Child vaccine rates hinge on educating parents

Pediatrician Sheldon Lippman, MD, used to ask parents who declined vaccines for their children to find another doctor.

Now the Brooklyn, N.Y., physician asks parents who refuse his vaccination recommendations to sign a form noting that they chose not to vaccinate their children against potentially fatal diseases. That sometimes is enough for them to realize the risks.

"When we break out that sheet that they're taking responsibility, some [parents] change their mind on the spot" and get the vaccine for their children, Dr. Lippman said.

A new study published online March 1 in Pediatrics found that although most parents consider vaccines to be beneficial for their children, more than half are concerned about serious adverse effects.

Researchers in January 2009 surveyed 1,552 parents with children age 17 and younger; 90% said vaccines are a good way to protect children from diseases. Similarly, 88% said they generally follow their physicians' vaccine recommendations.

But about one in five parents believes some vaccines cause autism, and 11.5% of respondents have refused at least one immunization their doctor suggested.

To alleviate parental concerns, the study recommends that physicians be well-informed of the evidence of vaccine safety and efficacy to better answer parents' questions. Public health officials also are urged to develop education campaigns that more effectively target specific fears.

Some physicians say they already are speaking with parents about the safety and benefits of vaccines. The challenge, they say, is helping parents sift through fact and fiction.

"How do you compete with Jenny McCarthy [an actress whose child has been diagnosed with autism] and ... all the flash of Hollywood out there saying things that just aren't true?" said pediatrician Pia Fenimore, MD, of Lancaster, Pa. "The answer is you build good, trusting relationships with parents."

Researchers for the Pediatrics study found that the human papillomavirus vaccine, the newest immunization addressed in the survey, was the most frequently declined. The most common reason was insufficient research on the immunization. Faring slightly better were the varicella and meningococcal conjugate vaccines, which were refused by 32.3% and 31.8% of parents who rejected at least one recommended vaccine.

The measles, mumps and rubella vaccine, which was linked to autism in a now-discredited study published in the Lancet in 1998, was declined by 17.7% of refusing parents. The main reason parents cited for refusal was having read or heard about problems with the MMR vaccine. The Pediatrics study was conducted before Lancet retracted the study.

Gary Freed, MD, MPH, author of the Pediatrics study, encouraged physicians to explain to parents why the autism link is scientifically unfounded and why immunizations are essential to their children's health. He said doctors should be prepared to provide information from credible scientific sources.

Adverse effects of lack of vaccination

Other research and events show the importance of proper vaccination.

A study in the January Archives of Pediatrics and Adolescent Medicine found that unvaccinated children were nine times more likely to contract chickenpox than were children who were fully immunized.

Before a varicella vaccine was licensed in 1995, the disease caused more than 10,000 hospitalizations and 100 deaths each year in the U.S.

In New York and New Jersey, where mumps has been spreading since June 2009, about 25% of those affected had not received the recommended two doses of MMR vaccine, said the Centers for Disease Control and Prevention. As of Jan. 29, the CDC said 1,521 mumps cases had been reported in that East Coast outbreak.

The critical question for physicians is when do unvaccinated children begin posing a risk to other patients, particularly in waiting rooms, said Meg Fisher, MD, a pediatric infectious disease specialist and medical director of Children's Hospital at Monmouth Medical Center in New Jersey. She is a member of the American Academy of Pediatrics Committee on Infectious Diseases.

Dr. Fisher said the AAP does not suggest that doctors fire patients who reject vaccine recommendations. Rather, the academy recommends that doctors continue discussing the importance of immunizations with reluctant parents or patients.

It is key, she said, that physicians listen to parents' concerns about vaccines and then address those fears.