In October 2007, Dr Robert Sears, in response to growing parental concerns about the safety of vaccines, published The Vaccine Book: Making the Right Decision for Your Child. Sears' book is enormously popular, having sold >40000 copies. At the back of the book, Sears includes “Dr Bob's Alternative Vaccine Schedule,” a formula by which parents can delay, withhold, separate, or space out vaccines. Pediatricians now confront many parents who insist that their children receive vaccines according to Sears' schedule, rather than that recommended by the American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the American Academy of Family Physicians. This article examines the reasons for the popularity of Sears' book, deconstructs the logic and rationale behind its recommendations, and describes how Sears' misrepresentation of vaccine science misinforms parents trying to make the right decisions for their children.

IntroductionVaccine acceptance is a critical component of sustainable immunization programs, yet rates of vaccine hesitancy are rising. Increased access to misinformation through media and anti-vaccine advocacy is an important contributor to hesitancy in the United States and other high-income nations with robust immunization programs. Little is known about the content and effect of information sources on attitudes toward vaccination in settings with rapidly changing or unstable immunization programs.ObjectiveThe objective of this study was to explore knowledge and attitudes regarding vaccines and vaccine-preventable diseases among caregivers and immunization providers in Botswana, the Dominican Republic, and Greece and examine how access to information impacts reported vaccine acceptance.MethodsWe conducted 37 focus groups and 14 semi-structured interviews with 96 providers and 153 caregivers in Botswana, the Dominican Republic, and Greece. Focus groups were conducted in Setswana, English, Spanish, or Greek; digitally recorded; and transcribed. Transcripts were translated into English, coded in qualitative data analysis software (NVivo 10, QSR International, Melbourne, Australia), and analyzed for common themes.ResultsDominant themes in all three countries included identification of health care providers or medical literature as the primary source of vaccine information, yet participants reported insufficient communication about vaccines was available. Comments about level of trust in the health care system and government contrasted between sites, with the highest level of trust reported in Botswana but lower levels of trust in Greece.ConclusionsIn Botswana, the Dominican Republic, and Greece, participants expressed reliance on health care providers for information and demonstrated a need for more communication about vaccines. Trust in the government and health care system influenced vaccine acceptance differently in each country, demonstrating the need for country-specific data that focus on vaccine acceptance to fully understand which drivers can be leveraged to improve implementation of immunization programs.

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The capacity of intramuscular (i.m.) inoculation of mice with homologous or heterologous host rotaviruses to induce protection from challenge was evaluated. i.m. inoculation with live, wild-type rotavirus (murine strain EDIM) induced complete protection from viral shedding after challenge for at least 6 weeks after inoculation; protection was correlated with production of virus-specific immunoglobulin A (IgA) by lamina propria (LP) lymphocytes. i.m. inoculation with inactivated EDIM, cell culture-adapted EDIM, or simian strain RRV was associated with partial protection, characterized by reduced viral shedding after challenge. Partial protection after challenge was not associated with production of virus-specific IgA by LP lymphocytes. The mechanisms by which i.m. inoculation induces virus-specific humoral immune responses in the small intestinal LP were examined. MATERIALS AND METHODS Mice. Conventionally reared, 6-to 8-week-old BALB/c female mice (Taconic Breeding Laboratories, Germantown, N.Y.) were housed in individual isolation units. Prior to inoculation, sera from these mice did not contain rotavirus-specific antibodies, as determined by enzyme-linked immunosorbent assay (ELISA). Virus. Murine rotavirus strain EDIM (P10[16], G3) was obtained from Richard Ward (Children's Hospital Research Foundation, Cincinnati, Ohio). Wildtype EDIM virus used in these studies was prepared by harvesting the small and large intestines of 6-to 10-day-old BALB/c mice 3 days after oral inoculation with wild-type EDIM. Cell culture-adapted EDIM used in these studies was used after 49 serial passages and plaque purification in MA104 cells. Simian rotavirus strain RRV (P5[3], G3) was obtained from N. Schmidt (Viral and Rickettsial Disease Laboratory, Berkeley, Calif.) and grown in MA104 cells. Cell cultureadapted rotaviruses were titrated for infectivity by plaque assay as described previously (19). The quantities of viral antigen in both cell culture-adapted and wild-type rotaviruses were measured by ELISA. Wild-type and cell culture-adapted EDIM were inactivated as described previously (8). Briefly, wild-type EDIM was diluted 10-fold and cell culture-adapted EDIM was diluted to a concentration of 1.5 ϫ 10 6 PFU/ml in brain-heart-kidney cell medium (Wistar Institute, Philadelphia, Pa.). Virus was added to a solution containing psoralen (HRI Associates, Concord, Calif.) at a concentration of 20 g/ml in distilled water (dH 2 O) and placed on ice for 15 min. Aliquots (0.6 ml) were placed in the center wells of a 24-well plate (Becton Dickinson, Lincoln Park, N.J.) and exposed to UV light (in a GBL-100 apparatus; George W. Gates, Franklin Square, N.Y.) at a distance of 7.5 cm for 15 min. Inactivated virus (containing Ͻ5 PFU of infectious EDIM per ml) did not induce viral shedding when administered orally to adult BALB/c mice. Immunization of animals. Adult mice were inoculated in the quadriceps femoris muscle (i.m.) with virus or medium (brain-heart-kidney) in a volume of 100 l. Mice were inoculated with 10 6 50% shedding doses (SD 5...