Parental Recall May Mislead on Children’s Vaccination Status

Parents may overestimate how many vaccinations their children have received, leading to missed opportunities for catch-up shots, new research finds.

Looking at 137 cases where parents and caregivers reported that children and teens were up to date on their vaccinations, a review of the records showed that this was not true in 21 cases, Rachel Isba, BMBCh, PhD, of Lancaster University, England, reported at the 12th World Congress of the virtual World Society for Pediatric Infectious Diseases (WSPID).

Isba presented research done on parental recall about children’s vaccination status, which is part of a larger project examining the potential for interventions that could be done as part of pediatric emergency department visits. These hospital visits might offer a “catch-up” opportunity for under-immunized children and young people, if clinicians could accurately identify them.

This study looked at the accuracy of parent and caregiver recall by comparing it to data in the medical care record. Isba and colleagues used age-appropriate MMR vaccination and tetanus vaccination combined as a proxy for overall vaccination status and found that parents and other caregivers for children often overestimated vaccination. Isba and colleagues worked with data collected between January 31, 2021, and September 30, 2021, an effort severely impeded by the pandemic’s impact. They looked at cases involving children and teens younger than 16.

A weakness of the study was that combined MMR and tetanus vaccination was used as a proxy measure for overall status. This was necessary owing to the structure of the vaccination data, Isba noted.

In response to a question at the WSPID conference, Isba said she thought only a small percentage of the parents and caregivers who gave inaccurate information were lying to hide a reluctance to vaccinate their children.

The reasons why parents and caregivers report vaccination status inaccurately during emergency department visits are complicated and varied, Isba said.

In many cases, parents and caregivers may simply have lost track of the schedule due perhaps to changing addresses or missing appointments. When medical staff question parents about vaccination, the parents and caregivers give the answer they believe is true, Isba said.

“I think a lot of them genuinely believe that their children are up to date, and that they just happen to be wrong,” Isba said.

Post-Pandemic Catch-up

Isba’s report comes as physicians seek to help millions of children around the world to catch up on routine vaccinations missed during the pandemic, Michelle Fiscus, MD, pediatrician and public health consultant for the National Academy for State Health Policy (NASHP), told Medscape Medical News in an email.

“This small study out of the UK highlights an important opportunity to provide catch-up vaccinations when children are seen in a hospital for minor ailments,” Fiscus wrote.

About 23 million children missed out on basic vaccines through routine immunization services in 2020, 3.7 million more than in 2019, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) reported in July.

“Since the childhood vaccination schedule is complex, it’s easy to understand how parents might not be aware of vaccinations their children may be missing,” Fiscus wrote. “This is why it’s so important that every administered vaccine is recorded in a jurisdiction’s immunization information system and that parents and caregivers are able to access those records at any time.”

NASHP on Feb. 28 issued a report, Recovering Routine Immunization Rates — State Strategies to Move beyond COVID-19.

Among the approaches highlighted in the report was use of digital tools, such as immunization information systems (IIS) that provide consumers with access to immunization records and forecasting schedules. In a survey conducted during a consumer access pilot project, 35% of those who accessed their records indicated they had an overdue vaccination, and 36% of those individuals took action by calling or visiting their clinicians, NASHP said. This approach reduces the burden tied to getting records from medical offices.

Mobile-phone reminders are another tool that’s been tried with some success, reported Yubraj Acharya, PhD, of Pennsylvania State University, Centre County, and coauthors in a November paper in the journal BMC Health Services Research.

They examined results of 16 studies done in Nigeria, where there are serious concerns about missed childhood vaccinations.

“Despite efforts by the Nigerian government and international partners to ensure optimal utilization of routine immunization, over 4 million children in Nigeria still miss out on vaccinations every year,” Acharya and coauthors wrote, noting that Nigeria is one of only 10 countries in the world with measles vaccine coverage of less than 50%.

Acharya and coauthors reported that pooled estimates of studies showed the proportion of mothers who owned at least one mobile phone was 96.4% while the proportion of mothers willing to receive mobile-phone reminders was 86.0%.

Most mothers preferred to receive text message reminders at least 24 hours before the routine immunization appointment day, and in the morning hours. Approximately 52.8% of the mothers preferred to receive reminders in English, the country's official language, Acharya and coauthors wrote.

In response to a request from Medscape for a comment on the Isba paper, Acharya noted the importance of finding ways to help children make up missed vaccinations.

“Vaccinations are backsliding — as a recent WHO report put it — globally due to the pandemic (due to disruptions from the pandemic as well as misinformation surrounding COVID-19 vaccines), so countries will need to find innovative ways to restore and preserve the strides made over the last decade,” Acharya told Medscape in an email.

Kerry Dooley Young is a freelance journalist based in Miami Beach, Florida. She is the core topic leader on patient safety issues for the Association of Health Care Journalists. Young earlier covered health policy and the federal budget for Congressional Quarterly/CQ Roll Call and the pharmaceutical industry and the Food and Drug Administration for Bloomberg. Follow her on Twitter at @kdooleyyoung

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