Saar Kuzi
Alessandra Coutinho Fernandes
William Cope
Richard Tapping
Kashif Ahmad
Reda Sadki
Shubhra Kanti Karmaker Santu
Adam P Rusch
Elle Meisner
Nereyda Ochoa
Landon J. Kunzelman
James DotimasFA16 Immunization Module’s Updates
Spacing Out Vaccines
Immunization schedules, which are set and annually updated by the CDC based on recommendations by the Advisory Committee on Immunization Practices (ACIP), provide ideal age checkpoints for when to give children vaccinations [1]. This may include administering multiple vaccines simultaneously, a fact that has caused many parents to worry whether such a bombardment of shots could be too much for their child’s immune system. In effect, there has been a shift towards spacing immunizations over a longer period of time. Many issues arise from this deviation in schedule, such as prolonged vulnerability to illness, possible trauma/fear from repetitive needle sticks, increased exposure to contagion at multiple office visits, and potential errors in administration due to “non-standard schedule”; this may involve missing doses or receiving extra when unnecessary [2].
In a survey done by the journal Pediatrics, 93% of the participating primary care physicians and pediatricians said they were asked monthly by parents to space out the recommended immunizations. 37% agreed to do so despite acknowledging that this would put the children and community at risk of spreading infectious diseases. Their main reasons were to maintain good rapport with their patients and that if they refused, these same patients would more than likely leave to find a doctor that would agree to space. They also expressed a lot of frustration with not having effective methods of convincing parents to follow the vaccination schedule, especially due to time constraints [3].
I think this raises a lot of questions on where you draw the line between satisfying your patients but also educating and discussing, even if this may cause minor controversy. Even if you disagree, do you still accommodate? Do you refuse and let them leave? Many of us may go into family practice/pediatrics, and so we will be dealing with myriad situations like these involving vaccinations, and I think we should all be aware of how we would go about handling them.
Resources:
[1]: http://www.cdc.gov/vaccines/parents/vaccine-decision/sets-schedule.html
[2]: http://commonhealth.legacy.wbur.org/2011/09/spacing-out-vaccines
[3]: http://time.com/3726887/doctors-space-out-vaccines/
@Daniel Reine I think it is interesting that there are parents that fight to have the vaccinations spread without truly understanding the mechanism and purpose of the vaccinations. I am not surprised that there has been a push for this, but I do wonder if parents would continue to request to have the vaccinations spread out if they had a complete understanding of the dangers associated with their request. @Emily Acton made a great point about needing to have doctors that are good educators so that the parents of the patients are truly aware of the consequences and potential dangers associated with not providing vaccines and or spacing out vaccinations.
Really interesting issue! Thank you for sharing Daniel! Out of curiosity, after reading your post and linked references, I did a general google search about spacing vaccines to see what type of information a parent might encounter online, and found a lot of ambiguous or incorrect information, with many webpages and forums containing what are in essence endorsements for the idea of going against medical recommendations (with accompanying support for these ideas from celebrities and politicians). Additionally, just looking at the public comments below the 2nd article you linked shows so much of the controversy surrounding the issue of vaccine schedules, and how easily inaccurate information can be spread.
I think this really lead to two big realizations for me: Firstly, I think this situation demonstrates how crucial being a good educator is for doctors. On the individual level, ability to communicate correct information in a clear way is the best tool we will have to counter the problematic choice of leaving a child unprotected during the spacing of vaccines, or refusing a patient and risking their departure. More so, I strongly agree with the point in the Times article about the medical organizations needing to make better use of mass media to spread correct information (as my google search showed me it is too easy to find a lot of unfounded information!)
I also wanted to share another interesting article I found about your topic focused more on the patient's perspective : https://www.ncbi.nlm.nih.gov/pubmed/26518397
Thanks again for sharing such an interesting subject!