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Naturopathic Academy of Primary Care Physicians Position Paper on Immunizations

Board of Directors: Bruce Milliman, ND; Hannah Gordon, ND; Jonathan Bell, ND; Joshua Green, ND; Molly Fox, ND; Taylor Kaufmann, ND Candidate; Esteban Ryciak, ND; Blake Myers, ND

Overview of Naturopathic Medicine and Immunization:

Childhood immunizations have an international public health impact by significantly reducing morbidity and mortality from vaccine-preventable diseases.

Immunizations are a scientifically sound and effective modality,i and are used by naturopathic physicians for the prevention of infectious diseases.

Public health workers are natural allies of the naturopathic profession and vice versa, with large overlaps in objectives and methods of supporting and maintaining health.

Naturopathic physicians understand that the incidence of vaccine-preventable diseases would increase if current immunization programs were not followed.

Naturopathic physicians are strong advocates of preventive medicine and protecting children and adults from adverse consequences of infectious disease, and therefore immunization is included under the naturopathic precept of Prevention.

Naturopathic physicians are morally obliged and legally mandated to carry out public health laws including those with respect to immunization.

Immunization contributes to less utilization of medications and invasive treatments for complications of vaccine-preventable diseases, and is therefore supported by the precept of First Do No Harm.

The AANP (American Association of Naturopathic Physicians) Scientific Affairs Committee has reviewed research on immunizations and concluded that the current Centers for Disease Control and Prevention’s (CDC) recommended immunization schedule is based on sound science and should serve as the main guidance for immunization practices.

It is well documented that communities with lower rates of immunization may suffer outbreaks of vaccine-preventable diseases, including significant morbidity and mortality.ii,iii,iv,v

The naturopathic precept of Doctor as Teacher directs naturopathic physicians to provide unbiased, complete information to patients and/or parents about immunizations.

There is currently no definitive evidence supporting any particular alternative immunization schedule.vi More than ten percent of families may be using alternative schedules.vii It would be preferable to follow an alternative schedule rather than avoid immunizing altogether.

Many families are removed from or refused entry to medical practices due to their immunization hesitation, resistance, or requests for an alternative immunization schedule, and they therefore may seek out naturopathic physicians for care and guidance.
This situation places naturopathic physicians in an opportune position to provide information and immunization coverage to those patients who might otherwise receive no immunizations at all.

Additional measures should also be recommended to reduce the consequences of vaccine-preventable disease including healthy diet, regular exercise, routine hand washing, good sleep hygiene, optimization of immune function and breast-feeding.

Position of the Naturopathic Academy of Primary Care Physicians:

• The Naturopathic Academy of Primary Care Physicians takes a clear pro-immunization position, with the understanding that there may be differences of opinion and dissent in both naturopathic and conventional medical communities and recommends that naturopathic physicians know, understand, and follow the immunization guidelines appropriate for the individual patient, and consistent with immunization regulations of local, state and federal jurisdictions.

• Patients should have access to immunizations by naturopathic physicians in the states and territories where they are regulated. To fully participate in public health efforts, naturopathic physicians should have full access to public health immunization programs.

• Naturopathic physicians should recommend, provide, or refer for appropriate immunizations according to CDC’s childhood immunization or catch-up schedules.

• Naturopathic physicians have a responsibility to contribute to research that provides impartial data in regards to immunization.

• Naturopathic physicians should follow generally accepted storage and administration guidelines for immunizations. Before immunizations are administered, the necessary Vaccine Information Statements should be provided to and discussed with the patient or parents, and the physician should participate in state-specific Immunization Information Systems.

• Naturopathic physicians should provide a copy of the official CDC immunization schedule and standard written informed consent for the patient or parent to sign, stating they understand the risks if there is variance from the CDC’s immunization schedule. If a patient receives immunizations outside the medical home, necessary details should be accurately recorded for those immunizations in order to track a patient’s immunization status in accordance with state laws.

• Naturopathic physicians who have patients with symptoms that are believed to be due to immunization adverse effects have a duty to report this to the Vaccine Adverse Event Reporting System.

i National Research Council. The Childhood Immunization Schedule and Safety: Stakeholder Concerns, Scientific Evidence, and Future Studies. Washington, DC: The National Academies Press, 2013.

ii Centers for Disease Control and Prevention (CDC). Vaccination coverage among children in kindergarten--United States, 2011-12 school year. MMWR Morb Mortal Wkly Rep. August 24, 2012 / 61(33);647-652.
iii Centers for Disease Control and Prevention (CDC). Poliovirus Infections in Four Unvaccinated Children --- Minnesota, August--October 2005. MMWR Morb Mortal Wkly Rep. October 21, 2005 / 54(41);1053-1055.

iv Centers for Disease Control and Prevention (CDC). Varicella Death of an Unvaccinated, Previously Healthy Adolescent. MMWR Morb Mortal Wkly Rep. April 12, 2013 / 62(14);261-263.
v Centers for Disease Control and Prevention (CDC). Pertussis Deaths--United States, 2000. MMWR Morb Mortal Wkly Rep. July 19, 2002 / 51(28);616-618.
vi Jackson ML. Challenges in comparing the safety of different vaccination schedules. Vaccine. 2013 Apr 19;31(17):2126-9.
vii Dempsey AF, Schaffer S, Singer D, Butchart A, Davis M, Freed GL. Alternative vaccination schedule preferences among parents of young children. Pediatrics. 2011 Nov;128(5):848-56.). 

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