Vaccines have been referred to as one of the most important medical advancements in all of mankind. One of the most controversial vaccines is the influenza vaccine. First developed in the 1940’s, the influenza vaccine has been a challenge to researchers due to the nature of the various strains of influenza; since they constantly evolve, a new vaccine must be developed each year to target the strains most likely to be present that flu season. The Centers for Disease Control (CDC) recommends that all healthy people ages 6 months and older get their flu vaccine each season. This includes pregnant women, as the CDC states that influenza is more likely to cause severe illness in women who are pregnant than those who are not (1). The anti-vaccine community often publishes misinformation without any credible resources regarding the influenza vaccine. This misinformation can be severely damaging to public health. One such example is a blog post disguised as an article published by Kate Tietje, a blogger and cookbook writer, on the website Modern Alternative Pregnancy entitled, “Are Children at Risk of ASD if Mom Gets the Flu? (2)” Tietje makes many inaccurate statements about both the flu vaccine and Autism Spectrum Disorder (ASD), criticizes many parts of this exploratory study without any basis of reason and advocates unapproved “alternatives” for the flu shot during pregnancy.
Tietje begins her blog in a condescending manner by referring to a then-new 2012 study by prominent researchers from Denmark as a “study,” stating that she’s using the term “loosely.” The title of the research is “Autism After Infection, Febrile Episodes, and Antibiotic Use During Pregnancy: An Exploratory Study (3)” It clearly states right in the title that it is an exploratory study, which means that it is just an initial look into a hypothesis or a theory. Therefore, her statements that she’s using the term “study” very “loosely” are both highly disrespectful and without sound reason, especially when considering that Tietje, a cookbook writer and Internet blogger without any medical training, is criticizing the work of highly respected, well-trained medical professionals and researchers.
One of the major “problems” which Tietje cites with this highly-respected study is their association with influenza during pregnancy and the development of ASD. Tietje states that “the study authors assume there is something in the natural infection- not the treatment, but the infection itself-that causes the increased risk of ASD. They have no basis for making such an assumption.” Dr. Atladottir and her team found that women who had influenza during pregnancy had a twofold risk of having a child who was diagnosed with Autism Spectrum Disorder (ASD). It is also a known medical fact that a developing brain exposed to teratogens, or any harmful agent, during the first six weeks of development can lead to severe birth defects and neurological developments (5). Therefore, Dr. Atladottir and her team absolutely do have a basis for making an educated statement, not an “assumption” that exposure to influenza during pregnancy could have led to the development of ASD. Further, their research was only to explore whether there is any association between certain fetal conditions and the development of ASD, so the authors of this study are not making any claims at all, in fact.
Titeje also criticizes the work for a supposed “reporting bias,” stating that the researchers didn’t confirm the medical records of these women to see whether they had a clinical diagnosis of influenza or not. She also stated that “Parents may not remember exactly if they had the flu during pregnancy.” According to the National Institutes of Health (NIH), testing is not needed for everyone as the symptoms of influenza are obvious and treatment with Tamiflu should begin as soon as possible (4). Further, the NIH states that the symptoms of influenza during pregnancy can include fever, body aches, headaches, fatigue, vomiting and diarrhea (4). It is inaccurate and quite insensitive for Tietje to state that women who experienced all of these awful symptoms and had to take a medication while pregnant might not “remember” this frightening experience, which likely kept them bed ridden for at least a few days. Lastly, Dr. Atladottir and her team were diligent in confirming any diagnoses of autism with the Danish Psychiatric Central Registrar, so it is ridiculous of Tietje to suggest that a team of highly-respected medical professionals and researchers wouldn’t take the time to confirm medical records.
Tietje criticizes the study for its “limited sample size.” She states, “There were about 97,000 children included in this study, all born in Denmark. That seems like a lot, but there are millions of children with ASD these days. Plus this study took place only in Denmark, so it’s impossible to say if that generalizes to the rest of the population.” Again, this is an exploratory study, so the population size of 97,000 people out of the total population of five million Danish residents doesn’t need to the meet the statistically significant value of 0.05 percent of the population overall; meeting just 0.02 percent for an exploratory study is perfectly acceptable. Further, Dr. Atladottir and her team found that only 976, or 1% of the children studied, had diagnoses of ASD. The CDC states that about 1% the U.S. population is living with ASD, so Dr. Atladottir’s findings are exactly in line with typical epidemiological population statistics typically seen in countries (6).
Another “problem” Tietje inaccurately states with the study is that there is no control group. She states, “To more accurately determine a link, pregnant women would have to be assigned to two groups: medication use, and no medication use.” This study is an exploratory study and never claimed to investigate the use of influenza treatments in the risk of developing ASD, therefore making her suggestion one which illustrates that she clearly has no understanding of the research process.
Tietje also states that the researchers did not explore additional health factors. She states, “Were they more likely to have disturbed/poor gut flora (yet another risk factor [for ASD]?” Again, this study was only an exploratory study on the effects of influenza, fevers and antibiotics, so it’s perfectly acceptable that the researchers did not explore other health factors. Further, there have been so scientific studies linking gut bacteria to a neurological disorder such as ASD, so it’s unacceptable and irresponsible for Tietje to share this misinformation without providing any evidence to back up such a claim.
Here’s a collection of inaccurate statements from Tietje which appear throughout her blog:
“When it comes right down to it, the entire study is useless. There is a potential link between flu and ASD but there are too many variables and unanswered questions to actually draw any conclusions or make any decisions based upon it.” Clearly this exploratory study was not useless, because it did show a potential link between influenza during pregnancy and ASD and therefore laid down some groundwork for a potential large-scale research study.
“Researchers are constantly looking for the cause of autism, but mostly in the wrong places. They want to look at genetic and uncontrollable factors. They do not want to honestly examine the role that modern technology could play. Anything that is not a biological norm needs to be cautiously used and thoroughly examined, rather than assumed to be innocent and beneficial.” An Internet blogger and cookbook writer is hardly qualified to suggest which places, exactly, researchers should be looking when exploring the causes of autism. Researchers look at genetic factors when exploring the causes of ASD because there have been many research articles which suggest this link. Since this blog post was written in 2012, the largest and most comprehensive genetic findings in terms of ASD have identified 65 different genes that play a role in ASD. These researchers found that 28 of these genes contribute to the risk of developing ASD with 99% confidence (7).
“There is no way to draw the conclusion that the flu is actually in any way dangerous to pregnant women (something I’m sure they’ve been wanting to show for years now). There is no way to draw the conclusion that the flu shot actually protects against the flu.” The CDC states that the influenza virus is especially problematic for pregnant woman, which is why they highly recommend that all pregnant women get their flu shot. Therefore, it is completely inaccurate of Tietje to state that the flu is not dangerous to pregnant women. Further, it’s completely inaccurate to state that the flu shot doesn’t prevent the flu. The CDC states that while it varies every season, the influenza vaccine reduces the risk of influenza in those who have been vaccinated by 50-60% (8).
“There is no way to draw the conclusion that the flu shot is actually safe for pregnant women or their babies. Yet they recommend it anyway, because that is what “they” do, and have done for five years or so now.” The influenza vaccine is perfectly safe for pregnant women, which is why the CDC recommends that all pregnant women protect themselves and their babies by getting vaccinated against influenza. In fact, the CDC has an entire fact sheet on the safety and effectiveness of the influenza vaccine during pregnancy (9).
“These shoddily-done studies and extensive conclusions are irresponsible science.” It is also irresponsible for non-medical professionals to write poor reviews of scientifically-sound research and make wildly inaccurate statements which can be severely damaging to public health.
Here’s the list of suggested flu shot “alternatives” which Tietje recommends:
“Instead of getting a flu shot, try this: Take fermented cod liver oil; Consume bone broth regularly; Consume fermented foods regularly; Avoid/limit sugar; Get plenty of rest These are all beneficial in pregnancy as well as in helping to ward off illness. They are very safe! If you do get sick, all of the above plus ginger tea are excellent. I have used ginger tea for colds and it knocks out a sore throat, at least temporarily. It’s also safe for all ages.” The U.S. Food and Drug Administration (FDA) does not make recommendations based up anecdotal evidence; you will never see an article form the FDA which states, “My grandma cured her influenza with cod liver oil, so you should take it, too.” This should be an immediate red flag to readers of this blog that her information is not sound. The FDA makes recommendations based upon empirical evidence, and there have been no research findings to support that any of the above are acceptable ways to prevent the flu with the exception of getting adequate rest. None of these items which Tietje recommends are recognized by the FDA as alternative influenza “alternatives,” because frequent hand washing and getting the influenza vaccine are the only ways to prevent the spread of influenza.
In conclusion, Kate Tietje’s analysis of a well-respected research study was a complete failure because she made many inaccurate statements about both the flu vaccine and Autism Spectrum Disorder (ASD), criticized many parts of a well-respected exploratory study without any basis of reason and advocated for unapproved “alternatives” for the flu shot during pregnancy. Indicating that the influenza vaccine is not safe during pregnancy is scientifically inaccurate and irresponsible, as the consequences for a woman who listens to this advice can be dire for herself and her baby.
By: Angela Quinn, BSN, RN
Angela Quinn is a Registered Nurse on Long Island, NY. She is passionate about nursing and public health. She is an Executive Board Member for Nurses Who Vaccinate and she is the founder of Correcting the Misconceptions of Anti-Vaccine Resources.