Getting Back on Track with Routine Immunizations

Vaccines are an important part of growing up, but some children in Santa Clara County have fallen behind on routine vaccinations. The County of Santa Clara Public Health Department has created materials for healthcare providers and office staff to encourage routine childhood vaccinations with parents and caregivers. Materials include counseling tips and conversation guides, wall posters in multiple languages, rack cards, and a cgov.org to order some of these for their practice, or visit https:// bit.ly/3CQSuR6.

In addition to sharing the campaign materials, you can join the Vaccines for Children (VFC) Program. VFC is a federal program that provides vaccines at no cost to eligible children. The federal government purchases vaccines, which are then shared with VFC participants. Learn more and enroll in the California VFC at https://eziz.org/vfc/overview/

Las vacunas son parte del desarrollo saludable

Cũng như những cột mốc phát triển khác, tiêm ngừa là một phần quan trọng của thời kỳ thơ ấu. Thuốc tiêm ngừa an toàn và giúp bảo vệ để trẻ em lớn lên khỏe mạnh và hạnh phúc.

Hãy hỏi bác sĩ loại tiêm ngừa nào con quý vị cần trong năm nay.

Al igual que su primer gol de fútbol, las vacunas son una parte importante del desarrollo infantil. Son seguras y protegen a los niños para que crezcan sanos, felices y fuertes.

Hable con el doctor de su hijo sobre las vacunas necesarias este año.

Like ngày ˛˝y tháng, vaccines are another part of growing up

Like many milestones, vaccines are an important part of childhood. Vaccines are safe and protect children, so they can grow up healthy, happy, and strong.

Talk to your child’s doctor about what vaccines they need this year.

PartOfGrowingUp.org

Yes!

Vaccines are another part of growing up

Just like their first soccer goal, vaccines are an important milestone. They are safe and protect children, so they can grow up healthy, happy, and strong. Talk to your child's doctor about what vaccines they need this year.

PartOfGrowingUp.org

VACCINE HESITANCY REBUTTALS: Strategies to Address Vaccine Hesitancy and Misinformation with Parents and Caregivers

When discussing childhood vaccines with parents, you may encounter hesitancy or resistance. It is important to address vaccine hesitancy and misinformation during these conversations by sharing additional information to encourage caregivers to vaccinate their children. As you communicate with parents, try to use ‘fact-focused’, positive language rather than restating misconceptions or myths as this may reinforce them. We provide several examples of what this can look like.

General Recommendations:

Use clear, easy-to-understand, language during these conversations

• Use non-judgmental language

Use motivational interviewing strategies to engage in conversation

• Practice reflective listening

Be empathetic

Motivational interviewing is a style of communication that sits somewhere between listening and giving information or advice. It is a tool designed to empower people by drawing out their own motivations and capacity for change through a series of questions or prompts.

Myths and misinformation you may hear from vaccine-hesitant parents/caregivers You might reply with…

“Vaccines aren’t safe.”

“Vaccines contain toxins and ingredients that are dangerous.”

“Vaccines can cause autism and Sudden Infant Death Syndrome (SIDS).”

As a parent, I know you want what’s best for your child. Vaccines are an important tool we use to make sure children grow up to be happy, healthy, and strong.

Vaccines protect children from serious diseases, including measles, mumps, rubella, polio, and whooping cough. These diseases can cause serious complications and even death. Vaccines are a safe and effective way to prevent these diseases, and they have been tested to ensure that they are safe and effective for children of all ages. Every vaccine undergoes extensive testing before being licensed, and vaccine safety continues to be monitored as long as a vaccine is in use.

Myths and misinformation you may hear from vaccine-hesitant parents/caregivers You might reply with…

“Vaccines are expensive” or “I can’t afford to get my child vaccinated.”

“Giving more than one vaccine at a time increases the risk of dangerous side effects or can overload a child’s immune system.”

Additional Resources

If you have health insurance, your child’s vaccines are covered by insurance plans. There may be a small co-payment or coinsurance for some doctor’s visits..

If you do not have insurance, all Santa Clara County community clinics offer free or low-cost routine vaccinations for children. Contact the County of Santa Clara Public Health Department for more information.

Giving several vaccines at once has no negative effect on a child’s immune system.

In fact, administering vaccines together can save time and money through fewer visits to your doctor and reduce discomfort for a child through fewer injections.

You can refer caregivers you work with to the following resources depending on their needs:

Healthychildren.org provides information on immunizations for parents, from the American Academy of Pediatrics.

Centers for Disease Control and Prevention (cdc.gov/vaccines) provides lists of recommended vaccines by age.

• VaccineInformation.org provides timely, accurate, and factual information about vaccines and the diseases they prevent.

VaccinateYourFamily.org provides information about vaccines for parents, pregnant women, adults, healthcare providers, and vaccine advocates.

Find a Clinic in Santa Clara County that will offer free or low-cost vaccines.

Myths and misinformation you may hear from vaccine-hesitant parents/caregivers You might reply with…

“It is better if my child catches the disease and builds their immunity that way.”

“Vaccines can infect my child with the disease it’s trying to prevent.”

“Vaccines can cause long term side effects, illness and even death.”

“The side effects from the vaccine are worse than the disease itself.”

• Vaccines are the best way to protect your child from getting seriously sick from diseases.

• Just like wearing a seat belt reduces your chances of being injured in a car accident, vaccines reduce the chance that a virus will cause serious health issues or death even if you are exposed.

If your child is exposed to a virus, they may experience serious or life-threatening health effects, and immunity may not last very long. Getting vaccinated is a much safer way for your child to build immunity against serious diseases.

Like any other medication we take, vaccines can have some potential side effects. However, the side effects are usually mild and will typically go away on their own after a few hours or days. Some common side effects may include:

Pain, redness, and swelling at the injection site

Fever Mild rash

Tiredness and irritability

Your child’s doctor or a pharmacist may keep an eye on your child for 15 minutes after giving a vaccine, just to make sure they do not have a serious reaction (e.g., an allergy).

“If everyone around me is immune, then my child doesn’t need to be vaccinated.”

Getting children vaccinated protects them and the people around them, including older adults, people who might have existing health issues, and others who may be more likely to end up in the hospital if they get sick. Children that are vaccinated are less likely to pass on an illness to someone else.

• However, if enough people choose not to get vaccinated, that means serious diseases—like measles or polio—can spread, even to people that have been vaccinated.

“Children don’t get COVID.”

“My child is healthy and will not get seriously ill if they get COVID.”

“If my child already had COVID, they don’t need to be vaccinated.”

“My child can still catch COVID even if they’re vaccinated, so what’s the point?”

Like adults, children are susceptible to COVID and can experience serious symptoms and long-term health problems, including death. This includes healthy children.

Even if your child catches COVID, the vaccine reduces their risk of serious outcomes, hospitalization, and the risk of developing long-term health problems (which can develop even after a mild illness).

It’s important to stay up to date by getting the most recent booster for COVID, as those protect against the most common strains circulating now.

CONVERSATION STARTERS: Talking to parents about recommended and required childhood vaccines

Throughout the United States, rates of childhood vaccination have declined during the course of the COVID pandemic.

This job aid offers suggestions that staff working in clinical or community settings can use to start a conversation with parents and caregivers about recommended and required vaccinations, using the opportunity afforded when you may be meeting with them for another reason.

Conversation Basics

Set a positive, affirming tone. “It’s great to see you today” or “It’s so good that you’re taking care of your child’s health.”

Use normalizing language, so that the caregiver doesn’t feel singled out or judged. “I talk about this with all of my [patients/families/individuals]” or “A lot of parents/caregivers have questions about...”

• Ask permission to continue the conversation. “May I ask you some questions about vaccines your child has had in the past?” or “Would it be okay if we spend some time talking about this today?”

• Ensure the caregiver knows it is their choice to vaccinate their child. “While I strongly recommend that your child receive the required and recommended vaccines, as their parent/ caregiver, this decision is completely up to you.” or “If you need to take some time to think about this after our conversation, you do not have to decide today. We can always revisit this conversation another time.”

Use presumptive language, if you are a healthcare provider. It is a best practice for healthcare providers to use “presumptive language 1 when talking about vaccinations with families. Using presumptive language assumes that vaccination is the default option and is shown to increase the likelihood that parents will vaccinate. Presumptive language is a strong, confident vaccine recommendation. It might sound like “Your child is due for 3 vaccines today: HPV, Meningococcal, and Tdap. The nurse is going to prepare them and will be back in a few minutes. Do you have any questions I can answer?”

Use inclusive language. For example, say “parent” instead of “father” or “mother.”

Conversation Starters and Follow Up Questions

Here we present several conversation starters as well as follow-up questions you may use to initiate and continue the conversation. You may modify these based on your role. We recommend practicing these with a co-worker or peer to increase comfortability in conversation.

Starting the Conversation

• “Many parents and caregivers I talk to appreciate the chance to talk about the recommended and required vaccines their child needs, so they know what to expect. Can we review which vaccines your child is due for?”

• “Since you’re here, I’d like to review the vaccines your child is currently recommended or required to receive. Over the past few years, some children have fallen behind on their vaccinations, and I’m working with all of my [patients/families/individuals] to get their children back on track. How does this sound?”

• “I know we often have conversations about your child’s health and development. One part of a child’s growth and development is getting their vaccines. Would it be okay if we have a conversation about this?”

• “Is your child planning to or do they currently attend childcare or school? There are several vaccinations that are required by the state of California for children attending childcare or school. Would you like to review them together?”

“We have [child’s name] down for a [reason for visit]. It’s nice to see you two again. We like to let everyone coming into our office know about the recommended and required vaccines children need at this age. Let’s plan to go through this today.”

Continuing the Conversation

• “I know that you prioritize your child’s health. What are your hopes and expectations for their health in the future?”

“Do you have any questions or concerns about getting your child vaccinated? It is possible that they may experience side effects but these are normal and mild.”

“I wanted to revisit the conversation that we had about vaccination a few weeks ago. How are you feeling about that?”

Endnotes

1

When there is vaccine-preventable disease in your community:

• It may not be too late to get protection by getting vaccinated. Ask your child’s doctor.

• If there are cases (or, in some circumstances, a single case) of a vaccine-preventable disease in your community, you may be asked to take your child out of school, childcare, or organized activities (for example, playgroups or sports).

• Your school, childcare facility, or other institution will tell you when it is safe for an unvaccinated child to return. Be prepared to keep your child home for several days up to several weeks.

• Learn about the disease and how it is spread. It may not be possible to avoid exposure. For example, measles is so contagious that hours after an infected person has left the room, an unvaccinated person can get measles just by entering that room. ­

• Each disease is different, and the time between when your child might have been exposed to a disease and when he or she may get sick will vary. Talk with your child’s doctor or the health department to get their guidelines for determining when your child is no longer at risk of coming down with the disease.

Be aware.

4 Any vaccine-preventable disease can strike at any time in the U.S. because all of these diseases still circulate either in the U.S. or elsewhere in the world.

4 Sometimes vaccine-preventable diseases cause outbreaks, that is, clusters of cases in a given area.

4 Some of the vaccine-preventable diseases that still circulate in the U.S. include whooping cough, chickenpox, Hib (a cause of meningitis), and influenza. These diseases, as well as the other vaccine-preventable diseases, can range from mild to severe and life-threatening. In most cases, there is no way to know beforehand if a child will get a mild or serious case.

4 For some diseases, one case is enough to cause concern in a community. An example is measles, which is one of the most contagious diseases known. This disease spreads quickly among people who are not immune.

If you know your child is exposed to a vaccine-preventable disease for which he or she has not been vaccinated:

• Learn the early signs and symptoms of the disease.

• Seek immediate medical help if your child or any family members develop early signs or symptoms of the disease. ­

IMPORTANT: Notify the doctor’s office, urgent care facility, ambulance personnel, or emergency room staff that your child has not been fully vaccinated before medical staff have contact with your child or your family members. They need to know that your child may have a vaccinepreventable disease so that they can treat your child correctly as quickly as possible. Medical staff also can take simple precautions to prevent diseases from spreading to others if they know ahead of time that their patient may have a contagious disease.

• Follow recommendations to isolate your child from others, including family members, and especially infants and people with weakened immune systems. Most vaccine-preventable diseases can be very dangerous to infants who are too young to be fully vaccinated, or children who are not vaccinated due to certain medical conditions.

• Be aware that for some vaccine-preventable diseases, there are medicines to treat infected people and medicines to keep people they come in contact with from getting the disease.

• Ask your health care professional about other ways to protect your family members and anyone else who may come into contact with your child.

• Your family may be contacted by the state or local health department who track infectious disease outbreaks in the community. ­

If you travel with your child:

• Review the CDC travelers’ information website (http://www.cdc.gov/travel) before traveling to learn about possible disease risks and vaccines that will protect your family. Diseases that vaccines prevent remain common throughout the world, including Europe. ­

• Don't spread disease to others. If an unimmunized person develops a vaccine-preventable disease while traveling, to prevent transmission to others, he or she should not travel by a plane, train, or bus until a doctor determines the person is no longer contagious.

For more information on vaccines, ask your child's health care professional, visit www.cdc.gov/vaccines or call 800-CDC-INFO (800-232-4636)

If You Choose Not to Vaccinate Your Child, Understand the Risks and Responsibilities

Reviewed March 2012

If you choose to delay some vaccines or reject some vaccines entirely, there can be risks. Please follow these steps to protect your child, your family, and others.

With the decision to delay or reject vaccines comes an important responsibility that could save your child’s life, or the life of someone else. Any time that your child is ill and you:

• call 911;

• ride in an ambulance;

• visit a hospital emergency room; or

• visit your child’s doctor or any clinic you must tell the medical staff that your child has not received all the vaccines recommended for his or her age. Keep a vaccination record easily accessible so that you can report exactly which vaccines your child has received, even when you are under stress.

Telling health care professionals your child's vaccination status is essential for two reasons:

• When your child is being evaluated, the doctor will need to consider the possibility that your child has a vaccinepreventable disease. Many of these diseases are now uncommon, but they still occur.

• The people who help your child can take precautions, such as isolating your child, so that the disease does not spread to others. One group at high risk for contracting disease is infants who are too young to be fully vaccinated. For example, the measles vaccine is not usually recommended for babies younger than 12 months. Very young babies who get measles are likely to be seriously ill, often requiring hospitalization. Other people at high risk for contracting disease are those with weaker immune systems, such as some people with cancer and transplant recipients.

Before an outbreak of a vaccinepreventable disease occurs in your community:

• Talk to your child’s doctor or nurse to be sure your child’s medical record is up to date regarding vaccination status. Ask for a copy of the updated record.

• Inform your child’s school, childcare facility, and other caregivers about your child’s vaccination status. ­

• Be aware that your child can catch diseases from people who don’t have any symptoms. For example, Hib meningitis can be spread from people who have the bacteria in their body but are not ill. You can’t tell who is contagious.

Vaccines are another part of growing up

Like your child’s first words, vaccines are an important milestone. They are safe and protect infants and toddlers, so they can grow up happy, healthy, and strong.

Your child needs certain vaccines to go to childcare and kindergarten. Talk to your child’s doctor today about what vaccines they need.

Do you have questions or concerns about vaccines?

It’s normal to have questions about vaccines. Your child’s doctor will be happy to answer any questions you have.

Here are some questions you could ask the doctor:

• What vaccines does my child need to attend childcare or to enter kindergarten?

• Is my child behind on any recommended or required vaccines?

• What should I know about the specific vaccines my child needs right now?

• Can you explain the purpose of the vaccines?

• What possible symptoms could my child have after getting vaccinated?

• Should any other family members get vaccinations from their doctor in order to best protect my child?

Some vaccines are required for children to attend school in California:

Hepatitis B

DTaP (Diphtheria, Tetanus, Pertussis)

Hib (Meningitis)

IPV (Polio)

MMR (Measles, Mumps, Rubella)

Varicella (Chickenpox)

Talk to your child’s doctor today about what vaccines they need to catch up on.

Visit PartOfGrowingUp.org for more information.

Some vaccines are required for children to attend school in California:

Hepatitis B

DTaP (Diphtheria, Tetanus, Pertussis)

Hib (Meningitis)

IPV (Polio)

MMR (Measles, Mumps, Rubella)

Varicella (Chickenpox)

Talk to your child’s doctor today about what vaccines they need to catch up on.

Visit PartOfGrowingUp.org for more information.

Like their first soccer goal, vaccines are another part of growing up

Vaccines are safe and protect kids, so they can grow up happy, healthy, and strong. Your child needs certain vaccines to go to school. Talk to your child’s doctor today about what vaccines they need.

Do you have questions or concerns about vaccines?

It’s normal to have questions about vaccines. Your child’s doctor will be happy to answer any questions you have.

Here are some questions you could ask the doctor:

What vaccines does my child need to attend school?

Is my child behind on any recommended or required vaccines?

What should I know about the specific vaccines my child needs right now?

Can you explain the purpose of the vaccines?

What possible symptoms could my child have after getting vaccinated?