40
Talking about Vaccination: Addressing patient & parent concerns Jennifer Hamilton, MD, PhD July 2014

Talking about Vaccination: Addressing patient & parent concerns Jennifer Hamilton, MD, PhD July 2014

Embed Size (px)

Citation preview

  • Slide 1
  • Slide 2
  • Talking about Vaccination: Addressing patient & parent concerns Jennifer Hamilton, MD, PhD July 2014
  • Slide 3
  • Slide 4
  • Courtesy Medical Journal of Australia We have NEVER seen this
  • Slide 5
  • Courtesy Medical Journal of Australia We have NEVER seen this (smallpox)
  • Slide 6
  • Images from AAP (left), CDC (right) Has anyone seen this?
  • Slide 7
  • Images from AAP (left), CDC (right) Has anyone seen this? (diphtheria the picture above shows the pseudomembrane over the tonsils)
  • Slide 8
  • Image from CDC We dont see this everyday
  • Slide 9
  • Image from CDC We dont see this everyday (pertussis, AKA whooping cough the sound file is more helpful than the picture)
  • Slide 10
  • Image from Britannica.com Some of us didnt have this
  • Slide 11
  • Image from Britannica.com Some of us didnt have this (varicella, AKA chicken pox)
  • Slide 12
  • Courtesy of University of Rochester Medical College were trying to get rid of this
  • Slide 13
  • Courtesy of University of Rochester Medical College were trying to get rid of this (meningococcal disease this is a post-mortem picture)
  • Slide 14
  • and were making progress against what killed her.
  • Slide 15
  • (photograph of Henrietta Lacks. Cells from the cervical cancer that killed her were developed as the HeLa cell line, without consent from her or her survivors.)
  • Slide 16
  • Why vaccinate?
  • Slide 17
  • Slide 18
  • Worries about vaccines They cause autism. They have mercury, which poisons children. They dont work. Theyre not needed anymore. There are too many! They encourage bad behavior. They hurt.
  • Slide 19
  • Youll hear: Vaccines cause autism Claims started with article by Andrew Wakefield published in The Lancet in 1998 Study later discredited: data was fabricated Diagnosis of autism sometimes coincides with vaccinations around age 2-3 but no evidence of cause and effect
  • Slide 20
  • Youll hear: Mercury is a poison Thimerosal (preservative) metabolized to ethylmercury Methylmercury is a potent toxin
  • Slide 21
  • Source: http://www.fda.gov/cber/vaccine/thimerosal.htm, July 6 2007 Thimerosal Content of Vaccines No Thimerosal DTap+HepB+IPV (Pediarix) Pneumococcus (Prevnar) IPV Varicella (Varivax) MMR (MMR-II) Influenza nasal (FluMist) Tdap Hep A Hib+HepB (Comvax) Hep B Recombivax Engerix B May Contain Thimerosal DTaP Infanrix none Daptacel none Tripedia yes Influenza injected depends on size Td varies with brand Hep A + Hep B (Twinrix) Meningitis Menomune depends on size Menactra none
  • Slide 22
  • Youll hear: They dont work
  • Slide 23
  • Youll hear: Theyre not needed
  • Slide 24
  • Slide 25
  • Slide 26
  • Pertussis is back and its killing infants.
  • Slide 27
  • Slide 28
  • Polio never went away completely and now its spreading
  • Slide 29
  • Youll hear: There are too many! Too many shots? Can use combination vaccines to limit number of injections Too many different germs? Fewer proteins/epitopes now than in prior schedules (DTP vs. DTaP; smallpox vaccine) Likely fewer germs than first year in day care
  • Slide 30
  • Youll hear: They encourage bad behavior. (HPV vaccine) Protect now against problems later Will help prevent several forms of cancer
  • Slide 31
  • Youll hear: They hurt. Yes, they can hurt. Other side effects: risk of fever and febrile seizure Can cuddle/soothe the child immediately afterwards Consider pain relievers like ibuprofen, acetaminophen
  • Slide 32
  • There have been problems OPV and polio Rotashield & intussusception Smallpox
  • Slide 33
  • There have been problems OPV and polio Rotashield & intussusception Oral polio vaccine contains weakened virus OPV highly effective OPV can transmit immunity contagious vaccine Relative risks increase as wild polio declines OPV no longer used in US, but is used in endemic areas
  • Slide 34
  • There have been problems OPV and polio Rotashield & intussusception Rotashield was first rotavirus vaccine approved in US Found to increase risk of intussusception, especially in older infants Newer RotaTeq and Rotarix vaccines intensely studied for this possibility Current vaccines limited to first dose under age 15 weeks
  • Slide 35
  • Slide 36
  • To start school in Philadelphia
  • Slide 37
  • Slide 38
  • Slide 39
  • Talking with parents: Tips from the CDC Take time to listen Solicit and welcome questions Keep the conversation going dont shut it down early Get a sense of what sort of information the parents are looking for Acknowledge benefits and risks Respect parents authority Reduce the stress of shots From http://www.cdc.gov/vaccines/hcp/patient-ed/conversations/downloads/talk-infants-bw-office.pdf
  • Slide 40
  • And if they say no? Some offices have parents sign something like an informed un-consent form Rarely, some physicians have refused to treat unvaccinated children. This approach is actively discouraged by the CDC.
  • Slide 41
  • Resources www.cdc.gov/vaccines/hcp/patient-ed/conversations/downloads/talk-infants-bw-office.pdf Poland, Gregory A., and Robert M. Jacobson. The Age-Old Struggle against the Antivaccinationists. New England Journal of Medicine 364, no. 2 (2011): 9799. doi:10.1056/NEJMp1010594. http://well.blogs.nytimes.com/2014/06/26/putting-us-all-at-risk-for- measles/?_php=true&_type=blogs&emc=eta1&_r=0 (editorial)http://well.blogs.nytimes.com/2014/06/26/putting-us-all-at-risk-for- measles/?_php=true&_type=blogs&emc=eta1&_r=0 Vaccination schedules: http://www.immunizationed.org/ (SHOTS app)http://www.immunizationed.org/ http://www.cdc.gov/vaccines/schedules/hcp/index.html