Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases.
Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases.
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DOI：
10.1056/nejmsa0806477
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发表时间：
2009-05-07
影响因子：
158.5
通讯作者：
Halsey, Neal
中科院分区：
文献类型：
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作者：
Omer, Saad B.;Salmon, Daniel A.;Halsey, Neal
疫苗是临床医生可用的最有效的预防工具之一。然而，免疫接种计划的成功取决于高接受率和覆盖率。有证据表明，美国拒绝接种疫苗的情况有所增加，而且拒绝接种的地理聚集性导致疫情爆发。免除学校免疫要求的儿童（一种拒绝接种疫苗的措施）患麻疹和百日咳的风险增加，并可能感染其他年龄太小而不能接种疫苗的儿童，因医疗原因不能接种疫苗的儿童，或接种疫苗但没有足够的免疫反应的儿童。临床医生可以在父母的决策中发挥至关重要的作用。父母，包括未接种疫苗儿童的父母，认为卫生保健提供者是最常见的免疫接种信息来源。尽管一些临床医生已经停止或考虑停止与拒绝接种疫苗的患者的供应商关系，但美国儿科学会生物伦理委员会建议不要这样做，并建议临床医生通过尊重地倾听父母的担忧并讨论非疫苗接种的风险来解决疫苗拒绝问题。
Vaccines are among the most effective prevention tools available to clinicians. However, the success of an immunization program depends on high rates of acceptance and coverage. There is evidence of an increase in vaccine refusal in the United States and of geographic clustering of refusals that results in outbreaks. Children with exemptions from school immunization requirements (a measure of vaccine refusal) are at increased risk for measles and pertussis and can infect others who are too young to be vaccinated, cannot be vaccinated for medical reasons, or were vaccinated but did not have a sufficient immunologic response. Clinicians can play a crucial role in parental decision making. Health care providers are cited as the most frequent source of immunization information by parents, including parents of unvaccinated children. Although some clinicians have discontinued or have considered discontinuing their provider relationship with patients who refuse vaccines, the American Academy of Pediatrics Committee on Bioethics advises against this and recommends that clinicians address vaccine refusal by respectfully listening to parental concerns and discussing the risks of nonvaccination.