Most members follow Academy lead on pertussis, polio vaccines

Most pediatricians are following the AAP recommendation for use of acellular pertussis vaccine and the inactivated poliovirus vaccine (IPV), according to a recent Periodic Survey of Fellows. The survey, conducted in mid-1998, assessed the adoption of two 1997 AAP recommendations: (1) giving preference to the safer acellular pertussis formulation to replace the whole-cell vaccine and (2) offering the option of choosing an IPV-only, OPV-only, or sequential IPV/OPV immunization schedule (subsequently, in December 1998, the Academy recommended the sequential IPV/OPV immunization schedule).

Use of acellular pertussis

Eight out of 10 pediatricians report they usually recommend the all-acellular pertussis vaccine for infants in their practice. Ten percent of pediatricians recommend the combined DTP and Hib, 7 percent recommend the DTP at 2, 4 and 6 months, and DTaP at 12 to 15 months and 4 to 6 years. Three percent either do not recommend a specific schedule or recommend some other schedule. There were no variations in pediatricians' adoption of the new form of the pertussis vaccine by measured practice characteristics.

When deciding what pertussis vaccine to use, respondents give primary consideration to the risk to the patient of adverse reactions (79 percent say this is a very important issue) and 52 percent say agency or organization recommendation is a strong influence in their decision. Forty-one percent of pediatricians give primary consideration to parents' opinion about what vaccine to use.

Use of IPV/OPV

Seven out of 10 pediatricians report they usually recommend the sequential IPV/OPV vaccine for infants in their practice. Sixteen percent of pediatricians recommend the all-OPV and 5 percent recommend the all-IPV schedule. Nine percent do not recommend a specific schedule.

Physicians who participate in bulk purchase programs are more likely to recommend IPV-containing schedules than those who do not participate (76 percent vs. 66 percent, p<.05). Pediatricians' adoption of IPV also varies by gender and region of the country. Male pediatricians are less likely to recommend IPV (71 percent vs. 80 percent, p<.01) and pediatricians in the Midwest (66 percent) are less likely than those in the Northeast (76 percent), South (80 percent) and West (75 percent) to recommend an IPV schedule (p<.05).

When deciding what polio vaccine to use, about six out of 10 pediatricians give primary consideration to patient risk of vaccine-associated paralytic polio (VAPP) (62 percent) and parents' opinion about which vaccine (60 percent). Nearly half (48 percent) say agency or organization recommendation is a strong influence in their decision.

Most pediatricians (72 percent) report "almost always" discussing the alternate polio vaccine schedules with parents in addition to providing them with vaccine information materials before immunizing their child. A large majority of pediatricians (80 percent) say parents "often" expect the doctor or nurse to guide them to a decision regarding the appropriate polio vaccine schedule, and 66 percent say parents "often" expect the doctor to make the decision for them.

AAP Periodic Survey #39 was conducted from May to September 1998. Surveys were mailed to 1,626 active AAP members in the United States, with a response rate of 76 percent. Responses are based on the 720 post-residency Fellows who provide primary care including immunizations.

Table: Portion of pediatricians reporting issue is "very important" in the decision
regarding which vaccine to use

COMMENTARY

Academy weighs latest data on vaccine recommendations

by Georges Peter, M.D., FAAP

The results of AAP Periodic Survey #39 indicate that most pediatricians follow AAP recommendations for immunization of their patients against pertussis and poliomyelitis. In mid-1998, at the time of this survey, the Academy was recommending expanded use of IPV with the option of one of the three acceptable schedules. Subsequently in December 1998, the Academy revised its guidelines and recommended that IPV should be given for the first two doses followed by either OPV, i.e., the sequential schedule, or IPV-only for the third and fourth doses of the schedule.

According to these survey results, widespread acceptance of the sequential schedule occurred within less than two years of the 1997 changes in AAP and ACIP recommendations.

To eliminate vaccine-associated paralytic polio (VAPP), last June the ACIP recommended the all-IPV schedule beginning Jan. 1, 2000. The Committee on Infectious Diseases (COID) currently is considering a change in AAP recommendations for 2000. The Academy supports the goals of elimination of VAPP and global eradication of poliomyelitis, and recognizes that the supply of OPV likely will be considerably reduced in the near future. The federal VFC contract for OPV expires in December and, as a result of the recent ACIP recommendations, will not be renewed.

Additional information from periodic Survey #39, to be published in November AAP News, and survey results published in the August Pediatrics Electronic Pages indicate that many pediatricians participate in VFC. The COID is reviewing guidelines for pediatricians for the use of the remaining supplies of OPV during the transition to an IPV-only schedule.

Dr. Peter is editor of the 1997 Red Book: Report of the Committee on Infectious Diseases.