Health

Speaking the language of vaccines (ICAAC and IDSA joint meeting)

Easing parents' fears about vaccine safety may mean moving beyond answers couched with scientific caveats.

By Susan J. Landers — Posted Dec. 15, 2008

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Childhood vaccines are entangled in a vast public controversy, and doctors often find themselves helping perplexed parents sort through misinformation before making a decision on immunization.

Mindful of these discussions, a panel of physicians and journalists offered pointers to those on the front lines during the joint meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America, held Oct. 25-28 in Washington, D.C.

Panelist Paul Offit, MD, director of the Vaccine Education Center at the Children's Hospital in Philadelphia, believes one way to address parents' fears is for physicians to sharpen their message and stop using the scientific language of the many reports that have found no link between autism and the measles, mumps and rubella vaccine.

A developer of the vaccine RotaTeq and author of Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure, Dr. Offit said the language of science can confuse lay people. Instead, physicians should ratchet up the message and state their point emphatically -- that the vaccine does not cause autism, he said.

"After you have done 10 studies and spent millions of dollars looking for the association between autism and MMR, I think you can be a little more definitive in your language."

One conversation at a time

Simon Dobson, MD, clinical associate professor of pediatrics at British Columbia Children's Hospital in Vancouver, often has what he calls the "eyeball-to-eyeball" conversation with a parent who is concerned about immunizations.

He recommends patience and good listening skills. Parents are often worried about something close to home, he said. "If you can nail that family myth or whatever it is that concerns them, the rest is easy."

Most worried parents relate stories about growing up knowing a child who had autism or another disability. After all, many panelists noted, because of vaccines, measles and other serious childhood diseases have never been seen by parents, or even many physicians, while autism is much more in evidence.

But the more difficult cases involve parents who have been "bombarded by the media," Dr. Dobson said. "They just don't know what to do and are paralyzed by indecision."

He, too, recommends cutting back on scientific evidence when discussing vaccine benefits. "I would go on and on about the benefits of the vaccine and the risk of the disease, and parents would get a glazed look."

Instead, he tries to tap parents' imaginations and urge them to think about what could happen if they forgo vaccines for their children. The anti-vaccine people use anecdotes, he said. "But we get the anecdotes beaten out of us in medical school." Nevertheless, he noted, "I can tell a tragic story. It has a great impact on parents."

For example, he asks parents to imagine what might happen if their child grows up to do good works in far-off countries where diseases such as polio are still endemic. If the child is not immunized, he or she could become infected, he relates.

"Parents may think of me as pompous -- a windbag in the pay of the government, big pharma and big business -- but they do respect my opinion," he said.

Also remember the conversations can take place over several office visits, Dr. Dobson said. "You don't need to do it all in one go. This is particularly true in the primary care setting."

British journalist Vivienne Parry, who also served on the UK Joint Committee on Vaccination and Immunisation, noted that the drop in the MMR vaccination rate in her country has led to outbreaks of disease. "People are much more afraid of autism than they are of measles."

Parry urged physicians to stand up in support of vaccines. "It has distressed me to see Paul Offit out there by himself," she said, referring to Dr. Offit's outspoken defense of vaccine safety, which has made him a target of anti-vaccine activists and the recipient of death threats. "Where are the other physicians supporting him?"

Physicians need to engage patients with simple and emotional language, she added. "You need to understand where the problems are coming from. The fears are natural. You need to think about that when you are communicating with patients."

Dr. Offit said he would like to see a recasting of the characters in this ongoing drama. Now, the anti-vaccine people are often identified as the only ones who care about children. "I just wish the story was told a different way," he said. As a result of the suspicion being raised that vaccines are connected to autism, "we continue to divert resources away from more promising leads."

Back to top


ADDITIONAL INFORMATION

MRSA on the rise

Rates of outpatient visits for skin and soft-tissue infections have increased in recent years, mirroring the spread of methicillin-resistant Staphylococcus aureus in the community. Researchers tallied visits to physicians' offices, hospital outpatient departments and emergency departments using data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, both 1997-2005. Numbers show annual visits per 1,000 population. Abscess and cellulitis are hallmark infections associated with MRSA.

All skin and
soft-tissue infections
Abscess and
cellulitis
1997 32 17
1998 35 20
1999 37 23
2000 33 21
2001 35 23
2002 40 22
2003 43 27
2004 49 32
2005 48 32

Source: "National Trends in Ambulatory Visits and Antibiotic Prescribing for Skin and Soft-Tissue Infections," Archives of Internal Medicine, July 28 (link)

Back to top


Alternative MRSA drugs are the focus of 2 trials

Staphylococcus aureus is a smart bug. It has figured out how to evade most of the antibiotics physicians have thrown at it and doesn't show signs of dumbing down soon, said presenters at the joint meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America. The meeting was held in Washington, D.C., Oct. 25-28.

The resistant forms of S. aureus -- referred to as methicillin-resistant Staphylococcus aureus -- are responsible for large increases in the numbers of patients with skin and soft-tissue infections who are showing up in physician's offices and emergency departments nationwide. A recent analysis of records from outpatient settings showed a doubling of the number of abscesses or cellulitis, which are MRSA hallmarks -- from 4.6 million to 9.6 million -- from 1997 to 2005. The highest rates were seen among children in urban emergency departments.

The community is where MRSA is now taking its greatest toll, said pediatric diseases specialist Robert Daum, MD, professor of pediatrics at the University of Chicago. He spoke during a symposium on treatment and prevention techniques.

The first step in treatment is draining the pus, noted Rachel Gorwitz, MD, MPH, a medical epidemiologist at the Centers for Disease Control and Prevention. Beyond that, the CDC, the AMA and IDSA advise in a joint statement sending the wound drainage for culture and susceptibility testing and, if signs of infection persist, prescribing an appropriate antibiotic.

However, not all physicians are on the same page when it comes to treatment beyond incision and drainage, noted Dr. Daum.

An array of opinions

An article in the Oct. 9 New England Journal of Medicine reported the results of a poll in which readers were asked to vote for the best of three treatment options for a 20-year-old college basketball player with a tender, red area on the right buttock.

In response, 41% of the more than 11,000 votes cast favored incision and drainage plus an oral antimicrobial agent against MRSA; 31% favored incision and drainage alone; and 28% favored incision and drainage plus an oral antimicrobial agent active against methicillin susceptible S. aureus.

Given this state of confusion and the scarcity of effective medications, the National Institutes of Health recently launched two clinical trials to determine whether older, off-patent antibiotics such as clindamycin and trimethoprim/sulfamethoxazole are effective treatments for the management of uncomplicated community-acquired MRSA.

But Dr. Daum would like to move the agenda from treatment to prevention with the development of an S. aureus vaccine. The need is apparent, he said. The rate of MRSA infections is now twice as high as were the number of Haemophilus influenzae infections several decades ago when the decision was made to develop that vaccine, he noted. "Now Haemophilus is largely gone."

In one possible bright spot, Henry Chambers, MD, a professor of medicine at the University of California, San Francisco, and infectious diseases director at San Francisco General Hospital, reported that the rate of infection from community-acquired MRSA may be dropping after peaking in 2004. "We may be riding the curve down."

Back to top


Treatment tips

From the ICAAC/IDSA joint meeting 2008:

Stopping flu transmission. A study presented at the joint meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America examined the effectiveness of steps to stop the transmission of the flu virus. Specifically, wearing masks and using alcohol-based hand sanitizers in a community setting may prevent the spread of seasonal influenza by as much as 50%, according to researchers from the University of Michigan School of Public Health in Ann Arbor. Their finding were presented during a slide session.

The researchers studied more than 1,000 students from seven university residence halls during the 2006-07 flu season and again during the last flu season. Participants were randomly assigned to six weeks of wearing masks; wearing masks and using hand sanitizers; or serving as controls and using no protections.

From the third week of the study on, both the mask and mask/hand sanitizer interventions showed a significant or nearly significant reduction in the rate of influenza-like illness symptoms in comparison to the control group.

The observed reduction rate remained even after adjusting for gender, race/ethnicity, hand-washing practices, sleep quality and flu vaccination, the researchers said.

Infectious waiting room toys. Toys in pediatric waiting rooms were found to harbor remnants of cold viruses even after cleaning with commercially available disinfectant cloths, according to a study conducted at the University of Virginia Children's Hospital in Charlottesville. Rhinovirus was detected most often.

The researchers also found some of the toys that were not contaminated before cleaning, tested positive for viral remains after cleaning. Twenty percent of the toys in the sick child waiting room were contaminated, 17% of the toys in the well child waiting room showed viral remains and, interestingly, no virus was found on any of the toys in the exam rooms.

The study was conducted during fall and winter on three separate dates in a pediatrician's office.

The findings were presented at a slide session.

Back to top


External links

Events from the joint meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America (link)

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn