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Vaccine Refusal: A Growing Problem

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The Polio Crusade- What Can We Learn From History? ... Major reductions of all other vaccine ... Internet and the Media. Jenny McCarthy- Generation Rescue ... – PowerPoint PPT presentation

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Title: Vaccine Refusal: A Growing Problem


1
Vaccine Refusal A Growing Problem
  • Adele Young RN, PNP-BC, PhD
  • Maggie Venzke RN, FNP-BC, MSN

2
The Polio Crusade- What Can We Learn From History?
  • http//www.pbs.org/wgbh/americanexperience/polio/

3
Vaccination a Public Health Success
  • Smallpox vanquished
  • Polio limited
  • Major reductions of all other vaccine preventable
    diseases.
  • So what is the problem?

4
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6
Approximation of Recommended Childhood
Immunization Schedule 1985
7
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9
Rates of Refusal
  • One study found a rate of 7.2 children per 1000
    vaccinated
  • 84 of a sample of Family and Pediatric
    Physicians reported a partial refusal and 54
    reported one or more total refusals in the last
    year.
  • School exemptions have increased steadily

10
Reasons for Refusal
  • Erroneous beliefs about contraindications
  • Perceived dangers of vaccination
  • Preference in making errors of omission vs.
    commission

11
Reasons Continued
  • Natural Risk vs. Manmade risk
  • Disagree with western or conventional medicine
  • Infringement of rights

12
Reasons cont.
  • Overloading the immune system
  • Moral objections over how the vaccines are made.
    Use of fetal tissue.
  • Lack of knowledge of the diseases that the
    immunization is targeted for. Underestimation of
    the risks of the disease.

13
Vaccines most often refused
  • Varicella (not seen as serious)
  • Dtap
  • Hepatitis B (why in children)
  • One study showed MMR to be the fifth most likely
    to be refused despite all the controversy

14
Who is most likely to refuse
  • White ( 9.8 vs. 2.8 Black and 1.5 Hispanic)
  • Better educated
  • Higher economic status
  • Willing and able to breast feed into toddler age
    group
  • Willing and able to keep child out of day care
    and home school

15
Role of school exemptions
  • All states allow medical exemptions
  • 48 states allow religious exemptions
  • 19 states allow philosophical
  • Some states make it easier. In Maryland a simple
    signature on the school physical form is all that
    is required. In fact it is easier to get an
    exemption then it is to fill in the vaccine
    record. California also is easy

16
Results of school exceptions
  • States that allow easy exemptions have a 50
    higher rate of pertussis
  • Also more likely to have measles out break

17
Vaccination Refusal Rates in Kindergarten
Students 2006-2007
18
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19
Alternative Schedule
20
Dr. Bob Selective Vaccination Schedule
  • 2 months DTaP, Rotavirus
  • 3 months Pc, Hib
  • 4 months DTap, Rotavirus
  • 5 months Pc, HIB
  • 6 months DTaP, Rotavirus
  • 7 months Pc, HIB
  • 15 months Pc, HIB
  • 5 years tetanus booster
  • 10 years titers for MMRV, Hep A
  • 11 years 3 doses HPV for girls
  • 12 years Hep B 3 doses

21
Dr. Bobs Alternative Schedule
  • 2 months DTaP, Rotavirus
  • 3 months Pc, Hib
  • 4 months DTap, Rotavirus
  • 5 months Pc, HIB
  • 6 months DTaP, Rotavirus
  • 7 months Pc, HIB
  • 9 months Polio, Flu
  • 11 months Flu
  • 12 months Mumps, Polio
  • 15 months Pc, HIB
  • 18 months Dtap, Varicella
  • 21 months Flu
  • 2 years Rubella, Polio
  • 2 ½ years Hep B, Hep A
  • 3 years Hep B, Measles, Flu
  • 4 years DTaP, Polio, Flu
  • 5 years MMR, Flu
  • 6 years Varicella
  • 12 years Tdap, HPV
  • 12y 2 mo. HPV
  • 13 years HPV, Meningococcal

The Vaccine Book- Making the Right Decision for
your Child by Robert W. Sears, M.D.,F.A.A.P
22
Dr. Sears and the Alternate Schedule
  • Pros According to Dr. Bob
  • 1 aluminum containing vaccine
  • No more than two at a time spreading out
  • Chemical exposure
  • Potential side effects
  • Starts out with most important vaccines and
    delays those with less risk because they are
    milder or not around.
  • Allows parents who would not vaccinate an
    alternative that would protect the child

23
Cons Not Considered by Dr. Bob
  • By offering this schedule implies that parents
    concerns over autism, chemicals, weakening the
    immune system are real and have valid scientific
    support.
  • Requires 7 additional office visits which will
    probably lead to less compliance, increased cost
    to the parents, further delay in vaccination, and
    increased stress on practices for tracking and
    administering vaccines.
  • Delays immunization for Polio, Varicella, Hep B,
    Hep A, Rubella, and especially measles leaving
    infants at risk for extended periods of time.
    (measles would be another two years).
  • Safety of the children in his groups depends on
    the current level of herd immunity, which in turn
    depends on most children following the
    recommended schedule.
  • For a more in depth discussion see Offit,P.,
    Moser,C. (2009). The problem with Dr. Bobs
    alternative vaccine schedule. Pediatrics.
    123e164-169.
  • http//pediatrics.aappublications.org/cgi/content/
    full/123/1/e164

24
Themes from the Anti-vaccine Groups
  • Vaccines are ineffective and harm the immune
    system
  • Vaccine adverse effects are under reported
  • Vaccine preventable diseases are not that serious
  • Vaccine supporters are all profit driven
  • Mandatory vaccination is a violation of civil
    rights
  • Vaccines are immoral
  • Diseases have declined homeopathic alternative

25
Where do they get information
  • Preference is for internet and alternative
    medicine sources

26
Anti-vaccine Web sites
  • Shootem up thedocumentary.com
  • Thinktwice Global Vaccine Insitute
  • Generation Rescue
  • Mothers Against Mercury
  • Nature News.com

27
KNOW THE FACTSFACT Autism began by affecting 1
in 10,000 it now affects 1 in 166 - a direct
correlation to the rise in vaccines added to the
schedule. (most of which contained mercury)
www.Shootemupthedocumentary.com
28
Internet and the Media
  • Jenny McCarthy- Generation Rescue
  • Campbell Brown CNN on Vaccines
  • http//www.generationrescue.org/green-our-vaccines
    .html
  • http//www.youtube.com/watch?vqoi6QmcU9IM

29
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31
Paul Offit, author of Autism's False Prophets
  • http//www.youtube.com/watch?vMTr-HLz7dPc

32
What Strategies Can Be Used to Limit Refusal and
Delay
33
In Your Practice
  • Put up posters clearly supporting vaccination
    including pictures of children with the disease
  • Provide visual aids that indicate where these
    diseases still occur emphasizing that they are
    only a plan ride away.
  • Provide information on any current outbreak in
    the USA.
  • Making the choice not to vaccinate not be
    passive. Have parent sign a form out lining the
    consequences of choosing not to vaccinate.

34
In Your Practice Cont.
  • Respectfully listen and provide information.
  • Show your personal support by indicating that you
    vaccinated your own children
  • Use combination vaccines and comfort measures
  • Point out that vaccination is a public health
    issue and choosing not to vaccinate puts other
    children at risk.

35
In your practice continued
  • Dismissing the refusing family from the practice
  • A recent study showed that 39 of physicians
    would ask refusing families to seek health care
    else where due to
  • Lack of shared goals
  • Lack of trust
  • Fear of litigation

36
Broader Strategies
  • Vaccine media campaigns
  • Reduce exemptions and make more difficult to
    obtain
  • Mandatory education for refusing families

37
DO THE S.W.O.T.
38
What is the immunization Issue for Adults?
  • Vaccine refusal is not the major issue for adults
  • It often that the provider did not address the
    need!

39
Strategies to Improve Adult Immunization Rates
Short Term
  • Effective Evidence-Based Strategies
  • Reminders
  • Provider and Patient
  • Education
  • Staff, Provider and Patient
  • Offer alternative sites for vaccine
    administration

NFID. A Call To Action Improving Influenza And
Pneumococcal Immunization Rates Among High-risk
Adults
40
Strategies to Improve Adult Immunization Rates-
Long Term
  • Effective Evidence-Based Strategies
  • Organizational change
  • Standing orders, standardized procedures,
    preprinted orders
  • Expanded access to vaccinations
  • Financial incentives
  • Provider and Patient, including reducing
    out-of-pocket costs
  • Assessment and feedback

41
Key Messages The Problem
  • Adult vaccination rates fall far below Healthy
    People 2010 leaving thousands of adults at risk
    for vaccine preventable diseases.
  • Many barriers contribute to low immunization
    rates.
  • Many adults are not aware of their need to
    receive immunizations as a preventive care
    measure.

42
Vaccine Refusal is Dangerous
  • Recent out breaks of measles, mumps, haemophilus
    influenza and pertussis both here and abroad has
    emphasized the seriousness of the current trend
    toward vaccine refusal.

43
Anti-vaccine Web sites
  • Shootem up thedocumentary.com
  • Thinktwice Global Vaccine Insitute
  • Generation Rescue
  • Mothers Against Mercury
  • Nature News.com

44
Websites for Providers
  • Immunization Action Coalition
  • http//www.immunize.org/
  • California Distance Learning Health Network
  • http//www.cdlhn.com/default.htm
  • American Academy of Pediatrics
  • http//www.aap.org
  • Pkids ,Project Immunize Virginia, CDC

45
References
  • Consultant for Pediatricians Supplement Issue
  • Oct. 2006 (vol 5 10) and Sept. 2008 (vol 7, 9)
  • Clarkson-Keller, V., Siktberg ,L.,
    Hodson-Carlton,K.,(2008). Overcoming obstacles
    to vaccination. American nurse today. 23-29.
  • Diekema, D. (2005). Responding to parental
    refusals of immunization of children.
    Pediatrics. 115(5)1428-1431.
  • Offit,P., Moser,C.,(2009) The problem with Dr.
    Bobs alternative schedule. Pediatrics. 123
    e164-e169
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