Reactions of Pediatricians to the Recommendation for Universal Varicella Vaccination

Robert David Newman · James Arnold Taylor

47 citations0/0 files storedArchives of Pediatrics and Adolescent Medicine

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Vaccine Coverage and Hesitancy Herpesvirus Infections and Treatments Clinical practice guidelines implementation

Abstract

OBJECTIVES: To determine the rate of self-reported adherence by pediatricians to the 1995 American Academy of Pediatrics and the Advisory Committee on Immunization Practices varicella immunization recommendations and to evaluate factors that might influence adherence. DESIGN: Mail survey. SETTING AND PARTICIPANTS: Washington State pediatricians. MAIN OUTCOME MEASURE: Logistic regression was used to identify demographic characteristics, attitudes about varicella vaccine, and previous experiences with the disease that were associated with self-reported adherence to universal varicella immunization recommendations. RESULTS: Completed surveys were returned by 76% of contacted pediatricians, of whom 42% reported following a policy of universal varicella immunization. In multivariate analysis, agreement with statements regarding the effectiveness of varicella vaccine in reducing rare but serious complications of the disease (odds ratio [OR], 4.90; 95% confidence interval [CI], 2.30-10.50) and in decreasing work loss by parents (OR, 4.21; 95% CI, 1.14-15.50) were associated with recommending universal immunization. Disagreement with statements concerning the lack of the need for varicella immunization because complications are rare (OR, 2.54; 95% CI, 1.12-5.74), it is not required for school entry (OR, 2.52; 95% CI, 1.37-4.64), and it is not medically cost-effective (OR, 2.25; 95% CI, 1.21-4.18) were also associated with universally recommending the vaccine. In addition, experience with varicella encephalitis was also associated with adherence to the recommendations (OR, 1.96; 95% CI, 1.06-3.65). Conversely, those who were concerned that varicella vaccine might not provide lifelong immunity were less likely to report recommending universal vaccination (OR, 0.36; 95% CI, 0.19-0.68). CONCLUSIONS: Fewer than 50% of responding Washington State pediatricians reported recommending universal varicella vaccination. Adherence to the recommendations appears to be influenced by personal experience, perceptions about the potential seriousness of varicella, and beliefs about the societal and medical cost-effectiveness of varicella vaccine.

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References

1998Designing and Conducting Health Surveys 1994Universal Hepatitis B Immunization of Infants: Reactions of Pediatricians and Family Physicians Over Time 1993Reactions of Pediatricians to a New Centers for Disease Control Recommendation for Universal Immunization of Infants With Hepatitis B Vaccine

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2000Attitudes and practices regarding varicella vaccination among physicians in Minnesota: implications for public health and provider education 2016Negative attitude and low intention to vaccinate universally against varicella among public health professionals and parents in the Netherlands: two internet surveys 2003A Look at the Pediatrician as Parent: Experiences with the Introduction of Varicella Vaccine 2003Varicella Vaccine 2002Understanding Physician Agreement with Varicella Immunization Guidelines 2004Reasons physicians accepted or declined smallpox vaccine, February through April, 2003 2009Varicella immunisation practice: Implications for provision of a recommended, non‐funded vaccine 2003Barriers to immunization: Attitudes of general practitioners to varicella, the disease and its vaccine

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