BACKGROUND:
Hailed as one of the greatest advancements to public health in the 20th century, vaccinations have been credited as contributing to a reduced incidence of select childhood diseases and deaths. However, this success has shrouded the seriousness of these childhood diseases - leading some parents and physicians to raise risk and benefit issues with continued vaccination.

OBJECTIVE:
The early identification and determination of scope of parent and physician vaccine concerns is the purpose of the Immunization Encounter Survey component of the National Primary Care Physician Immunization Survey.

METHOD:
Ninety-five medical practices were randomly selected from a pool of 300 practitioners from the physician survey component of the National Primary Care Immunization Survey -pediatricians or family practitioners who on average weekly vaccinate provide 9 or more children. Each participating practice was randomly assigned a survey week with all parents of children receiving vaccinations asked to complete a confidential series of pre and post visit vaccination questions. Participating practices were asked to complete a series of questions about the patient’s vaccination history, vaccine administered, and what questions or issues were discussed.

RESULT:
Physicians reported the following issues were most likely to be discussed during the visit: number of shots to be given (79%); short term side effects (75%); pain of discomfort from vaccination (72%); general safety (63%); whether vaccines were needed (49%); and, long term side effects (46%). Twenty-one percent of parents (n=778) reported they had vaccine concerns. Their concerns were as follows: child’s pain or discomfort (46%); number of shots given (44%); short term side effects (33%); general safety of vaccines (29%); vaccine additives (e.g. thimerosal) (20%); and risk of autism (3%).

CONCLUSION:
Most concerns of parents and physicians were related to short-term side effects such as pain or discomfort. Issues receiving media attention such as thimerosal and autism ranked lower as concerns.

LEARNING OBJECTIVES:
The participant should be able to identify three factore that influence the use of vaccines by physicians and parents.