Parental concerns about vaccines and choice of alternative vaccine schedules

Background: Parental concerns about vaccine safety and efficacy are increasing. Understanding the relationship between the parental concerns and requests for alternative schedules is an important step in designing effective counseling scripts for providers and public health officials. This study describes the prevalence of and relationship between specific concerns and specific alternative schedules in a pediatric practice with many hesitant and refusing parents. Methods: Medical records data were extracted for 168 patients in a solo pediatric practice in a large northeastern city. Data included specific vaccine concerns identified by parents during a vaccine counseling session and the vaccine schedule parents requested (e.g., ACIP, all vaccines but spaced, or decline all vaccines). The prevalence of each of 9 concerns and 7 alternative schedules was calculated. Bivariate associations between concerns and schedules were assessed using Fisher's exact test. Results: 40% of parents had one or more concerns. Common concerns identified were vaccines overtaxing the immune system (16%), the rareness of vaccine-preventable diseases (10%), a preference for natural immunity (7%), and autism (5%). There was considerable heterogeneity in the relationships between concerns and alternative schedule requests. For example, being concerned about vaccines overtaxing the immune system was significantly associated with a spaced schedule or postponing all vaccines to a certain age but not with declining all vaccines or choosing “Dr. Bob [Sears]'s” alternative schedule. Conclusions: Pediatricians should elicit the specific vaccine concerns that parents have and understand how concerns may be associated with requests for a particular alternative schedule in order to effectively promote vaccine adherence.