ChiroACCESS Article



Vaccination Issues: Will Chiropractic Vaccination be Mandated?



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ChiroACCESS Editorial Staff

  

ChiroACCESS



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March 9, 2011

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The subject of vaccination continues to be a controversial subject for the chiropractic profession.  We know that all vaccinations are not alike and the health risks associated with the many types of vaccines vary considerably just as the risk associated with different chiropractic procedures vary.  In addition, the potential adverse effects from many vaccinations are not as great as in past decades. 

The subject of vaccination continues to be a controversial subject for the chiropractic professionWith 20% of the population affected by influenza, the benefits versus risks of vaccination should be weighed carefully.  A recent study (February 2011) by the Center for Health Policy at Dartmouth compared the influenza vaccination rate of chiropractic patients to individuals that did not use chiropractic and found no significant difference.  These results contrast with some previous studies and suggest that perhaps the profession's attitudes regarding vaccination may be shifting.

Another vaccination related paper from the Bioethics Program at the Mayo Clinic this month concluded that "Mandatory influenza vaccination for health care workers is supported not only by scientific data but also by ethical principles and legal precedent. The recent influenza pandemic provides an opportunity for policymakers to reconsider the benefits of mandating influenza vaccination for health care workers, including building public trust, enhancing patient safety, and strengthening the health care workforce."  One of the reasons for a push to mandate vaccination among health care workers is that other research revealed that 40% of health care workers are not vaccinated.

Influenza vaccination among chiropractic patients and other users of complementary and alternative medicine: Are chiropractic patients really different?  [Link]

Prev Med. 2011 Feb 4. [Epub ahead of print]

Davis MA, Smith M, Weeks WB.
Center for Health Policy, The Dartmouth Institute for Health Policy & Clinical Practice, 35 Centerra Parkway, NH 03766, Lebanon; Grace Cottage Hospital, Townshend, VT, United States.

OBJECTIVE: Previous studies suggest a possible association between using chiropractic care and lower influenza vaccination rates. We examined adult influenza vaccination rates for chiropractic patients to determine if they are different than those for users of other complementary and alternative medicine (CAM).

METHOD: We used the 2007 National Health Interview Survey to examine influenza vaccination rates among adult respondents who were considered high priority for the influenza vaccine (n=12,164). We separated respondents into clinically meaningful categories according to age and whether or not they had recently used chiropractic care, some other type of CAM, or neither. We used adjusted logistic regression to determine whether user status predicted influenza vaccination.

RESULTS:
Only 33% of younger and 64% of older high priority Chiropractic Users were vaccinated in 2007; these rates approximated those of Non-CAM Users. However, younger Non-Chiropractic CAM Users were more likely than Non-CAM Users to have been vaccinated (p-value=0.05). In adjusted logistic regressions, we found statistically insignificant differences when comparing Chiropractic Users to Non-CAM Users for younger adults (OR=0.93(95% CI:0.76-1.13), or for older adults OR=0.90 (95% CI:0.64-1.20).

CONCLUSION:
Chiropractic Users appear no less likely to be vaccinated for influenza; whereas, younger Non-chiropractic CAM Users are more likely than Non-CAM Users to be vaccinated.

Adult vaccination coverage levels among users of complementary/alternative medicine - results from the 2002 National Health Interview Survey (NHIS).  [Link]

BMC Complement Altern Med. 2008 Feb 22;8:6.

Stokley S, Cullen KA, Kennedy A, Bardenheier BH.
Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. sstokley@cdc.gov

BACKGROUND: While many Complementary/Alternative Medicine (CAM) practitioners do not object to immunization, some discourage or even actively oppose vaccination among their patients. However, previous studies in this area have focused on childhood immunizations, and it is unknown whether and to what extent CAM practitioners may influence the vaccination behavior of their adult patients. The purpose of this study was to describe vaccination coverage levels of adults aged > or = 18 years according to their CAM use status and determine if there is an association between CAM use and adult vaccination coverage.

METHODS: Data from the 2002 National Health Interview Survey, limited to 30,617 adults that provided at least one valid answer to the CAM supplement, were analyzed. Receipt of influenza vaccine during the past 12 months, pneumococcal vaccine (ever), and > or = 1 dose of hepatitis B vaccine was self-reported. Coverage levels for each vaccine by CAM use status were determined for adults who were considered high priority for vaccination because of the presence of a high risk condition and for non-priority adults. Multivariable analyses were conducted to evaluate the association between CAM users and vaccination status, adjusting for demographic and healthcare utilization characteristics.
RESULTS: Overall, 36% were recent CAM users. Among priority adults, adjusted vaccination coverage levels were significantly different between recent and non-CAM users for influenza (44% vs 38%; p-value < 0.001) and pneumococcal (40% vs 33%; p-value < 0.001) vaccines but were not significantly different for hepatitis B (60% vs 56%; p-value = 0.36). Among non-priority adults, recent CAM users had significantly higher unadjusted and adjusted vaccination coverage levels compared to non-CAM users for all three vaccines (p-values < 0.001).

CONCLUSION: Vaccination coverage levels among recent CAM users were found to be higher than non-CAM users. Because CAM use has been increasing over time in the U.S., it is important to continue monitoring CAM use and its possible influence on receipt of immunizations among adults. Since adult vaccination coverage levels remain below Healthy People 2010 goals, it may be beneficial to work with CAM practitioners to promote adult vaccines as preventive services in keeping with their commitment to maintaining good health.

Vaccinating health care workers against influenza: the ethical and legal rationale for a mandate.  [Link]

Am J Public Health. 2011 Feb;101(2):212-6.

Ottenberg AL, Wu JT, Poland GA, Jacobson RM, Koenig BA, Tilburt JC.
Bioethics Research Program, Mayo Clinic, Rochester, MN 55905, USA. ottenberg.abigale@mayo.edu

Despite improvements in clinician education, symptom awareness, and respiratory precautions, influenza vaccination rates for health care workers have remained unacceptably low for more than three decades, adversely affecting patient safety. When public health is jeopardized, and a safe, low-cost, and effective method to achieve patient safety exists, health care organizations and public health authorities have a responsibility to take action and change the status quo. Mandatory influenza vaccination for health care workers is supported not only by scientific data but also by ethical principles and legal precedent. The recent influenza pandemic provides an opportunity for policymakers to reconsider the benefits of mandating influenza vaccination for health care workers, including building public trust, enhancing patient safety, and strengthening the health care workforce.

Pediatric vaccination and vaccine-preventable disease acquisition: associations with care by complementary and alternative medicine providers.  [Link]

Matern Child Health J. 2010 Nov;14(6):922-30.

Downey L, Tyree PT, Huebner CE, Lafferty WE.
Harborview Medical Center, Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of Washington, Box 359765, 325 Ninth Avenue, Seattle, WA 98104, USA. ldowney@u.washington.edu

This study investigated provider-based complementary/alternative medicine use and its association with receipt of recommended vaccinations by children aged 1-2 years and with acquisition of vaccine-preventable disease by children aged 1-17 years. Results were based on logistic regression analysis of insurance claims for pediatric enrollees covered by two insurance companies in Washington State during 2000-2003. Primary exposures were use of chiropractic, naturopathy, acupuncture, or massage practitioner services by pediatric enrollees or members of their immediate families. Outcomes included receipt by children aged 1-2 years of four vaccine combinations (or their component vaccines) covering seven diseases, and acquisition of vaccine-preventable diseases by enrollees aged 1-17 years. Children were significantly less likely to receive each of the four recommended vaccinations if they saw a naturopathic physician. Children who saw chiropractors were significantly less likely to receive each of three of the recommended vaccinations. Children aged 1-17 years were significantly more likely to be diagnosed with a vaccine-preventable disease if they received naturopathic care. Use of provider-based complementary/alternative medicine by other family members was not independently associated with early childhood vaccination status or disease acquisition. Pediatric use of complementary/alternative medicine in Washington State was significantly associated with reduced adherence to recommended pediatric vaccination schedules and with acquisition of vaccine-preventable disease. Interventions enlisting the participation of complementary/alternative medicine providers in immunization awareness and promotional activities could improve adherence rates and assist in efforts to improve public health.

Personal and professional immunization behavior among Alberta chiropractors: a secondary analysis of cross-sectional survey data.  [Link]

J Manipulative Physiol Ther. 2009 Jul-Aug;32(6):448-52.

Medd EA, Russell ML.
Department of Community Health Sciences, University of Calgary, Alberta, Canada. eamedd@ucalgary.ca

OBJECTIVES: This study examined the relationship among chiropractors' personal immunization decisions, the vaccination status of their children, and their interest in referring patients for immunization.

METHODS: This was a secondary analysis of data collected in a 2002 postal survey of Alberta chiropractors (response rate, 78.2%). Analysis was restricted to chiropractors with children (n = 325). Chiropractors indicated their own vaccination status, that of their children, and their interest in referring patients for immunization. Data analysis included frequencies, cross tabulations, and logistic regression models (alpha = .05).

RESULTS: Most respondents were male (83.4%), had more than one child (71.8%), and had graduated from chiropractic college a median of 13 years before survey. Of the chiropractors, 92.6% had ever been immunized, but only 35.7% would accept immunization for themselves in the future. Further, 66.8% had at least one immunized child, and 21.8% indicated interest in referring patients for immunization. Chiropractors who would accept immunization for self in the future, compared with those who would not, were more likely to indicate interest in patient referral for immunization (odds ratio, 11.4; 95% confidence interval, 5.4-24.0; P < .001). Chiropractors who have at least one immunized child, compared with those with none immunized, were 6.2 times more likely to indicate interest in referring patients for immunization (odds ratio, 6.2; 95% confidence interval, 1.4-28.4; P = .018).

CONCLUSIONS: Alberta chiropractors are consistent in their personal and professional behaviors. Chiropractors who accept vaccinations for themselves or their children are more likely to refer patients to public health for immunizations.

Attitudes towards vaccination among chiropractic and naturopathic students.  [Link]

Vaccine. 2008 Nov 18;26(49):6237-43. Epub 2008 Jul 30.

Busse JW, Wilson K, Campbell JB.
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada L8N 3Z5.

We have investigated the attitudes towards vaccination of undergraduate chiropractic and naturopathic students in the two major complementary and alternative medicine colleges in Canada. While the majority of the students were not averse to vaccination, we found in both colleges that anti-vaccination attitudes were more prevalent in the later years of the programs. Reasons for this are discussed, and we provide suggestions for strategies to address the situation.
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