Talking with Parents about Vaccines for Infants Tuesday, August 14, - - PDF document

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Tuesday, August 14, 2018 12:00 PM ET

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Agenda

Welcome and Introductions

William Schaffner, MD, NFID Medical Director Professor of Preventive Medicine and Infectious Diseases Vanderbilt University School of Medicine

Talking to Parents about Vaccines for Infants

Jenny Mullen, MPH Health Communication Specialist National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention Nathan E. Boonstra, MD General Pediatrician Blank Children’s Hospital

Questions and Answers

General Information

• Please note that this webinar is being recorded
• All phone lines will be placed on mute throughout the program
• To hear audio:
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• After the presentations, there will be a Question and Answer period
• Use the Chat box on the lower left side of your screen to type your question
• At the end of the webinar, participants will be directed to an online

evaluation

• Following the webinar, registered participants will receive an email with

a link to the presentation slides

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CME Credit & Evaluation

• The National Foundation for Infectious Diseases (NFID) is accredited by

the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians.

• NFID designates this enduring material for a maximum of 1.0 AMA PRA

Category 1 CreditTM.

• To receive credit, you must complete the online evaluation and pass the

post‐test with a score of 80% or higher

• Online evaluation and post‐test will be available following the webinar at:

bit.ly/TalkingwithParents‐0814

• Certificate will be available for print or download following successful

completion of online evaluation and post‐test until August 14, 2019

CPE Credit & Evaluation

• The National Association of Chain Drug Stores (NACDS) is accredited

by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. NACDS designates this enduring material as 1.0 contact hours of ACPE accredited continuing

• education. Talking with Parents about Vaccines for Infants (ACPE

Universal Activity # 0206‐9999‐18‐018‐L04‐P. Initial Release Date: 08/14/2018).

• To receive contact hour credit, you must complete the online

evaluation and pass the post‐test with a score of 80% or higher

• Online evaluation and post‐test will be available following the

webinar at:

nacds.learnercommunity.com/home

8/14/2018 4

Disclosures

• Marla Dalton (NFID staff, content reviewer) owns stock, stock
• ptions, patent, or other intellectual property from Merck & Co., Inc.
• William Schaffner (NFID medical director, presenter) serves as an

advisor or consultant for Dynavax, Merck & Co., Inc., Pfizer Inc., Seqirus, and SutroVax

• All other individuals in a position to control the content of this

activity have no relevant financial relationships to disclose

Presentation Image Rights

• Photographs and images included in this presentation are licensed

solely for CDC/NCIRD online and presentation use. No rights are implied or extended for use in printing or any use by other CDC Centers, Institute, and Offices or any external audiences.

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Learning Objectives

At the conclusion of this activity, participants will be able to:

• Describe key findings of CDC vaccine communication research with

parents of children less than two years of age

• List three steps in effective vaccine conversations with parents
• Summarize common questions that parents ask about infant vaccines
• Identify immunization communication resources for healthcare

professionals and parents Non‐profit 501(c)(3) organization dedicated to educating the public and healthcare professionals about causes, prevention, and treatment of infectious diseases across the lifespan

• Reaches consumers, healthcare

professionals, and media through:

• Coalition‐building activities
• Public outreach initiatives
• Professional educational programs

(ACCME accreditation with commendation)

• Scientific meetings, research, and

training

• Longstanding partnerships to

facilitate rapid program initiation and increase programming impact

• Flexible and nimble organization

About NFID

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Talking with Parents about Vaccines for Infants

Jenny Mullen, MPH Health Communication Specialist National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention

CDC Research with Parents of Infants & Young Children

• National Immunization Survey (annual)
• Online polls (periodic)
• Cognitive interviews (periodic)
• Longitudinal study of first time expectant moms (2014‐2016)

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Vaccine Coverage among Children 19‐35 Months, National Immunization Survey, US, 1994‐2016

Very Few US Toddlers Have Received No Vaccines

1 2009 2010 2011 2012 2013 2014 2015 2016 Healthy People 2020 Goal: <1%

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CDC Longitudinal Study of First Time Expectant Moms

• Initial survey showed that over 85% of respondents had already

made a plan for vaccinating their baby by their 2nd trimester

• However, only 6% of the women were very satisfied with their

current level of knowledge about childhood vaccines

• Internet search engines were their #1 source of information about

childhood vaccines during pregnancy

• Only 22.5% cited their ob‐gyn or primary care provider
• Results suggest a need for midwives and ob‐gyns to direct expectant

women to credible sources of childhood immunization information

Parents’ Reported Vaccination Behavior

2016 (n=2,510) My child received all of his/her vaccines at the time(s) they were recommended 86.1% My child has not received all of his/her vaccines at the time(s) they were recommended but I am actively working to catch up 2.3% I chose to delay, or get later, one or more, but not all of the recommended vaccines at the time(s) they were recommended 5.8% I chose to delay all of the recommended vaccines at the time(s) they were recommended 0.6% I chose to refuse, or never get, one or more, but not all, of the recommended vaccines at the time(s) they were recommended 2.3% I chose to refuse and delay some of the vaccines for my child at the time(s) they were recommended 1.4% I chose to refuse all of the recommended vaccines at the time(s) they were recommended 1.6%

CDC National Poll of Parents 2016 (unpublished data)

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Vaccine Questions & Concerns

Weighted Frequencies 2016 (n=2,510) Long‐term side effects from shots 30.1% Short‐term side effects from shots (e.g., fever, redness, etc.) 27.8% What ingredients are in vaccines 26.0% Whether vaccine ingredients are safe 24.5% The risks of combining vaccines together into one shot 22.6% What are the side effects I should look for 21.1% Can it be delayed until they are older 21.1% Does the child really need it 20.5% Has provider vaccinated his/her own child 19.9% Is it required or optional for daycare/school 18.6% Does provider recommend it 17.3% Usually don’t ask questions 16.2% How serious is the disease it prevents* 15.9%

CDC National Poll of Parents 2016 (unpublished data)

Trusted Vaccine Information Sources

2016 (n=2,511) First choice Second choice Third choice 1 Doctor or other Healthcare Professional (HCP) 94.9% 0% 0% 2 Family members 1.7% 41.3% 0% 3 Scientific or medical journal 0.4% 6.9% 29.6% 4 Internet 1.1% 14.9% 8.1% 5 Friends 0.7% 3.5% 14.4% 6 Books 0.1% 4.6% 3.7% 7 Media (magazines, newspapers, etc.) 0.1% 2.5% 2.5% 8 Other 0.5% 0.4% 2.7% 9 Celebrity or public figure 0.2% 0.1% 0.1%

CDC National Poll of Parents 2016 (unpublished data)

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Summary

• Most women we surveyed made decisions about childhood vaccines

while they were pregnant

• Most parents vaccinate or intend to vaccinate their infants according

to the CDC recommended schedule

• About 10‐11% of parents intend to space out or refuse at least some

vaccines

• Parents’ attitudes about childhood vaccines have remained

consistently positive on a national level

• Parents do have questions and concerns about vaccines, but

questions do not necessarily equal concerns

• Parents have questions regardless of their immunization plans
• The most common questions relate to side effects, vaccine

ingredients, and vaccine safety

• HCPs remain parents’ #1 trusted source of vaccine information

Nathan E. Boonstra, MD General Pediatrician Blank Children’s Hospital Des Moines, IA

Talking with Parents about Vaccines for Infants

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Anatomy of a Vaccine Conversation

Talking with Parents about Vaccines for Infants: www.cdc.gov/vaccines/hcp/conversations/talking‐with‐parents.html

• 1. Assume Parents Will Vaccinate
• Use a presumptive approach
• Some studies suggests that this results in higher vaccine

acceptance rates

• Instead of saying “What do you want to do about shots?” say “Your

child needs three shots today.”

• Instead of saying “Have you thought about the shots your child needs

today?” say “Your child needs DTaP, Hib, and Hepatitis B shots today.”

• NOTE: This does not mean pushing or pressing parents to vaccinate

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• 2. Give Your Strong Recommendation
• If parents still hesitate or express concerns, give your strong

recommendation

• If appropriate, you can add a brief supporting statement that uses a

mix of science and anecdote

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

“…these shots are very important to protect him from serious diseases” “…I believe in vaccines so strongly that I vaccinated my own children on schedule” “…this office has given thousands of doses of vaccines, and we have never seen a serious reaction”

• 3. Listen To & Respond To Parents’

Questions

• Questions don’t necessarily mean that parents will refuse to

vaccinate

• Try to understand the concerns behind questions
• If you don’t know the answer, share what you do know
• Acknowledge both the benefits and risks of vaccination—parents

want to know about side effects

• Document questions and concerns for future conversations

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Questions about the Vaccine Schedule & Number of Vaccines

• Share that no evidence suggests that receiving several vaccines at
• ne time will overwhelm a healthy child’s immune system
• Explain what antigens are and emphasize the small amount of

antigens in vaccines compared to the antigens babies encounter every day in their environment

• Remind parents that they must start each vaccine series on time and

their child must complete each multi‐dose series for the best protection

“There’s no proven danger in getting all recommended vaccines today. Any time you delay a vaccine you leave your baby vulnerable to disease. It’s really best to stay on schedule.”

Questions about Whether Vaccines Are More Dangerous for Infants Than Diseases They Prevent

• Share your experience of how these serious diseases still exist and

explain that outbreaks still occur in the US

• Teach parents that diseases eliminated in the US can infect

unvaccinated babies if travelers bring the diseases from other countries

• Remind parents that many vaccine preventable diseases can be

especially dangerous for young children, and there is no way to tell in advance if their child will get a severe or mild case

“I know you didn’t get all these vaccines when you were a baby. Neither did I. But we were both at risk of serious diseases like Hib and pneumococcal meningitis that could lead to deafness or brain damage. Today, we’re able to protect your baby from 14 serious diseases before his second birthday with vaccines.”

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Questions about Known Side Effects

• Remind parents that most side effects are mild and go away within a

few days

• Reassure parents that you and your staff are prepared to deal with

serious vaccine reactions

• Encourage parents to watch for possible side effects and provide

information on how to treat them

• Share your own experience (or lack thereof) with serious vaccine

side effects

“I’ll worry if your child doesn’t get vaccines today, because the diseases can be very dangerous— most, including Hib, pertussis, and measles, are still infecting children in the US We can look at the Vaccine Information Statements together and talk about how rare serious vaccine side effects are.”

Questions about Unknown Serious Long‐Term Side Effects

• Vaccines are not linked to increases in health problems such as

autism, asthma, or auto‐immune diseases

• There is no evidence to suggest that vaccines threaten a long,

healthy life

• The risk of diseases outweighs risks posed by vaccines

“We have years of experience with vaccines and no reason to believe that vaccines cause long‐term harm. I understand your concern, but I truly believe that the risk of diseases is greater than any risks posed by

• vaccines. Vaccines will get your baby off to a great start for a long,

healthy life.”

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Questions about Whether Vaccines Cause Autism

• Reassure parents that you understand their infant’s health is their

top priority, and it also is your top priority

• Share that the onset of autism symptoms often coincides with the

timing of vaccines but is not caused by vaccines

• Give your personal and professional opinion that vaccines are very

safe “Autism is a challenge for many families and people want answers— including me. But well designed and conducted studies that I can share with you show that MMR vaccine is not a cause of autism.”

More Questions? Infant Immunization FAQs

• Written for parents of children 0‐2

years of age

• English and Spanish
• HTML and PDF
• Co‐branded with American

Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP)

www.cdc.gov/vaccines/parents/parent‐questions.html

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What If Parents Refuse To Vaccinate?

• Continue the conversation during the next visit
• Inform parents about vaccine‐preventable disease

symptoms

• Remind parents to call before bringing their ill child

into the office

• Share CDC fact sheet: If You Choose Not to

Vaccinate Your Child, Understand the Risks and Responsibilities

• Consider having parents sign AAP’s Refusal to

Vaccinate form.

• www.aap.org/en‐

us/Documents/immunization_refusaltovaccinate.pdf

Wrapping Up The Conversation

• Remember that success comes in many forms
• For hesitant parents, may just need to leave door open for future

conversations

• Work with parents to agree on one action:
• Scheduling another appointment
• Read additional information you provide them
• If a parent declines once, it does not mean they always will

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Create Culture of Immunization in Your Practice

• Parents’ confidence is increased when they receive the same

information from different people

• Inconsistent messages from staff may confuse parents and create

mistrust

• A culture of immunization starts at the front desk and extends into

the waiting room, into the exam room, and finally to the check out desk

• Everyone plays a part:
• Receptionists and other support staff
• Nurses and nurse practitioners
• Physicians and physician assistants
• Medical assistants
• Office manager
• Vaccine coordinator

CDC Resources

Jenny Mullen, MPH

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Presentation: 10 Ways to Create a Culture of Immunization Within Our Pediatric Practice

Slide Deck Content:

• Concrete ways that everyone in

the practice can support parents’ vaccine decisions

• How to prepare your team to

address common patient questions

• How to implement a standardized

process

www.cdc.gov/vaccines/partners/childhood/professionals.html

Provider Resources for Vaccine Conversations with Parents

• Talking to Parents about Vaccines
• Understanding Vaccines and Vaccine Safety
• How Vaccines Work
• The Recommended Childhood

Immunization Schedule

• Ensuring the Safety of US Vaccines
• Understanding MMR Vaccine Safety
• Understanding Thimerosal, Mercury, and

Vaccine Safety

• The Advisory Committee on Immunization

Practices (ACIP)

• Diseases and the Vaccines that Prevent Them
• If You Choose Not to Vaccinate, Understand

the Risk, and Your Responsibilities

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How To Use Provider Resources

• Review Talking to Parents about Vaccines and vaccine safety sheets

with your staff; vaccine safety sheets may also be given to high information seeking parents with specific safety concerns

• Give parents fact sheets about any diseases/vaccines that they have

questions about

• Time permitting, talk through the fact sheet together with them
• Share If You Choose Not to Vaccinate, Understand the Risk and Your

Responsibilities with parents who are considering skipping vaccines

• Review it with your staff to identify talking points for vaccine‐hesitant

parents

• Create a waiting room display with fact sheets and the current CDC

immunization schedule

CDC Medscape Expert Commentaries

• Vaccine Communication with Parents: Best Practices –

Nancy Messonnier, MD

www.medscape.com/viewarticle/882865?src=par_cdc_stm_ms cpedt&faf=1

• Overcoming Vaccine Concerns and Refusals –

Anne Schuchat, MD www.medscape.com/viewarticle/742313

• Common Questions about 9‐Valent HPV Vaccine –

Lauri Markowitz, MD www.medscape.com/viewarticle/846509

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Parent‐Friendly Immunization Schedules & Quiz

• Easy‐to‐read versions in English and Spanish:
• Clearly explains the diseases prevented by each vaccine

www.cdc.gov/vaccines/schedules/easy‐to‐read/child.html

• Childhood vaccine quiz in English and Spanish:

www2a.cdc.gov/vaccines/childquiz/

Materials to Share with Parents

www.cdc.gov/vaccines/parents/resources

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How To Use Communication Resources

• Share with parents and also your peers
• Syndicate CDC web content on your practice website:

tools.cdc.gov/syndication/LearnMore.aspx

• Share infographics and listicles via social media channels
• Order posters and hang them in your waiting rooms or exam rooms
• Give copies of parent‐friendly CDC immunization schedules to parents
• Order or download fact sheets and make them available:
• Include in information packets for new patients
• Create a waiting room display
• Have copies available in exam rooms or a central location so that

you can give them to parents who have specific concerns

• All CDC materials are available for free download; certain materials

can be ordered from CDC‐INFO On Demand:

wwwn.cdc.gov/pubs/cdcinfoondemand.aspx

What If Parents Don’t Trust CDC?

• Refer to other credible websites:
• American Academy of Pediatrics Healthy Children:

www.healthychildren.org

• Children’s Hospital of Philadelphia Vaccine Education Center:

www.chop.edu/centers‐programs/vaccine‐education‐center

• National Foundation for Infectious Diseases: www.nfid.org
• Vaccinate Your Family: www.vaccinateyourfamily.org/
• Immunization Coalitions (e.g., Immunize Nevada, Vax Maine

Kids)

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Opportunities for Educating Staff & Parents

• National observances = good time to promote immunization
• National Infant Immunization Week (late‐April)

www.cdc.gov/vaccines/events/niiw

• National Immunization Awareness Month (August)

www.nphic.org/niam

Questions and Answers

View detailed agenda at: www.nfid.org/cvc Early Registration Deadline: September 27, 2018

Call for Poster Abstracts To Share Best Practices

• Submission deadline: September 10, 2018

Questions & Answers

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CME Credit & Evaluation

• The National Foundation for Infectious Diseases (NFID) is accredited by

the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians.

• NFID designates this enduring material for a maximum of 1.0 AMA PRA

Category 1 CreditTM.

• To receive credit, you must complete the online evaluation and pass the

post‐test with a score of 80% or higher

• Online evaluation and post‐test will be available following the webinar at:

bit.ly/TalkingwithParents‐0814

• Certificate will be available for print or download following successful

completion of online evaluation and post‐test until August 14, 2019

CPE Credit & Webinar Evaluation

• Visit: nacds.learnercommunity.com/home
• Select course Talking with Parents about Vaccines for Infants under

Claiming Credit

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• Login or sign‐up for a LearnSomething account
• Select “View Enrollment” and course title under “Activities”
• Enter Attendance Code, complete Post‐Test and Evaluation, and

enter NABP number and birthdate to claim credit

• Contact education@nacds.org with any questions

ATTENDANCE CODE:

PNXRCM

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CONNECT WITH NFID

instagram.com/nfid_vaccines/

Upcoming NFID NIAM 2018 Webinars

Registration: www.nfid.org/webinars Subscribe to NFID email updates: www.nfid.org/subscribe

• Increasing Adolescent Vaccination Rates

August 21, 2018 at 12:00 PM ET

• Preventing Hepatitis B Infections in US Adults

August 28, 2018 at 12:00 PM ET