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Physician attitudes regarding breakthrough varicella disease and a potential second dose of varicella vaccine
Matthew M Davis1, Mona Marin, Anne E Cowan
1Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI, USA. mattdav@med.umich.edu
Insights
Most physicians support the 1-dose varicella vaccine program, but many have seen breakthrough disease. A 2-dose recommendation may increase adoption, especially with a combination vaccine.
Area of Science:
- Immunization practices
- Pediatric infectious diseases
- Public health policy
Background:
- The 1-dose varicella vaccination program is widely recommended by physicians.
- A significant percentage of physicians report observing breakthrough varicella disease.
- Physician attitudes towards a 2-dose varicella vaccine recommendation are varied.
Purpose of the Study:
- To assess pediatricians' and family physicians' attitudes regarding the current 1-dose varicella vaccination schedule.
- To determine physicians' perceptions of the necessity for a 2-dose varicella vaccine recommendation to mitigate breakthrough disease.
- To explore factors influencing physician willingness to adopt a 2-dose varicella vaccination strategy.
Main Methods:
- A national mail survey was administered to 550 pediatricians and 550 family physicians in 2005.
- Eligible participants were physicians providing primary outpatient care to children aged 6 years or younger.
- A total of 727 surveys were returned, yielding a 69% response rate, with 610 physicians eligible for analysis.
Main Results:
- 94% of surveyed physicians routinely recommend the 1-dose varicella vaccine.
- 79% of respondents have encountered breakthrough varicella disease within the last 5 years.
- Only 38% agreed a second dose is necessary, though 65% of pediatricians and 39% of family physicians would adopt a 2-dose recommendation if officially advised.
Conclusions:
- Physicians generally support the existing 1-dose varicella vaccination policy.
- Physician adoption of a 2-dose recommendation may increase with official guidance from the Advisory Committee on Immunization Practices.
- The availability of a combination measles-mumps-rubella-varicella vaccine could further encourage the uptake of a 2-dose varicella schedule.
Objective:
We assessed physicians' attitudes about the 1-dose varicella vaccination program and whether physicians think a 2-dose recommendation is needed to reduce the risk of breakthrough disease.
Methods:
We conducted a national mail survey of a random sample of 550 pediatricians and 550 family physicians from April to June 2005. Physicians who provide outpatient primary care to children < or = 6 years of age were eligible for analysis.
Results:
Surveys were returned by 727 respondents, for a response rate of 69%; 610 physicians were eligible. Most respondents (94%) recommend routine 1-dose varicella vaccination, and 79% have seen breakthrough disease in the past 5 years (95% of pediatricians and 58% of family physicians). The majority (68%) agreed or strongly agreed that the current burden of breakthrough disease is acceptable. Only 38% (46% of pediatricians and 28% of family physicians) agreed or strongly agreed that a second dose of varicella vaccine is needed to address the burden of breakthrough disease, whereas 40% were neutral. However, if the Advisory Committee on Immunization Practices were to recommend a second dose of varicella vaccine, then 65% of pediatricians and 39% of family physicians would likely follow the recommendation. Most respondents (78%) would be more willing to recommend a second dose if a combination measles-mumps-rubella-varicella vaccine was available.
Conclusions:
Pediatricians and family physicians support the 1-dose varicella vaccination program. A new Advisory Committee on Immunization Practices recommendation for a second dose of varicella vaccine for children was issued after the survey (in June 2006). Two of 3 pediatricians and 2 of 5 family physicians stated that they would adopt a 2-dose recommendation in practice; rates of adoption may be bolstered with current availability of measles-mumps-rubella-varicella vaccine and harmonization of the varicella vaccination schedule with that of measles-mumps-rubella vaccine.
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