Fran Lowry

March 04, 2015

Because so many children are seen in the emergency department, emergency physicians are in a good position to screen for vaccinations and help parents understand information about vaccines, said Zachary Repanshek, MD, speaking at the American Academy of Emergency Medicine 21st Annual Scientific Assembly in Austin, Texas.

"We're not primary care doctors or pediatricians, but when we find a child who has not been vaccinated, we should ask why," Dr Repanshek, from Temple University School of Medicine in Philadelphia, told Medscape Medical News.

"If you do uncover a misconception or some sort of illogical thinking, you have an opportunity to act on that and try to set the wheels in motion to get the parent thinking that perhaps vaccination is not so bad," he explained.

Dr Zachary Repanshek

The population served by his emergency department is of low socioeconomic status, and most of the time these children go unvaccinated because they lack access to care, said Dr Repanshek.

"Personally, I have encountered very few parents who refuse to get their kids vaccinated. Instead, they either don't know about vaccines or have no primary doctor or pediatrician," he said.

When asking parents why their children are not vaccinated, it is important to be nonjudgmental.

"Vaccinations can be a hot topic and there can be a lot of judgment around it. If your patients get the sense that you are judging them, you've lost them," Dr Repanshek said.

"The key is to ask nonjudgmental questions, honestly trying to probe at what the underlying issue is," he added.

Vaccine Mythology

The most common misconception is that vaccines cause autism. "This is one myth that, despite the fact that there's no medical evidence for it, somehow persists in people's minds," he explained.

The myth began in 1998 when a study published in the Lancet claimed there was a link between autism and the measles, mumps, and rubella (MMR) vaccine. The study was retracted, but the misconception persists to this day.

That was the only study that ever suggested such a link, and every study done since has proven otherwise. "That right there is a perfect example of the power of a myth and how deeply engrained it can be, despite the mountain of evidence to the contrary," Dr Repanshek said.

Another misconception or myth is that vaccines contain harmful chemicals, such as mercury.

Thimerosal is a vaccine preservative that contains ethyl mercury, which gets flushed out of the body. In contrast, methyl mercury, which is the bad mercury, accumulates in the body. "You know what has the bad mercury in it?" he asked. "Tuna."

When you discover people who have such misconceptions, telling them they are wrong can backfire, he explained.

Instead, he advises, present the facts in short, easy-to-understand sentences. Explain that vaccines are safe, save lives, and have been around for hundreds of years.

"I would absolutely not bring up the Lancet study. In the short amount of time you have with patients in the ED, you are not going to get them to understand the depth of the issue. You have to start with small, core facts," he said.

For example, Dr Repanshek pointed out, "you could state that scientists have discovered certain genes that may point to a genetic cause of autism to replace the idea that vaccines cause autism."

Dr Robert Glatter

"It is vital that patients understand the importance of vaccination for measles as a responsibility, not only to themselves and their families, but to the community as a whole, said Robert Glatter, MD, from Lenox Hill Hospital in New York City.

When vaccination rates in local communities of at least 92% are not maintained, herd immunity can fail to protect people who are too young or too sick to be vaccinated against measles, Dr Glatter told Medscape Medical News.

"This includes children under the age of 1 year, as well as women who are pregnant and people who are immunosuppressed from cancer, HIV, or other immune deficiencies," he said.

Inadequate levels of herd immunity will result in continued outbreaks, placing those who cannot be vaccinated for medical reasons at risk for a potentially deadly disease, he added.

Because measles was eradicated in the United States in 2000, many young parents have not seen the devastating complications — which included pneumonia, respiratory failure, encephalitis, and even death — that were common before the introduction of widespread MMR vaccination in the late 1960s and 1970s.

"In fact, up until 1960, there were close to 500,000 cases of measles annually, resulting in 50,000 people requiring hospitalization, and almost 500 deaths per year," Dr Glatter reported.

"Our goal in the ED should be to promote positive messaging that effectively communicates the safety and efficacy of vaccination for measles," he said.

Although not all vaccines are 100% effective and some people can be nonresponders, in the majority of settings, the effectiveness of the MMR vaccine "approaches 95%," he noted.

Because of the strong track record of safety associated with the MMR vaccine, "we can provide parents with clear reasons to vaccinate their children. While not all parents will agree with vaccination, I feel that an ED visit for a pediatric patient is an opportunity to revisit the ethical and social responsibility of vaccination with caregivers and parents," Dr Glatter explained.

Dr Repanshek and Dr Glatter have disclosed no relevant financial relationships.

American Academy of Emergency Medicine (AAEM) 21st Annual Scientific Assembly. Presented March 2, 2015.

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