Smith Philip J, Kennedy Allison M, Wooten Karen, Gust Deborah A, Pickering Larry K
Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, National Immunization Program, MS E-32, 1600 Clifton Rd, NE, Atlanta, GA 30333, USA.
Pediatrics. 2006 Nov;118(5):e1287-92. doi: 10.1542/peds.2006-0923.
Parents who have concerns about vaccine safety may be reluctant to have their children vaccinated. The purpose of this study was to explore how vaccination coverage among children 19 to 35 months of age is associated with health care providers' influence on parents' decision to vaccinate their children, and with parents' beliefs about vaccine safety.
Parents of 7695 children 19 to 35 months of age sampled by the National Immunization Survey were administered the National Immunization Survey Parental Knowledge Module between the third quarter of 2001 and the fourth quarter of 2002. Health care providers were defined as a physician, nurse, or any other type of health care professional. Parents provided responses that summarized the degree to which they believed vaccines were safe, and the influence providers had on their decisions to vaccinate their children. Children were determined to be up-to-date if their vaccination providers reported administering > or = 4 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine, > or = 3 doses of polio vaccine, > or = 1 dose of measles-mumps-rubella vaccine, > or = 3 doses of Haemophilus influenzae type b vaccine, and > or = 3 doses of hepatitis B vaccine.
Of all of the parents, 5.7% thought that vaccines were not safe, and 21.5% said that their decision to vaccinate their children was not influenced by a health care provider. Compared with parents who responded that providers were not influential in their decision to vaccinate their children, parents who responded that providers were influential were twice as likely to respond that vaccines were safe for children. Among children whose parents believed that vaccines were not safe, those whose parents' decision to vaccinate was influenced by a health care provider had an estimated vaccination coverage rate that was significantly higher than the estimated coverage rate among children whose parents' decision was not influenced by a health care provider (74.4% vs 50.3%; estimated difference: 24.1%).
Health care providers have a positive influence on parents to vaccinate their children, including parents who believe that vaccinations are unsafe. Physicians, nurses, and other health care professionals should increase their efforts to build honest and respectful relationships with parents, especially when parents express concerns about vaccine safety or have misconceptions about the benefits and risks of vaccinations.
对疫苗安全性存在担忧的家长可能不愿让孩子接种疫苗。本研究的目的是探讨19至35个月大儿童的疫苗接种覆盖率与医疗保健提供者对家长为孩子接种疫苗决策的影响以及家长对疫苗安全性的看法之间的关联。
通过国家免疫调查抽取的7695名19至35个月大儿童的家长，于2001年第三季度至2002年第四季度接受了国家免疫调查家长知识模块的调查。医疗保健提供者被定义为医生、护士或任何其他类型的医疗保健专业人员。家长提供了他们认为疫苗安全的程度以及提供者对他们为孩子接种疫苗决策的影响的相关回答。如果儿童的疫苗接种提供者报告已接种≥4剂白喉和破伤风类毒素及无细胞百日咳疫苗、≥3剂脊髓灰质炎疫苗、≥1剂麻疹-腮腺炎-风疹疫苗、≥3剂b型流感嗜血杆菌疫苗以及≥3剂乙型肝炎疫苗，则确定该儿童疫苗接种及时。
在所有家长中，5.7%认为疫苗不安全，21.5%表示他们为孩子接种疫苗的决定不受医疗保健提供者的影响。与那些表示提供者对其为孩子接种疫苗的决定没有影响的家长相比，那些表示提供者有影响的家长认为疫苗对孩子安全的可能性是前者的两倍。在家长认为疫苗不安全的儿童中，那些家长为孩子接种疫苗的决定受医疗保健提供者影响的儿童的估计疫苗接种覆盖率显著高于家长决定未受医疗保健提供者影响的儿童的估计覆盖率（74.4%对50.3%；估计差异：24.1%）。
医疗保健提供者对家长为孩子接种疫苗有积极影响，包括那些认为疫苗不安全的家长。医生、护士和其他医疗保健专业人员应加大努力与家长建立诚实和尊重的关系，特别是当家长表达对疫苗安全性的担忧或对疫苗接种的益处和风险存在误解时。
