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Albers AN, Wright E, Thaker J, Conway K, Daley MF, Newcomer SR. Childhood Vaccination Practices and Parental Hesitancy Barriers in Rural and Urban Primary Care Settings. J Community Health 2023; 48:798-809. [PMID: 37119349 PMCID: PMC10148012 DOI: 10.1007/s10900-023-01226-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/01/2023]
Abstract
The purpose of our study was to identify primary care providers' (PCPs') practices in promoting childhood vaccination and their perceptions regarding barriers to vaccination in a primarily rural state. In January-May 2022, we conducted a mail and online survey of PCPs across Montana (n = 829). The survey included modules on routine immunizations in children 0-2 years old and COVID-19 vaccination in children 5-17 years old. The survey response rate was 36% (298/829). We categorized PCPs as working in rural (n = 218) or urban areas (n = 80), based on Rural-Urban Commuting Area codes. We then compared responses between rural and urban PCPs using chi-square tests. Urban PCPs (90-94%, depending on vaccine) stocked routinely recommended vaccines more frequently than rural PCPs (71-84%), but stocked the COVID-19 vaccine less often than rural PCPs (44% vs. 71%, respectively, p < 0.001). A higher percentage of rural providers reported parental beliefs that vaccine-preventable diseases are not severe enough to warrant vaccination (48% vs. 31%, p = 0.01) and concerns that vaccination will weaken their child's immune system (29% vs. 6%, p < 0.001). More rural (74%) compared to urban (59%) PCPs identified a social media campaign from local health departments promoting early childhood vaccinations as an effective strategy to increase childhood vaccination rates (p = 0.01). We identified key differences in some childhood vaccination practices and barriers between rural and urban PCPs. Interventions to increase rural vaccination rates could include increasing the number of providers stocking all recommended vaccines, identifying strategies to address parents' concerns regarding vaccine necessity, and collaborations with public health departments.
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Affiliation(s)
- Alexandria N Albers
- Center for Population Health Research, University of Montana, Missoula, MT, USA.
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA.
- , 32 Campus Drive, Missoula, MT, 59812, USA.
| | - Emma Wright
- Family Medicine Residency of Western Montana, University of Montana, Missoula, MT, USA
- Partnership Health Center, Missoula, MT, USA
| | - Juthika Thaker
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Kathrene Conway
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sophia R Newcomer
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
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Gastañaduy PA, Budd J, Fisher N, Redd SB, Fletcher J, Miller J, McFadden DJ, Rota J, Rota PA, Hickman C, Fowler B, Tatham L, Wallace GS, de Fijter S, Parker Fiebelkorn A, DiOrio M. A Measles Outbreak in an Underimmunized Amish Community in Ohio. N Engl J Med 2016; 375:1343-1354. [PMID: 27705270 DOI: 10.1056/nejmoa1602295] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although measles was eliminated in the United States in 2000, importations of the virus continue to cause outbreaks. We describe the epidemiologic features of an outbreak of measles that originated from two unvaccinated Amish men in whom measles was incubating at the time of their return to the United States from the Philippines and explore the effect of public health responses on limiting the spread of measles. METHODS We performed descriptive analyses of data on demographic characteristics, clinical and laboratory evaluations, and vaccination coverage. RESULTS From March 24, 2014, through July 23, 2014, a total of 383 outbreak-related cases of measles were reported in nine counties in Ohio. The median age of case patients was 15 years (range, <1 to 53); a total of 178 of the case patients (46%) were female, and 340 (89%) were unvaccinated. Transmission took place primarily within households (68% of cases). The virus strain was genotype D9, which was circulating in the Philippines at the time of the reporting period. Measles-mumps-rubella (MMR) vaccination coverage with at least a single dose was estimated to be 14% in affected Amish households and more than 88% in the general (non-Amish) Ohio community. Containment efforts included isolation of case patients, quarantine of susceptible persons, and administration of the MMR vaccine to more than 10,000 persons. The spread of measles was limited almost exclusively to the Amish community (accounting for 99% of case patients) and affected only approximately 1% of the estimated 32,630 Amish persons in the settlement. CONCLUSIONS The key epidemiologic features of a measles outbreak in the Amish community in Ohio were transmission primarily within households, the small proportion of Amish people affected, and the large number of people in the Amish community who sought vaccination. As a result of targeted containment efforts, and high baseline coverage in the general community, there was limited spread beyond the Amish community. (Funded by the Ohio Department of Health and the Centers for Disease Control and Prevention.).
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Affiliation(s)
- Paul A Gastañaduy
- From the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta (P.A.G., S.B.R., J.R., P.A.R., C.H., G.S.W., A.P.F.); and the Ohio Department of Health, Columbus (J.B., N.F., B.F., L.T., S.F., M.D.), Knox County Health Department, Mount Vernon (J.F., J.M.), and Holmes County Health Department, Millersburg (D.J.M.) - all in Ohio
| | - Jeremy Budd
- From the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta (P.A.G., S.B.R., J.R., P.A.R., C.H., G.S.W., A.P.F.); and the Ohio Department of Health, Columbus (J.B., N.F., B.F., L.T., S.F., M.D.), Knox County Health Department, Mount Vernon (J.F., J.M.), and Holmes County Health Department, Millersburg (D.J.M.) - all in Ohio
| | - Nicholas Fisher
- From the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta (P.A.G., S.B.R., J.R., P.A.R., C.H., G.S.W., A.P.F.); and the Ohio Department of Health, Columbus (J.B., N.F., B.F., L.T., S.F., M.D.), Knox County Health Department, Mount Vernon (J.F., J.M.), and Holmes County Health Department, Millersburg (D.J.M.) - all in Ohio
| | - Susan B Redd
- From the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta (P.A.G., S.B.R., J.R., P.A.R., C.H., G.S.W., A.P.F.); and the Ohio Department of Health, Columbus (J.B., N.F., B.F., L.T., S.F., M.D.), Knox County Health Department, Mount Vernon (J.F., J.M.), and Holmes County Health Department, Millersburg (D.J.M.) - all in Ohio
| | - Jackie Fletcher
- From the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta (P.A.G., S.B.R., J.R., P.A.R., C.H., G.S.W., A.P.F.); and the Ohio Department of Health, Columbus (J.B., N.F., B.F., L.T., S.F., M.D.), Knox County Health Department, Mount Vernon (J.F., J.M.), and Holmes County Health Department, Millersburg (D.J.M.) - all in Ohio
| | - Julie Miller
- From the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta (P.A.G., S.B.R., J.R., P.A.R., C.H., G.S.W., A.P.F.); and the Ohio Department of Health, Columbus (J.B., N.F., B.F., L.T., S.F., M.D.), Knox County Health Department, Mount Vernon (J.F., J.M.), and Holmes County Health Department, Millersburg (D.J.M.) - all in Ohio
| | - Dwight J McFadden
- From the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta (P.A.G., S.B.R., J.R., P.A.R., C.H., G.S.W., A.P.F.); and the Ohio Department of Health, Columbus (J.B., N.F., B.F., L.T., S.F., M.D.), Knox County Health Department, Mount Vernon (J.F., J.M.), and Holmes County Health Department, Millersburg (D.J.M.) - all in Ohio
| | - Jennifer Rota
- From the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta (P.A.G., S.B.R., J.R., P.A.R., C.H., G.S.W., A.P.F.); and the Ohio Department of Health, Columbus (J.B., N.F., B.F., L.T., S.F., M.D.), Knox County Health Department, Mount Vernon (J.F., J.M.), and Holmes County Health Department, Millersburg (D.J.M.) - all in Ohio
| | - Paul A Rota
- From the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta (P.A.G., S.B.R., J.R., P.A.R., C.H., G.S.W., A.P.F.); and the Ohio Department of Health, Columbus (J.B., N.F., B.F., L.T., S.F., M.D.), Knox County Health Department, Mount Vernon (J.F., J.M.), and Holmes County Health Department, Millersburg (D.J.M.) - all in Ohio
| | - Carole Hickman
- From the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta (P.A.G., S.B.R., J.R., P.A.R., C.H., G.S.W., A.P.F.); and the Ohio Department of Health, Columbus (J.B., N.F., B.F., L.T., S.F., M.D.), Knox County Health Department, Mount Vernon (J.F., J.M.), and Holmes County Health Department, Millersburg (D.J.M.) - all in Ohio
| | - Brian Fowler
- From the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta (P.A.G., S.B.R., J.R., P.A.R., C.H., G.S.W., A.P.F.); and the Ohio Department of Health, Columbus (J.B., N.F., B.F., L.T., S.F., M.D.), Knox County Health Department, Mount Vernon (J.F., J.M.), and Holmes County Health Department, Millersburg (D.J.M.) - all in Ohio
| | - Lilith Tatham
- From the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta (P.A.G., S.B.R., J.R., P.A.R., C.H., G.S.W., A.P.F.); and the Ohio Department of Health, Columbus (J.B., N.F., B.F., L.T., S.F., M.D.), Knox County Health Department, Mount Vernon (J.F., J.M.), and Holmes County Health Department, Millersburg (D.J.M.) - all in Ohio
| | - Gregory S Wallace
- From the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta (P.A.G., S.B.R., J.R., P.A.R., C.H., G.S.W., A.P.F.); and the Ohio Department of Health, Columbus (J.B., N.F., B.F., L.T., S.F., M.D.), Knox County Health Department, Mount Vernon (J.F., J.M.), and Holmes County Health Department, Millersburg (D.J.M.) - all in Ohio
| | - Sietske de Fijter
- From the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta (P.A.G., S.B.R., J.R., P.A.R., C.H., G.S.W., A.P.F.); and the Ohio Department of Health, Columbus (J.B., N.F., B.F., L.T., S.F., M.D.), Knox County Health Department, Mount Vernon (J.F., J.M.), and Holmes County Health Department, Millersburg (D.J.M.) - all in Ohio
| | - Amy Parker Fiebelkorn
- From the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta (P.A.G., S.B.R., J.R., P.A.R., C.H., G.S.W., A.P.F.); and the Ohio Department of Health, Columbus (J.B., N.F., B.F., L.T., S.F., M.D.), Knox County Health Department, Mount Vernon (J.F., J.M.), and Holmes County Health Department, Millersburg (D.J.M.) - all in Ohio
| | - Mary DiOrio
- From the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta (P.A.G., S.B.R., J.R., P.A.R., C.H., G.S.W., A.P.F.); and the Ohio Department of Health, Columbus (J.B., N.F., B.F., L.T., S.F., M.D.), Knox County Health Department, Mount Vernon (J.F., J.M.), and Holmes County Health Department, Millersburg (D.J.M.) - all in Ohio
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