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Jason M. Glanz, PhD; David L. McClure, PhD; David J. Magid, MD, MPH; Matthew F. Daley, MD; Eric K. France, MD, MSPH; Simon J. Hambidge, MD, PhD

Arch Pediatr Adolesc Med. 2010;164(1):66-70.

Objective  To quantify both the individual-level and attributable risk of varicella infection requiring medical care in children whose parents refuse varicella immunizations.

Design  Matched case-control study with conditional logistic regression analysis.

Setting  Kaiser Permanente of Colorado (KPCO) health plan between 1998 and 2008.

Participants  Each pediatric physician-diagnosed case of varicella (n = 133) was matched to 4 randomly selected controls (n = 493). Cases were matched by age, sex, and length of enrollment in KPCO.

Main Exposures  Varicella vaccine refusal.

Outcome Measures  Varicella infection.

Results  There were 7 varicella vaccine refusers (5%) among the cases and 3 (0.6%) among the controls. Children of parents who refused varicella immunizations were at a greatly increased risk of varicella infection requiring medical care (odds ratio, 8.6; 95% confidence interval, 2.2-33.3) compared with children of parents who accepted vaccinations (P = .004). In the entire KPCO pediatric population, 5% of varicella cases were attributed to parental vaccine refusal.

Conclusions  Children of parents who refuse varicella immunizations are at high risk of varicella infection relative to vaccinated children. These results will be helpful to health care providers and parents when making decisions about immunizing children.

Author Affiliations: Kaiser Permanente Colorado Institute for Health Research (Drs Glanz, McClure, Magid, Daley, and Hambidge); Department of Prevention, Kaiser Permanente Colorado (Dr France); Department of Epidemiology, Colorado School of Public Health (Dr Glanz); The Children's Hospital, Denver (Dr Daley); Department of Community Health Services, Denver Health (Dr Hambidge); and the Department of Pediatrics, University of Colorado Denver, Denver, Colorado (Drs Daley and Hambidge).

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RELATED LETTERS

Varicella Vaccine Refusal May Not Be Bad
Kenneth Harkavy
Arch Pediatr Adolesc Med. 2010;164(8):780.
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Jason Glanz and Simon J. Hambidge
Arch Pediatr Adolesc Med. 2010;164(8):780-781.
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