Vaccine knowledge and practices of primary care providers of exempt vs. vaccinated children

Daniel A. Salmon, William K.Y. Pan, Saad B. Omer, Ann Marie Navar, Walter Orenstein, Edgar K. Marcuse, James Taylor, M. Patricia de Hart, Shannon Stokley, Terrell Carter, Neal A. Halsey

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


Objective: Compare vaccine knowledge, attitudes and practices of primary care providers for fully vaccinated children and children who are exempt from school immunization requirements. Methods: We conducted a mailed survey of parent-identified primary care providers from four states to measure perceived risks and benefits of vaccination and other key immunization beliefs. Frequencies of responses were stratified by type of provider, identified by exempt versus vaccinated children. Logistic regression was used to calculate odds ratios for responses by provider type. Results: 551 surveys were completed (84.3% response rate). Providers for exempt children had similar attitudes to providers for non-exempt children. However, there were statistically significant increased concerns among providers for exempt children regarding vaccine safety and lack of perceived individual and community benefits for vaccines compared to other providers. Conclusions: The great majority of providers for exempt children had similar attitudes about vaccine safety, effectiveness and benefits as providers of non-exempt children. Although providers for exempt children were more likely to believe that multiple vaccines weaken a child's immune system and were concerned about vaccine safety and less likely to consider vaccines were beneficial, a substantial proportion of providers of both exempt and vaccinated children have concerns about vaccine safety and believe that CDC underestimates the frequency of vaccine side effects. Effective continuing education of providers about the risks and benefits of immunization and including in vaccine recommendations more information on pre and post licensing vaccine safety evaluations may help address these concerns.

Original languageEnglish (US)
Pages (from-to)286-291
Number of pages6
JournalHuman Vaccines
Issue number4
StatePublished - 2008
Externally publishedYes


  • Exemptions
  • Parents
  • Primary care providers
  • School immunizations
  • Vaccines

ASJC Scopus subject areas

  • Immunology
  • Pharmacology, Toxicology and Pharmaceutics(all)


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