The state of Texas has seen a rise in the number of patients
opting out of recommended vaccinations.
What have you seen as the effects
of this rise in opting out? How
have you seen Texas hospital
teams handle patient interaction
and patient education for those
patients and families who do not
follow medical recommendations
Texas Hospital Association
ROBERT HENDLER, M.D.
CHIEF MEDICAL OFFICER
As I have been in administration for many
years, my experience is with hospital staffs.
In Tenet Healthcare, I helped develop one
of the early influenza immunization policies. Given that our
inpatient population was, in many cases, elderly and possibly
immunocompromised by illness or treatments, immunization
for health care workers was a mandate. We carefully looked at
requests for personal, allergic, or religious reasons and found
few reasons to allow a refusal. Workers with an acceptable
excuse to not be immunized were required to wear masks
during flu season. Hand hygiene was emphasized. We saw no
flu spread in our hospitals.
Influenza immunization was a priority of the CDC at that
time with an increasing number of avoidable deaths due
to lack of immunization in the population. As I recall, the
CDC made the case that the hospitalized patient was an
ideal group to immunize due to age and complex illness who
required hospitalization. The CDC felt the opportune time to
immunize this group was while they were in hospital. Influenza
vaccination became a core measure of quality for U.S. hospitals.
Florida was the first state that put this requirement into law
and until that time, physicians deferred the immunization
stating they would give the shot in the office. Our data showed
that the follow-up immunization was a rare event. Thanks to
the change in protocol, immunizations rates increased, and
The same approach was used in the hospitalized patients
and all unimmunized patients were offered the shot. Refusing
immunization documentation with reason was a required part
of the medical record.
The importance of sharing vaccination science with refusing
patients is important. While logical discussions may not
work, it is important to share the tragedies of avoidable illness
and death common in the pre-immunization world and the
recurrence of epidemics in unimmunized populations.
For my personal reasons for being a strong advocate of
immunizations, listen to THA's latest Solutions podcast at
Texas Children's Hospital, Houston
JULIE BOOM, M.D.
DIRECTOR, IMMUNIZATION PROJECT & ASSOCIATE PROFESSOR, BAYLOR COLLEGE OF MEDICINE, HOUSTON
Less than two decades ago, measles, a very
contagious and potentially deadly disease,
was declared eliminated in the United
States. As a nation, we were able to accomplish eradication
of this serious childhood illness through vaccination.
Unfortunately, over the past two decades, parents have
increasingly chosen to exempt their children from childhood
vaccines based on misinformation. Today, with more than
56,000 children exempt from one or more childhood vaccines
in the state of Texas, we find our state and nation facing
the highest number of measles cases since eradication in
2000. As a result, some children and adults are now at risk of
contracting measles. There is no doubt, the current measles
cases represent a call to action for every medical professional –
physicians, nurses, staff and hospital administrators.
In the spirit of “do no harm,” we must first ensure we cannot
transmit diseases, such as measles, to our patients. Make it a
priority to confirm that your workplace is in compliance with
the Center for Disease Control and Prevention health careworker
vaccination recommendations. Regarding measles,
all employees should have presumptive evidence of immunity
to measles which includes any of the following: written
documentation of vaccination with two doses of live measles or
MMR vaccine administered at least 28 days apart, laboratory
evidence of immunity, laboratory confirmation of disease, or
birth before 1957 (see bit.ly/cdc-ACIP for additional details).
Parents of patients may approach any member of our
medical teams with questions regarding vaccines, especially
now when a disease like measles is frequently in the news.
For this reason, vaccine communication training for our
team members is especially important. Here are important
thoughts to consider:
First, recognize how important your advice is to those
around you. If parents or patients know you work for
a local medical practice or hospital, they will listen
intently for your advice. Be clear when you talk about
the importance of vaccines. Vaccines are safe,
effective and they save lives. Period.
Second, always offer vaccines using
presumptive words. Research has shown that
parents, even vaccine-hesitant parents,
are more likely to accept a vaccine when
presumptive words are used. For instance,
say, “Today, your daughter needs all of her
4-year-old vaccines – MMR, varicella, DTaP,
and polio,” instead of, “Have you thought
about giving your daughter her 4-year-old
vaccines today? The latter option is likely to be
met with more caution and resistance; parents
may even question your own thoughts about the
importance of vaccines.
Third, if a parent has questions about the vaccines, such as
MMR, listen carefully to the source of those concerns. Have
the parents read misinformation on the internet? Have wellmeaning
friends given them bad advice? Do they have a child
with developmental delay in the family? It is important to
understand the source of the concern to address the concern
Finally, use the CASE method to talk with families.
Developed by Alison Singer, CASE stands for Corroborate,
About me, Science, Explain/advise. Following careful listening,
medical professionals need to offer the vaccine-hesitant
parent or patient a statement to establish common ground – a
corroboratory statement. Strong corroboratory statements
include thoughts such as: “Other parents have mentioned that
concern to me,” or “That is a common story others have shared
with me.” Following a corroboratory statement, providers
and staff then explain their role in the medical profession as
someone who has learned about the importance of vaccines
(“About me”). Then, the provider explains the science that
directly addresses the concern that was voiced by the parent
or patient. To conclude, the provider or staff member should
offer their best medical advice regarding the situation at hand
(Explain/advise). Be clear and directive. Again, vaccines are
safe, effective and save lives. Period.