Advertisement

Adherence to the Advisory Committee on Immunization Practices Recommendation to Prevent Injuries from Postvaccination Syncope

A National Physician Survey
  • Wan-Ting Huang
    Affiliations
    Epidemic Intelligence Service, Division of Applied Sciences, Scientifıc Education and Professional Development Program Offıce, CDC, Atlanta, Georgia

    Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
    Search for articles by this author
  • Christina Suh
    Affiliations
    Department of Pediatrics, Children’s Hospital, Aurora, Colorado

    Colorado Health Outcomes Program, Children’s Hospital, Aurora, Colorado

    University of Colorado Denver, The Children’s Outcomes Research Program, Children’s Hospital, Aurora, Colorado
    Search for articles by this author
  • Elizabeth Campagna
    Affiliations
    Colorado Health Outcomes Program, Children’s Hospital, Aurora, Colorado

    University of Colorado Denver, The Children’s Outcomes Research Program, Children’s Hospital, Aurora, Colorado
    Search for articles by this author
  • Karen R. Broder
    Correspondence
    Address correspondence to: Karen R. Broder, MD, 1600 Clifton Road NE, MS D26, Atlanta GA 30333
    Affiliations
    Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
    Search for articles by this author
  • Matthew F. Daley
    Affiliations
    Department of Pediatrics, Children’s Hospital, Aurora, Colorado

    Colorado Health Outcomes Program, Children’s Hospital, Aurora, Colorado

    University of Colorado Denver, The Children’s Outcomes Research Program, Children’s Hospital, Aurora, Colorado
    Search for articles by this author
  • Lori A. Crane
    Affiliations
    Colorado School of Public Health, Children’s Hospital, Aurora, Colorado

    University of Colorado Denver, The Children’s Outcomes Research Program, Children’s Hospital, Aurora, Colorado
    Search for articles by this author
  • Shannon Stokley
    Affiliations
    Immunization Service Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
    Search for articles by this author
  • Allison Kempe
    Affiliations
    Department of Pediatrics, Children’s Hospital, Aurora, Colorado

    Colorado Health Outcomes Program, Children’s Hospital, Aurora, Colorado

    University of Colorado Denver, The Children’s Outcomes Research Program, Children’s Hospital, Aurora, Colorado
    Search for articles by this author

      Background

      Little is known about physicians' adherence to the 2006 Advisory Committee on Immunization Practices (ACIP) recommendation that providers strongly should consider observing vaccine recipients for 15 minutes to prevent injuries from postvaccination syncope.

      Purpose

      To assess physicians' knowledge, attitudes, and practices toward observing adolescents for 15 minutes postvaccination.

      Methods

      A survey was administered during October 2008–January 2009 to 425 pediatricians (Peds) and 424 family medicine physicians (FPs) from a nationally representative network. Adherence was defined as reporting routinely observing patients for ≥15 minutes after vaccination. Data analysis was completed in 2009.

      Results

      The overall response rate was 73%. A minority of physicians (37% Peds, 24% FPs) were aware that ACIP strongly encourages observing patients for 15 minutes postvaccination, but most physicians (69% Peds, 84% FPs) thought that their practice easily could adhere to this recommendation. Lack of room space (76% Peds, 65% FPs) was the most frequently reported barrier. Seventeen percent of physicians reported adherence to postvaccination observation. Practice in a hospital, university, or community health center compared with private practice (RR=1.64, 95% CI=1.05, 2.40); awareness of the ACIP syncope recommendation (RR=5.55, 95% CI=3.60, 9.37); and believing that postvaccination syncope can result in serious injuries (RR=1.74, 95% CI=1.06, 4.22) were independently associated with self-reported adherence.

      Conclusions

      Few physicians are aware of recommendations for postvaccination observation for syncope and even fewer adhere to them. Strategies to improve this should be developed and tested.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ost L.G.
        • Sterner U.
        • Lindahl I.L.
        Physiologic responses in blood phobics.
        Behav Res Ther. 1984; 22: 109-117
        • Braun M.M.
        • Patriarca P.A.
        • Ellenberg S.S.
        Syncope after immunization.
        Arch Pediatr Adolesc Med. 1997; 151: 255-259
        • Woo E.J.
        • Ball R.
        • Braun M.M.
        Fatal syncope-related fall after immunization.
        Arch Pediatr Adolesc Med. 2005; 159: 1083
        • CDC
        Syncope after vaccination—U.S., January 2005–July 2007.
        MMWR Morb Mortal Wkly Rep. 2008; 57: 457-460
        • Varricchio F.
        • Iskander J.
        • DeStefano F.
        • et al.
        Understanding vaccine safety information from the Vaccine Adverse Event Reporting System.
        Pediatr Infect Dis J. 2004; 23: 287-294
        • U.S. Food and Drug Administration
        Vaccines licensed for immunization and distribution in the U.S. with supporting documents.
        • Kroger A.T.
        • Atkinson W.L.
        • Marcuse E.K.
        • Pickering L.K.
        General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP).
        MMWR Morb Mortal Wkly Rep. 2006; 55: 1-48
        • Crane L.A.
        • Daley M.F.
        • Barrow J.
        • et al.
        Sentinel physician network as a technique for rapid immunization policy surveys.
        Eval Health Prof. 2008; 31: 43-64
        • Kleinman L.C.
        • Norton E.C.
        What's the risk?.
        Health Serv Res. 2009; 44: 288-302
        • Kroger A.T.
        • Sumaya C.V.
        • Pickering L.K.
        • Atkinson W.L.
        General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP).
        MMWR Morb Mortal Wkly Rep. 2011; 60: 1-61
        • American Academy of Pediatrics
        Active immunization.
        in: Pickering L.K. 2009 red book: report of the committee on infectious diseases. 28th ed. American Academy of Pediatrics, Elk Grove Village IL2009