PEDIATRICIANS' ATTITUDES, PERCEPTIONS, AND BEHAVIORS REGARDING DISCHARGING CHILDREN ON THE BASIS OF PARENTAL VACCINE REFUSAL IN THE STATE OF GEORGIA Open Access

Abstract

One of the greatest public health achievements of the 20th century is the significant decrease in vaccine preventable diseases as a result of vaccine development and mass immunization programs. In the United States, school vaccination requirements have had a dramatic impact in reducing disease morbidity and mortality. However, concerns regarding vaccine preventable diseases have shifted to worries about vaccine safety. Today, many parents worry that vaccines may cause more harm than the very diseases they are intended to prevent. Consequently, parents may be hesitant or refuse to immunize their children. Requests for nonmedical exemptions from vaccination requirements are becoming increasingly common. Research suggests that areas with high concentrations of nonmedical exemptions may be associated with recent outbreaks of vaccine preventable diseases, and as such, pose risks to public health. In an effort to minimize the risk to unvaccinated individuals, some physicians resort to discharging patients who, for nonmedical reasons, refuse vaccination.

In order to understand how public health professionals can address parental vaccination refusal and provide evidence to support physicians in maintaining supportive relationships with parents who express concerns regarding vaccines, a quantitative survey of primary care pediatricians in the state of Georgia was conducted. The goals of this research were to 1) estimate the proportion of primary care pediatricians within the state of Georgia who report discharging patients for vaccine refusal, and 2) understand the characteristics, behaviors, and attitudes regarding parental vaccine refusal of primary care pediatricians within the state of Georgia.

Approximately 46% of responding pediatricians reported they would support discharging a patient over complete vaccine refusal. More than half of responding pediatricians have personally discharged patients because of refusal to immunize. The primary reason for refusal is perceived to be due to concern over vaccine safety. A majority of respondents would willingly agree to an alternative vaccination schedule if a parent requested it. Findings generated from this research and its potential implications provide a foundation for areas of further research, and suggest a need for evaluation of existing practices and policies related to childhood vaccination refusals.

Table of Contents

Table of Contents
CHAPTER ONE: INTRODUCTION 1
Introduction & Rationale 1
Problem Statement 3
Statement of Significance 5
Definition of Terms 7
CHAPTER TWO: REVIEW OF THE LITERATURE 11
Introduction 11
Historical Development of Vaccines and Impact on Human Disease 11
Vaccination Policies in the United States 15
Current Trends of NMEs and Reasons for Vaccine Refusal 19
Autism 22
Thimerosal 24
Neurological Disorders 25
Antigenic Overload 25
Autoimmune Disorders 27
Natural Immunity 28
Impact of NMEs 28
National impact 28
Local impact 30
Prevalence of Discharge Due to Vaccine Refusal 31
AAP Recommendations 33
Parents' Decision-making Process 35
Summary 38
CHAPTER THREE: METHODOLOGY 40
Introduction 40
Population and Sample 40
Research Design 41
Instruments 42
Procedures 42
Data Collection and Analysis 43
Limitations and Delimitations 44
CHAPTER FOUR: RESULTS 47
Introduction 47
Findings 48
Demographic Composition 48
Practice Characteristics and General Policies 50
Perceptions Regarding Parental Vaccine Refusal 53
Behaviors and Attitudes Regarding Vaccine Refusals 54
Other Findings 60
Limitations 61
Summary 62
CHAPTER FIVE: CONCLUSIONS, IMPLICATIONS, AND RECOMMENDATIONS 63
Introduction 63
Summary of Study 63
Discussion 64
Implications 65
Recommendations 65
Conduct additional quantitative research. 65
Conduct qualitative research. 66
Evaluate current state school vaccination laws and exemption policies. 67
Evaluate current recommendations for health care providers, and resources for parents. 67
Evaluate current surveillance practices. 68
Conclusion 68
REFERENCES 69
APPENDIX A. Survey Instrument 77
APPENDIX B. Research Study Information Document 83
APPENDIX C. IRB Exemption Letter 85
APPENDIX D. Email Recruitment Letter 87

About this Master's Thesis

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School	Rollins School of Public Health
Department	Career Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Nonmedical Exemption Refusal Vaccine Discharge Vaccine Preventable Disease Parental Vaccine Refusal Childhood Outbreak
Committee Chair / Thesis Advisor	Alperin, Melissa (Moose), Emory University
Committee Members	Greenberg, M.D., David P.,
Partnering Agencies	National or regional non-profit organization (e.g., American Cancer Society)

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