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Pediatric Vaccination and Vaccine-Preventable Disease Acquisition: Associations with Care by Complementary and Alternative Medicine Providers

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Abstract

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.

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Acknowledgments

Yuki Durham, Research Consultant, Department of Health Services, University of Washington, provided assistance with literature review for this article. Financial support came from the National Center for Complementary and Alternative Medicine (Grant #5R01-AT000891). The Center approved the basic design of the study but had no role in management, analysis, or interpretation of data, nor did it assist in preparation, review, or approval of this manuscript. The authors are solely responsible for the article’s content, which does not necessarily represent the official views of the National Center for Complementary and Alternative Medicine or the National Institutes of Health.

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Authors and Affiliations

  1. 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

    Lois Downey

  2. Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA

    Patrick T. Tyree & Colleen E. Huebner

  3. Office of Health Services and Public Health Outcomes Research, University of Missouri – Kansas City, Kansas City, MO, USA

    William E. Lafferty

Authors
  1. Lois Downey
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  2. Patrick T. Tyree
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  3. Colleen E. Huebner
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  4. William E. Lafferty
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Corresponding author

Correspondence to Lois Downey.

Appendices

Appendix 1: Current Procedural Terminology (CPT) Codes Designating Vaccination

Vaccination against measles, mumps, and rubella

  • Either of the following:

    1. (1)

      Combination vaccine—CPT = 90707 or 90710

    2. (2)

      Measles vaccine—CPT = 90705 or 90708

      AND

      Mumps vaccine—CPT = 90704 or 90709

      AND

      Rubella vaccine—CPT = 90706 or 90708

Vaccination against chickenpox

  • CPT = 90710 or 90716

Vaccination against diphtheria and tetanus (with or without vaccination against pertussis)

  • Either of the following:

    1. (1)

      Combination vaccine—CPT = 90700, 90701, 90702, 90720, 90721, or 90723

    2. (2)

      Diphtheria vaccine—CPT = 90719

      AND

      Tetanus vaccine—CPT = 90703

Vaccination against H. influenzae type B

  • CPT = 90645, 90646, 90647, 90648, 90720, 90721, or 90748

Appendix 2: International Classification of Diseases (ICD-9) Codes Designating Disease Diagnoses

  • Chickenpox: ICD-9 beginning with 052 or 053

  • Diphtheria: ICD-9 beginning with 032 or V024

  • H. influenzae type B: ICD-9 = 038.41 or beginning with 041.5, 320.0, or 482.2

  • Hepatitis B: ICD-9 beginning with 070.2 or 070.3

  • Measles: ICD-9 beginning with 055

  • Mumps: ICD-9 beginning with 072

  • Pertussis: ICD-9 beginning with 033

  • Polio: ICD-9 beginning with 045

  • Rubella: ICD-9 beginning with 056

  • Tetanus: ICD-9 beginning with 037

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Downey, L., Tyree, P.T., Huebner, C.E. et al. Pediatric Vaccination and Vaccine-Preventable Disease Acquisition: Associations with Care by Complementary and Alternative Medicine Providers. Matern Child Health J 14, 922–930 (2010). https://doi.org/10.1007/s10995-009-0519-5

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