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Article |

Giving Pediatric Immunizations the Priority They Deserve

Raymond J. Mikelionis, MD
JAMA. 1993;270(10):1199-1200. doi:10.1001/jama.1993.03510100049029.
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To the Editor.  —The exhaustive(ing) five-page "Standards for Pediatric Immunization Practices"1 promoting safer and more universal immunizations presents 18 standards without even bothering to take a temperature. Specifically, standard 2: "[T]emperature measurements prior to immunization should not be required if they delay or impede the timely receipt of immunizations." Shouldn't immunizations be safe as well as timely? This also seems at odds with standard 2 (Table 2): "True Contraindications and Precautions: Moderate or severe illnesses with or without a fever." Temperature taking is the safest, easiest, most cost-effective evaluator of an illness. The standards appear to be unwilling to draw a cautionary temperature line by ignoring it altogether.Furthermore, while the 18 standards are arm-long on "provider-dos," they make no mention of provider protection from lawsuits. A percentage of immunizations, however small, will produce significant side effects, which are (typically) blamed on physicians. Going over the list of the


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