Collecting Student Misconceptions About the Flu Vaccine

Written by Kelly A. Hogan, University of North Carolina at Chapel Hill

Learning Outcomes:

– For students to find out what misconceptions they have about the flu vaccine

– To learn why the flu vaccine is sometimes ineffective

Activity Description: This can be done as a lecture opener to an immunology discussion or after the adaptive immune system is discussed. Students are surveyed (through a clicker system if available) to find out how many of them received the flu vaccine in the previous or current flu season. They are asked to anonymously write reasons if they chose not to get one. A discussion follows about misconceptions based upon their answers.

Time Needed: Survey and discussion can be completed in approximately 10 minutes.

Materials Needed: Handouts, clickers if available, notecards/paper for students

Activity Instructions:

  1. Survey your students to see how many of them have had the most current flu vaccine. (If your students are like mine, the majority will not have had the vaccine.) If you are using a clicker program, you can easily survey with this. If you are not using a clicker program and have a class of less than 32 students, you can use the free version of www.polleverywhere.com to survey students and get an instant histogram like clickers (students use laptops or cell phones to answer through either a web browser or a text message). Of course, a low-tech way to survey is to count raised hands!
  2. Next, seeing that many have not gotten the vaccine, push them to give you the reasons why they chose not get one. To get better responses, use an anonymous method. Have them write on blank paper and pass forward or have them text a free response to the question you might have already set up in www.polleverywhere.com.
  3. Discuss reasons. Below I state common misconceptions that my students had:

Misconceptions:

  1. I hear I can get the flu from it.
  2. I have gotten the flu from the flu shot. The vaccine doesn’t work.
  3. I never had the shot and I never got the flu.
  4. The shot is only for babies and old people.
  5. I can get scary, severe side effects from the vaccine. Vaccines are dangerous and I would rather get the flu.

Background information to discuss their misconceptions:

(Based on CDC’s flu vaccine information;  http://www.cdc.gov/flu/protect/keyfacts.htm for more information.)

1. I hear I can get the flu from it.

The flu shot is made from a virus that has been killed. You cannot get the flu from this. There is a nasal spray version of the vaccine made with weakened, live virus. While some people will have minor side effects, runny nose or headache etc., they will not have the “flu.” People with severely compromised immune systems should not get the nasal spray, since this is a live virus.  This misconception that people will get the flu perpetuates though because someone they know got the flu after being vaccinated (see misconception number 2).

2. I had the shot once, but still got the flu. The vaccine doesn’t work.

Sometimes, people have already been exposed to the flu and are not showing symptoms yet. They receive the vaccine and then develop the flu. (They would have shown symptoms of the flu with or without the vaccine.)

Sometimes the vaccine is not effective because it doesn’t match the circulating strain of virus or there are multiple strains circulating.

“The effectiveness of inactivated influenza vaccine depends primarily on the age and immunocompetence of the vaccine recipient, and the degree of similarity between the viruses in the vaccine and those in circulation. In years when the vaccine strains are not well matched to circulating strains, vaccine effectiveness is generally lower. The vaccine may also be lower among persons with chronic medical conditions and among the elderly, as compared to healthy young adults and children. In addition, estimates of vaccine effectiveness vary, based on the specificity of the outcome that is being measured in the study.” (CDC)

3. I never had the shot and I never had the flu.

There is nothing superhuman about these people. They will likely one day get the flu and if it is bad enough, they will reconsider getting a flu shot in the future!

4. The shot is only for babies and old people.

Everyone 6 months and older should get a flu vaccine. It’s especially important that the following groups get vaccinated either because they are at high risk of having serious flu-related complications or because they live with or care for people at high risk for developing flu-related complications: pregnant women, children younger than 5, but especially children younger than 2 years old, people 50 years of age and older, people of any age with certain chronic medical conditions, people who live in nursing homes and other long-term care facilities, people who live with or care for those at high risk for complications from flu.

5. I can get scary, severe side effects from it.

“Almost all people who receive influenza vaccine have no serious problems from it. However, on rare occasions, flu vaccination can cause serious problems, such as severe allergic reactions.” (CDC). People with allergies to chicken eggs or other ingredients of the vaccine should not be vaccinated.

Correlation does not equal cause and effect. It is understandable that people who fall ill look for reasons behind their illness. Remind students about sample size. Just because they heard about  friend of a friend…

The CDC keeps a list of side effects from the flu shot and flu nasal spray in their vaccine adverse event reporting system (VAERS). VAERS data contains coincidental events and those truly caused by vaccines.

Guillain-Barré Syndrome (GBS) is the most commonly cited serious side effect. “The potential association between the vaccine and GBS has been an area of ongoing research.” (CDC)

“Guillain-Barré syndrome (GBS) is a rare disorder in which a person’s own immune system damages their nerve cells, causing muscle weakness and sometimes paralysis. GBS can cause symptoms that last for a few weeks. Most people recover fully from GBS, but some people have permanent nerve damage. In very rare cases, people have died of GBS, usually from difficulty breathing. In the United States, for example, an estimated 3,000 to 6,000 people develop GBS each year on average, whether or not they received a vaccination.”

There is much information to read from the CDC about this: http://www.cdc.gov/flu/professionals/acip/adversetiv.htm

Practicing the Scientific Method: Are Girls Better than Boys at Some Tasks?

Written by Kelly A. Hogan, University of North Carolina at Chapel Hill

Learning Outcomes:

– To practice the scientific method, beginning with an observation

– To appreciate that there are multiple ways to test a single hypothesis

Activity Description: Students are given information about females being better at articulation than males. They are asked to follow the steps of the scientific method and design their own experiment to test this statement. After class discussion about the weaknesses/strengths relative to their designs, the instructor introduces a planned experiment involving the students and tongue twisters. Class data is compiled and the instructor leads the class in a discussion about the results and how they compare to other results.

Time Needed: This activity takes about 30 minutes.

Materials Needed: If interested in compiling class data: a calculator, an Excel spreadsheet, or clickers.

Activity Instructions:

1. Engage your students with a fun survey. Ask them a few questions, “Who is better at ______, men or women?”

Fill in the blanks with these ideas, based on “Sex Differences in the Brain,” Scientific American,, Sept 1992 by Doreen Kimura:

a. Fine motor skills (putting pegs in small holes, needle-pointing, surgery)

b. Learning a new route from a map

c. Remembering landmarks on a new route

d. Matching items that are alike (among a sea of similar items)

e. Spatial ability (rotating pictures of 3D items visually)

f. Naming objects in a category (i.e. name all objects you can think of that are red)

g. Articulation of words

2. Explain that on average, men have been found to excel at b and e, and women excel at the other activities.

(Based on “Sex Differences in the Brain.” Scientific American, Sept 1992 by Doreen Kimura)

3. Ask students, “Is this real? How was it tested? What could account for these differences?”

The article referenced above will give you a brief review about what might account for these differences. “Differing patterns of ability between men and women most probably reflect different hormonal influences on their developing brains. Early in life the action of estrogens and androgens (male hormones chief of which is testosterone) establishes sexual differentiation.” -Doreen Kimura

4. Choose one of these topics to focus on. I have chosen articulation. Explain articulation difficulty by having the students repeat this statement several times.

“We surely shall see the sun shine soon.” The students will recognize that this is a tongue twister.

5. Instruct the students to do this activity: “Using critical thinking, design a scientific approach to see if there is evidence for this statement, ‘Females are better at articulating than males.’ In your answer, you should write out the steps of the scientific method.” (If students have not yet had a mini lecture on these steps, this would be the time to do this.)

6. Allow them time to share their ideas for an experiment with classmates. Allow other classmates to comment on their designs. (To encourage participation here, you might have the groups switch ideas and read each other’s ideas.)

7. After a discussion period, tell them you had an experiment already planned (It is possible that they have come up with something similar. Now is a great time to stress to them that there are often a myriad of experimental designs to answer the same question. Science is creative.)

8. Detail your experimental design to them:

Observation: Females articulate better than males.

Question: Are females better at articulating than males?

Hypothesis: Females perform better on tongue twister challenges than males.

Prediction: If told to repeat a tongue twister 5 times as quickly as possible, then females will successfully complete the task faster than males.

Experimental Design: Students will be asked to work in small groups to time members of their group. They will collect data for each female and male in their group. The tongue twister the students will repeat is “a box of mixed biscuits in a biscuit mixer.” Have each student repeat it 5 times without errors and record this time in seconds. This will likely lead to laughter and fun and a noisy room!

9. After the class completes their group tasks, if you can manage to do so quickly, the class data can be compiled and averaged. (If your class is large and you are using clickers, you might quickly collect the data from the class by setting up MC options for ranges and show a quick histogram or collect open-ended answers and quickly manipulate a spreadsheet. The majority of my class completed it in under 17 seconds, but there were many that reported over 23 seconds.)

10. Be sure to discuss any weakness of the design and sampling errors. Are there other ways to test this skill? Can we now call this a theory? (One example of something to point out is that the males and females would need to be similar in every aspect aside from sex; for example, their average age should be the same. Depict an obvious pitfall if the males were all under 6 years of age and the females were college-aged.)

11. Lastly, let them know that this was a real experiment; it was one task in a series of experiments performed by Doreen Kimura and Elizabeth Hampson of the University of Western Ontarioin Canada. On average, women were faster than men when asked to repeat the sentence 5 times; women averaged 17 seconds. (Interestingly, the scientists found that the women’s values varied depending on where they were in their menstrual cycle. At peak estrogen levels at mid cycle, the average was 14 seconds.) When my class data didn’t match the reported data, I used it as an opportunity to explore the weaknesses of our specific design (no official unbiased data collector, reporting on peers, noisy room, uneven number of males and females etc.) Additionally, I used it as an opportunity to explain how science needs to be repeatable and what it means when a scientist can’t repeat another scientist’s experiment.

To see a discussion of the research on articulation: “Women’s skills linked to estrogen levels.” Science News, Nov 26, 1988 by Rick Weiss.

Learning to Think Critically Like a Scientist

Written by Kelly A. Hogan, University of North Carolina at Chapel Hill

Learning Outcomes:

– To discover “bad” scienceStreaming and download Inferno (2016)

– To recognize how media reports of scientific papers can cause the spread of misinformation and fear

– To have students suggest studies that would produce convincing data

Activity Description: Students are shown a summary of an infamous scientific article related to the MMR vaccine and autism. They are asked to evaluate if this fits the guidelines of good science. The class should come to the conclusion that it does not fit the guidelines of good science by determining what data is lacking.

Time Needed: 30 minutes with discussion

Materials Needed: Copies of the worksheet below

Activity Instructions: Students are given a summary of a monumental paper linking the MMR vaccine and autism. Students discuss their reactions and then spend time determining why the study was flawed and what kind of studies would be better. Class discussions are followed by a presentation of real data from studies similar to those they may have suggested. Lastly, the instructor reveals that the paper was retracted. Nonetheless, public fear and misinformation remain despite no supporting evidence linking the MMR vaccine to autism. (There are numerous news articles on the paper’s retraction that you can reference.)

Worksheet: Thinking Critically Worksheet

Background/Follow-up for the Instructor:

The following are questions students may come up with on their own for question 3 of the worksheet. Below each question is a brief summary of what was found in various studies.

  • Did autism rates increase after the introduction of the MMR vaccine?

– No. Sweden and UK studies (see below) showed no difference in the rate of autism before and after the introduction of MMR to society

  • Does onset of autism correlate with time of vaccination?

– No. UK studies show that age of onset does not correlate with the timing of the MMR vaccine, if given at all. (Although autism symptoms frequently present around the age this shot is most commonly administered).

  • What is the normal rate of autism (control group vs. a MMR vaccinated group)?

– Denmark: study involved over 500,000 children. No difference in autism risk in those vaccinated vs. those not vaccinated.

More specific information originally published on www.cdc.gov in 2004):

The MMR-autism theory came to the forefront when, in 1998,Wakefield and colleagues reviewed reports of children with bowel disease and regressive developmental disorders, mostly autism. The researchers suggested that MMR vaccination led to intestinal abnormalities, resulting in impaired intestinal function and developmental regression within 24 hours to a few weeks of vaccination. This hypothesis was based on 12 children. In 9 of the cases, the child’s parents or pediatrician speculated that the MMR vaccine had contributed to the behavioral problems of the children in the study. There are a number of limitations in the Wakefield et al. (1998) study:

1. The study used too few cases to make any generalizations about the causes of autism; only 12 children were included in the study. Further, the cases were referred to the researchers and may not be a representative sample of cases of autism.

2. There were no healthy control children for comparison. As a result, it is difficult to determine whether the bowel changes seen in the 12 children included in the study were similar to changes in normal children, or to determine if the rate of vaccination in autistic children was higher than in the general population.

3. The study did not identify the time period during which the cases were identified.

4. In at least 4 of the 12 cases, behavioral problems appeared before the onset of symptoms of bowel disease; that is, the effect preceded the proposed cause. It is unlikely, therefore, that bowel disease or the MMR vaccine triggered the autism.

In 2004, 10 of the 13 authors of the study retracted the paper’s interpretation, stating that the data were insufficient to establish a causal link between MMR vaccine and autism (Murch et al., 2004) The paper was fully retracted from Lancet in Feb 2010.

Epidemiologic studies have shown no relationship between MMR vaccination in children and development of autism:

In 1997, the National Childhood Encephalopathy Study (NCES) was examined to see if there was any link between measles vaccine and neurological events. The researchers found no indication that measles vaccine contributes to the development of long-term neurological damage, including educational and behavioral deficits (Miller et al., 1997).

A study by Gillberg and Heijbel (1998) examined the prevalence of autism in children born inSwedenfrom 1975-1984. There was no difference in the prevalence of autism among children born before the introduction of the MMR vaccine inSwedenand those born after the vaccine was introduced.

In 1999, the British Committee on Safety of Medicines convened a “Working Party on MMR Vaccine” to conduct a systematic review of reports of autism, gastrointestinal disease, and similar disorders after receipt of MMR or measles/rubella vaccine. It was concluded that the available information did not support the posited associations between MMR and autism and other disorders.

Taylor and colleagues (1999) studied 498 children with autism in theUKand found the age at which they were diagnosed was the same regardless of whether they received the MMR vaccine before or after 18 months of age or whether they were never vaccinated. Importantly, the first signs or diagnoses of autism were not more likely to occur within time periods following MMR vaccination than during other time periods. Also, there was no sudden increase in cases of autism after the introduction of MMR vaccine in theUK. Such a jump would have been expected if MMR vaccine was causing a substantial increase in autism.

Kaye and colleagues (2001) assessed the relationship between the risk of autism among children in theUKand MMR vaccine. Among a subgroup of boys aged 2-5 years, the risk of autism increased almost 4 fold from 1988 to 1993, while MMR vaccination coverage remained constant at approximately 95% over these same years.

Researchers in theU.S.found that among children born between 1980 and 1994 and enrolled inCaliforniakindergartens, there was a 373% relative increase in autism cases, though the relative increase in MMR vaccine coverage by the age of 24 months was only 14% (Dales et al., 2001). For more on this study, see California Data on Theory of Autism and MMR Immunization.

Researchers in theUK(Frombonne & Chakrabarti, 2001) conducted a study to test the idea that a new form, or “new variant,” of Inflammatory Bowel Disease (IBD) exists. This new variant IBD has been described as a combination of developmental regression and gastrointestinal symptoms occurring shortly after MMR immunization. Information on 96 children (95 immunized with MMR) who were born between 1992 and 1995 and were diagnosed with pervasive developmental disorder were compared with data from 2 groups of autistic patients (one group of 98 born before MMR was ever used and one group of 68 who were likely to have received MMR vaccine). No evidence was found to support a new syndrome of MMR-induced IBD/autism. For instance, the researchers found that there were no differences between vaccinated and unvaccinated groups with regard to when their parents first became concerned about their child’s development. Similarly, the rate of developmental regression reported in the vaccinated and unvaccinated groups was not different; therefore, there was no suggestion that developmental regression had increased in frequency since MMR was introduced. Of the 96 children in the first group, no inflammatory bowel disorder was reported. Furthermore, there was no association found between developmental regression and gastrointestinal symptoms.

Another group of researchers in theUK(Taylor et al., 2002) also examined whether MMR vaccination is associated with bowel problems and developmental regression in children with autism, looking for evidence of a “new variant” form of IBD/autism. The study included 278 cases of children with autism and 195 with atypical autism (cases with many of the features of childhood autism but not quite meeting the required criteria for that diagnosis, or with atypical features such as onset of symptoms after the age of 3 years). The cases included in this study were born between 1979 and 1998. The proportion of children with developmental regression or bowel symptoms did not change significantly from 1979 to 1988, a period which included the introduction of MMR vaccination in theUKin 1988. No significant difference was found in rates of bowel problems or regression in children who received the MMR vaccine before their parents became concerned about their development, compared with those who received it only after such concern and those who had not received the MMR vaccine. The findings provide no support for an MMR associated “new variant” form of autism and further evidence against involvement of MMR vaccine in autism.

Madsen et al. (2002) conducted a study of all children born inDenmarkfrom January 1991 through December 1998. There were a total of 537,303 children in the study; 440,655 of the children were vaccinated with MMR and 96,648 were not. The researchers did not find a higher risk of autism in the vaccinated than in the unvaccinated group of children. Furthermore, there was no association between the age at time of vaccination, the amount of time that had passed since vaccination, or the date of vaccination and the development of any autistic disorder. Though there were many more vaccinated than unvaccinated children in the study group, the sample was large enough to contain more statistical power than other MMR and autism studies. Therefore, this study provides strong evidence against the hypothesis that MMR vaccination causes autism.

DeStefano et al. (2004) conducted a study to see if there was a difference in the age at which children with autism and without autism received their first MMR vaccination. The study’s findings showed that children with autism received their first MMR vaccination at similar ages as children without autism.

So You Think You Are an Effective Multitasker?

Written by Kelly A. Hogan, University of North Carolina at Chapel Hill

Learning Outcomes:

– To point out that all humans are less effective at tasks as we juggle more and more at the same time

– To demonstrate an inverse relationship between multitasking during class and student learning

Activity Description: Students collect data about their own multitasking ability. The effectiveness of each single activity decreases as two tasks are performed simultaneously.

Time Needed: The worksheet will take approximately 5 minutes followed by discussion.

Materials Needed: Photocopies of the worksheets and student watches to measure seconds (or a classroom display of a computerized clock in a large classroom)

Activity Instructions: Hand out the worksheet and have the students work in pairs to record each other’s time. After the students have completed it, ask them what they think it demonstrates relative to the classroom. Encourage your students to see how switching between a quick text or email or website while trying to take notes in class could be more detrimental than they realize. Have a discussion about laptops in the classroom. This might be an opportunity to get their opinions and share your philosophy.

Fun background relative to this activity:

  1. This activity is based on demonstrations that David E. Meyer, a professor of psychology at the Universityof Michiganat Ann Arbordoes in his class. A typical student can do the individual tasks in about 2 seconds. You might guess that it should take about 4 seconds to combine the tasks, but it usually takes 15-20 seconds and usually includes mistakes. Meyer explains this is because there is a switching time cost. Additionally, studies have shown that people who consider themselves effective multitaskers performed worse on tasks that involved distraction, compared to people who considered themselves better at monotasking. (For more information about multitasking relative to the classroom, see “Divided Attention,” The Chronicle Review, Feb 28, 2010 by David Glenn.)
  2. Rigging a car with a red light to alert drivers when to brake, Car and Driver Magazine demonstrated how dangerous mutitasking can be when driving. Texting while driving is more dangerous than being legally drunk!

The magazine tested how long it takes a driver to hit the brake when sober, when legally drunk at .08, when reading an e-mail, and when sending a text. The driver drove 70 mph on a deserted air strip under different conditions. The results:

Unimpaired: .54 seconds to brake

Legally drunk: add 4 feet

Reading e-mail: add 36 feet

Sending a text: add 70 feet

Makes you wonder what texting during biology class does to exam scores!

Worksheet: Effective Multitasker Worksheet

Creating a Community for Active Learning on the First Day of Class

Written by Kelly A. Hogan, University of North Carolina at Chapel Hill

Learning Outcomes:

– To make students feel more comfortable sharing during class discussion

– To demonstrate to students that active learning involves every person in the class

Activity Description: Students are asked to complete a few small tasks that involve meeting their classmates and practicing a few active learning techniques. These are designed for the first day of class as an icebreaker and introduction to an active classroom.

Time Needed: 20 minutes

Materials Needed: Students will need plain paper or 3 x 5 notecards they can pass to each other.

Activity Instructions:

  1. Have the students introduce themselves to their classmates. Encourage them to meet people beside them, behind them, and in front of them. In a smaller class, you might have them introduce each other. This is also a good time to introduce yourself and share personal information and maybe funny photos of yourself to the class.
  2. Ask students to write down the answer to the following question on their blank paper (without putting their name on it): “What would encourage you to participate in class discussions? Are there rules that I and your classmates should follow that ensure everyone feels comfortable? What would they be?” You may have an alternative question you would find more useful in your class on day one. The two techniques below work well with any question.
  3. Call on a reporter: After students have had time to complete the question, call on one person to share. Inevitably that person will feel uncomfortable as will the whole class. Now, let that person know they are not going to share their answer. They have a few minutes to gather group answers. They will simply become a “reporter” for surrounding students. This should take the pressure off the student. In the meantime, have the other students discuss with their group, explaining you might call on some of them too.
  4. Pass the Paper: After you discuss a few of the student answers, try another technique. Have the students pass their notecards randomly to a neighbor. Each student should exchange a notecard with neighbors several more times until the class responses are well shuffled. Now, ask if some students will volunteer to read an interesting answer on the card they have in front of them. Let students know that if they are comfortable, they can always share their own ideas. Shuffling is one way to make people less self-conscious about sharing.