How to Respond When Patients Ask about Vaccines

Clinical Scenario

You are performing a postoperative check on a 1 year-old girl who required myringotomy and ventilating tubes for recurrent episodes of acute otitis media. After you apprise the parents that both tubes are in place and appear to be patent, they look at each other and then ask if you have time to speak with them about another health matter. You, of course, agree. The child’s mother begins to relate their long-time concerns about forthcoming decisions regarding childhood immunizations and the possible risks associated with these vaccines.

They have broached this topic with the child’s pediatrician on several occasions, but the pediatrician was adamant that if their daughter was to be his patient, she would have to be immunized according to the CDC-recommended immunization schedule. They are hopeful that you will be able to give them your viewpoint as a physician with a large number of pediatric patients. You take a moment to reflect on what you know about vaccines and the issue of vaccination hesitancy.

Until the last five years or so, you have taken for granted the fact that an appropriate number of children are being vaccinated according to the recommended vaccination schedule, and that the vaccination rate in your community has been sufficiently high. However, you have heard complaints recently from your pediatrician and family medicine colleagues regarding increasing hesitancy by young parents to allow their children to be vaccinated.

You have been in practice long enough to have seen the positive benefits of vaccines in reducing the risks of congenital rubella, meningococcal meningitis, epiglottitis, whooping cough, and a host of other serious illnesses that were more common early in your training. In fact, you are so thankful for the immunity imparted by these vaccines that you are quite puzzled when parents are hesitant to have their children vaccinated. Yet, you feel it is important to listen to the parents’ concerns and determine how to advise them.

How would you handle this case?

Discussion

From the time the first vaccines were licensed in the U.S. in 1914–1915 (for tetanus toxoid, rabies, and typhoid), there has been a steady expansion in the research and development of additional and improved vaccines, including the latest 9-valent human papillomavirus (HPV) vaccine in 2014.

Public health initiatives over the past century have responded to outbreaks of serious diseases that have been tamed or eradicated through the use of vaccinations. The outcomes have been so successful that the federal government, through the CDC, has developed recommended immunization schedules, which are periodically updated based on new research findings. While the federal government does not mandate immunization regulations, each state has its own mandates and exemptions, which vary widely across the country. In most states, the immunization requirements are mandated through public school attendance requirements; some private schools do not require proof of vaccination status.