title: Pediatric provider vaccine hesitancy: An under-recognized obstacle to immunizing children.
abstract: OBJECTIVE
  To describe vaccine attitudes among pediatric healthcare providers attending immunization conferences.
  
  
  METHODS
  Attendees of 5 American Academy of Pediatrics (AAP)-sponsored vaccine conferences held between June and November 2013 anonymously completed a questionnaire assessing vaccine attitudes and practices prior to the opening of educational sessions. Pearson's chi-square tests and Fisher's exact tests were used to analyze associations between vaccine attitudes, vaccine practices and provider characteristics.
  
  
  RESULTS
  680 providers attending AAP-sponsored vaccine conferences were included. 661/666 (99%) enrolled providers state they routinely recommend standard pediatric vaccines, yet, 30 (5%) state that they do not routinely recommend influenza and/or human papillomavirus (HPV) vaccines. These providers expressed vaccine safety (87/680 (13%)) and efficacy (21/680 (31%)) concerns and stated belief in vaccine misperceptions: vaccine causes autism (34/668, 5%), multiple vaccines at a single visit reduces vaccine efficacy (43/680, 6%) or overwhelms the immune system (63/680, 9%), and administering HPV vaccine will increase the likelihood of unprotected adolescent sexual activity (29/680, 4%). Six percent of providers who do not routinely recommend all pediatric vaccines correctly identified themselves as vaccine hesitant.
  
  
  CONCLUSIONS
  Vaccine hesitancy is under-recognized among pediatric providers attending AAP-sponsored immunization conferences. Educational interventions tailored to address provider vaccine concerns are needed to improve provider vaccine confidence.
authors.affiliation: Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY 13210, United States. Electronic address: suryadem@upstate.edu.
authors.forename: Manika
authors.initials: M
authors.lastname: Suryadevara
authors.affiliation: Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY 13210, United States.
authors.forename: Andrew
authors.initials: A
authors.lastname: Handel
authors.affiliation: Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY 13210, United States.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Bonville
authors.affiliation: Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, United States.
authors.forename: Donald A
authors.initials: DA
authors.lastname: Cibula
authors.affiliation: Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY 13210, United States.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Domachowske
mesh_terms: D002648:Child; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage; D030361:Papillomavirus Infections / Q000517:prevention & control; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000523:psychology*
chemical_list: D022542:Measles-Mumps-Rubella Vaccine
keywords: Pediatric vaccine; Vaccine attitudes; Vaccine hesitancy