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Nursing Excellence

The Online Newsletter for Children's Nurses
e-Edition, Volume 1, Issue 3 

Geneva Casella
Magnet LogoAddressing Parent’s Fear of the MMR Vaccine

Geneva K. Casella
RN Discovery Unit


Pediatric immunizations prevent 3 million deaths in children each year worldwide. Despite this success, a growing number of parents continue to refuse immunizations. According to the American Academy of Pediatrics (AAP), “Measles-mumps-rubella (MMR) vaccine was the most frequently refused immunization due to unfounded fears of a link to the development of autism, despite the fact that scientific studies have found no link between MMR vaccine and autism. But, as countless studies show, when fewer people immunize their children, diseases (like measles) that were practically gone start to gain traction. In order for vaccines to protect everyone, an estimated 85 to 95% of the population must be immunized” (American Academy of Pediatrics, 2008).

Research has proven since the MMR vaccine has become available in 1971, the number of cases of measles, mumps, and rubella have declined significantly. Before the vaccine was available in the U.S., nearly everyone who was exposed to measles contracted the measles, with nearly three-to-four million cases each year. For one-in-500 people, measles caused death. High levels of immunization in the U.S. have led to a 99% decrease in measles cases since doctors first started using the vaccine. There were 212,000 cases of mumps each year in the U.S. prior to the mumps vaccine. In 1998, there were only 606 cases of mumps in the U.S. The last disease prevented by the MMR vaccine, rubella, is harmful to pregnant women and their growing babies. In 1964-65, before the vaccine for rubella was available, 20,000 babies were born to mothers who had rubella. Of those 20,000 born, 11,600 were deaf, 3,580 were blind, and 1,800 were mentally retarded (National Institutes of Health, 2009).

Despite the overwhelming data that demonstrate that the health risks of not getting vaccinated are higher than getting vaccinated, parents are continuing to refuse vaccine administration. Parents refuse to vaccinate their children for many reasons. Most commonly, parents are not aware, or have no knowledge or memory of the seriousness of the disease that vaccines prevent. Therefore, their concern frequently shifts from the risk of the disease to the risks of the vaccines. Because signs of autism may appear around the same time children receive the MMR vaccine, some parents may worry that the vaccine causes autism. Vaccine safety experts, including experts at CDC and the American Academy of Pediatrics, agree that MMR vaccine is not responsible for recent increases in the number of children with autism. In 2004, a report by the Institute of Medicine concluded that no link between autism and MMR vaccine exists (Center for Disease Control, 2008).

“Healthcare professionals and parents are bound by the duty to seek medical benefit and minimize harm to children in their care. When faced with the decision to immunize a child, parents and physicians may not always agree on what constitutes the best interest of the child” (Diekema, 2005, 1543). What is the healthcare professionals role when faced with a parent who refuses consent to immunize their child? The principle behind this process arises out of respect for patient autonomy. The healthcare professional should listen carefully and respectfully to the parents concerns. Some parents may not use the same decision criteria as the physician and may weigh evidence very differently. Vaccines are safe, but they are not risk free; nor are they 100% effective. This may pose a dilemma for many parents. The healthcare professional should share honestly what is and is not known about the risks and benefits of the vaccine in question, attempt to understand the parent’s concerns about immunization, and attempt to correct any misperceptions and misinformation. The healthcare professional should also assist parents in understanding that the risks of any vaccine should not be considered in isolation but in comparison to the risks of remaining unimmunized. For example, although the risk of encephalopathy related to the measles vaccine is one in one million, the risk of encephalopathy from measles illness is 1000 times greater (Diekema, 2005, 1544). The healthcare professional has a responsibility to keep up to date regarding developments within the immunization program, and carefully consider these developments.

The overwhelming evidence currently available is that the MMR vaccine is safer than the alternative of not getting vaccinated. As healthcare professionals we must be well informed and promote good practice. Healthcare providers have a responsibility to endorse it emphatically; any less is a failure and may contribute to outbreaks of disease that once claimed thousands of lives prior to the invention of the MMR vaccine (Fry, 2002).




American Academy of Pediatrics. (2008). Facts for parents about vaccine safety. Retrieved June 13, 2009, from

American Academy of Pediatrics. (2004). Reducing vaccine liability strategies for pediatricians. Retrieved June 14, 2009, from

American Academy of Pediatrics. (2008). Vaccine safety the facts. Retrieved June 13, 2009, from

Center for Disease Control. (2008). Measles mumps and rubella MMR vaccine. Retrieved June 13, 2009, from

Center for Disease Control. (2008). MMR vaccines what you need to know. Retrieved June 14, 2009, from

Center for Disease Control. (n.d.). National vaccine program office immunization laws. Retrieved June 13, 2009, from

Diekema, D.S. (2005). Responding to parental refusals of immunization of children. American Academy of Pediatrics, 316(0031), 1542-1544.

Dukehealth. (2007). Does the MMR vaccine cause autism. Retrieved June 13, 2009,from

Fry, R. (2002). MMR vaccine debate. pubmed. National Institutes of Health. (2009). Aren't the diseases prevented by the MMR vaccine mild when compared to the lifelong symptoms of autism. Retrieved June 13,from



In This Issue
Seasons of Change
Change and Transition
Career Path to Success
Decreasing Medication Errors Through Reporting of Unusual Occurrences
Demystifying Simulation
Breastfeeding: Improving the Health of Baby and Mom
Addressing Parent’s Fear of the MMR Vaccine
NICU Nursing in Nepal