Should doctors turn away unvaccinated children to protect other patients?
CHICAGO — It took a family bout of rotavirus, a measles outbreak tied to Disneyland and stricter school enrollment rules to get Kristen O’Meara to take a harder look at and eventually switch her once-defiant stance against vaccinations for her children.
But the 40-year-old Palos Park, Ill., mom said if a doctor had taken the time to educate rather than scold her, she might have changed her mind sooner. And her family, including three young daughters, might have avoided being sick for days with the nasty intestinal bug.
Childhood immunizations remain a deeply divisive issue. And though studies purporting to link vaccines to autism have been widely discredited, pockets of parental resistance persist: According to surveys by Elk Grove Village, Ill.-based American Academy of Pediatrics of its member physicians, more doctors in 2013 than in 2006 reported encountering vaccine-hesitant families.
In a report released in September, the academy also revealed that as parents decline to have their children vaccinated, more pediatricians are turning such families away in the name of safeguarding the health of other patients.
The academy, in newly released guidelines for pediatricians, said excluding families who refuse to vaccinate their children can be “an acceptable option” if used as a last resort in areas where doctors are not scarce, and only after several attempts to educate and quell concerns. The report details reasons why some parents are skeptical of vaccines and suggests ways to address them.
Some local pediatricians had already made it their policy not to accept new patients who are not vaccinated; other doctors have severed ties with existing patients.
But other health-care professionals say keeping unvaccinated patients and their parents under their wing is better for public health, offering the best shot at swaying their views.
The Centers for Disease Control and Prevention, along with the pediatrics academy, recommend a schedule of vaccinations for children unless a medical reason, like cancer treatment that suppresses the immune system, dictates otherwise. The new AAP report stresses the need for further education for parents even before their children are born.
“We have to talk to our patients, our parents and make sure they understand,” said Dr. Kathryn Edwards, a Vanderbilt University pediatrics professor who co-wrote one of the AAP reports. “You need to listen to what they’re asking, answer their questions and give them (websites) that will help.”
“The decision to dismiss a family who continues to refuse immunization is not one that should be made lightly, nor should it be made without considering and respecting the reasons for the parents’ point of view,” the report states. “Nevertheless, the individual pediatrician may consider dismissal of families who refuse vaccination as an acceptable option.”
Edwards said research points to a few main reasons why parents question vaccines: They wrongly believe that the diseases the shots protect against aren’t serious, they question the safety of vaccines or they think any requirement to vaccinate is an infringement on personal rights.
That skepticism was behind O’Meara’s hesitancy.
As a first-time mom six years ago, she worried about the potential side effects of vaccines.
But instead of discussing and trying to allay her concerns, one pediatrician simply “shamed” her, O’Meara said.
“He didn’t bring me into the fold. He really wanted to point his finger at me,” said O’Meara, a Chicago Montessori schoolteacher and mother of 4-year-old twins and a 6-year-old. “I didn’t expect to be treated that way.”
The encounter, O’Meara said, left her angry and only heightened her mistrust of the mainstream health-care industry. She soon found a nontraditional doctor who supported her decision against vaccines.
It was the measles outbreak that spread through Disneyland visitors starting in 2014 that initially gave O’Meara and her husband second thoughts, leading her to start researching scientific papers on the topic.
Then, in March 2015, the entire family got sick with rotavirus, including O’Meara’s mother, who regularly cared for the children.
“When I realized it was rotavirus, I thought, ‘Huh, there’s a vaccine for that,’” O’Meara said. “It was eye-opening. (I thought), ‘We’re not as protected as I thought we were. Maybe I need to do more research. Maybe we just suffered through something that we didn’t have to.’”
Around the same time, the preschool O’Meara’s oldest daughter attended stopped accepting unvaccinated children. And O’Meara learned that Illinois had made it more difficult for parents to receive waivers from school vaccination requirements based on religious objections.
“I thought to myself, ‘I might as well take them in and vaccinate them, because they’re cracking down, anyway,’” O’Meara said.
A month later, O’Meara found a new pediatrician, and inquired about a catch-up schedule of vaccines for all three children. Since earlier this year, they’ve been fully vaccinated and have had no bad reactions, O’Meara said. Now she wishes she’d had more guidance from physicians who could have pointed her to the science earlier.
“It was just a whole bunch of things that happened during that time,” she said. “It wasn’t only that we had gotten sick. It was the catalyst.”
Dr. Don Seidman, an Elmhurst pediatrician and chair of pediatrics for DuPage Medical Group, said its doctors will continue to treat unvaccinated patients while trying to persuade their parents to have them immunized.
Seidman said in his experience, and according to one AAP study, about half the parents who are hesitant about vaccines change their minds after discussions with a doctor. And sometimes the prospect of losing their pediatrician will be enough to change parents’ minds.
“It’s worth it to make the effort,” Seidman said.
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