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Vaccine Refusals and Requests for Alternate Vaccine Schedules (AVS): National Surveys of Pediatricians

Catherine Hough-Telford, MD1; David Kimberlin, MD1; Karen G. O'Connor2

1Dept of Pediatrics, University of Alabama at Birmingham; 2Dept of Reserach, American Academy of Pediatrics (AAP)

Background: Parental lack of compliance with the ACIP/AAP immunization schedule is an increasing public health concern.

Objective: To examine trends in pediatricians' experiences with vaccine refusals and assess current demand for AVS.

Design/Methods: National, random sample AAP Periodic Surveys addressing vaccine refusals were conducted in 2006 and 2013 [response=53% both years; n=629 (2006), n=627 (2013)]. In 2013 only, questions about AVS requests were included. The frequency, reasons for, and management of both vaccine refusals and AVS were examined by using bivariate and multivariable analyses, for which practice characteristics, demographics, and survey year were controlled.

Results: Refusals: The proportion of pediatricians reporting parental refusals for vaccines increased from 75% in 2006 to 87% in 2013 (aOR 3.07, p<.001); on average pediatricians estimated 14% of parents refused ≥ one vaccine (2013 data). In both 2006 and 2013 the primary reasons for refusal were parental belief that immunization is unnecessary (63% v 73%, p<.01) and concern about autism (74% v 65%, p<.01). Nearly all pediatricians in both survey years (96%, 94%) reported attempts at educating parents after refusal. The proportion of parents persuaded to give permission for a vaccine (32%, 34%) and who were dismissed for continually refusing permission (6%, 9%) were similar across study years. Alternative schedule: In 2013, most pediatricians (87%) report having parents request an AVS; they estimate 16% of parents asked for an AVS for at least one vaccine during the past year. Pediatricians in suburban (aOR 7.22, p<.01) and rural areas (aOR 13.68, p<.05) were more likely to report AVS requests. The most often named parental reasons were concern for child discomfort from too many shots at once (75%) and immune system burden of multiple shots (73%). Nearly all pediatricians (94%) discuss the importance of immunization with parents requesting an AVS.

Conclusions: Between 2006 and 2013, parental refusals for vaccines and belief that immunizations are unnecessary increased despite pediatrician efforts to educate parents on the importance of vaccines. The belief that immunizations cause autism decreased during this period. In 2013, pediatricians report 1 out of 6 parents requested some form of an AVS. Greater public awareness of the benefits of immunization is needed.