Varicella immunization practices and the factors that influence them.

Objectives: To evaluate the varicella immunization practices of physicians in Rochester, NY, and to identify factors that predict whether physicians administer varicella vaccine to children.

Design: Evaluation of a 40-item survey addressing varicella immunization practices and opinions about varicella immunization that was sent to 241 pediatricians and family physicians.

Results: A total of 172 physicians (71.4%) completed the survey. Sixty-three percent administer the vaccine to some or all varicella-susceptible children aged 1 through 5 years, while 57% administer it to children aged 6 through 11 years, and 74% administer it to adolescents 12 years and older. Physicians who did not offer the immunization were more likely to believe that (1) the vaccine should not be given to preadolescent children because "varicella is a normal part of childhood"; (2) by giving the vaccine, varicella may shift from being primarily a childhood illness to being primarily an adult illness; (3) children get enough immunizations already and should not be given additional immunizations to prevent varicella; (4) it may be preferable to only immunize immunocompromised individuals and their close contacts; and (5) it would cost too much to immunize all American children who have not had varicella. Physicians most likely to offer the vaccine were pediatricians and those whose patients were covered primarily by private insurance plans. After becoming aware of morbidity and mortality rates for varicella-related complications, many physicians who did not administer the vaccine, or administered it only at the request of a parent, indicated that they would be more likely to offer it.

Conclusions: Most physicians in the Rochester area administer varicella vaccine, especially to adolescents 12 years and older. Specialty, predominant insurance type billed, and various opinions characterized those who did not offer the immunization. Providing these physicians with information about varicella-related complications may make them more likely to immunize.