REACTIONS OF PEDIATRICIANS TO THE RECOMMENDATION FOR UNIVERSAL VARICELLA VACCINATION

Objectives: To determine the rate of self-reported adherence by pediat ricians to the 1995 American Academy of Pediatrics and the Advisory Co mmittee on Immunization Practices varicella immunization recommendatio ns and to evaluate factors that might influence adherence. Design: Mai l survey. Setting and Participants: Washington State pediatricians. Ma in Outcome Measure: Logistic regression was used to identify demograph ic characteristics, attitudes about varicella vaccine, and previous ex periences with the disease that were associated with self-reported adh erence to universal varicella immunization recommendations. Results: C ompleted surveys were returned by 76% of contacted pediatricians, of w hom 42% reported following a policy of universal varicella immunizatio n. In multivariate analysis, agreement with statements regarding the e ffectiveness of varicella vaccine in reducing rare but serious complic ations of the disease (odds ratio [OR], 4.90; 95% confidence interval [Cl], 2.30-10.50) and in decreasing creasing work loss by parents (OR, 4.21; 95% Cl, 1.14-15.50) were associated with recommending universal immunization. Disagreement with statements concerning the lack of the need for varicella immunization because complications are rare (OR, 2 .54; 95% Cl, 1.12-5.74), it is not required for school entry (OR, 2.52 ; 95% Cl, 1.37-4.64), and it is not medically cost-effective (OR, 2.25 ; 95% Cl, 1.21-4.18) were also associated with universally recommendin g the vaccine. In addition, experience with varicella encephalitis was also associated with adherence to the recommendations (OR, 1.96; 95% Cl, 1.06-3.65). Conversely, those who were concerned that varicella va ccine might not provide lifelong immunity were less likely to report r ecommending universal vaccination (OR, 0.36; 95% Cl, 0.19-0.68). Concl usions: Fewer than 50% of responding Washington State pediatricians re ported recommending universal varicella vaccination. Adherence to the recommendations appears to be influenced by personal experience, perce ptions about the potential seriousness of varicella, and beliefs about the societal and medical cost-effectiveness of varicella vaccine.