Reactions of pediatricians to the recommendation for universal varicella vaccination.
OBJECTIVE
To determine the rate of self-reported adherence by pediatricians to the 1995 American Academy of Pediatrics and the Advisory Committee on Immunization Practices varicella immunization recommendations and to evaluate factors that might influence adherence.


METHODS
Mail survey.


METHODS
Washington State pediatricians.


METHODS
Logistic regression was used to identify demographic characteristics, attitudes about varicella vaccine, and previous experiences with the disease that were associated with self-reported adherence to universal varicella immunization recommendations.


RESULTS
Completed surveys were returned by 76% of contacted pediatricians, of whom 42% reported following a policy of universal varicella immunization. In multivariate analysis, agreement with statements regarding the effectiveness of varicella vaccine in reducing rare but serious complications of the disease (odds ratio [OR], 4.90; 95% confidence interval [CI], 2.30-10.50) and in decreasing work loss by parents (OR, 4.21; 95% CI, 1.14-15.50) were associated with recommending universal immunization. Disagreement with statements concerning the lack of the need for varicella immunization because complications are rare (OR, 2.54; 95% CI, 1.12-5.74), it is not required for school entry (OR, 2.52; 95% CI, 1.37-4.64), and it is not medically cost-effective (OR, 2.25; 95% CI, 1.21-4.18) were also associated with universally recommending the vaccine. In addition, experience with varicella encephalitis was also associated with adherence to the recommendations (OR, 1.96; 95% CI, 1.06-3.65). Conversely, those who were concerned that varicella vaccine might not provide lifelong immunity were less likely to report recommending universal vaccination (OR, 0.36; 95% CI, 0.19-0.68).


CONCLUSIONS
Fewer than 50% of responding Washington State pediatricians reported recommending universal varicella vaccination. Adherence to the recommendations appears to be influenced by personal experience, perceptions about the potential seriousness of varicella, and beliefs about the societal and medical cost-effectiveness of varicella vaccine.
Department of Pediatrics, University of Washington School of Medicine, Children's Hospital and Medical Center, Seattle, USA. rnewman@u.washington.edu
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Newman
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Taylor
D001291:Attitude of Health Personnel; D002644:Chickenpox / Q000517:prevention & control*; D019433:Chickenpox Vaccine / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D019983:Guideline Adherence; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D016015:Logistic Models; D008875:Middle Aged; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014611:Vaccination / Q000706:statistics & numerical data
D019433:Chickenpox Vaccine