Over the past few years, we’ve looked at all the excuses of why people don’t roll up their sleeves and protect themselves and their loved ones against vaccine-preventable diseases. It’s important for everyone, especially pediatricians, to recognize that one of the most common excuses is real and rational: needle phobia. Like the cartoon featured above indicates, the fear of needles — the fear of pain — affects children as well as adults. It is abundantly clear, however, that anxiety surrounding shots begins in childhood. Tara Haelle discovered a recent study which found that the 4-6 year old “booster” vaccines required for school entry — DTaP (a combination of diphtheria, tetanus, and pertussis vaccines), IPV (polio), MMR-V (measles, mumps, rubella, and chickenpox combo) — created the most trouble:
“People who are afraid of needles are less likely to get vaccines, less likely to fully vaccinate their kids, less likely to give blood and less likely to get a flu shot,” says Dr. Amy Baxter, lead study author and clinical associate professor at Medical College of Georgia in Augusta. Her study found that teens were more likely to fear needles if they had received multiple vaccine injections at a single well-child visit when they were 4 to 6 years old.
“Our findings suggest we risk training kids to avoid important vaccinations when they’re older,” she says. Skipping vaccines, she notes, endangers not only individuals’ health but also public health by putting herd immunity at risk. Herd immunity refers to the protection a highly vaccinated community provides to those who are too young, old or sick to get vaccinated.
Haelle drills down:
Needle phobia increased as the total shots received in one preschool well-visit increased, she found. Each additional injection preschoolers got at one time tripled their odds of having a strong fear of needles five years later…
Yet preteens’ needle fear showed no relationship with total vaccination shots since birth or their total number between ages 4 to 6. The only factor that made a difference was how many they got at one time — and only when they were preschoolers. Those who got four or five shots per visit as infants had no greater fear of needles than their peers, nor did those who got all their preschool shots but during multiple visits between 4 and 6 years old. Only those who got three or more shots at one preschool visit had greater needle phobia.
Should pediatricians consider spreading out the preschool (4-6 year old) booster shots — limiting the number of shots given at one time to two — to diminish the risk of needle phobia? Such a strategy would be risky:
Research shows that spacing out vaccines reduces the likelihood parents will return for all the doses, leaving children under-immunized, points out Dr. Michelle Berlin, co-director of the Oregon Health & Science University’s Center for Women’s Health.
“We know this is a real concern, not a theoretical one,” Berlin says. She also notes the limitations of a small, single-site study and describes Baxter’s results as “exploratory, not definitive.”
Still, Baxter worries about long-term consequences if medical and public health professionals don’t take the risk of needle phobia seriously, especially when solutions exist that don’t involve changing or disregarding the CDC schedule…
“We need to take responsibility for sending teenagers out into the world secretly afraid of needles and health care,” Baxter says.
Baxter’s study showed that needle phobia is a barrier to timely immunization of pre-teens and teenagers to prevent human papillomavirus (HPV) infections and cancer. Giving all vaccines completely and on time, according to the CDC’s gold standard schedule, should still be the public health goal to protect everyone:
Baxter emphasizes the importance of following the current CDC schedule, which is based on all available evidence on vaccines and diseases to date. She just wants physicians to recognize the potential risks of practices, such as multiple preschool immunizations in one visit, that may trigger a serious fear of needles.
“Given the implication that fearful teens opt out of preventive health care, we need to change something,” she says. “The worst thing for public health is if we’re giving so many injections parents and kids pick and choose — or refuse — and we lose herd immunity.”
*** On January 22, 2018, Pediatric Alliance and some of our pediatric colleagues from around the United States began participating in an 8-week AAP-sponsored immunization advocacy campaign on social media. Please follow all our social media posts during this project on Facebook and Twitter.