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Researchers surveyed primary care pediatricians about alternative childhood immunization schedules (ACISs) to find out how frequently parents requested ACISs, how comfortable pediatricians were with ACISs, and how willing pediatricians were to comply with parents' requests.
Of 475 primary care pediatricians in the Washington Chapter of the American Academy of Pediatrics, 311 (65%) completed the Internet-based survey, and 209 met eligibility criteria for the analysis (≥20 patients aged <2 years weekly). Most respondents (77%) reported that parents frequently or sometimes requested ACISs. Overall, 60% of respondents reported that they were comfortable using ACISs when requested by parents. Many pediatricians were comfortable delaying the following three vaccines for >4 months: hepatitis B (69%), varicella (53%), and inactivated poliovirus vaccine (45%). Few respondents were comfortable delaying Haemophilus influenzae type b vaccine (7%), pneumococcal conjugate vaccine (8%), and diphtheria-tetanus toxoids-acellular pertussis vaccine (9%). Parents with college degrees were more likely to request ACISs. Pediatricians in neighborhood or community clinic practice settings were significantly less comfortable using ACISs than those in small (≤2 physicians) practices.
Wightman A et al. Washington state pediatricians' attitudes toward alternative childhood immunization schedules. Pediatrics 2011 Dec; 128:1094.
Comment
The pediatrician's strong and definitive voice is the most effective tool that can be used against the practice of allowing alternative childhood immunization schedules. Delaying vaccination — any vaccination — tacitly gives credence to false notions about vaccines and threatens the child's health. I favor striking a balance by providing a definitive written statement against ACISs and creating a practice culture in which providers welcome questions, allow time to listen to concerns, and provide clear answers about the importance of vaccinations. A special article published in Pediatrics offers a concise discourse about the fallacies of the alternative approach and misconceptions of families and physicians who opt for alternative schedules.