More than a tenth of parents did not follow nationally recommended schedules for vaccinating their young children, according to results from a survey-based study published online Oct. 3 in Pediatrics.
Moreover, about a quarter (22%) of the parents of the 748 children in the study who followed published schedules expressed doubts about the merits of doing so, a finding that suggests that they might change to alternative schedules in the future. In the sample of respondents with young children, not having a regular health care provider for the child was associated with a likelihood of using an alternative schedule (adjusted OR, 18.66).
For their research, Dr. Amanda F. Dempsey and her colleagues at the University of Michigan in Ann Arbor analyzed survey responses from randomly selected parents of children between 6 months and 6 years of age (Pediatrics 2011 [doi:10.1542/peds.2011-0400]).
The surveys collected information on vaccine uptake and scheduling, and also parents’ attitudes about vaccination. Alternative vaccination was defined as having even one alteration from the schedule recommended by the Centers for Disease Control and Prevention.
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Of the 13% of parents who reported following a vaccination schedule different from that published by the Centers for Disease Control and Prevention, 53% said they had refused only certain vaccines.
Of the 13% of parents who reported following a vaccination schedule different from that published by the CDC, 53% said they had refused only certain vaccines, and 55% said they had delayed some vaccines until the child was older than the recommended age. A majority – 61% – said that their main rationale for deviating from published schedules was because doing so seemed safer. Very few parents – 2% overall and 17% of alternative vaccinators – refused all vaccines for their children.
Despite such perceptions, delaying or skipping vaccinations has been shown to increase individual and community risks for vaccine-preventable diseases. It is nonetheless increasingly common: The study found more formerly schedule-abiding parents moving to alternative schedules (30%) than the other way around (11%).
Only 8% of alternative vaccinators, meanwhile, reported using alternative schedules described by physician proponents of alternative vaccination. Rather, 41% said that they had created the schedules themselves, and 15% said a friend had influenced them.
DTaP and polio vaccines (6% each) were the least likely to be skipped; H1N1 and seasonal influenza vaccines the most (86% and 76%, respectively). Some parents said they deviated from published schedules by extending the intervals between doses of scheduled multidose vaccines, most commonly measles-mumps-rubella (MMR) and DTaP.
In their analysis of their results, Dr. Dempsey and her colleagues questioned whether the association between not having a regular care provider and alternative vaccination was because parents had trouble locating providers who would cooperate with their plans, or because "parents who tend not to engage in regular health care for their children ... also tend to follow an alternative vaccination schedule." Another possibility, they wrote, was that parents missed or delayed doses because of difficulty accessing care.
The study found many providers not explicitly discouraging of alternative vaccination practices, with 40% alternative vaccinators reporting that their clinicians "seemed supportive" of their plans, and 22% saying that their clinicians had recommended alternative schedules to them.
While 30% of alternative vaccinators described their doctors as hesitant to endorse an alternative schedule, only a small number – 8% – said they sought different doctors after their regular providers appeared hostile to the idea.
One encouraging finding, Dr. Dempsey and her colleagues wrote, was that "a large proportion of alternative vaccinators agreed that under-vaccination of children increases the risk of infection and spread of disease." This suggests that "parents who are ‘on the fence’ about vaccination have views that might be modifiable through targeted educational approaches."
Dr. Dempsey and her colleagues described as weaknesses of their study the fact that its participants were registered by a research firm, and "might have differed from the general population with respect to education or baseline health status." Sample sizes for specific types of schedule alterations were also small.
The study, part of the C.S. Mott Children’s Hospital National Poll on Children’s Health, was funded by the Clinical Sciences Scholars Program at the University of Michigan.
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. The other authors indicated they have no financial relationships relevant to this article.