As more individuals in the community are immunized, the odds of the non-immune person being exposed to a disease decrease. This is the concept of herd immunity. In order to avoid an outbreak of a disease at least 97% of the population in any given community must be immunized. However; no one can predict who will not become immune after a vaccine. For this reason, everyone in the community should be vaccinated. In the recent past, we have had outbreaks of measles and mumps from inadequate numbers of individuals receiving vaccines.
Contents
Parental Concerns
Some of the reasons for not receiving vaccines include:
- Parental refusal
- Complex schedule
- Provider or parent apprehension about multiple shots at one visit
- Religious issues
Video for Parental Concerns About Vaccines
View the following video which addresses some of these concerns. The end of the video is an outtake that seems to repeat itself so you may wish to stop the video at that point.
Media Plays into Compliance Issues
- False belief that fetal tissue is used to produce vaccines
- Inflammatory bowel disease (MMR)
- Autism with MMR
- Rotavirus vaccine and intussusception. The original vaccine was discontinued due to an increased incidence of intussusception.
- Multiple sclerosis (Hepatitis B)
- Sudden infant death syndrome
- Guillain-Barre syndrome (influenza vaccine)
- Febrile seizures (DTP and MMR)
- DTP was implicated more often which lead to the development of an acellular vaccine DTaP.
- Immune compromised patients and oral polio vaccine. Since the live virus is shed in the stool those who were immune-compromised and also handled the affected stool developed vaccine related polio.
- This led to the development of IPV (an inactive form of the polio vaccine).
Provider/Situational Issues Affecting Compliance
- Causes of missed opportunities
- Invalid precautions (runny nose, low-grade fever)
- Invalid contraindications (allergy to nonvaccine substance)
- Supposed adverse event from the previous dose that was not documented
How can we help Parents who are vaccine-hesitant?
- Listen to/question reasons for refusal/delay
- Be familiar with controversies/misconceptions
- Infant/child system not overwhelmed by multiple vaccines
- Emphasize risks/benefits of vaccines
- Provide Vaccine Information Statement (VIS)
- Document discussion about refusal/flag records of unimmunized children
Provider Resources for Compliance Issues
- Center for Disease Control & Prevention Advisory Committee on Immunization Practices
- NAPNAP Position Statement on Immunizations (2014): Everyone needs to be immunized according to the CDC recommendation.
- Educational materials “Pre-teens Need Vaccines, too“
- American Academy of Family Physicians
- American Academy of Pediatrics Immunization
- Child Vaccination Rates Across America
- Immunization Action Coalition
