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An increasing number of vaccines are available and recommended for routine use in children. Pediatricians must keep up-to-date as new vaccines are added to the schedule and the recommendations for older vaccines are revised. No vaccine is 100% safe or 100% effective. However, the benefits of vaccines far outweigh the risks.1 Not only do parents want and need to know about these vaccines, communication about their risks and benefits is legally mandated and ethically necessary to enable parents to make informed decisions.2
What specific vaccine information needs to be communicated and who must provide it are problematic decisions for many pediatricians to make. However, neither the law nor the American Academy of Pediatrics (AAP) Red Book is explicit about what must be included in vaccine communication.3,4 A recent national survey found a mismatch among legal mandates for vaccine risk-benefit communication, providers' perceptions of what parents needed to know, and the actual vaccine risk-benefit communication practices of providers.5 The survey also indicated that vaccine communication need not be costly in time or effort.
There is no gold standard for vaccine risk-benefit communication. This article reviews the legal requirements, the Red Book recommendations, and research findings regarding current practice patterns among pediatricians, family physicians, and immunization nurses. Recommendations from parents across the United States are also described.
WHAT IS TNE LAW?
The National Childhood Vaccine Injury Act of 1986 indicates that "Each health care provider who administers a vaccine set forth in the Vaccine Injury Table shall provide a copy of the current Centers for Disease Control and Prevention (QDC) Vaccine Information Statement (VIS) supplemented with visual presentations or oral explanations. Such materials shall be provided prior to the administration of (each) vaccine."3 The law does not specify what oral explanation is needed.
WHAT DOES THE AAP RED BOOK RECOMMEND?
The most recent edition of the Red Book recommends risk-benefit communication as follows:
The . . . parent . . . should be informed about the benefits to be derived from the vaccine in preventing disease in individuals and the community and about the risks of these vaccines. Questions should be encouraged so that the information is understood - When a parent initiates discussion about a vaccine controversy, the health care professional should discuss the specific concerns...