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The Importance of Vaccinations

      The Centers for Disease Control and Prevention (CDC) has called immunizations the greatest public health achievement of the 20th century.
      Centers for Disease Control and Prevention
      Ten Great Public Health Achievements—United States, 1900-1999.
      A child born today need not fear paralysis from polio, cervical cancer from human papilloma virus, mental retardation and profound hearing loss from Haemophilus influenzae b meningitis, or any number of other frightening, often life-threatening infections.
      One would anticipate that this medical advance would be universally embraced by both parents and health care professionals. Sadly, however, the antivaccine movement, fueled by a lack of respect for the evidence and a profound paranoia, remains alive and well. It is not an overstatement to lay the blame for a resurgence of deadly childhood infections, stemming from declining vaccination rates, at the feet of this movement. Nurse practitioners (NP) also bear some degree of the blame. While certainly not scientific, the anecdotal evidence from letters to JNP documents that some proportion of our readers buy into the pseudoscience of the antivaccine movement. Comments have ranged from bafflingly uninformed (“I don’t think there is enough evidence to support widespread immunizations”) to profoundly unethical (“I recommend to my patients that they not vaccinate their children”).
      Surveys of health care workers further document this small but potent minority who question the evidence for vaccine efficacy and safety. The most recent evidence can be found in dismal rates of influenza vaccination in health care workers. According to the CDC, only 63.5% of all health care workers and 70% of nurses were vaccinated in 2010-2011.
      Centers for Disease Control and Prevention
      Influenza Vaccination Coverage Among Health-Care Personnel—United States, 2010-11 Influenza Season.
      Many facilities have resorted to mandating influenza vaccination for their employees—policies that are endorsed by a wide range of professional groups, including the American Academy of Pediatrics, the American Pharmacists Association, the American Hospital Association, and others. Sadly, according to the Immunization Action Coalition’s Honor Roll for Patient Safety, none of these supporters represent nursing.

      Immunization Action Coalition. Mandatory influenza vaccination for healthcare workers. 2013. http://www.immunize.org/honor-roll/. Accessed January 18, 2013.

      Now the Institute of Medicine has waded into the fray with a just-released comprehensive report, “The Childhood Immunization Schedule and Safety: Stakeholder Concerns, Scientific Evidence, and Future Studies.”
      Institute of Medicine
      The Childhood Immunization Schedule and Safety: Stakeholder Concerns, Scientific Evidence, and Future Studies.
      The report notes that under the current vaccine schedule, children may receive up to 24 immunizations in the first 2 years of life and 5 injections in a single visit and correctly acknowledges that the sheer volume may be distressing to parents and is certainly upsetting to children. The authors clearly state that vaccines, like all drugs, are neither 100% risk-free or effective. However, the authors also unequivocally conclude that they are safe and that there is no evidence—none—that they cause autoimmune diseases, asthma, seizures, or developmental or behavioral disorders.
      It’s time for NPs to be part of the solution. We must preach the importance of vaccines, and then we must practice what we preach and be appropriately immunized ourselves.

      References

        • Centers for Disease Control and Prevention
        Ten Great Public Health Achievements—United States, 1900-1999.
        MMWR. 1999; 48 (Accessed January 18, 2013): 241-243
        • Centers for Disease Control and Prevention
        Influenza Vaccination Coverage Among Health-Care Personnel—United States, 2010-11 Influenza Season.
        MMWR. 2011; 60 (Accessed January 18, 2013): 1073-1077
      1. Immunization Action Coalition. Mandatory influenza vaccination for healthcare workers. 2013. http://www.immunize.org/honor-roll/. Accessed January 18, 2013.

        • Institute of Medicine
        The Childhood Immunization Schedule and Safety: Stakeholder Concerns, Scientific Evidence, and Future Studies.
        The National Academies Press, Washington, DC2013 (Accessed January 21, 2013)

      Biography

      Laurie Scudder, DNP, NP, is president of Nurse Practitioner Alternatives and a pediatric nurse practitioner in the school-based health program for the Harford County Public Health Department. She is also the associate editor of JNP.