title: Parental refusal of varicella vaccination and the associated risk of varicella infection in children.
abstract: OBJECTIVE
  To quantify both the individual-level and attributable risk of varicella infection requiring medical care in children whose parents refuse varicella immunizations.
  
  
  METHODS
  Matched case-control study with conditional logistic regression analysis.
  
  
  METHODS
  Kaiser Permanente of Colorado (KPCO) health plan between 1998 and 2008.
  
  
  METHODS
  Each pediatric physician-diagnosed case of varicella (n = 133) was matched to 4 randomly selected controls (n = 493). Cases were matched by age, sex, and length of enrollment in KPCO. Main Exposures Varicella vaccine refusal.
  
  
  METHODS
  Varicella infection.
  
  
  RESULTS
  There were 7 varicella vaccine refusers (5%) among the cases and 3 (0.6%) among the controls. Children of parents who refused varicella immunizations were at a greatly increased risk of varicella infection requiring medical care (odds ratio, 8.6; 95% confidence interval, 2.2-33.3) compared with children of parents who accepted vaccinations (P = .004). In the entire KPCO pediatric population, 5% of varicella cases were attributed to parental vaccine refusal.
  
  
  CONCLUSIONS
  Children of parents who refuse varicella immunizations are at high risk of varicella infection relative to vaccinated children. These results will be helpful to health care providers and parents when making decisions about immunizing children.
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, PO Box 378066, Denver, CO 80237-8066. jason.m.glanz@kp.org
authors.forename: Jason M
authors.initials: JM
authors.lastname: Glanz
authors.forename: David L
authors.initials: DL
authors.lastname: McClure
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Daley
authors.forename: Eric K
authors.initials: EK
authors.lastname: France
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Hambidge
mesh_terms: D016022:Case-Control Studies; D002644:Chickenpox / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D019433:Chickenpox Vaccine / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003120:Colorado / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D010290:Parents; D016312:Treatment Refusal; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D019433:Chickenpox Vaccine