Transcript Document

Centers for Disease Control and Prevention
Vaccine Safety Netconference
June 12, 2008
“Effectively Addressing Parents’ Concerns
about Immunizations”
Patricia Stinchfield, RN, MS, CPNP
Director, Infectious Disease/Immunology/Infection Control
Advisory Committee on Immunization Practices, voting member
representing National Association of Pediatric Nurse
Practitioners (NAPNAP)
Experience and Values Drive
Risk Communications
 My experience: 30 years as a pediatric RN,



21 of those as a Pediatric Nurse Practitioner
in Infectious Disease/Immunology
Cared for numerous children with vaccine
preventable diseases including pertussis,
measles, influenza, severe varicella and
rotavirus and pneumococcal, Hib and
meningococcal meningitis
Parents and many providers today have
never seen these diseases so the benefit of
vaccines is invisible
When you care for the sickest of the sick, the
bias is strong in favor of vaccination.
Vaccine Debates:
Impact on Parents
 National vaccine debates cause great
vaccine communication challenges at the
patient care level
 Parents can be confused, misinformed or
fearful of vaccines because of a story they
read/see.
 The vaccine communication challenges are
many
 The perspective is often skewed
(1 mom interviewed on news who vaccinates
represents 98% of parents, whereas the
other mom choosing not to vaccinate
interviewed represents 2% of parents)
Provider Impact
 40% of providers surveyed did not mention




vaccine risks with patients (Davis)
Research supports that physicians say little to
parents about immunizations
(Ball et al)
Parents want info from providers (Gellin)
Nurses reported the most education in
risk:benefit communication (Davis, et al) but
may not always have the responsibility to
educate
With recent media attention to the topic, more
and more providers are spending considerably
more time discussing immunization concerns
with parents
“An Infant’s Immune System is
Too Weak for Vaccines?”
 Take a moment early on and briefly




describe the power of the human immune
system
T and B lymphocytes are abundant in a
“lock and key” ability to deal with antigens
individually; therefore no “immune system
overload”
The ocean analogy
Even premature babies have the immune
capacity to respond to inactivated
vaccines
With few exceptions, when they are 60
days old, even in an NICU, babies are
started on their immunization series and
can make protective level antibodies
“So Many So Soon,
So Many at One Visit”
 Vaccinate by the recommended schedule





that has been thoroughly reviewed by
experts, most of whom are also parents
There is no physiologic reason to design
an alternative immunization schedule
There is no biological rationale for
splitting up a dose
To choose to delay is to choose to take a
risk
If avoidance of harm is the goal, to
prolong prevention is to delay protection
Choosing to not vaccinate not only
potentially endangers this baby, but
others as well.
“Is Thimerosal the Problem?”
 The preservative thimerosal has been removed





from vaccines with the exception of multi-dose
influenza
Multi-dose vials of influenza vaccine contain
thimerosal as a preservative
This requires time for conversation in the clinics
about thimerosal, even in mass influenza
vaccination settings
Danish cases of autism rose substantially after
thimerosal was removed in 1992 (AJPM 8/2003)
Theoretical/unproven risk with thimerosal vs.
real/considerable risk with disease
Education on the lack of scientific support for
thimerosal as a causative agent of autism is as
necessary as ever
“Do Vaccines Cause Autism?”
 The Institute of Medicine has reported that there is




no correlation between thimerosal content in
vaccines and autism (NEJM 9/07)
We do not yet know the cause of autism and
resources would be best spent understanding this
better
Epidemiological studies in different parts of the
world have shown no relationship vaccines and
autism (Danish study of 500,000 children over 7
years found no association. NEJM 2002)
Vaccine Safety Datalink did not show a
relationship between vaccines and autism or other
neurodevelopmental disorders (Pediatrics, 11/03)
Temporal association between things is not the
same as a causal association
Communication Challenges
 Time
 Prevention
 Complicated science
 Disease versus vaccine
 Emotions (fear, anxiety) can
be driving conversation
Communication Challenges
 Languages
 Perceptions
 Mind made up mentalities
 Information resource
challenges leads to
misinformation
What Strategies Can Reduce
Myths and Misperceptions?
 Listen. What is the root of the



misunderstanding? Fear?
Knowledge deficit? Attitude?
Experience? Emotions? Beliefs?
“Balanced” media—is it even
possible?
Modeling: Vaccinate Health care
Professionals
Storytelling: Sharing real
experiences
Wednesday, January 31, 2007
 Television news airs
photos a family has
shared of their 8 year
old son “Lucio” who
died of Influenza A.
 His parents’ hope is to
alert parents in order
to prevent other
children from dying.
 Droves of parents
called providers
concerned asking for
influenza vaccine
 Telling the real stories
makes a difference
Reasons Parents Give Not to
Immunize
 Medical
– Contraindications
– Precautions
 Philosophical
– Individual rights
– Alternative health
 Religious
 Safety
-Side effects
– Not health care
consumer
– Human or animal
tissue in vaccines
– “Good health is
achieved through
seeking God”
What is Safe?
 SAFE = No Harm from the vaccine?

No vaccine is 100% safe
SAFE = No Harm from the disease?
No vaccine is 100% effective
 Have we communicated realistic
expectations?
 Communicate that the safety and
effectiveness of receiving vaccines is far less
risky than being un-immunized
 To do nothing is to take a risk
Practical Thoughts on
Reducing Challenges
 Establish Rapport-trust is vital
 Determine understanding-what
have their experiences been?
 Break down emotional barriers
 Engage in 2 way conversation
 Give personal provider
experience with vaccine safety
issues
Practical Thoughts
continued
 Encourage questions
 Give perspective & real life
examples
 Provide supporting
information
 Focus: Keep control without
being controlling
Enhancing Vaccine
Communication
 Recognize the challenges
 Meet them where they are
 Share the goal of informed decision


making in partnership
Engage in a dialogue with trust and
open understanding
Be evidence based and as definitive
as the science allows
Individualize the message and
methods of communication.
Enhancing Vaccine
Communication
 Use current information, VIS
 Communicate clearly in plain
language with visual aids
 Use analogies
 Keep it interactive
 Use videos, group teaching
 Provide reliable websites
 Parent-to-parent sessions
 Taped phone messages
Use the Five C’s of Effective
Communication
 Chemistry
 Clarity
 Consistency
 Credibility
 Caring
Simple is Better
 Keep it simple
– A one sentence description of the disease
– A word about its prevalence/dangers in
your community and the world
– Describe the vaccine benefits
– Describe the vaccine risks and the risks of
not immunizing
– Advise about normal, local responses
– Inform about what to do in the event of a
severe adverse reaction
– Emphasize the return visits based on the
recommended schedule
Emphasize Ongoing Safety
Monitoring
 Many ways that vaccines are monitored on an




ongoing basis:
Vaccine Safety Datalink (large HMO data
analysis)
VAERS (Vaccine Adverse Event Reporting
System through the CDC & FDA, relies on
providers)
CISA centers (6 centers for immunization
safety assessments)
Ongoing post-marketing surveillance by
manufacturers
Summary
 Many vaccine communication challenges






exist in the practice setting today
Determine the origin of concerns
Address concerns with effective
risk:benefit communication strategies
Underscore safety is top priority for us all
Safety monitoring is ongoing
Utilize creative strategies to communicate
efficiently such as group classes, taped
phone messages, reliable resources
brochures, parent-to-parent sessions
Keep communication clear,
compassionate yet confident