More parents using alternative immunization schedules

Dempsey AF. Pediatrics. 2011;doi:10.1542/peds.2011-0400.

More than one in 10 parents of young children currently use a schedule for routine immunizations that is not endorsed by the American Academy of Pediatrics or Advisory Committee on Immunization Practices, according to a study published online this week.

A study by Amanda F. Dempsey, MD, and colleagues reported that increasing numbers of parents are following a schedule that is leaving their children at risk for vaccine-preventable diseases. In addition, those parents who are currently following the recommended schedule appear “at risk for switching to an alternative schedule,” the researchers concluded.

The cross-sectional, Internet-based survey included a nationally representative sample of parents of children aged 6 months to 6 years. Bivariate and multivariate analyses identified associations between demographic and attitudinal factors and alternative vaccination schedule use, according to the study results.

The response rate was 61% (n=748), and only 17% reported refusing all vaccines. Of the 13% of parents who reported following an alternative vaccination schedule, 53% refused only certain vaccines and/or delayed some vaccines until the child was older (55%).

About 30% of parents following an alternative schedule reported having initially followed the recommended vaccination schedule initially.

Among parents following the recommended vaccination schedule, 28% thought that delaying vaccine doses was safer than the schedule they used, and 22% disagreed that the best vaccination schedule to follow was the one recommended by vaccination experts.

Factors significantly associated with likelihood of using an alternative schedule included nonblack race and the absence of a regular health care provider for the child.

“The results of this study highlight the need to develop interventions quickly to quell the apparently growing concerns among parents about the safety and necessity of recommended childhood vaccines,” the study researchers concluded.

Disclosure: Dr. Dempsey receives compensation for service on an advisory board for Merck related to male human papillomavirus vaccination. The company had no input into the design, implementation, analysis or presentation of the results of this study, and Dr. Dempsey receives no research support from Merck.

David W. Kimberlin

Researchers from the University of Michigan have conducted a large Internet-based survey of parents across the country to assess if and how they embrace alternative schedules in vaccinating their children. Over 10% of respondents reported following an alternative schedule, and most of these realized that doing so put their child and others at risk of acquiring the infections that the vaccines prevent. This paradox may provide an opportunity to prevent deaths from vaccine-preventable diseases, in that at least there is common ground in understanding that there are definite risks involved in delaying immunizations.

Another important aspect of this report is the role that the pediatrician plays in the non-standard administration of vaccines. Of the parents who utilize alternative schedules, only 10% use those promoted by authors selling books on the subject. Instead, most use schedules that they or their friends put together, and only 8% indicated that they had to change providers because their child's doctor refused to go along with their vaccination preferences - meaning that the majority of these families' pediatricians agreed to administer the schedule in a manner other than recommended by the CDC and AAP.

This raises the obvious question of what would have happened if they had not agreed to do this. Some families would have shopped around for another medical provider, but I bet that most would have been influenced by a passionate endorsement of the current vaccine schedule by their pediatricians. Studies have consistently shown that most parents trust their pediatrician to provide the most accurate information about protecting their child's health.

When parents ask about what they should do or suggest an alternative schedule, we should say that vaccines save lives, that we have protected our own children against these diseases, and that we would want nothing less than the same for their children. In this global world, all vaccine-preventable diseases, except smallpox, are only 18 hours away by plane, and imported Hib bacteria would love to meet a 3-month-old child whose parents chose to delay initiation of immunizations.

David W. Kimberlin, MD
Infectious Diseases in Children Editorial Board member

Disclosure: Dr. Kimberlin reports no relevant financial disclosures.

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