In the last episode of our mini-series on Immunizations Updates, we are joined again by pediatric nurse practitioner, Dr. Maddie Manfredi, for a live role-play extended episode focused on motivational interviewing (MI) in the setting of vaccine hesitancy. During 5 cases built around common worries surrounding pediatric vaccines, Dr. Manfredi uses evidence-based approaches to explore hesitancy and reach a common goal– a child’s health and well-being.

The cases cover:

- Immune system overload

- Misinformation and distrust

- The autism myth

- Preference for a natural lifestyle

- Low risk disease perception

This episode demonstrates what a therapeutic relationship looks like and how to navigate real-world conversations with caregivers across a spectrum of hesitancy. Through five case-based scenarios, listeners will hear MI techniques applied in real time and walk away with practical scripts and strategies to use in clinical encounters.

Website: www.thepedsnp.com

Contact: [email protected]

Instagram: @thepedsnppodcast 

AACN Essentials Mapping (Domain. sub-competency): 

1.1f, 1.2g

2.2c, 2.2f, 2.3b, 2.4e 

3.1a, 3.2b, 3.3d 

4.1a, 4.1d, 4.2c 

5.1b, 5.2a, 5.3c 

6.2b, 6.3a 

7.1c, 7.2d 

8.2c, 8.3d 

9.1a, 9.2f, 9.3c 

10.2a, 10.2d, 10.3b

References:

Bernstein, T. A., Broome, M., Millman, J., Epstein, J., & Derouin, A. (2022). Promoting strategies to increase HPV vaccination in the pediatric primary care setting. Journal of Pediatric Health Care, 36(2), e36–e41. https://doi.org/10.1016/j.pedhc.2021.10.009

Bullen, M., Heriot, G.S., & Jamrozik, E. (2023). Herd immunity, vaccination and moral obligation. Journal of Medical Ethics, 49(9), 636–641. https://doi.org/10.1136/jme-2022-108485

Braun, C., & O'Leary, S. T. (2020). Recent advances in addressing vaccine hesitancy. Current Opinion in Pediatrics, 32(4), 601–609. https://doi.org/10.1097/MOP.0000000000000929

Brewer, N. T., Chapman, G. B., Rothman, A. J., Leask, J., & Kempe, A. (2017). Increasing vaccination: Putting psychological science into action. Psychological Science in the Public Interest: A Journal of the American Psychological Society, 18(3), 149–207. https://doi.org/10.1177/1529100618760521 

Brewer, N. T. (2021). What works to increase vaccine uptake. Academic Pediatrics, 21(4S), S9-S16. https://doi.org/10.1016.j.acap.2021.01.017

Centers for Disease Control and Prevention. (2024a, August 9). Reasons to vaccinate. https://www.cdc.gov/vaccines-children/reasons/index.html

Centers for Disease Control and Prevention. (2024c). Talking with parents about vaccines. https://www.cdc.gov/vaccines-children/hcp/conversation-tips/index.html

Eagan, R.L., Larson, H.J., & de Figueiredo, A. (2023). Recent trends in vaccine coverage and confidence: A cause for concern. Human Vaccines & Immunotherapeutics, 19(2), 2237374. https://doi.org/10.1080/21645515.2023.2237374

Frew, P.M., & Lutz, C.S. (2017). Interventions to increase pediatric vaccine uptake: An overview of recent findings. Human Vaccines & Immunotherapeutics, 13(11), 2503-2511. https://doi.org/10.1080/21645515.2017.1367069

Gagneur, A., Gutnick, D., Berthiaume, P., Diana, A., Rollnick, S., & Saha, P. (2024). From vaccine hesitancy to vaccine motivation: A motivational interviewing based approach to vaccine counselling. Human Vaccines & Immunotherapeutics, 20(1), 2391625. https://doi.org/10.1080/21645515.2024.2391625

Jarrett, C., Wilson, R., O'Leary, M., Eckersberger, E., Larson, H. J., & SAGE Working Group on Vaccine Hesitancy. (2015). Strategies for addressing vaccine hesitancy - A systematic review. Vaccine, 33(34), 4180–4190. https://doi.org/10.1016/j.vaccine.2015.04.040

Kestenbaum, L. A., & Feemster, K. A. (2015). Identifying and addressing vaccine hesitancy. Pediatric Annals, 44(4), e71–e75. https://doi.org/10.3928/00904481-20150410-07

Lafnitzegger, A., & Gaviria-Agudelo, C. (2022). Vaccine hesitancy in pediatrics. Advances in pediatrics, 69(1), 163–176. https://doi.org/10.1016/j.yapd.2022.03.011

Limaye, R. J., Opel, D. J., Dempsey, A., Ellingson, M., Spina, C., Omer, S. B., Dudley, M. Z., Salmon, D. A., & Leary, S. O. (2021). Communicating with vaccine-hesitant parents: A narrative review. Academic pediatrics, 21(4S), S24–S29. https://doi.org/10.1016/j.acap.2021.01.018

McClure, C. C., Cataldi, J. R., & O'Leary, S. T. (2017). Vaccine hesitancy: Where we are and where we are going. Clinical Therapeutics, 39(8), 1550–1562. https://doi.org/10.1016/j.clinthera.2017.07.003

Mical, R., Martin-Velez, J., Blackstone, T., & Derouin, A. (2021). Vaccine hesitancy in rural pediatric primary care. Journal of Pediatric Health Care, 35(1), 16–22. https://doi.org/10.1016/j.pedhc.2020.07.003

Minta, A. A., Ferrari, M., Antoni, S., Lambert, B., Sayi, T. S., Hsu, C. H., Steulet, C., Gacic-Dobo, M., Rota, P. A., Mulders, M. N., Wimmer, A., Bose, A. S., O'Connor, P., & Crowcroft, N. S. (2024). Progress toward measles elimination - Worldwide, 2000-2023. MMWR. Morbidity and Mortality Weekly Report, 73(45), 1036–1042. https://doi.org/10.15585/mmwr.mm7345a4

Nandi, A., & Shet, A. (2020). Why vaccines matter: understanding the broader health, economic, and child development benefits of routine vaccination. Human Vaccines & Immunotherapeutics, 16(8), 1900-1904. https://doi.org/10.1080/21645515.2019.1708669

 Nyhan, B., Reifler, J., Richey, S., & Freed, G. L. (2014). Effective messages in vaccine promotion: A randomized trial. Pediatrics, 133(4), e835–e842. https://doi.org/10.1542/peds.2013-2365

Obohwemu, K., Christie-de Jong, F., & Ling, J. (2022). Parental childhood vaccine hesitancy and predicting uptake of vaccinations: a systematic review. Primary Health Care Research & Development, 23, e68. https://doi.org/10.1017/S1463423622000512 

Offit, P. A., & Moser, C. A. (2009). The problem with Dr Bob's alternative vaccine schedule. Pediatrics, 123(1), e164–e169. https://doi.org/10.1542/peds.2008-2189 

O'Leary, S. T., Opel, D. J., Cataldi, J. R., Hackell, J. M.; Committee on Infection Diseases, Committee on Practice and Ambulatory Medicine, & Committee on Bioethics. (2024). Strategies for improving vaccine communication and uptake. Pediatrics, 153(3), e2023065483. https://doi.org/10.1542/peds.2023-065483

Opel, D. J., Heritage, J., Taylor, J. A., Mangione-Smith, R., Salas, H. S., DeVere, V., Zhou, C., & Robinson, J. D. (2013). The architecture of provider-parent vaccine discussions at health supervision visits. Pediatrics, 132(6), 1037–1046. https://doi.org/10.1542/peds.2013-2037

Opel, D. J., Mangione-Smith, R., Robinson, J.D., Heritage, J., DeVere, V., Salas, H.S., Zhou, C., & Taylor, J. A. (2015). The influence of provider communication behaviors on parental vaccine acceptance and visit experience. American Journal of Public Health, 105(10), 1998–2004. https://doi.org/10.2105/AJPH.2014.302425

Petca, A., Borislavschi, A., Zvanca, M. E., Petca, R. C., Sandru, F., & Dumitrascu, M. C. (2020). Non-sexual HPV transmission and role of vaccination for a better future (Review). Experimental and therapeutic medicine, 20(6), 186. https://doi.org/10.3892/etm.2020.9316 

Shattock, A. J., Johnson, H. C., Sim, S. Y., Carter, A., Lambach, P., Hutubessy, R. C. W., Thompson, K. M., Badizadegan, K., Lambert, B., Ferrari, M. J., Jit, M., Fu, H., Silal, S. P., Hounsell, R. A., White, R. G., Mosser, J. F., Gaythorpe, K. A. M., Trotter, C. L., Lindstrand, A., O'Brien, K. L., Bar-Zeev, N. (2024). Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization. Lancet (London, England), 403(10441), 2307–2316. https://doi.org/10.1016/S0140-6736(24)00850-X

Smith M. J. (2015). Promoting vaccine confidence. Infectious Disease Clinics of North America, 29(4), 759–769. https://doi.org/10.1016/j.idc.2015.07.004

Songol, A., Amiri-Farahani, L., Haghani, S., Pezaro, S., & Omrani Saravi, S. (2023). Comparing the effect of parental education via both lecture and film upon vaccination uptake for children under one year of age: A cluster randomized clinical trial. Vaccine, 41(5), 1067-1073. https://doi.org/10.1016/j.vaccine.2022.12.012

Szilagyi, P. G., Albertin, C. S., Gurfinkel, D., Saville, A. W., Vangala, S., Rice, J. D., Helmkamp, L., Zimet, G. D., Valderrama, R., Breck, A., Rand, C. M., Humiston, S. G., & Kempe, A. (2020). Prevalence and characteristics of HPV vaccine hesitancy among parents of adolescents across the US. Vaccine, 38(38), 6027–6037. https://doi.org/10.1016/j.vaccine.2020.06.074

World Health Organization. (n.d.). A brief history of vaccines. https://www.who.int/news-room/spotlight/history-of-vaccination/a-brief-history-of-vaccination

World Health Organization. (2015, August 18). Vaccine hesitancy: A growing challenge for immunization programmes. https://www.who.int/news/item/18-08-2015-vaccine-hesitancy-a-growing-challenge-for-immunization-programmes

World Health Organization. (2019). Ten threats to global health in 2019. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019

Zhou, F., Jatlaoui, T. C., Leidner, A. J., Carter, R. J., Dong, X., Santoli, J. M., Stokley, S., Daskalakis, D. C., & Peacock, G. (2024). Health and economic benefits of routine childhood immunizations in the era of the vaccines for children program - United States, 1994-2023. MMWR. Morbidity and Mortality Weekly Report, 73(31), 682–685. https://doi.org/10.15585/mmwr.mm7331a2  

As we continue on in our mini series on Immunizations Updates, we are joined by pediatric nurse practitioner Dr. Maddie Manfredi to explore the growing challenge of vaccine hesitancy. Together we will review the profound public health impact of immunizations, define vaccine hesitancy as a spectrum of decision-making rather than simple refusal, and discuss its implications for herd immunity and pediatric outcomes. Dr. Manfredi shares findings from her DNP project, including the use of a novel Caregiver Vaccine Readiness Survey to proactively identify concerns and guide more tailored, patient-centered conversations using motivational interviewing. We’ll highlight the critical role of provider communication in building trust, addressing caregiver concerns, and improving vaccine acceptance, with promising results shared from a DNP project on MMR vaccine acceptance. The episode underscores that how we communicate matters just as much as what we say and invites listeners to rethink traditional approaches in today’s complex sociopolitical landscape. Stay tuned for the next episode, where Dr. Carson and Dr. Manfredi model motivational interviewing strategies through case-based role play.

Website: www.thepedsnp.com

Contact: [email protected]

Instagram: @thepedsnppodcast 

AACN Essentials Mapping (Domain. sub-competency): 

1.1f, 1.2g

2.2c, 2.2f, 2.3b, 2.4e 

3.1a, 3.2b, 3.3d 

4.1a, 4.1d, 4.2c 

5.1b, 5.2a, 5.3c 

6.2b, 6.3a 

7.1c, 7.2d 

8.2c, 8.3d 

9.1a, 9.2f, 9.3c 

10.2a, 10.2d, 10.3b

References:

Bernstein, T. A., Broome, M., Millman, J., Epstein, J., & Derouin, A. (2022). Promoting strategies to increase HPV vaccination in the pediatric primary care setting. Journal of Pediatric Health Care, 36(2), e36–e41. https://doi.org/10.1016/j.pedhc.2021.10.009

Bullen, M., Heriot, G.S., & Jamrozik, E. (2023). Herd immunity, vaccination and moral obligation. Journal of Medical Ethics, 49(9), 636–641. https://doi.org/10.1136/jme-2022-108485

Braun, C., & O'Leary, S. T. (2020). Recent advances in addressing vaccine hesitancy. Current Opinion in Pediatrics, 32(4), 601–609. https://doi.org/10.1097/MOP.0000000000000929

Brewer, N. T., Chapman, G. B., Rothman, A. J., Leask, J., & Kempe, A. (2017). Increasing vaccination: Putting psychological science into action. Psychological Science in the Public Interest: A Journal of the American Psychological Society, 18(3), 149–207. https://doi.org/10.1177/1529100618760521 

Brewer, N. T. (2021). What works to increase vaccine uptake. Academic Pediatrics, 21(4S), S9-S16. https://doi.org/10.1016.j.acap.2021.01.017

Centers for Disease Control and Prevention. (2024a, August 9). Reasons to vaccinate. https://www.cdc.gov/vaccines-children/reasons/index.html

Centers for Disease Control and Prevention. (2024c). Talking with parents about vaccines. https://www.cdc.gov/vaccines-children/hcp/conversation-tips/index.html

Eagan, R.L., Larson, H.J., & de Figueiredo, A. (2023). Recent trends in vaccine coverage and confidence: A cause for concern. Human Vaccines & Immunotherapeutics, 19(2), 2237374. https://doi.org/10.1080/21645515.2023.2237374

Frew, P.M., & Lutz, C.S. (2017). Interventions to increase pediatric vaccine uptake: An overview of recent findings. Human Vaccines & Immunotherapeutics, 13(11), 2503-2511. https://doi.org/10.1080/21645515.2017.1367069

Gagneur, A., Gutnick, D., Berthiaume, P., Diana, A., Rollnick, S., & Saha, P. (2024). From vaccine hesitancy to vaccine motivation: A motivational interviewing based approach to vaccine counselling. Human Vaccines & Immunotherapeutics, 20(1), 2391625. https://doi.org/10.1080/21645515.2024.2391625

Jarrett, C., Wilson, R., O'Leary, M., Eckersberger, E., Larson, H. J., & SAGE Working Group on Vaccine Hesitancy. (2015). Strategies for addressing vaccine hesitancy - A systematic review. Vaccine, 33(34), 4180–4190. https://doi.org/10.1016/j.vaccine.2015.04.040

Kestenbaum, L. A., & Feemster, K. A. (2015). Identifying and addressing vaccine hesitancy. Pediatric Annals, 44(4), e71–e75. https://doi.org/10.3928/00904481-20150410-07

Lafnitzegger, A., & Gaviria-Agudelo, C. (2022). Vaccine hesitancy in pediatrics. Advances in pediatrics, 69(1), 163–176. https://doi.org/10.1016/j.yapd.2022.03.011

Limaye, R. J., Opel, D. J., Dempsey, A., Ellingson, M., Spina, C., Omer, S. B., Dudley, M. Z., Salmon, D. A., & Leary, S. O. (2021). Communicating with vaccine-hesitant parents: A narrative review. Academic pediatrics, 21(4S), S24–S29. https://doi.org/10.1016/j.acap.2021.01.018

McClure, C. C., Cataldi, J. R., & O'Leary, S. T. (2017). Vaccine hesitancy: Where we are and where we are going. Clinical Therapeutics, 39(8), 1550–1562. https://doi.org/10.1016/j.clinthera.2017.07.003

Mical, R., Martin-Velez, J., Blackstone, T., & Derouin, A. (2021). Vaccine hesitancy in rural pediatric primary care. Journal of Pediatric Health Care, 35(1), 16–22. https://doi.org/10.1016/j.pedhc.2020.07.003

Minta, A. A., Ferrari, M., Antoni, S., Lambert, B., Sayi, T. S., Hsu, C. H., Steulet, C., Gacic-Dobo, M., Rota, P. A., Mulders, M. N., Wimmer, A., Bose, A. S., O'Connor, P., & Crowcroft, N. S. (2024). Progress toward measles elimination - Worldwide, 2000-2023. MMWR. Morbidity and Mortality Weekly Report, 73(45), 1036–1042. https://doi.org/10.15585/mmwr.mm7345a4

Nandi, A., & Shet, A. (2020). Why vaccines matter: understanding the broader health, economic, and child development benefits of routine vaccination. Human Vaccines & Immunotherapeutics, 16(8), 1900-1904. https://doi.org/10.1080/21645515.2019.1708669

 Nyhan, B., Reifler, J., Richey, S., & Freed, G. L. (2014). Effective messages in vaccine promotion: A randomized trial. Pediatrics, 133(4), e835–e842. https://doi.org/10.1542/peds.2013-2365

Obohwemu, K., Christie-de Jong, F., & Ling, J. (2022). Parental childhood vaccine hesitancy and predicting uptake of vaccinations: a systematic review. Primary Health Care Research & Development, 23, e68. https://doi.org/10.1017/S1463423622000512 

O'Leary, S. T., Opel, D. J., Cataldi, J. R., Hackell, J. M.; Committee on Infection Diseases, Committee on Practice and Ambulatory Medicine, & Committee on Bioethics. (2024). Strategies for improving vaccine communication and uptake. Pediatrics, 153(3), e2023065483. https://doi.org/10.1542/peds.2023-065483

Opel, D. J., Heritage, J., Taylor, J. A., Mangione-Smith, R., Salas, H. S., DeVere, V., Zhou, C., & Robinson, J. D. (2013). The architecture of provider-parent vaccine discussions at health supervision visits. Pediatrics, 132(6), 1037–1046. https://doi.org/10.1542/peds.2013-2037

Opel, D. J., Mangione-Smith, R., Robinson, J.D., Heritage, J., DeVere, V., Salas, H.S., Zhou, C., & Taylor, J. A. (2015). The influence of provider communication behaviors on parental vaccine acceptance and visit experience. American Journal of Public Health, 105(10), 1998–2004. https://doi.org/10.2105/AJPH.2014.302425

Shattock, A. J., Johnson, H. C., Sim, S. Y., Carter, A., Lambach, P., Hutubessy, R. C. W., Thompson, K. M., Badizadegan, K., Lambert, B., Ferrari, M. J., Jit, M., Fu, H., Silal, S. P., Hounsell, R. A., White, R. G., Mosser, J. F., Gaythorpe, K. A. M., Trotter, C. L., Lindstrand, A., O'Brien, K. L., Bar-Zeev, N. (2024). Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization. Lancet (London, England), 403(10441), 2307–2316. https://doi.org/10.1016/S0140-6736(24)00850-X

Smith M. J. (2015). Promoting vaccine confidence. Infectious Disease Clinics of North America, 29(4), 759–769. https://doi.org/10.1016/j.idc.2015.07.004

 Songol, A., Amiri-Farahani, L., Haghani, S., Pezaro, S., & Omrani Saravi, S. (2023). Comparing the effect of parental education via both lecture and film upon vaccination uptake for children under one year of age: A cluster randomized clinical trial. Vaccine, 41(5), 1067-1073. https://doi.org/10.1016/j.vaccine.2022.12.012

Szilagyi, P. G., Albertin, C. S., Gurfinkel, D., Saville, A. W., Vangala, S., Rice, J. D., Helmkamp, L., Zimet, G. D., Valderrama, R., Breck, A., Rand, C. M., Humiston, S. G., & Kempe, A. (2020). Prevalence and characteristics of HPV vaccine hesitancy among parents of adolescents across the US. Vaccine, 38(38), 6027–6037. https://doi.org/10.1016/j.vaccine.2020.06.074

World Health Organization. (n.d.). A brief history of vaccines. https://www.who.int/news-room/spotlight/history-of-vaccination/a-brief-history-of-vaccination

World Health Organization. (2015, August 18). Vaccine hesitancy: A growing challenge for immunization programmes. https://www.who.int/news/item/18-08-2015-vaccine-hesitancy-a-growing-challenge-for-immunization-programmes

World Health Organization. (2019). Ten threats to global health in 2019. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019

Zhou, F., Jatlaoui, T. C., Leidner, A. J., Carter, R. J., Dong, X., Santoli, J. M., Stokley, S., Daskalakis, D. C., & Peacock, G. (2024). Health and economic benefits of routine childhood immunizations in the era of the vaccines for children program - United States, 1994-2023. MMWR. Morbidity and Mortality Weekly Report, 73(31), 682–685. https://doi.org/10.15585/mmwr.mm7331a2 

In the second episode of our Immunization Updates mini-series, we’ll break down the evolving—and increasingly confusing—2026 pediatric immunization landscape, helping clinicians make sense of diverging CDC and AAP vaccine schedules.

Following major federal changes to the ACIP process and subsequent shifts in CDC recommendations, several vaccines were reclassified from universal use to “high-risk” or “shared decision-making,” creating uncertainty for providers and families alike. We’ll walk through what changed, why it matters, and how these updates compare to the AAP’s continued endorsement of universal protection against 18 diseases.

Using real-world examples like HPV and RSV prevention, this episode unpacks how wording, categorization, and policy decisions impact clinical care, patient understanding, and public confidence. We end with practical strategies for navigating vaccine conversations, maintaining an AAP-aligned workflow, addressing insurance and liability concerns, and documenting when families choose alternate approaches. This episode is a must-listen for pediatric providers who want to stay grounded in evidence, communicate clearly with families, and confidently advocate for childhood immunizations in a shifting policy environment.

Website: www.thepedsnp.come

Contact: [email protected]

Instagram: @thepedsnppodcast 

AACN Essentials Mapping (Domain. sub-competency): 

1.1, 1.3 

2.5 

3.3, 3.5

4.2

6.1

9.1 

References: 

Abers, M. S., Ulrich, A. K., & Walensky, R. P. (2026). Universal Hepatitis B Vaccination at Birth-Risks of Revising the Recommendation. JAMA, 335(7), 569–570. https://doi.org/10.1001/jama.2025.24996

American Academy of Pediatrics. (2026, January 26). AAP’s 2026 immunization schedule keeps routine recommendations intact after overhaul of federal schedule. AAP News. https://publications.aap.org/aapnews/news/34141/

American Academy of Pediatrics. (2026). What is the difference between the AAP immunization recommendations and other vaccine schedules? HealthyChildren.org. https://www.healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/what-is-the-difference-between-the-AAP-recommended-immunization-schedule-and-other-vaccine-schedules.aspx

American Public Health Association. (2026, March 16). Federal Judge Blocks Immunization Schedule Changes, Stays ACIP Member Appointments. APHA News Releases. https://www.apha.org/news-and-media/news-releases/apha-news-releases/federal-judge-blocks-immunization-schedule-changes#:~:text=A%20coalition%20of%20leading%20medical,the%20December%202025%20ACIP%20meeting.

Arthur, E. (2025). AAP has been leading voice on childhood vaccine recommendations since 1930s. AAP News. Retrieved from https://publications.aap.org/aapnews/news/32762/AAP-has-been-leading-voice-on-childhood-vaccine?searchresult=1

Association of Immunization Managers. (2026, February 13). What to know about one-dose HPV vaccination. Childhood Immunization. https://www.immunizationmanagers.org/what-to-know-about-one-dose-hpv-vaccination/

Cacho, F., Gebretsadik, T., Anderson, L. J., Chappell, J. D., Rosas-Salazar, C., Ortiz, J. R....Hartert, T. (2024). Respiratory Syncytial Virus Prevalence and Risk Factors among Healthy Term Infants, United States. Emerging Infectious Diseases, 30(10), 2199-2202. https://doi.org/10.3201/eid3010.240609.

Centers for Disease Control and Prevention. (2025). Healthcare Professionals: Immunization Schedules. Vaccines and Immunizations. https://www.cdc.gov/vaccines/hcp/imz-schedules/index.html

Department of Health and Human Services. (2026). Fact Sheet: CDC Childhood Immunization Recommendations. Press Room. https://www.hhs.gov/press-room/fact-sheet-cdc-childhood-immunization-recommendations.html

Kates  J, Bell  C, Michaud  J, Williams  E, Tolbert  J. Tracking state actions on vaccine policy and access. KFF. September 24, 2025. Accessed December 28, 2025. https://www.kff.org/covid-19/tracking-state-actions-on-vaccine-policy-and-access/#:~:text=Thirteen%20states%20have%20moved%20to,recommendations%20apply%20to%20all%20vaccines

Mello, M. M., Walensky, R. P., Osterholm, M. T., & Brennan, T. A. (2026, January 13). Navigating conflicting vaccination recommendations: Guidance for clinicians. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2844090

Montori, V. M., Ruissen, M. M., Hargraves, I. G., Brito, J. P., & Kunneman, M. (2023). Shared decision-making as a method of care. BMJ evidence-based medicine, 28(4), 213–217. https://doi.org/10.1136/bmjebm-2022-112068 

O'Leary, S. T., Opel, D. J., Cataldi, J. R., Hackell, J. M., COMMITTEE ON INFECTIOUS DISEASES , COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE , & COMMITTEE ON BIOETHICS (2024). Strategies for Improving Vaccine Communication and Uptake. Pediatrics, 153(3), e2023065483. https://doi.org/10.1542/peds.2023-065483

Payne AB, Battan-Wraith S, Rowley EAK, et al. Effectiveness of nirsevimab among infants in their first RSV season in the United States, October 2023-March 2024: a test-negative design analysis. Lancet Reg Health Am. 2025;49:101196. Published 2025 Aug 6. doi:10.1016/j.lana.2025.101196

Radcliffe, C. R., Akkawi, G., & Carson, R. A. (2025). Practical Application of Nirsevimab Recommendations for Infants and Toddlers. Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners, 39(4), 638–645. https://doi.org/10.1016/j.pedhc.2024.11.005

Schering, S. (2026). 12 medical groups representing 1 million health care professionals endorse AAP immunization schedule. AAP News. https://publications.aap.org/aapnews/news/34259/12-medical-groups-representing-1-million-health

U.S. Department of Health and Human Services. (2026). Fact Sheet: CDC Childhood Immunization Recommendations. Press Room. https://www.hhs.gov/press-room/fact-sheet-cdc-childhood-immunization-recommendations.html

Welcome to our vaccine-focused mini-series, "Immunizations Updates"! Today we will use data from the United States' measles resurgence following the 2025 outbreak to explore what every pediatric provider needs to know as cases continue to climb. We walk through how measles slipped toward losing its elimination status, how today’s clinicians can rapidly rebuild their diagnostic instincts, and what early symptoms are most likely to be missed. We also break down high‑risk groups, key clinical clues, key references, practice tips, and highlights from Lyles & Carson’s recent 2026 reference for prevention and post-exposure prophylaxis for children with inflammatory bowel disease. Along the way, we’ll discuss practical strategies for vaccine advocacy, documentation, differential diagnosis, and post‑exposure management, giving you the tools to protect vulnerable kids and strengthen vaccine confidence in their communities.

Website: www.thepedsnp.come

Contact: [email protected]

Instagram: @thepedsnppodcast

AACN Essentials Mapping (Domain. sub-competency):

1.1f, 1.2g, 1.2h, 1.2i, 1.3d,

2.1d, 2.2j, 2.4g

3.1m, 3.2e, 3.3c, 3.3e, 3.3f, 3.5f, 3.5g, 3.6g

4.1i, 4.2f, 4.2k, 4.3e

9.1i, 9.2i, 9.3i

10.1c, 10.2g, 102i, 10.3l, 10.3o 

References:

American Academy of Pediatrics [AAP]. (2026). Measles Infection Prevention and Control Frequently Asked Questions. Patient Care. https://www.aap.org/en/patient-care/measles/measles-frequently-asked-questions/#:~:text=Because%20measles%20in%20HCP%20has,of%20serologic%20immunity%20is%20demonstrated.

Centers for Disease Control and Prevention [CDC]. (2026, February 20). Measles cases and outbreaks. Retrieved from https://www.cdc.gov/measles/data-research/index.html

Do, L. A. H., & Mulholland, K. (2025). Measles 2025. The New England Journal of Medicine, 392(25), 1–12. https://doi.org/10.1056/NEJMra2504516

Kiang, M. V., Bubar, K. M., Maldonado, Y., Hotez, P. J., & Lo, N. C. (2025). Modeling reemergence of vaccine-eliminated infectious diseases under declining vaccination in the US. JAMA. https://doi.org/10.1001/jama.2025.70336

Imdad, A., Mayo-Wilson, E., Haykal, M. R., Regan, A., Sidhu, J., Smith, A., & Bhutta, Z. A. (2022). Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. The Cochrane database of systematic reviews, 3(3), CD008524. https://doi.org/10.1002/14651858.CD008524.pub4

Lyles, J. L., & Carson, R. A. (2026). Prevention and post-exposure prophylaxis for measles in children with inflammatory bowel disease. Journal of pediatric gastroenterology and nutrition, 10.1002/jpn3.70336. Advance online publication. https://doi.org/10.1002/jpn3.70336

National Institutes of Health. (2025). Vitamin A and carotenoids. Health Information. https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/

Rhodesia, R.E. (2025). Public health wake-up call: Will the US lose measles elimination status? News. Contagion Live. https://www.contagionlive.com/view/public-health-wake-up-call-will-the-us-lose-measles-elimination-status-

Sheikh, I.N., Kamdar, K.Y., & Ardura, M.I. (2023). Ensure proper immunization for patients who received chemotherapy or transplantation. AAP News. https://publications.aap.org/aapnews/news/23569/Ensure-proper-immunization-for-patients-who?autologincheck=redirected

World Health Organization [WHO]. (2024). Provisional measles and rubella data. Retrieved from https://immunizationdata.who.int/global?topic=Provisional-measles-and-rubella-data

WHO. (2025). Measles. https://www.who.int/news-room/fact-sheets/detail/measles

Welcome to the Choosing Wisely Campaign series! This is the fifth and final episode of our 5-part series exploring the ABIM Foundation’s Choosing Wisely Lists. This campaign aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures.

Our last case-based episode focuses on a school-aged male presenting with new-onset enuresis. After a discussion of the differential diagnosis and evidence-based evaluation strategies, we apply recommendations from multiple AAP Choosing Wisely lists to create a care plan that is safe, resource-conscious, and child-centered.

Throughout this episode, we’ll highlight how ethical care principles—beneficence, nonmaleficence, autonomy, and justice—guide high-value decision-making and help us avoid unnecessary imaging, laboratory studies, and interventions that add cost without improving outcomes. This familiar case in pediatrics is worthy of a rewind to relisten to a throwback episode that will reinforce your skills and emphasize the clinical diagnosis and management without added diagnostics, referrals, or medications. 

This case closes out our series on Choosing Wisely in Pediatrics, but the principles we’ve explored should continue to inform your practice every day. If you missed earlier episodes, rewind to learn more about the campaign’s background and listen to cases on fever and cough, gastroenterology presentations, and more.

Series Learning Objectives:

Modified rMETRIQ Score: 15/15 What does this mean?

Competencies:

AACN Essentials:

NONPF NP Core Competencies:

References:

AAP Section on Emergency Medicine & Canadian Association of Emergency Physicians. (2022). Five things physicians and patients should question. Retrieved from https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWEmergencyMedicine.pdf

AAP Section on Gastroenterology, Hepatology, and Nutrition. (2023). Five things physicians and patients should question. https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWGastroenterology.pdf

AAP Section on Urology. (2022). Five things physicians and patients should question. Retrieved from https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWUrology.pdf

Daniel, M., Szymanik-Grzelak, H., Sierdziński, J., Podsiadły, E., Kowalewska-Młot, M., & Pańczyk-Tomaszewska, M. (2023). Epidemiology and Risk Factors of UTIs in Children-A Single-Center Observation. Journal of personalized medicine, 13(1), 138. https://doi.org/10.3390/jpm13010138

McMullen, P.C., Zangaro, G., Selzer, C., Williams, H. (2026). Nurse Practitioner Claims and the National Practitioner Data Bank: Trends, Analysis, and Implications for Nurse Practitioner Education and Practice. Journal for Nurse Practitioners, 22(1), p. 105569, https://doi-org.proxy.lib.duke.edu/10.1016/j.nurpra.2025.105569

Tabbers, M. M., DiLorenzo, C., Berger, M. Y., Faure, C., Langendam, M. W., Nurko, S., Staiano, A., Vandenplas, Y., Benninga, M. A., European Society for Pediatric Gastroenterology, Hepatology, and Nutrition, & North American Society for Pediatric Gastroenterology (2014). Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. Journal of pediatric gastroenterology and nutrition, 58(2), 258–274. https://doi.org/10.1097/MPG.0000000000000266

UCSF Benioff Children's Hospitals. (n.d.). Constipation & urologic problems. https://www.ucsfbenioffchildrens.org/conditions/constipation-and-urologic-problems

Vaughan, D. (2015). The Challenger Launch Decision: Risky Technology, Deviance, and Culture at NASA. University of Chicago Press. DOI: 10.7208/chicago/9780226346960.001.0001

Wilbanks, Bryan A. PhD, DNP, CRNA. Evaluation of Methods to Measure Production Pressure: A Literature Review. Journal of Nursing Care Quality 35(2):p E14-E19, April/June 2020. | DOI: 10.1097/NCQ.0000000000000411

Welcome to the Choosing Wisely Campaign series! This is the fourth episode of a 5-part series exploring the ABIM Foundation’s Choosing Wisely Lists. This campaign aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures.

Our third case-based episode presents a child with fever and cough. After a clear discussion of the case and thoughtful consideration of the etiology and treatment strategies, we use the AAP’s Choosing Wisely Hospital Medicine and Infectious Diseases lists to create a resource-conscious care plan that is safe and patient-centered.

In the coming episodes, we’ll explore the pediatric lists and apply our knowledge to cases of common presentations seen in primary and acute care pediatrics. 

Series Learning Objectives:

Modified rMETRIQ Score: 14/15

Competencies:

AACN Essentials:

NONPF NP Core Competencies:

References

ABIM Foundation. (2019). Communicating about overuse with vulnerable populations. Retrieved from https://www.choosingwisely.org/files/Communicating-About-Overuse-to-Vulnerable-Population_Final2.pdf

American Academy of Pediatrics [AAP] Committee on Infectious Diseases & Pediatric Infectious Diseases Society. (2018). Five things physicians and patients should question. Retrieved from https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWInfectiousDisease.pdf

de Benedictis, F. M., Kerem, E., Chang, A. B., Colin, A. A., Zar, H. J., & Bush, A. (2020). Complicated pneumonia in children. Lancet (London, England), 396(10253), 786–798. https://doi.org/10.1016/S0140-6736(20)31550-6

Kato, H. (2024) Antibiotic therapy for bacterial pneumonia. J Pharm Health Care Sci 10, 45. https://doi.org/10.1186/s40780-024-00367-5

Schlapbach, L. J., Watson, R. S., Sorce, L. R., Argent, A. C., Menon, K., Hall, M. W., Akech, S., Albers, D. J., Alpern, E. R., Balamuth, F., Bembea, M., Biban, P., Carrol, E. D., Chiotos, K., Chisti, M. J., DeWitt, P. E., Evans, I., Flauzino de Oliveira, C., Horvat, C. M., Inwald, D., … Society of Critical Care Medicine Pediatric Sepsis Definition Task Force (2024). International Consensus Criteria for Pediatric Sepsis and Septic Shock. JAMA, 331(8), 665–674. https://doi.org/10.1001/jama.2024.0179

Smith, D. K., Kuckel, D. P., & Recidoro, A. M. (2021). Community-Acquired Pneumonia in Children: Rapid Evidence Review. American family physician, 104(6), 618–625.

Society of Hospital Medicine, AAP, & Academic Pediatric Association. (2021). Five things physicians and patients should question. Retrieved from https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWHospitalmedicine.pdf

Yun K. W. (2024). Community-acquired pneumonia in children: updated perspectives on its etiology, diagnosis, and treatment. Clinical and experimental pediatrics, 67(2), 80–89. https://doi.org/10.3345/cep.2022.01452

Welcome to the Choosing Wisely Campaign series! This is the third episode of a 5-part series exploring the ABIM Foundation’s Choosing Wisely Lists. This campaign aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures.

Our second case-based episode presents an infant with diarrhea and diaper dermatitis. After a clear discussion of the case and thoughtful consideration of the etiology and treatment strategies, we use the AAP’s Choosing Wisely dermatology and gastroenterology, hepatology, and nutrition lists to create a resource-conscious care plan that is safe and patient-centered.

In the coming episodes, we’ll explore the pediatric lists and apply our knowledge to cases of common presentations seen in primary and acute care pediatrics. 

Series Learning Objectives:

Modified rMETRIQ Score: 15/15

Competencies:

AACN Essentials:

NONPF NP Core Competencies:

References

ABIM Foundation. (2019). Communicating about overuse with vulnerable populations. Retrieved from https://www.choosingwisely.org/files/Communicating-About-Overuse-to-Vulnerable-Population_Final2.pdf

AAP Section on Dermatology. (2021). Five things physicians and patients should question. https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWDermatology.pdf

AAP Section on Gastroenterology, Hepatology, and Nutrition. (2023). Five things physicians and patients should question. https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWGastroenterology.pdf

Harriet Lane Service (Johns Hopkins Hospital), Anderson, C. C., Kapoor, S., & Mark, T. E. (2024). The Harriet Lane handbook: a manual for pediatric house officers (23rd ed.). Elsevier. 

Jauregui, J., Nelson, D., Choo, E., Stearns, B., Levine, A. C., Liebmann, O., & Shah, S. P. (2014). External validation and comparison of three pediatric clinical dehydration scales. PloS one, 9(5), e95739. https://doi.org/10.1371/journal.pone.0095739

Johnson, H., & Yu, J. (2022). Current and Emerging Therapies in Pediatric Atopic Dermatitis. Dermatology and therapy, 12(12), 2691–2703. https://doi.org/10.1007/s13555-022-00829-4

Semon, A. K., Keenan, O., & Zackular, J. P. (2021). Clostridioides difficile and the Microbiota Early in Life. Journal of the Pediatric Infectious Diseases Society, 10(Supplement_3), S3–S7. https://doi.org/10.1093/jpids/piab063

Welcome to the Choosing Wisely Campaign series! This is the second episode of a 5-part series exploring the ABIM Foundation’s Choosing Wisely Lists. This campaign aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures.

The first of our case-based episodes presents a school age child with syncope. After a clear discussion of the case and thoughtful consideration of an acute care differential, we use the AAP’s Choosing Wisely cardiac list to create a resource-conscious care plan that is safe and patient-centered.

In the coming episodes, we’ll explore the pediatric lists and apply our knowledge to cases of common presentations seen in primary and acute care pediatrics. 

Series Learning Objectives:

Competencies:

AACN Essentials:

NONPF NP Core Competencies:

References:

AAP Section on Cardiology and Cardiac Surgery. (2020). Five things physicians and patients should question. https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWCardio.pdf

Gilpin, K., & Goode, Z. (2024). Syncope. Pediatrics in review, 45(10), 606–608. https://doi.org/10.1542/pir.2023-006053

Welcome to the Choosing Wisely Campaign series! This 5-part series will explore the ABIM Foundation’s Choosing Wisely Campaign, its historical precedent, and its goals. We will discuss how this initiative aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures.

The introduction episode dives into the historic 2010 editorial in the New England Journal of Medicine that inspired over 80 professional societies to write their “Top 5 Lists” of tests and procedures that could be avoided in evidence-based care. To better understand the problem, we then pick apart the survey that provided insight into why we over order and the harm it causes to vulnerable populations. 

In the coming episodes, we’ll explore the pediatric lists and apply our knowledge to cases of common presentations seen in primary and acute care pediatrics. 

Author: Becky Carson, DNP, APRN, CPNP-PC/AC

www.thepedsnp.com

Instagram: @thepedsnppodcast

Series Learning Objectives:

Competencies:

AACN Essentials:

NONPF NP Core Competencies:

Modified rMETRIQ Score: 15/15

Learn more about our peer review process at www.thepedsnp.com/peerreview

References:

ABIM Foundation. (2019). Communicating about overuse with vulnerable populations. Retrieved from https://www.choosingwisely.org/files/Communicating-About-Overuse-to-Vulnerable-Population_Final2.pdf

Brody, H. (2010). Medicine's ethical responsibility for health care reform--the Top Five list. The New England journal of medicine, 362(4), 283–285. https://doi.org/10.1056/NEJMp0911423

Lipitz-Snyderman, A., & Bach, P. B. (2013). Overuse of health care services: when less is more … more or less. JAMA internal medicine, 173(14), 1277–1278. https://doi.org/10.1001/jamainternmed.2013.6181

PerryUndem Research/Communication. (2014). Unnecessary tests and procedures in the health care system. Retrieved from https://www.choosingwisely.org/files/Final-Choosing-Wisely-Survey-Report.pdf

Smith-Bindman, R., Chu, P. W., Azman Firdaus, H., Stewart, C., Malekhedayat, M., Alber, S., Bolch, W. E., Mahendra, M., Berrington de González, A., & Miglioretti, D. L. (2025). Projected Lifetime Cancer Risks From Current Computed Tomography Imaging. JAMA internal medicine, e250505. Advance online publication. https://doi.org/10.1001/jamainternmed.2025.0505

Wyman, O. (2019). Right Place, Right Time: Health Information & Vulnerable Populations. https://www.oliverwyman.com/RightPlaceRightTime.html

This is the final episode of The Peds NP Acute Care PNP Faculty series. The series was created and peer-reviewed by national leaders in acute care PNP education in collaboration to meet the needs of our current and future colleagues. In the push for competency-based education where faculty verify the skills of what a student can do, rather than their knowledge, our series focuses on the application of didactic content with a practical approach so that you can learn nuances of clinical skills before you reach the bedside. 

As I come to an end of my time as a faculty member at the Catholic University of America and our Acute Care PNP Faculty series, I remember my graduation from Johns Hopkins. These terminal moments are likened to a graduation, and serve as a wonderful time for reflection. The episode recollects the student speaker commencement address given at my graduation, filled with vehicular metaphors and acknowledgements of failure. A common theme of “Onward” is woven throughout to remind listeners that, at whatever graduation you find yourself celebrating right now, be hopeful and excited at the good that is left to do in the world. 

The Peds NP will return in 2025 from Duke University…

Author: Becky Carson, DNP, APRN, CPNP-PC/AC

Peer Review:

This episode was peer reviewed using a modified revised METRIQ (rMETRIQ) Score. Learn more about The Peds NP's formal peer review process at www.thepedsnp.com/peerreview

rMETRIQ Score: 12/15

What does this score mean? This episode underwent a formal quality assurance and peer review process. It received a lower score because of the editorial nature of the content that could not achieve the highest score for question 1 and 4 criteria. There is sufficient background to situate the listener, but there are no referrals to other valuable sites. References are sited, but they do not correspond to specific statements.

Financial disclosures/conflicts of interest: None

Connect with The Peds NP

email: [email protected]

Instagram: @thepedsnppodcast

References:

Carson, R.A. (2024). Student speaker commencement address [Speech transcript]. Johns Hopkins School of Nursing Commencement. https://alumni.jhu.edu/commencement-2016(Original work published 2016).