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Fewer parents are refusing vaccines for their children, a physician survey suggests

A third of the health professionals surveyed reported that they had not seen any changes in the willingness of parents to accept vaccinations.

Last winter’s much-publicized “Disneyland” measles outbreak may have led to one positive outcome: an increase in vaccine acceptance among parents.

In a recent nationwide survey by the physician-oriented website Medscape, 42 percent of pediatricians and other health professionals said they believed parents had become more accepting of vaccines since the Disneyland outbreak — particularly the measles vaccine.

That trend is welcomed news for public health officials and others who have become concerned by the growing problem of parents refusing or delaying immunizations for their children.

But the news from the survey wasn’t all good. A third of the health professionals surveyed reported that they had not seen any changes in the willingness of parents to accept vaccinations.

Furthermore, the trend toward greater acceptance could be short-lived.

Some background

From Jan. 1 through Aug. 21 of this year, 188 cases of measles were reported in the U.S. in 24 states and the District of Columbia, according to the Centers for Disease Control and Prevention (CDC). Most have been linked to the measles outbreak that first surfaced at Disneyland last December, an outbreak that was probably started by an individual who became infected while traveling overseas.

Eighty-three percent of this year’s measles cases (at least, of the 173 that were reported through July) involved individuals who were unvaccinated, the Medscape report notes. That means, of course, that 17 percent of the people who came down with measles this year were already vaccinated — a factor that many parents use to justify their decision not to have their child vaccinated.

But among the 17 percent of cases in which the person developed the measles after being vaccinated, only 8 percent had received both recommended doses of the vaccine.

The number of measles cases reported this year are concerning, but will probably (and fortunately) not reach the 668 confirmed cases that occurred in 2014 — the highest number since the elimination of measles was declared in the U.S. in 2000. A majority of last year’s cases (338) involved a group of unvaccinated Amish people in Ohio, which may explain why that outbreak had little influence on vaccination decisions by parents elsewhere in the country.

This year’s Disneyland outbreak, however, seems to have resonated more with parents — and to have shifted at least some parents’ attitudes toward vaccines.

“More parents read the news and are open to counseling,” said one health professional in the Medscape survey. 

Key findings

Here are some of the other findings from the survey:

  • Not all vaccines are being equally refused. Among the clinicians surveyed, 58 percent said parents were most likely to refuse (or to request an alternative vaccination schedule for) the measles, mumps and rubella (MMR) and the human papillomavirus (HPV) vaccines.

“MMR's reputation seems to have been permanently stained by the now discredited link with autism; the perception of a connection persists,” write the author’s of the Medscape report. “… Objections to the HPV vaccine reported by survey participants include the fear that giving the vaccine will encourage sexual activity, and the conviction that the child is too young for sexual activity and therefore does not need the HPV vaccine. Media reports about complications associated with the HPV vaccine pose other barriers to its uptake.”

  • Of the clinicians who said they were seeing a greater acceptance of vaccines among parents, 49 percent attributed that increased acceptance to parental fears that their child would contract a vaccine-preventable disease. Another 23 percent said that the driving factor behind the growing acceptance was the fact that more schools, daycares and camps are denying admission to unvaccinated children.
  • Almost 80 percent of the clinicians said that they don’t modify their practices for families with unvaccinated children. Eighteen percent have separate hours for routine visits from unvaccinated children, however, and 13 percent have separate waiting areas and exam rooms for such children.

Practitioners say they keep serving families who refuse vaccinations primarily out of the hope that they can persuade them to change their minds.

  • When the clinicians were asked what would be most effective in encouraging more parents to have their children vaccinated, 70 percent said “better information from the media,” while 61 percent said “eliminating non-medical vaccine exemptions.” 

May be temporary

If there has been an upswing this year in vaccination acceptance among parents who previously refused them, it may be short-lived.

In a Medscape article that accompanied the release of the survey’s findings, a pediatrician in Washington State noted that a local measles outbreak had “led to a panic that temporarily increased vaccine acceptance, but that parents who had avoided immunization eventually began refusing again.”

The article also describes what happened when a group of physicians in Vermont sent a letter earlier this year to the parents of children in their practice who were either unimmunized or underimmunized. They asked the parents to reconsider their stance on immunization “in light of the current news.”

Only two or three of the 50 families who were sent the letter changed their minds and brought their children in for immunizations.

“It’s distressing, but not terribly surprising,” one of the physicians told Medscape.

You can read through a slide presentation of the survey’s findings on the Medscape website.

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Comments (1)

US measles cases down 68% compared to last year

Provisional case count through week 33

2014: 577
2015: 185

Change: -68%

Odd how that's not newsworthy, but perceptions of an increase in outbreaks is. It's almost like there's an agenda in the reporting and not just reporting of facts.

Also, this is a completely unfounded assertion:
"Eighty-three percent of this year’s measles cases (at least, of the 173 that were reported through July) involved individuals who were unvaccinated, the Medscape report notes."

What the Medscape report actually says:
"According to provisional data, as of July 24, 2015, approximately 17% of US residents who contracted measles were confirmed to have been vaccinated against measles"

One does not arrive at the confirmed unvaccinated percentage by subtracting the confirmed vaccinated from 100%. The April 17, 2015 MMWR helps by drilling down the numbers.

"Patients ranged in age from 6 weeks to 70 years; 26 (16%) were aged <12 months, 18 (12%) were aged 1–4 years, 27 (17%) were aged 5–19 years, 58 (36%) were aged 20–39 years, and 30 (19%) were aged ≥40 years. Twenty-two patients (14%) were hospitalized, including five with pneumonia. No other complications and no deaths have been reported.... The majority of the 159 patients with reported measles in the 2015 outbreaks were either unvaccinated (71 [45%]) or had unknown vaccination status (60 [38%]); 28 (18%) had received measles vaccine. Among the 68 U.S. residents who had measles and were unvaccinated, 29 (43%) cited philosophical or religious objections to vaccination, 27 (40%) were ineligible because they were too young to receive vaccination (26 patients) or had a medical contraindication (one), three (4%) represented missed opportunities for vaccination, and nine (13%) had other reasons for not being vaccinated (Figure 2)."

That shows that the percentage of cases where the person was confirmed unvaccinated was 45%, and within that for philosophical or religious reasons (the point of this and countless other articles focused on demonizing so-called "anti-vax" parents) is 29 out of 159, or 18%. Assuming 50/50 split philosophical/religious reasons, and seeing that people ages 1-19 accounted for 29% of cases, the number of children of "anti-vax" parents who got the measles this year in the US can probably be counted on one hand. This is nowhere in the ballpark of 83%.

Also:
"42 percent of pediatricians and other health professionals said they believed parents had become more accepting of vaccines since the Disneyland outbreak — particularly the measles vaccine."

Key word being "believed". That's not hard data. And 42% is not a majority.

The hard data we do have is from the annual National Immunization Survey, which consistently (ie, not increasing) shows the percentage of US children ages 19-35 months who received no vaccinations as 0.7-0.8%. Medical exemption rates are generally 0.2%, so that leaves "anti-vax" percentage at 0.5-0.6%. Assuming a 50/50 religious/philosophical split, the archetype demonized in the media as "anti-vax" comprises probably only 2 or 3 out of 1,000 cases -- which is far too small to have an effect on "herd immunity".

Sources:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6333md.htm?s_cid=mm6333md_w
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6433md.htm?s_cid=mm6433md_w
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6414a1.htm?s_cid=mm6414a1_w
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6433a1.htm