Senior Thesis 2016 By Pavel Stupakov-FINAL

1Running head: THYMEROSAL IN IMMUNIZATIONs

Thimerosal in Immunizations: Parents Perspectives, Scientific findings & Controversies.

Senior Thesis Project

Pavel Stupakov

Dominican University of California

3/15/2016

Spring

Dr. Luanne Linnard- Palmer

2THYMEROSAL IN IMMUNIZATIONS

Thimerosal in Immunizations: Parent's perspectives, Scientific Findings & Controversies

Authors: Pavel Stupakov

Abstract

Immunizations have been around for quite some time, and throughout recent history have

been scientifically proven to be effective and efficient in preventing contraction and spread of

communicable diseases. Vaccines are distributed across the globe and a lot of them require

preservatives to remain effective. Thimerosal, a mercury based preservative used in vaccines has

been found to have neurotoxic effects. Concerns have been expressed over possibilities of this

chemical causing autism and other chronic neurologic disabilities. The goal is to explore parent's

knowledge and perspectives of this chemical, research scientific findings that either support or

disprove this relationship and explore any controversies around the addition and administration

of this compound; thus, debunking the ultimate question of whether this chemical has any

continued health effects on children.

This paper will explore the negative impacts of Thimerosal exposure in the prenatal and

infancy stages on neurologic development as well as its links to autism spectrum and Attention

Deficit Hyperactivity Disorder in childhood which continues to be influential on whether

families immunize their kids.

The model/framework that will be used is the Health Belief Model. This paper will be

exploring parents perspectives on Thimerosal by incorporating the parent's perceived

susceptibility, severity, benefits, and barriers that they may believe or experience.


Acknowledgements: A thank you to Dr. Palmer for the influence to stick with this very

interesting topic.

Table of content:

Abstract............................................................................................................................................2

Introduction......................................................................................................................................3

Problem Statement...........................................................................................................................5

Purpose Statement/Aim...................................................................................................................5

Literature Review............................................................................................................................5

Conclusion/Summary.....................................................................................................................13

Theoretical Framework..................................................................................................................13

Research Proposal..........................................................................................................................14

References......................................................................................................................................19

Introduction

Thymerosal, "an organic-mercury (Hg) based compound, used as a preservative in many

childhood vaccines," (Hooker, 2014) has been found to be harmful by a large number of studies

throughout the years. As stated by David A. Geier in the review of Thimerosal, (2007) It was

first developed in 1927 and was originally marketed as an antimicrobial agent. He stated that

some of its most important uses were for preserving vaccines and injectables such as the Rho(D)

immune globulin. Geier mentioned that evidence predated back to the 1930 which stated that this

product was "potentially hazardous" (Geier, 2007) to humans. Directed studies "were conducted

to specifically examine the effects of Thimerosal on human infants or children with reported

outcomes of death; acrodynia; poisoning; allergic reaction; malformations; auto-immune


reaction; Well’s syndrome; developmental delay; and neurodevelopmental disorders, including

tics, speech delay, language delay, attention deficit disorder, and autism." (Hooker, 2014) In very

contrasting opinions, the United States Center for Disease Control and Prevention stated that

Thymerosal is a safe additive and that there are no relationship between Thimerosal-containing

vaccines and autism rates in children. (CDC, 2012) Geier stated that it wasn't until the 1980's that

Thymerosal was viewed as harmful and began to be recognized by the Food and Drug

Administration as toxic which caused restrictions of it in vaccines given to pregnant women and

infants; however, some forms of vaccines (multi-strain) still utilize Thymerosal as a preservative

until this day. With these alarming discrepancies in epidemiologists reporting's, it has become

increasingly important to delve into the realm of vaccinations and debunk the ultimate question

of whether this chemical has any continued health effects on children. The primary health effects

that will be discussed are on prenatal and infancy neurologic development, its links to Autism

Spectrum disorder and ADHD, because positive correlations of Thymerosal and these specific

disorders are being very influential on a portion of families decisions of immunizing their kids.

Three primary concepts will be utilized to explore Thimerosal and any negative impacts

it may or may not have. The first is to explore parents and families knowledge and perspectives

on vaccinations, as well as vaccinations that contain Thimerosal while incorporating the health

belief model into the research process and comprehension of these facts. The second is to

research scientific findings that either support or disprove the relationship of Thimerosal and

negative health effects; a number of studies will be utilized to look at positive and negative

correlations. Finally the third will be to explore controversies around the addition and

administration of this compound in order to answer the question previously stated of whether or

not this chemical has a continued effect on children and their development.


Problem statement

The negative impact of Thimerosal exposure in the prenatal and infancy stages on

neurologic development and its links to autism spectrum and ADHD disorders in childhood

continues to be influential on whether families immunize their kids.

Purpose Statement or aim

Thimerosal, a mercury based preservative used in vaccines has been found to have

neurotoxic effects. Concerns have been expressed over possibilities of this chemical causing

autism and other chronic neurologic disabilities. The goal is to explore parent's knowledge and

perspectives of these chemical, research scientific findings that either support or disprove this

relationship and explore any controversies around the addition and administration of this

compound; thus, debunking the ultimate question of whether this chemical has any continued

health effects on children. Nurses have the responsibility to inform the population about current

research and trends of preventive care as well as protect their patient population from harm. It's

important for nurses to know the relationship between Thimerosal and negative health effects.

Literature review

Links to Health Effects

Prenatal and infancy neurologic development is highly affected by drugs that interact

with the mother prenatally and the infant while he or she is at their vital developmental stages. It

is well and widely known that the way a child develops in utero and during the first years of life

will set the tone for the rest of the child's neurologic and psychological expression. If these


developmental stages are negatively impacted in any way, the child can develop Autism

Spectrum disorder as well as ADHD (Attention Deficit Hyperactivity Disorder) among many

other horrible conditions; in this case, the discussion and review will focus on the two. Autism

Spectrum Disorders are "a continuum of conditions that includes autism, Asperger's syndrome,

and other pervasive developmental disorders which are characterized by problems with social

interactions, communication, and stereotyped (repetitive or ritualistic) behaviors." (Marner,

2015) ADHD is a condition marked by inattention, hyperactivity, and impulsivity. (Marner,

2015) "It is primarily a disorder of self-regulation and executive function — skills that act as the

'brain manager' in everyday life," says Mark Bertin, M.D., a developmental behavioral

pediatrician and the author of The Family ADHD Solution. The mercury based compound

Thimerosal has been found to have adverse effects on psychomotor development index (PDI)

(Budzyn, 2012) of one and two year-olds due to neonatal exposure. "The overall deficit in the

PDI attributable to neonatal TCV (Thimerosal Containing Vaccines) exposure measured over the

course of the three-year follow-up was significantly higher in TCV group." (Budzyn, 2012)

"Although a measurable number of epidemiological studies have been conducted to clarify the

associations between mercury exposure during embryo or early infancy and later incidences of

autism spectrum disorders (ASD) or attention-deficit hyperactivity disorder (ADHD), the

conclusion still remains unclear." (Yoshimasu, 2014) The meta-analysis conducted by

Yoshimasu and associates stated that "There were no material associations between vaccination

Thimerosal exposures and autism or ADHD;" however, "mercury exposure caused by air

pollution was significantly associated" (Yoshimasu, 2012) with these two risks. The study also

stated that "Methylmercury exposure caused by maternal fish consumption was significantly

associated with an increased risk of offspring's ADHD. Thus; links between mercury compounds


effecting ADHD and Autism diagnoses have been found yet not directly related to vaccines

containing Thymerosal.

Parents Knowledge/Perspectives

Until the beginning of this century, every tetanus-containing vaccine in the US (e.g., the

DTP, tetanus toxoid (TT), diphtheria–tetanus (DT), and diphtheria–tetanus–acellular-pertussis

(DTaP)), Haemophilus influenza type b (Hib), hepatitis B (HepB), and a polysaccharide

meningococcal meningitis A, C, Y, and W-135 vaccine contained Thimerosal, many at a

concentration of 0.01% Thimerosal. (Geier, 2015) The use of Thimerosal is widespread and in

order to understand the proportion of people that use them and the impact it may have

on children, we need to be able to explore parental and families knowledge and perspectives on

vaccinations as well as vaccinations which contain Thimerosal. In order to do that, the

incorporation of the Health Belief Model was utilized in order to view the perspectives related to

it as well as the parental health action that the model proposes. "The model suggests that

decision-makers make a mental calculus about whether the benefits of a promoted behavior

change outweigh its practical and psychological costs or obstacles. That is, individuals conduct

an internal assessment of the net benefits of changing their behavior, and decide whether or not

to act." (Green, 2014)

Through Emily Bronson's application of grounded theory, "a general decision-making

process was identified. Stages in this process included: awareness, assessing and choosing,

followed by either stasis or ongoing assessment." (Brunson, 2013, p. 5467) The biggest

variation that occurred was during the assessment/assessing stage which involved parents

examining vaccination-related issues to make subsequent decisions. (Bronson, 2013) Research


began to suggest that there were 3 major assessment groups: acceptors, who rely primarily on

general social norms to make their vaccination decisions; reliers, who rely primarily on other

people for information and advice; and searchers, who seek for information on their own,

primarily from published sources. (Bronson, 2013) Results suggest that a one-size-fits-all

approaches to vaccination interventions are inappropriate. Instead, this research suggests that

interventions must be targeted to parents based on how they assess vaccination. In order to apply

the Health Belief Model, a distinguishing fact about the parental assessment group needs to be

made to apply them as acceptors, reliers, or searchers. From this study, it looks like 1/3 of the

parents studied used research as their basis for vaccinating their families and children thus only

1/3 would directly know about the effects of Thimerosal in these vaccinations on their children.

Scientific Evidence/Findings

A very important realm of Thimerosal exposure and its effects leads one to explore the

scientific findings among multiple studies of the research on Thimerosal and its addition to

vaccines. Is there supported scientific evidence to state that mercury based compounds in

vaccines are harmful to children or not? Many studies have been conducted over the years to sort

this mystery out. "Ethically and legally, the direct study of the effects of Thimerosal or ethyl-Hg

compound exposure on fetal/infant/childhood death in humans is proscribed;" (Geier,

2014) however, "on a theoretical basis, a number of previous researchers have investigated the

potential toxicokinetics of Hg exposure from Thimerosal in pregnant women" (Geier, 2014) in

hopes of useful findings. In an example: Goldman showed in his analysis of exposure to Hg from

Thimerosal during pregnancy (assuming 50% of the total dose would accumulate in the fetus)

that "administration of a single Thimerosal-preserved influenza vaccine (25 μg Hg per dose) in

comparison to the US EPA Hg safety limit would result in a fetus of average weight receiving a


Hg dose that could be ≥ 125,000 times the EPA Hg safety limit if it was administered at

≤ 8 weeks of gestation and, by 42 weeks of gestation, result in a fetus of average weight

receiving a Hg dose 34 times the EPA Hg safety limit." (Goldman, 2013) Utilizing the

assumption that Goldman made previously, "50% of the total dose would accumulate in the

fetus, that administration of a single Thimerosal-containing influenza vaccine with 1 μg Hg per

dose in comparison to the US EPA Hg safety limit would result in a fetus of average weight

receiving a Hg dose ≥ 5000 times the EPA Hg safety limit if it was administered at ≤ 8 week

gestation and, by 42 week gestation, result in a fetus of average weight receiving a Hg dose 1.4

times the EPA Hg safety limit." (Goldman, 2013) In similar results to Goldman, Brown and

Austin evaluated fetal exposure to Hg from one Thimerosal-preserved influenza shot during

pregnancy (25 μg Hg per dose). (Geier, 2014) "Doses of Hg exposure from administration of a

single Thimerosal-preserved influenza vaccine during pregnancy resulted in a developing fetus

receiving a dose of Hg in excess of the US EPA Hg safety limit from between 1,000,000 times to

10,000 times that safety limit at 1 week of development to 7.6 times to 0.1 times that limit at

38 weeks of development" (Brown, 2012, p. 1618). What these results mean is that the fetus is

receiving much higher levels (even if these levels were eliminated by 99% by the placenta, these

levels would still be above the recommended amount of Thimerosal exposure which in turn will

cause negative effects on the fetus and the future-born child.

"Overall, both Brown and Austin and Goldman concluded their toxicokinetic studies by

suggesting that, given the magnitude in excess of the EPA Hg safety limits presented by

exposure to a dose of Thymerosal-preserved vaccine during pregnancy, it is biologically

plausible for such exposures to result in fetal/infant death and developmental disability." (Geier,

2014)


In another much older example, Axton reported "two adults and four children were

injected (accidently) with abnormally large quantities of Thimerosal from inappropriately

prepared chloramphenicol-containing preparations. The children (aged between 6 weeks-old and

7 years-old) received between about 35 milligrams (mg) Hg per kilogram (kg) bodyweight and

162 mg Hg per kg bodyweight. All but one of them died within about 1 month (mortality

rate = 75%)." (Axton, 1972, p. 417) This example is rather old yet it still shows how extremely

fatal large doses of Thymerosal can be. In more recent studies, which compared a group of

infants at 6 months of age from communities with different fish-eating habits (rural communities

in comparison to urban infants) who were simultaneously exposed to methyl-Hg and ethyl-Hg

found that urban infants, who had the highest ethyl-Hg exposure from Thimerosal-containing

vaccines and relatively lower methyl-Hg in comparison to rural infants, also had the highest risk

of developmental delays (Dorea, 2012).

In another study, "among a cohort of infants with multiple exposures to neurotoxic

substances," (Geier, 2015, p. 216) "those showing the most severe neurodevelopmental delays in

psychomotor developmental index scores between 6 and 24 months of age were the ones with

exposure to higher levels of ethyl-Hg from Thimerosal-containing vaccines." (Marques, 2014, p.

135)

Finally another 2-phase study conducted by Geier in 2013 which examined the possible

"association between Hg exposure from Thimerosal in vaccines and the risk for an ASD

diagnosis in the US," (Geier, 2015, p. 218) came out with very conclusive results. In the first

phase of the study, "a hypothesis generating cohort study was conducted to examine the possible

relationship between exposure to Hg from a Thimerosal-containing DTaP vaccine in comparison

to Thimerosal-free DTaP vaccines and the risk of an ASD diagnosis in the VAERS database."


(Geier, 2013) And the second phase, a "hypothesis testing case–control study in the accessible

Vaccine Safety Datalink (VSD) database was conducted to examine the relationship between Hg

exposure from Thimerosal-containing hepatitis B vaccines given during specific time periods in

the first six months of life among cases diagnosed with an ASD and controls without such

exposures." (Geier, 2013) The results of the first phase of the study revealed a significantly

increased risk ratio for the incidence of an ASD diagnosis following the receipt of Thimerosal-

containing DTaP vaccine compared to the receipt of Thimerosal-free DTaP vaccine. While the

Results of the second phase stated that cases diagnosed with an ASD were significantly more

likely to have received increased mercury from Thimerosal-containing hepatitis B vaccine doses

given within the first, second, and sixth month of life than controls. (Geier, 2013) All these

results are pretty substantial and show a correlation between Thimerosal and

negative developmental effects on children as well as negative effects on all other populations.

Controversies

Finally the exploration of controversies around the studies and administration of

Thimerasol are important to address in order to answer questions of whether this chemical has

continued effects on children and their development; and the following is one of the main

controversies to this day. A review article written by Hooker and associates in 2014 stated that

malfeasance and controversy in research existed in order to show that Thimerosal in vaccines is

safe: In 2010, the CDC published another epidemiology study on Thimerosal and autism.

(Hooker, 2014) This case-control study was conducted using the records from three managed

care organizations (MCOs) consisting of 256 children with an ASD diagnosis and 752 controls

that were matched by birth year, gender, and MCO to the children with an ASD diagnosis.

Exposure to Thimerosal in vaccines and immunoglobulin preparations was determined from


electronic immunization registries, medical charts, and parent interviews. (Hooker, 2014) Study

stated that Prenatal Thimerosal exposure for the children within the study arose from the

Thimerosal-preserved inactivated-influenza vaccine given during pregnancy and the Rho

immunoglobulin administered to pregnant women to prevent Rh-factor incompatibility injury to

the developing child. (Price, 2010) Evidence from the background CDC report regarding the

Price study showed a significant risk of regressive autism due to prenatal Thimerosal exposure

levels, at exposure levels as low as 16 μg of Hg. However, the risk of regressive autism due to

prenatal Thimerosal exposure reported in that paper was 1.86 and yielded a value of 0.072 which

was deemed as insignificant based on the authors’ “cut-off” value of P." (Hooker, 2014)

However, hooker also stated that values between 0.05 and 0.10 are “marginally significant”

(Price, 2010) and should merit further study. In addition to this information, "upon further

analysis, it was found that the 2009 background report to the Price et al. study showed that the

prenatal Thimerosal exposure model was run in six different ways and that the most reliable

methods (those that factored out the postnatal Thimerosal exposure effects) found highly

statistically significant relative risks of up to 8.73 (P=0.009) for regressive ASD due to prenatal

Thimerosal exposures from Thimerosal-containing influenza vaccines and Rho immunoglobulin

products relative to no such prenatal Thimerosal exposures. Curiously, these more compelling

results were not reported in the paper. Withholding these data from the publication and, instead,

reporting a significantly lower value could appear to constitute scientific malfeasance on the part

of the authors of this study." (Hooker, 2014)

Summary/Conclusion:

In conclusion, Thimerosal, on multiple counts, ahs been found to be very dangerous on

the human body, especially on the development of neonates and infants. The effects of


Thimerosal are described with the current scientific findings and the results veer toward the

direction that administration of this dangerous compound has negative health effects on children

in that it has been shown to evoke conditions along the Autism Spectrum and other related

conditions such as Attention Deficit Hyperactivity Disorder. Parents need to be taught about

these chemicals and need to be influenced to do reading for themselves so they can make

educated decisions about their families lives and well being. The goal is not to say that

vaccinations are to be avoided, but to inform the population that Thimerosal-free vaccinations

exist and that they are much safer for their children's development than ones that do contain this

dangerous compound.

Theoretical framework: Health belief model

The health belief model is the exact theoretical framework that is required for such

findings due to it showing and influencing how adults and families choose their healthcare and

preventive care options. As stated previously, "The model suggests that decision-makers make a

mental calculus about whether the benefits of a promoted behavior change outweigh its practical

and psychological costs or obstacles. That is, individuals conduct an internal assessment of the

net benefits of changing their behavior, and decide whether or not to act." (Green, 2014) "The

model identifies four aspects of this assessment: perceived susceptibility to ill-health (risk

perception), perceived severity of ill-health, perceived benefits of behavior change, and

perceived barriers to taking action. The concept of self-efficacy, or the perceived ability to

actually take a recommended action, was later recognized as an important component or factor."


(green, 2014) This model is perfect for this topic and it helps understand the thought process

involved around ones health decisions.

---------------------------------------------------------------------------------------------------------------------

Methodss

Research questions/Hypothesis:

Is there a relationship between Thimerosal containing vaccines administered at infancy

(cumulative amount of exposure by 3 months of age) and neurologic developmental disorders in

children ages 6-10 years old?

Target population:

Children who are 6-10 years old at the time of the study.

Subjects:

Children who are 6-10 years old at time of study and mothers and fathers who have

extensive information on their children’s vaccination history. Will focus on the groups exposures

to Thymerosal that occur at the earliest stages of life: at birth, and up to the 3rd month of life. The

study may also include cumulative exposure at later ages to avoid limitations.

Sample size:

Sample size will be approximately N=3,000.

Sampling procedures:

The Thimerosal exposure groups will be of equal size and will al be asked to sign a

consent form notifying them of everything the study entails and the benefits of this study for the

population. The Children will be between 6 and 10 years old at the time of the study. The

participants will be randomly chosen for each exposure group which will be controlled by age.


First group will be chosen at random with an N=1000 (approximately). This group will have an

exposure of <25 mg ethyl mercury from cumulative Thimerosal exposure by 3 months of age.

Second group will be chosen at random with an N=1000 (approximately). This group will have

an exposure of > 25 mg, but < 62.5 mg ethyl mercury (cumulative) by 3 months of age. And

finally the third group will be chosen at random with an N=1000 (approximately). This group

will have an exposure of >62.5 mg ethyl mercury (cumulative) by 3 months of age. Total

N=3000. Approximately half of each of these exposure groups would ideally be exposed to

Hepatitis Vaccines. Exclusions of participants would include any severe or chronic prenatal

disorders, specific congenital disorders, low birth weights of less than 2,000 grams or a

gestational age of less than 37 weeks.

Concepts/constructs:

The study will include psychological, psychosocial, and behavioral domains. These

domains will be primarily based on exposure to methylmercury in early stages of life. Domains

will include verbal abilities, spatial/visual capabilities, attention and functioning abilities, short

term memory, fine and gross motor tasks as well as task achievements. Diagnostic outcomes may

lead to ADHD, Language alterations, or speech deficits and Autism spectrum diagnoses.

Operational definition

Instrument: Neuropsychological testing will be performed on all participants in the

study, and results will be measured based on set standards for a normally developing child based

on age and the expected developmental level.

Reliability/Validity:


Firstly, must have normative and reasonable standards of development for 6-10 year old

age group; preferably one that is used by psychologists and other health care professionals. The

neuropsychological test must have a clear track record of use and proven usefulness by

practicing MD’s such as psychologists, psychiatrists, developmental specialists as well as

educators. This instrument should be able to assess and diagnose susceptibility and exposure to

organic mercury as well as psychological disorders such as Autism spectrum, ADHD, and other

developmental alterations. Testing time must also be endurable by the participating children and

parents. (Have the tests be no more than 1-2 hours.)

Step by step procedures to collect data:

Proposed statistical analysis: The proposed outcome measures will consists of 2 parts.

First is results which are gathered after administering neuropsychological tests, and the second

part results are the confirmation of specific Neurodevelopmental disorders.

Results:

Part 1:

This part will identify children with indications of specific neurodevelopmental disorders.

Results will show comparison in the mean difference among exposure groups on

neuropsychological test results, as well as the results themselves. These tests would be very

sensitive for identifying children (participants) with possible neurodevelopmental disorders as

well as provide results of the specific disorder.

Part 2:


This part will provide a confirmatory diagnosis of a specific neurodevelopmental

disorder. Confirmatory neuropsychological tests and interviews will be used to diagnose the

impairment that is found within the participant. The results will compare the 3 exposure groups

and show prevalence of the specific neuropsychological disorder. Highly specific result for

confirming true cases of specific Neurodevelopmental disorders and their links to the exposure

of Thimerosal would be available after performing neuropsychological tests and exploring the

amounts of cumulative exposure.

Discussion

Based on findings that Thimerosal exposure has continued negative health effects on the

development of children, this proposed research would put forward results that support the

hypothesis that Thimerosal exposure from infancy to 3 months of age has negative health

impacts on neurodevelopmental disorder exacerbation in children ages 6-10. Children were

divided into 3 random groups of N = 1000 and will be designated into groups of none/low of

cumulative exposure of Thimerosal (<25 mg) containing vaccines, medium cumulative exposure

of >25 mg but less than 62.5 mg of Thimerosal containing vaccines, and finally a third group of

High exposure of Thimerosal containing vaccines of more than 62.5 mg of cumulative

Thimerosal exposure. Results will be based on a 2 part process: 1st part results will be based on

the administration and interpretation of standardized set of neuropsychological tests, and the 2nd

part’s results will be based on the evaluation and confirmation of specific neurodevelopmental

disorders found within the groups of participants.

Limitations:


Some limitations of this study include specificity of the neuropsychological tests that will

be performed. Another limitation is based on the age range that Is being studied as well as the

narrow range of infancy (birth to 3 months) that is being studied. Involvement of other

substances was not taken into account by this study, including alcohol, drugs (licit and elicit),

and tobacco use. Another limitation is that exposure to other neurotoxins such as arsenic or

pesticides are not being measured.

Implications for Nursing Practice:

Nurses have the responsibility to inform the population about current research and trends

of preventive care as well as protect their patient population from harm. It's important for nurses

to know the relationship between Thimerosal and negative health effects. By conducting such a

study, nurses will have direct access to evidenced based research that will help them spread

information about potentially dangerous compounds that our children and the rest of the

population are exposed to. Providing teaching is a primary prevention and with this evidence

based study, we would provide nurses with the tools necessary to provide this front- line illness

prevention.

Suggestions for further research

Further research on this topic would be beneficial to the public if it focused on other age

ranges of children, as well as health impacts of Thimerosal on adolescent neurodevelopment.

Including other potentially harmful substances as well as keeping in mind and implementing

other at-risk populations into the “participants/subjects” group of the study (such as participant’s

parents with prenatal complications) would yield more results and would help either support or

disprove whether Thimerosal containing vaccines have negative health effects on the population.


The Study Design written and made by Paul A. Stehr-Green (2000), helped the

formulation of these similar methods of the study. Variables were changes and the study

population of children as well as the break-down of sample size and groups studied (participants)

were changed. Source listed in the reference section of paper.

References:

David A. Geier, Lisa K. Sykes, Mark R. Geier (2007) A review of Thimerosal (Merthiolate) and

its Ethylmercury breakdown product: Specific Historical Considerations Regarding

Safety and Effectiveness, Journal of Toxicology and Environmental Health, Part B

10:575-596.

Brian Hooker, Janet Kern,, David Geier, Boyd Haley, Lisa Sykes, Paul King, and Mark Geier

(2014) Methodological Issues and Evidence of Malfeasance in Research Purporting to

Show Thimerosal in Vaccines Is Safe, BioMed Research International, Vol. 2014:8.

CDC Website, Centers for Disease Control and Prevention, Vaccine Safety

http://www.cdc.gov/

Kay, Marmer. (2015) Is it ADHD or Autism? Or Both?, ADDitude Magazine, article 10236.

Mrozek-Budzyn, Majewska R, Kieltuka A, Augustyniak M. (2012) Neonatal Exposure to

Thimerisal from vaccines and child development in the first 3 years of life. Neurotocivol

Teratol, 34(6):592-7. doi: 10.1016/j.ntt.2012.10.001

Edward C. Green, Elaine Murphy. (2014) Health Belief Model Study, The Wiley Blackwell

Encyclopedia of Health, Illness, Behavio,r and Society. D

OI: 10.1002/9781118410868.wbehibs410

Emily K. Brunson (2013) Study on: How Parents Make Decisions About Their Children's

Vaccinations. Vaccine, Vol. 31 Issue 4.6 p.5466-5470.


G. Goldman, (2013) Comparison of VAERS fetal-loss reports during three consecutive influenza

seasons: was there a synergistic fetal toxicity associated with the two-vaccine ,Hum Exp

Toxicol, 32, pp. 464–475

I.A. Brown, D.W. Austin, (2012) Maternal transfer of mercury to the developing embryo/fetus:

is there a safe level? Toxicol Environ Chem, 94 , pp. 1610–1627

David A. Geiera, , Paul G. Kingb, , Brian S. Hookerc, , José G. Dóread, , Janet K. Kerna, , , Lisa K.

Sykesb, , Mark R. Geier, (2015) Thimerosal: Clinical, epidemiologic and biochemical

studies, Clinica Chimica Acta. Vol. 444 p. 212-220. doi:10.1016/j.cca.2015.02.030

J.H. Axton, (1972) Six cases of poisoning after parenteral organic mercurial compound

(Merthiolate), Postgrad Med J, 48 , pp. 417–421

C. Price, A. Robertson, and B. Goodson, (2009) Thimerosal and Autism, ABT Associates. No

specified pages.

C. S. Price, W. W. Thompson, B. Goodson et al., (2010) “Prenatal and infant exposure to

thymerosal from vaccines and immunoglobulins and risk of autism,” Pediatrics, vol.

126, no. 4, pp. 656–664

J.G. Dorea, R.C. Marques, C. Isejima, (2012) Neurodevelopment of Amazonia infants: antenatal

and postnatal exposure to methyl- and ethylmercury, J Biomed Biotechnol, 2012, p.

132876

R.C. Marques, J.V. Bernard, J.G. Dorea, R. de Fatima, M. Moreira, O. Malm, (2014) Perinatal

multiple exposure to neurotoxic (lead, methylmercury, ethylmercury, and aluminum)

substances and neurodevelopment at six and 24 months of age, Environ Pollut, 187, pp.

130–135

D.A. Geier, B.S. Hooker, J.K. Kern, P.G. King, L.K. Sykes, M.R. Geier, (2013) A two-phase

study evaluating the relationship between Thimerosal-containing vaccine administration

and the risk for an autism spectrum disorder in the United States, Transl Neurodegener, 2

(1), p. 25

http://www.sciencedirect.com/science/journal/00098981


Paul A. Stehr-Green (2000), Conceptual Framework for Follow-up Study of Thimerosal

containing Vaccines and Neurologic Developmental Disorders.

http://www.nationalacademies.org/hmd/~/media/

2A500D4003334207A5AFCAC94AA1F4F7.ashx (Research proposal source)

http://www.nationalacademies.org/hmd/~/media/2A500D4003334207A5AFCAC94AA1F4F7.ashx

http://www.nationalacademies.org/hmd/~/media/2A500D4003334207A5AFCAC94AA1F4F7.ashx

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Senior Thesis 2016 By Pavel Stupakov-FINAL