ATLANTA—Physicians and nurses need to explain the risks of vaccine refusal while respectfully listening to parents' concerns, a special article in the May 7 issue of the New England Journal of Medicine urges.
Lead author Saad B. Omer, MBBS, PhD, MPH, is assistant professor of global health and epidemiology at Emory University's Rollins School of Public Health, with coauthors from the Johns Hopkins Bloomberg School of Public Health, the federal National Vaccine Program Office and the Washington State Department of Health.
Perceptions and concerns about vaccine safety have led to a jump in vaccine refusal in the United States over the last decade. Several states allow "personal belief" exemptions from school vaccination requirements in addition to exemption for religious or medical reasons.
In the article, Omer and his colleagues review evidence from several states that vaccine refusal puts children in communities where the practice has increased at substantially higher risk for infectious diseases such as measles and pertussis.
Even children whose parents did not refuse vaccination are put at risk because "herd immunity" normally protects children who are too young to be vaccinated, can't be vaccinated for medical reasons, or whose immune systems do not respond sufficiently to vaccination, the authors explain.
"The implication of recent research findings is that everyone who is living in a community with a high proportion of unvaccinated individuals has an elevated risk," Omer says.
In a recent survey of pediatricians, almost 40 percent said they would not provide care to a family that refused all vaccines, and 28 percent said they would not provide care to a family that refused some vaccines.
The authors advise primary care physicians and nurses not to break off relationships with parents that decline vaccines, citing the "critical role clinicians can play in explaining the benefits of immunization and addressing parental perceptions and concerns about its risks."
The attitudes of physicians and nurses overlap with and have an influence on the families they serve, the authors say. Research shows primary care providers for unvaccinated children were less likely to have confidence in vaccine safety and vaccines' benefits. In focus groups, parents who were uncertain about vaccinating their children were still open to discussions with clinicians.
The authors note an emerging trend for parents to delay rather than omit vaccination for their children, a phenomenon whose consequences could include exacerbation of health inequities.
Reference: Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. Omer, S.B., Salmon, D.A., Orenstein, W.A., deHart, M.P. and Halsey, N. N Engl J Med 360: 1981-8 (2009).
The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service. Its components include the Emory University School of Medicine, Nell Hodgson Woodruff School of Nursing, and Rollins School of Public Health; Yerkes National Primate Research Center; Emory Winship Cancer Institute; and Emory Healthcare, the largest, most comprehensive health system in Georgia. Emory Healthcare includes: The Emory Clinic, Emory-Children's Center, Emory University Hospital, Emory University Hospital Midtown, Wesley Woods Center, Emory University Orthopaedics & Spine Hospital, the jointly owned Emory-Adventist Hospital, and EHCA, a limited liability company created with Hospital Corporation of America. EHCA includes two joint venture hospitals, Emory Eastside Medical Center and Emory Johns Creek Hospital. The Woodruff Health Sciences Center has a $2.3 billion budget, 18,000 employees, 2,500 full-time and 1,500 affiliated faculty, 4,300 students and trainees, and a $5.5 billion economic impact on metro Atlanta.
Journal
New England Journal of Medicine