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Periodic Survey #45 Issues Surrounding Immunizations

Pediatricians' Use of Varicella Vaccine and Opinions on Universal Influenza Vaccine
American Academy of Pediatrics
Division of Health Policy Research


This report presents findings from Periodic Survey #45 on the use of the varicella vaccine and attitudes toward universal influenza immunization. The survey was initiated by the Committee on Infectious Disease (COID) to explore pediatricians' practices regarding the varicella vaccine and opinions regarding an annual influenza immunization for all children. The questions on the varicella vaccine replicate questions from PS#35, 1997, to enable us to track trends on this issue. Data on both these issues will be used in developing educational programs surrounding vaccine recommendations. The survey was conducted from February to June 2000; after six mailings a total of 1048 completed questionnaires were received for a response rate of 64.1%. These analyses are based on responses from 626 post-residency pediatricians who provide primary care.

Use of Varicella Vaccine, 2000 v 1997

In 2000, 9 out of 10 pediatricians offer varicella vaccine to all of their patients less than 14 years old. This represents a significant increase since 1997 in the proportion of pediatricians who offer this vaccine.

In 2000, 94% of pediatricians offer the varicella vaccine to all 12-18 month old patients compared to 69% in 1997 (p<.001) and 90% of pediatricians currently offer the vaccine to all patients 18 months to 13 years old compared to 64% in 1997 (p<.001).

In both survey years:

Pediatricians in group practices are more likely to offer varicella vaccine to all patients 12 to 18 months than are solo practitioners or those in hospital/clinic settings. (In 2000: 98% group v 86% solo v 89% hospital, p<.0001). (In 1997: 75% v 64% v 60%, p<.01).

Pediatricians with large numbers of Medicaid patients are less likely to offer the varicella vaccine than are those with fewer Medicaid patients. In 2000, 96% of pediatricians with <25% Medicaid patients and 95% of pediatricians with 25-50% Medicaid patients compared to 86% with >50% Medicaid patients offer the varicella vaccine to all patients (p<.0001); in 1997, 77%, 60%, and 53%, respectively, offer the varicella vaccine to all patients (p<.0001).

The primary reasons given in 1997 for not offering the vaccine to all patients under age 14 were ones of efficacy and necessity. However, the number of pediatricians who:

  • are concerned about the long term immunity of the vaccine (41% in 1997 v 21% in 2000, p<.01),

  • question the seriousness of the disease (31% in 1997 v 14% in 2000, p<.01), and

  • believe parents question the seriousness of the disease (40% in 1997 v 25% in 2000, p<05)

has decreased significantly in the past three years, although the latter reason remains one of the most frequently named in survey year 2000. Another frequently named reason for not offering the varicella vaccine in 2000 is the lack of a school or childcare requirement for the vaccine (24% of pediatricians reporting). This response option was not available in 1997.

Opinions on Universal Influenza Vaccine

Nearly all pediatricians (97%) currently offer an annual influenza vaccine to patients 6 months of age or older who are at high risk for complications of influenza (eg, those with asthma, congenital health disease, juvenile diabetes). Two-thirds of these pediatricians (67%) say they have no systematic method of identifying their high-risk patients; they identify them on a patient-by-patient basis.

Pediatricians are divided as to whether there should be a universal recommendation for annual influenza immunization among infants and children 6 months of age or older.

  • 30% of pediatricians think there should be a universal recommendation for annual influenza immunization, 43% disagree and 27% are unsure.

Pediatricians' opinions regarding universal immunization vary somewhat by practice characteristics.

A majority of pediatricians think the Academy should give very strong consideration to the following factors when deciding whether to recommend annual influenza vaccination of all children:

  • the risks for serious complications from influenza (64%);

  • the availability of an influenza vaccine that can be administered as a nasal spray (55%);

  • the concern about the safety of the vaccine (51%).

    If there were a recommendation for annual universal influenza vaccination, 73% of pediatricians prefer that school-aged patients receive the influenza vaccine at their office; 25% think children should receive the vaccine at school. However, pediatricians indicate a variety of acceptable sites for school-aged children to receive an influenza vaccine other than the pediatric office, eg, public health clinic (83%), schools (75%), teen clinic (62%), and pharmacy (20%).

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