In the JournalsPerspective

Mothers may delay vaccinating children if they receive discouraging information

Expectant mothers who receive discouraging information regarding immunization were more likely to delay infant immunization than mothers who received no immunization information, according to findings recently published in Pediatrics.

“Most future parents make their decisions regarding the immunization of their infant before that child’s birth,” Priya Veerasingam, MBChB, department of general pediatrics at Starship Children’s Hospital, Auckland New Zealand, and colleagues wrote. “... It is unknown whether receiving encouraging information increases or receiving discouraging information decreases the likelihood of timely immunization.”

Researchers examined data from a cohort of 6,682 infants born in New Zealand from 2009 to 2010, whose mothers received information about immunization approximately 39 weeks into their pregnancy. Independent connections of immunization information received with immunization timeliness were described by using adjusted ORs and CIs.

Veerasingam and colleagues indicated that 565 women received both encouraging and discouraging types of information, 846 received discouraging information, and 2,416 women received information considered encouraging.

Researchers found that on follow up, less than half of the original cohort remembered receiving the information about immunization. When compared with infants of women who received no immunization information (71% immunized on time), infants of women who received discouraging information only (57% immunized on time; OR = 0.49; 95% CI, 0.38–0.64) or encouraging and discouraging information (61% immunized on time; OR = 0.51; 95% CI, 0.42–0.63) were at lower odds of receiving all immunizations on time. Receiving encouraging information only was not connected with infant immunization timeliness (73% immunized on time; OR = 1; 95% CI, 0.87–1.15).

Veerasingam and colleagues offered a suggestion for implementing their findings.

“ ... It may be necessary to identify those parents who have already received information that discourages them from immunizing their infants and develop immunization promotion strategies specific to this group,” they wrote. “For information provided about immunization to be effective, it is important to determine the informational needs of the target population because these may vary between countries and by maternal demographics, such as parity or ethnicity.” – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.

Expectant mothers who receive discouraging information regarding immunization were more likely to delay infant immunization than mothers who received no immunization information, according to findings recently published in Pediatrics.

“Most future parents make their decisions regarding the immunization of their infant before that child’s birth,” Priya Veerasingam, MBChB, department of general pediatrics at Starship Children’s Hospital, Auckland New Zealand, and colleagues wrote. “... It is unknown whether receiving encouraging information increases or receiving discouraging information decreases the likelihood of timely immunization.”

Researchers examined data from a cohort of 6,682 infants born in New Zealand from 2009 to 2010, whose mothers received information about immunization approximately 39 weeks into their pregnancy. Independent connections of immunization information received with immunization timeliness were described by using adjusted ORs and CIs.

Veerasingam and colleagues indicated that 565 women received both encouraging and discouraging types of information, 846 received discouraging information, and 2,416 women received information considered encouraging.

Researchers found that on follow up, less than half of the original cohort remembered receiving the information about immunization. When compared with infants of women who received no immunization information (71% immunized on time), infants of women who received discouraging information only (57% immunized on time; OR = 0.49; 95% CI, 0.38–0.64) or encouraging and discouraging information (61% immunized on time; OR = 0.51; 95% CI, 0.42–0.63) were at lower odds of receiving all immunizations on time. Receiving encouraging information only was not connected with infant immunization timeliness (73% immunized on time; OR = 1; 95% CI, 0.87–1.15).

Veerasingam and colleagues offered a suggestion for implementing their findings.

“ ... It may be necessary to identify those parents who have already received information that discourages them from immunizing their infants and develop immunization promotion strategies specific to this group,” they wrote. “For information provided about immunization to be effective, it is important to determine the informational needs of the target population because these may vary between countries and by maternal demographics, such as parity or ethnicity.” – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.

    Perspective
    Kathryn Edwards

    Kathryn Edwards

    We are always trying to better understand how we can educate our patients about vaccines. In this regard, there are a couple of things that are pretty interesting about this study.

    First, the data were collected from 2009 to 2010, so we are talking about the situation with vaccine education that occurred 7 years ago. So we need to ask if the situation is currently the same.  Second, a discouraging part of the study was that more than 50% of the women did not receive any information about vaccination during pregnancy.  One would hope that the situation is different now, particularly in the United States since pregnant women are recommended to routinely receive influenza vaccines themselves during pregnancy. Pregnant women are also recommended to receive the tetanus-diphtheria-acellular pertussis, or Tdap, vaccine. The fact that pregnant women are routinely getting vaccines during their pregnancy would suggest now that nearly all pregnant women are hearing about vaccines during their late second to third trimesters.

    Third, most of the information about vaccinations that is discouraging or against vaccination is not coming from health care providers; rather, it’s coming from family, friends and the internet. It is very  important for parents to understand what are authoritative sources of vaccine  information, especially on the internet. Not every piece of information a patient gets is going to have the same level of credibility. Parents should be instructed as to what are credible sources of vaccine information.

    The study also suggested that, unfortunately, that encouraging information did not seem to increase the uptake or the timeliness of the vaccination; overall, about 73% were immunized on time in the group that had encouraging information. We ultimately would want to target 90% to 95% of vaccinations on time.

    These data also support that health care providers need to do a better job of talking about vaccinations with pregnant women for their own health, both in terms of prevention of influenza and whooping cough, but also for the potential that they deliver antibodies through the placenta to the baby and can prevent infant disease. We certainly saw that in the pertussis outbreak that occurred in the United Kingdom a few years ago, where immunizing the mothers aborted the outbreak in infants.

    The bottom line is that obstetricians, midwives and health care providers need to discuss vaccines with all pregnant women and answer their questions in a comprehensive and non-judgmental manner. It is also important that they provide patients with options for looking for credible websites, and advise patients not to obtain their information from friends and family, but from health care providers.

    • Kathryn Edwards, MD
    • Spokesperson, Infectious Diseases Society of America
      Professor of Pediatrics, Vanderbilt University School of Medicine, Division of Infectious Diseases

    Disclosures: Edwards reports no relevant financial disclosures.