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Article
September 1994

Intent to Immunize Among Pediatric and Family Medicine Residents

Author Affiliations

From the Division of General Pediatrics, Department of Pediatrics, University of Rochester (NY) School of Medicine and Dentistry.

Arch Pediatr Adolesc Med. 1994;148(9):926-929. doi:10.1001/archpedi.1994.02170090040005
Abstract

Objective:  To determine whether contraindications to immunization are inappropriately broadened for children with a fever or a neurologic condition.

Participants:  Pediatric and family medicine residents (N=52 and 23, respectively) at the University of Rochester (NY).

Design:  Cross-sectional survey. Residents rated how likely they would be to administer a diphtheria-tetanus-pertussis or measles-mumps-rubella vaccine in 17 clinical scenarios according to a rating scale ranging from 1 (never) to 5 (always). For all scenarios, the immunization was recommended by the American Academy of Pediatrics or the Immunization Practices Advisory Committee.

Results:  In only five and three of 17 scenarios would 90% or more of the pediatric residents and family medicine residents, respectively, have administered an immunization. For diphtheria-tetanus-pertussis vaccine, pediatric residents reported a lower likelihood of vaccinating a 2-month-old child with a low fever (temperature, 38.1°C than an afebrile child (mean score, 3.0 vs 4.7; P<.01). A 2-year-old child with idiopathic epilepsy, a 2-month-old child with intraventricular hemorrhage, and a 2-month-old child who had a parent with a seizure disorder each had a lower reported likelihood to be vaccinated than a same-aged child without a neurologic condition (2.8 vs 4.5; 4.1 vs 4.7; and 4.3 vs 4.7, respectively; each P<.01). For measles-mumps-rubella, pediatric residents reported a lower likelihood of vaccinating a 15-month-old child with a low fever than an afebrile child (4.2 vs 4.9; P<.01). A child with a progressive neurologic disease had a lower reported likelihood to be vaccinated than a child without a neurologic condition (3.5 vs 4.9;P<.01).

Conclusions:  Residents reported a lower likelihood of immunizing children with a fever or neurologic condition. Such practice styles may contribute to underimmunization. Residents need to be educated regarding which medical conditions contraindicate an immunization.(Arch Pediatr Adolesc Med. 1994;148:926-929)

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