1. Talking with Parents & Immunization Resources

2. Agenda Parental Concerns Parental Concerns Communication Strategies Communication Strategies Immunization Resources Immunization Resources

3. Objectives Describe concerns parents have regarding childhood vaccinations Describe concerns parents have regarding childhood vaccinations Identify science-based communication approaches to help address parental concerns Identify science-based communication approaches to help address parental concerns

4. Understanding and Addressing Parental Concerns

5. Common Parental Concerns Too Many Vaccines Too Many Vaccines Is Natural Immunity Better Is Natural Immunity Better Do We Still Need to Vaccinate? Do We Still Need to Vaccinate? Are Vaccines Safe? Are Vaccines Safe?

6. How do you respond? Have you heard… “Five vaccines seems like a lot for such a young baby...” or “Won’t this overwhelm his/her immune system?”

7. Too Many Vaccines? In a national survey of parents: In a national survey of parents: 23% questioned the number of shots given to children 23% questioned the number of shots given to children 25% were convinced vaccines weaken the immune system 25% were convinced vaccines weaken the immune system

9. Key Points Children are exposed to thousands of different antigens (bacteria, dust, etc.) daily Children are exposed to thousands of different antigens (bacteria, dust, etc.) daily Vaccines are just a small part of what a child’s immune system faces Vaccines are just a small part of what a child’s immune system faces Children able to generate protective immune responses to multiple vaccines at once Children able to generate protective immune responses to multiple vaccines at once Vaccinated children get fewer infections (both vaccine-preventable and unrelated) Vaccinated children get fewer infections (both vaccine-preventable and unrelated)

10. What Can You Say? Concerns about immune system being overwhelmed: Concerns about immune system being overwhelmed: Immune system not weakened/overwhelmed by multiple shots Immune system not weakened/overwhelmed by multiple shots Explain what happens when immune system is weakened Explain what happens when immune system is weakened Immune system deals with hundreds of viruses and bacteria during everyday activities Immune system deals with hundreds of viruses and bacteria during everyday activities Babies immune systems can handle multiple shots better than fighting off serious diseases Babies immune systems can handle multiple shots better than fighting off serious diseases

12. Alternative and Delayed Schedules Regular childhood schedule is well tested Regular childhood schedule is well tested Schedules designed to delay vaccine administration incur risks: Schedules designed to delay vaccine administration incur risks: Susceptible to disease for a longer time period Susceptible to disease for a longer time period No evidence for benefit; unknown effect on efficacy No evidence for benefit; unknown effect on efficacy Increased opportunities for known side effects Increased opportunities for known side effects Some single-ingredient vaccines not available Some single-ingredient vaccines not available Extra visits = extra time and cost Extra visits = extra time and cost

13. Wanting to use an alternative schedule: Wanting to use an alternative schedule: No benefit No benefit Vaccines are given as early as possible because babies are most susceptible to harm from disease. Vaccines are given as early as possible because babies are most susceptible to harm from disease. A choice not to get a vaccine is not a risk-free choice. It's just a choice to take a different risk. A choice not to get a vaccine is not a risk-free choice. It's just a choice to take a different risk. What Can You Say?

14. Resources

15. How do you respond? Have you heard… “I’d rather my child develop natural immunity. Isn’t it better?”

16. Isn’t Natural Immunity Better? YES... YES... Immunity after disease follows a single infection; vaccine immunity may require several doses, and/or boosters Immunity after disease follows a single infection; vaccine immunity may require several doses, and/or boosters

17. Isn’t Natural Immunity Better? …and NO …and NO The cost is pain, discomfort and the potential for complications, disability, death The cost is pain, discomfort and the potential for complications, disability, death Vaccines are one of the safest most effective disease prevention tools known Vaccines are one of the safest most effective disease prevention tools known

19. What Can You Say? Why take the risk? Why take the risk? Vaccines can safely and easily offer you the same level of immunity that you would get from natural infection but without the risk Vaccines can safely and easily offer you the same level of immunity that you would get from natural infection but without the risk When children are exposed to the disease, they are at risk for serious complications When children are exposed to the disease, they are at risk for serious complications Vaccine immunity is natural immunity Vaccine immunity is natural immunity

20. Resources

21. How do you respond? Have you heard… “I don’t see the point. I had chickenpox when I was little... and polio doesn’t even exist any more.”

22. No Benefit…? Vaccines are a victim of their own success! Vaccines are a victim of their own success! Never seen, rarely hear about Never seen, rarely hear about If we give a bunch of children vaccines, and no one catches anything, where’s the news in that? If we give a bunch of children vaccines, and no one catches anything, where’s the news in that? Perception that: Perception that: Risk of disease is low Risk of disease is low Risk from disease is low Risk from disease is low

23. Unprotected People in NC Cases of vaccine-preventable diseases are seen across the U.S., but also here in North Carolina Cases of vaccine-preventable diseases are seen across the U.S., but also here in North Carolina Measles in 2006 Measles in 2006 Mumps in 2010 Mumps in 2010 Pertussis (every year) Pertussis (every year)

24. Probable & Confirmed Pertussis Cases 1/01/2010 - 6/30/2010

26. What Can You Say? Vaccination keeps disease away Vaccination keeps disease away When we stop vaccinating, disease returns When we stop vaccinating, disease returns While some diseases are not common in the U.S., they are only a plane ride away While some diseases are not common in the U.S., they are only a plane ride away Share experiences you’ve had with these diseases Share experiences you’ve had with these diseases

27. Resources

28. How do you respond? Have you heard… “I’m just not sure vaccines are safe.” Or “Don’t vaccines cause autism?” Or “Are the additives in vaccines safe?”

30. Are Vaccines Safe? No vaccine (and no medication) is completely risk free No vaccine (and no medication) is completely risk free common mild side effects: pain, tenderness, redness common mild side effects: pain, tenderness, redness rare, serious side effects: anaphylaxis rare, serious side effects: anaphylaxis Because vaccines are given to healthy children, they must be as safe as possible Because vaccines are given to healthy children, they must be as safe as possible Benefit clearly outweighs risk

31. What Can You Say? Are vaccines safe? Are vaccines safe? Vaccines are safer than the diseases they prevent (risk/benefit) Vaccines are safer than the diseases they prevent (risk/benefit) Share most common reaction/side effects you’ve seen following vaccine Share most common reaction/side effects you’ve seen following vaccine Teach them what a normal reaction looks like/what to expect Teach them what a normal reaction looks like/what to expect

33. Vaccines and Autism Why is this a concern? Why is this a concern? Autism rates increasing around the world Autism rates increasing around the world Children start showing autistic symptoms around same time they get immunizations. Children start showing autistic symptoms around same time they get immunizations. BUT: BUT: Evidence of autism actually present before vaccines given Evidence of autism actually present before vaccines given Multiple independent studies have shown no link between autism and vaccines Multiple independent studies have shown no link between autism and vaccines The one study that suggested a connection was retracted and discredited The one study that suggested a connection was retracted and discredited Thimerosal (common preservative) was removed from all routine child vaccines in 2001 Thimerosal (common preservative) was removed from all routine child vaccines in 2001

34. What Can You Say? Do vaccines cause autism? Do vaccines cause autism? No. No one knows causes of autism No. No one knows causes of autism Genetics may play a role. Genetics may play a role. Taking parental concerns seriously – scientists thoroughly studied vaccines & autism and found vaccines did not increase risk of autism Taking parental concerns seriously – scientists thoroughly studied vaccines & autism and found vaccines did not increase risk of autism Autism rates same in vaccinated and unvaccinated children Autism rates same in vaccinated and unvaccinated children If don’t vaccinate – not reducing risk of autism, but are increasing the risk of contracting disease If don’t vaccinate – not reducing risk of autism, but are increasing the risk of contracting disease

36. Adjuvants: Aluminum Adjuvants enhance the immune response Adjuvants enhance the immune response Aluminum salts only adjuvant in US Aluminum salts only adjuvant in US Aluminum is everywhere in the environment: a major component of the earth’s crust, and found in air, food, and water. Aluminum is everywhere in the environment: a major component of the earth’s crust, and found in air, food, and water. Breastmilk and formula contain aluminum Breastmilk and formula contain aluminum Safety well established Safety well established

37. What Can You Say? What about other ingredients in vaccines? What about other ingredients in vaccines? Vaccines manufactured under the strictest of standards, including all ingredients Vaccines manufactured under the strictest of standards, including all ingredients Aluminum is naturally occurring element found in many foods including fruits and vegetables Aluminum is naturally occurring element found in many foods including fruits and vegetables Helps trigger body’s immune response Helps trigger body’s immune response Tiny amounts used in vaccines are very safe Tiny amounts used in vaccines are very safe

38. Resources http://www.chop.edu/

39. Communicating with Parents Take time to listen Take time to listen Validate their concerns Validate their concerns Use a “heart and head” approach Use a “heart and head” approach Balance risks and benefits Balance risks and benefits Be flexible Be flexible Direct them to reliable resources Direct them to reliable resources

40. Responding to Parent Refusals Give some vaccines if you can Give some vaccines if you can Revisit the immunization discussion at subsequent visits Revisit the immunization discussion at subsequent visits Good documentation of discussion of benefits of vaccine and risks of being unimmunized Good documentation of discussion of benefits of vaccine and risks of being unimmunized Sign a refusal waiver Sign a refusal waiver Diekema, Committee on Bioethics et al, Pediatrics 2005

41. Be a Role Model and Ask More of People May want to mention that you are up-to-date on your vaccines… May want to mention that you are up-to-date on your vaccines… May want to mention that your children, grandchildren, nieces, nephews, etc. are vaccinated May want to mention that your children, grandchildren, nieces, nephews, etc. are vaccinated Ask people to help you provide a community where children are safer from diseases Ask people to help you provide a community where children are safer from diseases

42. Healthcare Providers Can Make a Difference Can have a positive influence on parents decision to vaccinate their children Can have a positive influence on parents decision to vaccinate their children Including parents who believe that vaccinations are unsafe. Including parents who believe that vaccinations are unsafe. Work to increase your efforts to build honest and respectful relationships with parents Work to increase your efforts to build honest and respectful relationships with parents Their child’s health is your priority, too! Their child’s health is your priority, too! Smith PJ et al, Pediatrics 2006

43. Summary Many parents have questions or concerns about childhood vaccines Many parents have questions or concerns about childhood vaccines When parents are concerned about vaccines, we must find out why and address their concerns When parents are concerned about vaccines, we must find out why and address their concerns Most parents weigh risk and benefit, and determine that vaccines are right for their child and for society Most parents weigh risk and benefit, and determine that vaccines are right for their child and for society Most parents have great faith in their child’s provider Most parents have great faith in their child’s provider Most parents readily accept recommendations about vaccination Most parents readily accept recommendations about vaccination

44. Questions?

45. Immunization Resources

46. Immunization Branch Contact Information Main Line 919-707-5550 Help Desk 877-873-6247 Regional Nurse Consultant Call for clinical issues Regional Immunization Consultant Call for NCIR or assessments On-call nurse 919-707-5575 Fax800-544-3058

47. Immunization Branch’s Website www.immunizenc.org www.immunizenc.org

48. Provider Section Highlights Branch Memos Branch Memos Coverage Criteria Coverage Criteria Consultant List Consultant List Continuing Education Continuing Education E-newsletter- Vax Facts E-newsletter- Vax Facts

49. Vax Facts An e-newsletter from the Immunization Branch sent monthly An e-newsletter from the Immunization Branch sent monthly How to subscribe: How to subscribe: Send an email to this address: ncip.enewsletter-subscribe@lists.ncmail.net. Send an email to this address: ncip.enewsletter-subscribe@lists.ncmail.net. ncip.enewsletter-subscribe@lists.ncmail.net No need to include any special instructions in the subject line or in the body of the email message you send. No need to include any special instructions in the subject line or in the body of the email message you send.

50. Centers for Disease Control & Prevention (CDC) website - www.cdc.gov/vaccines www.cdc.gov/vaccines

51. Immunization Action Coalition (IAC) website - www.immunize.org www.immunize.org

52. Resources on CD

53. Top Ten Best Practices for Immunization Activities

54. Top Ten 1. The administration fee for each state-supplied vaccine cannot be greater than the rate established by the state's Medicaid program. 2. Stock and routinely provide all required and recommended vaccines to VFC eligible children based on your practice’s population. 3. Provide the most current Vaccine Information Statements (VIS) each time a vaccine is administered. 4. Record in the record *Name of vaccine given *Publication date of VIS *Date vaccine was given *Name & title of person who gave the vaccine *Name of vaccine manufacturer *Address of clinic where vaccine was given *Lot Number *Site *Date VIS was given *Route 5. Provide privately purchase vaccines for Insured (including Health Choice) patients.

55. Top Ten 6. Maintain temperatures in the refrigerator at 36º F to 46ºF (2º C to 8ºC) and in the freezer at +5ºF (-15ºC) or colder. 7. Keep extra containers of water in the refrigerator to help maintain cold temperatures. 8. Post a “Do Not Unplug” sign next to the refrigerator and freezer’s electrical outlet and at the circuit breaker. 9. Contact the NCIP if you have a storage issue and temperatures are out of the required range. 10. Post on the refrigerator the NCIP Minimum Required Vaccine Ordering, Handling, and Storage Procedures and the Disaster Recovery Plan (update yearly).