INTENT TO IMMUNIZE AMONG PEDIATRIC AND FAMILY MEDICINE RESIDENTS

Objective: To determine whether contraindications to immunization are inappropriately broadened for children with a fever or a neurologic co ndition. Participants: Pediatric and family medicine residents (N=52 a nd 23, respectively) at the University of Rochester (NY). Design: Cros s-sectional survey. Residents rated how likely they would be to admini ster a diphtheria-tetanus-pertussis or measles-mumps-rubella vaccine i n 17 clinical scenarios according to a rating scale ranging from 1 (ne ver) to 5 (always). For all scenarios, the immunization was recommende d by the American Academy of Pediatrics or the Immunization Practices Advisory Committee. Results: In only five and three of 17 scenarios wo uld 90% or more of the pediatric residents and family medicine residen ts, respectively, have administered an immunization. For diphtheria-te tanus-pertussis vaccine, pediatric residents reported a lower likeliho od of vaccinating a 2-month-old child with a low fever (temperature, 3 8.1 degrees 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 va ccinated 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 measl es-mumps-rubella, pediatric residents reported a lower likelihood of v accinating a 15-month-old child with a low fever than an afebrile chil d (4.2 vs 4.9; P<.01). A child with a progressive neurologic disease h ad a lower reported likelihood to be vaccinated than a child without a neurologic condition (3.5 vs 4.9; P<.01). Conclusions: Residents repo rted a lower likelihood of immunizing children with a fever or neurolo gic condition. Such practice styles may contribute to underimmunizatio n. Residents need to be educated regarding which medical conditions co ntraindicate an immunization.