Most pediatricians and family physicians reported having some families refuse vaccines, and 21% of pediatricians reported dismissal of these families from their practices, findings of a recent survey showed.
Vaccine preventable outbreaks and vaccine refusal continue to be a concern. Despite discouragement by the Centers for Disease Control and Prevention and the American Academy of Pediatrics (AAP), some physicians have started to dismiss families from their practices for refusing vaccines for their children.
CDC/Amanda Mills
Dr. Sean T. O’Leary of The Adult and Child Center for Outcomes Research and Delivery Sciences, University of Colorado, Aurora, and colleagues set out to study the prevalence of parents refusing one or more infant vaccines, physician response, and the association of dismissal to state exemption laws, and practice and provider characteristics.
They conducted a nationally representative survey of family physicians (FPs) and pediatricians with multivariable analysis. Their results were published online in Pediatrics (2015, Nov. 2. doi: 10.1542/peds.2015-2086).
The response rate was 61% (252) for FPs, 70% (282) for pediatricians, and 66% overall (534/815). Of those who responded, data from 83 were excluded because they reported not administering vaccines to children less than 2 years old.
Most respondents (83%) reported at least some parents refusing vaccines in a typical month. In states where philosophical exemptions are not allowed, pediatricians reported no refusals in a typical month more often than in states where exemptions are allowed (17% versus 8%, P = .03); family physicians did not report this difference. Vaccine refusal in 1%-4% of parents was reported by 63% of respondents, with 15% reporting a refusal rate of 5%-9%, and 5% reporting refusal by 10% or more. Likewise, 11% of the respondents reported an increase in vaccine refusal compared with the prior 12 months, whereas 23% reported a decrease and 66% reported a similar frequency.
Overall, 51% of respondents noted always or often requiring parents to sign a form after vaccine refusal (pediatricians 64% versus FPs 29%, P less than .0001).
Fourteen percent of the respondents reported always or often dismissing a family for refusing one or more infant vaccines (pediatricians 21% versus FPs 4%, P less than .0001).
In states without philosophical exemptions, 34% of pediatricians reported dismissal of families for vaccine refusal, versus 9% in states that allow exemptions (P less than .0001).
Finally, pediatrician respondents who reported dismissing patients were more often located in the South, in a state without philosophical exemptions for vaccines, and in private practice.
The authors noted that there are still many aspects of vaccine refusal that are not well understood. “Because many [pediatricians] still dismiss families despite recommendations to the contrary, this practice should be better explored and understood both for its causes and its intended and unintended consequences,” they wrote.
This study was funded by the CDC administered through the Rocky Mountain Prevention Research Center, University of Colorado, Aurora (grant). The authors report no financial disclosures.