Experts differ on whether
benefits outweigh risks of providing influenza vaccine to
- Copyright © 2009 by the American Academy of Pediatrics
Should a pediatrician administer the influenza vaccine to patients’ parents?
On the one hand, vaccinating parents against influenza helps to protect their children from the illness. On the other hand, it places the pediatrician at risk for liability should a parent have an adverse reaction to the vaccine, among other concerns.
“I think pediatricians realize that it is important for parents to get the (influenza) vaccine, particularly parents who have an infant younger than 6 months of age who can’t receive the vaccine,” said Olivia Whyte Thomas, M.D., FAAP, member of the AAP Committee on Practice and Ambulatory Medicine. “However, there are so many barriers in place that most practices haven’t started vaccinating parents.”
Benefits to children
Margaret C. Fisher, M.D., FAAP, chair of the AAP Section on Infectious Diseases executive committee, said she believes that immunizing parents with the flu vaccine would be a way of providing the best possible care to children, especially newborns and children with a chronic disease or illness who are at increased risk from influenza.
“Having a newborn or a child with a chronic illness changes a parent’s life because time is not their own anymore,” said Dr. Fisher. “There are so many things pulling them in different directions that if pediatricians could provide this service to them, it would not only benefit children but their parents, too. It fits into the whole idea of family-centered care.”
Dr. Fisher pointed out that a parent’s primary care provider should be notified that the parent has received the vaccine from the pediatrician so as not to disrupt the adult medical home. However, many adults don’t have a primary care physician, so offering the vaccine in the pediatric office setting could increase the odds of parents getting the vaccine because of convenience.
Updated AAP recommendations released in September advise that all children ages 6 months to 18 years be vaccinated against the flu through May 1. The Academy also recommends vaccinating household contacts or child care providers of children with high-risk conditions or of healthy children under the age of 5.
Although Dr. Thomas doesn’t think it is common for parents to ask pediatricians for the influenza vaccine, she thinks that the availability of the vaccine at so many public locations has spurred the idea of getting the vaccine at the pediatrician’s office.
“When I’m in the airport, I see signs saying, ‘get the flu vaccine here.’ If an airport can get around the liability issue, then it seems like we should be able to figure out a way to get around it because it makes sense to provide vaccines in a medical setting,” Dr. Fisher said.
Dr. Thomas said there are many issues to consider before vaccinating parents besides liability, including supply, reimbursement, whether parents become patients and records need to be established, and who is responsible for providing medical follow-up care if there is an adverse reaction.
Dr. Fisher said pediatricians should plan ahead to ensure adequate supply so as not to immunize parents at the expense of immunizing children. She also said that pediatricians are not reimbursed for this service, so those who do provide immunizations to adults charge a fee-for-service.
Dr. Thomas said there are no financial benefits to immunizing adults. In fact, costs associated with immunizing adults, such as storing an increased supply of the vaccine, may be financial obstacles to some practices.
Pediatricians who are considering administering the flu vaccine to parents should check with their malpractice insurance carrier to see if a parent would fall under the umbrella of malpractice insurance coverage, advises David Marcus M.D., FAAP, member of the AAP Committee on Medical Liability and Risk Management.
Pediatricians cannot ensure that parents are healthy before immunizing them, Dr. Marcus said, because they are not registered patients.
“Therein lies the problem with medical malpractice insurance companies. They (usually) don’t accept the risk of immunizing parents in a pediatrician’s office, so if any liability occurred because of a vaccine, that wouldn’t be a good thing,” he said.
However, Dr. Fisher said, “if you prevented disease in 20 neonates and their parents and somebody sued you, then you would still know that you protected 20 neonates.”
To reduce the risk of medical liability, pediatricians can consider the following when offering influenza vaccine to parents:
Check for contraindications.
Talk about vaccine benefits and risks.
Provide a Vaccine Information Statement (VIS) and ask whether there are any questions or concerns.
Document the vaccine administration date, vaccine manufacturer, lot number, physician’s name and address, edition and date of the VIS given, vaccine site, route of vaccine administration and vaccine expiration date. Keep the documentation on file at the office, and consider forwarding a copy to the parent’s primary care physician.
Comply with the National Vaccine Injury Compensation Program.
“We have a lot of what ifs,” said Dr. Thomas. “There are so many benefits to giving the vaccine to parents, but there are so many other pieces pediatricians may not be ready to take on yet.”