Intent to immunize among pediatric and family medicine residents.
OBJECTIVE
To determine whether contraindications to immunization are inappropriately broadened for children with a fever or a neurologic condition.


METHODS
Pediatric and family medicine residents (N = 52 and 23, respectively) at the University of Rochester (NY).


METHODS
Cross-sectional survey. Residents rated how likely they would be to administer a diphtheria-tetanus-pertussis or measles-mumps-rubella vaccine in 17 clinical scenarios according to a rating scale ranging from 1 (never) to 5 (always). For all scenarios, the immunization was recommended by the American Academy of Pediatrics or the Immunization Practices Advisory Committee.


RESULTS
In only five and three of 17 scenarios would 90% or more of the pediatric residents and family medicine residents, respectively, have administered an immunization. For diphtheria-tetanus-pertussis vaccine, pediatric residents reported a lower likelihood of vaccinating a 2-month-old child with a low fever (temperature, 38.1 degrees C) than an afebrile child (mean score, 3.0 vs 4.7; P < .01). A 2-year-old child with idiopathic epilepsy, a 2-month-old child with intraventricular hemorrhage, and a 2-month-old child who had a parent with a seizure disorder each had a lower reported likelihood to be vaccinated than a same-aged child without a neurologic condition (2.8 vs 4.5; 4.1 vs 4.7; and 4.3 vs 4.7, respectively; each P < .01). For measles-mumps-rubella, pediatric residents reported a lower likelihood of vaccinating a 15-month-old child with a low fever than an afebrile child (4.2 vs 4.9; P < .01). A child with a progressive neurologic disease had a lower reported likelihood to be vaccinated than a child without a neurologic condition (3.5 vs 4.9; P < .01).


CONCLUSIONS
Residents reported a lower likelihood of immunizing children with a fever or neurologic condition. Such practice styles may contribute to underimmunization. Residents need to be educated regarding which medical conditions contraindicate an immunization.
Campbell
J R
JR
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, NY.
Szilagyi
P G
PG
Rodewald
L E
LE
Winter
N L
NL
Humiston
S G
SG
Roghmann
K J
KJ
D001291:Attitude of Health Personnel; D002543:Cerebral Hemorrhage; D000075202:Contraindications; D003430:Cross-Sectional Studies; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage; D004338:Drug Combinations; D004827:Epilepsy; D005194:Family Practice / Q000706:statistics & numerical data*; D005334:Fever; D006304:Health Status; D006801:Humans; D007114:Immunization; D007223:Infant; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008458:Measles Vaccine / Q000008:administration & dosage; D022542:Measles-Mumps-Rubella Vaccine; D009108:Mumps Vaccine / Q000008:administration & dosage; D009518:New York; D010372:Pediatrics / Q000706:statistics & numerical data*; D012411:Rubella Vaccine / Q000008:administration & dosage; D011795:Surveys and Questionnaires
D015721:Diphtheria-Tetanus-Pertussis Vaccine; D004338:Drug Combinations; D008458:Measles Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D009108:Mumps Vaccine; D012411:Rubella Vaccine