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Personal Belief Exemptions to Required Immunizations: Putting a New Law Into Practice

Personal Belief Exemptions to Required Immunizations: Putting a New Law Into Practice. Personal Belief Exemptions to Required Immunizations: Putting a New Law Into Practice. Dean A. Blumberg, MD, FAAP Disclosure speakers bureau: sanofi pasteur

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Personal Belief Exemptions to Required Immunizations: Putting a New Law Into Practice

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  1. Personal Belief Exemptions to Required Immunizations: Putting a New Law Into Practice

  2. Personal Belief Exemptions to Required Immunizations: Putting a New Law Into Practice • Dean A. Blumberg, MD, FAAP • Disclosure • speakers bureau: sanofipasteur • Discussion: “off label” use of FDA approved vaccines • Catherine Martin • Nothing to disclose

  3. Personal Belief Exemptions to Required Immunizations: Putting a New Law Into Practice • Parental vaccine safety concerns • Increase in personal belief exemptions (PBEs) • Consequences of PBEs • PBE policies • Exemption policies and exemption rates • Washington experience • AB2109 • Summary • Governor’s signing statement • Implementation • Provider’s role • Resources • Questions

  4. Vaccine-Preventable Diseases:Baseline 20th Century & Current Morbidity MMWR 1999;48:245, 2013;62(33)

  5. Vaccine Adverse Event Myths • No credible scientific evidence that vaccines cause: • autism • multiple sclerosis • diabetes • asthma • inflammatory bowel disease • SIDS • overwhelm immune system

  6. Monday, February 17, 2014 New slide

  7. Permanent Medical Exemptions & Personal Beliefs Exemptions, Kindergarten Students, California Lee et al NVIC 2010

  8. Refused pertussis vaccination • 22.8 times increased risk of pertussis

  9. Invasive H. influenzae Type B Disease conjugates infants conjugates *est. MMWR 11/98 47:993, 1999;47:38,77, 2002;51:234

  10. parent/guardian deferral or refusel

  11. Varicella Mortality Rates, United States Marin et al Pediatrics 2011;128:214

  12. Refused varicella vaccination • 8.6 times increased risk of varicella

  13. Kindergarten PBEs by County 2000 2009 Lee et al NVIC 2010

  14. Dean, I inserted this next slide as it compares 10 years vs 9 years, - use whichever one you prefer

  15. New slide

  16. Vaccination Policies & Rates of Exemption Omer et al NEJM 2012;367:1170

  17. Vaccination Policies & Rates of Exemption Omer et al NEJM 2012;367:1170

  18. Vaccination Policies & Rates of Exemption Omer et al NEJM 2012;367:1170

  19. July 2011

  20. AB2109 Genesis • Objective • change PBE: Washington State as a model • Coalition • California Immunization Coalition • American Academy of Pediatrics, CA • California Academy of Family Physicians • California Medical Association • Health Officers Association of California

  21. AB2109: Implementation • Effective January 1, 2014 • Parents wanting to exempt their children from one or more required immunizations • must use form • Students affected • newly admitted to CA school (K-12th) • advancing to 7th grade • newly admitted to child care • Form must be signed no sooner than 6 months before admission to school/child care/advancing to 7th grade

  22. AB2109: Health Care Providers • Provide information • benefits and risks of required immunizations • health risks of specific vaccine-preventable diseases to child and community • Sign form along with parent • only parent signs for religious exemption • Who can sign form • MD, DO, NP, PA, naturopathic doctor, credentialed school nurse

  23. Parental Immunization Refusal • Listen carefully to concerns • encourage questions • Discuss known risks and benefits • risks to unimmunized child • Concerns about specific vaccines • discuss • administer other vaccines • Multiple injection concerns • modify schedule • Revisit discussion in future visits • Document

  24. Vaccine Safety Discussion Strategies • Empathize: acknowledge that there are many conflicting messages in the media • Assess level of scientific evidence desired • Maximize benefits to their child • not a public health discussion • vaccines provide protection • risk of disease for omitted vaccines • Provide appropriate resources

  25. Continued Vaccine Refusal • Challenges • time commitment for discussions • frustration • “Fire” patient from practice/clinic? • acknowledge differences • “it sounds like you and I have different philosophies” • agree to disagree on this subject

  26. MMWR 1999;48:241

  27. AB2109: Summary • Personal belief exemptions rising • linked to increased risk of vaccine-preventable diseases among those exempted and their community • New exemption process in California in 2014 • effect on exemption rate?

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