Adherence to the Advisory Committee on Immunization Practices Recommendation to Prevent Injuries from Postvaccination Syncope A National Physician Survey

Epidemic Intelligence Service, Division of Applied Sciences, Scientifıc Education and Professional Development Program Offıce, CDC, Atlanta, Georgia.
American journal of preventive medicine (Impact Factor: 4.53). 09/2011; 41(3):317-21. DOI: 10.1016/j.amepre.2011.04.016
Source: PubMed


Little is known about physicians' adherence to the 2006 Advisory Committee on Immunization Practices (ACIP) recommendation that providers strongly should consider observing vaccine recipients for 15 minutes to prevent injuries from postvaccination syncope.
To assess physicians' knowledge, attitudes, and practices toward observing adolescents for 15 minutes postvaccination.
A survey was administered during October 2008-January 2009 to 425 pediatricians (Peds) and 424 family medicine physicians (FPs) from a nationally representative network. Adherence was defined as reporting routinely observing patients for ≥15 minutes after vaccination. Data analysis was completed in 2009.
The overall response rate was 73%. A minority of physicians (37% Peds, 24% FPs) were aware that ACIP strongly encourages observing patients for 15 minutes postvaccination, but most physicians (69% Peds, 84% FPs) thought that their practice easily could adhere to this recommendation. Lack of room space (76% Peds, 65% FPs) was the most frequently reported barrier. Seventeen percent of physicians reported adherence to postvaccination observation. Practice in a hospital, university, or community health center compared with private practice (RR=1.64, 95% CI=1.05, 2.40); awareness of the ACIP syncope recommendation (RR=5.55, 95% CI=3.60, 9.37); and believing that postvaccination syncope can result in serious injuries (RR=1.74, 95% CI=1.06, 4.22) were independently associated with self-reported adherence.
Few physicians are aware of recommendations for postvaccination observation for syncope and even fewer adhere to them. Strategies to improve this should be developed and tested.

Download full-text


Available from: Wan-Ting Huang, Oct 05, 2015
14 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To develop and validate a general method (called regression risk analysis) to estimate adjusted risk measures from logistic and other nonlinear multiple regression models. We show how to estimate standard errors for these estimates. These measures could supplant various approximations (e.g., adjusted odds ratio [AOR]) that may diverge, especially when outcomes are common. Regression risk analysis estimates were compared with internal standards as well as with Mantel-Haenszel estimates, Poisson and log-binomial regressions, and a widely used (but flawed) equation to calculate adjusted risk ratios (ARR) from AOR. Data sets produced using Monte Carlo simulations. Regression risk analysis accurately estimates ARR and differences directly from multiple regression models, even when confounders are continuous, distributions are skewed, outcomes are common, and effect size is large. It is statistically sound and intuitive, and has properties favoring it over other methods in many cases. Regression risk analysis should be the new standard for presenting findings from multiple regression analysis of dichotomous outcomes for cross-sectional, cohort, and population-based case-control studies, particularly when outcomes are common or effect size is large.
    Health Services Research 10/2008; 44(1):288-302. DOI:10.1111/j.1475-6773.2008.00900.x · 2.78 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This report is a revision of General Recommendations on Immunization and updates the 2002 statement by the Advisory Committee on Immunization Practices (ACIP) (CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices and the American Academy of Family Physicians. MMWR 2002;51[No. RR-2]). This report is intended to serve as a general reference on vaccines and immunization. The principal changes include 1) expansion of the discussion of vaccination spacing and timing; 2) an increased emphasis on the importance of injection technique/age/body mass in determining appropriate needle length; 3) expansion of the discussion of storage and handling of vaccines, with a table defining the appropriate storage temperature range for inactivated and live vaccines; 4) expansion of the discussion of altered immunocompetence, including new recommendations about use of live-attenuated vaccines with therapeutic monoclonal antibodies; and 5) minor changes to the recommendations about vaccination during pregnancy and vaccination of internationally adopted children, in accordance with new ACIP vaccine-specific recommendations for use of inactivated influenza vaccine and hepatitis B vaccine. The most recent ACIP recommendations for each specific vaccine should be consulted for comprehensive discussion. This report, ACIP recommendations for each vaccine, and other information about vaccination can be accessed at CDC's National Center for Immunization and Respiratory Diseases (proposed) (formerly known as the National Immunization Program) website at http//
    MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control 01/2007; 55(RR-15):1-48.
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study compared the use of mail and Internet surveys of sentinel networks of physicians with traditional random sample mail surveys for three national vaccine policy surveys. Three nationally representative sentinel networks of physicians were established (pediatricians, n = 427; general internists, n = 438; and family physicians, n = 433). Surveys of the sentinel networks were compared with simultaneous surveys conducted with random samples of the American Medical Association (AMA) Physician Masterfile. Response rates were 74% to 78% for sentinel surveys and 29% to 43% for traditional random sample surveys. Respondents to the two methods were generally comparable in demographic characteristics. While there were some differences in responses to survey topic questions, none of the differences were likely to affect policy decisions. Sentinel networks represent the opinions and experiences of physicians in a manner equivalent to traditional mail surveys and may provide a more efficient approach to conducting physician surveys.
    Evaluation &amp the Health Professions 04/2008; 31(1):43-64. DOI:10.1177/0163278707311872 · 1.91 Impact Factor
Show more