While many pediatricians say they would be comfortable varying the official schedule for when children should receive vaccinations, they draw the line at delaying three particular vaccinations for potentially fatal diseases, according to a study by Seattle Children's Research Institute.
Nearly 80 percent of pediatricians surveyed in Washington have been asked by parents to vary the official vaccination schedule for their children, according to a study published by the Seattle Children’s Research Institute.
Sixty-one percent of the 290 doctors questioned for the research said they’re comfortable changing the ambitious schedule recommended by the U.S. Centers for Disease Control and Prevention, which has children getting as many as 26 inoculations by age 2 — and up to five shots at one time.
But the findings, published in the December issue of Pediatrics, found that doctors balked when it came to delaying three vaccines for diseases that too often prove deadly to young children:
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• The DtaP, which includes a vaccine for pertussis, also known as whooping cough.
• The Hib vaccine for Haemophilus influenza type b, which protects against a disease that can cause meningitis and is most dangerous to children under age 5.
• The PCV pneumococcal conjugate vaccine, which protects against bacterial meningitis and pneumonia from pneumococcal disease.
“When discussing alternative childhood immunization schedules, pediatricians have to balance two things: respecting the parents’ decision and protecting the health of the child,” said Dr. Douglas Opel, a study author and bioethicist at the Research Institute.
Pediatricians, navigating these competing interests, try to honor both goals by varying the schedule but not on vaccines they believe are “really vital to protecting the health of the child at a young age,” Opel said.
Pertussis is “actively circulating as we speak,” and the other two can cause “severe, life-threatening complications,” said Opel, an acting assistant professor of pediatrics at the University of Washington. “That’s why pediatricians are standing firm.”
On the other hand, most of the surveyed pediatricians were willing to at least consider delaying or changing the schedule for these vaccines:
• Hepatitis B, a disease spread by contact with infected blood or other body fluids. The recommended schedule has babies getting vaccinations at birth and for the next several months, in part because a mother with hepatitis B can pass the virus to a newborn;
• Varicella (chickenpox), recommended to be first given at about age 1.
• IPV, inactivated poliovirus, recommended at age 2 months, again at age 4 months, and beyond.
Opel and other authors said understanding pediatricians’ attitudes is an important component in knowing how best to address parents’ concerns about vaccines. Maintaining parents’ confidence is vital to “reaping the full potential benefits of modern medicine,” the authors wrote.
“Currently, however, parental acceptance of childhood immunizations is waning,” they said.
Between 2003 and 2008, there was a 17 percentage-point increase nationally in parents who refused or delayed immunizations for their children, and increasing numbers file philosophical exemption forms to avoid required vaccines for school-age children.
Washington, according to the state Department of Health, had the nation’s highest exemption rate in the 2009-2010 school year, with 6.2 percent of kindergartners having a parent-signed exemption form for one or more vaccines. State exemption rates have more than doubled over the past 10 years.
Public-health officials expect that rate eventually to drop in the wake of a new law that does not allow parents to exempt children unless they submit a signed form from a health-care provider who has provided the parent with risks and benefits of immunization.
Michele Roberts, health promotion manager of the Department of Health’s Immunization and Child Profile office, said the study helped put to rest anecdotes about pediatricians ending their relationships with parents who have concerns about vaccines for their children.
“Mostly, we see providers who want to work with parents, who start with where they’re at and go from there,” Roberts said. “I think providers in this state are really good about negotiating with parents — I don’t think we have many providers here who fire parents.”
Although the study didn’t address the reasons why parents want to vary the schedule, Opel said other surveys have found that they are most concerned about vaccine safety, both immediate and long-term.
While no pediatrician should insist that vaccines are 100 percent safe or 100 percent effective, he said, they should answer parents’ questions and concerns, and reassure them. “Most of the time, a large majority of the time, children don’t experience side effects.”
While Opel generally applauded the flexibility of pediatricians in responding to parental concerns, he said there’s no research on such alternative vaccination schedules. “We really ought to know how safe and effective these schedules are,” he said.
Carol M. Ostrom: 206-464-2249 or firstname.lastname@example.org. On Twitter @costrom.