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1 Talking with Parents about Vaccines for Infants Tuesday, August 14, :00 PM ET In Case of Technical Difficulties If you hear an echo: Make sure you are only logged in once on your computer Select one form of audio only (either computer speakers or telephone connection) If the audio is choppy: Press pause in the top left corner of your screen Wait 10 seconds and then click play Dial at any time for live assistance 1

2 Welcome and Introductions Agenda William Schaffner, MD, NFID Medical Director Professor of Preventive Medicine and Infectious Diseases Vanderbilt University School of Medicine Talking to Parents about Vaccines for Infants Jenny Mullen, MPH Health Communication Specialist National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention Nathan E. Boonstra, MD General Pediatrician Blank Children s Hospital Questions and Answers General Information Please note that this webinar is being recorded All phone lines will be placed on mute throughout the program To hear audio: Computer: Follow directions Phone: ; Access Code After the presentations, there will be a Question and Answer period Use the Chat box on the lower left side of your screen to type your question At the end of the webinar, participants will be directed to an online evaluation Following the webinar, registered participants will receive an with a link to the presentation slides 2

3 CME Credit & Evaluation The National Foundation for Infectious Diseases (NFID) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians. NFID designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit TM. To receive credit, you must complete the online evaluation and pass the post test with a score of 80% or higher Online evaluation and post test will be available following the webinar at: bit.ly/talkingwithparents 0814 Certificate will be available for print or download following successful completion of online evaluation and post test until August 14, 2019 CPE Credit & Evaluation The National Association of Chain Drug Stores (NACDS) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. NACDS designates this enduring material as 1.0 contact hours of ACPE accredited continuing education. Talking with Parents about Vaccines for Infants (ACPE Universal Activity # L04 P. Initial Release Date: 0). To receive contact hour credit, you must complete the online evaluation and pass the post test with a score of 80% or higher Online evaluation and post test will be available following the webinar at: nacds.learnercommunity.com/home 3

4 Disclosures Marla Dalton (NFID staff, content reviewer) owns stock, stock options, patent, or other intellectual property from Merck & Co., Inc. William Schaffner (NFID medical director, presenter) serves as an advisor or consultant for Dynavax, Merck & Co., Inc., Pfizer Inc., Seqirus, and SutroVax All other individuals in a position to control the content of this activity have no relevant financial relationships to disclose Presentation Image Rights Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation use. No rights are implied or extended for use in printing or any use by other CDC Centers, Institute, and Offices or any external audiences. 4

5 Learning Objectives At the conclusion of this activity, participants will be able to: Describe key findings of CDC vaccine communication research with parents of children less than two years of age List three steps in effective vaccine conversations with parents Summarize common questions that parents ask about infant vaccines Identify immunization communication resources for healthcare professionals and parents Non profit 501(c)(3) organization dedicated to educating the public and healthcare professionals about causes, prevention, and treatment of infectious diseases across the lifespan Reaches consumers, healthcare professionals, and media through: Coalition building activities Public outreach initiatives Professional educational programs (ACCME accreditation with commendation) About NFID Scientific meetings, research, and training Longstanding partnerships to facilitate rapid program initiation and increase programming impact Flexible and nimble organization 5

6 Talking with Parents about Vaccines for Infants Jenny Mullen, MPH Health Communication Specialist National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention CDC Research with Parents of Infants & Young Children National Immunization Survey (annual) Online polls (periodic) Cognitive interviews (periodic) Longitudinal study of first time expectant moms ( ) 6

7 Vaccine Coverage among Children Months, National Immunization Survey, US, Very Few US Toddlers Have Received No Vaccines 1 Healthy People 2020 Goal: <1%

8 CDC Longitudinal Study of First Time Expectant Moms Initial survey showed that over 85% of respondents had already made a plan for vaccinating their baby by their 2 nd trimester However, only 6% of the women were very satisfied with their current level of knowledge about childhood vaccines Internet search engines were their #1 source of information about childhood vaccines during pregnancy Only 22.5% cited their ob gyn or primary care provider Results suggest a need for midwives and ob gyns to direct expectant women to credible sources of childhood immunization information Parents Reported Vaccination Behavior My child received all of his/her vaccines at the time(s) they were recommended My child has not received all of his/her vaccines at the time(s) they were recommended but I am actively working to catch up I chose to delay, or get later, one or more, but not all of the recommended vaccines at the time(s) they were recommended I chose to delay all of the recommended vaccines at the time(s) they were recommended I chose to refuse, or never get, one or more, but not all, of the recommended vaccines at the time(s) they were recommended I chose to refuse and delay some of the vaccines for my child at the time(s) they were recommended I chose to refuse all of the recommended vaccines at the time(s) they were recommended 2016 (n=2,510) 86.1% 2.3% 5.8% 0.6% 2.3% 1.4% 1.6% CDC National Poll of Parents 2016 (unpublished data) 8

9 Vaccine Questions & Concerns Weighted Frequencies 2016 (n=2,510) Long term side effects from shots 30.1% Short term side effects from shots (e.g., fever, redness, etc.) 27.8% What ingredients are in vaccines 26.0% Whether vaccine ingredients are safe 24.5% The risks of combining vaccines together into one shot 22.6% What are the side effects I should look for 21.1% Can it be delayed until they are older 21.1% Does the child really need it 20.5% Has provider vaccinated his/her own child 19.9% Is it required or optional for daycare/school 18.6% Does provider recommend it 17.3% Usually don t ask questions 16.2% How serious is the disease it prevents* 15.9% CDC National Poll of Parents 2016 (unpublished data) Trusted Vaccine Information Sources 2016 (n=2,511) 1 Doctor or other Healthcare Professional (HCP) First choice Second choice Third choice 94.9% 0% 0% 2 Family members 1.7% 41.3% 0% 3 Scientific or medical journal 0.4% 6.9% 29.6% 4 Internet 1.1% 14.9% 8.1% 5 Friends 0.7% 3.5% 14.4% 6 Books 0.1% 4.6% 3.7% 7 Media (magazines, newspapers, etc.) 0.1% 2.5% 2.5% 8 Other 0.5% 0.4% 2.7% 9 Celebrity or public figure 0.2% 0.1% 0.1% CDC National Poll of Parents 2016 (unpublished data) 9

10 Summary Most women we surveyed made decisions about childhood vaccines while they were pregnant Most parents vaccinate or intend to vaccinate their infants according to the CDC recommended schedule About 10 11% of parents intend to space out or refuse at least some vaccines Parents attitudes about childhood vaccines have remained consistently positive on a national level Parents do have questions and concerns about vaccines, but questions do not necessarily equal concerns Parents have questions regardless of their immunization plans The most common questions relate to side effects, vaccine ingredients, and vaccine safety HCPs remain parents #1 trusted source of vaccine information Talking with Parents about Vaccines for Infants Nathan E. Boonstra, MD General Pediatrician Blank Children s Hospital Des Moines, IA 10

11 Anatomy of a Vaccine Conversation Talking with Parents about Vaccines for Infants: with parents.html 1. Assume Parents Will Vaccinate Use a presumptive approach Some studies suggests that this results in higher vaccine acceptance rates Instead of saying What do you want to do about shots? say Your child needs three shots today. Instead of saying Have you thought about the shots your child needs today? say Your child needs DTaP, Hib, and Hepatitis B shots today. NOTE: This does not mean pushing or pressing parents to vaccinate 11

12 2. Give Your Strong Recommendation If parents still hesitate or express concerns, give your strong recommendation If appropriate, you can add a brief supporting statement that uses a mix of science and anecdote I strongly recommend your child get these vaccines today. these shots are very important to protect him from serious diseases I believe in vaccines so strongly that I vaccinated my own children on schedule this office has given thousands of doses of vaccines, and we have never seen a serious reaction 3. Listen To & Respond To Parents Questions Questions don t necessarily mean that parents will refuse to vaccinate Try to understand the concerns behind questions If you don t know the answer, share what you do know Acknowledge both the benefits and risks of vaccination parents want to know about side effects Document questions and concerns for future conversations 12

13 Questions about the Vaccine Schedule & Number of Vaccines Share that no evidence suggests that receiving several vaccines at one time will overwhelm a healthy child s immune system Explain what antigens are and emphasize the small amount of antigens in vaccines compared to the antigens babies encounter every day in their environment Remind parents that they must start each vaccine series on time and their child must complete each multi dose series for the best protection There s no proven danger in getting all recommended vaccines today. Any time you delay a vaccine you leave your baby vulnerable to disease. It s really best to stay on schedule. Questions about Whether Vaccines Are More Dangerous for Infants Than Diseases They Prevent Share your experience of how these serious diseases still exist and explain that outbreaks still occur in the US Teach parents that diseases eliminated in the US can infect unvaccinated babies if travelers bring the diseases from other countries Remind parents that many vaccine preventable diseases can be especially dangerous for young children, and there is no way to tell in advance if their child will get a severe or mild case I know you didn t get all these vaccines when you were a baby. Neither did I. But we were both at risk of serious diseases like Hib and pneumococcal meningitis that could lead to deafness or brain damage. Today, we re able to protect your baby from 14 serious diseases before his second birthday with vaccines. 13

14 Questions about Known Side Effects Remind parents that most side effects are mild and go away within a few days Reassure parents that you and your staff are prepared to deal with serious vaccine reactions Encourage parents to watch for possible side effects and provide information on how to treat them Share your own experience (or lack thereof) with serious vaccine side effects I ll worry if your child doesn t get vaccines today, because the diseases can be very dangerous most, including Hib, pertussis, and measles, are still infecting children in the US We can look at the Vaccine Information Statements together and talk about how rare serious vaccine side effects are. Questions about Unknown Serious Long Term Side Effects Vaccines are not linked to increases in health problems such as autism, asthma, or auto immune diseases There is no evidence to suggest that vaccines threaten a long, healthy life The risk of diseases outweighs risks posed by vaccines We have years of experience with vaccines and no reason to believe that vaccines cause long term harm. I understand your concern, but I truly believe that the risk of diseases is greater than any risks posed by vaccines. Vaccines will get your baby off to a great start for a long, healthy life. 14

15 Questions about Whether Vaccines Cause Autism Reassure parents that you understand their infant s health is their top priority, and it also is your top priority Share that the onset of autism symptoms often coincides with the timing of vaccines but is not caused by vaccines Give your personal and professional opinion that vaccines are very safe Autism is a challenge for many families and people want answers including me. But well designed and conducted studies that I can share with you show that MMR vaccine is not a cause of autism. More Questions? Infant Immunization FAQs Written for parents of children 0 2 years of age English and Spanish HTML and PDF Co branded with American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP) questions.html 15

16 What If Parents Refuse To Vaccinate? Continue the conversation during the next visit Inform parents about vaccine preventable disease symptoms Remind parents to call before bringing their ill child into the office Share CDC fact sheet: If You Choose Not to Vaccinate Your Child, Understand the Risks and Responsibilities Consider having parents sign AAP s Refusal to Vaccinate form. Wrapping Up The Conversation Remember that success comes in many forms For hesitant parents, may just need to leave door open for future conversations Work with parents to agree on one action: Scheduling another appointment Read additional information you provide them If a parent declines once, it does not mean they always will 16

17 Create Culture of Immunization in Your Practice Parents confidence is increased when they receive the same information from different people Inconsistent messages from staff may confuse parents and create mistrust A culture of immunization starts at the front desk and extends into the waiting room, into the exam room, and finally to the check out desk Everyone plays a part: Receptionists and other support staff Nurses and nurse practitioners Physicians and physician assistants Medical assistants Office manager Vaccine coordinator CDC Resources Jenny Mullen, MPH 17

18 Presentation: 10 Ways to Create a Culture of Immunization Within Our Pediatric Practice Slide Deck Content: Concrete ways that everyone in the practice can support parents vaccine decisions How to prepare your team to address common patient questions How to implement a standardized process Provider Resources for Vaccine Conversations with Parents Talking to Parents about Vaccines Understanding Vaccines and Vaccine Safety How Vaccines Work The Recommended Childhood Immunization Schedule Ensuring the Safety of US Vaccines Understanding MMR Vaccine Safety Understanding Thimerosal, Mercury, and Vaccine Safety The Advisory Committee on Immunization Practices (ACIP) Diseases and the Vaccines that Prevent Them If You Choose Not to Vaccinate, Understand the Risk, and Your Responsibilities 18

19 How To Use Provider Resources Review Talking to Parents about Vaccines and vaccine safety sheets with your staff; vaccine safety sheets may also be given to high information seeking parents with specific safety concerns Give parents fact sheets about any diseases/vaccines that they have questions about Time permitting, talk through the fact sheet together with them Share If You Choose Not to Vaccinate, Understand the Risk and Your Responsibilities with parents who are considering skipping vaccines Review it with your staff to identify talking points for vaccine hesitant parents Create a waiting room display with fact sheets and the current CDC immunization schedule CDC Medscape Expert Commentaries Vaccine Communication with Parents: Best Practices Nancy Messonnier, MD cpedt&faf=1 Overcoming Vaccine Concerns and Refusals Anne Schuchat, MD Common Questions about 9 Valent HPV Vaccine Lauri Markowitz, MD 19

20 Parent Friendly Immunization Schedules & Quiz Easy to read versions in English and Spanish: Clearly explains the diseases prevented by each vaccine to read/child.html Childhood vaccine quiz in English and Spanish: www2a.cdc.gov/vaccines/childquiz/ Materials to Share with Parents 20

21 How To Use Communication Resources Share with parents and also your peers Syndicate CDC web content on your practice website: tools.cdc.gov/syndication/learnmore.aspx Share infographics and listicles via social media channels Order posters and hang them in your waiting rooms or exam rooms Give copies of parent friendly CDC immunization schedules to parents Order or download fact sheets and make them available: Include in information packets for new patients Create a waiting room display Have copies available in exam rooms or a central location so that you can give them to parents who have specific concerns All CDC materials are available for free download; certain materials can be ordered from CDC INFO On Demand: wwwn.cdc.gov/pubs/cdcinfoondemand.aspx What If Parents Don t Trust CDC? Refer to other credible websites: American Academy of Pediatrics Healthy Children: Children s Hospital of Philadelphia Vaccine Education Center: programs/vaccine education center National Foundation for Infectious Diseases: Vaccinate Your Family: Immunization Coalitions (e.g., Immunize Nevada, Vax Maine Kids) 21

22 Opportunities for Educating Staff & Parents National observances = good time to promote immunization National Infant Immunization Week (late April) National Immunization Awareness Month (August) Questions & Answers View detailed agenda at: Early Registration Deadline: September 27, 2018 Questions and Answers Call for Poster Abstracts To Share Best Practices Submission deadline: September 10,

23 CME Credit & Evaluation The National Foundation for Infectious Diseases (NFID) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians. NFID designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit TM. To receive credit, you must complete the online evaluation and pass the post test with a score of 80% or higher Online evaluation and post test will be available following the webinar at: bit.ly/talkingwithparents 0814 Certificate will be available for print or download following successful completion of online evaluation and post test until August 14, 2019 CPE Credit & Webinar Evaluation Visit: nacds.learnercommunity.com/home Select course Talking with Parents about Vaccines for Infants under Claiming Credit Select Add to Cart Login or sign up for a LearnSomething account Select View Enrollment and course title under Activities Enter Attendance Code, complete Post Test and Evaluation, and enter NABP number and birthdate to claim credit Contact education@nacds.org with any questions ATTENDANCE CODE: PNXRCM 23

24 CONNECT WITH NFID instagram.com/nfid_vaccines/ Upcoming NFID NIAM 2018 Webinars Increasing Adolescent Vaccination Rates August 21, 2018 at 12:00 PM ET Preventing Hepatitis B Infections in US Adults August 28, 2018 at 12:00 PM ET Registration: Subscribe to NFID updates: 24