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Dr. Swegler vaccinates more adults than children. In her experience, the rea- sons for vaccine resistance among each population vary. “Parents are still concerned about whether MMR vaccine causes autism. They worry about exposing their chil- dren to mercury, even though mercury was removed from children’s vaccines in 1999, with the exception of multidose flu vaccine,” she said. To tackle resistance to vaccines, Dr. Swegler often shares Vaccine-Prevent- able Disease: The Forgotten Story with her patients.
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chase from The Center for Vaccine Awareness and Research at Texas Chil- dren’s Hospital,
http://bit.ly/1gbIjod. It tells the story of people whose lives have been affected by vaccine-prevent- able diseases and can assist physicians in helping parents understand the im- portance of vaccines. (See “Resources to Spread Vaccine Facts,” page 33.) In addition to sharing personal ac- counts, using a presumptive approach toward childhood vaccines shows prom- ise. A study published in the November 2012 issue of Pediatrics reports that only 26 percent of parents resisted vaccine recommendations when physicians used a presumptive approach, which assumes parents will immunize their children. Eighty-three percent resisted, however, when physicians used a participatory ap- proach, which invites room for parental debate about vaccines. Dr. Terk says the presumptive ap-
proach is the gold standard in pediatric practice.
“I think it is terribly important to ap-
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proach the provision of vaccines as what we are supposed to do and not some- thing that is optional or up for discus- sion. It should be an assumption that we get our vaccines unless there is a true contraindication,” he said. A participatory approach presumes
safe room for deviation from the recom- mended vaccine schedule, Dr. Terk says, adding that delaying vaccination or de- viating from the recommended schedule enhances the risk a patient will contract a preventable disease.
34 TEXAS MEDICINE January 2014
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