(This is part of a series of guest posts by Dr. Mark McColl answering reader questions about vaccinations. It’s best to read my vaccine history and introduction of Dr. McColl first.)
Is it true that doctors get compensated for vaccinating kids?
Yes, the difference between the purchase price of the vaccine and what the insurance company reimburses me is about $3-5 per vaccine. This goes to cover the administrative costs of ordering, shipping, and refrigerating the vaccine. It goes toward the syringes and needles when required by the vaccine. It also goes toward the federally mandated Vaccine Information Sheets I’m required to photocopy and hand out for each vaccine. It covers the nurses time when insurances audit my vaccination records and the documentation necessary to prove I’m not just trying to commit insurance fraud. It also covers the bandaids.
Compensation for medical care is a fact of life. We get paid to diagnose and treat strep throat, sprained ankles, and kidney failure too. We get reimbursed to vaccinate children but none of us are running around wearing Prevnar team jerseys or promoting Menactra in front of ESPN cameras at the Pediatrician Playoffs. We could chuck it all and just tell parents to go get the vaccines at the health department and let them sort it out but the truth is that we love our patients. We care for them in much the same way we care for our own children. We want the best for them. In my mind there is nothing more pertinent to caring for children then preventing them from dying or being disabled when it is within my power to do so.
What are the risks of a child adopted from overseas being accidentally vaccinated twice (prior to coming to the US and once in the US)?
The recommended dosing schedule for vaccinations is really the minimum number of vaccinations needed to routinely establish an appropriate immune response in a majority of people. There are a host of factors that go into a person actually developing an appropriate response including their own immune system and the storage or handling of the vaccine. I mention these two factors because they may be the most pertinent for overseas vaccination. If a person is undernourished or otherwise very ill their immune system might not respond well. If a vaccine is kept out of proper refrigeration for too long the proteins can degrade and become useless. Third World countries are not known for their stable power grids.
A surprising number of children don’t mount the appropriate immune response when all the factors are perfect. Those children should legitimately be revaccinated. Adopted children might fall in the same category. If a child has had the appropriate vaccinations and responded well but the records are lost or unavailable revaccinating them carries no increased risk of allergic or adverse reaction.
Should parents and doctors trust the medical records from overseas?
That’s a judgement call. I’ve tended to trust the parent’s thoughts on this one. If I can read the vaccination record and the parents tell me the orphanage has a good reputation for caring for the children and the children don’t appear to be neglected, I go with it. I am also the kind of guy who would like to “trust but verify” so I tend to recommend titers for vaccines. If several of the titers are appropriate I tend to trust the whole set.
Should doctors give children some time to adjust to their new home and environment before giving them shots?
Out of all the things that happen to internationally adopted children vaccination is probably one of the least traumatic. I don’t think kids need to be jabbed when they get off the plane but I wouldn’t wait for them to get into college either.
Should parents be requesting titers before agreeing to vaccinations?
I think that’s very reasonable. Titers are a measurement of the amount of antibodies a person has against a specific threat. They are a way to measure if the body has responded against an infection in the past and sometimes used to gauge how prepared the body is to respond if challenged again. The one caveat to remember is that titers don’t guarantee protection. We know titers show the immune system has responded but there is no titer level at which you won’t ever get the disease. So if there is reliable evidence that a child has had a vaccination series and the titer is high enough that it has to be from vaccination or natural immunity I’d call it okay and not revaccinate.
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