Should Doctors “Fire” Vaccine Refusers? A Physician’s Point of View

A recent Wall Street Journal article suggested that more physicians are becoming comfortable with the idea of “firing” their patients who refuse vaccines.  Most do so because they are concerned about the spread of contagious diseases in their offices to infants and children too young or too ill to be protected with vaccines.

We thought the issue of how doctors work with families who have concerns about vaccines to be an important one affecting both pediatricians and patients,” said Shirley Wang, author of the  Wall Street Journal article. “The issue also raises broader questions about what doctors’ responsibilities are to patients.”

Dr. Melanie Mouzoon

Dr. Melanie Mouzoon is the Managing Physician of Immunization Practices and Travel Medicine at Kelsey-Seybold Clinic in Houston.  In this entry she explains what she believes, regarding vaccinations, to be her responsibilities to her patients and the community as well.

A Physician’s Point of View

When word gets around that a pediatrician is comfortable with families who refuse vaccines, are selective about which ones they will administer, or want to follow an untested schedule, that practice attracts many similar families.  Just as there are schools with high percentages of unimmunized children, there are pediatricians’ offices with the same problem.  In this situation, not only do pediatricians wind up spending more time discussing vaccine safety in an attempt to convince families to protect their children, they also have to worry about outbreaks of measles, pertussis and meningitis in their offices.

Other doctors feel that the trust, which is necessary in the physician-patient relationship, has deteriorated over time as discussions with families about the need for and safety of vaccines has become protracted and the refusers more entrenched and resentful.

Every pediatrician I know spends lots of time answering questions and concerns that parents have about their children.  Vaccines are not an exception to this rule.  As physicians, we see parent education as a part of our job.

When parents refuse vaccines, we do our best to determine what their fears are, what their experiences have been and where they are getting their information.  We respond with science-based information and honest answers and we do it visit after visit after visit, if they remain unconvinced.

We work with parents to accept at least some of the recommended vaccines, if not all.  We space out vaccines even though we know that this needlessly delays their protection. We discuss known risks of infection versus perceived and actual risks of vaccination. Despite this, some families won’t protect their children with vaccines.

Everyone knows that you need to change your car’s oil every so often.  You might follow your car’s scheduled maintenance guide or you might choose to stretch out service a little longer than recommended. However, eventually, you need to change the oil or your engine won’t perform as well.

If you went to your mechanic for other maintenance, but steadfastly refused to have the oil changed, he would do everything he could to convince you – up to a point. Eventually he has to choose either to keep you as a client (perhaps he can make more money fixing your engine rather than changing your oil) or tell you to find a mechanic whose advice you trust.  At least this scenario doesn’t involve risk to anyone else’s car!

I continue to advocate for vaccinations with families, because I care about their kids.  If they choose to leave my practice because I am adamant about ensuring their child gets vaccinated, so be it. I fully understand why some physicians would ask some families to seek care elsewhere.  If you don’t trust my advice regarding vaccines, why should you trust me with your medical care?

Dr. Melanie Mouzoon is certified by the American Board of Pediatrics and her expertise has been called on by local newspapers, radio and television stations.

 

 

The Community Immunity Spring Luncheon Awards: A Closer Look

The Community Immunity Spring Luncheon is TIP’s largest fundraising event and occurs every year in April.  This year it will be held on April 12th at 11:30 a.m. at the Junior League of Houston. While this event is a time for stakeholders and friends to support The Immunization Partnership, it is also a time for us to honor the people and organizations that have made significant strides in immunization advocacy and education.

Each year TIP presents two awards at the luncheon.  The Ralph D. Feigin M.D. Award for Excellence and the John R. Boettiger Jr. Award for Community Partnership. Both are named for individuals whose legacy mirrors the purpose of the award.

The Ralph D. Feigin M.D. Award for Excellence is presented to an individual who has committed his or her time and efforts towards immunization advocacy and education. It is named for the late Dr. Ralph Feigin of Texas Children’s Hospital. Dr. Feigin worked as the hospital’s Physician-in-Chief and as the President of Baylor College of Medicine.  Dr. Feigin’s specialty was infectious diseases and he worked tirelessly to promote and advocate for the vaccines that he knew could save lives.

Ralph D. Feigin M.D. Award for Excellence Recipient Dr. Peter J. Hotez

This year’s honoree is also a leader in the immunization world. Dr. Peter J. Hotez serves as President of the Sabin Vaccine Institute, an organization that works in partnership with Texas Children’s Hospital and Baylor College of Medicine. The Sabin Vaccine Institute’s mission to “reduce needless human suffering from vaccine preventable and neglected tropical diseases through innovative vaccine research and development” is closely related to the work of the late Dr. Feigin. It is for that reason that The Immunization Partnership believes that Dr. Hotez truly exemplifies Dr. Feigin’s spirit and dedication to promoting vaccinations.

New this year, the Community Partnership Award has been officially renamed the John R. Boettiger Jr.  Award for Community Partnership. It is given to an organization that works directly with the community to increase immunization rates. The award has been renamed in memory of John Boettiger Jr. ASA, CFA, CMC a former member of TIP’s Board of Directors who, through his work with TIP and other organizations including the Boy Scouts of America, embodied the spirit of community partnership.

TIP President and CEO, Anna Dragsbaek, worked closely with John as he served in several leadership positions within the organization.

“John was an outstanding board member, holding many different positions on both TIP’s board and advisory council,” said Dragsbaek.  “He had a special talent for connecting people and resources to community organizations and played a pivotal role in creating the strong board of directors that supports the work of TIP today.”

John’s dedication to his community represents the type of service that TIP is looking to acknowledge with the award.

“Our organization would not be the same today if he had not shared his time and talents with TIP,” said Dragsbaek.  “He truly embodies the spirit of community that TIP wants to honor in the Community Partnership Award.”

The Boettiger Award for Community Partnership recipient.

This year’s recipient is Houston Community College’s Coleman College. They have been an instrumental partner in TIP’s Immunization Champions project by supplying eager students willing to venture into doctor’s offices for the chance raise their immunization rates, instill vaccination best practices and to make a difference in the healthcare community.

The Community Immunity Luncheon will be a momentous occasion as we honor those who have worked side by side with us in our efforts to increase vaccination rates and ultimately to create a safer and healthier community.

Register now for our Community Immunity Spring Luncheon.

Should you wish to support the luncheon, sponsorship opportunities are still available.

One Doctor’s Plea: Protect Yourself and Your Family Against Pertussis

As pertussis cases continue to rise, Dr. Joshua Septimus is working to educate his patients about the dangers of the disease.

“Patients often think that, as adults, “whooping cough” is a disease of days past,” said Dr. Septimus.  “In fact, this disease has been raging through the adult and adolescent population, necessitating the development of an adult vaccine for the disease.”

While many may associate pertussis with infants, Dr. Septimus warns that they are not the only group at risk.

“As the epidemiology of whooping cough has moved from childhood to adults, new at-risk populations have emerged,” said Dr. Septimus.  “Asthmatics, patients with chronic lung disease and especially newborns exposed by their parents, grandparents and other family members are at risk.”

According to the Center for Disease Control (CDC), the onset of pertussis can be gradual and the disease itself can last for a number of weeks. Symptoms may mimic that of the flu, but whereas the average flu-sufferer can expect to get better in a couple of weeks, someone with pertussis will develop a severe cough.

Pertussis is nicknamed “whooping cough” because patients will often cough until they are out of air and are forced to inhale, creating a whooping sound.  The coughing may become so violent that people suffering from the disease will vomit during a coughing fit.

From the CDC website, a child with broken blood vessels in his eyes and face due to pertussis coughing.

If pertussis causes this kind of reaction in adults, imagine an infant’s tiny body wracked with powerful coughs and the toll that their desperate attempts to regain their breath must take.  Infants are also more likely to suffer deadly side-effects of the disease. Pneumonia, apnea (delayed or stopped breathing) and encephalopathy (disease of the brain) are just a few of the dangerous and often times deadly effects of pertussis in infants.

In 2010 the CDC reported more than 20,000 cases of pertussis. Of those cases 25% of them were in children under the age of seven.

“In San Diego, here in the United States, a fatal outbreak of the disease sickened many and KILLED several newborns,” said Dr. Septimus.  “I think I have talked until I am blue in the face about vaccinating against whooping cough to my patients who are expecting children and grandchildren. Please talk to your doctor about getting the whooping cough vaccine!”

For more information about pertussis and the recommended vaccinations against the disease, please visit http://www.cdc.gov/pertussis/index.html,

Dr. Joshua Septimus is a clinical assistant professor of medicine at Weill-Cornell Medical School and Baylor College of Medicine.

When it Comes to Vaccinations, Grandma Knows Best

When it comes to staying healthy and protecting children, grandmothers have a special kind of wisdom because they are living history books.

One topic that your grandmother can shed light on is the importance of vaccines. When she was a child, there weren’t many diseases that could be prevented with vaccines. Smallpox was one of the first diseases for which vaccines were developed, followed by polio. Your grandmother probably knew people who contracted polio, some of whom died and others who permanently lived in an iron lung.

Barbara Chew grew up during the Great Depression and can’t understand why parents would not want to vaccinate their children.

Growing up during the Great Depression, Barbara Chew witnessed the devastating effects of vaccine-preventable diseases.

“I struggle to keep from feeling totally judgmental when I hear about parents who refuse to protect their children,” said Barbara.  “I simply can’t understand it.”

Like Barbara, your grandmother remembers what it was like when people were afraid to go swimming because it was feared that polio was spread in the pool. She could tell you stories about waiting in line with her classmates to receive a sugar cube that contained the polio vaccine.

Unfortunately, we have not learned the lessons of our grandmother’s generation.  Polio, measles, mumps and rubella were just a cold, hard fact of life, as were all the permanent disabilities and deaths that they left in their wake. As soon as a new vaccine was developed, parents rushed to protect their children from these dreaded childhood diseases.  And the vaccines worked.  Most of the diseases of your grandmother’s generation have been nearly eradicated.

Barbara lived in a time when vaccine-preventable diseases wreaked devastating havoc on children and their families.

“Polio panic was a recurrent theme of my childhood,” said Barbara.  “Not only was my President a polio victim, but two friends died, two more wore leg braces for the rest of their lives.”

Even if a polio victim overcame the disease they still had to deal with the lasting physical effects.

“Another of my friends, Connie, was severely affected many years after her initial illness, when she was  a grandmother herself,” said Barbara. “The disease can begin producing symptoms in later life. Polio wasn’t listed as the cause of death when Connie died, but it sure made her last years pretty miserable.”

Today, vaccines have been a victim of their own success.  We don’t see many vaccine-preventable diseases anymore and therefore, we have forgotten how devastating they are when they strike.   Despite overwhelming evidence that vaccines are safe, many believe that the risks outweigh the benefits. Presumably, this is because we no longer live with the daily fear of contracting one of these devastating diseases.  We no longer live face to face with vaccine-preventable diseases on a daily basis…or do we?

In the last two years there have been nearly 6,000 cases of Pertussis in Texas (better known by its more common name “Whooping Cough” because of the whooping sound a baby makes when gasping for breath) and just recently, there was a case of measles in Houston. A Texas A&M student even lost his life to a vaccine-preventable form of meningitis. There have been outbreaks of mumps all over the US in recent years and several babies have died from an infantile form of meningitis.

Vaccines can prevent these diseases, but only if the majority of a community is immunized.  If fewer and fewer people get immunized, we all lose ‘community immunity’ because diseases can spread quickly, with devastating effects, in a population with low immunization rates.  Individuals who cannot be immunized (due to allergies or pre-existing medical conditions) are especially at risk in a community with low vaccination rates because they depend on us to protect them.

Ask your grandmother about the diseases that are now preventable with vaccines.   She will tell you that vaccines are nothing short of a miracle.

“I remember how thrilling it was to read the huge headline in the Times Herald when the “Salk” vaccine became available,” said Barbara. “My mother made sure my sister and I were standing in line when the vaccine first became available; the line stretched around the block.  Receiving the polio vaccine felt like a reprieve.”

Barbara considers immunizations something that everyone must do not only for themselves but for the good of the entire community.

After her granddaughter Anna had her first child, she made sure to keep her grandmother informed about the new baby. When Barbara learned that her great-grandson had received his first round of immunizations, she was ecstatic.

That’s because Barbara knew that by getting immunized and by protecting not only himself, but everyone around him against vaccine-preventable diseases that the newborn in the first month of his life had just performed his very first act of public service.

Immunize.  Prevent what’s preventable.