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      Effect of an educational intervention and parental vaccine refusal forms on childhood vaccination rates in a clinic with a large Somali population

      , 1 , 2

      Family Medicine and Community Health


      Vaccination, immunization, MMR, Somali

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          Objective: The purpose of this study is to improve vaccination rates at a clinic with a large Somali population, and many vaccine hesitant parents. The study evaluated the effectiveness of some new materials for vaccine hesitant parents.

          Methods: Educational sessions were given to providers and staff to give “talking points” and to introduce a vaccine refusal form. Chart reviews were done for notes from 50 random well child visits per month of children less than six years old for 7 months before and after the intervention.

          Results: Before the intervention, 44% of Somali children who needed shots did not get them at their well child visit. Afterwards, 34% of the Somali children did not get their needed shots. Of non-Somali children, 16.8% did not get needed shots before the intervention, and 12.7% did not get needed shots after the intervention ( P=0.07). The MMR was the most frequent vaccine omitted. After the intervention, 29 parents signed the vaccine refusal form.

          Conclusion: The “talking points” and vaccine refusal form were associated with improvements in immunization rates in this challenging patient population that were not statistically significant. Refusal form use was not well documented, so its true value requires further study.

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          Most cited references 12

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          A systematic review of interventions for reducing parental vaccine refusal and vaccine hesitancy.

          Unvaccinated individuals pose a public health threat to communities. Research has identified many factors associated with parental vaccine refusal and hesitancy toward childhood and adolescent immunizations. However, data on the effectiveness of interventions to address parental refusal are limited. We conducted a systematic review of four online databases to identify interventional studies. We used criteria recommended by the WHO's Strategic Advisory Group of Experts on immunization (SAGE) for the quality assessment of studies. Intervention categories and outcomes were evaluated for each body of evidence and confidence in overall estimates of effect was determined. There is limited evidence to guide implementation of effective strategies to deal with the emerging threat of parental vaccine refusal. There is a need for appropriately designed, executed and evaluated intervention studies to address this gap in knowledge.
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            Countering Vaccine Hesitancy

            Immunizations have led to a significant decrease in rates of vaccine-preventable diseases and have made a significant impact on the health of children. However, some parents express concerns about vaccine safety and the necessity of vaccines. The concerns of parents range from hesitancy about some immunizations to refusal of all vaccines. This clinical report provides information about addressing parental concerns about vaccination.
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              An outbreak of measles in an undervaccinated community.

              Measles is readily spread to susceptible individuals, but is no longer endemic in the United States. In March 2011, measles was confirmed in a Minnesota child without travel abroad. This was the first identified case-patient of an outbreak. An investigation was initiated to determine the source, prevent transmission, and examine measles-mumps-rubella (MMR) vaccine coverage in the affected community. Investigation and response included case-patient follow-up, post-exposure prophylaxis, voluntary isolation and quarantine, and early MMR vaccine for non-immune shelter residents >6 months and <12 months of age. Vaccine coverage was assessed by using immunization information system records. Outreach to the affected community included education and support from public health, health care, and community and spiritual leaders. Twenty-one measles cases were identified. The median age was 12 months (range, 4 months to 51 years) and 14 (67%) were hospitalized (range of stay, 2-7 days). The source was a 30-month-old US-born child of Somali descent infected while visiting Kenya. Measles spread in several settings, and over 3000 individuals were exposed. Sixteen case-patients were unvaccinated; 9 of the 16 were age-eligible: 7 of the 9 had safety concerns and 6 were of Somali descent. MMR vaccine coverage among Somali children declined significantly from 2004 through 2010 starting at 91.1% in 2004 and reaching 54.0% in 2010 (χ(2) for linear trend 553.79; P < .001). This was the largest measles outbreak in Minnesota in 20 years, and aggressive response likely prevented additional transmission. Measles outbreaks can occur if undervaccinated subpopulations exist. Misunderstandings about vaccine safety must be effectively addressed.

                Author and article information

                Family Medicine and Community Health
                Compuscript (Ireland )
                October 2017
                October 2017
                : 5
                : 3
                : 188-192
                1University of Minnesota Medical Center Family Medicine Residency Program, 2020 E. 28 th Street, Minneapolis, MN 55407, USA
                2North Memorial Family Medicine Residency Program, 1020 W Broadway Ave, Minneapolis, MN 55411, USA
                Author notes
                CORRESPONDING AUTHOR: Diane J. Madlon-Kay, University of Minnesota Medical Center Family Medicine Residency Program, 2020 E. 28 th Street, Minneapolis, MN 55407, USA, E-mail: madlo001@ 123456tc.umn.edu
                Copyright © 2017 Family Medicine and Community Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

                Self URI (journal page): http://fmch-journal.org/
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