Impact of health care providers' advice on vaccine refusal for children with an acute nervous system infection.

Sir, Based on a survey in infants’ parents and primary health care providers (HCP), Bakhache et al. underlined the influence of HCP on parental decisions to accept vaccination programs [1]. In the article, authors confirmed that the vast majority of interviewed HCP considered vaccines an important part of preventive care. Overall, 75 % of parents agreed that they trusted their HCP’s judgments about vaccine choices. We wonder whether parents’ nonacceptance of vaccination is influenced by HCP as well. We found out that HCP’s judgments may influence either the parents’ decision to immunize or not to immunize their child. This problem is particularly important when dealing with children recently affected by a severe infectious disease requiring hospitalization which, in most cases, would have been preventable by recommended vaccinations. We interviewed the parents of 40 children admitted to our Hospital (Bambino Gesu Children’s Hospital in Rome, Italy) from 1 December 2012 until 1 September 2013 because of acute central nervous system (ACNS) infection, including meningitis, encephalitis, and acute cerebellitis. Median age of the children was 3.3 years, and median hospital stay was 15 days, during which they received intravenous therapy and were subject to isolation measures. During the hospitalization and the medical visit 15 days after hospital discharge, we questioned parents about the vaccination of their children. Out of 40 patients, 10 had received the appropriate vaccines according to their age. Thirty parents did not complete the vaccination program for the following reasons: (1) lack of knowledge of the current vaccination program (18 cases), (2) inconvenient timing/parents’ forgetfulness (2 cases), and (3) advised against vaccination by HCP (10 cases). All parents reported having been seriously worried about their child’s health during hospitalization. We offered vaccination free of charge for unvaccinated children, explaining the benefits of immunization. Parents of 24 patients asked for immediate vaccination of their children. In six cases, parents refused vaccination for the following reasons: (1) vaccines are considered more dangerous than the diseases (2 cases), (2) vaccines are considered useless in most cases (1 case), (3) children have already benefited from herd immunity (1 case), (4) a child who has already experienced one ACNS infection is unlikely to contract another (1 case), and (5) the vaccine may cause cancer (1 case). All these parents stated that the reasons for their refusal were shared by their HCP. We fully support the conclusions of Bakhache et al. on the central role of HCP advice in providing disease education to parents. In fact, it is well known that HCP recommendation is a strong determinant of immunization success. However, parents frequently reported to have been advised against immunization by their HCP mainly due to erroneous contraindications. This finding raises concern that the communication process from HCP to family on immunization needs to be improved. Besides information programs on immunizations that target the general public, a thorough approach involving HCP education on safety and efficacy of vaccines and how to provide clear information to families is strongly needed Communicated by Willem Proesmans E. Bozzola (*) : L. Nicolosi :A. Vittucci :A. Villani Department of Pediatric, Pediatric and Infectious Diseases Unit, Bambino Gesu Children’s Hospital, IRCCS, Piazza Sant Onofrio 4, 00165 Rome, Italy e-mail: elena.bozzola@opbg.net