Pe­di­a­tri­cians is­sue policy state­ment on par­ents’ hes­i­tancy

Baltimore Sun - - FRONT PAGE - By Melissa Healy melissa.healy@la­

As grow­ing num­bers of Amer­i­can par­ents re­sist hav­ing their young chil­dren vac­ci­nated against a broad range of dis­eases, the na­tion’s pe­di­a­tri­cians are push­ing back.

The na­tion’s pe­di­a­tri­cians are push­ing back against par­ents who re­sist hav­ing their chil­dren vac­ci­nated against a broad range of danger­ous dis­eases by call­ing on states to stop of­fer­ing waivers to those with non­med­i­cal ob­jec­tions to the prac­tice.

In a policy state­ment is­sued Mon­day, the Amer­i­can Academy of Pe­di­atrics also said that if par­ents con­tinue to refuse vac­ci­na­tions de­spite ex­haus­tive ef­forts to change their minds, it would be “ac­cept­able” for doc­tors to ex­clude these fam­i­lies from their prac­tices.

The pro­nounce­ments aim to guide U.S. pe­di­a­tri­cians as they grap­ple with a ris­ing tide of vac­cine “hes­i­tancy” on the part of par­ents. Among doc­tors who are mem­bers of the na­tion’s largest or­ga­ni­za­tion of pe­di­a­tri­cians, 87 per­cent have been chal­lenged in the last year by par­ents who re­fused to have their chil­dren im­mu­nized, up from 75 per­cent in 2006.

Many pe­di­a­tri­cians have reached the end of their pa­tience with par­ents who are un­con­vinced of vac­cines’ life-sav­ing ben­e­fits. In 2013, 12 per­cent of pe­di­a­tri­cians rou­tinely asked par­ents to find an­other physi­cian if they weren’t will­ing to vac­ci­nate their chil­dren. In 2006, only 6 per­cent rou­tinely showed such par­ents the door, ac­cord­ing to sur­veys by the academy.

That step should be a last re­sort, the group said.

In a lengthy re­port also re­leased Mon­day by the AAP, 23 spe­cial­ists in pe­di­atrics and in­fec­tious dis­eases said doc­tors should be­gin dis­cussing the ben­e­fits of vac­cines as early as the first pre­na­tal visit. In do­ing so, they should be pre­pared to ex­plain the sci­en­tific ev­i­dence sup­port- ing vac­cines’ use.

The panel also urged pe­di­a­tri­cians to “per­son­al­ize” the mes­sage that vac­cines are safe, ef­fec­tive and pow­er­ful by shar­ing their own de­ci­sions to vac­ci­nate their chil­dren or grand­chil­dren. This par­tic­u­lar ad­vice was prompted by stud­ies show­ing that skep­ti­cal par­ents tend to value the safety and com­fort of their own chil­dren over ar­gu­ments em­pha­siz­ing the role of vac­cines in ben­e­fit­ing the public at large.

The pe­di­a­tri­cians’ group ac­knowl­edged a widely held view among rank-and­file mem­bers: that for a pro­fes­sion ded­i­cated to the well-be­ing of chil­dren and fam­i­lies, the decision to show pa­tients the door is of­ten dif­fi­cult.

“It was gut-wrench­ing,” said Dr. Ali­son Ziari, chief of pe­di­atrics at the Austin Re­gional Clinic, a Texas prac­tice that adopted a vac­ci­nate-or-leave policy in July 2015. “These are our fam­i­lies. We love them, and we want to care for them.”

Af­ter doc­tors had lengthy con­ver­sa­tions with par­ents re­luc­tant to vac­ci­nate their kids fully by the age of 2, the ma­jor­ity of fam­i­lies chose to get the im­mu­niza­tions and stay with the prac­tice, Ziari said. But the fam­i­lies of about 150 chil­dren — a small frac­tion of the more than 100,000 pe­di­atric pa­tients — per­sisted in their re­fusal and were asked to seek care else­where, she said.

The sur­vey re­sults re­leased Mon­day show that par­ents’ con­cerns about vac­cines have shifted in re­cent years. In 2006, pe­di­a­tri­cians reck­oned that nearly three-fourths of par­ents re­luc­tant to vac­ci­nate their chil­dren were mo­ti­vated by fear that some vac­cines could cause autism or have other ad­verse ef­fects on a child’s safety.

By 2013, safety con­cerns and the dis­cred­ited link be­tween vac­cines and autism ap­peared to be less prom­i­nent causes of parental re­sis­tance. In­stead, physi­cians at­trib­uted a grow­ing num­ber of parental ob­jec­tions to the view that vac­cines are an un­nec­es­sary dis­com­fort for their young chil­dren.

The new guide­lines fol­low a steady uptick in lo­cal out­breaks of vac­cine-pre­ventable dis­eases, most no­tably measles and whoop­ing cough. In 2015, a measles out­break orig­i­nat­ing at Dis­ney­land sick­ened 147 peo­ple in the United States, in­clud­ing 131 in Cal­i­for­nia.

A study pub­lished in the Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion in March found that peo­ple who re­fused to vac­ci­nate them­selves or their chil­dren played a key role in ini­ti­at­ing and ac­cel­er­at­ing those out­breaks.

Al­though all 50 states and the Dis­trict of Columbia re­quire that school­child­ren be im­mu­nized against a broad range of dis­eases, most states al­low par­ents to opt out if they have a re­li­gious ob­jec­tion to vac­cines and 18 al­low “philo­soph­i­cal ex­emp­tions” for those who ob­ject based on per­sonal, mo­ral or other grounds, ac­cord­ing to the Na­tional Con­fer­ence of State Leg­is­la­tures.

The Dis­ney­land out­break helped spark an ac­ri­mo­nious de­bate over these non-med­i­cal ex­emp­tions. Last month, a Cal­i­for­nia law re­mov­ing the state’s “per­sonal belief” ex­emp­tion took ef­fect, mak­ing Cal­i­for­nia one of three states — along with West Vir­ginia and Mis­sis­sippi — that no longer grant non­med­i­cal ex­emp­tions to vac­cines.

“It’s clear that states with more le­nient ex­emp­tions poli­cies have lower im­mu­niza­tion rates, and it’s these states where we have seen dis­ease out­breaks oc­cur as the rates slip below the thresh­old needed to main­tain com­mu­nity im­mu­nity,” said Dr. Ge­of­frey Si­mon, lead au­thor of the med­i­cal ex­emp­tions policy state­ment. “Non­med­i­cal ex­emp­tions to im­mu­niza­tions should be elim­i­nated.”

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