Today’s health headlines include a study published in the journal, Pediatrics, regarding parental attitudes towards the vaccination schedule recommended by the American Academy of Pediatrics, the American Academy of Family Physicians, and the Centers for Disease Control. As you will hear in the media reports, the study found that 1 in 10 American parents surveyed (750 in the study) reject or delay at least one vaccine recommended in the standard vaccination schedule.
Wow. At first glance, I was really stunned at that number—since a vast majority of families in my own practice DO follow the recommended schedule. How could this statistic be true? And if it is true, it is a wake up call for all health providers to do a better job at educating our patients!
Then, I took a closer look at the study itself. Here are a few things that you won’t hear on cable news that shed a bit more light on the subject.
#1. This parental survey was done in May 2010, but is only now being published. A lot has happened since May 2010 in the vaccine world (besides Michele Bachmann). In the same month that this survey was being done, the British researcher who published the now-retracted 1998 MMR-autism study in the Lancet lost his medical license for questionable practices. With this story, national media sided with modern medicine instead of conspiracy theorists on vaccine safety. That trend has been fairly consistent since then, and I think, has led to fewer parental concerns. The Institute of Medicine has also poured over 1000 articles on vaccine safety and published a comprehensive report in August 2011 that should reassure families about the safety of vaccinations. We’ve also seen about 10,000 cases and 10 infant deaths from whooping cough in California, and at last count—198 cases of measles in the U.S.—more cases than we have seen in over 15 years. Bottom line: these diseases are real, and vaccine safety continues to be monitored and proven.
#2. The response rate of the survey was only 61%—which may represent skewed data. People who choose to vaccinate may have no interest in spending time answering questions about vaccine safety. People who choose to delay or skip vaccinations may want to share their position. It is hard to know what motivates people to participate in a survey, but it may influence the study results.
#3.The study asked which vaccines that the parents refused or delayed. The #1 response: H1N1 vaccine. This was the vaccine that 86% of parents who did refuse vaccines, refused. This is NOT a surprise to me at all. Although there was outright hysteria regarding the H1N1 outbreak and calls for a rapidly available vaccine to combat it, there was also quite a bit of public anxiety about taking a vaccine that had not been field tested prior to use. Most healthcare providers felt comfortable recommending this vaccine (and taking it ourselves—which I did!) because it was manufactured exactly the same way as the seasonal flu vaccine, with the H1N1 flu strain. But the public was not nearly as enthusiastic. H1N1 was a lesson learned when it comes to health education. However, I don’t think that using data on whether people refused H1N1 vaccine should be compiled in the same data as the routine childhood vaccination series.
#4. The #2 most refused vaccine: seasonal flu shot, at 76%. For similar reasons to H1N1, seasonal flu shot is really a separate category for vaccine refusal. Except for New Jersey, flu vaccine is not required for school entry. While the CDC and AAP recommend annual flu vaccine, it is never included in the national immunization survey done annually by the CDC. While flu shots should be routine, just as important as those required for school entry, and universally accepted by parents just like the other childhood immunizations, parents opt to skip flu vaccine for themselves and their kids for no really good reason. Of all the vaccine-preventable diseases, we see influenza (aka “the flu”) every winter and we see people (particularly the very young and very old) die every year from it.
Perhaps what was most poignant to me about this study was a comment in the discussion section of the article. What influences a parent’s decision-making regarding vaccines? “A strong physician recommendation for vaccination has been shown to be a consistent predictor of vaccine utilization”.
In English: people still trust their doctors. The most effective message I can share with you and my own patients is that I vaccinate my own children to protect them, I wouldn’t do anything differently for yours.