Alternative Vaccination Schedule Preferences Among Parents of Young Children

Dempsey, Amanda F.; Schaffer, Sarah; Singer, Dianne; Butchart, Amy T.; Davis, Matthew M.; Freed, Gary L.

doi:10.1542/peds.2011-0400

Cited by 202 publications

(159 citation statements)

References 26 publications

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“…The use of alternative immunization schedules has increased in recent years. 1,20 Our finding that underimmunization increased in children born between 2000 and 2011 in Northern California agrees with an earlier analysis in this and other populations that found underimmunization increased among children born between 2004 and 2008. 25 Our analysis goes beyond current studies in that we found that spatial scan statistics could be used to identify incipient clusters of shot limiting and refusal.…”

Section: Discussion Major Findingssupporting

confidence: 91%

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Geographic Clusters in Underimmunization and Vaccine Refusal

et al. 2015

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BACKGROUND AND OBJECTIVE: Parental refusal and delay of childhood vaccines has increased in recent years and is believed to cluster in some communities. Such clusters could pose public health risks and barriers to achieving immunization quality benchmarks. Our aims were to (1) describe geographic clusters of underimmunization and vaccine refusal, (2) compare clusters of underimmunization with different vaccines, and (3) evaluate whether vaccine refusal clusters may pose barriers to achieving high immunization rates. METHODS: We analyzed electronic health records among children born between 2000 and 2011 with membership in Kaiser Permanente Northern California. The study population included 154 424 children in 13 counties with continuous membership from birth to 36 months of age. We used spatial scan statistics to identify clusters of underimmunization (having missed 1 or more vaccines by 36 months of age) and vaccine refusal (based on International Classification of Diseases, Ninth Revision, Clinical Modification codes). RESULTS: We identified 5 statistically significant clusters of underimmunization among children who turned 36 months old during 2010–2012. The underimmunization rate within clusters ranged from 18% to 23%, and the rate outside them was 11%. Children in the most statistically significant cluster had 1.58 (P < .001) times the rate of underimmunization as others. Underimmunization with measles, mumps, rubella vaccine and varicella vaccines clustered in similar geographic areas. Vaccine refusal also clustered, with rates of 5.5% to 13.5% within clusters, compared with 2.6% outside them. CONCLUSIONS: Underimmunization and vaccine refusal cluster geographically. Spatial scan statistics may be a useful tool to identify locations with challenges to achieving high immunization rates, which deserve focused intervention.

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Section: Discussion Major Findingssupporting

confidence: 91%

“…1,2 Underimmunization has been associated with elevated risk of vaccine-preventable disease in individual patients. [3][4][5][6][7][8][9] Beyond individual risk, nonmedical immunization exemptions have been associated with increased community risk of measles and pertussis outbreaks.…”

Section: What This Study Addsmentioning

confidence: 99%

Geographic Clusters in Underimmunization and Vaccine Refusal

et al. 2015

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“…7 Some areas have even lower immunization rates owing to clustering of unvaccinated or under-vaccinated children. 8,9 Moreover, the prevalence of concerns about the vaccine, 10,11 requests for exemptions from vaccination requirements, 9 and use of alternative schedules 12,13 suggest reason for concern about future MMR vaccination rates. For instance, parents who follow alternative schedules are more likely to refuse or delay MMR, 13,14 which is associated with increased measles risk.…”

Section: Resultsmentioning

confidence: 99%

Effective Messages in Vaccine Promotion: A Randomized Trial

et al. 2014

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OBJECTIVES: To test the effectiveness of messages designed to reduce vaccine misperceptions and increase vaccination rates for measles-mumps-rubella (MMR). METHODS: A Web-based nationally representative 2-wave survey experiment was conducted with 1759 parents age 18 years and older residing in the United States who have children in their household age 17 years or younger (conducted June–July 2011). Parents were randomly assigned to receive 1 of 4 interventions: (1) information explaining the lack of evidence that MMR causes autism from the Centers for Disease Control and Prevention; (2) textual information about the dangers of the diseases prevented by MMR from the Vaccine Information Statement; (3) images of children who have diseases prevented by the MMR vaccine; (4) a dramatic narrative about an infant who almost died of measles from a Centers for Disease Control and Prevention fact sheet; or to a control group. RESULTS: None of the interventions increased parental intent to vaccinate a future child. Refuting claims of an MMR/autism link successfully reduced misperceptions that vaccines cause autism but nonetheless decreased intent to vaccinate among parents who had the least favorable vaccine attitudes. In addition, images of sick children increased expressed belief in a vaccine/autism link and a dramatic narrative about an infant in danger increased self-reported belief in serious vaccine side effects. CONCLUSIONS: Current public health communications about vaccines may not be effective. For some parents, they may actually increase misperceptions or reduce vaccination intention. Attempts to increase concerns about communicable diseases or correct false claims about vaccines may be especially likely to be counterproductive. More study of pro-vaccine messaging is needed.

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“…Second, prior studies estimate that overall 10%-25% of children were undervaccinated because of vaccine-hesitant parents. 13,16,17 Our study, however, was unable to provide reasons for undervaccination as this information was not captured in the NIIS or assessed through reviews of medical records. Third, pertussis is highly underreported.…”

Section: Discussionmentioning

confidence: 99%

Undervaccination with diphtheria, tetanus, and pertussis vaccine: National trends and association with pertussis risk in young children

Huang¹,

Lin²,

Yang³

2017

Human Vaccines & Immunotherapeutics

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Background: The high coverage for 3 pertussis vaccine doses among Taiwanese children might not imply timely vaccination. Recently, resurgence of pertussis and challenges with availability of DTaP-IPV-Hib prompted this study. Methods: In the 1996-2012 national birth cohort, we calculated the prevalence and days of undervaccination against pertussis by age 36 months. We also compared the odds of undervaccination in each laboratory-confirmed pertussis patient at ages 3-35 months with sex-, residence-, and age-matched controls from the general population, using conditional logistic regression. Results: The prevalence of undervaccination was 60.6% (median 16 days) and decreasing (p < 0.0001). Among 145 cases and 2,900 controls, 58 (40.0%) and 721 (24.9%) were undervaccinated (OR 2.28, 95% CI 1.57-3.31). The attributable risk percent was 22.5% (95% CI 14.5-27.9). Conclusions: Undervaccination was decreasing. Approximately up to one-fifth pertussis cases in children aged 3-35 months could have been prevented with on-time vaccination.

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Alternative Vaccination Schedule Preferences Among Parents of Young Children

Abstract: More than 1 of 10 parents of young children currently use an alternative vaccination schedule. In addition, a large proportion of parents currently following the recommended schedule seem to be "at risk" for switching to an alternative schedule.

Cited by 202 publications

References 26 publications

Geographic Clusters in Underimmunization and Vaccine Refusal

Geographic Clusters in Underimmunization and Vaccine Refusal

Effective Messages in Vaccine Promotion: A Randomized Trial

Undervaccination with diphtheria, tetanus, and pertussis vaccine: National trends and association with pertussis risk in young children

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