Vaccine refusals and mandatory immunizations

[Deetee]

Seen the NEJM article on this subject yet?

Ivor would be interested in this bit:

Some clinicians have discontinued or have considered discontinuing their provider relationship with families that refuse vaccines.60,61 In a national survey of members of the American Academy of Pediatrics, almost 40% of respondents said they would not provide care to a family that refused all vaccines, and 28% said they would not provide care to a family that refused some vaccines.61

 

[jasonpatterson]

I wonder how many they actually turn away. Saying you will refuse someone is a lot easier than actually doing it.

These kids, though their parents are idiots, still need medical care. Their refusal could and should be met with strong, persistent opposition, but not working with them at all seems almost childish. After all, will cardiologists quit working with people who have heart problems but refuse to quit smoking and eating big macs by the dozen? At least in that case it's the patient who is hurting himself. In this case, it's the health of an innocent kid that is at stake.

 

[Beth]

Seen the NEJM article on this subject yet?

No I hadn't. Thanks for posting the link. I was interested to see that the level of exemptions being granted is still quite low "in states that allowed exemptions for philosophical or personal beliefs, the mean exemption rate increased from 0.99 to 2.54%."
So we really aren't talking about a very big percentage of the population even in areas with liberal policies regarding exemptions.

However, I didn't quite understand this part:

In a retrospective cohort study in Colorado based on data for the years 1987 through 1998, children with exemptions, as compared with unvaccinated children, were 22 times as likely to have had measles (relative risk, 22.2; 95% CI, 15.9 to 31.1) and almost six times as likely to have had pertussis (relative risk, 5.9; 95% CI, 4.2 to 8.2).3

Do you think they meant vaccinated as opposed to unvaccinated?

The recommended approach is one I can support:"The committee advises against more serious action in a majority of cases: "Continued refusal after adequate discussion should be respected unless the child is put at significant risk of serious harm (e.g., as might be the case during an epidemic). Only then should state agencies be involved to override parental discretion on the basis of medical neglect."

In other words, it's best to respect the parents decision even if you don't agree with it unless the risks to the child are much higher than normal.

The conclusion seemed quite sound as well. I particularly liked this part.

f the enormous benefits to society from vaccination are to be maintained, increased efforts will be needed to educate the public about those benefits and to increase public confidence in the systems we use to monitor and ensure vaccine safety.

 

[juryjone]

At least in that case it's the patient who is hurting himself. In this case, it's the health of an innocent kid that is at stake.

Not just that one innocent kid, but ALL the innocent kids the doctor treats in his practice. Dana McCaffrey was at a daycare center for 5 minutes and caught the whooping cough that ended her life at 4 weeks. If I were a doctor, I would also want to eliminate, as far as possible, any chance my patient could catch a fatal disease in the waiting room just because some idiot won't immunize their own kid.

For that reason, I think it might be easier than you suppose to turn away unvaccinated children.

 

[Skeptic Ginger]

I wonder how many they actually turn away. Saying you will refuse someone is a lot easier than actually doing it. ....

Despite the attention the antivaxxers get, they still represent a small number of people. So docs wouldn't be turning away all that many patients.

 

[Skeptic Ginger]

...Do you think they meant vaccinated as opposed to unvaccinated?

I'm pretty sure it's a typo.

...The conclusion seemed quite sound as well. I particularly liked this part....

The conference on vaccines I attended last month was focused on addressing the antivaxers for the first time as far as vaccine conferences I have been to. I think I mentioned in another thread I was pleased to see the CDC had a "communication science" position. They are seriously looking at barriers and facilitators to communicating vaccine safety and risk perception of vaccine preventable infections.

 

[dingogirl]

Not just that one innocent kid, but ALL the innocent kids the doctor treats in his practice. Dana McCaffrey was at a daycare center for 5 minutes and caught the whooping cough that ended her life at 4 weeks. If I were a doctor, I would also want to eliminate, as far as possible, any chance my patient could catch a fatal disease in the waiting room just because some idiot won't immunize their own kid.

For that reason, I think it might be easier than you suppose to turn away unvaccinated children.

So the child that Dana caught pertussis from was unvaccinated? If we want to protect people from catching pertussis in the doctor's office, doctors would have to ban anyone who's coughing, regardless of vaccine status.

“The prevailing opinion among experts is that there are about a million cases of pertussis among adolescents and adults in the United States annually,” said Michael E. Pichichero, MD, Professor of Microbiology and Immunology at the University of Rochester in New York. “Although the reported incidence according to the CDC in 2004 was only about 20,000, this is thought to be an underestimate by about 100-fold. I’ve seen estimates of one to three million cases per year,” he emphasized. “Based on data from Massachusetts, it would appear that about two thirds of those cases are occurring in adolescents, and one third are occurring in adults.”

Therefore, it would be wise for everyone to get boosters every ten years.

 

[Skeptic Ginger]

So the child that Dana caught pertussis from was unvaccinated? If we want to protect people from catching pertussis in the doctor's office, doctors would have to ban anyone who's coughing, regardless of vaccine status.

From the files of a really bad analogy.....


Clearly you are leaving out the part about willful endangerment.

 

[dingogirl]

I agree that unvaccinated children with whooping cough should be banned from the doctor's office. (Although I think most would just go to a naturopath) I'm just saying that if your goal is to protect people from whooping cough in the doctor's office, you would have to ban anyone with a cough.

 

[Dancing David]

You can't really ban infected people from the doctor's office.

Um, 'whooping couch' is very common amongst the host population, many adults have it and pass it around, 'a persistent cold'. Now the issue is that children having smaller bodies and less developed immune systems are more likely to suffer negative consequences.

Back to the OP, in my younger years when my daughter was born, one of her cohort at day care was unvaccinated. But a MD or someone at his office had filled out the forms that he was vaccinated. I do not know whats states require a doctor's office to certify the vaccinations.

Oral report by the parents may be acceptable in many states.

 

[Eos of the Eons]

Doctors quite often will stop seeing patients that don't follow their advice. They will often try to refer them to someone else first though, and hope they will listen to another doctor.

Once a physician/patient relationship is established, the general rule is that a physician has a duty to continue to provide care to the patient until that relationship is terminated by the mutual consent of the physician and patient, the patient’s dismissal of the physician, the services of the physician are no longer needed or the physician properly withdraws from the physician/patient relationship.

Both the ethical opinions and legal precedents agree that a physician may not intentionally and unilaterally sever an existing relationship with any patient, unless the physician provides reasonable notice to the patient, in writing, and sufficient time to locate another physician.

http://www.physiciansnews.com/law/202.html

I mean, how do treat someone that won't take your directions/advice? The doctor doesn't have to sit around and watch the train wreck they know is going to happen. They have rights too.

 

[blutoski]

I mean, how do treat someone that won't take your directions/advice? The doctor doesn't have to sit around and watch the train wreck they know is going to happen. They have rights too.

Yes, the immunization discussion may have just been one part of a larger breakdown of the relationship. The patient may be calling the doctor incompetent or a murderer, and nobody has to take that.

 

[empeake]

Are immunizations mandatory in the United States?

I ask because here in Mexico, they are for all children under the age of six. Also, beginning this year, they will also be mandatory for teenagers, men, women, and senior citizens that are treated in the National Health System (for those that receive treatment elsewhere, they are voluntary).

Also, you can't get a kid into any school (public or private) or government day-care center (and most private ones) if their National Immunization Record does not show the vaccinations are up to date. There is no getting around this based on personal or religious beliefs, as far as I know.

 

[drkitten]

Are immunizations mandatory in the United States?

I ask because here in Mexico, they are for all children under the age of six. Also, beginning this year, they will also be mandatory for teenagers, men, women, and senior citizens that are treated in the National Health System (for those that receive treatment elsewhere, they are voluntary).

Also, you can't get a kid into any school (public or private) or government day-care center (and most private ones) if their National Immunization Record does not show the vaccinations are up to date. There is no getting around this based on personal or religious beliefs, as far as I know.

That's the big difference. In the USA, almost everything needs to have a method of getting around it based on religious beliefs. So, yes, most immunizations are "mandatory" for a sufficiently small value of mandatory.

 

[Finster]

I can’t link yet but if you go to the WMUR.com website there is an article on the increase in anti vaccination in New Hampshire. The article is not too bad – could have emphasized the lack of evidence more but it could be worse. I find the comments truly depressing however. There are a couple of voices of reason but the depth of ignorance and paranoia in many of the comments is staggering.

 

[Rolfe]

Interestingly, vaccines are not compulsory in Britain at all, despite our evil commie Big Brother universal healthcare.

Rolfe.

 

[pgwenthold]

I'm pretty sure it's a typo.

The conference on vaccines I attended last month was focused on addressing the antivaxers for the first time as far as vaccine conferences I have been to. I think I mentioned in another thread I was pleased to see the CDC had a "communication science" position. They are seriously looking at barriers and facilitators to communicating vaccine safety and risk perception of vaccine preventable infections.

This has been something I have been pushing lately. I think the CDC and the AAP have been far too passive in addressing this problem. I keep asking (and don't get an answer) how they can sit back and allow folks like Jim Carey to out-and-out accuse them of being part of a consipiracy to hurt kids?

In his HuffPo piece, Jim Carey says, "...given the agenda of Big Pharma, the AAP, and the CDC..." Hmmm, exactly what "agenda" is he referring to? For some reason, I don't think he is referring to the mission to provide the best possible healthcare for the children of our country. So how does the AAP respond to the implication that they have anything besides that as a goal? Mostly it's silence, with a "you should talk to your doctor."

They need to come out with their own statement, saying something like, "The recommendations of the AAP were developed by the world's leading experts in pediatric healthcare*, and are given in order to provide the best possible healthcare available for the nation's young people."

*if it were me, I might add at this point "as opposed to two-bit actors" but that part is optional

 

[fls]

Doctors quite often will stop seeing patients that don't follow their advice.

I don't think that's true. Do you have some sort of documentation of this?

Linda

 

[shadron]

In Colorado you have to have a filled in vacc card on the first day present at school. I've heard that they won't allow the child in without it. I don't know what the status is with religious objections, but I had to make the trek to the doctor's office a number of times.

 

[empeake]

In Colorado you have to have a filled in vacc card on the first day present at school. I've heard that they won't allow the child in without it. I don't know what the status is with religious objections, but I had to make the trek to the doctor's office a number of times.

Does this apply to all schools in the state, or only to public ones?