How do physicians immunize their own children? Differences among pediatricians and nonpediatricians
How do physicians immunize their own children? Differences among pediatricians and nonpediatricians
复制标题
DOI：
10.1542/peds.2005-0885
复制
发表时间：
2005-11-01
期刊：
影响因子：
8
通讯作者：
Siegrist, CA
中科院分区：
文献类型：
--
作者：
Posfay-Barbe, KM;Heininger, U;Siegrist, CA
上下文免疫接种对全世界的公共卫生具有重要影响。许多研究表明，不同的疫苗可以有效地保护个人免受各种疾病的侵害。然而，一些父母选择不给他们的孩子接种疫苗的原因，例如，除其他外，怀疑其有用性，对安全性或有效性的担忧等，医生被称为通过回答问题和澄清误解对免疫接种率施加直接影响。然而，不知道他们如何使自己的孩子免疫。我们试图评估对疫苗接种问题感兴趣的医生如何免疫接种，或将免疫接种，他们自己的孩子。设计，设置和参与者。2004年10月，向2070名瑞士医生发送了一份11个问题的基于网络的调查，共有102个独立的答案。所有医生都是一个非营利的、基于网络的专家网络（InfoVac，www.infovac.ch）的订户，该网络每月发布新闻通讯，并在2天内回答有关免疫接种问题的问题。InfoVac网络覆盖了瑞士95%以上的儿科医生，但全科医生的覆盖率不到20%。所有答复都是匿名的，无法使用任何身份标识来追踪调查的参与者。问题分为两部分：（1）询问身为父母的医生，他们给自己的孩子接种了哪些疫苗，以及在什么年龄接种;（2）询问所有医生，如果他们在2004年有一个新生儿，他们会给自己的孩子接种哪些疫苗，以及在什么年龄接种。在调查时，瑞士提供的疫苗被认为是可能的答复，推荐的疫苗被认为是瑞士每年发布的联邦免疫接种计划中提到的疫苗。其中一个问题比较了他们自己的孩子和他们的病人之间的免疫接种实践。社会人口统计学，资格年，在不同的专业团体的成员，以及他们的实践类型也被要求。社会人口学特征采用标准描述性统计。对每个变量进行单变量统计分析，以确定其与因变量（儿科医生或非儿科医生）的关系。使用逻辑回归分析计算调整后的比值比（OR）和95%置信区间（CI），控制任何可能作为混杂因素的统计学显著人口统计学变量（性别，父母身份，工作场所，毕业年份和实践类型）。对于所有统计检验，在P = 1儿童时差异被认为是显著的。所有医生都报告在他们的实践中对儿童进行了免疫接种。与非儿科医生相比，儿科医生更有可能是女性，在私人诊所工作，但不太可能属于自我报告的替代医学协会。在非儿科医生中，317人是全科医生，144人是内科医生，95人是其他专家。92%的儿科医生遵循了官方为自己孩子提供的免疫接种建议。相比之下，在控制了性别、工作场所、执业类型和毕业年份后，非儿科医生更有可能没有给孩子接种麻疹、腮腺炎、B型肝炎或B型流感嗜血杆菌疫苗。他们更经常推迟白喉-破伤风-百日咳（DTP）（OR：4.5; 95% CI：2.0-10.19）和麻疹-腮腺炎-风疹（MMR）疫苗接种。尽管计划免疫率高于有效免疫率，但仍有10%的非儿科医生不遵守2004年的官方免疫建议。他们会更经常地避免使用联合疫苗，并将DTP和MMR免疫推迟到以后。几项比较证实了非儿科医生对最近获得许可的疫苗的使用较弱。除了瑞士目前推荐的疫苗外，两组医生都将甲型肝炎、流感和水痘疫苗添加到自己孩子的疫苗接种计划中。儿科医生更可能给自己的孩子接种肺炎球菌（OR：2.26; 95% CI：1.004-4.68）和脑膜炎球菌C（OR：2.26; 95% CI：1.62-3.17）疫苗。与此相反，他们接种森林脑炎病毒疫苗的可能性较低（OR：0.65，95%CI：0.44-0.95）。93%的受访医生同意目前官方的疫苗接种建议，并将其应用于自己的孩子。然而，观察到5%的非儿科医生不会使用流感嗜血杆菌B型疫苗，如果他们有一个孩子出生在2004年是出乎意料的，令人担忧。相比之下，两组都给予了比推荐给自己孩子的疫苗更多的疫苗。在瑞士对免疫接种感兴趣的医生中，很大一部分非儿科医生拒绝或推迟使用推荐的基于MMR或DTP的组合疫苗对自己的孩子进行免疫接种，这表明对诸如担心“免疫过载”等误解的澄清尚未达到卫生保健提供者的重要目标，因此他们不太可能充分回答父母的担忧。
Context. Immunization has an essential impact on public health worldwide. Numerous studies have shown the efficacy of different vaccines to protect individuals from various diseases. However, some parents choose not to vaccinate their children for reasons such as, among others, doubts regarding their usefulness, concerns over safety or efficacy, etc. Physicians are known to exert a direct influence on immunization rates by answering questions and clarifying misconceptions. Yet, it is unknown how they immunize their own children.Objective. We sought to assess how physicians interested in vaccination issues immunized, or would immunize, their own children.Design, Setting, and Participants. An 11-question, Web-based survey with a total of 102 discrete answers was sent to 2070 Swiss physicians in October 2004. All physicians were subscribers to a nonprofit, Web-based expert network (InfoVac, www.infovac.ch) that distributes monthly newsletters and answers question within 2 days on immunization issues. The InfoVac network reaches > 95% of pediatricians in Switzerland but < 20% of general practitioners. All responses were anonymous, and no identifier could be used to trace the participants of the survey. Questions were divided into 2 parts: (1) physicians who were parents were asked which vaccines they gave to their own children and at what age, and (2) all physicians were asked which vaccines they would give to their own child and at what age if they had a newborn child in 2004. Vaccines available in Switzerland at the time of the survey were offered as possible replies, and recommended vaccines were considered as those noted in the Swiss federal immunization schedule issued yearly. One question compared their immunization practice between their own children and their patients. Sociodemographics, qualifying year, membership in different professional groups, and their type of practice were also requested.Statistics. Standard descriptive statistics were used for sociodemographic characteristics. Univariate statistical analyses were performed for each variable to determine its relationship to the dependent variable, being a pediatrician or nonpediatrician. Logistic-regression analysis was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs), controlling for any statistically significant demographic variables that might function as confounders (gender, parenthood, workplace, year of diploma, and type of practice). For all statistical tests, differences were considered significant at P = 1 child. All physicians reported immunizing children in their practice. Pediatricians were more likely to be women and to work in private practice than nonpediatricians but less likely to belong to a self-reported alternative medicine association. Among the nonpediatricians, 317 were general practitioners, 144 were internists, and 95 were other specialists. Ninety-two percent of pediatricians followed the official immunization recommendations for their own children. In contrast, after controlling for gender, workplace, type of practice, and year of diploma, nonpediatricians were more likely not to have immunized their children against measles, mumps, hepatitis B, or Haemophilus influenzae type b. They more frequently postponed diphtheria-tetanus-pertussis (DTP) (OR: 4.5; 95% CI: 2.0-10.19) and measles-mumps-rubella (MMR) vaccination. Although projected immunization rates were higher than effective rates, 10% of nonpediatricians would still not follow the official immunization recommendations in 2004. They would more frequently refrain from using combination vaccines and postpone DTP and MMR immunization to later in life. Several comparisons confirmed the weaker use of the more recently licensed vaccines by nonpediatricians. In addition to vaccines currently recommended in Switzerland, both groups of physicians added hepatitis A, influenza, and varicella vaccines to the vaccination schedule of their own children. Pediatricians were more likely to give pneumococcal (OR: 2.26; 95% CI: 1.004-4.68) and meningococcal C (OR: 2.26; 95% CI: 1.62-3.17) vaccines to their own children. In contrast, they were less likely to give tick-borne encephalitis virus vaccine ( OR: 0.65; 95% CI: 0.44-0.95).Conclusions. Ninety-three percent of the surveyed physicians agree with the current official vaccination recommendations and would apply them to their own children. However, the observation that 5% of nonpediatricians would not use Haemophilus influenzae type b vaccine if they had a child born in 2004 is unexpected and concerning. In contrast, both groups gave additional vaccines than those recommended to their own children. Among physicians in Switzerland interested in immunization, a significant proportion of nonpediatricians decline or delay the immunization of their own children with the recommended MMR- or DTP-based combination vaccines, which indicates that clarification of misconceptions such as fear of "immune overload" has not yet reached important targets among health care providers who thus are unlikely to answer parental concerns adequately.