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    When 'firing' a patient for vaccine refusal is the only response


    Vaccination refusal has been in the public eye for awhile—from false fears that vaccines cause autism spectrum disorders to a measles outbreak at Disneyland. As the small minority of anti-vaccine parents continue to emit a loud voice, some physicians are firing back by dismissing patients who refuse immunizations.

    Recommended: Addressing vaccine fears and concerns

    According to the Centers for Disease Control and Prevention (CDC), 159 cases of measles were reported in the first quarter of 2015. The largest outbreak originated at Disneyland in California, and accounted for 70% of those early 2015 cases. Additionally, 28,660 cases of pertussis were reported in 2014, up from 28,639 cases in 2013, stressing the importance of children receiving the full set of diphtheria, tetanus, and acellular (DTaP) vaccines, including boosters.

    This outbreak and others have illustrated the importance of vaccinating against preventable diseases.

    A new study reveals the frequency of patient dismissal, and how vaccine refusal by parents is impacted by state support of immunization through laws opposing philosophical vaccine refusal.

    Overall, less than 1% of children received no vaccinations, according to CDC. National coverage met the Healthy People 2020 target of 90% for the full series of the polio vaccine (93.3%), more than 1 dose of measles, mumps, and rubella (91.5%); more than 3 doses of hepatitis B (HepB) (91.6%); and more than 1 dose of varicella (91%). Vaccination rates fell below the goal for more than 4 doses of DTaP, Haemophilus influenza type B, HepB at birth; more than 4 doses of pneumococcal conjugate vaccine; more than 2 doses of hepatitis A; and the full course of the rotavirus vaccine, according to CDC.

    In 2014, 23 outbreaks of measles were reported across 27 states, representing more cases than any year since 1994, according to lead study author Sean O’Leary, MD, of Colorado Children’s Hospital in Aurora. Although children living in poverty often fail to receive all of their vaccinations, the study attributes this increase in measles cases to parents who are actively declining vaccination.

    Pediatricians report spending significant time in educating parents on the benefits of vaccination and dispelling myths, but there are no best evidence-based strategies identified for effective communication to convince hesitant parents to vaccinate, according to the report.

    As a result, some physicians are resorting to dismissing families that refuse vaccinations for their children, even though the American Academy of Pediatrics (AAP) and the CDC discourage such policies.

    A 2002 report found that 39% reported they would dismiss families for refusing all vaccines. Since that time, says O’Leary, there has been little investigation into the practice of patient dismissal related to vaccination. For his study, O’Leary specifically examined state exemption policies in relation to the practice of dismissing families for vaccination refusal.

    NEXT: The impact of exemptions

    Rachael Zimlich, RN
    Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare ...

    1 Comment

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    • Dr. MK
      Why would I possibly not want to dismiss a family that doesn't agree with me on medical decisions? If they don't believe my opinion on vaccinations, why would they believe it for ear infections or anything else?


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