title: Vaccine knowledge and practices of primary care providers of exempt vs. vaccinated children.
abstract: OBJECTIVE
  Compare vaccine knowledge, attitudes and practices of primary care providers for fully vaccinated children and children who are exempt from school immunization requirements.
  
  
  METHODS
  We conducted a mailed survey of parent-identified primary care providers from four states to measure perceived risks and benefits of vaccination and other key immunization beliefs. Frequencies of responses were stratified by type of provider, identified by exempt versus vaccinated children. Logistic regression was used to calculate odds ratios for responses by provider type.
  
  
  RESULTS
  551 surveys were completed (84.3% response rate). Providers for exempt children had similar attitudes to providers for non-exempt children. However, there were statistically significant increased concerns among providers for exempt children regarding vaccine safety and lack of perceived individual and community benefits for vaccines compared to other providers.
  
  
  CONCLUSIONS
  The great majority of providers for exempt children had similar attitudes about vaccine safety, effectiveness and benefits as providers of non-exempt children. Although providers for exempt children were more likely to believe that multiple vaccines weaken a child's immune system and were concerned about vaccine safety and less likely to consider vaccines were beneficial, a substantial proportion of providers of both exempt and vaccinated children have concerns about vaccine safety and believe that CDC underestimates the frequency of vaccine side effects. Effective continuing education of providers about the risks and benefits of immunization and including in vaccine recommendations more information on pre and post licensing vaccine safety evaluations may help address these concerns.
authors.affiliation: Institute for Vaccine Safety and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Salmon
authors.forename: William K Y
authors.initials: WK
authors.lastname: Pan
authors.forename: Saad B
authors.initials: SB
authors.lastname: Omer
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Navar
authors.forename: Walter
authors.initials: W
authors.lastname: Orenstein
authors.forename: Edgar K
authors.initials: EK
authors.lastname: Marcuse
authors.forename: James
authors.initials: J
authors.lastname: Taylor
authors.forename: M Patricia
authors.initials: MP
authors.lastname: deHart
authors.forename: Shannon
authors.initials: S
authors.lastname: Stokley
authors.forename: Terrell
authors.initials: T
authors.lastname: Carter
authors.forename: Neal A
authors.initials: NA
authors.lastname: Halsey
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D000075202:Contraindications; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education / Q000523:psychology*; D006293:Health Promotion; D006801:Humans; D010290:Parents / Q000523:psychology; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D012572:School Health Services / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States; D014611:Vaccination / Q000009:adverse effects / Q000523:psychology*; D014612:Vaccines / Q000009:adverse effects*
chemical_list: D014612:Vaccines