Tag: vaccine coverage

The Unvaccinated Child

We know that your unvaccinated child is not healthier than vaccinated children.

And we know that among pediatric flu deaths, most are unvaccinated.

What else do we know about unvaccinated children?

Who’s Who Among Unvaccinated Children

Many children with cancer and other medical conditions benefit from herd immunity.
Many children with cancer and other medical conditions have medical exemptions to getting vaccinated and benefit from herd immunity. (CC BY 2.0)

Although it seems like unvaccinated kids all get grouped together, it is important to remember that not all unvaccinated kids are intentionally unvaccinated.

Some are too young to be vaccinated or fully vaccinated, some have medical exemptions, usually to just one or a few vaccines, and sometimes just temporary, and some have skipped or delayed one or more vaccines because of a lack of access to health care.

Whatever the reason, they are all at risk because they are unvaccinated.

The intentionally unvaccinated child poses the bigger risk though, because they tend to cluster together and are more likely to be either completely unvaccinated or to have skipped multiple vaccines. A child with a medical exemption because she is getting chemotherapy, on the other hand, very likely lives with a family who is completely vaccinated and protected. Similarly, a child with an allergy to a vaccine likely isn’t missing multiple vaccines.

Risks to the Unvaccinated Child

Of course, the main risk to the unvaccinated child is that they will get a potentially life-threatening vaccine-preventable disease.

While many vaccine-preventable diseases are no longer endemic in the United States and other developed countries, they have not been eradicated.

People do still get vaccine-preventable diseases in the United States.

And tragically, people do still die of vaccine-preventable diseases in the United States.

Can’t you just hide in the herd, depending on everyone else to be vaccinated and protected to keep these diseases away from your unvaccinated child? While that ends up being what happens most of the time, as there are no real alternatives to getting vaccinated, that strategy doesn’t always work. And it is a gamble that’s not worth taking and won’t keep working if more parents skip or delay getting their kids vaccinated.

Risks of the Unvaccinated Child to Everyone Else

Unvaccinated kids are also a risk to those around them, as they are more likely to get sick with a vaccine-preventable disease, since they have no immunity. No, they are not an instant danger if they don’t actually have a vaccine-preventable disease, but since you can be contagious a few days before you have symptoms, you are not always going to know when your child is sick and a risk to others.

Why does that matter if everyone else is vaccinated and immune?

Well, obviously, everyone else is not vaccinated and immune, including those with medical exemptions and those who are too young to be vaccinated. And since vaccines aren’t perfect, some people who are vaccinated can still get sick.

That’s why it is critical that if your unvaccinated child is sick or was exposed to someone who is sick, you are sure to:

  • notify health professionals about your child’s immunization status before seeking medical attention, as they will likely want to take precautions to keep you from exposing others to very contagious diseases like measles, mumps, and pertussis
  • follow all appropriate quarantine procedures that may have been recommended, which often extends up to 21 days after the last time you were exposed to someone with a vaccine-preventable disease
  • seek medical attention, as these are not mild diseases and they can indeed be life-threatening, even in this age of modern medicine

Hopefully you will think about all of these risks before your unvaccinated child has a chance to sick.

Getting Your Unvaccinated Child Caught Up

Fortunately, many unvaccinated kids do eventually get caught up on their vaccines.

It may be that they had a medical exemption that was just temporary and they are now cleared to get fully vaccinated.

Or they might have had parents who were following a non-standard, parent-selected, delayed protection vaccine schedule, but they have now decided to get caught up to attend daycare or school.

Others get over their fears as they get further educated about vaccines and vaccine myths and decide to get caught up and protected.

Is it ever too late to get vaccinated?

Actually it is.

In addition to the fact that your child might have already gotten sick with a particular vaccine preventable diseases, some vaccines are only given to younger kids.

For example, you have to be less than 15 weeks old to start the rotavirus vaccine. And you should get your final dose before 8 months. That means that if you decide to start catching up your fully unvaccinated infant at 9 months, then you won’t be able to get him vaccinated and protected against rotavirus disease. Similarly, Hib vaccine isn’t usually given to kids who are aged 5 years or older and Prevnar to kids who are aged 6 years or older, unless they are in a  high risk group.

Still, you will be able to get most vaccines. And using combination vaccines, you should be able to decrease the number of individual shots your child needs to get caught up. An accelerated schedule using minimum age intervals is also available if you need to get caught up quickly.

You should especially think about getting quickly caught up if there is an outbreak in your area or if you are thinking about traveling out of the country, as many vaccine-preventable diseases are still endemic in other parts of the world.

What to Know About The Unvaccinated Child

The main things to understand about the unvaccinated child is that they aren’t healthier than other kids, are just at more risk for getting a vaccine preventable disease, and should get caught up on their vaccines as soon as possible.

More on The Unvaccinated Child

Strategies for Increasing Childhood Vaccination Rates

How do we improve vaccination rates?

A very clever immunization reminder system for parents.
A very clever immunization reminder system for parents.

One way is to help parents get educated about vaccines, so that they understand that vaccines work, vaccines are safe, and that vaccines are necessary.

Strategies for Increasing Childhood Vaccination Rates

Vaccine-hesitant parents who might delay or skip some of their child’s vaccines aren’t the only reason vaccination rates aren’t where they should be though.

“Immunization levels in the United States are high, but gaps still exist, and providers can do much to maintain or increase immunization rates among patients in their practice.”

CDC on The Need for Strategies to Increase Immunization Levels

How do we fix these gaps in immunization rates?

Some easy things to do that can help increase vaccination rates might include:

  • regularly posting vaccine education material on your social media accounts
  • maintaining a good supply of vaccines
  • reminding parents to bring their immunization records with them to each appointment, especially if they are new patients
  • keeping accurate immunization records on each patient
  • carefully recording vaccines that have been given outside your office
  • using an immunization information system or immunization registry to make it easier to keep track of immunization records
  • generating lists of patients who’s vaccines are past due
  • using reminder and recall messages, either phone calls, text messages, or postcards, etc., so that parents are notified when vaccines are due soon or past due
  • using an electronic health record system to automatically generate prompts when vaccines are due at well visits and sick visits
  • manually reviewing your patient’s vaccination status at each visit, whether it is a sick visit, well visit, or just a nurse visit, to see if they need any immunizations. Remember, a mild illness is not usually a contraindication to getting vaccinated.
  • reducing missed opportunities to vaccinate kids by using standing orders and “nurse only” or “shots only” visits for vaccinations
  • having extended hours for some scheduled or walk-in vaccination clinics
  • enrolling in the Vaccines for Children program to provide free vaccine to families who are uninsured

And most importantly, office staff need to get educated about vaccines too, especially about the anti-vaccine talking points that might keep some kids from getting vaccinated on time. They should also understand the immunization schedule and catch-up immunization schedule, so they can easily recognize which vaccines are due.

“Pediatricians in the sample often provided parents with inconsistent, mixed messages and sometimes offered information about HPV or HPV vaccination that was inaccurate. Pediatricians used presumptive language in only 11 of 75 encounters; when used, presumptive language was associated with higher odds of accepting HPV vaccine.”

Sturm et al, on Pediatrician-Parent Conversations About Human Papillomavirus Vaccination: An Analysis of Audio Recordings

Pediatricians who are getting frustrated talking to parents who have been refusing vaccines might also learn a few new things, including how to use presumptive language.

What is presumptive language?

In the HPV vaccination study quoted above, it was defined as “a matter-of-fact statement that the child was due for or would receive HPV vaccine that day or at a future date, conveying a positive stance toward vaccination.” This is in contrast to a nonpresumptive style that “involved questions or uncertainty,” such as “do you want to get a shot today?”

“High-quality recommendations were strongly associated with HPV vaccination behavior, but only about one-third of parents received them.”

Gilkey et al, on Provider communication and HPV vaccination: The impact of recommendation quality

In addition to using presumptive language, another study has found that “By endorsing HPV vaccine highly, recommending same-day vaccination, and emphasizing cancer prevention, providers may be able to promote HPV vaccine initiation and completion while discouraging vaccine refusal and delay.”

Can these strategies work for your office?

What to Know About Increasing Childhood Vaccination Rates

From using reminder systems and standing orders to changing how you talk to parents, there are a lot of things that can be done to increase childhood vaccination rates.

More on Increasing Childhood Vaccination Rates

Is the Anti-Vaccine Movement Growing?

Boston Reverend Cotton Mather  actively promoted smallpox inoculation during a local epidemic.
Boston Reverend Cotton Mather actively promoted smallpox inoculation during a local epidemic.

We often have to remind people that the anti-vaccine movement didn’t start with Bob Sears, or Jenny McCarthy, or even with Andy Wakefield.

Did you know that the Reverend Cotton Mather’s house was bombed in Boston in 1721? Well, someone through a bomb through his window. Fortunately, it didn’t go off.

That’s 77 years before Jenner developed his smallpox vaccine!

What was Mather doing?

He had started a smallpox variolation program. He was trying to protect people in Boston from smallpox during one of the most deadly epidemics of the time.

So essentially, the anti-vaccine movement started before we even had real vaccines…

Is the Anti-Vaccine Movement Growing?

You see reports of more and more outbreaks of vaccine-preventable diseases, hear about new vaccine laws and mandates, and depending on who your friends are, may see a lot of anti-vaccine articles and vaccine injury stories getting shared on Facebook.

You have probably even heard about pediatricians firing families who refuse to vaccinate their kids.

So what’s the story?

Is the anti-vaccine movement growing?

Is there a growing resistance among parents to getting their kids vaccinated?

“Parents are taking back the truth. It is my expectation that this crack in the dam will serve to sound an alarm. To wake women up. To show them that they have relinquished their maternal wisdom, and that it is time to wrest it back.”

Kelly Brogan, MD

Is the world finally “waking up to the dangers of vaccines,” like many anti-vaccine experts have been claiming for years and years?

The Anti-Vaccine Movement is not Growing

Many people will likely tell you that the anti-vaccine is in fact growing.

You can read it in their headlines:

  • The worrying rise of the anti-vaccination movement
  • Will 2017 be the year the anti-vaccination movement goes mainstream?
  • Pediatricians calling anti-vaccine movement a growing problem
  • There’s Good Evidence That The Anti-Vaccine Movement Is Growing
  • I was skeptical that the anti-vaccine movement was gaining traction. Not anymore.

But the anti-vaccine movement is not necessarily growing.

The overwhelming majority of parents and adults are fully vaccinated.

What we do have is a very vocal minority of people who do their best to push misinformation and conspiracy theories about vaccines and vaccine dangers, and not surprisingly, they have some new ways to do it. Unfortunately, they use their anti-vaccine talking points to scare vaccine hesitant parents and those who might now be on the fence about vaccines to sometimes delay or skip some vaccines.

Most parents do their research though, don’t jump on the anti-vaccine bandwagon, and know that vaccines work, vaccines are safe, and vaccines are necessary.

The Anti-Vaccine Movement is Changing

A lot about the anti-vaccine movement hasn’t changed over the last 100 plus years.

Many early critics of vaccines were alternative medicine providers, including homeopaths and chiropractors, just like we see today. And like they do today, they argued that vaccines didn’t work, vaccines were dangerous, and that vaccines weren’t even necessary.

alicia-silverstone

The big difference?

Unlike when Lora Little, at the end of the 19th century, had to travel around the country to distribute her anti-vaccine pamphlet, Crimes of the Cowpox Ring, anti-vaccine folks can now just tweet or post messages on Facebook. It is also relatively easy to self-publish an anti-vaccine book and sell it on Amazon, put up your own anti-vaccine website, post videos on YouTube, or even make movies.

“Whatever you think about Andrew Wakefield, the real villains of the MMR scandal are the media.”

Ben Goldacre on The MMR story that wasn’t

Fortunately, all of that is balanced by something they don’t have anymore.

No, it’s not science. That was never on their side.

It’s that the media has caught on to the damage they were doing and isn’t as likely to push vaccine scare stories anymore.

Explaining the Popularity of the Anti-Vaccine Movement

The anti-vaccine movement has always been around and they are likely not going anywhere, whether or not they are growing.

Looking at the history of the anti-vaccine movement, it is clear that they have their ups and downs, times when they are more or less popular, but they are always there.

“By the 1930s… with the improvements in medical practice and the popular acceptance of the state and federal governments’ role in public health, the anti-vaccinationists slowly faded from view, and the movement collapsed.”

Martin Kaufman The American Anti-Vaccinations and Their Arguments

Why so many ups and downs?

As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks.
As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks. Chart by WHO

It is easily explained once you understand the evolution of our immunization programs, which generally occurs in five stages:

  1. pre-vaccine era or stage
  2. increasing coverage stage – as more and more people get vaccinated and protected, you pass a crossover point, where people begin to forget just how bad the diseases really were, and you start to hear stories about “mild measles” and about how polio wasn’t that bad (it usually wasn’t if you didn’t get paralytic polio…)
  3. loss of confidence stage – although vaccine side effects are about the same as they always were, they become a much bigger focus because you don’t see any of the mortality or morbidity from the diseases the vaccines are preventing. It is at this point that the anti-vaccine movement is able to be the most effective.
  4. resumption of confidence stage – after the loss of confidence in stage three leads to a drop in vaccine coverage and more outbreaks of a vaccine-preventable disease, not surprisingly, more people understand that vaccines are in fact necessary and they get vaccinated again. It is at this point that the anti-vaccine movement is the least effective, as we saw after outbreaks of pertussis in the UK in the 1970s and measles more recently. You also see it when there is a report of an outbreak of meningococcal disease on a college campus or a child dying of the flu on the local news, etc.
  5. eradication stage – until we get here, like we did when smallpox was eradicated, the anti-vaccine movement is able to cycle through stages two to four, with ups and downs in their popularity,

So the anti-vaccine movement is able to grow when they have the easiest time convincing you that the risks of vaccines (which are very small) are worse than the risks of the diseases they prevent (which are only small now, in most cases, because we vaccinate to keep these diseases away, but were life-threatening in the pre-vaccine era).

“As vaccine use increases and the incidence of vaccine-preventable diseases is reduced, vaccine-related adverse events become more prominent in vaccination decisions. Even unfounded safety concerns can lead to decreased vaccine acceptance and resurgence of vaccine-preventable diseases, as occurred in the 1970s and 1980s as a public reaction to allegations that the whole-cell pertussis vaccine caused encephalopathy and brain damage. Recent outbreaks of measles, mumps, and pertussis in the United States are important reminders of how immunization delays and refusals can result in resurgences of vaccine-preventable diseases.”

Paul Offit, MD on Vaccine Safety

Fortunately, most parents don’t buy into the propaganda of the anti-vaccine movement and don’t wait for an outbreak to get their kids vaccinated and protected. They understand that you can wait too long.

The bottom line – except for pockets of susceptibles and clusters of unvaccinated kids and adults, most people are vaccinated. If the anti-vaccine does grow, it eventually gets pulled back as more kids get sick.

What to Know about the Growing Anti-Vaccine Movement

Although they may have an easier time reaching more people on Twitter, Facebook, YouTube, and with Amazon, the overwhelming majority of parents vaccinate their kids and aren’t influenced by what some people think is a growing anti-vaccine movement.

More on the Growing Anti-Vaccine Movement

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