Survey of the prevalence of immunization non-compliance due to needle fears in children and adults

doi:10.1016/j.vaccine.2012.05.011

Vaccine

Volume 30, Issue 32, 6 July 2012, Pages 4807-4812

https://doi.org/10.1016/j.vaccine.2012.05.011 Get rights and content

Abstract

Needle fears are a documented barrier to immunization in children and adults. There is a paucity of data, however, regarding the prevalence of needle fears and their impact on immunization compliance. In this cross-sectional survey, a convenience sample of parents (n = 883) and children (n = 1024) attending a public museum in Toronto, Canada answered questions about needle fears and non-compliance with immunization due to needle fear. Altogether, 24% of parents and 63% of children reported a fear of needles. Needle fear was the primary reason for immunization non-compliance for 7% and 8% of parents and children, respectively. Interventions aimed at improving education about, and access to, analgesic interventions during immunization injections performed in childhood are recommended in order to prevent the development of needle fears and vaccine non-compliance.

Highlights

► 1907 children and parents were surveyed to determine prevalence of self-reported needle fear and impact on vaccine adherence. ► Needle fear was present in 2/3 of children and 1/4 of adults. ► Vaccine non-adherence due to needle fear occurred in 1/12 children and adults alike. ► Pre-emptive analgesia is recommended to prevent the harms of unmitigated pain.

Introduction

Routine immunization plays a key role in maintaining global public health. Despite its proven success, numerous individuals either refuse or delay immunization. Concern about potential harms is one of the reasons for immunization non-compliance. Parents perceive that the most common vaccine-related harm is a child's pain from multiple injections [1].

Injection-induced anxiety and pain are the most frequent adverse effect following immunization [2]. Over 90% of young children exhibit severe distress during immunization [3] and both parents and vaccinators admit they are non-compliant with childhood immunization schedules in an effort to reduce pain and distress [4], [5]. Compliance has been shown to decrease as the number of separate vaccine injections being administered increases [6]. Negative experiences with injections lead to the development of needle fears in some children which are carried into adulthood, and contribute to health care avoidance behaviors in adults, including immunization non-compliance [7]. Outbreaks of vaccine-preventable diseases have been documented to begin in individuals that refused immunization [8] or, due to reduced herd immunity, among infants too young to be immunized [9]. Thus, the success of immunization programs is compromised, in part, because fear-induced avoidance of immunization leads to sub-optimal coverage rates [10].

At present, there are no prevalence estimates of needle fears among children and adults undergoing immunization and the specific impact of needle fears on immunization compliance. We undertook this study to address this knowledge gap given the continual increase in the number of vaccines being recommended and the potential for needle fear to negatively impact vaccine uptake. The primary objectives were to determine the prevalence of needle fears in adults and children undergoing immunization and the reported impact of needle fear on vaccine compliance. Secondary objectives were to describe parental attitudes about, and experiences with, immunization in their children.

Section snippets

Methods

Participants included a convenience sample of adults and children attending the Ontario Science Centre (OSC) in Toronto, Ontario, Canada (http://www.ontariosciencecentre.ca) between June 18 and August 30, 2011. The OSC is an interactive science-based museum open to the public. The OSC was selected as the setting for recruitment because it provided access to a large and diverse sample of parents and children (∼4000/day). Individuals were eligible if: (1) they resided in the Greater Toronto Area

Results

In total, 1973 individuals participated. Of these, 949 were parents and 1024 were children. Parents reported on 1761 children. Responses from 40 individuals that participated in the pilot were included in the analysis. Both parents from the same family each completed a survey for 132 interviews – the responses from only 1 parent, selected at random, were included from the 66 couples. Thus, 883 parents were included. Participant characteristics are displayed in Table 1.

Two hundred and five

Discussion

In a convenience sample of 1024 children and 883 parents, needle fears were reported by about two-thirds of children and one-quarter of adults. Immunization non-compliance due to needle fear was reported by about one out of every dozen children and adults alike. Together, these data provide evidence that needle fears are both commonplace and a significant barrier to routine immunization.

The observed prevalence of needle fears among children in the present study is comparable to a previous

Acknowledgements

The authors wish to thank Sara Poirier and all the staff at the Ontario Science Centre for facilitating this study and for the interviewers for assisting in data collection.

Author Contributions: Dr. Taddio was involved in conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision, funding, administrative, technical and material support and supervision. Dr. Taddio had full access to all the data in the study and takes responsibility

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Survey of the prevalence of immunization non-compliance due to needle fears in children and adults

Abstract

Highlights

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgements

Clin Ther

Vaccine

Pain

Pain

J Anxiety Disord

Vaccine

Vaccine attitudes, concerns, and information sources reported by parents of young children: results from the 2009 HealthStyles Survey

Pediatrics

Physician and parent opinions: are children becoming pincushions from immunizations?

Arch Pediatr Adolesc Med

Too many shots? Parent, nurse, and physician attitudes toward multiple simultaneous childhood vaccinations

Arch Fam Med

Multiple scheduled injections contribute to missed opportunities to immunize during well care visits

Ambul Child Health

Fear of needles: nature and prevalence in general practice

Aust Fam Physician

Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases

N Engl J Med

Improving childhood vaccination rates

N Engl J Med

Delays in immunization have potentially serious health consequences

Paediatr Drugs

Guide to questionnaire construction and question writing