Literature Review on Ethical Dilemmas in Childhood Immunization

Bibliographic Information
(APA Format, 6th ed.)
Design /
methods Sample and Setting
Level
and
Strength/
Quality
of
Evidence
(see
scale
below)
Key Findings Limitations
and Strengths
Fermbatch, A., 2011
The method
was to review
literature in
order to
explore the
reasons for
which
parents
refuse to
vaccinate
their children
and the
ethical
dilemmas
faced by the
caregivers.
Literature reviews were
searched using proper
keywords from various
databases such as
Google Scholar,
Cochrane, Pubmed.
Level – IV
Quality of
Evidence
– A (High)
Numerous
reasons are there
for which
parents oppose
to immunize
their children.
But, providing
necessary
information
regarding its
importance to
the parents can
help in building
trust which can
help to avoid
ethical
dilemmas.
No direct studies were conducted but the main
strength was lot of evidences found from the
literature review.
Groom, H., 2007 Using data
from the
National
Immunizatio
n Survey, the
immunization
coverage rate
from the year
1996 to 2004
were
compared
The NIS survey data
was collected to
compare the analysis
progress.
Level – IV
Quality of
Evidence
– C (Low).
In order to
increase the
coverage among
children,
irrespective of
income,
residential
group, race as
well as
ethnicity, equal
emphasis should
There were many limitations. The study used data
from particular two years. Because of small sample
size, there were huge exclusions. Due to small
sample size, sufficient power was not present to
detect the differences. However, the strength was
the reliability of the evidences found.

among the
children aged
from 19 to 35
months.
be placed in the
public and
private
providers.
Miller, K., 2018
The method
was to review
different
researches
and findings
to extract
strong
evidences.
No specific sample size
is there.
Level – III
(Non-
experimen
tal study).
Quality of
Evidence
– A
(High).
Importance of
HPV has been
learned from the
success of many
countries and
healthcare
providers should
commit to
provide HPV
coverage among
countries.
The potential of HPV vaccine to prevent morbidity
was not clear for the United States but evidences
from different studies and findings were enough to
reach to the conclusion.
Tsai, Y., 2018
The study
used the
Medicaid
analysis
extract data
from the year
2008 to 2012
and included
children from
the age 0-17
to experiment
the data
finding.
Apart from the
Medicaid analysis
extract data, the sample
size was 1678288.
Level –II
(Quasi
experimen
tal study)
Quality of
Evidence
– A
(High).
It was found that
higher Medicaid
reimbursement
for the vaccine
administration
was associated
with the
increased
proportion of
children who are
receiving
immunization
services.
The study had some potential limitations.
Unobserved factors could bias the estimates, and
also, the findings do not apply to the payment
structure in the Medicaid managed-care programs.
The large sample size is the strength of the study.
Winter, K., 2018 Data of
California
Pertussis
Surveillance
of specific
age groups
were
calculated for
different
The pertussis cases of
20 years age and
younger from 2010 to
2014 were the sample
data.
Level – IV
Quality of
Evidence
– A
(High).
The result
revealed that an
increase in
parental Tdap
has some impact
on the infant
pertussis.
The study was unable to control all the time-
dependent factors and also the data was incomplete
which could create bias. However, the large
amount of evidence was the main strength.