Parental Concerns about Vaccines and Choice of Alternative Vaccine Schedules

Background: Parental concerns about vaccine safety and efficacy are increasing. Pediatricians report rising rates of requests for alternative schedules, and often spend considerable clinic time counseling worried parents about the vaccine schedule. Understanding the relationship between the specific concerns parents have about vaccines and the alternative schedules they request is an important step in designing effective counseling scripts and algorithms for pediatricians.

Objectives: To describe (1) the prevalence of specific vaccine concerns and requests for specific alternative schedules, and (2) the relationship between concerns and alternative schedules in a newly-opened pediatric practice.

Methods: Medical records data were extracted for 168 patients in a newly-opened solo pediatric practice in a large northeastern city. Data included specific vaccine concerns identified by parents during a vaccine counseling session and the vaccine schedule parents requested (e.g., ACIP, all vaccines but spaced, or decline all vaccines). The prevalence of each of 9 concerns and 7 alternative schedules was calculated. Bivariate associations between concerns and schedules were assessed using Fisher’s exact test.

Results: 40% of parents had one or more concerns. The most common concerns identified were vaccines overtaxing the immune system (16%), the rareness of vaccine-preventable diseases (10%), a preference for natural immunity (7%), and autism (5%). There was considerable heterogeneity in the relationships between concerns and alternative schedule requests. For example, being concern about vaccines overtaxing the immune system was significantly associated (at p < .05) with choosing a spaced schedule, postponing all vaccines to a certain age, and declining Hepatitis B, but not with declining all vaccines or choosing “Dr. Bob [Sears]’s” alternative schedule.

Conclusions: Pediatricians should elicit the specific vaccine concerns that parents have and understand how concerns may be associated with requests for a particular alternative schedule in order to effectively promote vaccine adherence.