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See Inside September 2011

Straight Talk about Vaccination

Parents need better information, ideally before a baby is born



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Last year 10 children died in California in the worst whooping cough outbreak to sweep the state since 1947. In the first six months of 2011, the Centers for Disease Control and Prevention recorded 10 measles outbreaks—the largest of which (21 cases) occurred in a Minnesota county, where many children were unvaccinated because of parental concerns about the safety of the standard MMR vaccine against measles, mumps and rubella. At least seven infants in the county who were too young to receive the MMR vaccine were infected.

These troubling statistics show that the failure to vaccinate children endangers both the health of children themselves as well as others who would not be exposed to preventable illness if the community as a whole were better protected. Equally troubling, the number of deliberately unvaccinated children has grown large enough that it may be fueling more severe outbreaks. In a recent survey of more than 1,500 parents, one quarter held the mistaken belief that vaccines can cause autism in healthy children, and more than one in 10 had refused at least one recommended vaccine.

This sad state of affairs exists because parents have been persistently and insidiously misled by information in the press and on the Internet and because the health care system has not effectively communicated the counterarguments, which are powerful. Physicians and other health experts can no longer just assume that parents will readily agree to childhood inoculations and leave any discussion about the potential risks and benefits to the last minute. They need to be more proactive, provide better information and engage parents much earlier than is usually the case.

Peril of Business as Usual
Right now pediatricians typically bring up the need for vaccines during the well-baby checkup held about two months after birth. That visit has a jam-packed agenda. In the usual 20 minutes allotted for the appointment, the physician must learn the answers to many questions, of which the following are but a sample: How many times is the baby waking to feed at night? Is the child feeding well? Where do measurements of height, weight and head circumference fall on a standard growth chart? Do the parents know how and when to introduce solid food and how to safely lay the child down to sleep? Are various reflexes good? Can the sounds of a heart murmur be heard through the stethoscope? Are the hip joints fitting properly in their sockets, or are they dislocated?

Generally in the final seconds of the visit, assuming all has gone well to this point, the doctor mentions the required schedule for six recommended inoculations: the first DTaP shot (for diphtheria, tetanus and pertussis, also known as whooping cough), the polio shot, a second hepatitis B shot (the first having been given in the first few days after birth), the pneumococcal conjugate shot (for bacterial pneumonia and meningitis), the HiB shot (for another type of meningitis) and finally the rotavirus vaccine (to prevent a severe diarrheal infection). This is the point in the visit at which more and more pediatricians report a disheartening turn of events: although most parents agree to the inoculations without hesitation, a growing number say they would like to delay or even refuse some or all of the vaccinations for their infants. 

A proper conversation that respects the reluctant parents’ concerns, answers their questions and reassures them that the inoculations are indeed necessary—that countless studies by hundreds of researchers over many decades have shown that vaccinations save millions of lives—will likely take at least another 20 minutes. Meanwhile, though, other families sit in the waiting room, itching for their own well-baby checkups to start.

This all too common scene should never happen. Having this discussion at the two-month well-baby visit is too late. By then, parents may have read about any issues on the Web or chatted with other moms and dads in the park. Discussion with medical professionals should begin long before, usually during, or even prior to, the pregnancy. The evidence summarized below should form the basis for these exchanges.

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