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Vaccines are one of the greatest advances in medical history. In just the past 50 years, polio, measles, rubella, mumps, and Haemophilus influenzae type B disease have nearly disappeared in the U.S. A group of experts has reviewed the history of immunizations in the U.S., the evidence that supports immunization requirements, and current threats to our successful immunization program. Their report includes the following:
In 1969, 17 states had laws that required immunization for school entry; by the early 1980s, all 50 states required immunization.
Rates of nonmedical exemptions (because of religious, philosophical, or personal beliefs) for required school immunizations increased from about 1% in 1991 to 1.5% to 2.5% in 2004. The exemption rate for religious reasons during this period remained at about 1%.
Concern about safety is the principal reason parents refuse immunizations.
Increasingly, parents are choosing to delay vaccination of their children or follow alternate vaccine schedules rather than schedules recommended by expert committees.
Unvaccinated children are significantly more likely to contract measles and pertussis than vaccinated children.
Compared with undervaccinated children, unvaccinated children are more likely to be white, live in higher-income households, and have a married mother with a college education.
Parents continue to report that healthcare providers are the most frequent source of information about immunizations.
The AAP Committee on Bioethics advises against discontinuing care for families that refuse vaccines, yet 40% of pediatricians report that they would no longer provide care to families who refuse all vaccines.
Omer SB et al. Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. N Engl J Med 2009 May 7; 360:1981.
Comment
During the past 10 years, new vaccines have been introduced at a dizzying pace. Is vaccine fatigue — among both parents and physicians — affecting immunization rates? The childhood immunization schedule used to be relatively easy to follow. Now, three separate schedules exist, each with detailed comments (http://www.cispimmunize.org/IZSchedule_Childhood.pdf, http://www.cispimmunize.org/IZSchedule_Adolescent.pdf, and http://www.cispimmunize.org/IZSchedule_Catchup.pdf). Simultaneous increases in the number of immunizations and rates of autism and allergic diseases have fueled concerns about a link between these conditions and vaccines, despite no credible evidence of an association. The more knowledgeable we are about possible safety issues, the better we can address parental concerns (JW Pediatr Adolesc Med Jan 28 2009). As we move toward a more complicated adolescent vaccination schedule, further adherence issues will arise, particularly because most adolescents visit their primary care provider less than once each year. I can envision a time when immunizations will be required for high school graduation just as they are for school entry. In view of the shift in perception about the safety of vaccines, we must remind our patients — and ourselves — that immunizations are responsible for saving more lives than virtually any other medical advance.