Talking about Vaccination: Addressing patient & parent
concerns Jennifer Hamilton, MD, PhD July 2014
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Courtesy Medical Journal of Australia We have NEVER seen
this
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Courtesy Medical Journal of Australia We have NEVER seen this
(smallpox)
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Images from AAP (left), CDC (right) Has anyone seen this?
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Images from AAP (left), CDC (right) Has anyone seen this?
(diphtheria the picture above shows the pseudomembrane over the
tonsils)
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Image from CDC We dont see this everyday
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Image from CDC We dont see this everyday (pertussis, AKA
whooping cough the sound file is more helpful than the
picture)
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Image from Britannica.com Some of us didnt have this
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Image from Britannica.com Some of us didnt have this
(varicella, AKA chicken pox)
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Courtesy of University of Rochester Medical College were trying
to get rid of this
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Courtesy of University of Rochester Medical College were trying
to get rid of this (meningococcal disease this is a post-mortem
picture)
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and were making progress against what killed her.
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(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.)
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Why vaccinate?
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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.
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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
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Youll hear: Mercury is a poison Thimerosal (preservative)
metabolized to ethylmercury Methylmercury is a potent toxin
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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
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Youll hear: They dont work
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Youll hear: Theyre not needed
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Pertussis is back and its killing infants.
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Polio never went away completely and now its spreading
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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
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Youll hear: They encourage bad behavior. (HPV vaccine) Protect
now against problems later Will help prevent several forms of
cancer
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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
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There have been problems OPV and polio Rotashield &
intussusception Smallpox
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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
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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
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To start school in Philadelphia
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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
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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.
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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