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Immunization Safety

Pediatrics Expert Advice from Henry Bernstein, M.D.

Q: What are your thoughts on immunization? It makes me uncomfortable that the AMA supports immunizations, yet before receiving immunization, you need to sign a waiver releasing your practitioner as the responsible party.

A: Immunizations are one of the most significant and cost-effective advances in medicine. They dramatically decrease the amount of illness and death associated with certain infectious diseases. Immunizations have eliminated small pox from the world and paralytic polio from the Western Hemisphere. Tetanus and diptheria are almost unheard of. The number of reported cases of measles and Hib in the United States are dropping each year. [Editor's note: Measles are currently on the rise in the U.S. due to a decrease in the use of the MMR vaccine and a resulting outbreak that originated at Disneyland in late 2014.] An ounce of prevention is worth a pound of cure. As I'm sure you can sense, I recommend immunizations for everyone.

So if vaccines are so wonderful, why does a patient need to sign a consent form? Informed consent is a process of communication. It allows parents to get the information they need to make health care choices for their child. Vaccines, unfortunately, are not totally without side effects, but their benefits far outweigh their risks.

The federal vaccine compensation laws require informed consent. The benefits, possible alternatives, and the risks or discomforts involved in administering a vaccine to a child need to be explained and discussed. It is important to take into account the parent's level of understanding, along with their need and desire for detail. It is also good practice to have documentation in the office chart that these areas were discussed with the doctor. Avoiding surprise is key, even if it involves discussing what might only be considered an inconvenience associated with giving the vaccine.

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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.


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