Well-Child Innoculations

=Objectives=

Describe the routine childhood immunization schedule.

 * '4:3:1:3:3:1' is commonly used jargon for: 4+DTP, 3+Polio, 1+MMR, 2+Hib, 3+HepB, 1+Varicella
 * The exact schedule is available on the ACIP website in a nice grid. Direct link to schedule.

Describe the flexibility and the nature of decisions each provider must make in order to make the schedule operational.

 * Who decides: Advisor Committee on Immunization Practices (ACIP). 15 experts appointed by US Health and Human Services come to agreement.
 * ACIP issues recommendations.
 * States make laws about what is required to enter schools. They determine religious (48 states) and philosophical (~38 states, including Oregon) exemptions.
 * Oregon law says you need a written statement for a medical exemption or a parental statement for religious/philosophical exemption. Link to Oregon vaccination law for schools

Describe ways in which the schedule is likely to change in the future.

 * In 1983, ACIP recommended that children received 8 inoculations before the age of 2.
 * In 1995, ACIP recommended that children received 15 inoculations before the age of 2.
 * In 2009, ACIP recommended that children received 26 inoculations before the age of 2.
 * If the trend continues, we're likely to see more vaccines
 * A focus on the safety of vaccine additives, could change the composition of the vaccines.

Describe common barriers that prevent the delivery of age-appropriate immunizations.

 * Rates are far below the 90% 4:3:1:3:3:1 goal
 * Improper contraindications: kid has a cold so they don't get the vaccination at their checkup visit (they should get it; missed opportunity).
 * Chronic diseased kids: docs treat the disease but routine preventive health maintainace is ignored
 * Immigration and foster care: records are lost.
 * Loss of access to care: no insurance, etc. (The feds will pay for vaccines but most people don't know it)
 * Paper documentation: lost cards. (we're moving to electronic records).
 * Concern about vaccinations

The Autism concern

 * Wakefield retracted MMR vaccine paper this is where the concern all started. Totally discredited, but parents still ask about it.
 * 1999 FDA review said there was no risk from mercury, but the institute of medicine decided to remove mercury from vaccines due to public relationship concerns
 * There is no causal relationship between MMR vaccines and autism
 * Insufficient information to determine causal relationship between thimerosol an autism (which has been removed from most vaccines).

Describe specific actions providers can take to increase the likelihood that their patients will be adequately immunized.

 * Put patient on a delayed vaccination schedule (not recommended by everyone)
 * Explain a scientific belief that there is no relationship between MMR, mercury, thimerosol and autism.
 * Immunizations are unlikely to weaken the immune system. Our current vaccines are much more pure now so that immune responses aren't mounted to contaminants (which are responsible for the adverse event profile).  In other words, "there's not a lot of other junk" in modern vaccines.
 * Communication! Ask the patient where they are getting their information; understand the source of their concerns so you can engage them.
 * You can't argue science with data.

=Links=
 * ACIP List of vaccinations - used as a slide, be familiar with this.
 * Oregon State Database for Immunizations, used by 86% of private clinics in the state of Oregon.
 * Defeat Autism Now!, "We need an alternative schedule".
 * See a list of Oregon providers who believe in the alternative schedule