More parents requesting alternative vaccine schedules

Pediatricians are more willing to delay the hepatitis B and varicella vaccines than immunizations for Haemophilus influenzae type b and DTaP, a study shows.

By Christine S. Moyer — Posted Dec. 9, 2011

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Research on the safety of delaying childhood immunizations is needed as pediatricians increasingly are faced with requests by parents to follow alternative vaccine schedules, says the author of a new study.

Three in four pediatricians in Washington state said parents sometimes or frequently request an alternative immunization schedule for their child, according to the study published online Nov. 28 in Pediatrics. Of those doctors, 64% are comfortable using such a plan.

Researchers did not ask pediatricians why they were comfortable following an alternative schedule. But study co-author Douglas J. Opel, MD, MPH, said it's likely that physicians want to maintain a relationship with the family so they can address their vaccine concerns and, in time, fully immunize the young patient.

"Pediatricians are in a difficult spot ... because they have to balance two competing interests -- the parent's right to make health care decisions for the child and the pediatrician's obligation to protect the health of the child," said Dr. Opel, a pediatrician at Seattle Children's Hospital and a bioethicist at Seattle Children's Research Institute.

He recommends that pediatricians be prepared for parents to ask to delay recommended childhood vaccines and be ready to discuss why they want to do so.

Researchers surveyed 209 pediatricians on their thoughts about alternative childhood immunization schedules and how often parents request them. Participants were members of the Washington state chapter of the American Academy of Pediatrics who saw at least 20 patients younger than age 2 each week.

The study found that 87% of pediatricians were willing to consider an alternative schedule for the hepatitis B vaccine. Doctors also said they probably would be flexible with the varicella vaccine and the inactivated polio immunization (link).

Significantly fewer pediatricians (36%) would consider an alternative schedule for Haemophilus influenzae type b vaccine, which prevents bacterial meningitis. Participants were hesitant to stray from Centers for Disease Control and Prevention recommendations on when to administer the diphtheria, tetanus and pertussis immunization and the pneumococcal conjugate vaccine.

Although many pediatricians are comfortable using alternative schedules, 96% said they would follow the recommended vaccine schedule for their own children.

The findings come as the U.S. is experiencing its largest measles outbreak in 15 years, with 220 reported cases of the disease since January, according to Nov. 25 data from the CDC. Cases of pertussis also are up, particularly in California, where 2,734 cases have been reported this year, according to Nov. 10 state data.

"You can make a link that if children are left unprotected for longer, they're at increased risk [of contracting vaccine preventable diseases], but we don't have explicit data to say that," Dr. Opel said.

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Demand for alternative vaccine schedules

Seventy-seven percent of Washington state pediatricians receive requests from parents to follow an alternative childhood immunization schedule. Pediatricians' willingness to consider an alternative schedule for eight recommended childhood vaccines varies, as does the percentage of doctors who feel comfortable delaying the immunizations less than four weeks and more than four months.

Willingness to delay by
Vaccine Parent requests Less than four weeks More than four months
Hepatitis B 87% 13% 69%
DTaP 39% 45% 9%
PCV 42% 46% 8%
Hib 36% 50% 7%
IPV 74% 20% 45%
Rotavirus 69% 49% 26%
MMR 58% 23% 31%
Varicella 76% 16% 53%

Source: "Washington State Pediatricians' Attitudes Toward Alternative Childhood Immunization Schedules," Pediatrics, published online Nov. 28 (link)

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