Abstract
Vaccines are one of the most successful public health interventions of all time. Sixteen diseases that afflicted generations of American children are now vaccine preventable. However, as the number of vaccines in the routine childhood immunization schedule has increased, parents have become more concerned about the safety and necessity of these vaccines than they are about the diseases themselves. Alternative vaccination schedules, which differ substantially from the US Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) recommended schedule, have become increasingly popular. In this chapter we review the science behind the official immunization schedule and explore parental concerns about the recommended immunization schedule. We review the problems inherent to alternative vaccine schedules; namely, they are not evidence based, prolong susceptibility to vaccine-preventable diseases, and result in unnecessary office visits and infant stress. We also provide evidence-based talking points and practical suggestions to help primary care providers work with families who request alternative schedules.
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Gellin BG et al. Do parents understand immunizations? A national telephone survey. Pediatrics. 2000;106(5):1097–102.
Centers for Disease Control and Prevention (CDC). Recommended childhood immunization schedule—United States, 1999. MMWR Morb Mortal Wkly Rep. 1999;48(1):12–6.
Offit PA et al. Addressing parents’ concerns: do multiple vaccines overwhelm or weaken the infant’s immune system? Pediatrics. 2002;109(1):124–9.
Centers for Disease Control and Prevention (CDC). Recommendation of the Advisory Committee on Immunization Practices (ACIP) for use of quadrivalent meningococcal conjugate vaccine (MenACWY-D) among children aged 9 through 23 months at increased risk for invasive meningococcal disease. MMWR Morb Mortal Wkly Rep. 2011;60(40):1391–2.
Fiore AE, Wasley A, Bell BP. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2006;55(RR-7):1–23.
Merriam Webster Dictionary. http://www.merriam-webster.com/dictionary/alternative.
Sears R. The vaccine book: making the right decision for your child. New York, NY: Little, Brown; 2007.
A user-friendly vaccination schedule. http://www.lewrockwell.com/miller/miller15.html (2012). Accessed 5 Feb 2012.
ChildrensHealthChoices.org. Alternative vaccination schedules. http://toomanytoosoon.org/ (2012). Accessed 5 Feb 2012.
Dempsey AF et al. Alternative vaccination schedule preferences among parents of young children. Pediatrics. 2011;128(5):848–56.
Smith PJ et al. The association between intentional delay of vaccine administration and timely childhood vaccination coverage. Public Health Rep. 2010;125(4):534–41.
Diekema DS, Comm B. Responding to parental refusals of immunization of children. Pediatrics. 2005;115(5):1428–31.
American Academy of Pediatrics. Parental refusal of immunization. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, editors. Red Book: 2009 Report of the committee on infectious diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009. p. 8–9.
Traveler may have spread measles in 5 US airports. http://www.aolnews.com/2011/02/27/traveler-may-have-spread-measles-in-5-us-airports/ (2012). Accessed 5 Mar 2012.
D’Arcy J. Measles outbreak after Super Bowl ignites vaccine debate. http://www.washingtonpost.com/blogs/on-parenting/post/measles-outbreak-after-super-bowl-ignites-vaccine-debate/2012/02/22/gIQAWNqPWR_blog.html(2012). Accessed 5 Mar 2012.
Feikin DR et al. Individual and community risks of measles and pertussis associated with personal exemptions to immunization. JAMA. 2000;284(24):3145–50.
Glanz JM et al. Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children. Pediatrics. 2009;123(6):1446–51.
Glanz JM et al. Parental decline of pneumococcal vaccination and risk of pneumococcal related disease in children. Vaccine. 2011;29(5):994–9.
Glanz JM et al. Parental refusal of varicella vaccination and the associated risk of varicella infection in children. Arch Pediatr Adolesc Med. 2010;164(1):66–70.
Janssen AP, Tardiff R, Herring RM, Smith MJ. Physician’s perceptions of current vaccine issues. Washington, DC: US Department of Health and Human Services; 2008.
Strine TW et al. Predictors of age-appropriate receipt of DTaP dose 4. Am J Prev Med. 2003;25(1):45–9.
Smith PJ et al. Parental delay or refusal of vaccine doses, childhood vaccination coverage at 24 months of age, and the Health Belief Model. Public Health Rep. 2011;126:135–46.
Marshall GS. Addressing concerns about vaccines. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, editors. The Vaccine Handbook: a practical guide for clinicians. West Islip, NY: Professional Publications, Inc; 2010. p. 211.
Fairchok MP et al. Epidemiology of viral respiratory tract infections in a prospective cohort of infants and toddlers attending daycare. J Clin Virol. 2010;49(1):16–20.
Offit PA, Moser CA. The problem with Dr. Bob’s Alternative Vaccine Schedule. Pediatrics. 2009;123(1):e164–9.
Draft NVAC vaccine safety working group report. http://www.hhs.gov/nvpo/nvac/documents/NVACVaccineSafetyWGReport041409.pdf (2009). Accessed 31 July 2009.
Chen RT et al. Vaccine safety datalink project: a new tool for improving vaccine safety monitoring in the United States. Pediatrics. 1997;99(6):765–73.
Thompson WW et al. Early thimerosal exposure and neuropsychological outcomes at 7 to 10 years. N Engl J Med. 2007;357(13):1281–92.
Smith MJ, Woods CR. On-time vaccine receipt in the first year does not adversely affect neuropsychological outcomes. Pediatrics. 2010;125(6):1134–41.
Meyerhoff AS, Jacobs RJ. Do too many shots due lead to missed vaccination opportunities? Does it matter? Prev Med. 2005;41(2):540–4.
Merck and Sanofi Pasteur Initiate Phase III study in the United States of pediatric combination vaccine to help prevent six infectious diseases. http://www.merck.com/newsroom/news-release-archive/research-and-development/2011_0421.html (2012). Accessed 5 Mar 2012.
Ramsay DS, Lewis M. Developmental change in infant cortisol and behavioral response to inoculation. Child Dev. 1994;65(5):1491–502.
Hanson D et al. Comparison of distress and pain in infants randomized to groups receiving standard versus multiple immunizations. Infant Behav Dev. 2010;33(3):289–96.
American Academy of Pediatrics. Managing injection pain. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, editors. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009. p. 20–1.
Salmon DA et al. Factors associated with refusal of childhood vaccines among parents of school-aged children: a case–control study. Arch Pediatr Adolesc Med. 2005;159(5):470–6.
Smith PJ et al. Association between health care providers' influence on parents who have concerns about vaccine safety and vaccination coverage. Pediatrics. 2006;118(5):e1287–92.
Wightman A et al. Washington state pediatricians’ attitudes toward alternative childhood immunization schedules. Pediatrics. 2011;128(6):1094–9.
Centers for Disease Control and Prevention (CDC). Invasive Haemophilus influenzae Type b disease in five young children – Minnesota, 2008. MMWR Morb Mortal Wkly Rep. 2009;58(3):58–60.
Centers for Disease Control and Prevention (CDC). Outbreak of measles – San Diego, California, January – February 2008. MMWR Morb Mortal Wkly Rep. 2008;57(8):203–6.
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Smith, M.J. (2013). Alternative Schedules: Why Not?. In: Chatterjee, A. (eds) Vaccinophobia and Vaccine Controversies of the 21st Century. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7438-8_16
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DOI: https://doi.org/10.1007/978-1-4614-7438-8_16
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