Counseling on Indications, Contraindications, and Potential Side Effects

The long-term relationship between primary care providers and patients is one of the most powerful tools in clinical preventive medicine. It is important for the provider to be aware of common misconceptions the public has about vaccinations, which may contribute to a patient declining an immunization. The conversation starts with an exploration of patient knowledge about the vaccine(s), followed by targeted counseling around fears and misconceptions. Although these fears are often exaggerated, it is true that some vaccines have side effects, such as local pain, irritation, fever, vasovagal syncope, occasionally cellulitis, or rarely, an unexpected allergy, anaphylaxis or seizure. Certain vaccines contain ingredients to which some patients may be severely allergic, including gelatin (MMR), or yeast (Hep B). There is growing evidence that the influenza vaccination is safe for patients with egg allergy. Other patients have contraindications to certain vaccines, such as pregnancy (rubella) or HIV (zoster). It is also helpful to review with the patient whether the vaccine might protect other people at home or at work. In most clinical practices, an excellent resource for immunization questions is the nursing staff, who are often responsible for counseling patients, administering immunizations, and storing vaccines. One excellent resource for providers, patients, and parents is the CDC website¬†“Basic and Common Questions.”

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