title: Parental decline of pneumococcal vaccination and risk of pneumococcal related disease in children.
abstract: BACKGROUND
  An increasing number of parents are choosing to decline immunizations for their children. This study examined the association between the parental decision to decline pneumococcal conjugate (PCV7) vaccinations and the risk of hospitalization due to pneumococcal disease or lobar pneumonia in children.
  
  
  METHODS
  We conducted a case-control study nested within a cohort of children enrolled in the Kaiser Permanente Colorado (KPCO) health plan between 2004 and 2009. Each child hospitalized with pneumococcal disease or lobar pneumonia (n=106) was matched to 4 randomly selected controls (n=401). Cases were matched to controls by age, sex, high-risk status, calendar time, and length of enrollment in KPCO. Disease status and parental vaccination decisions were validated with medical record review. Cases and controls were classified as vaccine decliners or vaccine acceptors.
  
  
  RESULTS
  Among 106 cases, there were 6 (6%) PCV7 vaccine decliners; among 401 controls, there were 4 (1%) vaccine decliners. Children of parents who declined PCV7 immunization were 6.5 times (OR=6.5; 95% CI=1.7, 24.5) more likely to be hospitalized for invasive pneumococcal disease or lobar pneumonia than vaccinated children.
  
  
  CONCLUSIONS
  Parental decline of pneumococcal vaccination apparently increases the risk for hospitalization due to pneumococcal disease or lobar pneumonia in children. Providers can use this information when helping parents weigh the benefits and risks of immunizing their children.
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, CO 80237-8066, USA. 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: Sean T
authors.initials: ST
authors.lastname: O'Leary
authors.forename: Komal J
authors.initials: KJ
authors.lastname: Narwaney
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Daley
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Hambidge
mesh_terms: D016022:Case-Control Studies; D002675:Child, Preschool; D003120:Colorado / Q000453:epidemiology; D005260:Female; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D022242:Pneumococcal Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology*; D018570:Risk Assessment; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines