The relationship between vaccine refusal and self-report of atopic disease in children

Enriquez, Rachel; Addington, Whitney; Davis, Faith; Freels, Sally; Park, C. Lucy; Hershow, Ronald C.; Persky, Victoria

doi:10.1016/j.jaci.2004.12.1128

« Previous Next »The Journal of Allergy and Clinical Immunology
Volume 115, Issue 4 , Pages 737-744, April 2005

The relationship between vaccine refusal and self-report of atopic disease in children

Rachel Enriquez, PhD
- From the Division of Allergy, Pulmonary and Critical Care Medicine, School of Medicine, Vanderbilt University, Nashville
- Reprint requests: Rachel Enriquez, PhD, Division of Allergy, Pulmonary and Critical Care Medicine, T-1218 Medical Center North, 1161 21st Ave South, Nashville, TN 37232-2650.
Whitney Addington, MD
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, University of London
Faith Davis, PhD
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago
Sally Freels, PhD
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago
C. Lucy Park, MD
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago
Ronald C. Hershow, MD, MPH
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago
Victoria Persky, MD
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago

Received 26 October 2004; received in revised form 23 December 2004; accepted 27 December 2004.

Nashville, Tenn, London, United Kingdom, and Chicago, Ill

Background

In the last 3 decades, there has been an unexplained increase in the prevalence of asthma and hay fever.

Objective

We sought to determine whether there is an association between childhood vaccination and atopic diseases, and we assessed the self-reported prevalence of atopic diseases in a population that included a large number of families not vaccinating their children.

Methods

Surveys were mailed to 2964 member households of the National Vaccine Information Center, which represents people concerned about vaccine safety, to ascertain vaccination and atopic disease status.

Results

The data included 515 never vaccinated, 423 partially vaccinated, and 239 completely vaccinated children. In multiple regression analyses there were significant (P < .0005) and dose-dependent negative relationships between vaccination refusal and self-reported asthma or hay fever only in children with no family history of the condition and, for asthma, in children with no exposure to antibiotics during infancy. Vaccination refusal was also significantly (P < .005) and negatively associated with self-reported eczema and current wheeze. A sensitivity analysis indicated that substantial biases would be required to overturn the observed associations.

Conclusion

Parents who refuse vaccinations reported less asthma and allergies in their unvaccinated children. Although this relationship was independent of measured confounders, it could be due to differences in other unmeasured lifestyle factors or systematic bias. Further research is needed to verify these results and investigate which exposures are driving the associations between vaccination refusal and allergic disease. The known benefits of vaccination currently outweigh the unproved risk of allergic disease.

Key words: Immunization, asthma, allergic rhinitis, eczema, prevalence, cross-sectional survey

Abbreviations used: DTP, Diphtheria, tetanus, and pertussis, HiB, Haemophilus influenzae B, MMR, Measles, mumps, and rubella, NVIC, National Vaccine Information Center, RR, Rate ratio