Omer SB, Salmon DA, Orenstein WA, deHart MP, & Halsey N. (2009). Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. The New England Journal Of Medicine, 360(19), 1981-8. doi:10.1056/NEJMsa0806477
The article, “Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases” focuses on school immunization requirements, immunization refusal trends, the risk of refusing vaccines for the individual and their community, reasons why parents refuse vaccines, and the role of health care providers to inform their patients about vaccines. A common theme of this article is the importance of herd immunity, specifically through the immunization of school-aged children. Each state possesses their own standards of immunizations for school entry; although, the Supreme Court has supported the states’ power to implement the requirements since 1922. This article provides many statistics regarding the increased likelihood of contracting vaccine-preventable diseases for children who do not follow the recommended vaccination schedule according to the Advisory Committee on Immunization Practices and the American Academy of Pediatrics. 69% of parents who refuse vaccines for their children are concerned with the vaccine causing harm for their child. Parents refer to healthcare providers as the most often used source of information for vaccinations. It is important for providers to present both the risks and benefits of vaccines and remain up-to-date with this topic. This article stresses the fact that vaccine refusal increases the individual risk of disease and increases the risk for the whole community. “If the enormous benefits to society from vaccination are to be maintained, increased efforts will be needed to educate the public about those benefits and to increase public confidence in the systems we use to monitor and ensure vaccine safety” (Omer et al, 2009). I plan to use this article in discussion regarding the reasons parents choose not to vaccinate their children, the reasons why it is important to consider the individual and community health, and recommendations for health care providers in helping families decide to vaccinate or not.
Luthy KE, Beckstrand RL, Callister LC, & Cahoon S. (2012). Reasons parents exempt children from receiving immunizations. The Journal Of School Nursing : The Official Publication Of The National Association Of School Nurses, 28(2), 153-60. doi:10.1177/1059840511426578
This research article focuses on the reasons why parents choose to be noncompliant with vaccination recommendations, as well as how healthcare providers may help parents decide to vaccinate or not. This study collected information from 287 parents who responded to an open-ended question about why they exempted their children from vaccinations. There were five reasons, which appeared most frequently: parental perceptions, health care system issues, chronic disease concerns, immune system concerns, adverse reaction concerns, and other reasons. The author stresses the important roles health care providers play in helping parents make fact-based decisions instead of focusing on misconceptions. For example, a well-known study arguing there is a correlation between MMR (measles, mumps, rubella) vaccine and autism was proven inaccurate, but still influences parental decisions. It is important for healthcare providers to educate parents about the ability of the immune system to respond to multiple vaccines at the same time. Parents also need to understand their risky decision in abstaining from vaccinations during infancy because of their infants’ high susceptibility to disease. I plan to use this article in providing recommendations for providers of how to educate parents about the risk of not vaccinating their children, as well as informing providers of the reasons why parents make a decision to avoid vaccinations. This knowledge will help providers to better communicate with their patients/clients and families.
Freed, G. L., Clark, S. J., Butchart, A. T., Singer, D. C., & Davis, M. M. (2010). Parental vaccine safety concerns in 2009. Pediatrics, 125(4), 654-659.
The article titled “Parental Vaccine Safety Concerns in 2009” was developed to determine the prevalence of parental vaccine refusal and vaccine concerns. The study shows that a large majority of parents still vaccinate their children; although in 2009, 11.5% of parents refused to vaccinate. It is important to consider the reasons why people choose to not vaccinate and the affects of that decision. By decreasing immunization, an individual chooses to also reduce their protection from vaccine-preventable diseases. Not only does that individual suffer from an increased likelihood of disease, but public health is also put at risk. Risk of outbreaks increase as more people decide to abstain from immunization. In the study, 25% of parents reported that a reason they chose to not vaccinate is because some vaccines cause autism in healthy children, despite the fact that multiple expert committees have failed to show association between vaccinations and autism. The authors strongly recommend for education programs for parents because information is not reaching parents in a convincing manner. They recommend a redesign of vaccine information programs to focus on safety concerns and targeted for specific groups of parents. I plan to incorporate this article in my consideration of noncompliance by parents. With this information, I will better formulate a solution for making known the misconceptions about vaccinations.
Humiston, S. G., Albertin, C., Schaffer, S., Rand, C., Shone, L. P., Stokley, S., & Szilagyi, P. G. (2009). Health care provider attitudes and practices regarding adolescent immunizations: a qualitative study. Patient education and counseling, 75(1), 121-127.
The authors of “Health care provider attitudes and practices regarding adolescent immunizations: a qualitative study” identify three themes explaining factors that impede or facilitate vaccination based on their telephone interviews with physicians and nurses. These three themes include (1) health care profession “buy-in” factors, (2) parent/patient “buy-in” factors as projected by the participants, and (3) delivery factors. Health care professional buy-in factors include organizational recommendations, financial considerations, and vaccine and disease characteristics. The parent/patient buy-in factors include things such as school requirements, physician recommendations, finances, media, perceived disease risk, and vaccine characteristics. Lastly, the delivery factors include supply, timing/scheduling, verifying vaccination, and optimization of office visits. This article recommends that primary care practitioners become aware of their professional organization’s recommendations of adolescent vaccinations and relay the information at their office meetings, where practices come meet consensus on their policies. I will use this information to further understand why people choose not to vaccinate and why some physicians may or may not take time to discuss the importance of vaccination with their patients.
Hendrix KS, Sturm LA, Zimet GD, & Meslin EM. (2016). Ethics and Childhood Vaccination Policy in the United States. American Journal Of Public Health, 106(2), 273-8. doi:10.2105/AJPH.2015.302952
This article recognizes the need for better communication with vaccine-hesitant and vaccine-opposing families. It describes three communication approaches for discussing vaccinations with families including the (1) presumptive approach– when the physician assumes the family will agree to the recommended vaccination,- (2) “participatory approach- when a physician makes no assumptions and considers the family’s input on vaccination,- and (3) the guiding approach- when the physician addresses the family’s specific concerns and helps them to decide to vaccinate in the end. Another way to educate families on vaccinations is the informed opt-out process, which parents are given information about what it’s like to watch their child suffer from a vaccine-preventable illness. Lastly, the article discusses the importance to balance respect of the parental rights and maximizing the greater good of herd immunity. I plan to use this article by incorporate its unique ways of presenting vaccination options to parents within my recommendations to providers and a solution to the lack of education on this issue.
Hornig M, Briese T, Buie T, Bauman ML, Lauwers G, Siemetzki U, … Lipkin WI. (2008). Lack of association between measles virus vaccine and autism with enteropathy: a case-control study. PloS One, 3(9), E3140. doi:10.1371/journal.pone.0003140
This article examines the case-control study determining if autism and/or GI disturbances in children are related to the their MMR vaccines. The study reports they found the age of exposure to MMR relative to onset of GI problems and autism inconsistent. It claims there is no causal role for the MMR vaccine as a trigger of autism or GI disturbances in the children studied. “The work reported here eliminates the remaining support for the hypothesis that ASD with GI complaints is related to MMR exposure.” They continue to state there is no relationship between the timing of MMR and the onset of GI complaints or autism. Not only is there no relationship in the timing of MMR exposure, but there is also strong evidence against the association of autism with MMR exposure. I plan to use this specific study and information as evidence to give providers and parents who question the relationship between the MMR vaccine and autism.
DeStefano F, Price CS, & Weintraub ES. (2013). Increasing exposure to antibody-stimulating proteins and polysaccharides in vaccines is not associated with risk of autism. The Journal Of Pediatrics, 163(2), 561-7. doi:10.1016/j.jpeds.2013.02.001
The objective of the study, “Increasing Exposure to Antibody-Stimulating Proteins and Polysaccharides in Vaccines Is Not Associated with Risk of Autism,” was to evaluate the relationship between autism and the level of immunologic stimulation given within the first two years of life. The article begins by explaining a previous study completed in 2004, which provides evidence that favors rejection of possible causal associations between vaccines and autism. It continues by stating reasons parents have become weary of vaccinations for their children according to a recent survey. These concerns include: (1) a possible link between vaccines and learning disabilities, (2) administration of too many vaccines within the first two years of life, and (3) administration of too many vaccinations within one trip to the doctor’s office. The study evaluated the association of immunologic stimulation levels within the ages of birth to two years and the risk of autism, by using the number of antibody-stimulating proteins and polysaccharides contained in vaccines. With this method, the study found no evidence of association between exposure to antibody-stimulating proteins and polysaccharides contained in immunizations given within the first two years of life and autism. The study did find there was a substantial decrease in antigenic load from vaccines with the removal of whole-cell pertussis vaccine from the childhood vaccination schedule. Although the 2012 routine childhood schedule has more vaccines on the schedule than in the 1990s, the largest number of antigens a child could be exposed to within the first two years of life was still on 315 in 2012. In the 1990s the antigens a child could be exposed to by age 2 years was several thousand. This means children are exposure to more vaccine antigen today and the results found provide relevant data for the current immunization schedule. In conclusion of this article, the researchers describe that an infant could be exposed to thousands of vaccines at once in theory. They continue to state there is no evidence to support a relationship between the development of autism and the immunologic stimulation from vaccines within the first two years of life. I plan to use this as another source for providers and clients proving there is no evidence supporting a causal relationship between vaccines and learning disabilities.
Laskowski, M. (2016). Nudging Towards Vaccination: A Behavioral Law and Economics Approach to Childhood Immunization Policy. Texas Law Review, 94(3).
This article focuses on the ways US policies should change in order to protect citizens from vaccine-preventable diseases specifically through herd immunity. It begins by discussing the invalidity found in the 1998 Andrew Wakefield study, which claimed there to be a connection between the MMR vaccine and autism. The study was discredited after it was made known that Wakefield had received around a half million British pounds from a lawyer who was preparing a class action again a producer of MMR vaccine and there were plans to start a company to sell diagnostic tests. Unfortunately, the effects of this study still linger in the concerns of parents regarding vaccinations. Herd Immunity is found to be especially important for vulnerable people, including newborns and individuals with weak immune systems, because these people depend on the immunity of the people around them to protect them from disease. The percentage of people required to obtain herd immunity is different for each vaccine; although, for measles approximately 95% of the community needs to be vaccinated. With national averages falling due to the growing anti-vaccination movement, doctors and state legislators are seeking to find better ways to increase child immunization rates to levels, which achieve herd immunity. The author of this article suggests various ways to increase child immunization rates. She suggests that biases are a result of parents underestimating the benefits and underestimating the potential harm of immunizations. First, the author recommends that childhood immunization is an area that may benefit from regulation that confronts the biases parents’ hold by nudging them to vaccinate their child. The author recommends taking a “Libertarian Paternalistic Approach,” to eliminating personal-belief exemptions. She believes we should do this by “setting defaults, increasing opt-out transaction costs, and framing information to combat, as well as capitalize on, biases.” I plan to use the information about the inaccurate Wakefield study to help parents to understand the lack of a relationship between learning disabilities and the MMR vaccine. I will also use the recommendations to reach herd immunity within the United States as a solution for the problem of a decreased level of childhood immunization rates.
Bradford, W. D., & Mandich, A. (2015). Some State Vaccination Laws Contribute To Greater Exemption Rates And Disease Outbreaks In The United States. Health Affairs, 34(8).
The objective of this article was to highlight the relationship between vaccination policies and state-level vaccination exemption nrates, to help policy makers and health providers in finding interventions to decrease a number of exemptions given, and to reduce the number of preventable diseases. The study found that not all state laws relating to vaccination exemptions have affected the public in the same way. It was found that when the state department of health approval for nonmedical exemptions requires a physician signature of an exemption application and there are criminal or civil punishments for noncompliance with immunization requirements, there is a reduction in exemption rates. The study suggests there is a link found between the exemption law effectiveness and the incidence of preventable disease. States with more effective policies had lower incidences of pertussis, for example. California, Mississippi, and Virginia are the only three states that require medical reasons to approve an exemption. The study concludes by recommending more states adopt stricter exemption standards because of herd immunity being at risk.
Klein, N. P., Fireman, B., Yih, W. K., Lewis, E., Kulldorff, M., Ray, P., … & Belongia, E. A. (2010). Measles-mumps-rubella-varicella combination vaccine and the risk of febrile seizures. Pediatrics, 126(1), e1-e8.
The objective of this study was to reevaluate the risk of seizures after the MMR and MRRV vaccine. The study used data from 2000-2008 of children with seizures and fever and within 12-23 months of age after the MMRV and separate MMR + varicella vaccines. The study found there is an increased risk of seizure during days seven to ten after the MMRV than after the MMR + varicella vaccination. The risk of having a febrile seizure after the MMRV vaccine increased an additional 1 febrile seizure for every 2,300 doses, as opposed to having the vaccines given separately. The study recommends that healthcare providers, who suggest the MMRV vaccine, to inform their patients of the increased risk of seizures and fever. I plan to use this study to inform providers of the difference in risks of the two different vaccinations. I hope providers find this information helpful and will use it, when deciding how to best vaccinate children. I will also use this study as documentation as a reason for concern of parents regarding vaccination.