Parents' Vaccine Acceptance Continues to Rise, Clinicians Say

Marcia Frellick

July 27, 2016

The percentage of clinicians who see a rise in the numbers of families willing to get their children vaccinated increased again in the Medscape Vaccine Acceptance Report 2016 , published today.

Last year, when healthcare professionals were asked about vaccine acceptance over the past year in a similar Medscape survey, 42% said that overall vaccine acceptance had increased. This year, 46% believed the same. At the same time, 12% of clinicians reported that they saw less acceptance of vaccines this year.

That greater acceptance may be encouraging because in the last survey experts wondered whether the increased level of acceptance was a temporary reaction to the measles outbreak that originated in California. That survey noted that in the first 7 months of 2015, measles was reported in 173 US residents from 24 states and the District of Columbia.

"Overall, vaccine acceptance appears at least to be steady, and trending in the right direction," the new survey reports.

Hesitancy, Refusal Remain Significant

Still, more than 1 in 3 clinicians reported they see no change in willingness of parents to accept vaccines. Vaccine hesitancy remains significant, and refusal has been linked with outbreaks of invasive Haemophilus influenzae type b disease, chicken pox, pneumococcal disease, measles, and pertussis, the report notes.

"Despite changes in policy, the availability of information, and significantly greater awareness about the risks associated with vaccine refusal, the modest increase in acceptance we saw this year suggests that work still needs to be done to improve vaccination acceptance," Hansa Bhargava, MD, pediatric editor for Medscape and WebMD, said in a statement.

In the 2016 survey, 1551 physicians, nurse practitioners, and physician assistants in pediatrics, family medicine, and public health responded. Only clinicians who worked in a practice where vaccines were administered to youth younger than 18 years old were included.

The top reason for perceived rise in acceptance, given by 72% of clinicians, was a general increase in concern about infectious diseases. Next, at 53%, was that acceptance was fueled by parents' fear of their children acquiring a vaccine-preventable disease, such as pertussis or measles.

Parents' concerns that unvaccinated children would be kept out of school, camp, or daycare were cited by 44% of respondents — a significantly higher proportion than last year, when 33% believed school requirements were a key motivator.

A factor that recently came into play is California's law, passed last year and effective July 1, 2016, that eliminates philosophical/personal belief and religious exemptions to school-mandated vaccines.

The authors note that parents of children who have not had the 10 vaccines schools require (diphtheria, H influenzae type b, measles, mumps, pertussis, polio, rubella, tetanus, hepatitis B, and chicken pox) may have been scrambling to get them before school resumes.

HPV Tops Refused Vaccines

The three vaccines most often refused or requested on an alternative schedule were for human papillomavirus (HPV) (61%), influenza (39%), and measles-mumps-rubella (MMR) (37%).

Slow uptake of the HPV vaccine is consistent with reports nationwide that only 40% of girls and 21% of boys are receiving the recommended three doses. The vaccine is recommended for girls and boys beginning at age 11 or 12 years.

The top reason for perceived lack of HPV vaccine acceptance, cited by 71% of clinicians, is that parents don't believe their child is at risk for a sexually transmitted infection.

Providers play a key role here as the report revealed that despite evidence-based information about benefits, 7% of clinicians indicated that they are ambivalent about the vaccine and don't promote it as strongly as other vaccines.

The report authors note that elimination of the nasal spray option for the influenza vaccine this year could further impede vaccination rates for children.

Last year, respondents identified the MMR vaccine (52%) as most often refused or given on an alternate schedule, compared with 37% for MMR this year. This finding suggests that uptake of the MMR vaccine has indeed increased since the 2015 measles outbreak.

The number 1 perceived reason for less acceptance of vaccines was fear of a connection between vaccines and autism spectrum disorder, a connection disproven in several studies.

Next were parents' fear of ingredients added to vaccines, reported by 71% of clinicians, or fear of other effects on children from the vaccines, reported by 70%.

1 in 10 Dismiss Refusing Families

As to whether clinicians would dismiss families that refused required vaccinations, 90% said they would not and 10% said they would. Dismissing patients is not recommended by the American Academy of Pediatrics.

But accepting them comes with risk to all. Most respondents (82%) who do not dismiss refusing families also make no modification to the clinic or its procedures to protect other children from vaccine-preventable diseases.

Those who do make accommodations said they try to schedule those patients at the end of the day, require them to enter through a separate entrance, wear a mask, or skip the waiting room and go directly to an exam room.

The survey was conducted from May 8 to May 31, 2016. The margin of error was ± 2.49% at a 95% confidence level.

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