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 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 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.