Immunize Georgia, Vol. 2 (Aug. 2005)

What's Inside

2 GRITS Provider Update 4 Impacting Immunization

Rates

5 Understanding and

Responding to Parents

Insert Parent Pages

Who Refuse Vaccination

Spot Light

Immunize 2005vol.2 Georgia's Little Guys
A PUBLICATION OF CHILDREN'S HEALTHCARE OF ATLANTA AND THE GEORGIA IMMUNIZATION PROGRAM

Spread The Word,

The Georgia

Not Pertussis
Each week, in the MMWR Weekly, "Notifiable Diseases/Deaths in Selected Cities Weekly Report," pertussis is the only disease
demonstrating an increase and most often is "beyond

Immunization Study Collaboration and Cooperation for Georgia's Children

historical limits."
With the rise in pertussis nationwide, health officials are urging all healthcare professionals to be on the alert for its signs and symptoms. In 2004, 20,000 cases of pertussis were reported, compared to around 1,000 in 1976, and 38 percent of these cases were adolescents*.1

The Georgia Department of Human Resources, Division of Public Health has completed the 2004

Consequences of pertussis in adolescents and adults Studies have shown that pertussis is responsible for around 20 to 30
percent of "cases of cough lasting more than two weeks in adults and adolescents".2 Exposure can cause up to 90 percent of household contacts to catch pertussis.3 Because pertussis can be less severe for adolescents and adults, they may unknowingly be infecting infants and other family members. Those who were vaccinated in childhood may have a false sense of security since the protection from the pertussis vaccine wears off after five to 10 years.

Georgia Immunization Study to assess immunization coverage rates of two-year-old children in Georgia. Each year, the process is complex, requiring cooperation from all healthcare

Recognizing and responding to pertussis Pertussis, also known as whooping cough, causes severe coughing, is highly contagious and
potentially deadly. Between coughing episodes, infected persons may have no symptoms. For more information on the three stages of pertussis, please visit Chapter One of the Guidelines for the Control of Pertussis Outbreaks at http://www.cdc.gov/nip/publications/ pertussis/guide.htm
continued on page 3

continued on page 3

GRITS

Provider Update

The target date for all pediatricians and family physicians to partner with GRITS is December 31, 2005. At the end of July, over 1,500 pediatricians and family physicians had actively joined into partnership with the Georgia Immunization Program and GRITS. Some practices are finding creative solutions to address a multitude of service delivery situations.
Among these, Kaiser Permanente Georgia (KPGA) was recently awarded the America's Health Insurance Plans (AHIP) Grant for Innovation in Immunization Practices to support its collaboration with GRITS entitled "Immunizing Georgia's Adolescents." Through combining a health plan and state interventions, one objective is to raise Georgia's private and public health care providers' adolescent immunization rate average to the national Healthy People 2010 goal of 90 percent in five years.

Practitioners and providers at all points of access for adolescents are prepared to give appropriate immunizations (e.g., dermatology, dentistry, emergency departments, schools and the high-risk population of the State Department of Juvenile Justice, etc.). KPGA has steadily raised its adolescent immunization rate to 77 percent for its current national NCQA 90th percentile level performance. The national Health Plan Employer Data and Information Set (HEDIS) average for adolescent immunizations was 59 percent in 2004. Taking the partnership a step further, KPGA is sharing 50 percent of the awarded grant monies with GRITS.
For medical offices that have had personnel changes, retraining of new office staff will be critical to the success of the registry. To schedule your first training or a retraining of your personnel, please contact the GRITS Training Coordinator at 1-888-223-8644.

Pediatric Partners of Augusta/GRITS Champion

In May of this year, after extensive exploration and consulting with GRITS staff, Pediatric Partners of Augusta (PPA) began entering patient information into the GRITS registry. A primary care practice with nine primary care physicians, each with 5,000 to 10,000 patients of varying ages, PPA decided it was time to begin using the registry and take advantage of its benefits. According to Sonja Herrmann, practice manager, PPA made it mandatory for all staff to utilize GRITS to the fullest potential.
PPA's computer system was not compatible with GRITS, raising the question who will enter this historical data and who will enter immunizations on a daily basis? Staff quickly overcame the initial challenge, and in three short months, PPA had entered and updated over 10,000 patient records.
Patient records were being pulled two weeks ahead of the appointment times, so the team decided to have the front desk staff enter the historical information on those patients as they pulled the records. Two part time college students with a career interest in nursing (Maria Gentile) and healthcare marketing (Britni Combs) were hired to enter the historical information on the patients. When parents call for shot records, they are no longer given manually entered forms. Instead, staff enter the GRITS information on the child, and a professional shot record

is provided. When other Georgia physicians call to request immunization information on a patient, the patient's record is pulled and entered into GRITS. They are then told the information can be found in the GRITS system as a way of promoting and encouraging other physicians to utilize GRITS.
At the end of each day, nurses enter the shots provided to their patients, and they have become more attentive to educating parents on the shots to be provided that day and the benefits of the Immunization program. During slower afternoon times, the telephone operators have been trained to enter patients who have not been entered thus far. The front desk staff, particularly Stacy McKenzie, has also taken on the task of educating parents/ patients about GRITS and its benefits. GRITS Posters are displayed in the waiting room, and the Web site, www.pedpartners.com, encourages viewers to ask them about GRITS.
Herrmann emphasizes the practice's commitment to enter the information correctly and comprehensively. Christina Rios, GRITS Coordinator, and Mary Craps, L.P.N. have taken active roles in leading staff to success. The team effort has paid off, and staff members have embraced the goal of utilizing all the benefits of GRITS, making Pediatric Partners of Augusta true GRITS Champions.

2

IGLG / 2005 / VOL. 2

continued Spot Light from page 1

providers in Georgia. In previous years, the Georgia Immunization Program (GIP) looked at the vaccination coverage status (4:3:1) for four doses of DTP/DTaP (Diphtheria, Tetanus, Pertussis), three doses of OPV/IPV (Polio oral or injected), and one dose of MMR (Measles, Mumps, Rubella), which has been the traditional standard for looking at immunization coverage levels.
As more vaccines have been routinely recommended by the Advisory Committee on Immunization Practices, the American Academy of Pediatrics and the American Academy of Family Physicians, the GIP has decided to begin looking at a higher standard of coverage reviewing a child's immunization history not only for the vaccines mentioned previously but also for three doses of Hib (Haemophilus influenzae type b), three doses of Hep B (Hepatitis B) by age two and one dose of Varicella (Chickenpox). According to Mike Chaney, program manager for the GIP, "Both public and private providers are working hard to provide all vaccines at the earliest possible age to Georgia's children. It is only fitting to start looking at the results with a new standard by exploring a broader full coverage of routinely recommended immunizations." For the 2004 Georgia Immunization Study, with the higher standard of 4:3:1:3:3:1, the statewide coverage rate was 81.3 percent compared to 85.1 percent for the previous 4:3:1 standard. The 81.3 percent rate is comparable with the results of the 2004 National Immunization Survey (NIS) performed by the Centers for Disease Control and Prevention. In the 2004 NIS, Georgia ranked fourth using the higher standard.
In looking at the results with the new standard, Public Health District 2, Gainesville, had a coverage rate of 94 percent. Ninety-three percent of the children were located and had received all these shots. The coverage level for District 2 under the previous standard of 4:3:1 was 100 percent. According to Janie Dalton, assistant clinical coordinator, District 2, Gainesville, locating a child's immunization history information requires a team effort, persistence and knowing your medical community.
Public health representatives collect data by reviewing immunization records at local health departments and through the Georgia Registry of Immunization Transactions and Services (GRITS) program, which was instrumental in locating children this year. If records are not complete or found, representatives contact parents either by phone, letter or a home visit. Representatives take this opportunity to refer the parent and child to the health department or private physician to receive recommended immunizations.
Completing this important study would not be possible without cooperation from public health offices, Women, Infants and Children (WIC), GRITS, parents and physician's offices where 75 percent of all immunizations in this year's study were received. To access the Georgia Immunization Study Results and read the full report, go to: http://www.health.state.ga.us/pdfs/publications/ reports/gaimmunizationstudy.04.pdf

Spread The Word, Not Pertussis continued from page 1
According to the MMWR, "the actual number of pertussis cases (especially among adolescents and adults) continues to be substantially underreported because the pertussis cough illness resembles other conditions; infected persons might not seek medical care; and availability of reliable diagnostic tests is limited".4 Pertussis can be misdiagnosed as a stomach virus, common cold/cough or pneumonia. It can take up to two weeks for the strong coughing spasms to begin, and this cough can last as long as six weeks, causing vomiting, hernias or broken ribs.
The classic whooping sound occurs mainly in younger infant victims. Infants often require hospitalization with intensive respiratory support. In infants, complications such as secondary bacterial pneumonia, seizures, encephalopathy and even death can occur.
The Epidemiology Branch of the Georgia Division of Public Health recommends confirmatory laboratory testing for all suspect or probable cases. Nasopharyngeal culture with a Dacron swab is the preferred test. It is also critical that public health be notified when a case of pertussis is suspected to facilitate necessary follow up treatment of all contacts. All household contacts should be placed on chemoprophylaxis regardless of age and immunization status.
Preventing Pertussis with new vaccines According to Dr. Steve Cochi, acting Director of CDC's National Immunization Program, "Treatment of pertussis is effective only if given early before symptoms can be recognized as pertussis. Therefore, vaccination is the best way to prevent suffering from pertussis." In Spring 2005, the Food and Drug Administration (FDA) approved two new vaccines which will protect adolescents and adults from tetanus, diphtheria AND pertussis. Previously, no pertussis vaccine was available for anyone over age seven.
At the June Advisory Committee on Immunization Practices (ACIP) meeting, new recommendations were made for vaccinating adolescents against pertussis. Listed below are the new recommendations for adolescents: 11 and 12 year olds: one dose of Tdap in place of the tetanus-
diphtheria (Td) booster. 13 to 18 year olds: one dose of Tdap if they missed the 11 to
12 year dose of Td. 11 to 18 year olds: one dose of Tdap if they have already been
vaccinated with Td and it has been five years since the last dose of Td. A recommendation for the use of Tdap in adults is expected in the future.
continued on page 4
IGLG / 2005 / VOL. 2 3

Impacting Immunization Rates in the Adolescent and Young Adult Population

In 2002, the Standards for Child and Adolescent Immunization Practices were revised to focus on "the most desirable immunization practices, which health care professionals should strive to achieve". With the increase in newly developed vaccines available to adolescents and young adults, it will be critical to utilize the Standards to impact immunization rates in this population. The Standards can be a guide for ways to promote the immunization services provided in your office. To review the 17 Standards and a discussion of the Revision of the Standards, please go to: http://www.cdc.gov/nip/recs/rev-immz-stds.htm.
Many resources offer suggestions for how to improve the immunization care in your office, especially for adolescents and young adults. As noted in the March 2005 special edition of The Journal of Family Practice, subtitled "Focus on Childhood Immunizations How to Overcome Barriers to Vaccination: Practical Strategies for Providers," provider-related barriers include missed opportunities to vaccinate, immunizations given too early and more immunizations given than needed. Caregiver barriers include cost and lack of access to resources and a medical home.
Many healthcare providers went into the medical field because they care. However, modern managed healthcare has reduced a provider's ability to establish relationships with patients, leaving them too busy to sit and listen to a teenager or young adult. Developing a trusting relationship with your patients can engage the teenagers whom you meet. This alone can make your days

more rewarding, especially with the knowledge that you are helping to prevent illness with the care you provide.
Action Steps: For family practices, pull family charts at each visit to ensure
all siblings and adults are up-to-date on immunizations.1 Give a copy of the vaccination record to the adolescent for
him to keep track of his vaccine requirements.1 Offer vaccinations at acute care visits as well as at physical
exams for sports participation and employment.1 Develop a standing order for nurses to administer vaccines.1 Utilize the GRITS Registry to assist with recalls/reminders.1 Offer evening and weekend hours. Schedule a class for staff to review the latest immunization
information with the Georgia Immunization Program. Call 404-657-3158. Utilize the primer from the American Medical Association entitled "Roadmaps for Clinical Practice Series Improving Immunization: Addressing Racial and Ethnic Populations." Included in the series is Delivering Culturally Effective Health Care to Adolescents. The Resources for Physicians and Patients is extremely comprehensive. To review, please visit http:// www.ama-assn.org/ama/pub/category/9958.html.
1 "Meningococcal Disease: A New Strategy for Improved Prevention Moving
Toward an Adolescent Strategy." Release Date: March 2005.

Spread The Word, Not Pertussis continued from page 3

Action Steps: Infants need to complete the DTaP vaccine series. Adolescents need a health check to receive the necessary
vaccines. Pertussis should be suspected with a persistent cough lasting
longer than six days. Nasopharyngeal culture should be performed on all suspect
cases. Call the Notifiable Disease Epidemiology Section at 404-657-2588 for questions on collecting and transporting specimens for culture. Call 866-PUB-HLTH immediately when a suspect or confirmed case is identified. Work in conjunction with all healthcare providers in your community to "Spread the Word, not Pertussis."

*For the purposes of this article, "adolescent" age will refer to the age 11 to 21.
(1) "Two Tdap vaccines get nod from FDA advisory committee". Infectious Diseases in Children. April 2005.
(2) "Adults Are Whooping, but Are Internists Listening?" Annals of Internal Medicine. May 17, 2005; 142: No. 10.
(3) "Pertussis on the Rise: New Vaccine Targets Adolescents". Contemporary Pediatrics. May 2005.
(4) CDC. Pertussis - Summary of Notifiable Diseases - United States, 2003. MMWR April 22, 2005; 52(54); 1-85.
(5) "The Rise of Adolescent and Adult Pertussis in the United States - Diagnosis, Treatment and Prophylaxis of Pertussis in Adolescents and Adults". Advanced Studies
in Medicine. May 2005; Volume 5, (5A).

IGLG / 2005 / VOL. 2 4

Understanding and Responding to Parents who Refuse Vaccination

Many may not remember the effects of vaccine-preventable diseases, a fact which is impacting the decisions of parents who refuse vaccinations.1 In a survey of American Academy of Pediatrics (AAP) fellows on immunization-administration practices, seven to 10 percent had a parent refuse an immunization for a child in the 12 months preceding the survey. The vaccine refused the most was MMR followed by Varicella, PCV, HepB and DTaP respectively. Almost all of those surveyed said they educate and document refusal. A small number always (4.8 percent) or sometimes (18.1 percent) tell parents they will no longer care for the child if the parent still refuses after efforts to educate are exhausted. Parents rejected immunizations on the basis of religious or philosophical beliefs and because they felt the benefits of immunization do not justify the risks to their child.
Additionally, a national survey showed that 25 percent falsely believe their child's immune system could become weakened as a result of too many immunizations.1,2 With the rates of non-medical exemptions increasing and children with exemptions contributing to outbreaks, several studies have sought to understand the difference in perception between parents who immunize and those who choose the exemption. Much of the news now focuses on potential adverse reactions rather than the benefits of vaccines.
According to the AAP, several key steps can be taken when responding to a parent who refuses vaccines:
Listen carefully and respectfully to concerns.
o Parents weigh evidence differently than medical professionals.
o "Vaccines are not risk-free; nor are they 100 percent effective. This poses a dilemma for many parents and should not be minimized."1
Share honestly what is known and not known about the risks and benefits of the vaccine in question.
Attempt to understand the parent's concerns by asking questions.3
o Have they had a bad experience?
o Have they obtained troubling information?
o Do they have religious or philosophical reservations?

o Ask them to identify the source of the concerns or beliefs.
o Paraphrase to the parent what they have told you and ask them if you have correctly interpreted what they have said.
Attempt to correct any misperceptions and misinformation.
Discuss each vaccine separately, since most parents have concerns about one or two vaccines. This parent may be willing to allow other needed vaccines.
Use the Vaccine Information Statements (VIS) for discussing benefits and risks. Updated versions of VISs can be found at www.cdc. gov/nip/publications/VIS/. In a variety of languages, VISs can be found at www.immunize.org/vis/.3
For parents concerned about multiple vaccinations:
o offer suggestions for reducing the pain of injections
o offer a schedule that does not require multiple injections at a single visit.
Explore issues of cost and assist family with these concerns.
Seek to build respect and trust.
Revisit the discussion of immunizations at each visit.
Unless the child is put at risk of serious harm, a parent's continued refusal should be respected.
Good documentation helps address issues of liability.
Have parents complete the document, "Refusal to Vaccinate," which can be found at www.cispimmunize.org.
For parents who refuse vaccination, educate them about their responsibilities to protect other family members and community members, including people who may be immunocompromised (keeping sick children home and other ways to limit the spread of infection).3
You may also want to advise them of the state school or childcare entry laws, which can require that unimmunized children stay home from school during outbreaks of vaccine-preventable diseases.3
Deciding to discharge patients from a practice because a parent refuses to vaccinate their child is not recommended and should only be done after attempts to work with the family have failed. "Maintaining the relationship in the face of disagreement conveys respect and at the same time allows the child access to medical care."
Refer parents to reputable data-based Web sites such as:
o www.immunizationinfo.org
o www.vaccinesafety.edu
1) "Responding to Parental Refusals of Immunization of Children." Pediatrics 2005; 115: 5.1428-1431.
2) "Factors Associated with Refusal of Childhood Vaccines Among Parents of School-aged Children." Archives of PEDIATRICS & Adolescent Medicine 2005;159: 470-476.
3) "Providers' Guide: Helping Parents Who Question Vaccines." Centers for Disease
Control and Prevention. www.cdc.gov/nip. Accessed on June 14, 2005.

5

IGLG / 2005 / VOL. 2

Upcoming Events

Georgia Infection Control Network October 12 14, 2005 Unicoi Lodge, Helen, Georgia www.gicn.org
Pediatrics on Peachtree Georgia Chapter AAP Fall Meeting October 20-22, 2005 Sheraton Buckhead Hotel 404-881-5091 www.gaaap.org
Advisory Committee on Immunization Practices October 26-27, 2005 Atlanta Century Center Marriott www.cdc.gov/nip/acip
GAFP 57th Annual Assembly Nov 9-12, 2005 Cobb Galleria, Atlanta 800.392.3841 www.gafp.org
Immunize Georgia's Little Guys Newsletter Online Please visit www.choa.org/immunization to download current and previous volumes of the Newsletter, including the Parent Pages. For other continuing education opportunities, go to Home page, For Professionals and then CME/ Continuing Ed.
2005 Children's Healthcare of Atlanta/CHDA913350 jt08.05 DPH05/067H

Immunize Georgia's Little Guys
Published by Children's Healthcare of Atlanta 1655 Tullie Circle NE, Atlanta, Georgia 30329-2321
Children's Healthcare of Atlanta 404-250-kids, www.choa.org
Immunize Georgia's Little Guys Angie Matthiessen, M.S.W. 404-785-7225, fax 941-505-8267 angie.matthiessen@choa.org
Georgia Immunization Program 404-657-3158, fax 404-657-1463 http://health.state.ga.us/programs/immunization/
Vaccines For Children Program 404-657-5013, fax 404-657-5736 800-848-3868, fax 800-372-3627
American Academy of Family Physicians Georgia Chapter 404-321-7445, www.gafp.org
American Academy of Pediatrics Georgia Chapter 404-876-7535, www.gaaap.org
CDC-INFO Contact Center 800-232-4636, www.cdc.gov/nip
CDC Spanish-Language Hotline 800-232-0233, www.cdc.gov/spanish/

Children's Healthcare of Atlanta Community Health Development and Advocacy 1655 Tullie Circle Atlanta, Georgia 30329-2321

Please route to:
Physician(s) Nurse Practitioner(s) Registered Nurse(s) Nurse Tech(s) Office Manager

Parent Pages / IGLG / 2005 / VOL. 2
ParentPages
SHOTSMARTS FROM IMMUNIZE GEORGIA'S LITTLE GUYS

Pertussis is on the Rise Protect Your Family and Friends

Most of us, including parents and physicians, have never seen the terrible "whooping cough" (pertussis) and have become comfortable with the idea that immunizations have eliminated the disease.

We might even think that pertussis only affects children. In reality though, 20,000 cases of pertussis were reported in 2004, compared to around 1,000 in 1976 and 38 percent of these cases came from adolescents.*1
Because pertussis can look like a common cold in adolescents and adults, it can be hard to identify.
Many people who received the pertussis vaccine in childhood don't know that its protection wears off after five to 10 years.
Outbreaks spread quickly where teenagers and young adults spend time together schools, sports and close living situations.
Infants can catch pertussis from siblings and parents when they are still too young to be vaccinated against the disease or if they have not been vaccinated.
Adolescents and Adults Pertussis in adolescents or adults begins with cold symptoms and
a cough that slowly gets worse. It can take up to one or two weeks for the strong coughing fits to
begin and can last as long as six weeks. The coughing can lead victims to vomit or can lead to a hernia
or broken rib.
Infants and Young Children The classic whooping sound occurs mainly in infants and young
children. Infants with pertussis can end up in the hospital with severe illness
such as bacterial pneumonia, seizures and encephalopathy. Effects can linger for many months or can lead to a traumatic death.
Prevent Pertussis with Vaccines In spring 2005, the Food and Drug Administration (FDA) approved two new vaccines which will protect adolescents and adults from tetanus, diphtheria AND pertussis. Previously, no pertussis/"whooping cough" vaccine was available for those over seven years of age.

At a recent meeting of vaccine experts, new recommendations were made for vaccinating adolescents against pertussis. Listed below are the new recommendations for adolescents: 11 and 12 year olds: one dose of Tdap in place of the tetanus-
diphtheria (Td) booster currently given to adolescents. 13 to 18 year olds: one dose of Tdap if they missed the 11 to 12
year dose of Td. 11 to 18 year olds: one dose of Tdap if they have already been
vaccinated with Td and it has been five years since the last dose of Td. A recommendation for the use of Tdap in adults is expected in the future.
According to Dr. Steve Cochi, acting director of CDC's National Immunization Program, "Treatment of pertussis is effective only if given early before symptoms can be recognized as pertussis. Therefore, vaccination is the best way to prevent suffering from pertussis. This recommendation is an important step in reducing this potentially serious disease."
Action Steps: If you have a young infant in your house, get the vaccine yourself. Severe coughing for a week or more requires immediate attention. Keep young children and pregnant women away from people who
are coughing. Educate baby sitters and your child's school on pertussis. Be sure infants complete the DTaP vaccine series. Have your adolescent complete his preadolescent health check to
receive needed vaccines. Work with the doctor in your community to "Spread the Word, not
Pertussis."
*For the purposes of this article, "adolescent" age will refer to ages 11 to 21. (1) "Two Tdap vaccines get nod from FDA advisory committee." Infectious Diseases in
Children. April 2005.

2005 Children's Healthcare of Atlanta/CHDA913350 jt08.05 DPH05/067H

Parent Pages are intended to be copied and distributed to parents.

www.choa.org 404-250-kids www.health.state.ga.us/programs/immunization/

Parent Pages / IGLG / 2005 / Vol.2

Common Parent Concerns about Vaccines

Getting vaccines for your child can be confusing when you are trying to understand what vaccines are needed and why.
Each vaccine has many letters - capital letters and small letters - and some of them require several shots for your child to be fully protected from disease. You may be asking, "Why should we vaccinate and what is it actually preventing?"
When you go to your child's doctor, they often give you information about the vaccines your child needs. It can sometimes feel like a quick process and you may not feel like you have the time to ask questions. But that is what the doctor is there for to answer your questions.
You may also be hearing information in the news or on the Internet that is confusing. One thing is for sure, your doctor cares about your child and that is why he/she wants him vaccinated. Listed below are some of the more common concerns parents may have about vaccinating their child.
Thimerosal Thimerosal is a mercury-based preservative used in vaccines
since the 1930s to prevent vaccines from becoming contaminated with bacteria or fungi. Many of the recommended vaccines never contained or used thimerosal as a preservative. With the exception of some influenza vaccines, the vaccines used to protect preschool children against 12 infectious diseases are either thimerosalfree or contain extremely small amounts of thimerosal. Some thimerosal-free influenza vaccine is available. In 2004, the Immunization Safety Review Committee at the IOM* released a report which found no evidence that links thimerosal or the MMR vaccine with autism.

The form of mercury found in thimerosal is ethylmercury, not methylmercury, which is the form that has been shown to damage the nervous system.
MMR Many large and well-designed studies have found no link
between MMR and autism. The 1998 study that raised the concern that MMR causes
autism was based on 12 children. In 2004, 10 of the 13 authors of this study retracted the
interpretation of the study's results. There is no evidence that giving a child the three doses
separately will help it may leave the child unprotected against measles, mumps or rubella. Separate doses increase the number of doctor visits, costs and discomfort to your child.
Important Messages The organisms that cause vaccine-preventable diseases are
still present. Unvaccinated children are at risk of serious and deadly
diseases. We are only an airplane ride away from many parts of the
world where these diseases still exist and where vaccines are not available. The benefits of childhood vaccines are proven.
You may have other questions or concerns not addressed here. If so, ask your child's doctor or nurse for more information. Finding information on the Internet is as good as its source, so be sure to look at sites that are respected and trusted, including the ones listed below: American Academy of Pediatrics
http://www.cispimmunize.org Centers for Disease Control and Prevention
http://www.cdc.gov/nip Immunization Action Coalition
http://www.immunize.org/catg.d/4038myth.pdf Institute of Medicine: Public Health and Prevention
http://www.iom.edu

*The Institute of Medicine (IOM) is a committee which includes experts in the fields of pediatrics, neurology, immunology, internal medicine, infectious diseases and genetics. The IOM is a scientific private, nonprofit organization that provides scientific advice to the government.

** Information for this article was adapted from the following sources: Infectious Diseases in Children. July 2005. American Academy of Pediatrics Web site:
http://cispimmunize.org/fam/thimerosal.htm.

2005 Children's Healthcare of Atlanta/CHDA913350 jt08.05 DPH05/067H

Parent Pages are intended to be copied and distributed to parents.

www.choa.org 404-250-kids www.health.state.ga.us/programs/immunization/