If we’re the safety net we claim to be, I think emergency physicians should confront the increasing number of parents who refuse to vaccinate their kids based on nonmedical exemptions, even in the face of states increasingly requiring vaccination.1 When I spoke about this at a past ACEP Scientific Assembly, I was surprised there was some resistance to this idea, particularly in light of the measles outbreaks in New York, California, Minnesota, and most recently in Washington state, or the nationwide increase in kindergarten nonmedical exemption rates over the past decade or so. I therefore want to revisit this contentious topic, beginning with a real case.
A mother brings her 6-month-old child to the emergency department for a high fever and listlessness. The girl has a temperature of 104.9°F and pulse of 199, but she perks up with some IV fluids. Her labs show a normal total white blood cell count and a low bicarb (13). The assessment: viral illness and dehydration. However, the emergency physician orders blood cultures and antibiotics just in case. The mom refuses to allow her child to receive antibiotics because one of the girl’s older siblings reportedly experienced some antibiotic-related side effects.