TALKING TO PARENTS ABOUT VACCINATION: ADDRESSING QUESTIONS AND CONCERNS
Get Started
According to data collected by telephone interviews with a subset of parents (n=3,924) who had completed the National Immunization Survey in 2003 or 2004 2: 28% of parents reported doubts about vaccines2
When parents were classified according to level of doubt expressed2:
- 9% reported being unsure about vaccination even though they had accepted it for their child.2
- 13% reported delaying their child's vaccination.2
- 6% reported refusing vaccination.2
Of those parents who reported doubts, many reported concern about safety and side effects2
- 83% of unsure parents reported this concern, as did 76% of parents who delayed vaccination, and 79% of parents who refused vaccination.2
Parents in your practice may want to know about:
- Vaccine safety and possible side effects
- Perceived risk between vaccines and autism
- Vaccine ingredients
- The number of shots at one time
- The risks versus the benefits of vaccination
Today's parents can access information about vaccines from a wide array of sources, including the news media, the Internet, 4 other parents, and family members. Some parents may not have the ability to differentiate between accurate and inaccurate information or to determine if a source is credible or not.
Research shows that parents still consider physicians to be the most reliable source for vaccination information. 3,5
Vaccine information from you may help inform parents of the importance of vaccination for their children and help them understand the safety profile of the vaccine.
Parents may have questions about the immunization schedule
Sharing your own expertise about the CDC's ACIP pediatric immunization schedule can help address questions about the number of shots given at one time
- Major deviations from the recommended pediatric immunization schedule may put children at risk for diseases for which vaccines have been developed6
-
-
Vaccinations are given at the age when:
Children are generally most at risk for these diseases 7A child's immune system will respond to the vaccinations 8
- Vaccinations are scheduled at the earliest possible age because babies don't get immunity from their mothers for several important diseases for which vaccines have been developed.7
- Additional resources to complement this
discussion can be found at:
-
www.aap.org/immunization/families/families.html
www.cdc.gov/vaccines/vac-gen/default.htm
- Questions about delaying vaccination
-
- A recent analysis of data from a previous study involving vaccines and children 7 to 10 years of age (N=1,047) showed no benefit in delaying or refusing vaccination.9
- There was no significant difference in test results in areas including speech, language, behavioral regulation, and general intellectual functioning in children who received vaccines on time versus children who had either delayed vaccinations or no vaccinations at all.9
- The current CDC pediatric immunization schedule is recommended by ACIP, AAP, and AAFP10
Parents may have questions about the ingredients in a vaccine
It may help them to know why the following ingredients are used in making vaccines:
- Aluminum
-
- Aluminum salts are used in some vaccines as an adjuvant to enhance the immune response in the person who receives the vaccination.11
- Vaccines containing aluminum as an adjuvant have been used for more than 60 years.11
- The most common exposure to aluminum occurs through food and drinking water.11
- Mercury/Thimerosal
-
- Thimerosal is a mercury- containing compound that has been used since the 1930s to help prevent microorganisms such as bacteria from contaminating vaccines.12
-
Thimerosal has been removed or reduced to trace amounts in all vaccines recommended for children 6 years of age and younger, with the exception of some vaccines given for flu and vaccines contained in multidose vials.12
The FDA requires that vaccines in multidose vials contain preservative because multiple punctures of the vial may accidentally contaminate the vaccine. 12
- Antibiotics
-
- Certain antibiotics may be used during the manufacturing of vaccines to help prevent bacterial contamination.11
- Very small amounts of these antibiotics may be in the vaccine itself.11
- Examples of antibiotics used in making vaccines include neomycin, polymyxin B, streptomycin, and gentamicin.11
- Antibiotics most likely to cause severe allergic reactions, such as penicillins, cephalosporins, and sulfa drugs, are not used in making vaccines.11
- Formaldehyde
-
- Formaldehyde has been used for many years to inactivate viruses and detoxify bacterial toxins during the making of vaccines.11
- Formaldehyde is diluted during the manufacturing process, but very small amounts may be found in some vaccines.11
- Although high concentrations of formaldehyde can be harmful, everyone has detectable quantities of natural formaldehyde in their circulation—it's an essential component in human metabolism.11
- An additional resource to complement this
discussion can be found at:
-
www.aap.org/immunization/families/families.html
Parents may have questions about the overall benefits of vaccination
Parents with no firsthand experience with diseases for which there are vaccines may wonder if the benefits of vaccination are worth the risk13
- They may have little or no understanding of how vaccination has helped improve the health and life expectancy of today's children13
-
-
They may not understand that, according to the CDC, vaccination has been as important to the dramatic improvement in health and life expectancy achieved during the 20th century as14:
Motor-vehicle safety (including child safety seats)
Control of infectious diseases
Fluoridation of drinking water to reduce tooth decay in children
- Additional resources to complement this discussion
can be found at:
-
www.aap.org/immunization/families/families.html
www.cdc.gov/vaccines/spec-grps/parents.htm
Parents may not realize that unvaccinated children
are at risk13,15
- Even though uncommon in the United States, the diseases for which there are vaccines available are still a threat to children and their communities16,17
-
-
In a shrinking world, despite high levels of vaccination in the United States, unvaccinated American children will be exposed to diseases for which vaccines have been developed if they18:
Travel through airports or outside the United States
Visit tourist destinations within the United States that are popular with foreign tourists
Are exposed to unvaccinated people from other countries
who are visiting here
-
Although infrequent, outbreaks of childhood diseases for which vaccines have been developed have continued to occur.16,17
In order for vaccines to protect everyone, an estimated 85% to 95% of the population must be vaccinated. 19High levels of immunity in other children have kept the number of cases low. 16Decreasing levels of immunity could lead to a resurgence of diseases for which vaccines have been developed. 20
Use your own experience to explain the risks associated with the disease(s) for which the child is scheduled to receive a vaccine, as well as the profile of the vaccine13
Parents may be concerned about the side effects of multiple vaccinations at one time13,21
- For these parents, it may help to explain your experiences with side effects after vaccination visits.13
-
- Nurses and office staff can also play a key role by answering questions and providing parents with educational materials.13
Contraindications to vaccination
Explain to parents the circumstances under which a routine vaccination might be contraindicated (eg, a previous anaphylactic reaction or allergy, chronic/serious illness, or an immunocompromised condition).22
- Additional resources to complement this
discussion can be found at:
-
www.aap.org/immunization/families/families.html
www.cdc.gov/vaccines/spec-grps/parents.htm
Some may be worried that their child's immune system will be overwhelmed by the number of shots21
- Information for these parents may include:
-
- While today's children receive more shots than previous generations, today's vaccines contain fewer proteins that stimulate the immune system.21
- 50 years ago, a single vaccine given to children contained 200 of these proteins.21
- Together, 11 routinely recommended vaccines contain fewer than 130 proteins.21
- There is no evidence to suggest that the recommended childhood vaccines can “overload” the immune system.7
- In fact, every day a child encounters from 2,000 to 6,000 similar proteins through contact with shared toys, doorknobs, or playground equipment.8
Parents may have questions or concerns about the safety of vaccines
Information about the approval process in the United States and ongoing monitoring of vaccine safety may address some of their questions
- Vaccines undergo testing to demonstrate the safety and efficacy profile of the vaccine.23
-
- Research and development may take up to 15 to 20 years.24
- Clinical trials can include several hundred to several thousand volunteers.23
- Vaccines must meet a threshold of efficacy and safety before being made available to the public.18
- Manufacturing processes must meet quality controls.23
- Additional resources to complement this
discussion can be found at:
-
www.aap.org/immunization/families/families.html
- Vaccine safety is carefully monitored through an ongoing process.23
-
- The FDA and the CDC maintain the Vaccine Adverse Events Reporting System (VAERS), through which health care professionals and the general public can report adverse events that occur after vaccination.23
- Vaccines are routinely monitored by their manufacturers after they have been approved for public use.23
Parents may appreciate knowing that vaccinating their child also helps protect their family and friends
Parents may not know that diseases for which there are vaccines can spread easily among people who are not vaccinated15
- It's important they understand that:
-
- People coming into the community from areas where diseases for which there are vaccines are still common, may bring these diseases with them.18
- If enough people in the community are vaccinated against these diseases, many bacteria or viruses that cause them cannot spread.25
- To protect everyone, it is estimated that about 85% to 95% of the population must be vaccinated, depending on the disease.19
- If children don't receive recommended vaccines, there may be an increase in diseases for which there are vaccines even though they are no longer common in the United States.19
- Additional resources to complement this
discussion can be found at:
-
www.cdc.gov/vaccines/vac-gen/howvpd.htm
www.aap.org/immunization/families/families.html
Many people may not be aware that group, or herd, immunity protects those who cannot be vaccinated25
- Parents may not realize that their unvaccinated child can spread diseases for which there are vaccines to vulnerable family members or friends, such as:
-
- Infants who are too young to be vaccinated26
- Family members or friends who cannot be vaccinated for medical reasons and those who cannot make an adequate response to vaccination26
When you talk to parents about vaccines, you may find it helpful to...
Recognize that conversations about vaccines may be emotionally charged
- Parental concerns about vaccines stem from a desire to protect their child's health, so it may be helpful to personalize the conversation.13
- Let parents know that you, too, have their child's best interest at heart.13
Customize your conversation for each parent
- Talk about vaccination in language that parents can relate to.13
-
As much as possible, ascertain whether the parents understand how vaccines work.13
Customizing your approach can help you avoid frustrating parents who want to know the science, as well as those who do not. 13
Discuss both the risks and benefits of vaccination
- Always discuss the known risks and side effects of vaccination.13
- Remind parents about the potential side effects that they should be watching for—and offer information about when and how to treat any side effects.13
Make the conversation more relevant to the parents by talking about any local or regional outbreaks of diseases for which vaccines have been developed
- Share how having children vaccinated can help reduce the risk of outbreaks of diseases for which vaccines have been developed.19
- Remind parents that if vaccination is not conducted routinely, the serious and life-threatening diseases that vaccines are now helping to prevent can return.13
Discuss your recommendations and the ACIP pediatric immunization schedule
- It may be helpful to share why you chose to (or would choose to) vaccinate your own children according to the recommended schedule.13
Extended conversation about vaccination may be important or necessary for some parents. Contact the patient's health plan for complete information and CPT® codes for the additional time you take for these discussions.
References
1. Fredrickson DD, Davis TC, Arnold CL, et al. Childhood immunization refusal: provider and parent perceptions. Fam Med. 2004;36(6):431–439. 2. Gust DA, Darling
N, Kennedy A, et al. Parents with doubts about vaccines: which vaccines and reasons why. Pediatrics. 2008;122(4):718–725. 3. American Academy of Pediatrics
(AAP). Informing patients and parents. In: Pickering LK, Baker CJ, Kimberlin DW, et al, eds. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th
ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009:5–8. 4. Zimmerman RK, Wolfe RM, Fox DE, et al. Vaccine criticism on the World Wide Web. J Med
Internet Res. 2005;7(2):e17. 5. Freed GL, Clark SJ, Butchart AT, et al. Parental vaccine safety concerns in 2009. Pediatrics. 2010;125(4):654–659. 6. Offit PA, Moser
CA. The problem with Dr Bob's alternative vaccine schedule. Pediatrics. 2009;123(1):e164–e169. 7. Centers for Disease Control and Prevention (CDC). Frequently
asked questions about multiple vaccines and the immune system. http://www.cdc.gov/vaccinesafety/Vaccines/multiplevaccines.html. Updated March 24, 2010.
Accessed October 7, 2010. 8. American Academy of Pediatrics (AAP). The childhood immunization schedule: why is it like that? http://www.aap.org/immunization
/families/faq/Vaccineschedule.pdf. Published October 2008. Accessed October 7, 2010. 9. Smith MJ, Woods CR. On-time vaccine receipt in the first year does not
adversely affect neuropsychological outcomes. Pediatrics. 2010;125(6):1134–1141. 10. Centers for Disease Control and Prevention (CDC). Recommended
immunization schedules for persons aged 0 through 18 years—United States, 2010. MMWR Morb Mortal Wkly Rep. 2010;58(51,52):Q1–Q4. 11. US Food and Drug
Administration. Common ingredients in U.S. licensed vaccines. http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/ucm187810.htm.
Updated October 23, 2009. Accessed October 7, 2010. 12. US Food and Drug Administration. Thimerosal in vaccines. http://www.fda.gov/BiologicsBloodVaccines
/SafetyAvailability/VaccineSafety/ucm096228.htm. Updated March 31, 2010. Accessed October 7, 2010. 13. Centers for Disease Control and Prevention (CDC).
Talking with parents about vaccines for infants. http://www.cdc.gov/vaccines/spec-grps/hcp/downloads/talk-infants-color-office.pdf. Updated October 2009.
Accessed October 7, 2010. 14. Centers for Disease Control and Prevention (CDC). Ten great public health achievements—United States, 1900-1999. MMWR Morb
Mortal Wkly Rep. 1999;48(12):241–243. 15. Salmon DA, Moulton LH, Omer SB, et al. Factors associated with refusal of childhood vaccines among parents of
school-aged children: a case-control study. Arch Pediatr Adolesc Med. 2005;159(5):470–476. 16. Centers for Disease Control and Prevention (CDC). Update:
measles—United States, January–July 2008. MMWR Morb Mortal Wkly Rep. 2008;57(33):893–896. 17. Centers for Disease Control and Prevention (CDC). Notes
from the field: pertussis—California, January–June 2010. MMWR Morb Mortal Wkly Rep. 2010;59(26):817. 18. American Academy of Pediatrics (AAP). Vaccine
safety: the facts. http://www.aap.org/immunization/families/VaccineSafety_parenthandout.pdf. Published 2008. Accessed October 7, 2010. 19. American Academy
of Pediatrics (AAP). Facts for parents about vaccine safety. http://www.aap.org/advocacy/releases/autismparentfacts.htm. Published March 2008. Accessed
October 7, 2010. 20. Health Protection Agency (HPA). Confirmed measles cases in England and Wales: an update to end-May 2008. Health Protection Report
[serial online]. 2008;2(25). http://www.hpa.org.uk/hpr/archives/2008/hpr2508.pdf. Published June 20, 2008. Accessed October 28, 2010. 21. Offit PA, Quarles J,
Gerber MA, et al. Addressing parents' concerns: do multiple vaccines overwhelm or weaken the infant's immune system? Pediatrics. 2002;109(1):124–129.
22.Centers for Disease Control and Prevention (CDC). Guide to vaccine contraindications and precautions. http://www.cdc.gov/vaccines/recs/vac-admin/
downloads/contraindications-guide-508.pdf. Accessed October 7, 2010. 23. Centers for Disease Control and Prevention (CDC). History of vaccine safety.
http://www.cdc.gov/vaccinesafety/vaccine_monitoring/history.html. Updated July 8, 2010. Accessed October 18, 2010. 24. Plotkin SA. Why certain vaccines
have been delayed or not developed at all. Health Affairs. 2005;24(3):631–634. 25. Kane M, Lasher H. The Case for Childhood Immunization. Occasional paper #5.
Seattle, WA: Children's Vaccine Program at PATH; 2002. 26. Centers for Disease Control and Prevention (CDC). How vaccines prevent disease. http://www.cdc.gov/vaccines/vac-gen/howvpd.htm. Updated August 7, 2009. Accessed October 7, 2010.
Talking to Parents About Vaccination:
Addressing Questions and Concerns
A useful resource that offers you tips to
answer parents’ questions and help them
make informed choices. Resources include:
 Overall benefits of vaccination
Vaccine ingredients and safety
Vaccination schedule
To order a printed copy of the brochure,
please call the Merck Vaccine Customer
Center at 877.VAX.MERCK (877.829.6372).
Additional complimentary patient education materials to facilitate conversation:
Exam Room Easel With Tear Pad
Display this desktop easel and tear pad
in your waiting room or exam room to give
parents a list of Web sites with information
on childhood vaccinations.
Order Now
Refill Tear Pads for Easel
Refill your easel with these tear pads.
Each sheet is an easy way to give
parents a list of Web sites with
information on childhood vaccinations.
Order Now
NOND-1003773-0003 01/12
|
|
