Nursing Dilemma: Vaccine-Wary Parents

By Steve Goodman

The vaccine debate first arose from a study by British researcher Andrew Wakefield. Published in 1998 in The Lancet, the study suggested there was a connection between the MMR vaccine and autism. It claimed that mercury in the vaccine caused the developmental disorder in 12 youngsters. The findings were never confirmed. And, several studies done since have found no link between vaccines and autism. But, that hasn't stopped the continued concern among parents.

Listen and Be Sympathetic

The current climate surrounding vaccines is confusing at best. Make it a point to be cognizant and sympathetic to any concerns your patients' parents may have about vaccines. Parents refusing a vaccine or questioning the need for one are not doing so to be difficult. These parents honestly feel they have their child's best interest at heart.

"Healthcare professionals can best respond to the concerns of 'vaccine hesitant' parents by trying to understand, respect and address their 'health belief systems,'" says Edgar K. Marcuse, MD, a professor of Pediatrics at the University of Washington in Seattle.

Always keep in mind that parents' questions about vaccine safety are not entirely unfounded, nor are they necessarily a bad thing. It was parents' concern that helped create many positive changes in immunizations, such as the phasing out of the oral polio vaccine and the removal of mercury from vaccines. Without the activism of parents, the Vaccine Injury Compensation Program (VICP)-a federal Omnibus program that allows those who have been injured as a result of vaccines to get fair compensation without the need to sue a vaccine's manufacturer-would never have been created.

Respectfully Relay the Facts

According to Marcuse, the key to carrying on a meaningful conversation with reluctant parents is to identify the root of their concern-respect it and never belittle them. He uses the following language when speaking to parents: We understand that you want to do what is best for your son or daughter; so do we. I understand you are bombarded with conflicting information and do not know whom to believe, but science is the best tool we have to get reliable answers to important questions.

Make sure you provide parents with the information and tools necessary to make an informed and educated decision about vaccinations. Present a fair representation of the risks and benefits of each vaccine. In any discussion with a parent regarding vaccination, it is important to make them aware of the facts:

--- According to U.S. Centers for Disease Control and Prevention (CDC), since last year the reported cases of measles have more than doubled. The CDC, The American Academy of Pediatrics and several other state and municipal public health officials believe this is largely due to parents refusing to have their kids inoculated.

--- According to the National Institutes of Health, before the measles immunization was developed, there were hundreds of thousands of cases every year, many resulting in death.

--- The American Academy of Pediatrics says extensive reports from several leading researchers have found no "proven association" between autism and measles vaccines.

--- According to the CDC, since 2001, Thimerosal has not been used in any vaccines given to preschoolers in the United States.

--- The CDC's National Immunization Program reminds us that the Varicella (Chickenpox) vaccine has never been implicated in causing autism.

--- According to the CDC, 1 out of 6 people who receive the MMR vaccine may be susceptible to a fever, while 1 out of 20 may experience a mild rash. In very rare cases, 1 out of 3,000 may experience seizures, and 1 out of 1 million may experience serious allergic reactions.

--- According to the CDC, approximately 70% of children and 17% of adults vaccinated for smallpox may experience a fever of over 100 degrees. About 15-20% of children and fewer than 2% of adults may experience a fever of over 102 degrees Fahrenheit.

Don't Force Them to Make a Decision

Accept the possibility that you may not sway vaccine hesitant parents during their child's office visit, if at all.

"We wish we could make the world completely safe for [their] child, [but] we can not," says Marcuse. "Unfortunately, in the real world, parents need to accept that there are important threats to [their] child's health and safety we cannot eliminate. But, we can help [them] protect [their] child. As healers it is our greatest responsibility to assist [parents] to get the information [they] need to decide to take action to protect [their] child against serious diseases that can result in life-long disability."

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