immune system is not really overwhelmed in any way. And we’ve certainly seen that with a lot of our patients who come to us after oncology treatment, they often have to have revaccination and they have anywhere up to 8 injections at the first visit. And we feel very comfortable doing that because they absolutely don’t have any issues with having it. They don’t have extensive side effects or anything like that either, so I think that while it may be a concern, it’s not actually a true worry.  

08:35 Rachael 

Yeah, that’s really reassuring. I guess sometimes it’s tricky speaking from the perspective of a new parent and all the overwhelming amount of information and conversations from grandparents and things like that, when they might say, you know, back in my day, we had one vaccine and that was it. But vaccines back then were so different to what we have now, the technology is better. And as you said, we don’t need as much of each antigen, do we?  

09:00 Sonja Elia 

No, exactly. So it’s very, very small amounts in the vaccinations and certainly has changed significantly compared to what we used to use many, many years ago. And so a lot of families worry about reactions they may have had as a child, or a family member may have had as a child. And one example of those is just the whooping cough vaccine. We used to use the whole whooping cough bacteria and now we’re so clever that we can actually just take out five little strands and that’s how we make the whooping cough vaccine now. You still get the same level of protection, but just using a lot less. And so you know, that’s what I say about the companies that make vaccines. They really just use the very smallest amount they need to, to get enough of immune response without really overwhelming anyone’s immune system.  

09:45 Rachael 

Yeah, I think that’s really interesting. Yeah. When you hear about family members, when I was little and I experienced this. But it also relies on patient recall at the time like now we’ve got, you know, safety services and surveillance systems where we can record symptoms appropriately and timelines and. And, you know, everything’s really clearly documented about how events have unfolded. But yeah, certainly when I talked to my parents about it and they think ohh, I think we did this maybe… and you know it really is recall. So it’s not necessarily true I guess.  

10:21 Sonja Elia 

No, exactly. Yeah. And sometimes families actually believe that it was from the vaccine, and it may have been something that just coincidentally occurred at the same time around the vaccination. And they’re just then saying that’s what it was from. But it may not necessarily have been.  

10:35 Rachael 

So when we look at the actual childhood schedule: Why do you think these recommendations are to have them at the time point? Is it also to do with the level of disease around for those specific children when they’re at that age, or can you comment more on that?  

10:50 Sonja Elia 

So it’s for lots of different reasons actually that the schedule looks the way that it does. So one of the first things is we know that in the last trimester of pregnancy, when mum’s pregnant with the baby, that there’s good placental transfer of antibodies. So when the infant is born, there are some antibodies that have transferred across from mum that will give some protection to the infant. Now some of those drop off almost immediately and some of them last a little bit longer. So one of the examples is the whooping cough. That’s why we give Mum a booster during her pregnancy so that she’s got a good top up of those antibodies so that the infants actually protected for about the first six weeks of life. So that’s why we don’t introduce the whooping cough vaccine to an infant until six weeks of age. And likewise with some of the other antigens that we give pneumococcal, rotavirus, they’re not protective until you’ve actually had the 1st and maybe the 2nd dose of the vaccination, so we need to give those early because that’s the time that an infant is most at risk of catching whooping cough, but also getting severe complications from those diseases like pneumococcal and rotavirus as well. But in terms of those antibodies, we know that the measles, mumps, rubella and chickenpox antibodies last a bit longer in the infant after delivery. And they start to drop off from six months of age and by about nine months of age to sort of completely gone. And so that’s why we wait until 12 months of age when we introduce the measles, mumps, rubella vaccination. So it really has a lot to do with, yes, what is the burden of disease? Who is most at risk of catching the bugs? And who do we need to protect earlier? But it is also a little bit around the immune system, so it’s a quite a clever way in which the National Immunisation Program is developed.  

12:28 Rachael 

Yeah, very well considered. I guess another conversation that we sometimes hear relates to the need for vaccination in the first place. So, in Australia, we hardly see polio or Hib anymore. You know, measles isn’t so widespread as it was. How important, actually are vaccines?  

12:46 Sonja Elia 

Great question. I mean it’s so important I get asked a lot from families about this particular topic and I guess, yes, we are very lucky in Australia in that a lot of the diseases have been eradicated. So we don’t see polio in Australia and our measles is extremely low. We don’t have an endemic measles problem. But I see lots of families who are travelling overseas and a lot of the families that I see who are travelling overseas are travelling to measles-endemic countries. And so that’s what makes immunisation so important, because all it takes is for a child to travel to another country and pick up, you know, measles, and bring it back because they haven’t had their vaccination yet. And we certainly here in Australia we give the vaccine at 12 months of age because we don’t have a measles problem, but all it takes is for somebody to come across from overseas and then we get this cluster of cases, and that cluster of cases is always children who are not immunised, maybe some older persons who are unsure of their vaccination status, or infants who are too little yet to have received their vaccine. And all it takes again is, you know, we haven’t seen polio in Australia, but that’s not to say that somebody can’t bring it across to Australia again and suddenly will have a problem, particularly in people who may be immune compromised and haven’t had you know all of their vaccinations. So that’s why it’s really important that we continue to maintain what they call herd immunity, which is, you know, immunisation levels of 95% or greater because we just don’t want to see the importation of any of these diseases. 

14:15 Rachael 

And I think it’s also really important to remember with a lot of these diseases you’re actually infectious before you show symptoms.  

14:22 Sonja Elia 

Yes, exactly. Yeah. So people say. Oh, I’ll just stay home if I get any symptoms of being unwell. But it is too late already for that.  

14:29 Rachael 

Yeah, you’ve already spread that love, haven’t you? That’s right. I just wanted to touch on one more final point that we do often hear about when we’re out immunising, and it does create a little bit of confusion across the board for families and individuals as well. But can you actually receive vaccines if you are unwell?

14:49 Sonja Elia 

Yeah, it is a question we get asked a lot, and particularly during winter when children have got coughs and colds and runny noses. Really the only contraindication to anyone having a vaccination? I mean, there’s lots of different contradictions, but particularly pertaining to being unwell is that if a person has a fever. So if the person to be vaccinated has a temperature of 38.5 or greater, then we would hold off on giving immunisations. And mostly because we don’t want to cloud the clinical picture. They start getting a fever, you’ll think it’s from the vaccine, but maybe they’re intercurrent illness has gotten worse. So that’s the time that we would hold off on giving a vaccine. But certainly for people who have a cough, a runny nose or anything like that, if they’re on antibiotics, we’re not worried about those things at all. If we were, we would never vaccinate anyone during the winter months, cause everybody has a cough and a runny nose. It’s really, truly if you’ve got a fever. 

15:38 Rachael 

Yeah, OK, really good to get a good answer out of that one, that’s great. Thank you. Before we go, I’m hoping you might be able to stick around to answer a couple of audience questions?  

15:47 Sonja Elia 

Yeah, of course.  

15:52 Rachael 

Okay, great. Researchers rushed the development of the COVID vaccines, so how can we trust their safety and effectiveness?  

15:59 Sonja Elia 

That’s a good question. When you are performing a clinical trial of any vaccination or in fact a clinical trial of anything, you first of all you have to try and get lots of funding to actually run your study. And the technology for vaccine development has always been there. It’s not like this was suddenly something new. Oh, how do we develop a vaccine? The vaccine drug companies have been developing vaccines for many, many years. But when you need to run a clinical trial to determine safety and whether or not this vaccine works well, you need lots of people to participate in the study and you need a lot of money to run that study. And so what we saw through COVID development was lots of people putting up their hands to be involved in the study, cause if they thought there was going to be any protection from a trial vaccine, they were happy to be a part of it. So we had lots of high numbers of people willing to participate in the study and we also have lots of government throwing money at the vaccine development as well, which is just unheard of. So, there were lots of different factors which really helped that vaccine development. So, it wasn’t really rushed. It was just that we were able to expediate the process because there was a lot more resources and as well as a lot more participants prepared to participate in those clinical trials.  

17:10 Rachael 

Another question from the audience. My kids haven’t been vaccinated and they haven’t caught measles yet. This one’s not necessarily a question, but do you want to comment on that thought?  

17:20 Sonja Elia 

So I would say that that was good fortune, rather than good planning. I think that as I mentioned earlier, I think in Australia you’re very fortunate that we don’t have an endemic measles problem. So we don’t have sort of a grumbling of cases going along. We sort of have nothing and then someone comes from overseas, and we get this cluster of cases. And it’s surprising where a person can go in one day. Whenever you get that contact tracing from the Department of Health, they went to this shopping centre, this GP clinic, this airport lounge, they go everywhere. And again, it’s really only going to affect you if you live in those areas and have been to those places. But measles spreads pretty quickly, like very quickly. So it’s really just good fortune that the child has not actually got measles yet, but it would just be a matter of time and certainly if the family were ever going to travel or receive guests from overseas, then those risks increase. 

18:14 Rachael 

And why are eggs used to make vaccines? 

18:18 Sonja Elia 

So eggs are really only used for the influenza vaccine. I’ve actually been fortunate enough to go to the factory and watch the vaccine being made at the laboratory. And so they actually just use the egg white as a culture for growing the virus. So they actually inject the egg protein with the virus and it replicates and grows, and then they’re able to suck out the virus to actually make the vaccine. However, in saying that again with new technologies and new, you know, resources available, they’ve actually been able to make influenza vaccines without using eggs. So certainly if had anyone had any concerns around eggs being used for vaccines, it really only pertains to the flu vaccine. And even then, the actual remaining albumin content, the egg protein content in the vaccine, is so minuscule that we’ve actually safely immunised a lot of children who are anaphylactic to egg with the flu vaccine cultured in egg and there’s been no reactions.  

19:11 Rachael 

Another one from the audience. I don’t vaccinate for religious reasons. Now again, that one’s not a question, but do you want to add some comments to that?  

19:17 Sonja Elia 

When speaking with religious leaders, most have come out to suggest that there’s no real religious reason not to vaccinate a child. I’d encourage them to speak to their religious leader to get some more advice from them. But again, that would probably just be their opinion. I wouldn’t imagine that as a whole religion group that that would be a recommendation.  

19:38 Rachael 

Do the COVID vaccines affect fertility?  

19:41 Sonja Elia 

There certainly has been, you know, myths in the past with regards to the HPV vaccine and some fertility issues. And I think that arose because there were some menstrual changes with some young girls who had received the HPV vaccine. And I think one of the things I’m always reassured about in terms of vaccine safety is that if we think there’s a problem, we go looking for it. And we seen the same with MMR and autism, so, we actually go looking for the problem. And there’s no evidence to support that the HPV vaccine affects fertility. And the same thing with the COVID vaccines as well. So while some women may have experienced some menstrual changes then, I suggest that they speak to their local physician, or maybe to a gynaecologist if required. But I certainly think just because something occurs within the time frame of having a vaccine, doesn’t necessarily mean that that’s the cause. 

20:30 Rachael 

Sonja, it’s been fabulous chatting with you today. Hopefully we’ve been able to share some helpful information and guidance for our listeners. So thank you so much for sharing your time with us.  

20:38 Sonja Elia 

Thank you. 

20:39 MVEC credits 

This podcast was produced with the assistance of Podcast Recording Services. MVEC is a part of the World Health Organization’s Vaccine Safety Net. All members are verified by the World Health Organization as a source of reliable and credible vaccine safety information. MVEC provides vaccine education and news on our website, mvec.mcri.edu.au and through our newsletter and social media profiles. You’ll find links to subscribe to our newsletter and social media profiles in the notes of this episode. MVEC also offers professional development opportunities for healthcare providers through our online education portal and our events.