PERIODIC SURVEY OF FELLOWS
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
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,
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
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.
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
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%).