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Some U.S. Parents Ignoring Vaccination Guidelines

MONDAY Oct. 3, 2011 -- More than one in 10 parents don't follow recommended vaccination guidelines for their children, opting instead for an "alternative" schedule that could involve skipping doses or delaying shots.

And parents who do follow official recommendations show some inclination to move toward an alternative schedule, according to new research.

The findings alarm the authors of the study, published in the November issue of Pediatrics.

"This really highlights to me that there's probably going to be a continuing increase in the number of parents who choose to follow alternative schedules," said study author Dr. Amanda Dempsey. "We really need to start allocating government and educational resources to stem the growing tide of discontent about vaccines among parents."

This isn't the first time investigators have noticed the shift.

"There's been a trend over the past couple of decades of parents changing the vaccination schedule," said Dempsey, an assistant professor of pediatrics and communicable diseases at the University of Michigan Medical School in Ann Arbor. "We've seen evidence that this can have detrimental effects because there have been more and more outbreaks of vaccine-preventable diseases, including measles, pertussis and mumps, [as a result of] vaccination rates being lower than recommended."

One study found that every 1 percent increase in the number of under-immunized children doubled the risk of pertussis (whooping cough).

In this study, the authors gave "alternative" a broad meaning, namely anything other than the schedule recommended by the U.S. Centers for Disease Control and Prevention.

About 750 parents of children aged 6 months to 6 years responded to an Internet survey in May of 2010.

Thirteen percent of parents surveyed reporting using an alternative schedule. Of these, more than half (53 percent) refused certain vaccines and/or delayed some vaccines until a child was older (55 percent).

The MMR (measles mumps rubella) vaccine was most commonly delayed (45 percent of parents surveyed), and 43 percent of parents postponed the DTaP (diphtheria-tetanus-pertussis) vaccine.

Overall, 2 percent of parents refused all recommended vaccines, and parents most likely to adopt an alternative schedule were those who were not black and who didn't have a regular pediatrician or other health care provider.

About a third of respondents had at one point followed CDC recommendations, then switched to a schedule of their own making.

Meanwhile, 28 percent of parents following the recommended schedule thought delaying some doses might be safer and 22 percent didn't think the official schedule was the best possible schedule.

The main reason for adapting the vaccine schedule seemed to be about safety, Dempsey said.

Dempsey said in her own clinical practice that "people generally tend to delay until after concerns about autism have abated, which is 3- to-4 years of age."

A recent Institute of Medicine report concluded that children's vaccines are typically safe, with bad reactions occurring only rarely and then not causing any lasting problems.

But not all agree that those conclusions are airtight.

"These are not surprising findings and reflect the higher education level of young parents making informed health care decisions for their children today. They are more aware that vaccines are like prescription drugs and carry risks that can be greater for some children than others because, biologically, children are not all the same," said Barbara Loe Fisher, co-founder and president of the National Vaccine Information Center in Vienna, Va.

"The days when people obeyed doctors' orders without question are over. Pediatricians are going to have to get used to answering questions about vaccines and working with parents in a relationship that involves shared decision-making," she added.

More information

View the recommended immunization schedule at the U.S. Centers for Disease Control and Prevention.

Posted: October 2011


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