A combination of public health awareness campaigns, scientific advances and documentation is helping to keep the rate of childhood vaccination high despite objections from parents concerned about vaccines.
Shannon Stokley, M.P.H., acting deputy director for the CDC Immunization Services Division, discusses childhood immunization rates during the 2017 AAFP State Legislative Conference.
Speakers at the 2017 AAFP State Legislative Conference held here Nov. 2-4 discussed successes in vaccination -- which has prevented an estimated 381 million cases of illness among those born between 1994 and 2016 -- and what physicians can do to maintain or even expand those success stories.
In 1964, the list of diseases that could be prevented with a vaccine numbered only six: smallpox, polio, diphtheria, pertussis, tetanus and measles. In 1985, rubella and mumps were added to the list. Now there are 16 diseases that can be prevented through routine childhood vaccination.
"Vaccination in this country is the norm," said Shannon Stokley, M.P.H., acting deputy director for the CDC's Immunization Services Division. "Less than 1 percent of toddlers were not vaccinated."
By the time children reach kindergarten, the overall rate still exceeds 90 percent, with vaccination rates for measles, mumps and rubella at 94 percent.
Even so, and despite vaccination requirements at day care facilities, schools and universities, gaps remain. Part of that is due to state laws that allow for vaccination exemptions. Twenty-nine states allow exemptions for religious reasons, and 18 states grant exemptions based on philosophical objections. Just three states allow exemptions only for medical reasons.
Still, Stokley pointed out, even the 2 percent of kindergarteners who have vaccination exemptions often receive some vaccines. Ninety-five percent of these exempted children have had at least one dose of vaccine, with the average being 22 doses. By comparison, kindergarteners without an exemption have received an average of 28 vaccine doses.
Health officials are also concerned about the "gray zone" of kindergarteners who have no documentation of receiving vaccinations or requesting exemptions, Stokley said. About 8 percent of schoolchildren fall into this category, but even 91 percent of these children have received a measles vaccination.
"We should ensure that all children have documentation on file and make sure they have their vaccines," Stokley said.
Stokley outlined what physicians can do to encourage parents to schedule vaccines for their children. Foremost, they should raise the issue as a statement rather than a question. She suggested that the physician cite the child's age and note that several vaccines are recommended at that time, emphasizing that they should be administered that same day.
"You should say, 'He's due for three shots today' rather than ask patients, 'What would you like to do?' Make it a recommendation instead of leaving it to the patient," Stokley said.
And parents' questions about vaccines should be taken as requests for assurance, not resistance, she noted.
Stokley said that for parents who might be hesitant about vaccines, researchers found that this "presumptive approach" encountered less resistance.
Overcoming resistance is important, and a preventive measure such as vaccination should be seen for the long-term investment in health that it is. Physicians can counter objections with success stories, such as a 70 percent reduction in HPV-related cancer that can be attributed to increased vaccination in the past decade.
"Every dollar spent on childhood vaccines saves $10," said Megan Miller, senior director for health integration for the Association of State and Territorial Health Officials. "But as new and more vaccines come out, it costs more to vaccinate children."
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