Talking with Talking with Parents Parents

& Immunization & Immunization ResourcesResources

AgendaAgenda

Parental ConcernsParental Concerns Communication StrategiesCommunication Strategies Immunization ResourcesImmunization Resources

ObjectivesObjectives

Describe concerns parents have Describe concerns parents have regarding childhood vaccinations regarding childhood vaccinations

Identify science-based Identify science-based communication approaches to help communication approaches to help address parental concernsaddress parental concerns

Understanding and Understanding and Addressing Parental Addressing Parental

ConcernsConcerns

Common Parental Common Parental ConcernsConcerns

Too Many VaccinesToo Many Vaccines Is Natural Immunity Is Natural Immunity

BetterBetterDo We Still Need to Do We Still Need to

Vaccinate?Vaccinate?Are Vaccines Safe?Are Vaccines Safe?

How do you respond?How do you respond?

Have you heard…Have you heard…

““Five vaccines seems like a lot Five vaccines seems like a lot for such a young baby...” for such a young baby...”

oror

““Won’t this overwhelm his/her Won’t this overwhelm his/her immune system?”immune system?”

Too Many Vaccines?Too Many Vaccines?

In a national survey of parents:In a national survey of parents: 23% questioned the number of shots 23% questioned the number of shots

given to childrengiven to children 25% were convinced vaccines weaken 25% were convinced vaccines weaken

the immune systemthe immune system

Key PointsKey Points Children are exposed to thousands of Children are exposed to thousands of

different antigens (bacteria, dust, etc.) different antigens (bacteria, dust, etc.) daily daily Vaccines are just a small part of what a Vaccines are just a small part of what a

child’s immune system faceschild’s immune system faces Children able to generate protective Children able to generate protective

immune responses to multiple vaccines at immune responses to multiple vaccines at onceonce

Vaccinated children get fewer infections Vaccinated children get fewer infections (both vaccine-preventable and unrelated)(both vaccine-preventable and unrelated)

What Can You Say?What Can You Say? Concerns about immune system being Concerns about immune system being

overwhelmed:overwhelmed: Immune system not weakened/overwhelmed Immune system not weakened/overwhelmed

by multiple shots by multiple shots Explain what happens when immune system Explain what happens when immune system

is weakened is weakened Immune system deals with hundreds of Immune system deals with hundreds of

viruses and bacteria during everyday viruses and bacteria during everyday activities activities

Babies immune systems can handle multiple Babies immune systems can handle multiple shots better than fighting off serious diseasesshots better than fighting off serious diseases

Alternative and Alternative and Delayed SchedulesDelayed Schedules

Regular childhood schedule is well Regular childhood schedule is well tested tested

Schedules designed to delay vaccine Schedules designed to delay vaccine administration incur risks: administration incur risks: Susceptible to disease for a longer time periodSusceptible to disease for a longer time period No evidence for benefit; unknown effect on efficacyNo evidence for benefit; unknown effect on efficacy Increased opportunities for known side effectsIncreased opportunities for known side effects Some single-ingredient vaccines not availableSome single-ingredient vaccines not available Extra visits = extra time and costExtra visits = extra time and cost

Wanting to use an alternative Wanting to use an alternative schedule:schedule: No benefitNo benefit Vaccines are given as early as possible Vaccines are given as early as possible

because babies are most susceptible to because babies are most susceptible to harm from disease.harm from disease.

A choice not to get a vaccine is not a A choice not to get a vaccine is not a risk-free choice. It's just a choice to risk-free choice. It's just a choice to take a different risk. take a different risk.

What Can You Say?What Can You Say?

Resources Resources

How do you respond?How do you respond?

Have you heard…Have you heard…

““I’d rather my child develop natural I’d rather my child develop natural immunity. Isn’t it better?” immunity. Isn’t it better?”

Isn’t Natural Immunity Isn’t Natural Immunity Better?Better?

YES...YES... Immunity after disease follows a Immunity after disease follows a

single infection; vaccine immunity single infection; vaccine immunity may require several doses, and/or may require several doses, and/or boostersboosters

Isn’t Natural Immunity Isn’t Natural Immunity Better?Better?

……and NOand NO The cost is pain, discomfort and the The cost is pain, discomfort and the

potential for complications, disability, potential for complications, disability, deathdeath

Vaccines are one of the safest most Vaccines are one of the safest most effective disease prevention tools effective disease prevention tools knownknown

What Can You Say?What Can You Say?

Why take the risk?Why take the risk? Vaccines can safely and easily offer Vaccines can safely and easily offer

you the same level of immunity that you the same level of immunity that you would get from natural infection you would get from natural infection but without the riskbut without the risk

When children are exposed to the When children are exposed to the disease, they are at risk for serious disease, they are at risk for serious complications complications

Vaccine immunity is natural immunity Vaccine immunity is natural immunity

ResourcesResources

How do you respond?How do you respond?

Have you heard… Have you heard…

““I don’t see the point. I had I don’t see the point. I had chickenpox when I was chickenpox when I was little... and polio doesn’t little... and polio doesn’t even exist any more.” even exist any more.”

No Benefit…?No Benefit…? Vaccines are a victim of their own Vaccines are a victim of their own

success!success! Never seen, rarely hear aboutNever seen, rarely hear about

If we give a bunch of children vaccines, If we give a bunch of children vaccines, and no one catches anything, where’s the and no one catches anything, where’s the news in that?news in that?

Perception that: Perception that: Risk Risk ofof disease is low disease is low Risk Risk fromfrom disease is low disease is low

Unprotected People in Unprotected People in NCNC

Cases of vaccine-preventable Cases of vaccine-preventable diseases are seen across the diseases are seen across the U.S., but also here in North U.S., but also here in North CarolinaCarolina Measles in 2006Measles in 2006 Mumps in 2010Mumps in 2010 Pertussis (every year)Pertussis (every year)

Probable & Confirmed Pertussis Cases 1/01/2010 - 6/30/2010

What Can You Say?What Can You Say?

Vaccination keeps disease awayVaccination keeps disease away When we stop vaccinating, disease When we stop vaccinating, disease

returnsreturns While some diseases are not While some diseases are not

common in the U.S., they are only a common in the U.S., they are only a plane ride awayplane ride away

Share experiences you’ve had with Share experiences you’ve had with these diseasesthese diseases

ResourcesResources

How do you respond?How do you respond?

Have you heard…Have you heard…

““I’m just not sure vaccines are safe.”I’m just not sure vaccines are safe.”

OrOr

““Don’t vaccines cause autism?”Don’t vaccines cause autism?”

OrOr

““Are the additives in vaccines safe?”Are the additives in vaccines safe?”

Are Vaccines Safe?Are Vaccines Safe?

No vaccine (and no medication) is No vaccine (and no medication) is completely risk freecompletely risk free common mild side effects: pain, tenderness, common mild side effects: pain, tenderness,

rednessredness rare, serious side effects: anaphylaxisrare, serious side effects: anaphylaxis

Because vaccines are given to healthy Because vaccines are given to healthy children, they must be as safe as children, they must be as safe as possible possible

Benefit clearly outweighs riskBenefit clearly outweighs risk

What Can You Say?What Can You Say?

Are vaccines safe?Are vaccines safe? Vaccines are safer than the diseases Vaccines are safer than the diseases

they prevent (risk/benefit)they prevent (risk/benefit) Share most common reaction/side Share most common reaction/side

effects you’ve seen following vaccineeffects you’ve seen following vaccine Teach them what a normal reaction Teach them what a normal reaction

looks like/what to expectlooks like/what to expect

Vaccines and AutismVaccines and Autism Why is this a concern?Why is this a concern?

Autism rates increasing around the worldAutism rates increasing around the world Children start showing autistic symptoms Children start showing autistic symptoms

around same time they get immunizations. around same time they get immunizations. BUT:BUT:

Evidence of autism actually present before Evidence of autism actually present before vaccines givenvaccines given

Multiple independent studies have shown no Multiple independent studies have shown no link between autism and vaccineslink between autism and vaccines

The one study that suggested a connection The one study that suggested a connection was retracted and discreditedwas retracted and discredited

Thimerosal (common preservative) was Thimerosal (common preservative) was removed from all routine child vaccines in removed from all routine child vaccines in 20012001

What Can You Say?What Can You Say? Do vaccines cause autism?Do vaccines cause autism?

No. No one knows causes of autismNo. No one knows causes of autism Genetics may play a role. Genetics may play a role.

Taking parental concerns seriously – Taking parental concerns seriously – scientists thoroughly studied vaccines & scientists thoroughly studied vaccines & autism and found vaccines did not increase autism and found vaccines did not increase risk of autismrisk of autism

Autism rates same in vaccinated and Autism rates same in vaccinated and unvaccinated childrenunvaccinated children

If don’t vaccinate – not reducing risk of If don’t vaccinate – not reducing risk of autism, but are increasing the risk of autism, but are increasing the risk of contracting disease contracting disease

Adjuvants: AluminumAdjuvants: Aluminum

Adjuvants enhance the immune Adjuvants enhance the immune responseresponse

Aluminum salts only adjuvant in USAluminum salts only adjuvant in US Aluminum is everywhere in the Aluminum is everywhere in the

environment: a major component of the environment: a major component of the earth’s crust, and found in air, food, earth’s crust, and found in air, food, and water. and water. Breastmilk and formula contain aluminumBreastmilk and formula contain aluminum

Safety well establishedSafety well established

What Can You Say?What Can You Say? What about other ingredients in What about other ingredients in

vaccines?vaccines? Vaccines manufactured under the Vaccines manufactured under the

strictest of standards, including all strictest of standards, including all ingredients ingredients

Aluminum is naturally occurring Aluminum is naturally occurring element found in many foods element found in many foods including fruits and vegetablesincluding fruits and vegetables Helps trigger body’s immune responseHelps trigger body’s immune response Tiny amounts used in vaccines are very Tiny amounts used in vaccines are very

safesafe

ResourcesResources

http://www.chop.edu/

Communicating with Communicating with ParentsParents

Take time to listenTake time to listen Validate their concernsValidate their concerns Use a “heart and head” approachUse a “heart and head” approach Balance risks and benefitsBalance risks and benefits Be flexibleBe flexible Direct them to reliable resourcesDirect them to reliable resources

Responding to Parent Responding to Parent RefusalsRefusals

Give some vaccines if you canGive some vaccines if you can Revisit the immunization discussion at Revisit the immunization discussion at

subsequent visitssubsequent visits Good documentation of discussion of Good documentation of discussion of

benefits of vaccine and risks of being benefits of vaccine and risks of being unimmunizedunimmunized

Sign a refusal waiverSign a refusal waiver

Diekema, Committee on Bioethics et al, Pediatrics 2005

Be a Role Model and Ask Be a Role Model and Ask More of PeopleMore of People

May want to mention that you are up-May want to mention that you are up-to-date on your vaccines…to-date on your vaccines…

May want to mention that your May want to mention that your children, grandchildren, nieces, children, grandchildren, nieces, nephews, etc. are vaccinatednephews, etc. are vaccinated

Ask people to help you provide a Ask people to help you provide a community where children are safer community where children are safer from diseasesfrom diseases

Healthcare Providers Can Healthcare Providers Can Make a DifferenceMake a Difference

Can have a positive influence on Can have a positive influence on parents decision to vaccinate their parents decision to vaccinate their children children Including parents who believe that Including parents who believe that

vaccinations are unsafe. vaccinations are unsafe. Work to increase your efforts to build Work to increase your efforts to build

honest and respectful relationships honest and respectful relationships with parentswith parents Their child’s health is your priority, too! Their child’s health is your priority, too!

Smith PJ et al, Pediatrics 2006

SummarySummary Many parents have questions or concerns about Many parents have questions or concerns about

childhood vaccineschildhood vaccines When parents are concerned about vaccines, we When parents are concerned about vaccines, we

must find out why and address their concerns must find out why and address their concerns Most parents weigh risk and benefit, and Most parents weigh risk and benefit, and

determine that vaccines are right for their child determine that vaccines are right for their child and for societyand for society

Most parents have great faith in their child’s Most parents have great faith in their child’s providerprovider

Most parents readily accept recommendations Most parents readily accept recommendations about vaccinationabout vaccination

Questions?Questions?

Immunization Immunization ResourcesResources

Immunization BranchImmunization BranchContact InformationContact Information

Main LineMain Line 919-707-5550919-707-5550

Help DeskHelp Desk 877-873-6247877-873-6247

Regional Nurse Regional Nurse ConsultantConsultant

Call for clinical Call for clinical issuesissues

Regional Regional Immunization Immunization

ConsultantConsultant

Call for NCIR or Call for NCIR or assessmentsassessments

On-call nurseOn-call nurse 919-707-5575919-707-5575

FaxFax 800-544-3058800-544-3058

Immunization Branch’s Immunization Branch’s Website Website

www.immunizenc.orgwww.immunizenc.org

Provider Section Provider Section HighlightsHighlights

Branch MemosBranch Memos Coverage CriteriaCoverage Criteria Consultant ListConsultant List Continuing EducationContinuing Education E-newsletter- Vax FactsE-newsletter- Vax Facts

Vax FactsVax Facts

An e-newsletter from the An e-newsletter from the Immunization Branch sent monthlyImmunization Branch sent monthly

How to subscribe:How to subscribe: Send an email to this address: Send an email to this address:

ncip.enewsletter-subscribe@lists.ncmailncip.enewsletter-subscribe@lists.ncmail.net.net. . No need to include any special instructions No need to include any special instructions

in the subject line or in the body of the in the subject line or in the body of the email message you send. email message you send. 

Centers for Disease Control & Centers for Disease Control & Prevention (CDC) website - Prevention (CDC) website -

www.cdc.gov/vaccineswww.cdc.gov/vaccines

Immunization Action Immunization Action Coalition (IAC) website - Coalition (IAC) website -

www.immunize.orgwww.immunize.org

Resources on CDResources on CD

Top Ten Best Practices for

Immunization Activities

Top Ten1. The administration fee for each state-supplied vaccine cannot be

greater than the rate established by the state's Medicaid program.

2. Stock and routinely provide all required and recommended vaccines to VFC eligible children based on your practice’s population.

3. Provide the most current Vaccine Information Statements (VIS) each time a vaccine is administered.

4. Record in the record *Name of vaccine given *Publication date of VIS *Date vaccine was given *Name & title of person who gave the vaccine *Name of vaccine manufacturer *Address of clinic where vaccine was given*Lot Number *Site *Date VIS was given *Route

5. Provide privately purchase vaccines for Insured (including Health Choice) patients.

Top Ten6. Maintain temperatures in the refrigerator at 36º F to 46ºF

(2º C to 8ºC) and in the freezer at +5ºF (-15ºC) or colder.

7. Keep extra containers of water in the refrigerator to help maintain cold temperatures.

8. Post a “Do Not Unplug” sign next to the refrigerator and freezer’s electrical outlet and at the circuit breaker.

9. Contact the NCIP if you have a storage issue and

temperatures are out of the required range.

10. Post on the refrigerator the NCIP Minimum Required Vaccine Ordering, Handling, and Storage Procedures and the Disaster Recovery Plan (update yearly).