• Improving vaccination rates in children

    Having trained and practiced in various areas across the country, I’ve seen wide variation in the ways parents choose to care for their children. For instance, when I was in Seattle, it seemed that far more mothers chose to breast feed their children than here in Indiana. On the other hand, it felt like far more parents refused vaccinations for their children in Seattle. There’s a piece in the NEJM right now (written by Doug Diekema, an emergency physician I remember well from my time at Seattle Children’s) that confirms this perception:

    At first glance, U.S. vaccination rates appear reasonable: coverage among children entering kindergarten exceeds 90% for most recommended vaccines. A closer look, however, reveals substantial local variation. In Washington State’s San Juan County, for example, 72% of kindergartners and 89% of sixth graders are either noncompliant with or exempt from vaccination requirements for school entry. Only 52.5% of kindergartners and 4% of sixth graders were adequately immunized against pertussis for the 2010–2011 school year. Not surprisingly, the county also has one of the state’s highest incidence rates of pertussis.

    Undervaccination has consequences, not only just for those who don’t get the vaccines:

    In 2010, California reported over 9000 cases of pertussis — more than the state had seen since 1947. Of these, 89% occurred among infants younger than 6 months, a group too young to be adequately immunized and largely dependent on herd immunity for protection from infection. Ten of these infants died from their infection.

    As I’ve often said, you don’t vaccinate your children just to protect them. You do it also to protect those who can’t protect themselves.

    Doug also has some thoughts on how to make things better that are pretty well thought out:

    Because parents who oppose vaccination on the basis of personal beliefs will probably remain opposed despite the best efforts of clinicians and public health experts, the most effective way to increase vaccine coverage is to improve immunization rates among children whose parents either are open to vaccination but encounter barriers to obtaining vaccines or hesitate because of fears and concerns about safety. Health care professionals, health care organizations, and state and federal policymakers all share responsibility in this endeavor.

    First, socioeconomic barriers and disincentives to vaccination should be eliminated…

    Second, school-entry requirements should be strengthened and enforced…

    Third, misinformation regarding vaccines must be addressed promptly and aggressively…

    Fourth, clinicians, health care organizations, and public health departments must learn to use the tools of persuasion effectively.

    He ends with a suggestion with which I agree wholeheartedly:

    Finally, clinicians must set an example. We’re unlikely to achieve optimal vaccination rates until health care professionals comply with vaccine recommendations for themselves and their children. The unwillingness of many clinicians to submit to influenza vaccination each year is disgraceful, sets a poor example, and gives patients reason to question the safety and efficacy of vaccines. A logical place to begin increasing public confidence in vaccines is with the example we set.

    Vaccinate your children. Vaccinate yourselves.

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    • If only 4% of 6th graders are adequately immunized, that means that the standards are not being communicated to health care providers and parents, since it is implausible that only 4% of parents are willing to follow the recommended health advice for their children.

      It would be interesting to see how changes in the average health plan coverage for prevention impact the chances that kids have routine annual health checks.