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Idoko OT, Hampton LM, Mboizi RB, Agbla SC, Wallace AS, Harris JB, Sowe D, Ehlman DC, Kampmann B, Ota MO, Hyde TB. Acceptance of multiple injectable vaccines in a single immunization visit in The Gambia pre and post introduction of inactivated polio vaccine. Vaccine 2016; 34:5034-5039. [PMID: 27570237 DOI: 10.1016/j.vaccine.2016.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/12/2016] [Accepted: 07/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND As the World Health Organization (WHO) currently recommends that children be protected against 11 different pathogens, it is becoming increasingly necessary to administer multiple injectable vaccines during a single immunization visit. In this study we assess Gambian healthcare providers' and infant caregivers' attitudes and practices related to the administration of multiple injectable vaccines to a child at a single immunization visit before and after the 2015 introduction of inactivated polio vaccine (IPV). IPV introduction increased the number of injectable vaccines recommended for the 4-month immunization visit from two to three in The Gambia. METHODS We conducted a cross-sectional questionnaire-based survey before and after the introduction of IPV at 4months of age in a representative sample of all health facilities providing immunizations in The Gambia. Healthcare providers who administer vaccines at the selected health facilities and caregivers who brought infants for their 4month immunization visit were surveyed. FINDINGS Prior to IPV introduction, 9.9% of healthcare providers and 35.7% of infant caregivers expressed concern about a child receiving more than 2 injections in a single visit. Nevertheless, 98.8% and 90.9% of infants received all required vaccinations for the visit before and after IPV introduction, respectively. The only reason why vaccines were not received was vaccine stock-outs. Infant caregivers generally agreed that vaccinators could be trusted to provide accurate information regarding the number of vaccines that a child needed. CONCLUSION Healthcare providers and infant caregivers in this resource limited setting accepted an increase in the number of injectable vaccines administered at a single visit even though some expressed concerns about the increase.
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Affiliation(s)
| | - Lee M Hampton
- Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA
| | - Robert B Mboizi
- Vaccines and Immunity Theme, Medical Research Council Unit, Gambia
| | - Schadrac C Agbla
- Vaccines and Immunity Theme, Medical Research Council Unit, Gambia
| | - Aaron S Wallace
- Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA
| | - Jennifer B Harris
- Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA
| | - Dawda Sowe
- Ministry of Health and Social Welfare, Banjul, Gambia
| | - Daniel C Ehlman
- Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit, Gambia; Academic Department of Paediatrics, Imperial College London, UK
| | - Martin O Ota
- WHO Regional Office for Africa, Brazaville, Congo
| | - Terri B Hyde
- Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA
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Tabana H, Dudley LD, Knight S, Cameron N, Mahomed H, Goliath C, Eggers R, Wiysonge CS. The acceptability of three vaccine injections given to infants during a single clinic visit in South Africa. BMC Public Health 2016; 16:749. [PMID: 27501859 PMCID: PMC4977687 DOI: 10.1186/s12889-016-3324-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 07/19/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The Expanded Programme on Immunisation (EPI) has increased the number of antigens and injections administered at one visit. There are concerns that more injections at a single immunisation visit could decrease vaccination coverage. We assessed the acceptability and acceptance of three vaccine injections at a single immunisation visit by caregivers and vaccinators in South Africa. METHODS A mixed methods exploratory study of caregivers and vaccinators at clinics in two provinces of South Africa was conducted. Quantitative and qualitative data were collected using questionnaires as well as observations of the administration of three-injection vaccination sessions. RESULTS The sample comprised 229 caregivers and 98 vaccinators. Caregivers were satisfied with the vaccinators' care (97 %) and their infants receiving immunisation injections (93 %). However, many caregivers, (86 %) also felt that three or more injections were excessive at one visit. Caregivers had limited knowledge of actual vaccines provided, and reasons for three injections. Although vaccinators recognised the importance of informing caregivers about vaccination, they only did this sometimes. Overall, acceptance of three injections was high, with 97 % of caregivers expressing willingness to bring their infant for three injections again in future visits despite concerns about the pain and discomfort that the infant experienced. Many (55 %) vaccinators expressed concern about giving three injections in one immunisation visit. However, in 122 (95 %) observed three-injection vaccination sessions, the vaccinators administered all required vaccinations for that visit. The remaining seven vaccinations were not completed because of vaccine stock-outs. CONCLUSIONS We found high acceptance by caregivers and vaccinators of three injections. Caregivers' poor understanding of reasons for three injections resulted from limited information sharing by vaccinators for caregivers. Acceptability of three injections may be improved through enhanced vaccinator-caregiver communication, and improved management of infants' pain. Vaccinator training should include evidence-informed ways of communicating with caregivers and reducing injection pain. Strategies to improve acceptance and acceptability of three injections should be rigorously evaluated as part of EPI's expansion in resource-limited countries.
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Affiliation(s)
- Hanani Tabana
- School of Public Health, Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
- Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lilian D Dudley
- Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Stephen Knight
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Neil Cameron
- Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Hassan Mahomed
- Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Metro District Health Services, Western Cape Government: Health, Cape Town, South Africa
| | - Charlyn Goliath
- Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Metro District Health Services, Western Cape Government: Health, Cape Town, South Africa
| | - Rudolf Eggers
- Department of Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Charles S Wiysonge
- Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Larson HJ, Jarrett C, Schulz WS, Chaudhuri M, Zhou Y, Dube E, Schuster M, MacDonald NE, Wilson R. Measuring vaccine hesitancy: The development of a survey tool. Vaccine 2015; 33:4165-75. [PMID: 25896384 DOI: 10.1016/j.vaccine.2015.04.037] [Citation(s) in RCA: 525] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In March 2012, the SAGE Working Group on Vaccine Hesitancy was convened to define the term "vaccine hesitancy", as well as to map the determinants of vaccine hesitancy and develop tools to measure and address the nature and scale of hesitancy in settings where it is becoming more evident. The definition of vaccine hesitancy and a matrix of determinants guided the development of a survey tool to assess the nature and scale of hesitancy issues. Additionally, vaccine hesitancy questions were piloted in the annual WHO-UNICEF joint reporting form, completed by National Immunization Managers globally. The objective of characterizing the nature and scale of vaccine hesitancy issues is to better inform the development of appropriate strategies and policies to address the concerns expressed, and to sustain confidence in vaccination. The Working Group developed a matrix of the determinants of vaccine hesitancy informed by a systematic review of peer reviewed and grey literature, and by the expertise of the working group. The matrix mapped the key factors influencing the decision to accept, delay or reject some or all vaccines under three categories: contextual, individual and group, and vaccine-specific. These categories framed the menu of survey questions presented in this paper to help diagnose and address vaccine hesitancy.
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Affiliation(s)
- Heidi J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom and Department of Global Health, University of Washington, Seattle, USA.
| | - Caitlin Jarrett
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom and Department of Global Health, University of Washington, Seattle, USA
| | - William S Schulz
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom and Department of Global Health, University of Washington, Seattle, USA
| | | | | | - Eve Dube
- Institut National de Santé Publique du Québec, Canada
| | | | - Noni E MacDonald
- Department of Paediatrics, Dalhousie University, Canadian Centre for Vaccinology, IWK Health Centre, Halifax, Canada
| | - Rose Wilson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom and Department of Global Health, University of Washington, Seattle, USA
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Wallace AS, Mantel C, Mayers G, Mansoor O, Gindler JS, Hyde TB. Experiences with provider and parental attitudes and practices regarding the administration of multiple injections during infant vaccination visits: lessons for vaccine introduction. Vaccine 2014; 32:5301-10. [PMID: 25092632 DOI: 10.1016/j.vaccine.2014.07.076] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/11/2014] [Accepted: 07/21/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION An increasing proportion of childhood immunization visits include administration of multiple injections. Future introduction of vaccines to protect against multiple diseases will further increase the number of injections at routine immunization childhood visits, particularly in developing countries that are still scaling up introductions. Parental and healthcare provider attitudes toward multiple injections may affect acceptance of recommended vaccines, and understanding these attitudes may help to inform critical decisions about vaccine introduction. METHODS We conducted a systematic review of the literature to examine factors underlying reported parental and healthcare provider concerns and practices related to administration of multiple injections during childhood vaccination visits. RESULTS Forty-four articles were identified; 42 (95%) were from high income countries, including 27 (61%) from the USA. Providers and parents report concerns about multiple injections, which tend to increase with increasing numbers of injections. Common parental and provider concerns included apprehension about the pain experienced by the child, worry about potential side effects, and uncertainty about vaccine effectiveness. Multiple studies reported that a positive provider recommendation to the parent and a high level of concern about the severity of the target disease were significantly associated with parental acceptance of all injections. Providers often significantly overestimated parental concerns about multiple injections. DISCUSSION Providers may play a critical role in the decision for a child to receive all recommended injections. Their overestimation of parental concerns may lead them to postpone recommended vaccinations, which may result in extra visits and delayed vaccination. More research is needed on interventions to overcome provider and parental concern about multiple injections, particularly in developing countries.
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Affiliation(s)
- Aaron S Wallace
- Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-A04, Atlanta, GA 30329, United States.
| | - Carsten Mantel
- Immunizations, Vaccines and Biologicals Programme, World Health Organization, Geneva, Switzerland
| | - Gill Mayers
- Immunizations, Vaccines and Biologicals Programme, World Health Organization, Geneva, Switzerland
| | - Osman Mansoor
- United National Children's Fund, New York, NY, United States
| | - Jacqueline S Gindler
- Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-A04, Atlanta, GA 30329, United States
| | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-A04, Atlanta, GA 30329, United States
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Marshall H, Clarke M, Sullivan T. Parental and community acceptance of the benefits and risks associated with meningococcal B vaccines. Vaccine 2014; 32:338-44. [DOI: 10.1016/j.vaccine.2013.11.042] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 11/05/2013] [Accepted: 11/11/2013] [Indexed: 11/15/2022]
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Bigham M, Remple VP, Pielak K, McIntyre C, White R, Wu W. Uptake and behavioural and attitudinal determinants of immunization in an expanded routine infant hepatitis B vaccination program in British Columbia. Canadian Journal of Public Health 2006. [PMID: 16619992 DOI: 10.1007/bf03405322] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION British Columbia (BC) implemented a universal infant hepatitis B (HB) immunization program in 2001. The study objective was to evaluate HB immunization coverage among the first six-month cohort of eligible infants in the province outside of the Vancouver-Richmond health region and to assess parent/guardian behavioural and attitudinal determinants of HB immunization. METHODS A cross-sectional survey of HB immunization was conducted using a random sample of eligible infants born between 1 January-30 June 2001. HB immunization coverage data were obtained from the provincial Public Health Information System, and through a telephone survey of 487 of eligible infants' parents/guardians that was conducted between October 2002-January 2003. At this time, parents/guardians were also asked about behaviours and attitudes towards immunization, based on the Immunization Health Belief Model Scale. RESULTS HB immunization coverage with at least one dose of HB vaccine was 89% and uptake of 3 doses of HB vaccine was 78%. HB immunization was significantly associated (p<0.001) with a recommendation for HB immunization from a health care professional. The main reason for non-HB immunization was parental concern about side effects. DISCUSSION Seventy-eight percent of infants completed the 3-dose HB vaccination schedule. Parental behaviour regarding HB immunization of their children was strongly influenced by a supportive recommendation from either a nurse or doctor.
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Affiliation(s)
- M Bigham
- Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC.
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