Canadian Immunization Guide
Seventh Edition - 2006
Canadian Immunization Guide 2006
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Part 1
General Guidelines
Communicating Effectively about
Immunization
Public concern regarding vaccine safety
can reduce vaccine coverage and result in resurgence of
vaccine-preventable diseases. As trusted information sources,
health care providers have a vital role in the continued success
of immunization programs. To be most effective, providers must
have skill and expertise, not only in the principles and
practices of immunization but also in risk communication. This
section outlines the general principles of risk communication and
identifies additional resources for providers and the
public.
Principles of risk
communication
The goal of effective risk communication
is the development of an informed decision-making partnership.
The process involves both education and advocacy, and is
facilitated through advance preparation by all participants,
clear messaging, and an open and respectful atmosphere. An
individual's perception of risk is influenced by experience
as well as personal, religious and cultural contexts.
Furthermore, events that are familiar, involve a natural process,
seem to be under an individual's control, are of a
voluntary nature or involve a decision to forgo something are
generally perceived as less risky than those that are unfamiliar,
involve a man-made process, involve loss of control, are
mandatory or involve a decision to do something rather than avoid
something. A decision to become immunized or immunize a child
clearly falls into the latter "high risk" category
regardless of the true odds. Framing the risks in the right
context is very important. Countering an individual's
concerns by citing the greater dangers of a familiar event, like
driving a car, while true, may be counterproductive.
For effective risk communication,
physicians and other health care providers should attempt to do
the following:
- Communicate current
knowledge, taking into account
what an individual already knows and the level of detail
requested. The process need not be time-consuming. It is useful
to have varied information formats (visual, audio, printed material, Web
sites) tailored to a range of educational levels and languages as
appropriate to a given practice/clientele. Given the volume, accessibility and
variable quality of material available on the Internet, it is
also helpful to provide guidance on how to assess Web site
reliability. Several excellent resources are listed at the end of
this section.
- Respect differences of opinion
about immunization. Some
individuals will express reluctance or refusal to accept
immunization for themselves or their children. It is important to
both gauge the strength of this stance as well as discover its
underlying reasons.
- Represent the risks and benefits
of vaccines fairly and openly. Contrast the known and theoretical risks
of vaccine with the known risks associated with the
vaccine-preventable infection (see at the end of this Guide for a table on Comparison of Effects of Diseases and
Vaccines). It is also important to counter the
notion that vaccine-preventable diseases are gone (see box).
- Adopt a patient-centred
approach. Effective decision
making is best done in a partnership between the provider or
vaccinator and the parent or patient. Central to this is the
acceptance that individuals have input into the decision to
immunize and retain responsibility for their own or their
child's health. A decision to do something rather than to
avoid something may cause greater concern when it comes to
immunizing children. It may be helpful to present the facts and
then ask those responsible to consider what the child would
choose, were he or she old enough to do so.
- Make the most of each opportunity
to present clear, evidence-based messages regarding vaccines and
immunizations (see box). Encourage questions, address
misinformation, and provide valid and appropriate resources,
including authoritative Web sites, for those who want more
information.
Conclusion
As long as the diseases that vaccines
prevent are rarely seen by the general public today, vaccine
safety concerns will continue to have a high profile.
Careful and timely counselling can help
people to weigh the benefits of vaccines and the risks of the
disease that the vaccine will prevent, as well as the small risk
posed by the vaccine itself. By providing vaccines in a climate
of appropriate informed consent, including discussion of commonly
held misconceptions, health care providers can help ensure that
immunization will maintain its status as one of the most
effective preventive measures in the history of
medicine.
Immunization Truths
- Immunization is the best protective
strategy against vaccine-preventable diseases.
- The vaccines used in Canada are both
effective and safe.
- Health authorities worldwide take
vaccine safety very seriously. Expert committees in Canada
investigate reports of serious adverse events following
immunization.
- Vaccines do not weaken the immune
system. Rather, they harness and train it to defend, rapidly,
against vaccine-preventable pathogens before illness can
occur.
- Vaccine-preventable infections are far
more dangerous than vaccines (see the Table on Comparison of Effects of Diseases and
Vaccines at the end of the
Guide ) .
- The bacteria and viruses that cause
vaccine-preventable diseases are not gone.
- Diphtheria, pertussis, polio, measles,
mumps, rubella, varicella, hepatitis A and B are well adapted
human pathogens that, to a greater or lesser extent, are
contagious and are still occurring in parts of the
world.
- Tetanus is a soil organism - it
will never be eliminated.
- Haemophilus influenzae type b, Streptococcus pneumoniae and Neisseria
meningitidis can survive in the
nose and throat and will likely never be completely
eliminated.
- Unvaccinated individuals have a much
greater chance of getting a vaccine-preventable disease than
those who have received the vaccine. This is true even in
countries where high levels of immunization provide some degree
of protection to susceptible individuals (i.e., herd immunity).
Three examples:
- An outbreak of rubella occurred in 2005
among unimmunized individuals in Ontario.
- Children in the United States who did
not receive measles vaccine were 22 to 35 times more likely to get measles than
immunized children.
- Children in the United States who did
not receive pertussis vaccine were almost 6 times more likely to get whooping
cough than immunized children.
- When vaccine coverage drops,
vaccine-preventable diseases return:
- In Japan, pertussis vaccine coverage
dropped from 90% to less than 40% because of public concern over
two infant deaths that followed DPT immunization. Prior to the
drop in coverage there were 200 to 400 cases of pertussis each
year in Japan. From 1976 to 1979, following the marked drop in
vaccine coverage, there were 13,000 cases of pertussis, of which
over 100 were fatal.
- In Ireland, measles vaccine coverage
dropped to 76% following allegations of a link with autism. The
number of measles cases increased from 148 in 1999 to 1200 in
2000, along with several child deaths due to the complications of
measles.
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References and Web resources for
immunization risk communication
A. How to
communicate
Spier RE. Perception of risk of vaccine adverse events: a
historical perspective. Vaccine
2001;20:S78-84.
Stoto MA, Evans G, Bostrom A. Vaccine risk communication. American Journal of
Preventive Medicine
1998;14(3):237-39.
Summary. Workshop on Vaccine
Communication, October 5-6, 2000, Arlington,
Virginia. URL:
<http://www.dhhs.gov/nvpo/pubs/vcwsummary.pdf>.
Tenrreiro KN. Time-efficient strategies to ensure vaccine
risk/benefit communication. Journal of Pediatric Nursing
2005;20:469-76.
B. What to
communicate
Canadian Coalition for Immunization
Awareness and Promotion. Addressing patient concerns. URL:
<http://www.immunize.cpha.ca/english/links/hlthprv.htm>
(English); <http://www.immunize.cpha.ca/francais/hcprovdf/provresf/provparf.htm> (French).
Canadian Paediatric Society. URL:
<www.cps.ca>
Children's Hospital of
Philadelphia Vaccine Education Center. URL: <http://www.chop.edu/consumer/jsp/microsite/microsite.jsp?id=75918>.
Gold R and Canadian Paediatric
Society. Your child's best
shot: a parent's guide to vaccination, 2nd ed. 2002. URL: <www.cps.ca/english/publications/Bookstore/YourChildsBestShot.htm>.
Immunization Action Coalition. URL:
<www.immunize.org>. (Information in several formats,
including video.)
National Network for Immunization
Information. URL: <www.immunizationinfo.org>. Communicating with patients about
immunization. URL: <http://www.immunizationinfo.org/healthProfessionals/resource_kit.cfm>.
C. How to evaluate Web site
quality and reliability
Centers for Disease Control and
Prevention. URL: <http://www.immunizationinfo.org/parents/evaluatingWeb.cfm> (tips on how to assess vaccine Web
sites).
World Health Organization. URL:
<http://www.who.int/immunization_safety/safety_quality/vaccine_safety_websites/en/>. Vaccine safety net
- lists sites with information related to vaccine safety
that meet criteria related to credibility, content, accessibility
and design.
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