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What is the problem?
Immunizations have a huge impact on improving the health of children in the United States. Many parents today have never seen first-hand the devastating consequences that vaccine-preventable diseases have on a child, a family or community. While some diseases, such as polio and diphtheria, are not as common in the U.S., they persist around the world. Travelers can bring these diseases into the U.S. Such diseases can spread when it reaches a community in the U.S. where groups of people are unvaccinated. With greater amounts of parents opting out of vaccinating their children, the U.S. faces the risk of greater exposure to vaccine-preventable diseases and potentially death (CDC, 2018a).

Who is affected?
EVERYONE! Individuals at greatest risk for the spread of disease are infants who may be too young to be fully immunized, pregnant women and/or immunocompromised individuals, like the elderly or individuals with cancer that cannot get certain vaccines. In addition, communities with unvaccinated individuals further increase the risk for spread of disease (CDC, 2018a).

How?
Although certain diseases are no longer prevalent in the U.S, travelers from abroad can bring these potentially deadly diseases into the country. Such diseases can spread when it reaches a community in the U.S. where groups of people are unvaccinated (CDC, 2018a).

Where?
The U.S. is at an increased risk for the development of these serious diseases. However, diseases do not stop at the border. Because certain diseases are still prevalent in other countries and individuals are able to travel abroad, the risk runs worldwide (CDC, 2018a).

When?
The risk of vaccine-preventable diseases increases due to the increased number of parents choosing to not vaccinate their children (CDC, 2018a).

Why?
Misinformation about vaccines and their potential side effects/ complications cause parents to question the necessity of immunizations (CDC, 2018a). In addition, some parents believe their child is not at risk for diseases. Some parents believe a disease is no longer in circulation. Some parents believe their child is protected not by vaccine, but by something else the parent is doing (i.e. using herbals, supplements, essential oils). If herd immunity, or all healthy individuals that are able to get vaccinated, do not meet 95% immunity, the entire community is at risk for an outbreak of a serious disease (CDC, 2018a).

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The recommended immunization schedule protects children (0-18 years old) from 14 diseases, including: Chicken pox (Varicella), Diphtheria, Hib, Hepatitis A, Hepatitis B, Influenza (Flu), Measles, Mumps, Pertussis, Polio, Pneumococcal, Rotavirus, Rubella and Tetanus (CDC, 2019). The immunization schedule, disease, disease spread, symptoms and complications are listed in the 'Immunization Schedule' by age within this presentation. Below, I will discuss the pros and cons on immunization for children, in accordance to credible literature.

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Current barriers to effective immunization of children is caused by misleading information found on the internet or shared by other individuals with false information.

As a nurse, it is vital to bust these myths. Patient education will potentially save the lives of not only children, but many others in the community!

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How do germs make a child sick? What are vaccines and how do they prevent diseases?

A child encounters thousands of bacteria and viruses every day. This occurs through the food they eat, the air they breathe and the things they put in their mouths. When one of these germs gets into the body, it can quickly multiply causing an infection. The immune system will fight back by creating antibodies, or infection fighting cells, which protect the child from illness. Children are born with an immune system that can fight most germs. However, there are some dangerous diseases that a child’s body simply cannot handle. This is where vaccines come into play. Vaccines help children to fight infections by introducing a small number of antigens into the body. Antigens are parts of germs that cause a child’s immune system to go to work. After a child gets a vaccine, the immune system remembers the vaccine antigen and attacks the germ if it ever invades the body again. The antigens in vaccines are weakened or dead, so they do not cause any illness. Vaccines contain only a tiny fraction of antigens that a child encounters in their environment daily. It can take a few weeks for a vaccine to start working. More doses may be required to best protect the child. The recommended immunization schedule is designed to give a child the best protection possible from 14 serious diseases. Vaccine-preventable diseases can be very serious, may require hospitalization or even be deadly, especially in infants and young children (CDC, 2017a). This presentation will discuss all of the pros and cons to vaccinating children from 0-18 years of age.

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As the most trusted profession, nurses play a critical role in educating parents about the need for immunizations in children.

-Utilize risk communication to help parents understand the potentially fatal risks of vaccine-preventable diseases

-A decrease in immunization coverage can cause an emergence of diseases, including death

-In order to effectively answer parent's questions, nurses must understand how immunizations work in the body

-In order to improve confidence in vaccines, nurses must communicate how vaccine safety is monitored

-Effectively communicate the risk of disease versus the risk of a vaccine side effect

(Nursing World, 2019).

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1. Mandatory vaccines infringe upon constitutionally protected religious freedoms.
According to the Universal Family Church, parents should decide whether their children should be vaccinated and that, "God intended the health decisions of individuals  should be honored by all authorities" (Vaccination Liberation, 2008).

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1. Vaccines can save children's lives.
According to the CDC, it is estimated that 732,000 American children were saved from death and 322 million cases of childhood illnesses were prevented between 1994 and 2014 due to vaccination (CDC, 2014).

2. The ingredients in vaccines are safe in the amounts used.
According to the CDC, ingredients, such as thimerosal, formaldehyde, and aluminum, can be harmful in large doses but they are not used in harmful quantities in vaccines. All pediatric vaccines manufactured for the U.S market are available in formulation that contain no thimerosal (a mercury compound) or only trace amounts (CDC, 2018c).
Paul Offit, MD, notes that children are exposed to more bacteria, viruses, toxins, and other harmful substances in one day of normal activity than are in vaccines (Heyworth, 2014). The FDA requires up to 10 or more years of testing for all vaccines before they are licensed, and then they are monitored by the CDC and the FDA to make sure the vaccines and the ingredients used in the vaccines are safe (CDC, 2018d).

3. Major medical organizations state that vaccines are safe. These organizations include CDC, FDA, Institute of Medicine (IOM), American Medical Association (AMA), American Academy of Pediatrics (AAP), UNICEF, U.S Department of Health and Human Services (HHS), World Health Organization (WHO), National Foundation for Infectious Diseases (NFID) and American Academy of Family Physicians (AAFP).

4. Adverse reactions to vaccines are extremely rare.
The CDC states that any vaccine can cause side effects. However, most are minor and include a sore arm, redness or swelling at the puncture site or a low-grade fever. These symptoms will go away within a few days. These side effects are very minimal in contrast to the pain, discomfort and trauma caused by the diseases (CDC, 2018b). Allergic reactions and anaphylaxis following vaccines are rare and occur at a rate of approximately one per million doses for many vaccines (CDC, 2017b). Children with a history of an allergic reaction following a previous immunization should be reported to the health care provider (HCP). In addition, the HCP must be notified of a child's allergy to eggs or gelatin prior to the administration of the following vaccines: influenza, MMR and varicella (CDC, 2017b) to prevent adverse reactions. The disease-prevention benefits of getting vaccines are much greater than the possible side effects for almost all children (CDC, 2018b).

5. Vaccines protect the community.
Herd immunity, or community immunity, can only occur when 95% of healthy individuals are vaccinated against a contagious disease. This percentage decreases the risk of an outbreak of the disease. Herd immunity provides protection for children and adults who cannot be vaccinated due to age or an immunocompromised state (U.S Department of Health and Human Services, 2014).

6. Vaccine-preventable diseases have not disappeared so vaccination is still necessary.
While some diseases are no longer common in the U.S, they persist around the world. It is imperative to continue to protect children with vaccines because outbreaks of vaccine-preventable diseases like pertussis, mumps and measles can and do occur in the U.S (CDC, 2018a).

7. Vaccines eradicated smallpox and have nearly eradicated other diseases such as polio.
Due to vaccination, smallpox no longer exists and children are no longer vaccinated against the disease. The last case of smallpox in the U.S was in 1948. The last case in the world was 1977 in Somalia. In the 20th century, there were 16,316 deaths from polio and 29,004 deaths from smallpox yearly in the U.S. By 2012, there were no reported cases of polio or smallpox. According to UNICEF, Afghanistan, Nigeria and Pakistan reported 500 cases of polio in 2014. This number is significantly down from 350,000 cases in 1988. In 20th century U.S, the annual death rates were reported for the following diseases: diphtheria killed 21,053, measles killed 530,217, mumps killed 162, 344, rubella killed 47,745 and Hib killed 20,000 people. By 2012, each of these diseases were decreased by 99% because of vaccinations (NFID, 2012).

8. Vaccines save parents time and money.
A child with a vaccine-preventable disease can be denied attendance to school or child care facilities. Some vaccine-preventable diseases can result in prolonged disabilities and can take a financial toll on the family because of lost time at work, medical bills or long-term disability care. However, getting vaccinated against these diseases is a good investment and is usually covered by insurance (CDC, 2018a).

9. Vaccines do not cause autism.
Vaccine ingredients do not cause autism (CDC, 2015).

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How to Talk to Parents about Vaccines for their Children

1.   Assume parents will vaccinate.

State which vaccines the child needs to receive as though you presume parents are ready to accept recommended vaccines for their child during that visit.

Example:

Instead of saying, “Have you thought about the shots your child needs today?,” say “Your child needs DTaP, Hib and Heptatitis B shots today.”

According to the CDC, parents are more likely to express concerns when providers utilize language that asks parents about their immunization plans. The presumptive approach resulted in significantly more parents accepting vaccines for their child.

2.   Give your strong recommendation.

Many parents may consult family members, friends and the internet for information on vaccines. However, parents consistently rank healthcare professionals as their most trusted source for immunization information. A strong recommendation is vital for vaccine acceptance. Share the importance of vaccines to protect children from vaccine-preventable diseases and potentially death.

Example:

“I strongly recommend your child get these vaccines today…”

“…These shots are very important to protect from serious diseases.”

3.   Listen to and respond to parent’s questions.

It is important that parents feel heard and healthcare professionals should seek to understand parents’ concerns and provide requested information. By listening to the parents, a nurse may build rapport and establish trust, resulting in parent’s listening to the recommendation. Offer your knowledge on vaccines and provide pamphlets for reinforcement of education.

If parents still refuse immunizations, it is important to continue the conversation about vaccines during the next visit and restate your strong recommendation. Inform parents about symptoms of vaccine-preventable diseases. Remind parents to call before bringing their child into the office when the child is ill to ensure the office can take necessary precautions to protect others. Share a fact sheet that explains the risks involved with the decision to not immunize their children, including risks to other members of the community.

(CDC, 2018e).

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Do you have any questions in regard to vaccinating children?

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Two Curricular Concepts:
1.   Patient education

-As a nurse, educate parents on the pros vs. cons of vaccinating children and any potential side effects

-Reinforce how vaccines are monitored and continuously monitored for safety
-Assure parents that vaccines do not contain any significant amount of ingredients that can be harmful to their child

-Ensure to address any parent’s questions or concerns

-Re-educate parents on the truth behind vaccines, dispelling any myths (i.e. vaccines do not cause autism)

-Address the risks of vaccine-preventable diseases, including death

2.   Patient advocacy

-Children do not necessarily have a say in their immunization. It is imperative that nurses are being patient advocates and to be the voice for our pediatric patients.

-Continue to educate parents and reinforce the importance of vaccination for the child and their surrounding community

Leadership Role...
The two curricular concepts that I have learned during my education at SCOHS has prepared me to take on a leadership role once I become a practicing RN. As a nurse, I have the ability to create a rapport with patients and build trust. A trusting relationship with parents and their children can result in promoting safety in their lives. My professional recommendation carries weight as my education will present factual information to parents. Patient education and taking the time to listen to parent's concerns can result in an increase in immunization among children. However, at times, patient education may not suffice. As a RN, I plan to be a role model and lead by example. When patients see how strictly nurses follow facility guidelines and protocols, they will follow in their lead. I plan to promote safety in all of my patients' lives through patient education and advocacy.