Parents Distrust, Delay Vaccines, Survey Finds

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Parents are increasingly skipping or delaying vaccines for their young children, despite doctors' concerns that doing so will leave their children and community at risk for preventable diseases.

A nationwide survey found that more than 1 in 10 parents vaccinated their children outside of the recommended schedule developed by the U.S. Centers for Disease Control and Prevention.

Only 2 percent of parents in the study refused all vaccines for their children. But many showed distrust of the official recommended vaccination schedule, and 13 percent reported using an alternative vaccine schedule, meaning they skipped or delayed vaccines, according to the paper published today (Oct. 3) in the journal Pediatrics.

Even among the parents who followed the recommended schedule, 25 percent said they believed delaying vaccines avoided side effects, and 29 percent thought allowing parents to skip vaccines let them avoid "those vaccines that aren't really necessary."

Despite these beliefs, vaccine researcher Dr. Paul Offit said that vaccines are safe, and that delaying vaccines does not protect against rare side effects.

"What do you get for delaying it? Nothing," said Offit, chief of Infectious Diseases at the Children's Hospital of Philadelphia.

The survey responses also indicated parents were not aware of the risks of delaying vaccines. For instance, 81 percent of parents who skipped or delayed vaccines did not "agree" with the fact that leaving children unvaccinated puts them and their community at risk for disease.

"That's wrong," Offit said. "Those decisions are being made not only on false beliefs on vaccine safety, but also false believes on contagious disease and transmission." He added that the vaccination schedule was developed out of safety data from the clinical trials of vaccines.

What's behind the distrust?

Researchers asked 748 families with children ages 6 months to 6 years about their vaccine choices, education, income and demographics. They also asked parents whether they agreed or disagreed with common facts, fears and assumptions about childhood vaccines.

Dr. Amanda Dempsey, lead author on the study, said parents' past experiences may sway their decisions to skip vaccines in their children.  The most commonly skipped vaccines were the flu and chicken pox (varicella) shots.

"Most people of parenting age today have had chicken pox, or have had at least something they thought was the flu," Dempsey said, and they survived these illnesses.

However, Dempsey said doctors have seen the rare cases where the virus leads to hospital stays and the risk of death.

Dempsey said she was not surprised that the MMR (measles, mumps and rubella) vaccine was more often delayed rather than skipped. "That's the vaccine that has been most controversially related to autism," she said. Dempsey said families often delay the vaccine until after ages 2 to 4, which is when signs of autism most often appear. [Vaccines and Autism Timeline: How the Truth Unfolded]

While memory of the flu and chickenpox may sway people toward thinking those vaccinations are unneeded, so too could lack of experience with some diseases.

"When you increase coverage of vaccines, the rates of those diseases start going down," said Dr. Saad Omer, an assistant professor of Global Health, Epidemiology and Pediatrics at Emory University.

So fewer people can remember seeing someone with the disease, and "at the same time, people start hearing more about the real or perceived vaccine adverse events," Omer said.

This creates an environment where parents are more likely to fear the vaccine more than the disease.

Add to that fear the unpleasant experience of injecting young children with five shots at a time, and it could create "a perfect storm" of vaccine fears, Offit said.

Yet while physician associations back the CDC guidelines, only 8 percent of surveyed parents who asked to change the vaccination schedule had to find another doctor because one refused to participate in the alternative schedule.

Distrust is likely to continue

It is now so common for doctors to encounter parents who refuse vaccines, that the American Academy of Pediatrics (AAP) drafted an official position on how to respond to the request, Dempsey said.

The AAP recommends that "we should work with families not to fire them from our clinics," Dempsey said. "Although it would be ideal to get all the vaccines, it's better to get some in and not to alienate the family completely."

But this position comes with drawbacks. "When you say, OK, we'll do it your way, there's a tacit agreement that you are right," Offit said.

Dempsey said the results of the study imply distrust of vaccines is likely to continue. Of the parents who wanted to delay or skip vaccines, 30 percent said they started on the recommended schedule.

"Overall, what our study showed to me is that this problem is not going to go away soon, and it's likely going to get work due to people's tenuous attitudes toward vaccines," she said.

Pass it on: More than 1 in 10 parents are not following the recommended schedule of vaccinations.

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