Reactions of Pediatricians to the Recommendation for Universal Varicella Vaccination

OBJECTIVES: To determine the rate of self-reported adherence by pediatricians to the 1995 American Academy of Pediatrics and the Advisory Committee on Immunization Practices varicella immunization recommendations and to evaluate factors that might influence adherence. DESIGN: Mail survey. SETTING AND PARTICIPANTS: Washington State pediatricians. MAIN OUTCOME MEASURE: Logistic regression was used to identify demographic characteristics, attitudes about varicella vaccine, and previous experiences with the disease that were associated with self-reported adherence to universal varicella immunization recommendations. RESULTS: Completed surveys were returned by 76% of contacted pediatricians, of whom 42% reported following a policy of universal varicella immunization. In multivariate analysis, agreement with statements regarding the effectiveness of varicella vaccine in reducing rare but serious complications of the disease (odds ratio OR, 4.90; 95% confidence interval CI, 2.30-10.50) and in decreasing work loss by parents (OR, 4.21; 95% CI, 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% CI, 1.12-5.74), it is not required for school entry (OR, 2.52; 95% CI, 1.37-4.64), and it is not medically cost-effective (OR, 2.25; 95% CI, 1.21-4.18) were also associated with universally recommending the vaccine. In addition, experience with varicella encephalitis was also associated with adherence to the recommendations (OR, 1.96; 95% CI, 1.06-3.65). Conversely, those who were concerned that varicella vaccine might not provide lifelong immunity were less likely to report recommending universal vaccination (OR, 0.36; 95% CI, 0.19-0.68). CONCLUSIONS: Fewer than 50% of responding Washington State pediatricians reported recommending universal varicella vaccination. Adherence to the recommendations appears to be influenced by personal experience, perceptions about the potential seriousness of varicella, and beliefs about the societal and medical cost-effectiveness of varicella vaccine.