Fear not the only issue behind dip in vaccination trends

WASHINGTON-After a 12-year upward trend, vaccination rates among children enrolled in commercial HMO insurance plans dropped almost four percentage points this year, raising concerns that parents are avoiding evidence-based treatment based on a popular-though disproved-theory that vaccines are linked to autism.

In its executive summary, NCQA notes one plausible reason for the disparity could be that the comparatively well educated members more typical of commercial plans might "endanger their children's health-and the public's health-because of their greater access to and overvaluing of misinformation" spread by activists who claim vaccines are linked to autism.

However, two Wisconsin immunization experts dismiss that theory as outdated and overly simplistic.

"As we have discovered, this is much more complicated with issues including access to care and financial concerns nearly as significant as concerns about vaccine safety," says James H. Conway, MD, associate professor of pediatrics, Division of Pediatric Infectious Diseases, University of Wisconsin School of Medicine and Public Health. "Within the vaccine safety category, there are 10 to 15 different issues consistently voiced by families choosing to not immunize."

Those issues include fears about aluminum and mercury in vaccines, and parents' concern about the high number of infant vaccinations recommended at one time, says Diane McHugh, RN, an immunization specialist with Public Health Madison Dane County (Wisc.), and coordinator of the Dane County Immunization Coalition.

"Parents worry about the side effects of so many vaccines given at one time," McHugh says. "What's not publicized as well is that they've dramatically lowered the content of the virus in each shot."

Other reasons she says parents might not stay on schedule with immunizations include a limited number of pediatricians offering evening or weekend hours. The additional access is especially helpful for working parents with minimal or no benefits.

Also, diminished benefits or rising deductibles can cause parents to skip care, and so can ignorance of the clinical importance of following a best-practice timeline for administration of vaccines. A lack of transportation to appointments can affect the commercially insured, while transportation is sometimes available for low-income children on Medicaid.