personal belief exemptions to required immunizations: putting a new law into practice

Personal Belief Exemptions to Required Immunizations: Putting a New Law Into Practice

Personal Belief Exemptions to Required Immunizations: Putting a New Law Into Practice

Dean A. Blumberg, MD, FAAP– Disclosure

» speakers bureau: sanofi pasteur– Discussion: “off label” use of FDA

approved vaccines Catherine Martin

– Nothing to disclose

Parental vaccine safety concerns– Increase in personal belief exemptions (PBEs)– Consequences of PBEs

PBE policies– Exemption policies and exemption rates– Washington experience

AB2109– Summary– Governor’s signing statement– Implementation

Provider’s role– Resources

Questions

Personal Belief Exemptions to Required Immunizations: Putting a New Law Into Practice

Vaccine-Preventable Diseases:Baseline 20th Century & Current Morbidity

MMWR 1999;48:245, 2013;62(33)

Vaccine Adverse Event Myths

No credible scientific evidence that vaccines cause:– autism– multiple sclerosis– diabetes– asthma– inflammatory bowel disease– SIDS– overwhelm immune system

Monday, February 17, 2014

New slide

1977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

PME PBE

Year of Assessment

Perc

ent o

f Stu

dent

s

Lee et al NVIC 2010

Permanent Medical Exemptions & Personal Beliefs Exemptions, Kindergarten Students, California

Refused pertussis vaccination• 22.8 times increased risk of pertussis

Invasive H. influenzae Type B Disease

MMWR 11/98 47:993, 1999;47:38,77, 2002;51:234

conjugatesconjugates

infants

*est.

parent/guardian deferral or refusel

Marin et al Pediatrics 2011;128:214

Varicella Mortality Rates, United States

Refused varicella vaccination– 8.6 times increased risk of varicella

2009

Lee et al NVIC 2010

Kindergarten PBEs by County2000

Dean, I inserted this next slide as it compares 10 years vs 9 years, - use whichever one you prefer

PBEs Among Children Entering Kindergarten

2000 2010

New slide

Vaccination Policies & Rates of Exemption

Omer et al NEJM 2012;367:1170

Vaccination Policies & Rates of Exemption

Omer et al NEJM 2012;367:1170

Vaccination Policies & Rates of Exemption

Omer et al NEJM 2012;367:1170

July 2011

AB2109 Genesis

Objective– change PBE: Washington State as a model

Coalition– California Immunization Coalition– American Academy of Pediatrics, CA– California Academy of Family Physicians– California Medical Association– Health Officers Association of California

AB2109: Implementation Effective January 1, 2014 Parents wanting to exempt their children

from one or more required immunizations– must use form

Students affected– newly admitted to CA school (K-12th)– advancing to 7th grade– newly admitted to child care

Form must be signed no sooner than 6 months before admission to school/child care/advancing to 7th grade

AB2109: Health Care Providers

Provide information– benefits and risks of required immunizations– health risks of specific vaccine-preventable

diseases to child and community Sign form along with parent

– only parent signs for religious exemption Who can sign form

– MD, DO, NP, PA, naturopathic doctor, credentialed school nurse

Parental Immunization Refusal

Listen carefully to concerns– encourage questions

Discuss known risks and benefits– risks to unimmunized child

Concerns about specific vaccines– discuss– administer other vaccines

Multiple injection concerns– modify schedule

Revisit discussion in future visits Document

Vaccine Safety Discussion Strategies

Empathize: acknowledge that there are many conflicting messages in the media

Assess level of scientific evidence desired Maximize benefits to their child

– not a public health discussion– vaccines provide protection– risk of disease for omitted vaccines

Provide appropriate resources

Continued Vaccine Refusal

Challenges– time commitment for discussions

» frustration “Fire” patient from practice/clinic?

– acknowledge differences» “it sounds like you and I have different

philosophies”– agree to disagree on this subject

MMWR 1999;48:241

AB2109: Summary

Personal belief exemptions rising– linked to increased risk of vaccine-preventable

diseases among those exempted and their community

New exemption process in California in 2014– effect on exemption rate?

Educational Resources

ImmunizeCA.org

Provider Resources for Vaccine Conversations with Parents

• Updated information to help healthcare professionals talk to parents about:

• Vaccines• Vaccine-preventable diseases• Vaccine safety

• Resources healthcare professionals can give parents

www.cdc.gov/vaccines/conversations

www2.aap.org/immunization/families/families.html

American Academy of Pediatrics

Childhood Immunization Support Program

(CISP)

www.immunizationinfo.org/professionalsNational Network for Immunization Information

Children’s Hospital of PhiladelphiaVaccine Education Center

www.chop.edu/service/vaccine-education-center

Immunization Action Coalition (IAC)www.immunize.org

February 18, 2014CDPH Webinar

ShotsforSchool.org

Vaccine Safety Concerns: Resources

CDC– www.cdc.gov/vaccinesafety/index.html

AAP– www2.aap.org/immunization/families/safety.html

NNII– www.immunizationinfo.org/professionals

CHOP– www.chop.edu/service/vaccine-education-center/vaccine-

safety Shots for School

– www.shotsforschool.org

For more information:

Shotsforschool.org

info@immunizeca.org