Parents reluctant to have their children immunized against common diseases present a frequent, often daunting challenge to family physicians and pediatricians. “There are many reasons parents may want to avoid vaccinations for their kids,” says Robert Brayden, MD, professor of pediatrics at University of Colorado and board president of the Colorado Children’s Immunization Coalition. “Some are concerned about mercury [used in vaccines as a preservative] — they fear it can cause seizures or nervous system disorders. Some worry about aluminum, a vaccine adjuvant, stimulating an immune system response. Others believe vaccine manufacturers give physicians financial incentives to immunize patients.”
Robert Brayden, MD (photo from childrenscolorado.org)
For the record:
Mercury is an ingredient in the preservative thimerosol, discontinued or used in only trace amounts in children’s vaccines since 2001. Extensive research has shown that vaccines containing thimerosol do not cause autism. The reduction or elimination of thimerosol in vaccines came as part of a general move to discontinue mercury in all products, although the type of mercury in thimerosol is not the same as the mercury that poses a health hazard in some seafood and other sources.1
The levels of aluminum in vaccines are not dangerous to an infant’s or child’s health and actually stimulate a more prolonged immune response. Aluminum is a common element in the natural environment and appears in air, water, soil, food, breast milk and infant formula.2
Physicians often lose money on vaccines. But recognizing their life-saving benefits, doctors encourage immunizations to keep children healthy and to safeguard the health of the general population.3
Brayden’s approach to hesitant parents begins with communication. “I encourage people to discuss their concerns and I truly listen.” Then he uses the example of a disease — tetanus, which is not transmitted person-to-person — and the vaccine that prevents it. Because the tetanus bacterium is found universally in soil, it threatens every human being. The disease it causes is characterized by jaw spasms (“lockjaw”), stiff neck, difficulty swallowing and stiff abdominal muscles. Tetanus can also cause fever, sweating, elevated blood pressure and rapid heart rate. The disease can be cured with weeks of intensive treatment, but 10 percent of its victims die.4
Martha Johns, MD, MPH, FACPM, HealthTeamWorks medical director for Guidelines and Implementation, agrees with Brayden that the clinician must start by listening to parents’ concerns. In addition to emphasizing vaccines’ ability to protect against a host of serious illnesses, she describes the importance of "herd immunity." "Herd immunity protects unimmunized individuals from the contagious disease because a critical percentage of members of the community are immunized and the disease does not easily spread, reducing the probability of infection throughout a population," Johns says.
Brayden notes that vaccination has dramatically reduced the worldwide rate of tetanus. “If we had the health system of Somalia, we’d have 53 million cases of tetanus a year worldwide.” Because of vaccination, there were fewer than 10,000 reported cases in 2010.5 “If the world had the U.S. rate of tetanus immunization, there would be only 630 cases a year,” Brayden says.
He estimates that 3 percent of his patients don’t receive immunizations because of parents’ wishes, and that about 7 percent of children seeking to enroll in school have incomplete immunization records. (Colorado schools require that children show proof of vaccination against preventable diseases.)
Ultimately, “It’s important to keep one’s emotions out of this discussion,” Brayden says. “If a parent decides not to immunize, thinks you’re full of bunk, then people have to agree to disagree. I can’t make everybody see the benefit of vaccines. We can’t prevent every bad outcome. I just have to think I did the best I could.”
HealthTeamWorks has posted the 2012 immunization schedules for children and adolescents on our website. The schedules endorse those approved by the Advisory Committee on Immunization Practices, the American Academy of Pediatrics and the American Academy of Family Physicians.
1. Immunize Colorado. Fact or fiction – Thimerosol. www.immunizeforgood.com/fact-or-fiction/thimerosal, accessed March 1, 2012.
2. Immunize Colorado. Fact or fiction – Aluminum. www.immunizeforgood.com/fact-or-fiction/aluminum, accessed March 1, 2012.
3. Immunize Colorado. Fact or fiction – Vaccines are money-makers for docs? www.immunizeforgood.com/fact-or-fiction/vaccines-are-money-makers-for-docs, accessed March 1, 2012.
4. Immunization Action Coalition. www.vaccineinformation.org/tetanus/qandadis.asp, accessed March 1, 2012.
5. World Health Organization. Immunization surveillance, assessment and monitoring – Tetanus. www.who.int/immunization_monitoring/diseases/tetanus/en/index.html, accessed March 1, 2012.