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Nov./Dec. 2009
Vol. 19 No. 11
Annual Meeting Coverage
Understanding Opposition and Barriers to Vaccination
Ed Susman

Today’s anti-vaccine movement had its impetus in one event in the early 1980s, according to immunization advocate Paul Offit, MD: a television show that aired in Washington, D.C., in 1982 called “DPT Vaccine Roulette.”  Dr. Offit, chief of infectious diseases and director of the Vaccine Education Center at Children’s Hospital in Philadelphia, shared this conclusion during a presentation at the opening plenary session of the 47th Annual Meeting of IDSA, one of several sessions that addressed immunization issues.

Based on the belief that their children had suffered permanent harm from the pertussis vaccine, Dr. Offit said, a small group of advocates, featured in that program, “were ultimately able to gather a grassroots group of parents who were very media savvy, who were politically connected. Any time a new vaccine was introduced from that point, they were very good about getting media access.”

The movement that followed has contributed to outbreaks of pertussis in 2006, measles in 2008, and recent deaths from Haemophilus influenzae, all of which occurred in undervaccinated groups, Dr. Offit suggested. But after 25 years of attacks on science, the pendulum may be swinging back, he said, as people pay more attention to protecting their children through vaccination rather than withholding their children from vaccination because of unproven claims.

Obstacles to vaccination, however, come not only come from parents – usually well-educated, and upper middle-class – but sometimes from physicians as well, said Marietta Vazquez, MD, assistant professor of pediatrics at Yale University School of Medicine in New Haven, Conn., and an oral abstract session presenter. In a matched case-control study, researchers found that vaccinating pregnant mothers against influenza reduced the risk of hospitalization of their infants within six months of birth.

As part of the study, researchers also interviewed parents to determine their risk factors for influenza. “When we asked pregnant women about why they didn’t get [influenza] vaccinations,” Dr. Vazquez said, “what we found, in large strokes, was that obstetricians do not offer influenza vaccine.”

William Schaffner, MD, FIDSA, professor of medicine at Vanderbilt University Medical Center in Nashville, Tenn., and chair of IDSA’s Immunization Work Group, has observed the same phenomenon. “We find that obstetricians are not used to vaccinating,” Dr. Schaffner said. “Their office staff doesn’t know how to order the vaccine. They are uncomfortable with billing procedures and all that paraphernalia: how you keep the vaccine safe, what’s the temperature of the refrigerator.”

In a “Meet the Professor” discussion at the meeting, Dr. Offit noted that his hospital’s vaccine education program was developed, in part, in response to a doctor who questioned vaccination. “When we created our vaccination center, we wanted to educate young parents through doctors,” he said, “but we also wanted to educate young doctors at the same time.”

The reason some in both groups are not compelled by vaccination may be the same, Dr. Offit suggested: “They don’t see those diseases, didn’t grow up with those diseases, and for them, it has become a matter of faith.”

During a symposium on controversies in infection control, Thomas R. Talbot, MD, MPH, assistant professor of medicine and preventive medicine at Vanderbilt University, gave a review of states’ vaccination requirements for school entry. All 50 states have medical exemptions for parents to opt out of such requirements for their children, Dr. Talbot said, while 48 states have religious exemptions, and 21 have philosophical/personal belief exemptions.

In a review of state vaccination laws, Dr. Talbot noted that declination rates in those states that allowed personal belief exemptions from school-entry requirements rose from 0.99 percent in 1999 to 2.54 percent in 2004.  In contrast, those states allowing only medical and religious exemptions noted no increase in declination rate (1.0 percent for both years).

In the case of influenza, reluctance among some physicians and other health care workers (HCWs) to support immunization—and the risk that these workers will spread influenza to patients—are two of the reasons that many hospitals and health systems are implementing  mandatory influenza vaccination programs for HCWs—a move supported by IDSA (see related IDSA News story).

“Health care worker influenza vaccination has been recommended for several decades, but voluntary programs overall have not been effective at markedly improving rates,” Dr. Talbot said.  “Mandating does increase vaccination rates. The argument regarding patient safety must be pushed.”

A poster presentation, meanwhile, shared the results of a survey at a large children’s hospital that helps shed light on how one institution’s physicians, nurses, and allied HCWs feel about influenza immunization. The survey found that physicians were more likely than the other two worker groups to favor mandatory vaccination against influenza for HCWs, said Mary Anne Jackson, MD, FIDSA, chief of the section of infectious diseases at Children’s Mercy Hospital & Clinics and professor of pediatrics at the University of Missouri in Kansas City School of Medicine. Nurses were the next most likely group to support such policies, followed by allied HCWs.

Even among doctors, myths and misperceptions about influenza vaccination persisted, the survey found. These included the mistaken belief that a person who is not showing influenza symptoms could not transmit influenza to patients, Dr. Jackson said. These knowledge gaps were more common among nurses and allied HCWs than among doctors.

The survey also examined workers’ attitudes about vaccinating their children against influenza and other diseases. “Most of the health care workers who had children had immunized them, but not against influenza,” Dr. Jackson said. According to the survey results, allied health care workers believed that it should be up to the parent to decide which vaccine a child should receive.

Audio and synchronized speaker slides from sessions at the 2009 IDSA Annual Meeting are available for purchase online.
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