personal belief exemptions to required immunizations: putting a new law into practice
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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 - PowerPoint PPT PresentationTRANSCRIPT
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
