Increasing needle fear in the past two decades impacts acceptability and adherence to injectable biologic medications, immunomodulatory, and allergen immunotherapy. We hypothesized that the 6-fold increase in scheduled vaccines (since the 1970s) correlates with needle fear by birth year. METHODS: We conducted a systematic literature search [1958 to 2016] using the search terms Blood Injection Injury phobia, needle phobia, vasovagal, and needle fear. Additional studies were identified using bibliographies and via pediatric pain Listserv peer request. Studies were included if data provided included average birth year/age and percent endorsing needle fear (either present/absent or with Visual Analogue Scale (VAS)). Number of recommended injected vaccines from 0-6 years by birth year was determined by using CDC website http://www.cdc.gov/ vaccines/schedules/past.html, sources of historical schedules (1921+) and state schedules. The correlation between average fear and scheduled vaccines was calculated using the Kendall rank correlation coefficient for non-linear non-parametric associations. RESULTS: Eighteen studies were identified, with 15 meeting inclusion criteria. Of 8459 subjects, 36% were under the age of 18; average birth year ranged from 1931 to 2003. The curve of increasing needle fear correlated strongly with increasing vaccine number (Kendall's tau b 5 0.747, 95%CI 0.513 to 0.982, p50.0003). CONCLUSIONS: The increase in reported needle fear related to the increased number of childhood vaccines. As 2/3 of our sample were adults, these results imply fear acquired in childhood persists. As more immunologic therapies rely on percutaneous delivery, atraumatic methods to give vaccines and research on resilience and fear reduction are needed to enhance immunotherapy adherence.
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