KEYWORDS:
Key Words: immunization, vaccine refusal

BACKGROUND:
Parent confidence in childhood vaccinations is showing signs of weakening. Pediatricians now confront a growing trend of parental vaccination refusal.

OBJECTIVE:
Objectives: 1) To assess pediatricians' priorities for 11 vaccinations recommended by the American Academy of Pediatrics; 2) to examine pediatricians' attitudes toward parental vaccination refusal; and 3) to estimate the proportion of pediatricians preferring to dismiss families
refusing vaccination from their practices.

METHOD:
Methods: We conducted a survey mailed to 1004 randomly selected American Academy of Pediatrics members.

RESULT:
Results: We received 429 returns (42.7% response rate). Most respondents
rated the DTaP, HiB, MMR and IPV vaccines "extremely important" (95.7%,
94.1%, 94.7% and 85.1% respectively). None rated the DTaP, HiB, MMR or IPV
"optional". Significant percentages rated the PCV7, HBV and VZV "somewhat
important" (27.7%, 25.4% and 36.1%, respectively). A striking percentage
rated the PCV7, HBV vaccine, VZV and IPV "optional" (4.6%, 2.3%, 6.6% and
0.9% respectively).
We asked pediatricians to distinguish between parents refusing selected
vaccinations (selective refusers) and those refusing all vaccinations
(total refusers). Eighty-five percent of respondents indicated seeing a
selective refuser within the past 12 months; 53.5% faced at least one total
refuser within the past year. According to 73.4% of pediatricians,
refusals "always" or "almost always" concerned vaccine safety for selective
refusers; 79% said this was true for total refusers. If repeated attempts
to convince parents to accept vaccines failed, 28% indicated that they would dismiss a selective refuser and 39% would dismiss a total refuser from their practice.

CONCLUSION:
Conclusions:
1. Pediatricians highly value 8 of 11 recommended childhood vaccinations.
2. A significant proportion believes selected vaccinations only "somewhat important" or "optional".
3. U.S. pediatricians report frequent parental vaccine refusal.
4. Parents typically worry about vaccine safety.
5. Many pediatricians would dismiss families refusing some/all vaccinations from their practices regardless of parents' concerns.

LEARNING OBJECTIVES:
Learning Objectives:
1. What importance do pediatricians place on childhood immunizations?
2. How often do pediatricians dismiss families for refusing vaccinations?
3. What are the most common reasons families have for refusing vaccinations?