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BACKGROUND: Understanding the causes of low levels of childhood immunization is critical to preventing outbreaks of vaccine-preventable diseases. Hence, we examined physicians' knowledge and attitudes about measles and pertussis vaccines and barriers to immunization. METHODS: We developed a telephone questionnaire, subjected it to a pilot test, and subsequently interviewed Minnesota pediatricians, general practitioners, rural family physicians, and urban family physicians. The physicians were selected by a random process. RESULTS: The response rate was 76.4 percent (411 of 538 eligible physicians). Almost all physicians thought that vaccine efficacy was high and that the likelihood of serious side effects was low. Respondents were divided, however, about the likelihood of serious complications from pertussis disease and the role of adults as a pertussis reservoir. Many physicians inappropriately believed certain conditions were contraindications to vaccination; for instance, 33 percent of physicians would not administer measles, mumps, and rubella vaccine to a child whose mother was pregnant. Many physicians (31 percent) would not administer four vaccines simultaneously because of concerns that included parental acceptance and vaccine efficacy. Physicians were more likely to refer children without insurance (P < 0.001) or with Medicaid (P < 0.001) than children with insurance to health department vaccine clinics for immunization. CONCLUSIONS: For immunization rates to reach high levels, changes are needed in health care system issues, such as vaccine reimbursement, and in provider practices, such as interpretation of vaccine contraindications.
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