1. Objection to Immunization of
Children by American Parents
Presenters:
Minerva Sanchez
Amanda Siwek
Julian Prado
2. Defining Terms
A Vaccine is a product that produces immunity from a
disease and can be administered through needles
injections, by mouth, or by aerosol.
A Vaccination is the injection of a killed or weakened
organism that produces immunity in the body against
that organism.
An Immunization is the process by which a person or
animal becomes protected from a disease.
http://www.vaccines.gov/basics/index.html
3. History
1796-1798 Edward Jenner
Protection by Cowpox Infection
http://www.historyofvaccines.org/content/timelines/pioneers
4. History cont.
1879 Louis Pasteur
First Laboratory-developed Vaccine
http://www.historyofvaccines.org/content/timelines/pioneers
5. History cont.
1940-2000 Hilleman
Vaccine for Japanese Encephalitis
Measels
Mumps
Rubella
Hepatitis B
http://www.historyofvaccines.org/content/timelines/pioneers
6. History in the US
In 1855, Massachusetts became the first U.S. state to
require vaccination for schoolchildren.
Today in the United States, all states require that
children be vaccinated for certain diseases before
school entry (the required immunizations vary by
state)
Currently, CDC recommends vaccination against 16
vaccine preventable diseases for children
http://www.historyofvaccines.org/content/articles/cultural-perspectives-vaccination
http://www.cdc.gov/
7. History in the US, Cont.
The resulting recommended vaccination list included
vaccines for seven diseases in the 1970s:
Tetanus
Diphtheria
Pertussis (whooping cough)
Polio
Measles
Mumps
Rubella
Protection for the remaining seven diseases on the
schedule, however, required only three vaccinations:
Polio vaccination
Combined vaccination for Tetanus, Diphtheria, and Pertussis (DTP vaccine)
Combined vaccination for Measles, Mumps, and Rubella (MMR vaccine).
http://www.historyofvaccines.org/content/articles/development-immunization-
8. History in the US, Cont.
As of early 2014, the U.S. immunization schedule for children ages 0-
6 years includes recommendations for the following vaccinations:
Hepatitis B
Rotavirus
Diphtheria, Tetanus, and
Pertussis (combined DTaP
vaccine)
Hib (Haemophilus
influenzae type b)
Pneumococcal
Polio (inactivated vaccine)
Influenza
Measles, Mumps, and Rubella
(combined MMR vaccine)
Varicella (chickenpox)
Hepatitis A
Meningococcal (certain high-
risk groups only)
9. Description of Health Behavior
Opting Out or Delaying Vaccinations
Philosophical beliefs
Personal beliefs, attitudes, lack of knowledge, over-
perception of risks, emotions, moods, past experiences.
Link between Vaccines and Autism
Religion
Adverse side effects
Lifestyle
Myths and misinformation about vaccine safety
abound and can confuse parents who are trying to
make sound decisions about their children's
healthcare.
Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases —
NEJM. (n.d.). Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMsa0806477#t=article
10. PH Significance of Behavior
Statistics
Non-Medical Exemptions
1991-2004 Mean State-Level Increased from 0.98% to
1.48%.
Religious Exemptions
1991-2004 Mean State Level remained at 1%
Philosophical/Personal Beliefs
1991-2004 Mean State-Level Increase from 0.99% to
2.54%.
Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases — NEJM.
(n.d.). Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMsa0806477#t=article
11. PH Significance of Behavior Cont.
According to a periodic survey from the fellows of the American Academy of Pediatrics
(AAP on immunization-administration practices) 7 of 10 pediatricians reported that they
had had a parent refuse an immunization on behalf of a child in the 12 months
preceding the survey. Measles- vaccine was refused most frequently.
12. PH Significance of Behavior Cont.
Exemptions
Religious Reasons (48 States)
Philosophical Reasons (20 States)
Washington State (San Juan County)
Non-compliant or Exempt
72% of Kindergartners
89% of 6th Graders
Highest incidence of Pertussis
http://phes.co/obj/Newengland/Ahmed/Improving%20Childhood%20Vaccination%20Rates
.pdf
13. Intervention in Modifying Behavior
Developing Trust with Provider
Provider and Parent Consult Time
Educate Parents
Risks and Benefits
Provide Informational Pamphlets
Listen to Parent’s concerns
Allow a manageable vaccine schedule
http://pediatrics.aappublications.org/content/118/5/e1287.full
14. Intervention in Modifying Behavior
Cont.
Minimize Financial Barriers
Minimize Language Barriers
Good public health policies balance both individual
rights and community needs. Therefore, public health
officials must recognize and respect diverse social and
cultural perspectives toward immunization policies, to
help support their success and acceptance.
http://pediatrics.aappublications.org/content/118/5/e1287.full
15. Risk Factors
Delayed immunization is a major public health problem-
associated with measles epidemic in recent years
Better financial access to preventive care is a necessary
but not sufficient condition for timely immunization.
There are also social implications of not vaccinating your
child -- from exclusion to quarantine.
If there were no vaccines, there would be many more
cases of disease. Comparing the risk from disease with the
risk from the vaccines can give us an idea of the benefits
we get from vaccination.
16. Risk Factors Continue
The fact is that a child is far more likely to be seriously
injured by one of these diseases than by any vaccine.
A parent must alert medical personal of your child’s
vaccination status
Women who are pregnant but not vaccinated can be
vulnerable to diseases that may complicate their
pregnancy.
People who choose not to vaccinate their children also
put others at risk if their child isn't vaccinated and
becomes ill.
http://www.health.ny.gov/prevention/immunization/vaccine_safety/harm.htm
17. Related Theories:
The Theory of Planned
Behavior
TPB is best suited with the
concepts that are associated
with the attitudes and
behaviors of opting out of
vaccinations.
Parents opt out of having their
children immunized because
of a previous perception
regarding the issue that led
them to having this “planned
behavior”.
Health Behavior Model
The HBM is also a great
model associated with the
objections of immunization in
children, as the perceived
susceptibility and perceived
benefits are related to the
behavior performance, or in
this case attitude toward the
immunization.
Both of the TPB and the HBM represent the health
behaviors in parents on the topic of immunization of
children
18. Vaccines are among the most effective tools available for preventing infectious
diseases and their complications. High immunization coverage has resulted in
drastic declines in vaccine-preventable diseases through “Herd Immunity”.
Outbreaks and clusters of vaccine-preventable diseases often start among persons
who refuse vaccination, which rapidly spread through unvaccinated populations.
Behind every advance in vaccine research, there is a man or woman--often a
group--whose contributions to the field are worthy of historical note. Without
Edward Jenner, smallpox could not have been defeated. Without Jonas Salk and
Albert Sabin, polio might still be spreading, unchallenged, throughout the world.
The discoveries that seem smaller, or were not publicly heralded in their time, are
no less important. Thomas Peebles made a trip to a private school outside of
Boston to collect blood from measles patients in 1954; the strain of measles virus
he isolated from a student named David Edmonston is still used in measles
vaccines today. In 1961, a poultry farm employee named W.F. Lamoreux bonded
with Maurice Hilleman over both being born in Montana. The descendants of the
flock of specially bred chickens Lamoreux sold to Hilleman are still being used to
create vaccines at Merck.
Vaccines Save Lives!
Conclusion
http://www.historyofvaccines.org/content/timelines/pioneers
20. References
Association Between Health Care Providers' Influence on
Parents Who Have Concerns About Vaccine Safety and
Vaccination Coverage. (June). Retrieved June 11, 2014, from
http://pediatrics.aappublications.org/content/118/5/e1287.full
Basics | Vaccines.gov. (n.d.). Retrieved June 6, 2014, from
http://www.vaccines.gov/basics/index.html
Diekema, D. S. (2012). Improving Childhood Vaccination Rates.
New England Journal of Medicine, 366(5), 391-393. doi:
10.1056/NEJMp1113008
Pioneers. (n.d.). Retrieved June 6, 2014, from
http://www.historyofvaccines.org/content/timelines/pioneers
Vaccine Refusal, Mandatory Immunization, and the Risks of
Vaccine-Preventable Diseases — NEJM. (n.d.). Retrieved from
http://www.nejm.org/doi/full/10.1056/NEJMsa0806477#t=article
21. Bocian, Alison B., et al. "Association between parents'
preferences and perceptions of barriers to vaccination and the
immunization status of their children: a study from pediatric
research in office settings and the national medical
association." Pediatrics Dec.2002: 1110
Diekema, Douglas S. "Responding to parental refusals of
immunization of children." Pediatrics, Vol. 115 No. 5 May1,
2005 pp. 1428 -1431 (doi: 10.1542/peds.2005-0316)
The History of Vaccines. (2014). Cultural Perspectives on
Vaccination. A Project of The College of Physicians of
Philadelphia. Retrieved from
http://www.historyofvaccines.org/content/articles/
Graff, Amy. (2014) State-by-state look at how many parents aren’t
vaccinating their children. SFGate. Hearst Newspapers.
Retrieved from http://blog.sfgate.com/sfmoms/2014/02/19/state-
by-state-look-at-how many-parents-arent-vaccinating-
their-children/
References
22. Centers for Disease Control and Prevention. Vaccine
Safety. Retrieved on 03 June 2014. Retrieved from
http://www.cdc.gov/vaccinesafety/Vaccines/multiplevaccine
s.html.
Department of Health. The Harm of Skipping Vaccination or
Delaying. Retrieved on 03 June 2014. Retrieved from
http://www.health.ny.gov/prevention/immunization/vaccine_
safety/harm.htm
World Health Organization. Health Topics: Immunization.
Retrieved on 10 June 2014. Retrieved from
http://www.who.int/topics/immunization/en/
References
Editor's Notes
9/19/2015
Vaccines cause immunization, and there are also some diseases that cause immunization after an individual recovers from the disease.
According to the World Health Organization (WHO): Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to avert between 2 and 3 million deaths each year. It is one of the most cost-effective health investments, with proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations. It has clearly defined target groups; it can be delivered effectively through outreach activities; and vaccination does not require any major lifestyle change.
In the late eighteenth century, Edward Jenner, an English physician, observed that dairymaids infected by cowpox, a disease caught from cows with symptoms very similar to those of smallpox, then became immune to smallpox. He concluded that cowpox provided protection against the disease.
In 1796, he drew pus from the hand of a woman with cowpox and used it to inoculate an eight-year-old boy. The boy fell ill, but recovered very quickly. Three months later, the child was inoculated with smallpox and showed no signs of infection. Jenner repeated the experiment several times and published his findings in 1798. It was he who coined the term "vaccination", based on the Latin word vaccinus meaning "from cows". It now designates the process of inoculating weakened or dead pathogens to confer immunity to a disease.
Louis Pasteur produced the first laboratory-developed vaccine: the vaccine for chicken cholera (Pasteurella multocida).
Pasteur attenuated, or weakened, the bacteria for use in the vaccine. He happened upon the method of attenuation by accident: in his lab, he was studying fowl cholera by injecting chickens with the live bacteria and recording the fatal progression of the illness. He had instructed an assistant to inject the chickens with a fresh culture of the bacteria before a holiday. The assistant, however, forgot. When the assistant returned a month later, he carried out Pasteur’s wishes. The chickens, while showing mild signs of the disease, survived. When they were healthy again, Pasteur injected them with fresh bacteria. The chickens did not become ill. Pasteur eventually reasoned the factor that made the bacteria less deadly which was exposure to oxygen.
Maurice Hilleman helped develop a Japanese encephalitis vaccine to protect American troops in WWII. It was never widely tested but given to thousands of U.S Soldiers and likely prevented disease in many of them.
The daughter of Dr. Hilleman Jeryl Lynn Hilleman was 5 years old when she got mumps back in 1963 and her father, Dr. Hilleman, took swabs that yielded the strains used to develop a vaccine. Dr. Hilleman later combined it with measles and rubella vaccines to offer a single M.M.R. shot.
We don't vaccinate just to protect our children. We also vaccinate to protect our grandchildren and their grandchildren. With one disease, smallpox, we "stopped the leak" in the boat by eradicating the disease. Our children don't have to get smallpox shots any more because the disease no longer exists. If we keep vaccinating now, parents in the future may be able to trust that diseases like polio and meningitis won't infect, cripple, or kill children. Vaccinations are one of the best ways to put an end to the serious effects of certain diseases. ~CDC
In addition, the 7-18 years schedule recommends human papillomavirus (HPV) vaccination and meningococcal vaccination.
These schedules are reviewed annually; new vaccines are considered for addition to the schedule after licensure, though not all licensed vaccines are added to the schedule. (The yellow fever vaccine, for example, is unlikely to be added to the schedule, as only individuals traveling to yellow fever endemic areas need to be vaccinated against it.)
Parents are opting out or delaying vaccinating their children due to many factors some of which include: Personal beliefs, attitudes, lack of knowledge overperception of risks, emotions, moods, past experiences.
Other reasons parents are opting out of vaccinating their children are due to adverse side effects, religious beliefs, and also the belief of a link between Autism and Vaccines. Another reason are Myths and misinformation about vaccine safety which can confuse parents who are trying to make sound decisions about their childrens healthcare.
One U.S. study showed that children with nonmedical vaccination exemptions were 35 times more likely to contract measles than vaccinated children.
Lifestyle may also be a reason of why a parents would opt out of vaccinating. Parents may feel that their healthy lifestyle may promote their children’s health, and the risk of an infectious disease is reduced.
Recent parental concerns about perceived vaccine safety issues, such as a reported association between vaccines and autism, though not supported by a credible body of scientific evidence, has led increasing numbers of parents to refuse or delay vaccination for their children.
There has been an increase in state-level rates of nonmedical exemptions from immunization requirements. Between 1991 and 2004, the mean state-level rate of nonmedical exemptions increased from 0.98 to 1.48%. The increase in exemption rates was not uniform. Exemption rates for states that allowed only religious exemptions remained at approximately 1% between 1991 and 2004; however, in states that allowed exemptions for philosophical or personal beliefs, the mean exemption rate increased from 0.99 to 2.54%.
All states allow exemptions for medical reasons, 48 for religious reasons, and 20 for philosophical reasons. Exemption rates vary widely, from less than 0.1% among kindergarteners in Mississippi to 6.2% among those in Washington State. Moreover, within Washington State, in the year 2010–2011 exemption rates for K–12 grade students varied significantly by county, ranging from 1.2% to 25.4%.
In Washington State’s San Juan County, for example, 72% of kindergartners and 89% of sixth graders are either non-compliant with or exempt from vaccination requirements for school entry. Only 52% of kindergartners and 4% of sixth graders were adequately immunized against pertussis for the 2010-2011 school year. San Juan is the county with the state’s highest incidence of pertussis.
Medical Exemption: The child’s immune status is compromised by a permanent or temporary condition
The child has a serious allergic reaction to a vaccine component.
The child has had a prior serious adverse event related to vaccination.
Religion Exemption: Some states statutes indicate that to receive a religious exemption, a family must belong to a religious group with bona fide objections to vaccination. They may, as Iowa does, ask a parent to attest that "immunization conflicts with a genuine and sincere religious belief and that the belief is in fact religious, and not based merely on philosophical, scientific, moral, personal, or medical opposition to immunizations." Other states simply require that a parent sign a form stating that he or she has religious objections to vaccination.
Personal Exemption: In most cases, parents must file a one-time or annual form with a school district attesting to a personal objection to vaccination. In states with all three types of exemptions, personal belief exemptions tend to be most common. And, in states that allow philosophical and personal exemptions from vaccination requirements, such exemptions increased from 0.99 to 2.45% between 1991 and 2004.
HealthCare Providers should listen carefully and respectfully to parents concerns. They should be knowledgeable about the risks and benefits of vaccines so that misinformation and misconceptions may be corrected. Taking steps to reduce the pain of injection and permit a schedule of immunization that minimizes the number of injections at a single visit.
Work with parents so that any financial barriers to vaccination are eliminated or minimized and build a respectful relationship with parents so that the parents’ decision not to vaccinate their children can be revisited.
Minimize Language barriers by providing information about vaccines in several languages.
Good public health policies balance both individual rights and community needs. Therefore, public health officials must recognize and respect diverse social and cultural perspectives toward immunization policies, to help support their success and acceptance.
Yet all public health interventions, including vaccination, include health risks. In addition, individualism is a strong tenet of U.S. citizens’ ideals and values. Thus, individuals want to exercise their right to protect themselves and/or their children if they do not accept existing medical evidence about the relative safety of vaccines, or if their ideological beliefs do not support vaccination
3. If sick or exposed to disease, your child may need to be isolated from others, including family. If there is an outbreak in your community, you may be asked to take your child out of school and other organized activities, causing your child to miss school and special events. Your child's illness or inability to go about their daily activities also may impact your work and household income.
The benefits of vaccination greatly outweigh the slight risk, and more injuries and deaths would occur without vaccinations.
2. because unvaccinated children can require treatment that is out of the ordinary, medical staff may be less familiar, and less experienced, with the procedures required to appropriately treat your child.
3. A pregnant woman who contracts rubella in the first trimester may have a baby with congenital rubella syndrome (CRS), which can cause heart defects, developmental delays and deafness.
5. Special groups of people cannot be vaccinated, including those with compromised immune systems (e.g. those with leukemia or other cancers). These people rely on the general public being vaccinated so their risk of exposure is reduced.
The threat of death by disease isn't the only medical consequence of skipping vaccinations. An unvaccinated child faces lifelong differences that could potentially put him or her at risk.
