ATLANTA — Pediatricians have embraced the current rotavirus vaccine to a much greater extent than have family physicians, Shannon Stokley said at the winter meeting of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.

Merck & Co.'s live, oral pentavalent vaccine RotaTeq is currently the only rotavirus vaccine available on the U.S. market. (See related story above.)

To assess the rates of adoption and attitudes toward the Rotateq vaccine among physicians who treat children, in October 2007 the CDC sent surveys by mail and e-mail to a nationwide sample of 2,500 members of the American Academy of Pediatrics and 3,500 members of the American Academy of Family Physicians. After exclusion of those who don't see infants under 6 months of age, the final sample of responders comprised 359 pediatricians and 264 family physicians. Responders did not differ from nonresponders with respect to sociodemographic factors, region of the country, or practice setting or location, said Ms. Stokley of the CDC's National Center for Immunization and Respiratory Diseases.

Pediatricians were far more likely to administer the rotavirus vaccine, with 86% versus 45% of family physicians saying they “routinely” give it. Three percent of pediatricians said they offer it but not routinely, versus 14% of family physicians, while just 11% of pediatricians do not offer the vaccine, compared with 42% of family physicians.

Similarly, 70% of pediatricians “strongly” recommend the vaccine to their patients, compared with just 22% of family physicians, while 18% and 33%, respectively, said they recommend the vaccine but not strongly. Ten percent of pediatricians versus 37% of family physicians inform patients about the rotavirus vaccine without recommending it.

Seventeen percent of pediatricians and 44% of family physicians agreed with the statement “The rotavirus vaccine is not necessary for my patients,” while 88% of pediatricians and 64% of family physicians agreed that “Rotavirus vaccine should be routinely recommended for all eligible infants.”

Knowledge about the vaccine also differed between the two specialties. A total of 69% of pediatricians vs. 30% of family physicians knew the age by which the first dose of rotavirus vaccine should be administered (12 weeks), while 62% and 32%, respectively, knew the age by which all three doses should be administered (32 weeks).

Both specialties cited as barriers to vaccination the failure of some insurance companies to cover the vaccine (19% of pediatricians, 22% of family physicians), the “up-front” costs to purchase the vaccine (17% and 22%, respectively), and lack of adequate reimbursements (15% vs. 18%). However, concern about the safety of rotavirus vaccine was far less common among pediatricians than among family physicians (9% vs. 25%), as was concern about addition of another vaccine to the schedule (5% vs. 22%), Ms. Stokley reported.

A total of 292 of the pediatricians and 109 of the family physicians said that they were familiar with a postmarketing surveillance report published on March 16, 2007, in which neither the passive Vaccine Adverse Events Reporting System nor the active Vaccine Safety Datalink identified an increased risk for intussusception following receipt of RotaTeq (MMWR 2007;56:218–22).

Of those respondents, 91% of the pediatricians versus 62% of the family physicians agreed that the number of intussusception cases reported does not exceed the number expected by chance, 8% versus 24% were uncertain about that, and 1% versus 11% said that the number of cases does exceed the number expected by chance. The report caused 3% of the pediatricians and 11% of the family physicians to stop giving the rotavirus vaccine, while it did not alter practice for 88% and 79%, respectively. Seven percent of pediatricians and 6% of family physicians said they continued to give it and told all their patients about the report.

Seventy-nine percent of pediatricians and 63% of family physicians felt that the message regarding intussusception was communicated clearly, while about a third of each group felt that the findings should not have been publicized because they raised concern unnecessarily.

In the discussion that followed Ms. Stokley's presentation, AAFP coliaison Dr. Jonathan Temte of the University of Wisconsin, Madison, said that family physicians “have a long tradition of a little bit of skepticism” about recommendations because of their broad scope of practice and that, moreover, he has noticed a certain degree of “vaccine fatigue” among family physicians because of the rapid increase in new vaccines and new recommendations over the last few years. “I think that has to be kept in mind so we don't lose what has been a very strong ally over the last few years for immunization practice,” Dr. Temte added.

Dr. Doug Campos-Outcalt, the other AAFP coliaison, said that the lack of adequate reimbursement for vaccine administration is a major issue among family physicians. “They lose money on each vaccine … to the point of diminishing returns. I think we've got to address this issue.”

More Pediatricians Than Family Physicians Embrace RotaTeq