Frequency of Alternative Immunization Schedule Use in a Metropolitan Area

Oregon Immunization Program, Oregon Health Authority, Portland, Oregon 97008, USA.
PEDIATRICS (Impact Factor: 5.47). 06/2012; 130(1):32-8. DOI: 10.1542/peds.2011-3154
Source: PubMed


Recent studies have described an increase in parental hesitancy regarding vaccines as well as increases in parental adoption of vaccine schedules that delay or limit receipt of recommended vaccines. This study quantifies potential prevalence and trends in alternative schedule compliance by measuring consistent shot-limiting in a metropolitan area of Oregon.
Retrospective cohort analysis using the Oregon ALERT Immunization Information System to track children born between 2003 and 2009 in the Portland metropolitan area. Joinpoint regression was used to analyze prevalence trends in consistent shot-limiting during that time period. The 2007-2009 Haemophilus influenzae type b vaccine shortage and increased availability of combination vaccines were also examined for their effects on shot-limiting rates.
A total of 4502 of 97,711 (4.6%) children met the definition of consistent shot-limiters. The proportion of consistent shot-limiters in the population increased from 2.5% to 9.5% between 2006 and 2009. Compared with those with no or episodic limiting, consistent shot-limiters by 9 months of age had fewer injections (6.4 vs 10.4) but more visits when immunizations were administered (4.2 vs 3.3). However, only a small minority of shot-limiters closely adhered to published alternative schedules.
The percentage of children consistently receiving 2 or fewer vaccine injections per visit between birth and age 9 months increased threefold within a 2-year period, suggesting an increase in acceptance of non-Advisory Committee on Immunization Practices vaccine schedules in this geographic area.

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    • "Although the campaign was conducted with reference to the geographical community of Fremantle and the broader lifestyle that this Fremantle identity connotes, our findings are potentially applicable to other similar communities, particularly because we did not limit survey responses to Fremantle residents only. There are isolated " Fremantle-type " individuals throughout broader populations , connected by online and social media, and there are other communities with apparent similarities to Fremantle in terms of lifestyle and values, with Portland in the USA [41] [42] a popularly referenced example. While similarities between national and international 'hesitant communities' need to be mapped and crossnational virtual 'hesitant communities' also require investigation, we hope our strategy and limited findings will help researchers in those settings develop and test new ideas. "
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    ABSTRACT: This paper presents results of a study determining the efficacy of a values based approach to changing vaccination attitudes. It reports an evaluation survey of the "I Immunise" campaign, conducted in Fremantle, Western Australia, in 2014. "I Immunise" explicitly engaged with values and identity; formulated by locals in a community known for its alternative lifestyles and lower-than-national vaccine coverage rates. Data was collected from 304 online respondents. The campaign polarised attitudes towards vaccination and led some to feel more negatively. However, it had an overall positive response with 79.6% of participants. Despite the campaign only resonating positively with a third of parents who had refused or doubted vaccines, it demonstrates an important in-road into this hard-to-reach group.
    Full-text · Article · Oct 2015 · Vaccine
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    • "Previous work has shown that the V64.05 and V64.06 ICD-9-CM codes are highly specific for intentional parental delay or refusal of childhood vaccination [10]. Children identified as being on a known alternative schedule had a vaccination pattern consistent with the alternative and selective schedules described in The Vaccine Book [20], were consistent shot-limiters [6], delayed starting all vaccinations until past four months, or were completely unvaccinated. Vaccination status was assessed at the end of followup for children whose follow-up ended between ages 12 and 23 months. "
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    ABSTRACT: Background: In addition to antigens, vaccines contain small amounts of preservatives, adjuvants, and residual substances from the manufacturing process. Some parents have concerns about the safety of these ingredients, yet no large epidemiological studies have specifically examined associations between health outcomes and vaccine ingredients, other than thimerosal. This study examined the extent to which the Vaccine Safety Datalink (VSD) could be used to study vaccine ingredient safety in children. Methods: Children born 2004-2011 were identified in VSD data. Using immunization records, two cohorts were identified: children who were up-to-date and children who were undervaccinated before age 2 years. A database was also created linking vaccine type and manufacturer with ingredient amounts documented in vaccine package inserts. Thirty-four ingredients in two or more infant vaccines were identified. However, only amounts (in mg) for aluminum were consistently documented and commonly contained in infant vaccines. Analyses compared vaccine aluminum exposure across cohorts and determined the statistical power for studying associations between aluminum exposure and hypothetical vaccine adverse events. Results: Among 408,608 children, mean cumulative vaccine aluminum exposure increased from 1.11 to 4.00mg between ages 92-730 days. Up-to-date children were exposed to 11-26% more aluminum from vaccines than undervaccinated children. Power analyses demonstrated that safety studies of aluminum could detect relative risks ranging from 1.1 to 5.8 for a range of adverse event incidence. Conclusions: The safety of vaccine aluminum exposure can be feasibly studied in the VSD. However, possible biological mechanisms and confounding variables would need to be considered before conducting any studies.
    Preview · Article · Oct 2015 · Vaccine
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    • "Rapid global sharing of public concerns and sometimes uncertainty around vaccines [4] are leading to an increase in the number of people questioning vaccines, seeking alternative vaccination schedules [5] [6] and sometimes delaying or refusing vaccination [7]. "
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    ABSTRACT: Vaccine “hesitancy” is an emerging term in the literature and discourse on vaccine decision-making and determinants of vaccine acceptance. It recognizes a continuum between the domains of vaccine acceptance and vaccine refusal and de-polarizes previous characterization of individuals and groups as either anti-vaccine or pro-vaccine. The primary aims of this systematic review are to: 1) identify research on vaccine hesitancy; 2) identify determinants of vaccine hesitancy in different settings including its context-specific causes, its expression and its impact; and 3) inform the development of a model for assessing determinants of vaccine hesitancy in different settings as proposed by the Strategic Advisory Group of Experts Working Group (SAGE WG) for dealing with vaccine hesitancy. A broad search strategy, built to capture multiple dimensions of public trust, confidence and hesitancy around vaccines, was applied across multiple databases. Peer-reviewed studies were selected for inclusion if they focused on childhood vaccines [≤7 years of age], used multivariate analyses, and were published between January 2007 and November 2012. Our results show a variety of factors as being associated with vaccine hesitancy but they do not allow for a complete classification and confirmation of their independent and relative strength of influence. Determinants of vaccine hesitancy are complex and context-specific – varying across time, place and vaccines.
    Full-text · Article · Apr 2014 · Vaccine
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