NHIS data show acupuncture, chiropractic linked to lower vax rates
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Staff Writer, MedPage Today
Children who received certain types of complementary and alternative medicine (CAM) were less likely to have received a flu shot, data from the CDC’s National Health Interview Survey indicated.
Child vaccination was significantly less common in households that reported using CAM therapies for their children, such as acupuncture or chiropractic manipulation (but excluding multivitamin and mineral supplements), compared with families that had never used these therapies, reported William K. Bleser, PhD, of Pennsylvania State University in University Park, and colleagues.
Even after adjusting for confounders, children treated with CAM had lower odds of receiving the influenza vaccine, the authors wrote in Pediatrics.
Bleser told MedPage Today that he felt the main takeaway from the study was the importance of communication between pediatricians and any practitioners of complementary or alternative medicine.
“A lot of people are using alternative medicine and physicians need to make sure they create a dialogue with their patients so they can take all that information into context when they advise their patients on the health decisions they make,” he said. “It would be especially important if CAM advisors and medical advisors could work together as well and open up some of these lines of communication, and hopefully there will be no declines in vaccination among those patients.”
Bleser added that the influenza vaccine was specifically chosen because its uptake is lower than other routinely recommended vaccines, so there is more opportunity for failure than with a three-shot series.
Overall, use of complementary and alternative medicine other than vitamin/mineral supplements in children was uncommon (ranging from 3.8% for alternative medical systems such as acupuncture to 7.6% for biologically-based therapies such as herbal supplements).
But unadjusted analyses found a significant difference in rates of influenza vaccination among children whose parents said they used alternative medical systems versus never used (33% vs 43%,P=0.008). Similar results were seen for manipulative and body-based therapies (35% versus 43%, respectively, P=0.002).
However, 62% of children had used multivitamins or minerals, and flu shots were actually more common in this group versus those who never used these supplements (45% versus 39%, P<0.001).
When adjusted for health service use covariates, children who used alternative medical systems were still less likely to have received the influenza vaccine in the last 12 months (adjusted OR 0.61, 95% CI 0.44-0.85), as were those who used manipulative and body-based therapies (adjusted OR 0.74, 95% CI 0.58-0.94) than their never-used counterparts.
“These specific types of CAM may require contact with CAM practitioners shown to have vaccine-critical viewpoints, advise against vaccination or advise vaccine schedules different from those recommended by the federal government,” the authors speculated.
They examined data covering approximately 9,000 children in the most recent Child Complementary and Alternative Medicine file from the 2012 NHIS (data were provided by adult household members). While 43% of children were reported to have received the flu shot, vaccine uptake was significantly lower among children without a usual source of care, without a recent well-child checkup and without serious chronic conditions. Race/ethnicity was also a factor, with non-Hispanic white children having the lowest vaccination uptake.
The authors were limited by the cross-sectional design of the NHIS. Also, use of individual CAM therapies — the survey asked about 37 different types — was too small to be analyzed separately, and children younger than 4 were excluded from the survey, though they are at high risk for influenza complications.
Bleser said that having the ability to examine the data longitudinally and having a large enough data set to look at individual types of complementary and alternative medicine would be areas for further study.
It would be “interesting to have a large enough data source to look at individual types of CAM and see which … might be driving that relationship and which ones don’t have any association with flu vaccination at all,” he noted.
This study was supported by grants from Pennsylvania State University and the NIH.
Bleser disclosed providing consultation on mumps vaccine litigation unrelated to this study.
Other co-authors disclosed no conflicts of interest.
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