V. C. Ziesenitz,1 P. M. Mullins,2 J. N. van den Anker,3 M. E. Amirshahi4; 1Department of Pediatric Cardiology, Heidelberg University, Heidelberg, Germany and Division of Pediatric Clinical Pharmacology, Children's National Medical Center, Washington, DC, 2George Washington University School of Medicine and Health Sciences, Washington, DC, 3Division of Pediatric Clinical Pharmacology, Children's National Medical Center, Washington DC, and Department of Pediatric Pharmacology, University Children's Hospital, Basel, Switzerland, 4Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC

BACKGROUND: Over the past decade, an increasing number of parents choose not to vaccinate their children, which has coincided with outbreaks of vaccine-preventable diseases (VPD), such as pertussis, mumps and measles. This study describes patterns of childhood vaccinations (VAC) and outbreaks of VPD in the setting of the current anti-VAC movement.
METHODS: A retrospective review of the CDC’s National Ambulatory Care Survey (NAMCS) 2006-2010 was performed. Visits for children < 15 years were included. Visits were stratified by age group (<1, 1-4, 5-14 yr) according to the US VAC schedule. Primary reason for visit and VAC use (bacterial/viral, toxoids, immune globulins) were compared between 2006 and 2010. The incidence of VPD in children < 15 years was assessed in the CDC’s Morbidity and Mortality Weekly Reports.
RESULTS: A weighted estimate representing 797.2 million visits was included. Between 2006 and 2010 there was an increase in preventive care visits (30.0 to 36.7%) and VAC visits (13.3 to 20.2%, all p < 0.0001). Overall, VAC use increased from 23.3 to 29.9% of prescribed drugs between 2006 and 2010, peaking in 2008, which included bacterial and viral VAC (6.4 to 7.3%, and 11.6 to 17.5%, respectively) in all patients, the use of immunoglobulins in infants increased (0 to 0.5%, all p < 0.0001). Despite outbreaks of pertussis (18,665 cases in 2010), measles (95 cases in 2008) and mumps (1,466 cases in 2006), a slight reduction in the specific VAC use was found (toxoids 5.3 to 5.1%, measles-mumps-rubella (MMR) 1.8 to 1.6%). Influenza VAC increased from 1.5 to 6.3% following the 2009 H1N1 outbreak (all p < 0.0001).
CONCLUSION: Despite recent anti-VAC campaigns, overall VAC have increased from 2006 to 2010. Toxoid and MMR VAC use decreased, which should raise public health concern in the context of disease outbreaks.