pediatrics
Vaccine Hesitancy
Introduction
Despite the rigorous Childhood Vaccination in place in the United States, some parents remain concerned about the safety of the use and schedule of vaccines in children. These concerns have led some parents to not allow their children to receive some or all of the recommended vaccines. In the United States, rates of vaccine exemptions increased from 1% in 2006 to 2% in 2016 to 2017. During the 2021–2022 school year, this number increased to 2.6% overall, with one state reporting 10% of children in kindergarten with an exemption ( The decision to defer or refuse vaccines affects public health. When the proportion of the overall population that is immune to a disease (herd immunity) decreases, disease prevalence increases, increasing the possibility of disease in people at risk. People may be at risk because They were previously vaccinated, but the vaccine did not induce immunity (eg, 2 to 5% of recipients do not respond to the first dose of measles vaccine). Immunity may wane over time (eg, in older adults). They (ie, some immunocompromised patients) cannot receive live-virus vaccines (eg, measles-mumps-rubella, varicella) and rely on herd immunity for protection against such diseases. Conversations with reluctant parents typically require asking about specific concerns and explaining the risks and benefits of vaccines and the supporting evidence in plain language. These conversations provide opportunities to clarify misconceptions and engage in shared decision-making ( General references ). In particular, clinicians must make sure that the parents of their patients are aware of the possible serious effects (including death) of vaccine-preventable childhood diseases such as measles and pertussis. Resources for these discussions include the CDC's 