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Vaccination trends, concerns are focus of medical ethics symposium

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Parental fears are driving a change in treatment methods for physicians and pediatricians around New Jersey, but not all medical professionals believe the fears are unwarranted.

Vaccine questions circulating through the Internet are making it harder for doctors to give children and teens the vaccines they should be getting in one visit. Instead, a requested breakup of the vaccine “schedule,” which includes 14 vaccines, means they could be split into two to three different visits.

Flu and HPV vaccines are the most perplexing for doctors in New Jersey, as many parents are wary about the increasing number of vaccinations required for their children, and choose not to add optional vaccines to the list.

This became a bigger issue, especially in suburban parts of the state, after a 2007 law made it easier to opt out of otherwise-required vaccines.

A bill to revert to pre-2007 requirements for immunizations introduced this year was met with a significant amount of public outcry.

Right now, that bill is “dead in the water, because Gov. (Chris) Christie is not going to sign it,” said Wayne Yankus, a retired pediatrician who gave testimony for the bill in Trenton.

Yankus was part of a panel of medical professionals at Hackensack University Medical Center’s annual biomedical ethics symposium last week, and discussed the topic of vaccine objections around the country.

“The issue is with control. And parents don’t want to lose what little control they perceive they have now over their children. Because who educates our children? The Internet educates our children. When I testify in Trenton, there are maybe seven physicians testifying on one side for science, and 75 on the other side testifying in the name of religion,” Yankus said.

The doctors recounted the widespread objection that was blamed for measles outbreaks in both Ohio and California, and noted the reaction to the California case was greater because it occurred in Disneyland, despite the effect being greater in Ohio.

The attention highlighted the difference in urban and suburban attitudes evident in the decisions to opt out, the doctors said, a trend that can be clearly seen in New Jersey within a single health system.

Saint Barnabas in West Orange and Beth Israel in Newark both belong to the Barnabas Health System, yet the latter sees virtually no opt-outs, while Saint Barnabas sees more refusals or requests for a breakup of vaccine schedules.

Saint Barnabas has increasingly seen requests to break up the vaccines, beginning with one or two at a time, John Kinteraglau, a pediatrician affiliated with Saint Barnabas Medical, told NJBIZ.

“After the first or second immunization, they are more willing. Once they are exposed to it and there are no side effects, they become braver or are more relaxed and follow the schedule,” he said.

Sabah Amir, chairman of AtlantiCare Regional Medical Center Department of Pediatrics in Atlantic County, told NJBIZ he deals with at least 20 parent refusals per year, mostly due to fears perpetuated by the Internet.

Joshua Rosenblatt, chairman of pediatrics at Children’s Hospital of New Jersey at Newark Beth Israel, told NJBIZ that, while he sees few opt-outs, the ones he has seen are mostly for vaccination against human papillomavirus, or HPV.

“They believe that, because HPV is sexually transmitted, their child will feel more comfortable being sexually active (once vaccinated). They use that as a reason not to vaccinate,” he said.

Other reasons why the trend of refusals has come about include a false sense of security and the age gap, according to the doctors at the Hackensack event.

Because the vaccines have worked in creating a healthier population, and major outbreaks haven’t occurred in recent years, parents have become complacent about the need to vaccinate.

Younger doctors running a practice might even be more willing to accept refusals for that reason, Yankus said.

Magna Dias, medical director of Children’s Hospital of Philadelphia at AtlantiCare, said that, because of her exposure to polio during her upbringing in India, she feels strongly about the need for vaccinations, but understands the complacency in the U.S.

“We are reaping the benefits of healthier population because of the vaccine efforts. They are the single greatest improvement in medicine in the last century. At the same time, we it is a victim of its own success,” Dias told NJBIZ.

Refusals of vaccines used to occur infrequently: About 0.5 percent of the population would refuse, Paul Offit, a professor of vaccinology at the University of Pennsylvania, said at the Hackensack event.

Now, that number has increased to 3.5 or as high as 5 percent in some communities.

“In some ways, we ask a lot of our citizens,” Offit said, highlighting the fact that children are now required to get several vaccines “to prevent diseases people don’t see.”

While the trend of refusals has plateaued, and transformed into an increase in requests for a breakup of scheduling, Kinteraglau said, there will always be outliers who remain staunchly against vaccines.

In fact, some in the audience raised concerns about the safety of vaccines. Though they are considered evidence-based treatment, and virtually all concerns have been debunked, analysis of the data is key to those assertions.

Ariel Sherbany, a physician at Hackensack, said that, while the media helps perpetuate some of the fears, the other part of the problem is with the data.

“One day, sugar is good for you; the next day, it is bad for you,” he said, while attending the symposium last week. “It’s not black and white. The older vaccines had problems, but the newer ones have minimal risks.”

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Anjalee Khemlani

Anjalee Khemlani

Anjalee Khemlani covers health care. You can contact her at anjaleek@njbiz.com.

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