OBJECTIVE
To determine whether contraindications to immunization are inappropriately broadened for children with a fever or a neurologic condition.
PARTICIPANTS
Pediatric and family medicine residents (N = 52 and 23, respectively) at the University of Rochester (NY).
DESIGN
Cross-sectional survey. Residents rated how likely they would be to administer a diphtheria-tetanus-pertussis or measles-mumps-rubella vaccine in 17 clinical scenarios according to a rating scale ranging from 1 (never) to 5 (always). For all scenarios, the immunization was recommended by the American Academy of Pediatrics or the Immunization Practices Advisory Committee.
RESULTS
In only five and three of 17 scenarios would 90% or more of the pediatric residents and family medicine residents, respectively, have administered an immunization. For diphtheria-tetanus-pertussis vaccine, pediatric residents reported a lower likelihood of vaccinating a 2-month-old child with a low fever (temperature, 38.1 degrees C) than an afebrile child (mean score, 3.0 vs 4.7; P < .01). A 2-year-old child with idiopathic epilepsy, a 2-month-old child with intraventricular hemorrhage, and a 2-month-old child who had a parent with a seizure disorder each had a lower reported likelihood to be vaccinated than a same-aged child without a neurologic condition (2.8 vs 4.5; 4.1 vs 4.7; and 4.3 vs 4.7, respectively; each P < .01). For measles-mumps-rubella, pediatric residents reported a lower likelihood of vaccinating a 15-month-old child with a low fever than an afebrile child (4.2 vs 4.9; P < .01). A child with a progressive neurologic disease had a lower reported likelihood to be vaccinated than a child without a neurologic condition (3.5 vs 4.9; P < .01).
CONCLUSIONS
Residents reported a lower likelihood of immunizing children with a fever or neurologic condition. Such practice styles may contribute to underimmunization. Residents need to be educated regarding which medical conditions contraindicate an immunization.
[1]
S. Humiston,et al.
Immunization practices of primary care practitioners and their relation to immunization levels.
,
1994,
Archives of pediatrics & adolescent medicine.
[2]
V. Dietz,et al.
Standards for Pediatric Immunization Practices
,
1993
.
[3]
K. McConnochie,et al.
Immunization opportunities missed among urban poor children.
,
1992,
Pediatrics.
[4]
L. Markowitz,et al.
Vaccination levels and missed opportunities for measles vaccination: a record audit in a public pediatric clinic.
,
1992,
Pediatrics.
[5]
D. Langkamp,et al.
Primary care physicians' knowledge about diphtheria-tetanus-pertussis immunizations in preterm infants.
,
1992,
Pediatrics.
[6]
G. Stollerman,et al.
The measles epidemic. The problems, barriers, and recommendations. The National Vaccine Advisory Committee.
,
1991,
JAMA.
[7]
W. Orenstein,et al.
Measles outbreak among unvaccinated preschool-aged children: opportunities missed by health care providers to administer measles vaccine.
,
1989,
Pediatrics.
[8]
K. Margolis,et al.
Organizational strategies to improve influenza vaccine delivery. A standing order in a general medicine clinic.
,
1988,
Archives of internal medicine.
[9]
J. Cherry,et al.
Influence of parental knowledge and opinions on 12-month diphtheria, tetanus, and pertussis vaccination rates.
,
1988,
American journal of diseases of children.
[10]
M. Morgan,et al.
Measles immunisation: feasibility of a 90% target uptake.
,
1987,
Archives of disease in childhood.
[11]
R. Baker,et al.
Failure to vaccinate against whooping cough.
,
1986,
Archives of disease in childhood.
[12]
K J Roghmann,et al.
Missed opportunities for childhood vaccinations in office practices and the effect on vaccination status.
,
1993,
Pediatrics.