Do most parents use the alternative vaccine schedule?

I see this as a glass half-full, glass half-empty issue. Recently, a study was published in Pediatrics detailing research conducted in May of 2010 about parents’ preferences to use alternative vaccination schedules versus following the recommended CDC vaccination schedule. The majority of the media coverage focused on the finding that over 10% of parents followed a schedule other than the one recommended by the CDC. Not perfect and not ideal from a public health stand point. Yet, of course, the other way to see this is that nearly 90% of parents did follow the physician-recommended schedule. That’s a pretty good success rate for doctors.

As a pediatrician practicing in Washington State, I saw this study half-full. As I read through the methods, results, and discussion, I took notes on the cover page. I actually made that little doodle. I couldn’t help but think about the nearly 90% of families (87%) who followed the recommended schedule to protect their children and their communities. Clearly 87% is not 100% (I get that) and it leaves our communities and our children at risk, but I believe we can continue to improve trust with ongoing education.

Focusing on the group that does vaccinate their children on the schedule may be a good strategy to understanding where we can improve our communication about the benefits of vaccination. We often focus on the group that doesn’t vaccinate but we miss insight from those of us who do immunize our children on the schedule.

Details: The study was conducted on over 2000 respondents, where 771 families qualified by reporting having a child between 6 months and 6 years of age. They were asked if they followed the CDC schedule and then if they didn’t, they were asked to answer a series of closed-ended questions regarding the nitty gritty of the schedule they used. Parents’ age, gender, race/ethnicity, and level of education and family insurance were collected.

Glass Half Full Findings:

Only 2% of all the families interviewed refused all vaccines for their children. Two percent simply isn’t much.
13% of parents reported following an alternative vaccination schedule, with most families stating they only refused certain vaccines (53% of them). This means that nearly 90% of parents reported following the CDC recommendations. That’s nearly an A minus!
Of the “alternative vaccinators,” a large minority of parents reported having initially following the recommended schedule.
55% of families that were on alternative schedule ended up giving all of the recommended vaccines but on a delayed schedule.
Of the “alternative vaccinators,” only 8% of that group followed a well-known alternative schedule such as that offered up by Dr Bob Sears or Dr Donald Miller.
Several families free-text responded that they had worked with their child’s physician” to develop the schedule.” Fantastic. A true partnership between the patient and physician and one that is transparent and necessary for catch-up immunizations.

Now I can imagine physicians screaming at me at this point, directing me to all of the issues with the above findings and why they aren’t necessarily positive. I’m not ignorant, but I still experience those findings as hopeful for our communities. Our job really may be activating those parents who do vaccinate and who do follow the CDC schedule to share their stories and their “whys” behind protecting their children from harm with vaccines.

For me, the most concerning finding resided in a group that followed doctors’ advice but doubted their own choice. Of the group that vaccinated their young children on the CDC’s recommended schedule, 28% reported that they felt the alternative schedule was actually safer. What? Oh no. This certainly serves as a wake-up call that we clearly aren’t doing a good job explaining the benefits of the schedule. And we may not be checking back in with families after vaccinations. As I stated in the mission of this blog, what I know in my heart is that parents want to do what is right for their children. This statistic challenges that parents feel reassured after vaccine-visits. And it serves as a reminder for physicians everywhere.

Glass Half Empty Finding:

1 in 5 parents who followed the recommended CDC schedule felt that delaying vaccines was safer than the CDC schedule they had used with their children. Unsettling. As the authors point out, this finding represents that 1 in 5 families may be “at risk” for changing to an alternative vaccination schedule. This would assume that housing doubt (about anything) would stop a parent from immunizing. In my experience, that’s not exactly how parenting works. Sometimes, we do what is recommend by those we trust (our children’s physician, a vaccinologist) because they are more expert than we are and understand more about the risks and benefits. And we sometimes remain concerned. I suspect this group represents that sentiment. And from my vantage point, late tonight after a long day in clinic, it seems like this is simply part of parenthood at times…
Most families indicated that they came up with the new schedule themselves (41%), or took advice from a friend (15%) or family member.
22% disagreed with the statement that the best vaccination schedule to follow was the one recommended by vaccination experts. Befuddling. If we don’t let our national and world vaccine experts hold our trust, who should get it? Simply don’t understand this. Remember earlier this year a study found the far majority of parents trusted their child’s pediatrician most when getting information about vaccine safety. Regardless, the 22% statistic confirms we need to do more to explain how vaccine research is conducted and why it is best to immunize early to maximize protection for children.
86% of families using the alternative schedule had refused the H1N1 vaccine for their children. Gasp.
76% of families using the alternative schedule had refused the seasonal influenza vaccine for their children. Did you see my recent video about influenza?
The vaccines most commonly spaced out were the MMR (45%) and the DTaP (43%). As many of you know, we have widely elevated circulating rates of pertussis (whooping cough) in the US. An infant died in the county where I practice last month from whooping cough, while 2 other infants were hospitalized. Many studies have found that underimmunization in communities significantly increases the risk of contracting and spreading vaccine-preventable diseases. Further, for 2011, the Health District in Snohomish County (where I see patients in clinic) has had 80 laboratory-confirmed or epidemiologically-linked cases of pertussis reported. In contrast, for all of 2010, Snohomish County had only 25 cases, and for 2009–only 33 cases.

Glass half empty or glass half full? How do you see it? How do these numbers make you feel? Since no vaccine is 100% effective, all of our children (and all of us) are dependent on an entire community being immunized to avoid vaccine preventable disease. Does this study make you upset?

Do you use an alternative schedule against your doctor’s and vaccine experts’ advice? Why?

Wendy Sue Swanson is a pediatrician who blogs at Seattle Mama Doc.

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