Lori Kestenbaum, MD

is a fellow in Pediatric Infectious Diseases at The Children’s Hospital of Philadelphia. She graduated with a BS in Psychology from Duke University and received her MD from the Perelman School of Medicine at the University of Pennsylvania. She completed her residency in Pediatrics at The Children’s Hospital of Philadelphia in 2012.  She is currently a member of the American Academy of Pediatrics, the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Follow her on Twitter @lorikestenbaum.

Moving parents toward vaccine acceptance

There are different types of parents who refuse vaccines.  There are those who adamantly refuse all vaccines and cannot be moved from this position, and there are those who in general have their children vaccinated, but hesitate on those that seem “optional,” such as the annual flu vaccine or the HPV vaccine.  With an extra minute, you can move these parents to vaccine acceptance.  

In clinic this week, in a visit for Lyme disease in a 12-year-old girl, I asked as part of my routine history if the child’s vaccines were up-to-date.  The mother responded, “Yes. Well, we put off one.” And the child looked at me and said, “Yeah, THAT one. The sex one.” 

“Oh. Are you referring to the HPV vaccine?” I said as I launched into my rehearsed set of facts designed to move parents.  “I realize the benefits are many years away, but its recommended that you get your doses now because your immune system will have a better response to the vaccine while you are younger and protect you better in the future.” 

“Oh,” the mother said.  “I hadn’t realized that. We should get that one this year, then.” 

And that was that.  I had more of my usual facts prepared to fire off at them, about the fact that getting the vaccine didn’t increase rates of sexual activity, or the logistics of getting vaccinated when you are 22 and have a job is impractical, or all of the other things I say…. But they had converted, with just one fact.

Next, on the inpatient side, an 8-year-old boy lay in his bed in the pediatric ICU with respiratory distress and fever from influenza.  Why hadn’t he had a flu shot this year? “I had just decided not to do it this year,” his mother said.  “I had no idea a child could get this sick – no one ever told me.  #fluvaccineconvert.” 

We all laughed.  And then I felt ashamed for the medical profession.  We are the holders of facts about vaccines, and it is our responsibility to ensure that patients and parents get accurate information. If a parent says, “I hadn’t realized that” or “No one ever told me that” it means we have neglected one of our primary responsibilities as pediatricians: to arm families with the factual information that they need to raise healthy children.  When parents make unsafe decisions for their children, we have to advocate even more for the child.  So take the extra minute or two to know the facts and to work with these families.  Parents who understand the importance and efficacy of vaccines in general can be moved to accept vaccines that cause hesitation.  You will prevent the child from suffering anything from a 4-day hospitalization to cervical cancer, just by sharing a few facts.