The evidence is clear: Practitioners who fail to administer immunizations according to the Centers for Disease Control and Prevention and Advisory Committee on Immunization Practices schedules results in adverse outcomes for children and adolescents who are needlessly exposed to vaccine preventable diseases (VPDs). Community chaos occurs when parents offer resistance and refuse to have their children vaccinated and then, these behaviors are coupled with a failure to vaccinate on schedule. Ms. Zimlich’s infectious disease article, PCV13 serotypes still contribute to pneumococcal disease, provides evidence of the chaos that contributes to children acquiring invasive pneumococcal diseases (IPDs) that are preventable. All pediatric provider practices are at risk of being engulfed by the chaos, whether the child is a patient in the practice, or children in the practice have been exposed to unvaccinated children who have a VPD, or the community, as a whole, resists taking actions to confront and stop the chaos. The philosophical underpinnings of Chaos Theory1 provides insights into a community in chaos when providers and parents fail to follow evidence-based scientific recommendations and guidelines in clinical practice: Behaviors of complex systems, specifically referencing immunization resistant communities [inclusive of providers and parents] result in unpredictable future states and, in this example, exposure of innocent children too early to be vaccinated or unable to be immunized to prevent VPDs.
The facts as presented
A study was conducted at 8 US hospitals between 2014 and 2017 evaluating children aged 4 to 7 years, with IPD.
- PCV13 serotypes accounted for 23.9% of the IPD isolates during the study period
- Serotypes 3, 19A, and 19F accounted for 91% of the cases
- 40% of those children with IPD received either no doses of the vaccine or just 1 dose, thus these children were vulnerable to IPD
Three recognizable patterns that adversely affect pediatric healthcare outcomes and continue to be of concern for all pediatric providers include: 1). Vaccine refusing parents who permit their children to be exposed to VPD without a scientific basis for their refusals, thus exposing other children to VPDs; 2). Pediatric providers who fail to follow current recommendations in the immunization schedule; and 3). The need for rigorous research studies investigating the underpinnings for best clinical practices for pediatric and adolescent populations by providers who do not follow national recommendations and vaccine refusing parents.
Since the 2019 measles crisis, some states have updated immunization laws removing non-medical exemptions and require all children to be vaccinated to enter and attend school. Even with the passage of these laws, chaos can be expected to erupt. All providers must ‘think outside of the box’ for potential problems that may contribute to a new direction of chaos. School nurses have a particular obligation to carefully review vaccine records submitted to the school by the parents, to ensure accuracy of the records. Professional accountability by all providers must meet the highest of standards. Research studies investigating the rationale for provider and refusing parent decisions followed by evidence-based interventions to address the findings need to be supported. Prevention of IPDs through the highest standards of clinical practice and rigorous research studies is a challenge, we as pediatric providers, must accept and act upon.
1. Oestreicher C. A history of chaos theory. Dialogues Clin Neurosci. 2007;9(3):279-89.