Number of Vaccine Refusals Growing, Survey Finds

Diana Swift

August 30, 2016

The proportion of pediatricians reporting parental vaccine refusals rose significantly between 2006 and 2013, according to a fellows survey from the American Academy of Pediatrics (AAP).

The survey report, published online August 29 and scheduled to appear in the September issue of Pediatrics, examines two AAP periodic surveys of its membership: one from 2006 with 629 respondents, and the other from 2013 with 627 respondents.

In 2013, 87.0% of pediatricians said they had experienced parental vaccine refusals in the previous 12 months compared with 74.5% in 2006 (P < .001).

In addition, pediatricians estimated the percentage of parents in their practices who refused one vaccine rose from an average of 4.5% in 2006 to 8.6% in 2013 (P < .001). For parents refusing more than one vaccine, the figure climbed from 2.5% to 4.8% (P < .001), and for all vaccines, it rose from 2.1% to 3.3% (P = .07).

In contrast, the "Medscape Vaccine Acceptance Report 2016," based on a May 2016 survey of 1551 pediatricians and other healthcare professionals who treat patients younger than 18 years, noted a more positive trend: 46% of respondents believed vaccine acceptance had increased more than a year ago compared with 42% who thought it had decreased. Almost three quarters (72%) of participants attributed the change to greater general concern about infectious diseases, whereas 44% cited fears of denied access to schools, day cares, and camps.

In the current AAP study, the perception among respondents was that parents who refuse vaccines increasingly consider immunizations unnecessary: 63.4% in 2006 vs 73.1% in 2013 (P = .002). In addition, pediatricians reported that providing vaccine education persuaded only about a third of vaccine refusers to change their minds.

Lead author Catherine Hough-Telford, MD, was struck by the shift in the reasons for vaccine refusal between the 2006 AAP survey and the 2013 version. "In 2006, concern about autism and thimerosal was the most frequent reason, while in 2013, more pediatricians said parents thought vaccination was unnecessary," said Dr Hough-Telford, a pediatrician at Pediatric Health Alliance in Tampa, Florida, in comments to Medscape Medical News.

"Vaccines are a victim of their own success." Although misperceptions in the media and on the internet have played a role in vaccine hesitancy, she said, "another big part is that parents who are making decisions about vaccination have never seen what devastation vaccine-preventable diseases can do. They've never lived through a polio epidemic."

She also noted the high rate (about 95%) of pro-vaccine parent counseling reported by pediatricians in both survey years. "As pediatricians, we feel strongly about vaccination and see it as [a] very important part of the health of children and society."

In terms of postponing recommended immunization schedules, in the 2013 AAP survey, 75.0% (95% confidence interval [CI], 71.3% - 78.7%) of pediatricians said parents delay vaccines (a question not asked in 2006) because of the potential pain and discomfort of their children, resulting from receiving too many vaccines at a time, and 72.5% (95% CI, 68.6% - 76.3%) cited parental concerns about burdening young immune systems with too many vaccines. These reasons were followed by safety concerns other than autism, at 56.8%, and autism concerns, at 53.9%.

Overall, 87.6% of respondents reported receiving parental requests to delay at least one vaccine in the preceding 12 months, with 7.3% requesting the delay of one vaccine, 7.1% some vaccines, and 4.3% all vaccines.

"Future studies should focus on specific, unique approaches that address parents who refuse and those who delay separately," the authors write.

Although no statistically significant differences between geographic regions emerged, significant variations appeared by practice location, with inner-city pediatricians less likely than those in urban, suburban, or rural locations to encounter requests for delays.

Patient Dismissal?

Assessing physician attitudes, the 2006 poll found that 6.1% of pediatricians reported "always" dismissing patients from their practices for continued vaccine refusal, a percentage that almost doubled to 11.7% in 2013 (P = .004).

In the 2016 Medscape survey, 10% of healthcare professionals surveyed said they either dismissed or did not accept families whose children were not vaccinated on schedule.

Of pediatricians who had dismissed patients, 79.9% in the 2013 AAP survey and 87.4% in 2006 listed the reason as lack of trust between physician and patient. In 2013, 80.5% of pediatricians also listed concern for their other patients as a main reason for dismissing unvaccinated patients; the question was not asked in 2006.

On the issue of education for vaccine-refusing parents, 95.8% of respondents in 2006 said they provided education vs 94.0% in 2013 (P = .20). In 2006 and 2013, pediatricians reported that, on average, 31.9% and 34.4%, respectively, of those initially refusing vaccination changed their minds after education. An estimated average of 15.9 weeks elapsed between refusal and permission in 2013.

The authors emphasize "the importance of initiating conversations about vaccines with an understanding of the reasons for parents' concerns, as captured in our study, to best devise effective strategies to promote vaccinations in the refusing and delaying parent."

The survey was funded by the AAP and Centers for Disease Control Childhood Immunization Support Program cooperative agreement. The authors have disclosed no relevant financial relationships. The authors of the clinical report, which received no external funding, have disclosed no relevant financial relationships.

Pediatrics. Published online August 29, 2016. Abstract

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