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Kreidl P, Breitwieser MM, Würzner R, Borena W. 14-year-old Schoolchildren can Consent to Get Vaccinated in Tyrol, Austria: What do They know about Diseases and Vaccinations? Vaccines (Basel) 2020; 8:vaccines8040610. [PMID: 33076305 PMCID: PMC7711586 DOI: 10.3390/vaccines8040610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 01/26/2023] Open
Abstract
In Austria, consent to receiving vaccines is regulated at the federal state level and in Tyrol, children aged 14 years are allowed to consent to receiving vaccination. In August 2017, we investigated determinants associated with vaccine hesitancy, having been vaccinated against measles and human papillomavirus (HPV) and the intention to vaccinate among schoolchildren born in 2002 and 2003. Those who consider measles and HPV a severe disease had a significantly higher intention to be vaccinated (prevalence ratio (PR) of 3.5 (95% CI 1.97–6.32) for measles and a PR of 3.2 (95% CI 1.62–6.35) for HPV). One-third of the participants (32.4%; 95% CI 27.8–37.4) were not aware that they are allowed to consent to receiving vaccines. The most common trusted source reported by respondents (n = 311) was the medical doctor (80.7%; 95% CI 75.7–84.7). The main finding related to the aim of the study was that the proportion of objectors is below 4% and therefore it should still be possible to reach measles elimination for which a 95% uptake is necessary. Although the proportion of objectors is not higher compared to adults, we recommend to intensify health education to increase health literacy.
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Affiliation(s)
- Peter Kreidl
- Department for Hygiene, Microbiology and Public Health, Medical University Innsbruck, 6020 Innsbruck, Austria; (P.K.); (R.W.)
| | | | - Reinhard Würzner
- Department for Hygiene, Microbiology and Public Health, Medical University Innsbruck, 6020 Innsbruck, Austria; (P.K.); (R.W.)
| | - Wegene Borena
- Institute of Virology, Department for Hygiene, Microbiology and Public Health, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Correspondence: ; Tel.: +43-512-9003-71737
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402
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Tomljenovic H, Bubic A, Hren D. Decision making processes underlying avoidance of mandatory child vaccination in Croatia - a qualitative study. CURRENT PSYCHOLOGY 2020; 41:6210-6224. [PMID: 33071526 PMCID: PMC7553369 DOI: 10.1007/s12144-020-01110-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 11/26/2022]
Abstract
Despite extensive research evidencing child vaccination is safe and effective, we are witnessing a trend of increasing vaccine hesitancy which is listed among the top ten global health threats. Although some countries incorporate mandatory vaccination programs, no particularly efficient strategies for addressing vaccine avoidance have so far been identified. Within this study we investigated perceptions and reasoning of vaccine hesitant parents from Croatia where child vaccination is mandatory. The aims were to reveal different strategies by which they avoid mandatory vaccination schedules and hypothetical situations in which they would reconsider vaccinating, as well as to identify features of related decision-making. We conducted 25 semi-structured interviews with vaccine hesitant parents and analyzed the data using the framework of thematic analyses. The identified themes were related to the parents’ decision-making process, reflection as well as justification of their decision, avoidance behavior of mandatory vaccination schedules and related consequences, dealing with outcomes of the decision and reconsidering vaccinating. The results support and extend previous findings regarding vaccine reasoning, linking hesitancy with the experientially intuitive thinking style and social intuitionist model of moral reasoning. The findings provide important insights into vaccination avoidance and potential for reconsideration, as well as dealing with related risks. Furthermore, we offer a general framework as well as practical guidelines that may help the development of strategies aimed at increasing vaccination rates.
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Affiliation(s)
| | - Andreja Bubic
- Chair for Psychology, Faculty of Humanities and Social Sciences, University of Split, Split, Croatia
| | - Darko Hren
- Chair for Psychology, Faculty of Humanities and Social Sciences, University of Split, Split, Croatia
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403
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Shukla A, McKenna M, Hayes C, Klevens RM. Association of human papillomavirus vaccination with exposure to dental or medical visits. J Public Health Dent 2020; 80:327-332. [PMID: 33037654 DOI: 10.1111/jphd.12408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 06/20/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) infection is associated with oropharyngeal cancers. The Centers for Disease Control and Prevention (CDC) estimate that >15,000 new cases of HPV-associated oropharyngeal cancers are diagnosed in the United States annually. We evaluated an association between HPV vaccination and dental visits in the previous year. METHODS Data were analyzed from the 2012, 2014, and 2016 Massachusetts Behavioral Risk Factor Surveillance System (MA-BRFSS) datasets. We created four categories of exposures to healthcare services in the past 12 months: a) both medical and dental visits, b) medical visit only, c) dental visit only, d) neither. Outcomes were HPV vaccination ever or influenza vaccination within the past 12 months. Logistic regression, controlled for race and education, was used to measure the association between medical/dental visits and vaccination status. Separate models were generated by sex. RESULTS Crude and adjusted odds ratio of influenza and HPV vaccination were highest among males and females with both medical and dental visits. Women with both medical and dental provider visits had 3.7 times higher odds of being vaccinated for influenza and 1.7 times higher odds of being vaccinated for HPV. There were no differences in crude or adjusted odds among both males and females if the type of healthcare visits were only medical or only dental. CONCLUSION No difference in association between vaccination and medical or dental healthcare exposures suggests that oral health professionals might partner in promotion of positive health behaviors, including HPV vaccination. The type of provider did not affect the outcome as per this study.
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Affiliation(s)
- Anubhuti Shukla
- Department of Oral Health Policy & Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA.,Department of Cariology, Restorative Dentistry and Dental Public Health, Indiana University School of Dentistry, IN, USA
| | - Maria McKenna
- Massachusetts Department of Public Health, Boston, MA, USA
| | - Catherine Hayes
- Director, Dental Services Office of Clinical Affairs, UMass Medical School, Worcester, MA, USA
| | - Ruth Monina Klevens
- Department of Oral Health Policy & Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA.,Massachusetts Department of Public Health, Boston, MA, USA
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404
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Mellucci C, Tamburrano A, Cassano F, Galletti C, Sguera A, Damiani G, Laurenti P. Vaccine Hesitancy among Master's Degree Students in Nursing and Midwifery: Attitude and Knowledge about Influenza Vaccination. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7191. [PMID: 33019559 PMCID: PMC7579204 DOI: 10.3390/ijerph17197191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 11/16/2022]
Abstract
Influenza vaccination among healthcare workers may reduce morbidity and protect fragile patients. Most of the evidence concerning the vaccine hesitancy of healthcare workers reported lack of knowledge and wrong attitude. The aims of this study were to explore the knowledge and attitudes about influenza vaccination among master's degree students in Nursing and Midwifery, and to evaluate the effectiveness of their involvement in the hospital vaccination campaign in order to increase intention to receive immunization. The students of nurses and midwives were involved in the vaccination sessions of the 2018-19 hospital campaign. They were recruited to complete an online survey. Students of the 2nd year (involved in the vaccination campaign) and the 1st year (not involved) were compared. Descriptive and inferential statistics were performed for data analysis. Students who intend to receive influenza vaccination in the following year registered a percentage of 83.6% and showed an overall attitude of 66.8%. The involvement of the students in the vaccination campaign led to a significant increase in their positive vaccination attitude (80.9% vs. 87.0%) and in their intention to receive flu vaccination in the following year (67.7% vs. 100%). A positive attitude towards vaccinations was observed by nurses and midwives. Their involvement in the planning and activities during the vaccination campaign could positively influence their opinions and intention to receive vaccination.
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Affiliation(s)
- Claudia Mellucci
- Section of Hygiene, Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.M.); (F.C.); (C.G.); (G.D.); (P.L.)
| | - Andrea Tamburrano
- Section of Hygiene, Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.M.); (F.C.); (C.G.); (G.D.); (P.L.)
| | - Fabiana Cassano
- Section of Hygiene, Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.M.); (F.C.); (C.G.); (G.D.); (P.L.)
| | - Caterina Galletti
- Section of Hygiene, Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.M.); (F.C.); (C.G.); (G.D.); (P.L.)
- Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Anna Sguera
- Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Gianfranco Damiani
- Section of Hygiene, Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.M.); (F.C.); (C.G.); (G.D.); (P.L.)
- Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Patrizia Laurenti
- Section of Hygiene, Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.M.); (F.C.); (C.G.); (G.D.); (P.L.)
- Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
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405
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Bennett N, Sutton B, Strachan J, Hoskins A, Malloy MJ, Worth LJ. Measles immunisation status of healthcare workers in smaller Victorian hospitals: can we do better? Aust N Z J Public Health 2020; 44:346-348. [DOI: 10.1111/1753-6405.12989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/01/2020] [Accepted: 03/01/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Noleen Bennett
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre Doherty Institute for Infection and Immunity Victoria
- Department of Nursing, Melbourne School of Health Sciences The University of Melbourne Victoria
| | - Brett Sutton
- Department of Health and Human Services Victorian State Government
| | - Janet Strachan
- Department of Health and Human Services Victorian State Government
| | - Alex Hoskins
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre Doherty Institute for Infection and Immunity Victoria
| | - Michael J. Malloy
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre Doherty Institute for Infection and Immunity Victoria
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health The University of Melbourne Victoria
| | - Leon J. Worth
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre Doherty Institute for Infection and Immunity Victoria
- Department of Medicine The University of Melbourne Victoria
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406
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A randomized controlled trial of an online immunization curriculum. Vaccine 2020; 38:7299-7307. [PMID: 32988690 DOI: 10.1016/j.vaccine.2020.09.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/29/2020] [Accepted: 09/14/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Immunization education for physicians-in-training is crucial to address vaccine concerns in clinical practice. Vaccine education is not standardized across residency programs. The Collaboration for Vaccination Education and Research (CoVER) team developed an online curriculum for pediatric (Peds) and family medicine (FM) residents. METHODS A cluster randomized controlled trial (RCT) was performed during the 2017-2018 academic year to evaluate the CoVER curriculum. A convenience sample of residency institutions were randomly allocated to the intervention or control group, with stratification by residency type. The intervention, the CoVER curriculum, consisted of four online modules and an in-person training guide. Control sites continued with their standard vaccine education. Pre-intervention and post-intervention surveys were emailed to residents in both groups. The primary outcomes compared between groups were changes in "vaccine knowledge," "vaccine attitudes/hesitancy," and "self-confidence" in immunization communication. The team assessing outcomes was unblinded to assignments. Hierarchical general linear model was used to adjust for residency type and residency year; residency site was modeled as a random effect. RESULTS Overall, 1444 residents from 31 residency programs were eligible to participate (734 intervention, 710 control). The pre-intervention response rate was 730 (51%) and post-intervention was 526 (36%). Average knowledge scores increased from pre-intervention (control 53%; CoVER 53%) to post-intervention (control 58%; CoVER 60%). Increases in vaccine knowledge among FM residents were greater for CoVER compared to controls (p = 0.041). Vaccine hesitancy was more common among FM (23%) than Peds (10%) residents. In all three residency years, residents in the CoVER group showed greater increases in self-confidence in ability to discuss vaccines with parents/patients (p < 0.03) compared to control group. CONCLUSION The CoVER curriculum is an effective model to standardize immunization education of physicians-in-training. This RCT demonstrated the effectiveness of the CoVER curriculum to improve resident confidence in their ability to discuss vaccines with parents and patients.
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407
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Holroyd TA, Sauer MA, Limaye RJ. Vaccine decision-making among parents of children on Medicaid with and without autism spectrum disorder. Vaccine 2020; 38:6777-6784. [PMID: 32917415 DOI: 10.1016/j.vaccine.2020.08.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 08/03/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The belief that there is a link between the MMR vaccine and autism has led to a decline in childhood-immunization uptake and a resurgence of preventable infectious diseases. This study aimed to understand how the vaccine decision-making process differed between parents with a child diagnosed with autism and parents with a child that did not have autism. METHODS Interviews were conducted in September-December 2018 with 24 racially and demographically diverse parents of children on Medicaid at two Baltimore clinics serving Medicaid patients, one of which only serves families of children with autism. We conducted a semi-structured, qualitative, in-person in-depth interview study to explore parental perceptions of vaccine-decision making. Interviews with participants were transcribed from audio recordings. We then extracted and analyzed the types of barriers each participant experienced. RESULTS Parent descriptions of their vaccine decision-making process focused on three primary factors: concerns about vaccines, the relationship between the child's provider and the parent, and risk perception. These findings are in line with existing literature that has articulated key factors in the vaccine decision-making process generally. Parents of a child with autism were more likely to consider the idea that vaccines were linked to autism in their decision-making process, and were less likely to be influenced by personalized recommendations from the child's health care provider. CONCLUSION Parental concerns about vaccines, the parent-provider relationship, and vaccine risk perception all contribute to vaccine decision-making among parents of children with and without ASD. However, providers may find it especially difficult to manage parental misconceptions about vaccines and developmental disabilities. Future studies can identify alternative communication techniques and determine what mechanisms may be more effective in encouraging vaccine acceptance among parents of children with ASD.
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Affiliation(s)
- Taylor A Holroyd
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, United States; International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, United States.
| | - Molly A Sauer
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, United States; International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, United States.
| | - Rupali J Limaye
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, United States; International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, United States; Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, United States; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, United States.
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408
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Perceptions of French healthcare students of vaccines and the impact of conducting an intervention in health promotion. Vaccine 2020; 38:6794-6799. [PMID: 32896467 DOI: 10.1016/j.vaccine.2020.08.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/10/2020] [Accepted: 08/14/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND The perceptions of healthcare students of vaccines have been poorly explored and appropriate training strategies to address possible confidence gaps concerning vaccination for these future professionals is still a subject of debate. METHODS A questionnaire to assess the perceptions of vaccination and the feeling of preparedness to address patient concerns was submitted to 874 multidisciplinary healthcare students enrolled in the French program "Service Sanitaire des Etudiants en Santé" (SSES). The evolution of their perceptions during the year and the impact of having performed a primary prevention intervention in the context of the SSES program were assessed. RESULTS In total, 530 students of nursing (42.5%), medicine (31.5%), physiotherapy (11.3%), pharmacy (10.9%), and midwifery (3.8%) completed the questionnaires. Among them, 7.0% carried out an intervention within the topic "vaccination and hygiene" and 93.0% within another topic ("nutrition and physical activity" or "addiction"). A portion of the students showed traits of vaccine hesitancy, including specific concerns about side effects (61.5%) or the number of vaccines in the vaccination schedule (30.0%). They felt ill prepared to address vaccine-hesitant patients, with poor confidence of their knowledge about vaccines (52.5%), their ability to inform patients about the side effects (42.5%), the benefit/risk of adjuvants (51.7%), and the rules for introducing a new vaccine (51.9%). They showed significant differences in perception depending on their curriculum. Misconceptions and hesitancy concerning vaccines were significantly improved after the students had performed the primary prevention intervention, regardless of the topic. CONCLUSIONS A portion of French healthcare students show traits of vaccine hesitancy, with significant differences depending on the courses attended. Programs of health promotion, such as the French SSES program, which includes a primary prevention intervention conducted by multidisciplinary groups of students, may improve the global confidence of healthcare students concerning vaccination.
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409
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Investigating HPV- and HPV Vaccine-Related Knowledge, Perceptions, and Information Sources among Health Care Providers in Three Big Cities in China. Vaccines (Basel) 2020; 8:vaccines8030499. [PMID: 32887401 PMCID: PMC7564272 DOI: 10.3390/vaccines8030499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 11/17/2022] Open
Abstract
The limited access to vaccination and vaccine hesitancy are prevalent even among health care providers in less developed countries. This study assessed the relationships between (i) health care providers' knowledge on human papillomavirus (HPV) and vaccination for HPV and (ii) their perceptions, demographic characteristics, and the use of information sources. In this large-scale online survey, participants (n = 1394) were recruited from hospitals of three big cities in China (Shanghai, Guangzhou, and Shenzhen). Descriptive analysis, the chi-square test, and logistic regression analysis were used to answer different research questions. Health care providers' overall knowledge scores are consistent with their perceptions about HPV and HPV vaccine. Occupation, specialty, the type of hospitals, and the frequency of participants' search for information using professional informational sources are the most significant characteristics that are closely associated with their knowledge of HPV and its vaccine. Targeted educational interventions are needed to improve health care providers' engagement in the promotion of the HPV vaccine. Such interventions, besides increasing knowledge, should also emphasize the importance of appropriate information sources to acquire information.
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410
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Agrawal A, Kolhapure S, Di Pasquale A, Rai J, Mathur A. Vaccine Hesitancy as a Challenge or Vaccine Confidence as an Opportunity for Childhood Immunisation in India. Infect Dis Ther 2020; 9:421-432. [PMID: 32447713 PMCID: PMC7452967 DOI: 10.1007/s40121-020-00302-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Indexed: 01/12/2023] Open
Abstract
Vaccines have contributed substantially to decreasing the morbidity and mortality rates of many infectious diseases worldwide. Despite this achievement, an increasing number of parents have adopted hesitant behaviours towards vaccines, delaying or even refusing their administration to children. This has implications not only on individuals but also society in the form of outbreaks for e.g. measles, chicken pox, hepatitis A, etc. A review of the literature was conducted to identify the determinants of vaccine hesitancy (VH) as well as vaccine confidence and link them to challenges and opportunities associated with vaccination in India, safety concerns, doubts about the need for vaccines against uncommon diseases and suspicions towards new vaccines were identified as major vaccine-specific factors of VH. Lack of awareness and limited access to vaccination sites were often reported by hesitant parents. Lastly, socio-economic level, educational level and cultural specificities were contextual factors of VH in India. Controversies and rumours around some vaccines (e.g., human papillomavirus) have profoundly impacted the perception of the risks and benefits of vaccination. Challenges posed by traditions and cultural behaviours, geographical specificities, socio-demographic disparities, the healthcare system and vaccine-specific features are highlighted, and opportunities to improve confidence are identified. To overcome VH and promote vaccination, emphasis should be on improving communication, educating the new generation and creating awareness among the society. Tailoring immunisation programmes as per the needs of specific geographical areas or communities is also important to improve vaccine confidence. Fig. 1 Plain language summary.
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Affiliation(s)
| | | | | | - Jayant Rai
- Medical Affairs Department, GSK, Lucknow, India
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411
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Glanternik JR, McDonald JC, Yee AH, Howell Ba A, Saba KN, Mellor RG, Fireman B, Klein NP. Evaluation of a Vaccine-Communication Tool for Physicians. J Pediatr 2020; 224:72-78.e1. [PMID: 32522526 DOI: 10.1016/j.jpeds.2020.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/18/2020] [Accepted: 06/03/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate a Kaiser Permanente Northern California physician training tool entitled "Effective Communication without Confrontation" aimed at improving communication with vaccine-hesitant parents, building trust, and alleviating physician stress surrounding vaccination visits. STUDY DESIGN Trainings were held May to July 2015. Pre- and post-training surveys assessed physician comfort and perceived effectiveness in communicating with vaccine-hesitant parents. We measured vaccination coverage at the 2-, 4-, and 6-month well-child visits, and days undervaccinated at 9 months of age. We compared vaccination rates before and after the training. RESULTS Of 415 physicians who received training, 249 completed post-training surveys. Physicians reported that the training helped them feel "much more or more" comfortable talking with parents who are unsure (72.3%), want to delay (73.9%), or refuse (63.5%) vaccinations and "much more or more" effective at persuading parents who are unsure (67.5%) or want to delay vaccinations (61.4%). They reported feeling "the same or less" effective persuading parents who refuse vaccinations (66.3%). Vaccine coverage remained unchanged and high from before to after the training (95%-96%), as did parent satisfaction with his or her child's provider (4.73/5.00). CONCLUSIONS The Effective Communication without Confrontation training did not increase vaccine coverage, but did improve physicians' comfort and perceived effectiveness communicating with most vaccine-hesitant parents and may help to ease potentially stressful vaccination visits.
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Affiliation(s)
- Julia R Glanternik
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA.
| | - Julia C McDonald
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Arnold H Yee
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA
| | - Amanda Howell Ba
- Regional Health Education, Kaiser Permanente Northern California, Oakland, CA
| | - Katrina N Saba
- Department of Pediatrics, Kaiser Permanente, Oakland, CA
| | - R Grant Mellor
- Department of Pediatrics, Kaiser Permanente, Stockton, CA
| | - Bruce Fireman
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA
| | - Nicola P Klein
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA
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412
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Yörük S. Factors associated with childhood vaccine hesitancy and measles vaccine hesitancy among healthcare students. Nurs Health Sci 2020; 22:1030-1037. [DOI: 10.1111/nhs.12762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Selda Yörük
- School of Health, Department of Midwifery Balıkesir University, Cagis Campus Balikesir Turkey
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413
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Antinolfi F, Battistella C, Brunelli L, Malacarne F, Bucci FG, Celotto D, Cocconi R, Brusaferro S. Absences from work among healthcare workers: are they related to influenza shot adherence? BMC Health Serv Res 2020; 20:763. [PMID: 32811477 PMCID: PMC7433058 DOI: 10.1186/s12913-020-05585-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/27/2020] [Indexed: 11/18/2022] Open
Abstract
Background The coverage for influenza vaccination among healthcare workers (HCWs) is inadequate in many countries despite strong recommendations; is there evidence that influenza vaccination is effective in preventing absenteeism? Aim of the study is to evaluate the influenza vaccination coverage and its effects on absences from work among HCWs of an Italian academic healthcare trust during the 2017–2018 influenza season. Methods We performed a retrospective study to identify predictive characteristics for vaccination, and a retrospective cohort study to establish the effect of vaccination on absences among the vaccinated and non-vaccinated cohorts between December 2017 and May 2018. Overall absence rates over the whole observation period and sub-rates over 14-days intervals were calculated; then comparison between the two groups were conducted applying Chi-square test. Results Influenza vaccination coverage among 4419 HCWs was 14.5%. Age, university degree, medical care area and physician profile were positively associated with vaccine uptake. Globally during influenza season non-vaccinated HCWs lost 2.47/100 person-days of work compared to 1.92/100 person-days of work among vaccinated HCWs (p < 0.001); significant differences in absences rates resulted when focusing on the influenza epidemic peak. Conclusions Factors predicting influenza uptake among HCWs were male sex, working within medical care area and being a physician. Absenteeism among HCWs resulted to be negatively correlated with vaccination against influenza. These findings add evidence to the urgent need to implement better influenza vaccination strategies towards HCWs to tackle vaccine hesitancy among professionals.
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Affiliation(s)
| | - Claudio Battistella
- Department of Medicine, University of Udine, Udine, Italy.,ULSS4 Veneto Orientale Trust, San Donà di Piave, Venezia, Italy
| | - Laura Brunelli
- Department of Medicine, University of Udine, Udine, Italy.,Udine Healthcare and University Integrated Trust, Udine, Italy.,Friuli Centrale Healthcare University Trust, Udine, Italy
| | | | | | - Daniele Celotto
- Department of Medicine, University of Udine, Udine, Italy.,Giuliano Isontina Healthcare University Trust, Trieste, Italy
| | - Roberto Cocconi
- Udine Healthcare and University Integrated Trust, Udine, Italy.,Friuli Centrale Healthcare University Trust, Udine, Italy
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414
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Sweileh WM. Bibliometric analysis of global scientific literature on vaccine hesitancy in peer-reviewed journals (1990-2019). BMC Public Health 2020; 20:1252. [PMID: 32807154 PMCID: PMC7433157 DOI: 10.1186/s12889-020-09368-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 08/10/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Vaccine hesitancy is a growing threat to national and global health security. The current study was undertaken to provide insights into the global scientific literature on vaccine hesitancy in peer-reviewed journals. METHOD The current study was a descriptive bibliometric study. A validated search strategy on vaccine hesitancy was implemented using SciVerse Scopus. Bibliometric indicators such as (1) annual growth of publications, (2) key players, (3) research themes, (4) pathogens/diseases encountered, (5) top-cited documents, and (6) annual growth of publications stratified by world region and by age category were presented. The study period was from 1990 to 2019. RESULTS Search strategy found 2791 documents. The h-index of the retrieved literature was 89. The leading journal was Vaccine (369; 13.2%%) followed by Human Vaccines and Immunotherapeutics (129; 4.6%). Authors from the USA led with 1125 (40.3%) followed by authors from Italy (234; 8.4%) and the UK (204; 7.3%). The US CDC led with 140 (5.0%) documents followed by Emory University (USA) (81, 2.9%). The list of active authors included six from the USA while the remaining were from France, Australia, and Canada. Research themes in the retrieved literature focused on influenza, human papillomavirus, and the role of parents in immunization of their children. The region of the Americas and the European region had the greatest share of publications and showed steep growth of publications lately. Vaccine hesitancy research on adolescents was most noticed after 2007 while that on children was present all the time but escalated lately. Titles/abstracts analysis indicated that 621(22.3%) documents focused on influenza, 392 (14.0%) focused on Human papillomavirus, and 292 (10.5%) focused on measles. The top-cited documents in literature published after 2015 focused on the definition and strategies to overcome vaccine hesitancy. CONCLUSION The last decade witnessed a noticeable increase in the number of publications. Influenza vaccine and parental concerns about the human papillomavirus vaccine were the main focus of the retrieved literature. Information on vaccine hesitancy needs to be collected from all countries to build a better coalition against the anti-vaccination groups. Re-building trust in vaccines requires targeting parents by providing adequate information on the vaccines.
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology, Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
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415
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Ferrand J, Hockensmith R, Houghton RF, Walsh-Buhi ER. Evaluating Smart Assistant Responses for Accuracy and Misinformation Regarding Human Papillomavirus Vaccination: Content Analysis Study. J Med Internet Res 2020; 22:e19018. [PMID: 32744508 PMCID: PMC7432152 DOI: 10.2196/19018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/18/2020] [Accepted: 07/02/2020] [Indexed: 01/30/2023] Open
Abstract
Background Almost half (46%) of Americans have used a smart assistant of some kind (eg, Apple Siri), and 25% have used a stand-alone smart assistant (eg, Amazon Echo). This positions smart assistants as potentially useful modalities for retrieving health-related information; however, the accuracy of smart assistant responses lacks rigorous evaluation. Objective This study aimed to evaluate the levels of accuracy, misinformation, and sentiment in smart assistant responses to human papillomavirus (HPV) vaccination–related questions. Methods We systematically examined responses to questions about the HPV vaccine from the following four most popular smart assistants: Apple Siri, Google Assistant, Amazon Alexa, and Microsoft Cortana. One team member posed 10 questions to each smart assistant and recorded all queries and responses. Two raters independently coded all responses (κ=0.85). We then assessed differences among the smart assistants in terms of response accuracy, presence of misinformation, and sentiment regarding the HPV vaccine. Results A total of 103 responses were obtained from the 10 questions posed across the smart assistants. Google Assistant data were excluded owing to nonresponse. Over half (n=63, 61%) of the responses of the remaining three smart assistants were accurate. We found statistically significant differences across the smart assistants (N=103, χ22=7.807, P=.02), with Cortana yielding the greatest proportion of misinformation. Siri yielded the greatest proportion of accurate responses (n=26, 72%), whereas Cortana yielded the lowest proportion of accurate responses (n=33, 54%). Most response sentiments across smart assistants were positive (n=65, 64%) or neutral (n=18, 18%), but Cortana’s responses yielded the largest proportion of negative sentiment (n=7, 12%). Conclusions Smart assistants appear to be average-quality sources for HPV vaccination information, with Alexa responding most reliably. Cortana returned the largest proportion of inaccurate responses, the most misinformation, and the greatest proportion of results with negative sentiments. More collaboration between technology companies and public health entities is necessary to improve the retrieval of accurate health information via smart assistants.
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Affiliation(s)
- John Ferrand
- School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Ryli Hockensmith
- School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | | | - Eric R Walsh-Buhi
- School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
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416
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Picchio CA, Carrasco MG, Sagué-Vilavella M, Rius C. Knowledge, attitudes and beliefs about vaccination in primary healthcare workers involved in the administration of systematic childhood vaccines, Barcelona, 2016/17. ACTA ACUST UNITED AC 2020; 24. [PMID: 30755298 PMCID: PMC6373069 DOI: 10.2807/1560-7917.es.2019.24.6.1800117] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundHealthcare professionals are a reliable and impactful source of information on vaccination for parents and children.ObjectivesWe aimed to describe the knowledge, attitudes and beliefs primary care professionals involved in administration of childhood vaccines in Barcelona have about vaccines and vaccination.MethodsIn 2016/17, surveys were administered in person to every public primary care centre (PCC) with a paediatrics department (n = 41). Paediatricians and paediatric nurses responded to questions about disease susceptibility, severity, vaccine effectiveness, vaccine safety, confidence in organisations, key immunisation beliefs, and how they vaccinate or would vaccinate their own children. We used standard descriptive analysis to examine the distribution of key outcome and predictor variables and performed bivariate and multivariate analysis.ResultsCompleted surveys were returned by 277 (81%) of 342 eligible participants. A quarter of the respondents reported doubts about at least one vaccine in the recommended childhood vaccination calendar. Those with vaccine doubts chose the response option 'vaccine-hesitant' for every single key vaccine belief, knowledge and social norm. Specific vaccine knowledge was lacking in up to 40% of respondents and responses regarding the human papilloma virus vaccine were associated with the highest degree of doubt. Being a nurse a risk factor for having vaccine doubts (adjusted odds ratio (ORa) = 2.0; 95% confidence interval (95% CI): 1.1-3.7) and having children was a predictor of lower risk (ORa = 0.5; 95% CI: 0.2-0.9).ConclusionsDespite high reported childhood immunisation rates in Barcelona, paediatricians and paediatric nurses in PCC had vaccine doubts, especially regarding the HPV vaccine.
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Affiliation(s)
- Camila Andrea Picchio
- Universitat Autonoma de Barcelona, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,Servei Programes i Intervencions Preventives, Agencia de Salut Publica de Barcelona, Barcelona, Spain
| | - Mireia Garcia Carrasco
- Universitat Autonoma de Barcelona, Barcelona, Spain.,Servei Programes i Intervencions Preventives, Agencia de Salut Publica de Barcelona, Barcelona, Spain
| | - Maria Sagué-Vilavella
- Universitat Autonoma de Barcelona, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,Servei d'Epidemiologia, Agencia de Salut Publica de Barcelona, Barcelona, Spain
| | - Cristina Rius
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto Carlos III, Madrid, Spain.,Universitat Autonoma de Barcelona, Barcelona, Spain.,Servei d'Epidemiologia, Agencia de Salut Publica de Barcelona, Barcelona, Spain
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417
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Filia A, Bella A, D'Ancona F, Fabiani M, Giambi C, Rizzo C, Ferrara L, Pascucci MG, Rota MC. Childhood vaccinations: knowledge, attitudes and practices of paediatricians and factors associated with their confidence in addressing parental concerns, Italy, 2016. ACTA ACUST UNITED AC 2020; 24. [PMID: 30755294 PMCID: PMC6373065 DOI: 10.2807/1560-7917.es.2019.24.6.1800275] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Paediatrician recommendations are known to influence parental vaccine decisions. Aim Our aim was to examine vaccination knowledge, attitudes and practices among paediatricians in Italy and identify factors associated with their confidence in addressing parental questions. Methods An electronic questionnaire survey was conducted from February to March 2016, among a sample of Italian paediatricians. Results The survey was completed by 903 paediatricians (mean age: 56 years). Of 885 who responded to the specific question, 843 (95.3%) were completely favourable to vaccinations. Sixty-six per cent (570/862) felt sufficiently knowledgeable about vaccinations and vaccine-preventable diseases to confidently discuss them with parents. Paediatricians who were male, who were 55 years or older, who had participated in training courses in the last 5 years, who reported that taking courses and reading the scientific literature had contributed to their knowledge, or who had implemented vaccination promotion activities, felt more knowledgeable than other paediatricians. When asked to rate their level of agreement with statements about vaccine safety and effectiveness, only 8.9% (80/903) responded fully as expected. One third (294/878) did not systematically verify that their patients are up to date with the immunisation schedule. Only 5.4% (48/892) correctly identified all true and false contraindications. Conclusions The majority of paediatricians in Italy are favourable to vaccination but gaps were identified between their overall positive attitudes and their knowledge, beliefs and practices. Targeted interventions are needed aimed at increasing paediatricians’ confidence in addressing parents’ concerns, strengthening trust towards health authorities and improving systems barriers.
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Affiliation(s)
- Antonietta Filia
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Fortunato D'Ancona
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Massimo Fabiani
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Cristina Giambi
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Caterina Rizzo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Lorenza Ferrara
- Regional Epidemiology Unit for Infectious Diseases (SeREMI), ASL, Alessandria, Italy
| | | | - Maria Cristina Rota
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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418
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Huber A, Gazder J, Dobay O, Mészner Z, Horváth A. Attitudes towards varicella vaccination in parents and paediatric healthcare providers in Hungary. Vaccine 2020; 38:5249-5255. [PMID: 32546413 DOI: 10.1016/j.vaccine.2020.05.091] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Varicella vaccination is important in prevention of childhood infection. Aim of this cross-sectional study was to survey attitudes and determinants of support or refusal of varicella vaccination in parents and in paediatric healthcare professionals, mainly health visitors in Hungary prior to the introduction of this vaccine in National Immunization Program in 2019. METHODS Between October 2018 and February 2019, 1042 parents and 198 healthcare professionals completed a self-administered anonymous questionnaire regarding sociodemographic background, knowledge and attitudes towards varicella vaccination, and reasons for non-vaccination. RESULTS From the participating parents 53.3% have vaccinated at least one of their children. Vaccination rate was significantly higher in families with <3 children, living in the capital, among those who have seen complications of varicella and among parents with university degree. Most important positive determinant was recommendation of the vaccine by healthcare professionals: 77.8% of parents accepted vaccination when recommended by the paediatrician, despite the cost of the vaccine, whereas only 17.3% of parents vaccinated their children when the vaccine was not recommended by paediatrician. Most important reasons for non-vaccination was finding the vaccine unnecessary, concerns regarding side effects, and not believing in the vaccine's effectiveness. Among paediatric healthcare professionals, support rate of universal varicella vaccination was 76.3%. Support rate was higher among those who have seen complications of varicella more often and those who consider varicella a severe infection. Reasons of professionals who do not support universal varicella vaccination were similar to those of vaccine hesitant parents. Practice of intentional exposure of non-immune child to infected ones still exist. CONCLUSIONS Educational programs are needed for parents and health visitors to address concerns regarding vaccination. Paediatricians are the most trusted source of information for parents hence they have a significant responsibility and parents likely follow their recommendations.
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Affiliation(s)
- Annamária Huber
- Semmelweis University, Institute of Medical Microbiology, Budapest, Hungary
| | - Judit Gazder
- Health Visitor Service, Municipality of Tatabánya City, Hungary
| | - Orsolya Dobay
- Semmelweis University, Institute of Medical Microbiology, Budapest, Hungary
| | - Zsófia Mészner
- Heim Pál National Paediatric Institute, Budapest, Hungary
| | - Andrea Horváth
- Semmelweis University, Institute of Medical Microbiology, Budapest, Hungary.
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Montagna MT, De Giglio O, Napoli C, Fasano F, Diella G, Donnoli R, Caggiano G, Tafuri S, Lopalco PL, Agodi A. Adherence to Vaccination Policy among Public Health Professionals: Results of a National Survey in Italy. Vaccines (Basel) 2020; 8:E379. [PMID: 32664507 PMCID: PMC7565131 DOI: 10.3390/vaccines8030379] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/05/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023] Open
Abstract
Starting from 2013, the number of unvaccinated people alarmingly increased in Italy; therefore, in 2017 a new Vaccine National Plan was approved. Healthcare workers (HCWs), especially public health professionals (PHPs, i.e., workers in in the sector of hygiene and preventive medicine), have an important role in informing and promoting vaccinations. In this context, the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health (GISIO-SItI) conducted a national survey to assess knowledge, attitude, and practices towards recommended vaccinations among PHPs. The survey was conducted during October 2019 with an anonymous questionnaire distributed to PHPs attending the 52° SItI National Congress. Overall, 57.1% of operators answered correctly to all seven recommended vaccinations, 12.8% reported to be vaccinated for all seven recommended vaccinations, while 30% were naturally immunized. A higher immunization coverage was reported for anti-hepatitis B (88.9%) and measles (86.1%), and 81.3% of the participants reported being offered the influenza vaccination during the 2018/2019 season. The majority of our sample indicated that hepatitis B (95%) and influenza (93.7%) were the recommended vaccines for HCWs, while less was known regarding varicella, pertussis, diphtheria, and tetanus boosters every 10 years. PHPs who were vaccinated (or who intended to be vaccinated) were more likely to recommend vaccinations to their patients and provided a reassuring example to those hesitant patients. Finally, this is the first study that identified good algorithms (using the techniques of machine learning as Random Forest and Deep Learning) to predict the knowledge of PHPs regarding recommended vaccinations with possible applications in other national and international contexts.
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Affiliation(s)
- Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.T.M.); (F.F.); (G.D.); (G.C.); (S.T.)
| | - Osvalda De Giglio
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.T.M.); (F.F.); (G.D.); (G.C.); (S.T.)
| | - Christian Napoli
- Department of Medical Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy;
| | - Fabrizio Fasano
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.T.M.); (F.F.); (G.D.); (G.C.); (S.T.)
| | - Giusy Diella
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.T.M.); (F.F.); (G.D.); (G.C.); (S.T.)
| | | | - Giuseppina Caggiano
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.T.M.); (F.F.); (G.D.); (G.C.); (S.T.)
| | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.T.M.); (F.F.); (G.D.); (G.C.); (S.T.)
| | - Pier Luigi Lopalco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126 Pisa, Italy;
| | - Antonella Agodi
- Coordinator of GISIO-SItI Working Group, Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy;
| | - GISIO-SItI Working Group
- GISIO-SItI Working Group–Italian Study Group of Hospital Hygiene–Italian Society of Hygiene, Preventive Medicine and Public Health, Viale Cittá d’Europa, 74, 00144 Rome, Italy;
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420
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Wong LP, Wong PF, AbuBakar S. Vaccine hesitancy and the resurgence of vaccine preventable diseases: the way forward for Malaysia, a Southeast Asian country. Hum Vaccin Immunother 2020; 16:1511-1520. [PMID: 31977285 DOI: 10.1080/21645515.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
This study engaged health professionals in in-depth, semi-structured interviews to explore their opinions concerning the issues surrounding vaccine hesitancy in Malaysia and strategies to improve vaccination to stamp the rise of vaccine preventable diseases (VPDs). Opinions on how to address the resurgence of VPDs in the era of increasing vaccine hesitancy were obtained. Eight health professionals, including geriatricians, pediatricians, microbiologists, public health specialists, and family medicine specialists were interviewed. The influence of anti-vaccination propaganda, past-experience of adverse event following immunization (AEFI), perceived religious prohibition, a belief that traditional complementary and alternative medicine (TCAM) use is safer, pseudoscience beliefs, and anti-vaccine conspiracy theories were identified as reasons for refusing to vaccinate. The interplay of social, cultural and religious perspectives in influencing perceived religious prohibition, pseudoscience beliefs, and the use of TCAM contributing to vaccine refusal was found. Five broad themes emerged from the health professionals regarding strategies to address vaccine hesitancy, including establishing an electronic vaccination registry, increasing public awareness initiatives, providing feedback to the public on the findings of AEFI, training of front-line healthcare providers, and banning the dissemination of anti-vaccine information via social media. With regards to identifying strategies to address the resurgence of VPDs, mandatory vaccination received mixed opinions; many viewed supplementary immunization activity and the prevention of travel and migration of unvaccinated individuals as being necessary. In conclusion, the present study identified unique local cultural, traditional and religious beliefs that could contribute to vaccine hesitancy in addition to issues surrounding vaccination refusal similarly faced by other countries around the world. This information are important for the formulation of targeted intervention strategies to stamp vaccine hesitancy in Malaysia which are also a useful guide for other countries especially in the Southeast Asia region facing similar vaccine hesitancy issues.
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Affiliation(s)
- L P Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
| | - P F Wong
- Department of Pharmacology, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
| | - S AbuBakar
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
- Tropical Infectious Diseases Research and Educational Centre (TIDREC), University of Malaya , Kuala Lumpur, Malaysia
- WHO Collaborating Centre for Arbovirus Reference and Research (Dengue and Severe Dengue) MAA-12, University of Malaya , Kuala Lumpur, Malaysia
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421
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Morales KF, Menning L, Lambach P. The faces of influenza vaccine recommendation: A Literature review of the determinants and barriers to health providers' recommendation of influenza vaccine in pregnancy. Vaccine 2020; 38:4805-4815. [PMID: 32499068 PMCID: PMC7306152 DOI: 10.1016/j.vaccine.2020.04.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/09/2020] [Accepted: 04/12/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION WHO recommends influenza vaccination for pregnant women and health providers (HPs), yet global uptake for both is persistently low. Research suggests that HPs greatly influence uptake of influenza vaccine in pregnant women. Our review studies HPs' recommendation of influenza vaccine to pregnant women, determinants and barriers to recommendation, and the role that HPs may play in global influenza vaccine coverage. METHODS We undertook a comprehensive global review of literature relating to HPs' recommendation of seasonal influenza vaccines to pregnant women and the determinants and barriers to recommendation and how this may vary by country and context. We evaluated data from each study including frequency of HP recommendation, vaccine coverage, determinants and barriers to recommendation, and the odds of recommending. We tracked the frequency of determinants and barriers to recommendation in heat maps and organized data by world regions and income classifications. RESULTS From 32 studies in 15 countries, we identified 68 determinants or barriers to HPs' recommendation. Recommendation rates were highest (77%) in the Americas and lowest in South East Asia (18%). A HP's own influenza vaccine status was a main determinant of recommendation in multiple country contexts and from different provider types. Financial barriers to recommendation were present in higher-income countries and policy-related barriers were highlighted in lower-income countries. HP perceptions of safety, efficacy, and the utility of vaccine were the most frequently cited barriers, relevant in almost every context. CONCLUSIONS HP recommendation is important to influenza vaccine implementation in pregnant women. A HP's own status is an important recommendation determinant in multiple contexts. Vaccine program implementation plans should consider the impact of HPs' knowledge, awareness and vaccine confidence on their own uptake and recommendation practices, as well as on the uptake among pregnant women. Addressing safety and efficacy concerns is relevant in all contexts for HPs and pregnant women.
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Furman FM, Zgliczyński WS, Jankowski M, Baran T, Szumowski Ł, Pinkas J. The State of Vaccine Confidence in Poland: A 2019 Nationwide Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124565. [PMID: 32599943 PMCID: PMC7345001 DOI: 10.3390/ijerph17124565] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 01/06/2023]
Abstract
Vaccination is considered as one of the most successful and cost-effective public health interventions. This study aimed to assess (1) the attitudes and behaviors towards mandatory childhood vaccination, with particular emphasis on socio-economic factors determining the vaccine confidence among adults in Poland as well as to (2) identify the potential impact of anti-vaccination movement on vaccination coverage among children and adolescents aged ≤19 years. This cross-sectional study was carried in 2019 on a nationwide, representative sample of 1079 individuals aged 18 and over in Poland (53.7% females). Most of the respondents (74.6%) agreed or strongly agreed that mandatory vaccinations are safe, and only 8% of participants neglected the safety of vaccines. The results of multivariate analysis showed that the lowest level of vaccine confidence was observed among participants aged 25–34 years (aOR: 0.48, 95%CI: 0.29–0.80; p = 0.01). There was a positive correlation (r = 0.35; p < 0.001) between trust in doctors and vaccine confidence. Moreover, there was a positive correlation between trust in scientific knowledge and vaccine confidence (r = 0.19; p < 0.001). Also, a negative correlation (r = −0.13; p < 0.001) between trust in horoscopes and vaccine confidence was observed. Most of the parents declared (97.7%), that their children were vaccinated following the national immunization programme. However, 8.5% of parents who currently vaccinated their children declared that they would stop vaccinating children when vaccination obligation will be abolished. This study demonstrates relatively high confidence in mandatory vaccination among adults in Poland. While most of society trusts in vaccine safety, young adults are the least trustful of vaccinations.
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Affiliation(s)
- Filip M. Furman
- Home Hospice “Socrates”, Armii Krajowej 2/4, 05-800 Pruszków, Poland;
| | - Wojciech Stefan Zgliczyński
- School of Public Health, Centre of Postgraduate Medical Education, Kleczewska 61/63, 01-826 Warsaw, Poland; (M.J.); (J.P.)
- Correspondence: ; Tel.: +48-22-5601-150
| | - Mateusz Jankowski
- School of Public Health, Centre of Postgraduate Medical Education, Kleczewska 61/63, 01-826 Warsaw, Poland; (M.J.); (J.P.)
| | - Tomasz Baran
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183 Warsaw, Poland;
| | - Łukasz Szumowski
- Department of Cardiac Arrhythmia, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland;
| | - Jarosław Pinkas
- School of Public Health, Centre of Postgraduate Medical Education, Kleczewska 61/63, 01-826 Warsaw, Poland; (M.J.); (J.P.)
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‘Problem patients and physicians’ failures': What it means for doctors to counsel vaccine hesitant patients in Switzerland. Soc Sci Med 2020; 255:112946. [DOI: 10.1016/j.socscimed.2020.112946] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 02/03/2023]
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Loiacono MM, Mitsakakis N, Kwong JC, Gomez GB, Chit A, Grootendorst P. Development and Validation of a Clinical Prediction Tool for Seasonal Influenza Vaccination in England. JAMA Netw Open 2020; 3:e207743. [PMID: 32597991 PMCID: PMC7324952 DOI: 10.1001/jamanetworkopen.2020.7743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/07/2020] [Indexed: 01/14/2023] Open
Abstract
Importance Timely identification of patients likely to miss seasonal influenza vaccination (SIV) could help health care practitioners tailor services and gain efficiency. Objective To develop and validate a predictive model of SIV uptake among at-risk adults. Design, Setting, and Participants This prognostic study constructed a prediction model for vaccine uptake by adults at increased risk of influenza-associated complications. Drawing from the Clinical Practice Research Datalink database's records of primary care data of 324 284 adults routinely collected at general practices across England from January 2011 to December 2016, logistic regression models were trained on data from patients registered from January 2012 to December 2013 and validated with out-of-sample data from patients registered from January 2015 to December 2016. Data were extracted from the database December 2018 and analyzed between September 2019 and December 2019. Exposures Covariates included sex, age, race/ethnicity, smoking status, socioeconomic status, previous pneumococcal vaccination, prior season SIV uptake, and clinical risk conditions. Main Outcomes and Measures The main outcome was patient-level SIV uptake. Model performance was measured via misclassification rate, Brier score, sensitivity, specificity, and area under the curve. Results The training data sets consisted of 324 284 (aged 18 to 64 years) and 186 426 (aged 65 years or older) patients. The mean (SD) age in the training data among patients aged 18 to 64 years was 45 (13) years; 161 487 (49.8%) were women, and 102 133 (31.5%) were categorized as white. Among patients aged 65 years or older, the mean (SD) age was 77 (8) years; 96 169 (51.6%) were women, and 64 996 (34.9%) were categorized as white. The validation data sets consisted of 35 210 patients aged 18 to 64 years and 25 497 aged 65 years or older. The mean (SD) age in the validation data set among patients aged 18 to 64 years was 42 (14) years; 17 296 (49.1%) were women, and 13 346 (37.9%) were categorized as white. Among patients aged 65 years or older, the mean (SD) age was 73 (8) years; 13 135 (51.5%) were women, and 9641 (37.8) were categorized as white. Among patients aged 18 to 64 years, SIV uptake was 35.9% (95% CI, 35.7%-36.0%) and 32.6% (95% CI, 32.1%-33.1%) for the training and validation data sets, respectively. Among patients aged 65 years or older, SIV uptake was 83.1% (95% CI, 82.9%-83.2%) and 76.1% (95% CI, 75.5%-76.6%) for the training and validation data sets, respectively. Prior season SIV uptake and pneumococcal vaccination status were the best predictors of SIV uptake. Predicted SIV uptake probabilities for patients aged 18 to 64 years were reliable, but biased toward underpredicting, whereas, among patients aged 65 years or older, they were variable and biased toward overpredicting. Briefly, in out-of-sample validation among patients aged 18 to 64 years, misclassification rates were 0.163 to 0.164, Brier scores were 0.124 to 0.125, area under the receiver operating characteristic curve values ranged from 0.876 to 0.877, sensitivity ranged from 0.705 to 0.720, and specificity ranged from 0.896 to 0.902. In patients aged 65 years or older, misclassification rates were 0.120 to 0.125, Brier scores were 0.0953 to 0.0959, area under the receiver operating characteristic curve was 0.877, sensitivity ranged from 0.919 to 0.936, and specificity ranged from 0.680 to 0.753. Conclusions and Relevance This study suggests that data obtained from primary care records could accurately predict SIV uptake among at-risk adults. Further research is needed to assess the feasibility and efficacy of implementing this model in clinical settings.
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Affiliation(s)
- Matthew M. Loiacono
- Vaccine Epidemiology and Modeling, Sanofi Pasteur, Swiftwater, Pennsylvania
- Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada
| | | | - Jeffrey C. Kwong
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
| | - Gabriela B. Gomez
- Vaccine Epidemiology and Modeling, Sanofi Pasteur, Lyon, France
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, United Kingdom
| | - Ayman Chit
- Vaccine Epidemiology and Modeling, Sanofi Pasteur, Swiftwater, Pennsylvania
- Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada
| | - Paul Grootendorst
- Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada
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425
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Knowledge and Attitude towards Vaccination among Healthcare Workers: A Multicenter Cross-Sectional Study in a Southern Italian Region. Vaccines (Basel) 2020; 8:vaccines8020248. [PMID: 32456273 PMCID: PMC7350011 DOI: 10.3390/vaccines8020248] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 01/29/2023] Open
Abstract
Background: In Italy, the loss of confidence towards vaccination resulted in low vaccine coverage, also among healthcare workers (HCWs). Indeed, low vaccination coverage among HCWs can lead to dangerous outbreaks of disease, reduce productivity, and increase absenteeism. The aim of this study was to investigate the vaccine coverage and attitudes toward vaccination among HCWs. Methods: A multicenter cross-sectional study was conducted among HCWs referred to all hospitals of the Local Health Authority 02 of Abruzzo Region, Italy. The survey was based on the questionnaire proposed by the H-ProImmune Project. Results: A total of 347 HCWs were enrolled in the study. Of these, 57.3% reported missing diphtheritis-tetanus-pertussis (DTP) vaccination, 50.1% reported missing measles-mumps-rubella (MMR) vaccination, and 62.5% reported missing flu vaccination. Regarding attitudes, other healthcare professionals reported to believe more in natural immunization compared to vaccination (26.5%; p < 0.001), and they were worried about long-term effects of vaccination (10.2%; p = 0.044). Conclusions: This survey showed all vaccination coverage considered resulted below the 95% threshold. Training on vaccination and mandatory measures may be needed in order to achieve better coverage.
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426
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Neufeind J, Betsch C, Habersaat KB, Eckardt M, Schmid P, Wichmann O. Barriers and drivers to adult vaccination among family physicians - Insights for tailoring the immunization program in Germany. Vaccine 2020; 38:4252-4262. [PMID: 32409138 DOI: 10.1016/j.vaccine.2020.04.052] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND In Germany, vaccination gaps exist mainly among adolescents and adults. Family physicians (FPs) administer adult vaccines. FPs strongly influence the vaccination behavior and attitudes of their patients, so their own vaccination-related attitudes and behaviors are critical to achieve high vaccination coverage. The aim of this study was to identify determinants of FPs' own vaccination uptake and their recommendation behavior. METHOD 700 FPs participated in a random sampled telephone survey. Respondents were interviewed in both their roles as vaccine recipients and vaccine providers. Thus, participants indicated their own vaccination status and recommendation behavior as primary outcomes. Primary determinants were the 5C psychological antecedents of vaccination. In addition, participants indicated demographic data and other barriers towards vaccination. Association between outcome and determinants were examined using logistic regression models. RESULTS Around 60% of physicians reported to be vaccinated against influenza, pertussis and hepatitis B, and the majority claimed to recommend vaccines to patients. Own vaccination status was significantly associated with the recommendation of vaccines. Of the psychological determinants confidence in the safety of vaccines was associated with own vaccination and recommendation behavior. Collective responsibility, constraints and complacency were associated with own vaccination status. Being from western Germany and being a homeopathic FP were independently associated with lower own vaccination behavior. Vaccine shortages (52.5%) and cost coverage problems (25.6%) were reported frequently as system-related barriers. There was a perception that the National Immunization Technical Advisory Group was influenced by other interests (14.8%) and that people are vaccinated against too many diseases (8%). Around 40% had implemented an office-based reminder system. DISCUSSION FPs' vaccination behaviors are associated with various psychological determinants and additional barriers. In particular, confidence can leverage FPs' vaccination behaviors. Promoting office-based reminder systems, reducing system-related barriers, and building trust in official recommendations are additional measures to improve adult vaccination in Germany.
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Affiliation(s)
- Julia Neufeind
- Charité University Medicine Berlin, Berlin, Germany; Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Berlin, Germany.
| | - Cornelia Betsch
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany; Media and Communication Science, University of Erfurt, Erfurt, Germany
| | | | - Matthias Eckardt
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Philipp Schmid
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany; Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Ole Wichmann
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Berlin, Germany
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427
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Cole J, Berman S, Gardner J, McGuire K, Chen AMH. Implementation of a motivational interviewing-based decision tool to improve childhood vaccination rates: Pilot study protocol. Res Social Adm Pharm 2020; 17:619-624. [PMID: 32360123 DOI: 10.1016/j.sapharm.2020.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Parental concerns regarding the safety and efficacy of vaccines have been on the rise over the past decade, resulting in a decline in comprehensive vaccine coverage in children. Healthcare practitioners face many challenges when recommending childhood vaccinations, with many parents refusing vaccination due to these and other concerns. Effective communication strategies and tools can equip providers to communicate with vaccine hesitant parents, but validated tools are currently lacking. OBJECTIVES This study aims to develop a validated parental communication tool utilizing motivational interviewing to increase vaccination adherence in children ages 6 years and younger. METHODS The MOTIVE (Motivational Interviewing Tool to Improve Vaccination Adherence) tool will first be developed based on the most recent literature regarding vaccine hesitancy and related health beliefs. Following tool development, the tool will be reviewed via an external review process to ensure practicality of the tool for use in clinical practice. In implementing the MOTIVE tool, providers and clinic staff will be trained regarding vaccine hesitancy and motivational interviewing. The tool will then be implemented in routine well-child appointments. The primary outcome of this study is the percentage of children 0-6 years of age completing all recommended doses of the core vaccine series after implementation of the MOTIVE tool as compared to prior vaccination years. Secondary outcomes will also include parental attitudes towards vaccines and provider knowledge regarding motivational interviewing components and vaccine hesitancy. PROJECT IMPACT Following completion of this study, the MOTIVE tool will be made available for other providers for use in their own clinical practice. The availability of effective communication tools will allow healthcare providers to engage in productive conversations regarding vaccination, aiming to increase vaccine uptake.
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Affiliation(s)
- Justin Cole
- Cedarville University School of Pharmacy, 251 N. Main St, Cedarville, OH, 45314, USA.
| | - Sarah Berman
- Cedarville University School of Pharmacy, 251 N. Main St, Cedarville, OH, 45314, USA.
| | - Julia Gardner
- Cedarville University School of Pharmacy, 251 N. Main St, Cedarville, OH, 45314, USA.
| | - Kalista McGuire
- Cedarville University School of Pharmacy, 251 N. Main St, Cedarville, OH, 45314, USA.
| | - Aleda M H Chen
- Cedarville University School of Pharmacy, 251 N. Main St, Cedarville, OH, 45314, USA.
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Badur S, Ota M, Öztürk S, Adegbola R, Dutta A. Vaccine confidence: the keys to restoring trust. Hum Vaccin Immunother 2020; 16:1007-1017. [PMID: 32298198 PMCID: PMC7227637 DOI: 10.1080/21645515.2020.1740559] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/27/2020] [Accepted: 03/04/2020] [Indexed: 12/14/2022] Open
Abstract
During the 20th century, the discovery of modern vaccines and ensuing mass vaccination dramatically decreased the incidence of many infectious diseases and in some cases eliminated them. Despite this, we are now witnessing a decrease in vaccine confidence that threatens to reverse the progress made. Considering the different extents of low vaccine confidence in different countries of the world, both developed and developing, we aim to contribute to the discussion of the reasons for this, and to propose some viable scientific solutions to build or help restore vaccine confidence worldwide.
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Affiliation(s)
- Selim Badur
- EM, Vaccines Scientific Affairs and Public Health, GSK, Istanbul, Turkey
| | - Martin Ota
- EM, Vaccines Scientific Affairs and Public Health, GSK, Wavre, Belgium
| | | | - Richard Adegbola
- Immunisation & Global Health Consulting, RAMBICON, Lagos, Nigeria
| | - Anil Dutta
- Vaccines R&D Medical, GSK, Wavre, Belgium
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429
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Rencken CA, Dunsiger S, Gjelsvik A, Amanullah S. Higher education associated with better national tetanus vaccination coverage: A population-based assessment. Prev Med 2020; 134:106063. [PMID: 32197975 DOI: 10.1016/j.ypmed.2020.106063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 01/25/2020] [Accepted: 03/13/2020] [Indexed: 01/05/2023]
Abstract
Vaccination coverage among United States (U.S.) adults for tetanus continues to be lower than the national goals. Education has demonstrated a positive impact on vaccination coverage. However, recently there have been outbreaks of vaccine preventable conditions in areas with high college completion rates. This study assessed the relationship between education and tetanus vaccination. Data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS), a self-reported annual survey for non-institutionalized adults in the US from the Centers for Disease Control, was analyzed in 2019. The outcome was up-to-date tetanus vaccination if received within the last 10 years. Education was categorized into 1) grade 11 or less, 2) grade 12/GED, 3) college 1-3 years, and 4) college 4 or more years. Bivariate analyses and multivariable logistic regression were conducted on the analytic sample (n = 417,473) using Stata 15, accounting for weighting and the complex survey design. In 2016, 59.9% of U.S. adults had up-to-date tetanus vaccination. Higher education level was associated with increased odds of up-to-date tetanus vaccination. The highest odds were for those with 4 or more years of college education [aOR = 1.31; 95% (CI: 1.26-1.35)]. Female sex, Black (non-Hispanic), unemployed, not being married, not having insurance or a personal health care provider, and above 45 years of age had lower odds of up-to-date tetanus vaccination. Targeted community specific vaccination education programs for those without tertiary education may help enhance the knowledge and thus the overall vaccination status in the U.S.
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Affiliation(s)
- Camerin A Rencken
- Brown University School of Public Health, Providence, RI, United States of America.
| | - Shira Dunsiger
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | - Annie Gjelsvik
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America
| | - Siraj Amanullah
- Department of Emergency Medicine, Department of Pediatrics, Brown Medical School, Providence, RI, United States of America; Department of Health Services Policy and Practice, Brown University School of Public Health, Providence, RI, United States of America
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Stefanoff P, Sobierajski T, Bulinska-Stangrecka H, Augustynowicz E. Exploring factors improving support for vaccinations among Polish primary care physicians. PLoS One 2020; 15:e0232722. [PMID: 32357190 PMCID: PMC7194393 DOI: 10.1371/journal.pone.0232722] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/20/2020] [Indexed: 11/19/2022] Open
Abstract
In Poland, primary care physicians are the most used and most trusted source of information on immunisation. We aimed to explore factors influencing support for vaccinations among physicians employed in the childhood immunisation programme, in order to inform education of healthcare workers and programme organization. In June-July 2017, we carried out a national cross-sectional survey of physicians working in randomly selected primary healthcare practices, and interviewed them by telephone. We assessed support for vaccinations using an ordinal scale (0–6) comprised of three equally weighted questions on the respondent support of the programme and vaccination of self and family. We also created a scale (0–3) based on correct answers to vaccination myths. We used ordered logistic regression to investigate factors independently influencing support for vaccinations, reporting the proportional odds ratios and 95% confidence intervals for one unit increase in the support score. Of 2,609 respondents contacted, we interviewed 500 (19%). The median vaccination support score (0–6) was 5 (IQR 2). After adjusting for other variables, we did not find significant effects of sex, medical specialty, adhering to recommendations, attending a conference in previous year, using non-scientific sources of information and self-assessed knowledge on vaccination support score. Age over 60 years, correctly addressing vaccination myths and use of one or more than one scientific sources of knowledge, significantly improved support for vaccinations (aOR = 1.97, 1.57, 3.09 and 2.68, respectively). We recommend to increase the amount, quality and accessibility of evidence-based educational materials for primary care physicians working with childhood immunisations.
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Affiliation(s)
- Pawel Stefanoff
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health – National Institute of Hygiene, Warsaw, Poland
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
- * E-mail:
| | - Tomasz Sobierajski
- Institute of Applied Social Sciences, University of Warsaw, Warsaw, Poland
| | | | - Ewa Augustynowicz
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health – National Institute of Hygiene, Warsaw, Poland
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431
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Fu C, wei Z, Zhu F, Pei S, Li S, Zhang L, Sun X, Wu Y, Liu P, Jit M. Acceptance of and preference for COVID-19 vaccination in healthcare workers: a comparative analysis and discrete choice experiment.. [PMID: 0 DOI: 10.1101/2020.04.09.20060103] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
AbstractBackgroundA major obstacle to successful coronavirus disease (COVID-19) vaccine rollout is vaccine hesitancy. Acceptance of and preferences for COVID-19 vaccination among healthcare workers (HCWs) is critical, because they are a key target group for vaccination programs, and they are also highly influential to vaccine uptake in the wider population. This study sought to comparatively determine the acceptance of and preference for COVID-19 vaccination among HCWs and the general population.MethodsAn Internet-based, region-stratified discrete-choice experiment was conducted among 352 HCWs and 189 general population respondents recruited in March 2020 from 26 Chinese provinces. We accessed knowledge of disease, attitude towards and acceptance of COVID-19 vaccination. Several attributes (related to COVID-19 disease, COVID-19 vaccination and one social acceptance) were identified as key determinants of vaccine acceptance.ResultsHCWs had a more in-depth understanding of COVID-19 and showed a higher willingness to accept COVID-19 vaccines with lower effectiveness and/or more severe adverse effects compared to the general population. 76.4% of HCWs (vs 72.5% of the general population) expressed willingness to receive vaccination (χ2=2.904, p=0.234). High levels of willingness to accept influenza (65.3%) and pneumococcal (55.7%) vaccination were also seen in HCWs. Future COVID-19 disease incidence (OR: 4.367, 95% CI 3.721–5.126), decisions about vaccination among social contacts of respondents (OR 0.398, 95% CI 0.339–0.467), and infection risk >30% (OR 2.706, 95% CI 1.776–2.425) significantly increased the probability of vaccination acceptance in HCWs.ConclusionMulti-component interventions to address the key determinants of hesitancy in both HCWs and in the general population should be considered for COVID-19 vaccination programs.
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432
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Hadjipanayis A, Dornbusch HJ, Grossman Z, Theophilou L, Brierley J. Mandatory vaccination: a joint statement of the Ethics and Vaccination working groups of the European Academy of Paediatrics. Eur J Pediatr 2020; 179:683-687. [PMID: 31773329 DOI: 10.1007/s00431-019-03523-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/31/2019] [Accepted: 11/03/2019] [Indexed: 11/24/2022]
Abstract
Vaccinating children is amongst the most cost-effective interventions for reducing children's morbidity and mortality. Parents who choose not to vaccinate their children despite having been informed about the evidence on safety and efficacy of vaccines may seriously jeopardise the health of both their own children and others. Contemporary ethical thinking about the limits of parental decision-making over their children's healthcare treatment often considers the zone of parental discretion. However, with vaccination this is slightly less direct as the benefits are not only accumulated by an individual child but also by children as a population. Forcing parents is of course not the only solution to counteracting the fear of vaccines. Health authorities should certainly fund research and deploy resources on combatting vaccine disinformation.Conclusion: It would be preferable to achieve high rates of vaccination coverage by educating both parents and physicians without adopting any legislation for mandatory vaccination. However, in countries where vaccination uptake is low and/or outbreaks of vaccine-preventable diseases occur, the implementation of mandatory vaccination will most probably save children's lives. EAP calls for action to make all scheduled childhood vaccinations a matter of fact for all European children.
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Affiliation(s)
- Adamos Hadjipanayis
- Department of Paediatrics, Larnaca General Hospital, Larnaca, Cyprus. .,Medical School, European University of Cyprus, Nicosia, Cyprus. .,European Academy of Paediatrics, Brussels, Belgium.
| | - Hans Jürgen Dornbusch
- European Academy of Paediatrics, Brussels, Belgium.,Medical University of Graz, Graz, Austria
| | - Zachi Grossman
- European Academy of Paediatrics, Brussels, Belgium.,Pediatric Clinic, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Leda Theophilou
- Paediatrics University of Nicosia, Arch. Makarios III Hospital, Nicosia, Cyprus
| | - Joe Brierley
- European Academy of Paediatrics, Brussels, Belgium.,Paediatric Bioethics Centre & Paediatric Intensive Care, Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, WC1N 1EH, UK
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Mijović H, Greyson D, Gemmell E, Trottier MÈ, Vivion M, Graham JE, Dubé È, Bettinger JA. Perinatal health care providers' approaches to recommending and providing pertussis vaccination in pregnancy: a qualitative study. CMAJ Open 2020; 8:E377-E382. [PMID: 32414884 PMCID: PMC7239636 DOI: 10.9778/cmajo.20190215] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND In 2018, the Canadian National Advisory Committee on Immunization and the Society of Obstetricians and Gynaecologists of Canada recommended a single dose of tetanus toxoid, reduced diphtheria toxoid and reduced acellular pertussis (Tdap) vaccine in every pregnancy. To understand how perinatal health care providers in Canada are translating recent recommendations for universal antenatal Tdap vaccine into routine clinical practice, we examined health care providers' perceptions of what influences their ability to recommend and provide Tdap vaccine consistently to pregnant women. METHODS Between June 2018 and July 2019, we conducted semistructured telephone interviews with perinatal health care providers (nurses, midwives, family physicians and obstetricians) from 5 provinces (British Columbia, Manitoba, Ontario, Quebec and Nova Scotia) representing diverse educational experiences, practice settings and models of care. We analyzed the data using interpretive description. RESULTS We interviewed 44 perinatal health care providers (13 family physicians, 12 midwives, 10 obstetricians and 9 nurses) practising in a variety of settings. Health care providers' ability to recommend and provide antenatal Tdap vaccine was strongly influenced by structural constraints in the Canadian perinatal health care system. The participants' clinical training varied, which resulted in different knowledge and practices. Participants felt hindered by a lack of lay information resources. Consistent and convenient vaccine access was perceived to be key to promoting confidence and encouraging uptake, yet antenatal Tdap vaccine was not easily accessible for all women. INTERPRETATION Our findings suggest that Canada's fragmented health care model has a detrimental effect on health care providers' ability to recommend and ensure access to antenatal Tdap vaccine. Lessons from this study are pertinent to the implementation of successful pertussis vaccine programs and future pregnancy vaccination initiatives.
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Affiliation(s)
- Hana Mijović
- Vaccine Evaluation Center (Mijović, Greyson, Gemmell, Bettinger), BC Children's Hospital Research Institute, University of British Columbia; Department of Pediatrics (Mijović, Bettinger), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Communication (Greyson), University of Massachusetts, Amherst, Mass.; Quebec National Institute of Public Health (Trottier, Vivion, Dubé), Québec, Que.; Department of Pediatrics (Graham), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Anthropology (Dubé), Université Laval, Québec, Que
| | - Devon Greyson
- Vaccine Evaluation Center (Mijović, Greyson, Gemmell, Bettinger), BC Children's Hospital Research Institute, University of British Columbia; Department of Pediatrics (Mijović, Bettinger), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Communication (Greyson), University of Massachusetts, Amherst, Mass.; Quebec National Institute of Public Health (Trottier, Vivion, Dubé), Québec, Que.; Department of Pediatrics (Graham), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Anthropology (Dubé), Université Laval, Québec, Que
| | - Emily Gemmell
- Vaccine Evaluation Center (Mijović, Greyson, Gemmell, Bettinger), BC Children's Hospital Research Institute, University of British Columbia; Department of Pediatrics (Mijović, Bettinger), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Communication (Greyson), University of Massachusetts, Amherst, Mass.; Quebec National Institute of Public Health (Trottier, Vivion, Dubé), Québec, Que.; Department of Pediatrics (Graham), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Anthropology (Dubé), Université Laval, Québec, Que
| | - Marie-Ève Trottier
- Vaccine Evaluation Center (Mijović, Greyson, Gemmell, Bettinger), BC Children's Hospital Research Institute, University of British Columbia; Department of Pediatrics (Mijović, Bettinger), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Communication (Greyson), University of Massachusetts, Amherst, Mass.; Quebec National Institute of Public Health (Trottier, Vivion, Dubé), Québec, Que.; Department of Pediatrics (Graham), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Anthropology (Dubé), Université Laval, Québec, Que
| | - Maryline Vivion
- Vaccine Evaluation Center (Mijović, Greyson, Gemmell, Bettinger), BC Children's Hospital Research Institute, University of British Columbia; Department of Pediatrics (Mijović, Bettinger), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Communication (Greyson), University of Massachusetts, Amherst, Mass.; Quebec National Institute of Public Health (Trottier, Vivion, Dubé), Québec, Que.; Department of Pediatrics (Graham), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Anthropology (Dubé), Université Laval, Québec, Que
| | - Janice E Graham
- Vaccine Evaluation Center (Mijović, Greyson, Gemmell, Bettinger), BC Children's Hospital Research Institute, University of British Columbia; Department of Pediatrics (Mijović, Bettinger), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Communication (Greyson), University of Massachusetts, Amherst, Mass.; Quebec National Institute of Public Health (Trottier, Vivion, Dubé), Québec, Que.; Department of Pediatrics (Graham), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Anthropology (Dubé), Université Laval, Québec, Que
| | - Ève Dubé
- Vaccine Evaluation Center (Mijović, Greyson, Gemmell, Bettinger), BC Children's Hospital Research Institute, University of British Columbia; Department of Pediatrics (Mijović, Bettinger), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Communication (Greyson), University of Massachusetts, Amherst, Mass.; Quebec National Institute of Public Health (Trottier, Vivion, Dubé), Québec, Que.; Department of Pediatrics (Graham), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Anthropology (Dubé), Université Laval, Québec, Que
| | - Julie A Bettinger
- Vaccine Evaluation Center (Mijović, Greyson, Gemmell, Bettinger), BC Children's Hospital Research Institute, University of British Columbia; Department of Pediatrics (Mijović, Bettinger), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Communication (Greyson), University of Massachusetts, Amherst, Mass.; Quebec National Institute of Public Health (Trottier, Vivion, Dubé), Québec, Que.; Department of Pediatrics (Graham), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Anthropology (Dubé), Université Laval, Québec, Que.
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Kocoglu-Tanyer D, Dengiz KS, Sacikara Z. Development and psychometric properties of the public attitude towards vaccination scale - Health belief model. J Adv Nurs 2020; 76:1458-1468. [PMID: 32153034 DOI: 10.1111/jan.14349] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/21/2020] [Accepted: 02/24/2020] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to develop and psychometrically evaluate the Public Attitude Towards Vaccination Scale - Health Belief Model. DESIGN A methodological and prospective psychometric study. METHOD A three-phase construct was used to develop the Public Attitude Towards Vaccination Scale - Health Belief Model and to determine its psychometric properties: (1) creation of the item pool/conceptualization; (2) evaluation of the items; and (3) psychometric evaluation. This scale was tested using the construct validity (exploratory and confirmatory factor analyses) and the reliability analysis. A psychometric assessment of the scale was conducted with 586 individuals. Data were collected between January - April 2018. RESULTS Items of the scale were obtained by appraising the literature concerning vaccination and the other Health Belief Model scale and conducting interviews with mothers. The content validity ratio of this scale calculated according to experts' opinions ranged between 0.769 and 1.00. According to the exploratory factor analysis, there were five factors with an eigenvalue higher than 1 in the scale. These five factors accounted for 68.9% of the total variance. In confirmatory factor analysis, values of fit indices were excellent or acceptable. This scale had high internal consistency and test-retest reliability. CONCLUSION This study successfully developed the Public Attitude Towards Vaccination Scale - Health Belief Model. In addition to researchers, this scale can be used by nurses while providing counselling for people with vaccine hesitancy/refusal. IMPACT This measurement tool can be used to understand and address 'vaccine hesitancy' by researchers. The results of the research using this measurement tool will provide valuable information to policymakers for preventing vaccine hesitancy. The validity and reliability of this scale can easily be conducted in different languages.
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Affiliation(s)
- Deniz Kocoglu-Tanyer
- Department of Public Health Nursing, Faculty of Nursing, Selcuk University, Konya, Turkey
| | - Kubra Sultan Dengiz
- Department of Public Health Nursing, Faculty of Nursing, Necmettin Erbakan University, Konya, Turkey
| | - Zeynep Sacikara
- Department of Public Health Nursing, Faculty of Nursing, Necmettin Erbakan University, Konya, Turkey
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435
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Hargreaves AL, Nowak G, Frew P, Hinman AR, Orenstein WA, Mendel J, Aikin A, Nadeau JA, McNutt LA, Chamberlain AT, Omer SB, Randall LA, Bednarczyk RA. Adherence to Timely Vaccinations in the United States. Pediatrics 2020; 145:peds.2019-0783. [PMID: 32086389 DOI: 10.1542/peds.2019-0783] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To estimate (1) the proportion of children not adhering to the Advisory Committee on Immunization Practices (ACIP) recommended early childhood immunization schedule and (2) associations between schedule adherence, sociodemographic characteristics, and up-to-date immunization status by 19 to 35 months of age. METHODS We used 2014 National Immunization Survey provider-verified vaccination data to classify vaccination patterns as "recommended" (ie, in line with ACIP dose- and age-specific recommendations), "alternate" (ie, in line with either limiting the number of shots per visit or skipping at least 1 vaccine series), or "unknown or unclassifiable" (ie, not in line with ACIP recommendations or clearly limiting shots per visit or vaccine series). We evaluated the association between vaccination patterns and up-to-date status for all ACIP-recommended vaccinations (including rotavirus and hepatitis A vaccines) using Poisson regression. RESULTS The majority of children's patterns were classified as "recommended" (63%), with 23% and 14% following alternate or unknown or unclassifiable patterns, respectively; 58% of children were up-to-date with all ACIP-recommended immunizations by 19 to 35 months. Not being up-to-date was associated with alternate (prevalence ratio = 4.2, 95% confidence interval: 3.9-4.5) and unknown or unclassifiable (prevalence ratio = 2.4, 95% confidence interval: 2.2-2.7) patterns. CONCLUSIONS High vaccine coverage by 19 to 35 months of age may miss nonadherence to the recommended immunization schedule in the first 18 months of life, leaving children vulnerable to preventable diseases. With more than one-third of US children not following the ACIP schedule, targeted interventions are needed to minimize vaccine delays and disease susceptibility.
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Affiliation(s)
- Allison L Hargreaves
- Hubert Department of Global Health and.,Division of Infectious Diseases, Department of Medicine, School of Medicine, and
| | - Glen Nowak
- Grady College of Journalism and Mass Communication, University of Georgia, Athens, Georgia
| | - Paula Frew
- Hubert Department of Global Health and.,Division of Infectious Diseases, Department of Medicine, School of Medicine, and
| | | | - Walter A Orenstein
- Division of Infectious Diseases, Department of Medicine, School of Medicine, and.,Emory Vaccine Center, Emory University, Atlanta, Georgia
| | - Judith Mendel
- National Vaccine Program Office, Department of Health and Human Services, Washington, DC; and
| | - Ann Aikin
- National Vaccine Program Office, Department of Health and Human Services, Washington, DC; and
| | - Jessica A Nadeau
- Institute for Health and the Environment, School of Public Health, State University of New York-University at Albany, Rensselaer, New York
| | - Louise-Anne McNutt
- Institute for Health and the Environment, School of Public Health, State University of New York-University at Albany, Rensselaer, New York
| | | | - Saad B Omer
- Hubert Department of Global Health and.,Emory Vaccine Center, Emory University, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health
| | - Laura A Randall
- Hubert Department of Global Health and.,Division of Infectious Diseases, Department of Medicine, School of Medicine, and
| | - Robert A Bednarczyk
- Hubert Department of Global Health and .,Emory Vaccine Center, Emory University, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health
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436
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Pullagura GR, Violette R, Houle SK, Waite NM. Shades of gray in vaccination decisions – Understanding community pharmacists’ perspectives of, and experiences with, influenza vaccine hesitancy in Ontario, Canada. Vaccine 2020; 38:2551-2558. [DOI: 10.1016/j.vaccine.2020.01.085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 02/01/2023]
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437
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Elkin LE, Pullon SRH, Stubbe MH. 'Should I vaccinate my child?' comparing the displayed stances of vaccine information retrieved from Google, Facebook and YouTube. Vaccine 2020; 38:2771-2778. [PMID: 32107061 DOI: 10.1016/j.vaccine.2020.02.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/27/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
Whether to vaccinate or not is currently a hot topic in social discourse. Despite the majority view that childhood vaccination is safe and effective, websites and social media content opposing such vaccination are common. In this study, we searched the internet platforms Google, Facebook and YouTube for childhood vaccine information. We made every attempt to minimise selection bias generated by internet algorithms. We compared the displayed stances of vaccine information retrieved. Most of the information had a clearly stated stance on vaccines or made some sort of recommendation on whether or not to vaccinate. Despite our careful attempt to search comprehensively and systematically for vaccine information with as little bias as possible, this search yielded a sizeable minority of vaccine negative information. This research shows that negative vaccine information persists and is readily accessible online despite algorithm and policy changes in recent years, even when searching in the least biased way possible. It is important that vaccine-promoting entities and agencies continue to make every effort to maximize their presence online so that parents searching the internet to answer the question 'should I vaccinate my child?' continue to receive vaccine positive information.
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Affiliation(s)
- Lucy E Elkin
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand.
| | - Susan R H Pullon
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Maria H Stubbe
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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438
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Della Polla G, Napolitano F, Pelullo CP, De Simone C, Lambiase C, Angelillo IF. Investigating knowledge, attitudes, and practices regarding vaccinations of community pharmacists in Italy. Hum Vaccin Immunother 2020; 16:2422-2428. [PMID: 32048892 PMCID: PMC7644221 DOI: 10.1080/21645515.2020.1720441] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The purposes of this cross-sectional study were to determine the level of knowledge, attitudes, and behaviors related to vaccinations among community pharmacists in Italy and to understand the characteristics associated with the different outcomes of interest. The data were collected between September 2018 and April 2019 using semi-structured telephone interviews among a nationally representative sample of community pharmacists. Out of 550 pharmacists who were contacted, a total of 389 responded yielding a response rate of 70.7%. Only 23.9% indicated correctly all ten mandatory vaccinations for newborn. Participants with a lower number of years since degree, employee compared to owners, those who often/always collected information about public’s immunization, and who have received information from educational activities were more likely to know all ten mandatory vaccinations for newborn. Almost all (91.7%) believed that they could play a prominent role in the educational interventions on vaccinations and 75.3% that they should be more engaged in these interventions. Only 23.7% had recommended HPV vaccine to 11–12 years-old adolescents. Pharmacists who have obtained information from educational activities, who knew all ten mandatory vaccinations for newborn, and who believed that they should be more engaged in vaccination interventions were more likely to recommend the vaccine. The HPV vaccine was less likely recommended by those who have obtained information from scientific journals, mass-media and internet, and educational activities compared to those who have not received any information, who worked a higher number of hours per week, who often/always collected data on immunization, and employee pharmacists compared to owners. The findings may be useful to design interventions that can overcome the knowledge gaps of community pharmacists and to improve vaccine recommendations.
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Affiliation(s)
- Giorgia Della Polla
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli" , Naples 80138, Italy
| | - Francesco Napolitano
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli" , Naples 80138, Italy
| | - Concetta Paola Pelullo
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli" , Naples 80138, Italy
| | - Caterina De Simone
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli" , Naples 80138, Italy
| | - Chiara Lambiase
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli" , Naples 80138, Italy
| | - Italo Francesco Angelillo
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli" , Naples 80138, Italy
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439
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Ecarnot F, Pedone C, Cesari M, Maggi S, Antonelli Incalzi R. Knowledge about vaccines and vaccination in older people: Results of a national survey by the Italian Society for Gerontology & Geriatrics. Vaccine 2020; 38:1535-1540. [PMID: 31822428 DOI: 10.1016/j.vaccine.2019.11.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is wide variation among physicians in the level of knowledge regarding vaccines and vaccination. We sought to compare the level of vaccine knowledge between qualified specialists and postgraduate residents. METHODS A questionnaire designed ad hoc by a consensus group was circulated to the Directors of 51 geriatrics internship programs in Italy. It investigated demographics, information sources, knowledge about influenza, pneumonococcal and herpes zoster vaccines and target groups. The proportion of correct responders was compared between residents and qualified specialists, and between best (top quartile) and worst (bottom quartile) performers. RESULTS A total of 459 questionnaires were analyzed; 245 (53%) were females; 253 (55%) were qualified specialists, 206 (45%) were residents. Mean age was 40.3 (SD: 12.8) years, almost 60% worked in acute care wards. On average, 33% of patients asked for information about vaccination. Residents answered significantly better on 7 out of 18 questions, and numerically albeit non-statistically higher correct response rates on a further 8 questions. There were significantly more men among the poor performers (p < 0.001), and significantly more residents among the best performers (p < 0.001). Overall, the rates of correct answers were low, with >50% of correct responses achieved on only 5 out of 18 questions (27.8%); for 2 questions, <20% responded correctly. CONCLUSIONS Postgraduate residents in training have an overall better level of knowledge of vaccines, vaccination indications and practices than qualified specialists. This study provides avenues to develop targeted interventions to ensure health care providers are up to date and providing accurate information to patients.
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Affiliation(s)
- Fiona Ecarnot
- Department of Cardiology, University Hospital Besancon, and EA3920, University of Franche-Comté, Besancon, France.
| | - Claudio Pedone
- Unit of Geriatrics, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Geriatric Unit, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Stefania Maggi
- CNR, Institute of Neuroscience - Aging Branch, Padua, Italy.
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440
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Musa S, Skrijelj V, Kulo A, Habersaat KB, Smjecanin M, Primorac E, Becirovic D, Jackson C. Identifying barriers and drivers to vaccination: A qualitative interview study with health workers in the Federation of Bosnia and Herzegovina. Vaccine 2020; 38:1906-1914. [DOI: 10.1016/j.vaccine.2020.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/20/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
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441
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Wong LP, Wong PF, AbuBakar S. Vaccine hesitancy and the resurgence of vaccine preventable diseases: the way forward for Malaysia, a Southeast Asian country. Hum Vaccin Immunother 2020; 16:1511-1520. [PMID: 31977285 DOI: 10.1080/21645515.2019.1706935] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
This study engaged health professionals in in-depth, semi-structured interviews to explore their opinions concerning the issues surrounding vaccine hesitancy in Malaysia and strategies to improve vaccination to stamp the rise of vaccine preventable diseases (VPDs). Opinions on how to address the resurgence of VPDs in the era of increasing vaccine hesitancy were obtained. Eight health professionals, including geriatricians, pediatricians, microbiologists, public health specialists, and family medicine specialists were interviewed. The influence of anti-vaccination propaganda, past-experience of adverse event following immunization (AEFI), perceived religious prohibition, a belief that traditional complementary and alternative medicine (TCAM) use is safer, pseudoscience beliefs, and anti-vaccine conspiracy theories were identified as reasons for refusing to vaccinate. The interplay of social, cultural and religious perspectives in influencing perceived religious prohibition, pseudoscience beliefs, and the use of TCAM contributing to vaccine refusal was found. Five broad themes emerged from the health professionals regarding strategies to address vaccine hesitancy, including establishing an electronic vaccination registry, increasing public awareness initiatives, providing feedback to the public on the findings of AEFI, training of front-line healthcare providers, and banning the dissemination of anti-vaccine information via social media. With regards to identifying strategies to address the resurgence of VPDs, mandatory vaccination received mixed opinions; many viewed supplementary immunization activity and the prevention of travel and migration of unvaccinated individuals as being necessary. In conclusion, the present study identified unique local cultural, traditional and religious beliefs that could contribute to vaccine hesitancy in addition to issues surrounding vaccination refusal similarly faced by other countries around the world. This information are important for the formulation of targeted intervention strategies to stamp vaccine hesitancy in Malaysia which are also a useful guide for other countries especially in the Southeast Asia region facing similar vaccine hesitancy issues.
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Affiliation(s)
- L P Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
| | - P F Wong
- Department of Pharmacology, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
| | - S AbuBakar
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia.,Tropical Infectious Diseases Research and Educational Centre (TIDREC), University of Malaya , Kuala Lumpur, Malaysia.,WHO Collaborating Centre for Arbovirus Reference and Research (Dengue and Severe Dengue) MAA-12, University of Malaya , Kuala Lumpur, Malaysia
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442
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Rosso A, Massimi A, Pitini E, Nardi A, Baccolini V, Marzuillo C, De Vito C, Villari P. Factors affecting the vaccination choices of pregnant women for their children: a systematic review of the literature. Hum Vaccin Immunother 2020; 16:1969-1980. [PMID: 31916903 PMCID: PMC7482832 DOI: 10.1080/21645515.2019.1698901] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
In recent years, an increase in vaccine hesitancy has led to a decrease in vaccination coverage in several countries. We conducted a systematic review of studies that assessed knowledge of and attitudes toward pediatric vaccinations, and the vaccination choices and their determinants among pregnant women. A total of 6,277 records were retrieved, and 16 full texts were included in the narrative synthesis. The published literature on the topic shows that, overall, pregnant women believe that vaccines are important for the protection of their children and the community, but various concerns and misunderstandings persist around vaccine safety and efficacy, which reduce the trust of expectant mothers in immunization. Nevertheless, such attitudes and choices vary depending on the vaccine being considered and the corresponding determinants should therefore be studied in the context of each specific vaccination. Further research on this topic is needed, particularly in non-western countries.
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Affiliation(s)
- Annalisa Rosso
- Deparment of Public Health and Infectious Diseases, Sapienza University of Rome , Rome, Italy.,Local Health Unit-Azienda Sanitaria Locale Roma 2 , Rome, Italy
| | - Azzurra Massimi
- Deparment of Public Health and Infectious Diseases, Sapienza University of Rome , Rome, Italy
| | - Erica Pitini
- Deparment of Public Health and Infectious Diseases, Sapienza University of Rome , Rome, Italy
| | - Angelo Nardi
- Deparment of Public Health and Infectious Diseases, Sapienza University of Rome , Rome, Italy
| | - Valentina Baccolini
- Deparment of Public Health and Infectious Diseases, Sapienza University of Rome , Rome, Italy
| | - Carolina Marzuillo
- Deparment of Public Health and Infectious Diseases, Sapienza University of Rome , Rome, Italy
| | - Corrado De Vito
- Deparment of Public Health and Infectious Diseases, Sapienza University of Rome , Rome, Italy
| | - Paolo Villari
- Deparment of Public Health and Infectious Diseases, Sapienza University of Rome , Rome, Italy
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443
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Guzman-Holst A, DeAntonio R, Prado-Cohrs D, Juliao P. Barriers to vaccination in Latin America: A systematic literature review. Vaccine 2020; 38:470-481. [DOI: 10.1016/j.vaccine.2019.10.088] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/14/2019] [Accepted: 10/18/2019] [Indexed: 11/16/2022]
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444
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Silveira MF, Buffarini R, Bertoldi AD, Santos IS, Barros AJ, Matijasevich A, Menezes AMB, Gonçalves H, Horta BL, Barros FC, Barata RB, Victora CG. The emergence of vaccine hesitancy among upper-class Brazilians: Results from four birth cohorts, 1982–2015. Vaccine 2020; 38:482-488. [DOI: 10.1016/j.vaccine.2019.10.070] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/18/2019] [Accepted: 10/25/2019] [Indexed: 01/05/2023]
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445
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Paoli S, Lorini C, Puggelli F, Sala A, Grazzini M, Paolini D, Bonanni P, Bonaccorsi G. Assessing Vaccine Hesitancy among Healthcare Workers: A Cross-Sectional Study at an Italian Paediatric Hospital and the Development of a Healthcare Worker's Vaccination Compliance Index. Vaccines (Basel) 2019; 7:E201. [PMID: 31795438 PMCID: PMC6963296 DOI: 10.3390/vaccines7040201] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/28/2019] [Indexed: 11/17/2022] Open
Abstract
Healthcare workers (HCWs) in paediatric hospitals are an important source of advice on vaccinations, but vaccine hesitancy can affect even these professionals. The aim of this study is to assess this phenomenon, measuring it by means of a scoring system. A survey was conducted in five departments of an Italian paediatric university hospital of national interest. Vaccination against influenza was considered a behavioral indicator of vaccination uptake. Using the collected data, the healthcare worker's vaccination compliance index (HVCI) was computed. The results demonstrate statistically significant differences between departments and professional profiles. Nearly 80% of the sample was not immunized against seasonal influenza. According to the HVCI scores, the most hesitant departments are the intensive care unit, emergency room, and oncohematology department, while the most hesitant professional profiles are nurses and auxiliary staff. The score of the unvaccinated is significantly lower than that of the vaccinated, and the same difference was found between those who self-perceive to be skilled versus unskilled. The HVCI score was statistically verified as a predictive parameter to assess vaccination against seasonal influenza. By means of strategic training policies, both HVCI and perceived skills could be improved, suggesting that hospital management should draw a complex intervention program to fight against hesitancy.
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Affiliation(s)
- Sonia Paoli
- Department of Health Science, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (F.P.); (M.G.); (D.P.); (P.B.); (G.B.)
| | - Chiara Lorini
- Department of Health Science, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (F.P.); (M.G.); (D.P.); (P.B.); (G.B.)
| | - Francesco Puggelli
- Department of Health Science, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (F.P.); (M.G.); (D.P.); (P.B.); (G.B.)
| | - Antonino Sala
- Management Department, Meyer Children’s University Hospital, Viale Gaetano Pieraccini 24, 50139 Florence, Italy;
| | - Maddalena Grazzini
- Department of Health Science, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (F.P.); (M.G.); (D.P.); (P.B.); (G.B.)
| | - Diana Paolini
- Department of Health Science, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (F.P.); (M.G.); (D.P.); (P.B.); (G.B.)
| | - Paolo Bonanni
- Department of Health Science, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (F.P.); (M.G.); (D.P.); (P.B.); (G.B.)
| | - Guglielmo Bonaccorsi
- Department of Health Science, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (F.P.); (M.G.); (D.P.); (P.B.); (G.B.)
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446
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Bruel S, Peyrard-Chevrier K, Ginzarly M, Frappé P, Savall A. Human papillomavirus (HPV) vaccination: What can be found on the Web? Qualitative analysis of the Doctissimo.fr forum data. Rev Epidemiol Sante Publique 2019; 68:25-31. [PMID: 31718831 DOI: 10.1016/j.respe.2019.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 08/14/2019] [Accepted: 09/20/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Vaccine hesitancy is a major issue in general practice. Regarding human papillomavirus, less than 20% of young French girls are vaccinated. With widespread availability of health information, the Internet seems to be a place of choice to discuss this reluctance. The main objective of this study was to explore perceptions of human papillomavirus vaccination through an analysis of the Doctissimo.fr forum data. METHODS Using Nvivo software, a qualitative study was carried out from October 2017 to May 2018 on the Doctissimo.fr discussion forum. Online discussion threads not having any message since 2010 were excluded. All threads were analyzed by two independent evaluators. RESULTS Faced with the doubt that emanated from the discussions and the confusion about the role of the vaccine, Internet users used multiple references in order to develop a reliable discourse. The general practitioner remained a trusted person. While the vaccine was perceived as risky, the cervical smear was approved and encouraged. Although the vaccine remained a feminine concern, males also entered this debate. Through their shared experiences, Internet users tried to influence others about whether or not to get vaccinated. CONCLUSION Changing the sexual image of the vaccine could help to establish a collective vaccination policy. Public health policies play an essential role by working with general practitioners and by increasing visibility on the web. The usefulness of the vaccine in 2019 seems to be questioned by Internet users as shown by their major approval of cervical smears. However, these two methods remain complementary in the fight against cervical cancer.
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Affiliation(s)
- S Bruel
- Department of General Practice, Saint-Étienne, Jean Monnet University, 10, rue de la Marandière, 42270 Saint-Priest en Jarez, France; University of Lyon, Claude Bernard Lyon 1 University, Saint-Etienne University, 42023 Saint-Étienne, France; HESPER EA 7425, 69008 Lyon, France.
| | - K Peyrard-Chevrier
- Department of General Practice, Saint-Étienne, Jean Monnet University, 10, rue de la Marandière, 42270 Saint-Priest en Jarez, France
| | - M Ginzarly
- The Clinic, Dubai International Financial Center, United Arab Emirates
| | - P Frappé
- Department of General Practice, Saint-Étienne, Jean Monnet University, 10, rue de la Marandière, 42270 Saint-Priest en Jarez, France
| | - A Savall
- Department of General Practice, Saint-Étienne, Jean Monnet University, 10, rue de la Marandière, 42270 Saint-Priest en Jarez, France
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447
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Deml MJ, Jafflin K, Merten S, Huber B, Buhl A, Frau E, Mettraux V, Sonderegger J, Kliem P, Cattalani R, Krüerke D, Pfeiffer C, Burton-Jeangros C, Tarr PE. Determinants of vaccine hesitancy in Switzerland: study protocol of a mixed-methods national research programme. BMJ Open 2019; 9:e032218. [PMID: 31678955 PMCID: PMC6830664 DOI: 10.1136/bmjopen-2019-032218] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Vaccine hesitancy is a complex public health issue referring to concerns about the safety, efficacy or need for vaccination. Relatively little is known about vaccine hesitancy in Switzerland. This ongoing study (2017-2021) focuses on biomedical and complementary and alternative medicine (CAM) providers and their patients since healthcare professionals play important roles in vaccination decision-making. This national research programme seeks to assess the sociocultural determinants of vaccine hesitancy regarding childhood and human papillomavirus vaccines in Switzerland. We aim to provide a detailed characterisation of vaccine hesitancy, including CAM and biomedical perspectives, patient-provider interactions, and sociocultural factors, to establish the mediating effects of vaccine hesitancy on underimmunisation, and to design an intervention to improve vaccination communication and counselling among physicians, parents and adolescents. METHODS AND ANALYSIS Our transdisciplinary team employs a sequential exploratory mixed-methods study design. We have established a network of more than 150 medical providers across Switzerland, including more than 40 CAM practitioners. For the qualitative component, we conduct interviews with parents, youth, and biomedical and CAM providers and observations of vaccination consultations and school vaccination information sessions. For the quantitative component, a sample of 1350 parents of young children and 722 young adults (15-26 years) and their medical providers respond to questionnaires. We measure vaccine hesitancy with the Parent Attitudes about Childhood Vaccines 15-item survey and review vaccination certificates to assess vaccination status. We administer additional questions based on findings from qualitative research, addressing communication with medical providers, vaccine information sources and perceptions of risk control vis-à-vis vaccine-preventable diseases. The questionnaires capture sociodemographics, political views, religion and spirituality, and moral foundations. ETHICS AND DISSEMINATION The study was approved by the local ethics committee. The results will be published in peer-reviewed journals and disseminated to healthcare professionals, researchers and the public via conferences and public presentations.
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Affiliation(s)
- Michael J Deml
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kristen Jafflin
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Benedikt Huber
- Department of Pediatrics, HFR Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Andrea Buhl
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Eleonora Frau
- University of Basel, Basel, Switzerland
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Valérie Mettraux
- University of Basel, Basel, Switzerland
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Joanna Sonderegger
- University of Basel, Basel, Switzerland
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Paulina Kliem
- University of Basel, Basel, Switzerland
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Rachele Cattalani
- University of Basel, Basel, Switzerland
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | | | - Constanze Pfeiffer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Philip E Tarr
- University of Basel, Basel, Switzerland
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
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Deml MJ, Notter J, Kliem P, Buhl A, Huber BM, Pfeiffer C, Burton-Jeangros C, Tarr PE. “We treat humans, not herds!”: A qualitative study of complementary and alternative medicine (CAM) providers’ individualized approaches to vaccination in Switzerland. Soc Sci Med 2019; 240:112556. [DOI: 10.1016/j.socscimed.2019.112556] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 08/30/2019] [Accepted: 09/12/2019] [Indexed: 11/27/2022]
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Sturkenboom M, Bahri P, Chiucchiuini A, Grove Krause T, Hahné S, Khromava A, Kokki M, Kramarz P, Kurz X, Larson HJ, de Lusignan S, Mahy P, Torcel-Pagnon L, Titievsky L, Bauchau V. Why we need more collaboration in Europe to enhance post-marketing surveillance of vaccines. Vaccine 2019; 38 Suppl 2:B1-B7. [PMID: 31677952 DOI: 10.1016/j.vaccine.2019.07.081] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 11/19/2022]
Abstract
The influenza A/H1N1 pandemic in 2009 taught us that the monitoring of vaccine benefits and risks in Europe had potential for improvement if different public and private stakeholders would collaborate better (public health institutes (PHIs), regulatory authorities, research institutes, vaccine manufacturers). The Innovative Medicines Initiative (IMI) subsequently issued a competitive call to establish a public-private partnership to build and test a novel system for monitoring vaccine benefits and risks in Europe. The ADVANCE project (Accelerated Development of Vaccine benefit-risk Collaboration in Europe) was created as a result. The objective of this paper is to describe the perspectives of key stakeholder groups of the ADVANCE consortium for vaccine benefit-risk monitoring and their views on how to build a European system addressing the needs and challenges of such monitoring. These perspectives and needs were assessed at the start of the ADVANCE project by the European Medicines Agency together with representatives of the main stakeholders in the field of vaccines within and outside the ADVANCE consortium (i.e. research institutes, public health institutes, medicines regulatory authorities, vaccine manufacturers, patient associations). Although all stakeholder representatives stated they conduct vaccine benefit-risk monitoring according to their own remit, needs and obligations, they are faced with similar challenges and needs for improved collaboration. A robust, rapid system yielding high-quality information on the benefits and risks of vaccines would therefore support their decision making. ADVANCE has developed such a system and has tested its performance in a series of proof of concept (POC) studies. The system, how it was used and the results from the POC studies are described in the papers in this supplementary issue.
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Affiliation(s)
- Miriam Sturkenboom
- Julius Global Health, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands; VACCINE.GRID, Spitalstrasse 33, Basel, Switzerland; P-95, Koning Leopold III laan 1, 3001 Heverlee, Belgium.
| | - Priya Bahri
- European Medicines Agency, 30 Churchill Pl, Canary Wharf, London E14 5EU, UK.
| | - Antonella Chiucchiuini
- Takeda Pharmaceuticals International GmbH, Thurgauerstrasse 130, 8152 Glattpark, Switzerland.
| | - Tyra Grove Krause
- Department of Infectious Disease, Epidemiology and Prevention, Statens Serum Institut, Artillerivej 3, DK-2100, Denmark.
| | - Susan Hahné
- National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, the Netherlands.
| | - Alena Khromava
- Sanofi Pasteur, 1755 Steeles Ave W, North York, ON M2R 3T4, Canada.
| | - Maarit Kokki
- European Center for Disease Prevention and Control, Gustav III:s boulevard 40, 169 73 Solna, Sweden.
| | - Piotr Kramarz
- European Center for Disease Prevention and Control, Gustav III:s boulevard 40, 169 73 Solna, Sweden.
| | - Xavier Kurz
- European Medicines Agency, 30 Churchill Pl, Canary Wharf, London E14 5EU, UK.
| | - Heidi J Larson
- London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK.
| | - Simon de Lusignan
- University of Surrey, Guildford, Surrey GU2 7XH, UK; Royal College of General Practitioners, 30 Euston Square, London NW1 2FB, UK.
| | - Patrick Mahy
- Sciensano, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.
| | - Laurence Torcel-Pagnon
- Vaccine Epidemiology and Modelling (VEM), Sanofi Pasteur, Campus SANOFI LYON, 14 Espace Henry Vallée, 69007 Lyon, France.
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Karlsson LC, Lewandowsky S, Antfolk J, Salo P, Lindfelt M, Oksanen T, Kivimäki M, Soveri A. The association between vaccination confidence, vaccination behavior, and willingness to recommend vaccines among Finnish healthcare workers. PLoS One 2019; 14:e0224330. [PMID: 31671115 PMCID: PMC6822763 DOI: 10.1371/journal.pone.0224330] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/11/2019] [Indexed: 12/11/2022] Open
Abstract
Information and assurance from healthcare workers (HCWs) is reported by laypeople as a key factor in their decision to get vaccinated. However, previous research has shown that, as in the general population, hesitancy towards vaccines exists among HCWs as well. Previous studies further suggest that HCWs with a higher confidence in vaccinations and vaccine providers are more willing to take the vaccines themselves and to recommend vaccines to patients. In the present study with 2962 Finnish HCWs (doctors, head nurses, nurses, and practical nurses), we explored the associations between HCWs' vaccination confidence (perceived benefit and safety of vaccines and trust in health professionals), their decisions to accept vaccines for themselves and their children, and their willingness to recommend vaccines to patients. The results showed that although the majority of HCWs had high confidence in vaccinations, a notable share reported low vaccination confidence. Moreover, in line with previous research, HCWs with higher confidence in the benefits and safety of vaccines were more likely to accept vaccines for their children and themselves, and to recommend vaccines to their patients. Trust in other health professionals was not directly related to vaccination or recommendation behavior. Confidence in the benefits and safety of vaccines was highest among doctors, and increased along with the educational level of the HCWs, suggesting a link between confidence and the degree of medical training. Ensuring high confidence in vaccines among HCWs may be important in maintaining high vaccine uptake in the general population.
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Affiliation(s)
| | - Stephan Lewandowsky
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Jan Antfolk
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Paula Salo
- Department of Psychology, University of Turku, Turku, Finland
- Finnish Institute of Occupational Health, Turku, Finland
| | - Mikael Lindfelt
- Department of Theological Ethics, Åbo Akademi University, Turku, Finland
| | - Tuula Oksanen
- Finnish Institute of Occupational Health, Turku, Finland
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Turku, Finland
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anna Soveri
- Department of Psychology, Åbo Akademi University, Turku, Finland
- Institute of Clinical Medicine, University of Turku, Turku, Finland
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