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Standard childhood vaccines: Parental hesitancy or refusal

Julie A Boom, MD
C Mary Healy, MD
Section Editors
Morven S Edwards, MD
Jan E Drutz, MD
Deputy Editor
Mary M Torchia, MD


This topic reviews the reasons why some parents refuse or are hesitant to have their child(ren) immunized; the consequences of vaccine refusal; and an approach to the management of parents who refuse vaccines for their children. Standard childhood immunizations for children are discussed separately. (See "Standard immunizations for children and adolescents".)


In 2015, the World Health Organization Strategic Advisory Group of Experts Working Group on Vaccine Hesitancy provided the following definition: "Vaccine hesitancy refers to a delay in acceptance or refusal of vaccination despite availability of vaccination services. Vaccine hesitancy is complex and context specific, varying across time, place, and vaccines. It is influenced by factors such as complacency, convenience, and confidence" [1]. Complacency refers to the perception that the risks of vaccine-preventable diseases are low; convenience refers to the availability, affordability, and accessibility of vaccines; and confidence refers to trust in the safety and effectiveness of vaccines, the health care system, and policymakers who recommend vaccines.


Immunization is one of the most effective preventative health measures and has saved countless children from death or serious disability (figure 1). Despite this, immunization is an emotional issue for many parents. As vaccine-preventable diseases become less common and parents have little familiarity with the devastating effects of vaccine-preventable illnesses, the benefits of immunization may seem less important than the potential adverse effects [2].

Mainstream media and internet discussions on vaccines, fueled by celebrity opinion, often give equal or greater weight to ill-informed opinion or anecdotal claims about the dangers of vaccines compared with the rigorous scientific studies that prove vaccines are safe and effective [2-5]. The mainstream media has a limited ability (or perhaps preference) to adequately communicate scientific data on vaccines, and Internet sites are not subject to constraints regarding scientific accuracy or fairness of their reporting. The resulting misinformation leads to unnecessary parental concerns. Health care providers need to understand these concerns in order to effectively address them and aid parents in choosing immunization for their children. (See 'Approach to management' below.)


All 50 states in the United States require some immunizations for school entry (typically for kindergarten, seventh grade, and college entry). However, parents can elect to exempt their children from immunizations. There are three types of exemption:


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