Vaccination against vaccine-preventable diseases is an essential component of women’s primary and preventive health care. To provide the best care for our patients, obstetrician-gynecologists are increasingly called to be vaccinators. The indications and types of vaccines recommended for our patients are expanding [
We hypothesized that experience and familiarity with VAERS are not common among obstetrician-gynecologists. To test this hypothesis and determine more specific knowledge deficits, we conducted a survey to assess the familiarity of practicing obstetrician-gynecologists with VAERS. In this paper, we report the findings of this ten-question assessment.
We invited a total of 1,000 practicing ob-gyns who are members of the American College of Obstetricians and Gynecologists (ACOG) to participate. Three hundred recipients were members of the Collaborative Ambulatory Research network (CARN), a group of physicians who have agreed to participate in 3 to 4 research surveys per year [
The survey included the following demographic questions: gender, year of birth, year completed training, state of practice, location of practice, practice setting category, primary medical specialty, race/ethnicity, and primary race/ethnicity of patients. A total of ten questions were asked, nine knowledge questions and one question about the familiarity with VAERS. Question 1 asked about physicians’ familiarity with VAERS (in terms of prior use), and Question 2 asked physicians to indicate what the purpose of VAERS is. Questions 3, 4, and 5 asked responders to indicate who sponsors VAERS, the primary objectives of VAERS, and who can report to VAERS. Questions 6 and 7 asked respondents to indicate if they are legally obligated to report an adverse vaccine event to VAERS and what can be reported to VAERS. Question 8 asked physicians to indicate which of seven listed possibilities are recognized limitations of VAERS. Question 9 asked whether the adverse event rate for a vaccine can be calculated using VAERS. The final question asked physicians to select which options were true regarding followup after a report is filed with VAERS. A copy of the survey and the correct answers is included in the Survey below. To examine whether those who had responded to the survey might be more knowledgeable or interested in VAERS than those who did not, we sent a letter with three of the study questions to all of the survey recipients who had not returned a survey. The letter included year of birth, gender, and Questions 1, 7, and 8.
Please give an overall assessment of your familiarity with the Vaccine Adverse Event Reporting System (VAERS) (Please check one):
Have used VAERS before (9.2%) Have not used VAERS, but am familiar with its purpose (73.7%) Have not heard of VAERS (17.1%) What is the Vaccine Adverse Event Reporting System (VAERS)? (Please check one):
Online registry developed by anti-vaccine activists (0.9%) Pre-licensure adverse event reporting system (2.4%) Adverse event compensation program (3.7%) Who sponsors VAERS? (Please select all that apply):
NIH (13.5%)
Private industry (21.7%) What are the primary objectives of VAERS? (Please select all that apply):
Who can report to VAERS? (Please select all that apply):
True/False: If an adverse event occurs with a vaccine, the physician is legally required to report this adverse event to VAERS? (Please check one): 5.2% did not answer
True (34.3%)
Which is the best statement regarding what can be reported to VAERS? (Please check one):
Only those adverse events suspected to be vaccine-related (31.2%) Only those adverse events that require medical attention (2.4%) Only those adverse events that require hospitalization (.3%) What are recognized limitations to VAERS data? (Please select all that apply):
True/False: One can calculate the adverse event rate for a vaccine using VAERS? (Please check one): 6.7% did not answer
True (21%)
After a report is filed with VAERS, which of the following are true? (Please select all that apply):
No follow up is available (5.8%)
Medical records sent to VAERS become public record documents (6.1%).
Note that correct answers are in italic with (%) of responders who chose each option.
We computed descriptive statistics for all questions. For nine of the ten questions, participants were asked knowledge questions that have correct answers. For these questions, participants were grouped into two groups (answered correctly or answered incorrectly), and we computed the percent of respondents answering correctly. We assessed differences in age and gender between those who answered the question correctly and those who did not. For questions without a correct answer (which include only one question about familiarity with VAERS), we analyzed differences in age and gender among the response options.
In obstetrician-gynecologists, age and gender are highly associated. Hence, when gender differences were assessed, we controlled age using a dichotomous variable. Participants were grouped using a median split into two roughly equal sized groups: physicians born between 1933 and 1958 (51%,
Data were analyzed using a personal computer based version of SPSS 17.0 (SPSS Inc., Chicago, IL). One-way analysis of variance was used for continuous variables;
The response rate for CARN participants was 57% (171/300). For non-CARN participants, the response rate was 32.1% (225/700). Overall, a total of 397 physicians responded to the survey (39.7% response rate). One responder could not be identified as CARN or non-CARN. Twenty responders were considered ineligible and were eliminated from data analysis (i.e., 9 physicians indicated being retired, and 11 physicians returned the survey blank), leaving 377 eligible responders (167 CARN, 209 non-CARN, and one unidentified). Of the 377 eligible responders, 50 did not complete the survey and were excluded from analysis, resulting in a total sample of 327 obstetrician-gynecologists. We found no significant differences between CARN and non-CARN responders (data not shown); therefore, we collapsed the data and analyzed in aggregate form.
The sample demographics are presented in Table
Demographic variables of responding physicians (
Demographic variables |
|
---|---|
Age (year of birth) | 1958 (±9.7) |
Females | 1962 (±8.3) |
Males | 1954 (±9.4) |
Gender | |
Male | 153 (47%) |
Female | 171 (53%) |
Practice location | |
Urban-inner city | 148 (45%) |
Suburban | 126 (39%) |
Other | 48 (15%) |
Practice type | |
Solo private practice | 63 (19%) |
Group practice | 177 (54%) |
Community hospital facility | 35 (11%) |
University full-time faculty and practice | 31 (10%) |
Other (i.e., public health, government, volunteer, |
19 (6%) |
Primary medical specialty | |
General obstetrics and gynecology | 238 (73%) |
Gynecology only | 66 (20%) |
Obstetrics only | 6 (2%) |
Other (i.e., REI, urogynecology, etc.) | 15 (5%) |
Race/ethnicity | |
White, non-Hispanic | 268 (82%) |
White, Hispanic | 13 (4%) |
Asian/Pacific Islander | 28 (9%) |
African American | 10 (3%) |
Native American/multiracial | 6 (2%) |
Primary race/ethnicity of patients | |
White, non-Hispanic | 233 (72%) |
White, Hispanic | 27 (8%) |
African American | 21 (6%) |
Multiracial | 34 (10%) |
Asian/Pacific Islander/native American/unsure | 10 (4%) |
The provided VAERS Survey shows the responses to all of the survey questions. Overall, only one respondent answered all nine knowledge questions correctly. When asked about the sponsors of VAERS, only 12.5% correctly indicated that the CDC and FDA are the sponsors and that NIH and private industry are not. A total of 43.4% correctly selected all four objectives of VAERS. A total of 24.2% of the sample correctly indicated all six of the individuals listed can report to VAERS. When asked what happens after a report is filed, 17.4% correctly indicated that VAERS staff could request additional information and that patient consent is not required.
The number of recognized limitations to VAERS identified by each physician was summed for a total “limitations score.” The mean “limitations score” was 4.0 (
Gender differences were found on some of the survey questions. As shown in Figure
Familiarity with VAERS broken down by males and females (data not controlled for age) (
Percent of males and females that know all of the objectives of VAERS (data not controlled for age) (
A total of 77 ob-gyns returned a letter. Of the 77, 12 were retired or did not complete over half of the questions on the letter and were therefore excluded. Therefore, a total of 65 letter responders were included in the letter analysis.
We compared the survey responses with letter responses to assess potential differences between those who responded to the survey and those who did not respond. The number of eligible letter responders was 65, with 18 from the CARN group and 47 from the non-CARN group. Letter responders were not significantly different from survey responders in gender or year of birth. The mean year of birth was 1960 (
Safety concerns are one of the most common immunization concerns cited by patients [
To determine more specific information about knowledge deficits, we stratified the answers to this survey based on age and gender. When we compared age differences, older physicians were less familiar with VAERS in general and with the specific objectives of VAERS in particular. For controlling age, we stratified the data by gender and found that women were more likely than men to state that they were aware of VAERS and also to know all the objectives of VAERS. When stratifying both by age and gender, older women were more likely to know the correct answers to VAERS objectives than older males, but in the younger group, the gender differences were not seen. This study does not address attitudinal or practice differences in immunization administration nor were we able to find other studies documenting the frequency of immunization administration in obstetrician-gynecologist practices based on provider age or gender. However, studying these differences could provide useful insight into how we see ourselves or practice as providers of immunizations and allow more targeted CME strategies.
This survey addresses knowledge and use of VAERS. As a survey with a response rate of 37% and a sample size of 1000, this study has some weakness in generalizability. Those who responded to the survey may be more likely to have knowledge or interest in VAERS. We tested this by sending all nonresponders a brief letter soliciting responses to three of the survey questions. When comparing survey responders and letter responders, we did not see differences in familiarity with VAERS and prior use of VAERS supporting the generalizability of our survey. While some differences may be present between responders and nonresponders, these differences may not be as important as the similar low prior use of VAERS between these two groups.
Regarding obstetrician-gynecologist use and knowledge of VAERS, the message is simple and clear: it could be better. More broadly, the role of ob/gyns as immunizers also could improve. We can be encouraged that about 50% of eligible pregnant patients received the flu vaccine in 2011 (compared to 17% prior to the H1N1 pandemic). However, we can utilize a multifactorial approach to further improve the knowledge about and integration of immunizations into the ob-gyn’s practice. The American Congress of Obstetricians and Gynecologists (ACOG) has launched a website, which provides scientific and practical information to facilitate integration of immunizations into clinicians’ offices [
The medical benefits of immunizations are clear. The benefits to our patients of increasing vaccine coverage are also clear. This survey demonstrates that familiarity, understanding, and use of the VAERS data base merit improvement. Further research comparing attitudes and practice patterns of obstetrician-gynecologists regarding immunization is also merited so that we can strategically implement education efforts to enhance obstetrician-gynecologist’s utilization of vaccines: a proven primary prevention tool.
This study is funded by Grant, UA6MC19010, through the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program.