Young doctors apt to question use of vaccines

Recent medical school graduates are less likely to believe that immunizations are safe and effective compared with their older practicing counterparts, a new study shows.

By Christine S. Moyer — Posted Nov. 7, 2011

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At times, physicians struggle to persuade parents to vaccinate their children. Now research shows that doctors, particularly young ones, also are skeptical about the efficacy and safety of immunizations.

A study presented Oct. 21 at the Infectious Diseases Society of America's annual meeting in Boston shows that doctors overall support the use of vaccines. But recent medical school graduates are more likely than older doctors to believe immunizations do more harm than good, said lead study author Saad Omer, PhD, MPH.

Omer said part of the problem could be that new physicians have seen fewer patients who are ill with vaccine-preventable diseases, such as pertussis, than longer-practicing doctors.

"If you have seen a case of whooping cough and have heard a child whoop ... that experience is a little more visceral" than treating a child with influenza, and that could influence how a physician thinks about immunizations, Omer said. He is an infectious diseases epidemiologist at the Emory Vaccine Center in Atlanta.

The findings are important "because health care providers have been shown to be the most frequently used and most trusted source of vaccine information for parents," he said.

About three in four parents have a lot of trust in the vaccine information they receive from their child's doctor, said a study of 1,552 parents published online April 18 in Pediatrics. But Austin, Texas, pediatrician Ari Brown, MD, said that if physicians doubt the safety and effectiveness of vaccines, they might let vaccine-hesitant parents delay recommended childhood immunizations or refuse them altogether.

"We've been pounding the pavement for the last decade trying to help the public understand the importance of childhood vaccines. But maybe we need to take a closer look at our own health care providers," Dr. Brown said.

For the study presented in Boston, researchers surveyed the vaccine attitudes of 551 primary care physicians and other health professionals, including nurse practitioners. Most of the participants were pediatricians and family physicians. They were asked whether the recommended vaccine schedule overloads children's immune systems and whether children receive too many immunizations. Omer would not release data pending the study's publication.

Recent medical school graduates were less likely than older practicing doctors to believe that vaccines are effective, the study said. Younger health professionals were more likely than longer-practicing medical professionals to question the safety of immunizations for polio, measles, mumps, rubella and varicella.

The findings come as the U.S. is experiencing its largest measles outbreak in 15 years, according to the Centers for Disease Control and Prevention. As of Oct. 20, there had been 212 reported cases of measles in the U.S. since January, and 68 people were hospitalized due to the disease, said the Infectious Diseases Society of America.

Of those infected, 86% were unvaccinated or had an unknown vaccination status, the IDSA said. Most of the cases stemmed from infections acquired in places such as western Europe, Africa and Asia, where measles is prevalent.

Cases of pertussis also are up from the norm, particularly in California, where 2,462 cases have been reported this year, according to Sept. 15 state data. In 2010, another abnormal year, 9,146 pertussis cases were reported in California.

The uptick in vaccine-preventable disease outbreaks is due, in part, to children not receiving immunizations at the ages recommended by the CDC, infectious diseases experts say.

Dealing with hesitant parents

A separate study presented at the IDSA meeting shows that pediatricians in the Midwest struggle with parents who are reluctant to vaccinate their children.

Researchers asked 695 pediatricians about their experiences with parents who have concerns about immunizing their children. The doctors are in Illinois, Iowa, Kansas, Minnesota, Missouri, North Dakota, Nebraska, South Dakota and Wisconsin.

Their experiences with parents varied. Some said more than half of parents delayed or refused vaccines for their children.

The immunizations most frequently turned down or delayed were for measles, mumps and rubella; human papillomavirus; and influenza, the study found. The most common reasons given by parents were fear of autism, too many shots and concern about serious side effects.

Many doctors have taken action: 21% of pediatricians discharged families from their practice for continued refusal of all childhood vaccines. Minnesota had the lowest percentage of discharges (less than 1%), and Iowa had the highest (38%).

"The study shows that pediatricians are frustrated with this issue, and many believe they're being asked to carry the lion's share of responsibility for counseling families on the importance of giving children vaccines and the importance of vaccines in the overall public health strategy," said pediatrician Thomas Tryon, MD, the study's lead author. He is section chief of urgent care in the Dept. of Pediatrics at Children's Mercy Hospitals and Clinics in Kansas City, Mo.

Dr. Tryon said there should be more discussion about how pediatricians can address the issue of vaccine hesitancy and refusal by parents while protecting other patients in the waiting room who are too ill or too young to receive immunizations.

"This is a significant issue for us as pediatricians," he said.

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External links

"Are Younger Doctors More Skeptical of Vaccines? Evaluation of a Provider Cohort Effect on Immunization Beliefs," Infectious Diseases Society of America, Oct. 21 (link)

"Parental Vaccine Hesitancy and Refusal: Perceptions of Midwestern Members of the American Academy of Pediatrics," Infectious Diseases Society of America, Oct. 21 (link)

"Sources and Perceived Credibility of Vaccine-Safety Information for Parents," Pediatrics, published online April 18 (link)

Pertussis page of California Dept. of Public Health (link)

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