Common Barriers to Childhood Immunizations: Addressing Parental Concerns Regarding Vaccinations

Size: px

Start display at page:

Download "Common Barriers to Childhood Immunizations: Addressing Parental Concerns Regarding Vaccinations"

Elisabeth Davis
6 years ago
Views:

1 Common Barriers to Childhood Immunizations: Addressing Parental Concerns Regarding Vaccinations Teresa Domack, MD & Lauren Melman, MD Middlesex Hospital Family Medicine

2 Objectives Discuss vaccination rates in Connecticut Discuss barriers to immunization, including: Vaccination Exemptions Parental Concerns General Safety (side effects, ingredients) Vaccine Specific Concerns (Varicella, MMR) Acquire strategies to talk to parents about vaccinations

3 CT Vaccination Rates

4 CT Exemption Rates

5 State Vaccination Requirements Exist, but states offer non-medical exemptions WV, MI, CA - only states to offer ONLY medical exemption Prior to 2015 (Senate Bill 277) CA: 1,000 medical 18,000 non-medical personal belief exemptions Connecticut Exemptions: Medical Religious

8 I ve never even heard of these diseases...why do we even need vaccines for them!

9 Educate Parents Vaccines - victims of their own success

10 Educate Parents We live in a world of international air travel Travelers bring disease -measles outbreaks in Europe

11 Educate Parents Diseases are making a comeback Whooping Cough: CT: 81 confirmed cases in 2016 Measles: US: 118 confirmed cases in 2017 Last in CT in 2014

13 DANGER! DANGER! We are dipping below HERD IMMUNITY Due to more and more parents opting out of vaccinating their kids

15 HERD IMMUNITY Contraindications to Vaccinations Infants Pregnancy Severe Immunodeficiency Hx of thrombocytopenia or TTP Severe allergic reaction to vaccine

16 MEASLES MADE A COMEBACK!

17 Won t all these vaccines be too much for my child s immune system?

18 VACCINE IMPACT ON THE IMMUNE SYSTEM Child s immune system is incredibly strong Antigens are everywhere: Vaccines - just a tiny fraction of antigens they encounter everyday Perspective - Wheat Flour: 40 antigens vs Rubella: 5 antigens Vaccine antigens: weakened or killed germs Imitate an infection, but do not cause serious illness Vaccinated children are not at greater risk of other infections

19 VACCINE IMPACT ON THE IMMUNE SYSTEM Children exposed to fewer immunological components in vaccines today Theoretical capacity of an infant's immune system Ability to respond to about 10,000 vaccines at any time If 11 vaccines were given at once: using up <0.1% of the immune system

20 Is the chickenpox vaccine really necessary? Isn t natural infection better?

21 Natural Infection versus Immunization Price paid for natural immunity Chickenpox complications: PNA Meningitis Necrotizing fasciitis Before vaccine: 10,000 hospitalized 100 deaths/year

22 I heard there is formaldehyde and mercury in vaccines-- how can that be safe?

23 Vaccine Ingredient Safety Adjuvants: Aluminum Stabilizers: Gelatin Inactivating Agents: Formaldehyde Preservatives: Thimerosal (Mercury) The lowest amounts necessary AND studied as part of the vaccine during safety testing Substances found in certain vaccines cause no harm other than the rare instances of hypersensitivity reasons such as anaphylaxis in those with severe allergies to either gelatin or egg proteins

24 ALUMINUM Found in: Food (7-9 mg per day) Health Products Aluminum ingestion in the first 6 months of life: Breast-feeding: 7 mg Milk-based formula: 35 mg Soy formula: 117 mg All vaccines at 6 months mg of aluminum

25 FORMALDEHYDE Naturally produced by our body 2 month old infant: 1.1 mg Found in food: 4.6 mg/kg - turkey 6.8 mg/kg - apples 19.5 mg/kg - potatoes Formaldehyde in individual vaccines: < 0.1 mg

26 THIMEROSAL Removed from most childhood immunizations as a precaution in 2001 With exception of multi-dose influenza vials Research shows that Thimerosal does not cause ASD Nine CDC studies found no link Studies have shown that there is no link between receiving vaccines and developing ASD 2013 CDC study: total amount of antigens from vaccines received was the same between children with ASD and those that did not have ASD

27 THIMEROSAL

28 Why do so many children get diagnosed with autism right after getting vaccines?

29 MMR and Autism Dr. Wakefield sparks a firestorm Myths, once released - are hard to reign in..

30 MMR and Autism Studies have found no link between the MMR vaccine & ASD CORRELATION does not equal CAUSATION First dose of the MMR vaccine = 12 to 15 months Autism symptoms can become noticeable = 15 months 18 month developmental screen ASQ-SE: If abnormal: blame the last new thing to happen = VACCINES

31 "Everywhere absolutely I go, not! someone is talking about the danger of vaccines. There are moms posting Theoretically, about their how kids' many side vaccinations effects just do about you think every a newborns online parenting immune forum! system can handle at once?

32 VACCINE SIDE EFFECTS YES - They happen! Nothing is 100% safe Discuss common side effects with parents Complications - extremely rare & should be weighted against vaccinations enormous benefits Vaccines tested in more children over a longer period of time than any other drug US Vaccine Adverse Event Reporting System (VAERS) RotaShield and intussusception

33 VACCINE SIDE EFFECTS MMR: febrile seizures 1:2500 Studies found no long-term effects of simple febrile seizures IF IT BLEEDS - IT LEADS

34 Vaccine Safety: Epidemiological Evidence 2013 Institute of Medicine report: The Childhood Immunization Schedule and Safety: Stakeholder Concerns, Scientific Evidence, and Future Studies The most comprehensive examination of the immunization schedule to date Uncovered NO evidence of major safety concerns associated with adherence to the childhood immunization schedule

35 Can we space out the vaccines? Seems like alot to give in 1 day

36 Spacing out Vaccination/Alt Schedules Vaccine schedules are in place for a reason - CDC recommended schedule determined by clinical trials Immunize as early as possible to protect during the vulnerable early months most susceptible to diseases Whooping Cough outbreaks, most are <6 months Fewer office visits for immunizations Saves parents time and money Results in less stress/trauma for the child Less exposure to sick people with less clinic visits

37 I don t have time for this. a well child visit is only 20 minutes! For the most part, the point of a WCC is to see that the child is: Alive Growing and developing appropriately Addressing parental concerns and providing guidance

38 What is it that frightens you? There is POWER in this question. Have a respectful conversation and address all parental concerns fully. If you succeed and properly address fears, changes are greater you will be able to change their minds!

39 Conversation Strategies Take time to listen Solicit and welcome questions Ask where did you get this information? Science versus anecdote Measles requires quarantine...for weeks! 4 cases of pertussis at CCMC recently, let's give dtap today Acknowledge benefits and risks Success = keeping the conversation going

40 Conversation Strategies Compromise: Pediatrician Alternative to Sears Schedule (PASS) When adopting a Physician's Alternative to the Sears Schedule (PASS), we are acknowledging both that we have found a way to compromise within limits, and that we still insist upon providing the best possible care for our patients, families and the community -AAP Bioethics Committee

41 References 1. Andrews N, Miller E, Grant A, Stowe J, Osborne V, Taylor B. Thimerosal exposure in infants and developmental disorders: a retrospective cohort study in the United kingdom does not support a causal association. Pediatrics 2004;114: Center for Disease Control and Prevention. Atlanta, GA: Vaccine Safety Monitoring. Atlanta, GA: Last Reviewed October 6 th, Accessed September 20 th, Centers for Disease Control and Prevention. Atlanta, GA: Common Vaccine Safety Concerns. Last Reviewed October 6th, Accessed September 20 th, Centers for Disease Control and Prevention. Atlanta GA: Vaccines Do Not Cause Autism. Last Reviewed October 6 th, Accessed September 20 th, Centers for Disease Control and Prevention. Atlanta GA: VaxView. Last Reviewed October 6 th, Accessed September 20 th, Center for Disease Control and Prevention. Atlanta, GA: Talking with Parents about Vaccines for Infants. Reviewed March Accessed September 18, Center for Disease Control and Prevention. Atlanta, GA: Diseases and the Vaccines that Prevent Them. Last Reviewed November 30 th, Accessed September 18 th, Croen LA, Matevia M, Yoshida CK, Grether JK. Maternal Rh D status, anti-d immune globulin exposure during pregnancy, and risk of autism spectrum disorders. Am J Obstet Gynecol 2008;199:234.e Department of Public Health. State of Connecticut. Connecticut Immunization Program: Immunization Laws and Regulations. Last Modified September 15 th, Accessed October 5 th, DeStefano F, Price CS, Weintraub ES. Increasing exposure to antibody-stimulating proteins and polysaccharides in vaccines is not associated with risk of autism. The Journal of Pediatrics 2013;163: Duffner PK, Berman PH, Baumann RJ, Fisher PG, Green JL, Schneider S, Davidson C. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics 2011; Hviid A, Stellfeld M, Wohlfahrt J, Melbye M. Association between thimerosal-containing vaccine and autism. Jama 2003;290: Institute of Medicine. The Childhood Immunization Schedule and Safety: Stakeholder Concerns, Scientific Evidence, and Future Studies. Washington (DC): National Academies Press (US); Keith LS, Jones DE, Chou CH. Aluminum toxicokinetics regarding infant diet and vaccinations. Vaccine 2002;20 Suppl 3:S Mitkus RJ, King DB, Hess MA, Forshee RA, Walderhaug MO. Updated aluminum pharmacokinetics following infant exposures through diet and vaccination. Vaccine 2011;29: Offit PA, Jew RK. Addressing parents' concerns: do vaccines contain harmful preservatives, adjuvants, additives, or residuals? Pediatrics 2003;112:

42 References 1. Offit PA, Jew RK. Addressing parents' concerns: do vaccines contain harmful preservatives, adjuvants, additives, or residuals? Pediatrics 2003;112: Offit, PA, Hackett CJ. Addressing parents concerns: do vaccines cause allergic or autoimmune disease? Pediatrics. 2003;111(3): Offit, PA, Quarles J, Gerber MA, Hackett CJ, Marcuse EK, Kollman TR, Gellin BG, Landry S. Addressing parents concerns: do multiple vaccines overwhelm or weaken the infant s immune system? Pediatrics. 2002;109(1): Parker SK, Schwartz B, Todd J, Pickering LK. Thimerosal-containing vaccines and autistic spectrum disorder: a critical review of published original data. Pediatrics 2004;114: Parker SK, Schwartz B, Todd J, Pickering LK. Thimerosal-containing vaccines and autistic spectrum disorder: a critical review of published original data. Pediatrics 2004;114: Price CS, Thompson WW, Goodson B, et al. Prenatal and infant exposure to thimerosal from vaccines and immunoglobulins and risk of autism. Pediatrics. 2010;126: Schultz ST. Does thimerosal or other mercury exposure increase the risk for autism? A review of current literature. Acta neurobiologiae experimentalis 2010;70: Taylor LE, Swerdfeger AL, Eslick GD. Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine. 2014;32: Uno Y, Uchiyama T, Kurosawa M, Aleksic B, Ozaki N. The combined measles, mumps, and rubella vaccines and the total number of vaccines are not associated with development of autism spectrum disorder: the first case-control study in Asia. Vaccine 2012;30: Verstraeten T, Davis RL, DeStefano F, et al. Safety of thimerosal-containing vaccines: a two-phased study of computerized health maintenance organization databases. Pediatrics 2003;112:

Vaccine Hesitancy: What is it? What can you do about it?

Vaccine Hesitancy: What is it? What can you do about it? November 12, 2016 Family Medicine Forum, Vancouver Monika Naus MD MHSc FRCPC FACPM BC Centre for Disease Control School of Population and Public