2019-20 TOW #7: Immunizations

A huge thanks to our amazing immunization experts Drs. Doug Opel and Annika Hofstetter for developing materials for next weeks’ TOW on immunizations. This is a timely topic given the measles outbreaks and back-to-school visits, and the relatively lower immunization rates for WA state compared to national rates. Hopefully, thanks to our colleagues here, we will continue to make inroads to protect our children.

Teaching materials for immunizations:

Take-home points:

  1. Why are issues around immunizations so important to know well as pediatricians? Immunizations are arguably the biggest success story of public health in the 20th century and the most important component of the recommended well child visit schedule. While vaccine safety has been extensively studied, no vaccine is 100% safe or 100% effective. This has contributed to the controversies around vaccines. Yet, we know vaccines are overwhelmingly effective to decrease morbidity and mortality from vaccine-preventable diseases.
  2. How many parents are vaccine hesitant? While only about 1% of parents are anti-vaccine (choosing no vaccines), about 1/3 are considered vaccine hesitant, and the vast majority (about 2/3) are vaccine accepters. Vaccine-hesitant parents are the ones where we may have the most influence to change their approach/decision.
  3. How is it best to bring up the topic of vaccines in clinic? As Doug Opel and team identified in a study in Pediatrics (see above), choosing a “presumptive stance” (i.e., “today your child is due for these vaccines”) rather than a more collaborative approach (e.g. “what vaccines did you want to give today?”) was associated with more likelihood of vaccines being accepted by parents. It’s always important to use good general communication skills including being open to questions, honest, respectful of parents, and not coming across as offended or defensive. The CHOP vaccine app has helpful info for parents as well.
  4. Why have vaccines developed such a negative reputation? Partly it’s because there are many more of them and that’s been worrisome to some parents. But mostly it’s been related to vaccines, especially MMR, being wrongly associated with causing autism. The study that first suggested this association was published in the Lancet and was eventually retracted as people recognized the poor study design and even falsified data. The lead author had his medical license revoked. Unfortunately, the repercussions of this unethical study were incredibly detrimental, and we are still dealing with them.
  5. What are the most controversial ingredients in vaccines? Those that have specifically raised concerns are thimerosol (a preservative that was taken out of most vaccines despite lack of evidence that it could cause neurological problems), aluminum (an adjuvant that helps vaccines work better – concentrations are less than what a baby ingests in breastmilk by age 6 months), animal-derived gelatin (used as a stabilizer in some vaccines – objectionable to some people in Muslim faith though there have been statements from imams that they can be given) and aborted fetal material (used as cell strains to grow MMR, varicella – of special concern to devout Christians or Catholics – the Vatican has said parents could accept these vaccines).

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