Decisions about childhood immunizations ultimately rest with parents.  Still, concerned parents are pitted against public health experts in a tense debate around the pros and cons of vaccinating kids.  As more and more families refuse the battery of shots which protect children against diseases such as meningitis and pertussis, public health risks rise for everyone.  Yet, the concept of "vaccination for public good" is not one that is broadly understood by the general public.  We, as nurses, are well-positioned to arm our clients with facts about immunizations' safety and importance in order to help families make informed decisions.

Alarmingly, two months ago 12 San Diego children contracted measles, an illness that can lead to pneumonia, cerebral edema, and death when unchecked.  Measles was all but eliminated in this country thanks to the success of childhood immunization programs.  It now appears to be making a comeback. 

Twenty US states allow parents to refuse vaccination on personal grounds.  Often, those who opt out of inoculating their children against diseases such as measles fear links between the vaccines and the later development of autism or other neurological disorders.  The number of Americans refusing vaccination has nearly tripled in the last 15 years.

Parents who decide not to vaccinate their children tend to do so for two reasons.  They believe that they are protecting their children from presumed risks of virus-based inoculations.  They also feel that their children will be safe from diseases like measles due to the "herd" factor.  The theory holds that vaccinated children cannot act as vectors to spread illness.  Subsequently, unvaccinated children will be protected by association with the vast majority of children who have been immunized.

However, there are important flaws in this logic.  Firstly, vaccines are not 100 percent effective.  The measles vaccine, for example, is only 95 percent effective.  Further, vaccinations are given according to a schedule.  If a given disease is reintroduced to a population, children who are too young for certain vaccinations are particularly vulnerable to infection and able to spread that infection.

Mass vaccination campaigns and the introduction of vaccination timelines into pediatric standards of care have yielded enormous public health gains.  However, these very successes may have lulled the public into a dismissive approach toward illnesses which, when contracted, can be serious and frightening.  Physicians and public health officials blame unofficial websites and other non-scientifically based sources for proliferating fear-based agendas about the dangers of immunizations.  Well-educated, economically privileged, and well-intended parents are especially susceptible to such messages. 

As health care providers, we are charged with the task of providing evidence-based information.  Only parents who are given complete counseling about the risks and benefits of vaccination both for individual children and for the community at large can make informed decisions. Parents can be encouraged to bring printed information with them to appointments so that we can help them to tease fact from fiction.  We can also steer clients toward verified and legitimate websites, such as the CDC website, or the website of the American Academy of Family Physicians, for further evidence-based discussions surrounding childhood vaccinations.

References

Steinhauer, J. (2008, March 21). Public Health Risk Seen as Parents Reject Vaccines. New York Times.

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