User login
Roughly one out of every four children in New York state is vaccinated under a schedule that intentionally deviates from the one recommended by the Centers for Disease Control and Prevention, according to a study published in the Journal of Pediatrics.
“The number of children vaccinated off schedule has been increasing in recent years,” said lead investigator Jessica A. Nadeau, Ph.D., of the State University of New York, University at Albany, Rensselaer, and her associates, adding that “The continuing use of alternative schedules has prompted questions regarding the effects of these deviations on undervaccination, disease risk, and the safety and effectiveness of these new vaccine patterns” (J. Pediatr. 2015;166:151-6).
In a retrospective cohort study, Dr. Nadeau and her coinvestigators analyzed data on all children born in New York state, but not in New York City, between Jan. 1, 2009, and Aug. 14, 2011, ultimately ending up with 337,945 children from the New York state Immunization Information System (NYSIIS). Of those, 222,628 (81%) were deemed eligible for inclusion in the study because they had received, starting at age 41 days, at least three vaccinations by age 9 months.
Children were classified into two groups: those who had been vaccinated following the recommended vaccination schedule as outlined by the Centers for Disease Control and Prevention, and those who were vaccinated intentionally following an alternative schedule. Investigators then compared visits for vaccinations made over the course of the study period between both cohorts.
Analysis of the accumulated data revealed that 154,150 subjects (69.3%) were considered to be following the routine vaccination schedule.
However, 56,607 subjects (25.4%) were considered to be following alternative schedules. Of those, 20,412 of those subjects (36.1% of subset) were on restrictive schedule only, 16,877 subjects (29.8% of subset) were classified as selective refusals only, and 19,318 subjects (34.1% of subset) were classified as both restrictive and selective refusals of vaccinations.
The remaining 11,871 individuals (5.3%) in the study population were classified as following an “unknown” vaccination schedule.
Children who followed the routine schedule were far more likely to be up to date on their vaccinations than those following alternative schedules: 89.8% vs. 14.8%, respectively (P < .05). The most commonly missed or refused vaccines in the alternative cohort were rotavirus (78.8%), hepatitis B (13.1%), and pneumococcal conjugate vaccine (6.6%).
“Although parents and physicians may view an alternative schedule as the middle ground between the routine schedule and choosing not to vaccinate, intentional deviation from the routine schedule through an alternative schedule leaves children without adequate protection from vaccine preventable disease,” warned Dr. Nadeau and her coauthors, adding that “the reemergence of vaccine-preventable diseases, coupled with increasing proportions of children using an alternative schedule, may set the stage for more widespread outbreaks of vaccine-preventable diseases.”
The authors reported that the study was supported by funding from the Centers for Disease Control and Prevention, but made no other relevant financial disclosures.
Using alternative vaccination schedules, or refusing vaccinations altogether, is certainly a common problem not only in New York state, but also across the country. We’ve lost an understanding, both on the part of the public and on the part of health care providers, as to why we even have schedules. We have them because it’s about trying to gain protection for children as quickly as possible against the diseases they’re most likely to contract after the immunity protection from the mother wanes, which happens even if the mother is still breastfeeding. This idea of getting the vaccinations on schedule – for example, at age 2 months, 4 months, and 6 months – is specifically intended to achieve the goal of immunity by the time that protection from the mother has waned.
Because the schedule has been handed down by the American Academy of Pediatrics and the Centers for Disease Control and Prevention as “recommended” with no detailed explanation why, many pediatricians are unaware of the immunology and all the research that went into creating the schedule. It requires the health care provider’s agreement and the parent’s request to have the results shown in this study, where one in four children intentionally deviated from the routine schedule. If a parent asks me to deviate, I have the knowledge as an immunologist and infectious disease specialist to explain why I don’t think that’s a good idea. And when I do, the parents agree to the routine schedule. But if you’re not informed as to why, then you have other information from sources that are not as well informed, recommending all these alternative vaccination schedules.
We, as health care providers, can never force a parent to do something. There should be discussion between provider and parent to inform the latter of the risks of delaying vaccinations or following alternative schedules. The unfortunate thing is that by not following the recommendations, the parent is making the child more susceptible to contracting the very disease she should have been vaccinated against. I’m aware of a recent case in which an alternative schedule was used, but the child did not achieve full immunity, and as a result, contracted bacterial spinal meningitis and died. Now that parent feels tremendous guilt, and the doctor in charge of caring for the child also feels guilt and wonders if pushing the parent harder to stick to the recommended schedule would have saved the child’s life.
There was also a recent research study that surprised everyone – by Nyhan B et al. (Pediatrics 2014;133:e835-42) – because we’re searching for a way to solve all these problems that we’ve encountered over the last 10 years or so in achieving more complete and more timely vaccination. But the findings of that study were disappointing because the investigators tried several different approaches to achieve that outcome, but none of them worked. And, in some cases, trying to educate parents about certain misconceptions or correcting false information turned out to be counterproductive.
Dr. Michael E. Pichichero is a specialist in pediatric infectious diseases and is the director of the Research Institute at Rochester (N.Y.) General Hospital, as well as a pediatrician at Legacy Pediatrics in Rochester. He was asked to comment on the article by Dr. Nadeau et al. Dr. Pichichero said he had no relevant financial disclosures.
Using alternative vaccination schedules, or refusing vaccinations altogether, is certainly a common problem not only in New York state, but also across the country. We’ve lost an understanding, both on the part of the public and on the part of health care providers, as to why we even have schedules. We have them because it’s about trying to gain protection for children as quickly as possible against the diseases they’re most likely to contract after the immunity protection from the mother wanes, which happens even if the mother is still breastfeeding. This idea of getting the vaccinations on schedule – for example, at age 2 months, 4 months, and 6 months – is specifically intended to achieve the goal of immunity by the time that protection from the mother has waned.
Because the schedule has been handed down by the American Academy of Pediatrics and the Centers for Disease Control and Prevention as “recommended” with no detailed explanation why, many pediatricians are unaware of the immunology and all the research that went into creating the schedule. It requires the health care provider’s agreement and the parent’s request to have the results shown in this study, where one in four children intentionally deviated from the routine schedule. If a parent asks me to deviate, I have the knowledge as an immunologist and infectious disease specialist to explain why I don’t think that’s a good idea. And when I do, the parents agree to the routine schedule. But if you’re not informed as to why, then you have other information from sources that are not as well informed, recommending all these alternative vaccination schedules.
We, as health care providers, can never force a parent to do something. There should be discussion between provider and parent to inform the latter of the risks of delaying vaccinations or following alternative schedules. The unfortunate thing is that by not following the recommendations, the parent is making the child more susceptible to contracting the very disease she should have been vaccinated against. I’m aware of a recent case in which an alternative schedule was used, but the child did not achieve full immunity, and as a result, contracted bacterial spinal meningitis and died. Now that parent feels tremendous guilt, and the doctor in charge of caring for the child also feels guilt and wonders if pushing the parent harder to stick to the recommended schedule would have saved the child’s life.
There was also a recent research study that surprised everyone – by Nyhan B et al. (Pediatrics 2014;133:e835-42) – because we’re searching for a way to solve all these problems that we’ve encountered over the last 10 years or so in achieving more complete and more timely vaccination. But the findings of that study were disappointing because the investigators tried several different approaches to achieve that outcome, but none of them worked. And, in some cases, trying to educate parents about certain misconceptions or correcting false information turned out to be counterproductive.
Dr. Michael E. Pichichero is a specialist in pediatric infectious diseases and is the director of the Research Institute at Rochester (N.Y.) General Hospital, as well as a pediatrician at Legacy Pediatrics in Rochester. He was asked to comment on the article by Dr. Nadeau et al. Dr. Pichichero said he had no relevant financial disclosures.
Using alternative vaccination schedules, or refusing vaccinations altogether, is certainly a common problem not only in New York state, but also across the country. We’ve lost an understanding, both on the part of the public and on the part of health care providers, as to why we even have schedules. We have them because it’s about trying to gain protection for children as quickly as possible against the diseases they’re most likely to contract after the immunity protection from the mother wanes, which happens even if the mother is still breastfeeding. This idea of getting the vaccinations on schedule – for example, at age 2 months, 4 months, and 6 months – is specifically intended to achieve the goal of immunity by the time that protection from the mother has waned.
Because the schedule has been handed down by the American Academy of Pediatrics and the Centers for Disease Control and Prevention as “recommended” with no detailed explanation why, many pediatricians are unaware of the immunology and all the research that went into creating the schedule. It requires the health care provider’s agreement and the parent’s request to have the results shown in this study, where one in four children intentionally deviated from the routine schedule. If a parent asks me to deviate, I have the knowledge as an immunologist and infectious disease specialist to explain why I don’t think that’s a good idea. And when I do, the parents agree to the routine schedule. But if you’re not informed as to why, then you have other information from sources that are not as well informed, recommending all these alternative vaccination schedules.
We, as health care providers, can never force a parent to do something. There should be discussion between provider and parent to inform the latter of the risks of delaying vaccinations or following alternative schedules. The unfortunate thing is that by not following the recommendations, the parent is making the child more susceptible to contracting the very disease she should have been vaccinated against. I’m aware of a recent case in which an alternative schedule was used, but the child did not achieve full immunity, and as a result, contracted bacterial spinal meningitis and died. Now that parent feels tremendous guilt, and the doctor in charge of caring for the child also feels guilt and wonders if pushing the parent harder to stick to the recommended schedule would have saved the child’s life.
There was also a recent research study that surprised everyone – by Nyhan B et al. (Pediatrics 2014;133:e835-42) – because we’re searching for a way to solve all these problems that we’ve encountered over the last 10 years or so in achieving more complete and more timely vaccination. But the findings of that study were disappointing because the investigators tried several different approaches to achieve that outcome, but none of them worked. And, in some cases, trying to educate parents about certain misconceptions or correcting false information turned out to be counterproductive.
Dr. Michael E. Pichichero is a specialist in pediatric infectious diseases and is the director of the Research Institute at Rochester (N.Y.) General Hospital, as well as a pediatrician at Legacy Pediatrics in Rochester. He was asked to comment on the article by Dr. Nadeau et al. Dr. Pichichero said he had no relevant financial disclosures.
Roughly one out of every four children in New York state is vaccinated under a schedule that intentionally deviates from the one recommended by the Centers for Disease Control and Prevention, according to a study published in the Journal of Pediatrics.
“The number of children vaccinated off schedule has been increasing in recent years,” said lead investigator Jessica A. Nadeau, Ph.D., of the State University of New York, University at Albany, Rensselaer, and her associates, adding that “The continuing use of alternative schedules has prompted questions regarding the effects of these deviations on undervaccination, disease risk, and the safety and effectiveness of these new vaccine patterns” (J. Pediatr. 2015;166:151-6).
In a retrospective cohort study, Dr. Nadeau and her coinvestigators analyzed data on all children born in New York state, but not in New York City, between Jan. 1, 2009, and Aug. 14, 2011, ultimately ending up with 337,945 children from the New York state Immunization Information System (NYSIIS). Of those, 222,628 (81%) were deemed eligible for inclusion in the study because they had received, starting at age 41 days, at least three vaccinations by age 9 months.
Children were classified into two groups: those who had been vaccinated following the recommended vaccination schedule as outlined by the Centers for Disease Control and Prevention, and those who were vaccinated intentionally following an alternative schedule. Investigators then compared visits for vaccinations made over the course of the study period between both cohorts.
Analysis of the accumulated data revealed that 154,150 subjects (69.3%) were considered to be following the routine vaccination schedule.
However, 56,607 subjects (25.4%) were considered to be following alternative schedules. Of those, 20,412 of those subjects (36.1% of subset) were on restrictive schedule only, 16,877 subjects (29.8% of subset) were classified as selective refusals only, and 19,318 subjects (34.1% of subset) were classified as both restrictive and selective refusals of vaccinations.
The remaining 11,871 individuals (5.3%) in the study population were classified as following an “unknown” vaccination schedule.
Children who followed the routine schedule were far more likely to be up to date on their vaccinations than those following alternative schedules: 89.8% vs. 14.8%, respectively (P < .05). The most commonly missed or refused vaccines in the alternative cohort were rotavirus (78.8%), hepatitis B (13.1%), and pneumococcal conjugate vaccine (6.6%).
“Although parents and physicians may view an alternative schedule as the middle ground between the routine schedule and choosing not to vaccinate, intentional deviation from the routine schedule through an alternative schedule leaves children without adequate protection from vaccine preventable disease,” warned Dr. Nadeau and her coauthors, adding that “the reemergence of vaccine-preventable diseases, coupled with increasing proportions of children using an alternative schedule, may set the stage for more widespread outbreaks of vaccine-preventable diseases.”
The authors reported that the study was supported by funding from the Centers for Disease Control and Prevention, but made no other relevant financial disclosures.
Roughly one out of every four children in New York state is vaccinated under a schedule that intentionally deviates from the one recommended by the Centers for Disease Control and Prevention, according to a study published in the Journal of Pediatrics.
“The number of children vaccinated off schedule has been increasing in recent years,” said lead investigator Jessica A. Nadeau, Ph.D., of the State University of New York, University at Albany, Rensselaer, and her associates, adding that “The continuing use of alternative schedules has prompted questions regarding the effects of these deviations on undervaccination, disease risk, and the safety and effectiveness of these new vaccine patterns” (J. Pediatr. 2015;166:151-6).
In a retrospective cohort study, Dr. Nadeau and her coinvestigators analyzed data on all children born in New York state, but not in New York City, between Jan. 1, 2009, and Aug. 14, 2011, ultimately ending up with 337,945 children from the New York state Immunization Information System (NYSIIS). Of those, 222,628 (81%) were deemed eligible for inclusion in the study because they had received, starting at age 41 days, at least three vaccinations by age 9 months.
Children were classified into two groups: those who had been vaccinated following the recommended vaccination schedule as outlined by the Centers for Disease Control and Prevention, and those who were vaccinated intentionally following an alternative schedule. Investigators then compared visits for vaccinations made over the course of the study period between both cohorts.
Analysis of the accumulated data revealed that 154,150 subjects (69.3%) were considered to be following the routine vaccination schedule.
However, 56,607 subjects (25.4%) were considered to be following alternative schedules. Of those, 20,412 of those subjects (36.1% of subset) were on restrictive schedule only, 16,877 subjects (29.8% of subset) were classified as selective refusals only, and 19,318 subjects (34.1% of subset) were classified as both restrictive and selective refusals of vaccinations.
The remaining 11,871 individuals (5.3%) in the study population were classified as following an “unknown” vaccination schedule.
Children who followed the routine schedule were far more likely to be up to date on their vaccinations than those following alternative schedules: 89.8% vs. 14.8%, respectively (P < .05). The most commonly missed or refused vaccines in the alternative cohort were rotavirus (78.8%), hepatitis B (13.1%), and pneumococcal conjugate vaccine (6.6%).
“Although parents and physicians may view an alternative schedule as the middle ground between the routine schedule and choosing not to vaccinate, intentional deviation from the routine schedule through an alternative schedule leaves children without adequate protection from vaccine preventable disease,” warned Dr. Nadeau and her coauthors, adding that “the reemergence of vaccine-preventable diseases, coupled with increasing proportions of children using an alternative schedule, may set the stage for more widespread outbreaks of vaccine-preventable diseases.”
The authors reported that the study was supported by funding from the Centers for Disease Control and Prevention, but made no other relevant financial disclosures.
FROM THE JOURNAL OF PEDIATRICS
Key clinical point: Almost 25% of children in New York state are vaccinated under a schedule that intentionally deviates from the one recommended by the CDC, possibly leading to increased rates of infection and disease outbreaks.
Major finding: Proportion of children vaccinated following an alternative schedule was 25%; these children were significantly less likely to be up to date at age 9 months (15%), compared with those whose vaccinations adhering to recommended schedule (90%, P < .05).
Data source: Retrospective cohort study of 222,628 children in New York state, outside of New York City.
Disclosures: The authors reported that the study was supported by funding from the Centers for Disease Control and Prevention, but made no other relevant financial disclosures.
