Vaccination Usage Among the Amish

To the Editors:

I read with interest the article by Yoder and Dworkin on vaccine usage among an old-order Amish community in Illinois.¹ In the past year, I have cared for 2 unvaccinated Amish children with Haemophilus influenzae type b meningitis, one of whom died. My experience with these and other Amish families is consistent with the findings of Yoder and Dworkin. Most Amish parents readily accept vaccination for their children when the issue is discussed with compassion and respect. A common reason for abstaining from vaccination in the Amish community is the avoidance of any type of insurance, and the concomitant view that immunizations represent a form of insurance against future harm. Since learning this, I try to explain that immunizations are best thought of as prevention against imminent danger; they are more like scooping your child out of the way of a cart that is careening toward him than they are like purchasing an insurance policy.

The Amish people with whom I have had the privilege to serve are generally bright and rational. They want to keep their children out of harm's way just as much as any other parent. I applaud Yoder and Dworkin for bringing to light an important issue: namely, that undervaccination among the Amish is an important, and often correctable, problem.

Thomas G. Boyce, MD, MPH

Department of Pediatric and Adolescent Medicine

Division of Infectious Diseases and Immunology

Mayo Clinic College of Medicine

Rochester, MN

[email protected]