COMMUNICATING WITH PARENTS/CAREGIVERS

With several newer vaccines available in the open market, it is an arduous task for pediatricians to offer ideal advice to parents regarding pros and cons of each vaccine. Most of these vaccines are included in the Indian Academy of Pediatrics (IAP) recommendations necessitating one- to-one discussion. Thus, pediatricians are required to communicate properly with clarity and appropriate information that should help parents to make their own decision in favor or against each of these vaccines. Ideally, we need to offer a balanced scientific view without appearing to suggest one way or another. Unfortunately, most of the educated parents would leave the choice to their pediatricians and it is quite unfair to take responsibility for making a choice for parents.

Prerequisite of one-to-one discussion is commitment on the part of pediatricians to inform relevant facts about disease and vaccines. It takes very little time if one uses structured format covering important aspects in simple language. Following points need to be discussed regarding each vaccine.

  • Risk of developing disease: It is not possible to evaluate risk of
    disease in an individual child, but figures from literature may be quoted, e.g. the risk of invasive pneumococcal disease (IPD) in a healthy child aged less than 1 year is roughly 200 per 100,000 (as per Western data). Some general statements are also helpful. Water or food-borne infections are preventable to some extent but not airborne droplet infections. Risk of complications of disease is higher in infants and younger children and in undernourished populations. Age prevalence of disease decides appropriate age of vaccination as per the standard recommendations.
  • Efficacy of vaccine: No vaccine provides 100% protection though most of the vaccines do offer a high degree of protection. Vaccines significantly decrease chance of disease and even partial protection is useful to prevent complications. Occasional failure of vaccine protection is no reason to consider against its use.
  • Safety of vaccine: Vaccines are very safe and serious adverse reactions are extremely rare. Media outbursts of fatal reactions to vaccines are mostly due to human error of administration and not due to the vaccine itself. Thus, benefits of vaccines outweigh the risk of side effects caused by vaccines.
  • Cost of vaccine: Decision of affordability should be left to parents. It is important to reiterate facts that all vaccines are equally efficacious even though they may differ in their cost. For example, DTwP (diphtheria, tetanus, and whole-cell pertussis) and DTaP (diphtheria, tetanus, and acellular pertussis) are equally efficacious though differ in reactogenicity. Similarly, vaccines from different manufacturers are equally effective and indigenously manufactured vaccines are usually as good as imported ones. Finally, it is important to emphasize that the above discussion is based on the current understanding of vaccines and its present place in prevention of disease. With increasing experience over time, there can be a change in the recommendations of individual vaccines and it is necessary to adapt to such changes. For example, a second dose of MMR is now recommended.
  • Many new vaccines are likely to be introduced over the next few years. It would be a challenge for pediatricians to develop communication skills to discuss pros and cons of all these vaccines. But far more relevant is the need to keep updated on issues related to vaccines and disease prevention. It is only then that “one-to-one discussion” will become more meaningful.
  • Source : IAP guidebook on Immunisation 2018-19 by ACVIP

Source : IAP guidebook on Immunisation 2018-19 by ACVIPSource : IAP guidebook on Immunisation 2018-19 by ACVIP Cost of vaccine: Decision of affordability should be left to parents. It is important to reiterate facts that all vaccines are equally efficacious even though they may differ in their cost. For example, DTwP (diphtheria, tetanus, and whole-cell pertussis) and DTaP (diphtheria, tetanus, and acellular pertussis) are equally efficacious though differ in reactogenicity. Similarly, vaccines from different manufacturers are equally effective and indigenously manufactured vaccines are usually as goodSource : IAP guidebook on Immunisation 2018-19 by ACVIP

Leave a comment

Your email address will not be published. Required fields are marked *