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Hodel KVS, Fiuza BSD, Conceição RS, Aleluia ACM, Pitanga TN, Fonseca LMDS, Valente CO, Minafra-Rezende CS, Machado BAS. Pharmacovigilance in Vaccines: Importance, Main Aspects, Perspectives, and Challenges-A Narrative Review. Pharmaceuticals (Basel) 2024; 17:807. [PMID: 38931474 PMCID: PMC11206969 DOI: 10.3390/ph17060807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/29/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Pharmacovigilance plays a central role in safeguarding public health by continuously monitoring the safety of vaccines, being critical in a climate of vaccine hesitancy, where public trust is paramount. Pharmacovigilance strategies employed to gather information on adverse events following immunization (AEFIs) include pre-registration data, media reports, clinical trials, and societal reporting. Early detection of AEFIs during clinical trials is crucial for thorough safety analysis and preventing serious reactions once vaccines are deployed. This review highlights the importance of societal reporting, encompassing contributions from community members, healthcare workers, and pharmaceutical companies. Technological advancements such as quick response (QR) codes can facilitate prompt AEFI reporting. While vaccines are demonstrably safe, the possibility of adverse events necessitates continuous post-marketing surveillance. However, underreporting remains a challenge, underscoring the critical role of public engagement in pharmacovigilance. This narrative review comprehensively examines and synthesizes key aspects of virus vaccine pharmacovigilance, with special considerations for specific population groups. We explore applicable legislation, the spectrum of AEFIs associated with major vaccines, and the unique challenges and perspectives surrounding pharmacovigilance in this domain.
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Affiliation(s)
- Katharine Valéria Saraiva Hodel
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
| | - Bianca Sampaio Dotto Fiuza
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
| | - Rodrigo Souza Conceição
- Department of Medicine, College of Pharmacy, Federal University of Bahia, Salvador 40170-115, Bahia State, Brazil
| | - Augusto Cezar Magalhães Aleluia
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
- Department of Natural Sciences, Southwestern Bahia State University (UESB), Campus Vitória da Conquista, Vitória da Conquista 45031-300, Bahia State, Brazil
| | - Thassila Nogueira Pitanga
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
- Laboratory for Research in Genetics and Translational Hematology, Gonçalo Moniz Institute, FIOCRUZ-BA, Salvador 40296-710, Bahia State, Brazil
| | - Larissa Moraes dos Santos Fonseca
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
| | - Camila Oliveira Valente
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
| | | | - Bruna Aparecida Souza Machado
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
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Fauzi IS, Nuraini N, Sari AM, Wardani IB, Taurustiati D, Simanullang PM, Lestari BW. Assessing the impact of booster vaccination on diphtheria transmission: Mathematical modeling and risk zone mapping. Infect Dis Model 2024; 9:245-262. [PMID: 38312350 PMCID: PMC10837633 DOI: 10.1016/j.idm.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/23/2023] [Accepted: 01/11/2024] [Indexed: 02/06/2024] Open
Abstract
The COVID-19 pandemic caused significant disruptions in the healthcare system, affecting vaccinations and the management of diphtheria cases. As a consequence of these disruptions, numerous countries have experienced a resurgence or an increase in diphtheria cases. West Java province in Indonesia is identified as one of the high-risk areas for diphtheria, experiencing an upward trend in cases from 2021 to 2023. To analyze the situation, we developed an SIR model, which integrated DPT and booster vaccinations to determine the basic reproduction number, an essential parameter for infectious diseases. Through spatial analysis of geo-referenced data, we identified hotspots and explained diffusion in diphtheria case clusters. The calculation of R0 resulted in an R0 = 1.17, indicating the potential for a diphtheria outbreak in West Java. To control the increasing cases, one possible approach is to raise the booster vaccination coverage from the current 64.84% to 75.15%, as suggested by simulation results. Furthermore, the spatial analysis revealed that hot spot clusters were present in the western, central, and southern regions, posing a high risk not only in densely populated areas but also in rural regions. The diffusion pattern of diphtheria clusters displayed an expansion-contagious pattern. Understanding the rising trend of diphtheria cases and their geographic distribution can offer crucial insights for government and health authorities to manage the number of diphtheria cases and make informed decisions regarding the best prevention and intervention strategies.
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Affiliation(s)
| | - Nuning Nuraini
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, Institut Teknologi Bandung, Bandung, Indonesia
- Center for Mathematical Modeling and Simulation, Institut Teknologi Bandung, Bandung, Indonesia
| | - Ade Maya Sari
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, Institut Teknologi Bandung, Bandung, Indonesia
| | - Imaniah Bazlina Wardani
- Study Program of Biology Education, Faculty of Education and Teacher Training, UIN Kiai Haji Achmad Siddiq Jember, Jember, Indonesia
| | | | | | - Bony Wiem Lestari
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
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Lohiniva AL, Nurzhynska A, Alhassan H, Shetye M, Ayiku P. Understanding Factors Influencing Polio Vaccine Uptake in Ghana-Developing Meaningful Community Mobilization and Engagement Strategies in Collaboration with Religious Leaders. Am J Trop Med Hyg 2022; 107:1345-1350. [PMID: 36315999 PMCID: PMC9768250 DOI: 10.4269/ajtmh.22-0271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/05/2022] [Indexed: 12/30/2022] Open
Abstract
This qualitative study explores how religious leaders in Ghana view polio and polio vaccine-related knowledge and perceptions of the community members. It also examines the personal characteristics of those who are most likely to accept or reject the vaccine. On the basis of the findings, this study provides a set of evidence-based recommendations to support religious leaders' efforts to create polio vaccine demand in their communities. The study is based on focus group discussions conducted with religious leaders from various geographic locations across Ghana. The discussions were transcribed verbatim and analyzed thematically. Twenty religious leaders, including Christian, Muslim, and leaders of traditional African religions, participated in the study. The findings show that both religious leaders and community members lack knowledge and have multiple culturally and religiously influenced explanations for polio. In addition, the findings reveal that vaccine safety and efficacy are linked to emotional narratives, and receiving the polio vaccine is not a social norm in all communities. Educated mothers in urban settings were identified as those most receptive to the polio vaccine. To create polio vaccine demand, religious leaders need to combat misinformation and the negative perceptions about the vaccine. Recommendations include conveying high-quality information to community members, developing tactics to address culturally and religiously sensitive matters, using emotionally inspired personal accounts to enhance positive attitudes toward polio vaccines and act as catalysts for positive social norms towards the polio vaccine. Educated mothers from urban areas can be engaged as champions in vaccine demand creation.
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Affiliation(s)
- Anna-Leena Lohiniva
- UNICEF Ghana, Accra, Ghana;,Address correspondence to Anna-Leena Lohiniva, UNICEF Country Office, P.O. Box 5051, 4-8 Rangoon Close, Accra-North, Ghana. E-mail:
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Bezbaruah R, Chavda VP, Nongrang L, Alom S, Deka K, Kalita T, Ali F, Bhattacharjee B, Vora L. Nanoparticle-Based Delivery Systems for Vaccines. Vaccines (Basel) 2022; 10:1946. [PMID: 36423041 PMCID: PMC9694785 DOI: 10.3390/vaccines10111946] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022] Open
Abstract
Vaccination is still the most cost-effective way to combat infectious illnesses. Conventional vaccinations may have low immunogenicity and, in most situations, only provide partial protection. A new class of nanoparticle-based vaccinations has shown considerable promise in addressing the majority of the shortcomings of traditional and subunit vaccines. This is due to recent breakthroughs in chemical and biological engineering, which allow for the exact regulation of nanoparticle size, shape, functionality, and surface characteristics, resulting in improved antigen presentation and robust immunogenicity. A blend of physicochemical, immunological, and toxicological experiments can be used to accurately characterize nanovaccines. This narrative review will provide an overview of the current scenario of the nanovaccine.
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Affiliation(s)
- Rajashri Bezbaruah
- Department of Pharmaceutical Sciences, Faculty of Science and Engineering, Dibrugarh University, Dibrugarh 786004, Assam, India
| | - Vivek P. Chavda
- Department of Pharmaceutics and Pharmaceutical Technology, L. M. College of Pharmacy, Ahmedabad 380008, Gujarat, India
| | - Lawandashisha Nongrang
- Department of Pharmaceutical Sciences, Faculty of Science and Engineering, Dibrugarh University, Dibrugarh 786004, Assam, India
| | - Shahnaz Alom
- Department of Pharmaceutical Sciences, Faculty of Science and Engineering, Dibrugarh University, Dibrugarh 786004, Assam, India
- Department of Pharmacology, Girijananda Chowdhury Institute of Pharmaceutical Science-Tezpur, Sonitpur 784501, Assam, India
| | - Kangkan Deka
- Department of Pharmacognosy, NETES Institute of Pharmaceutical Science, Mirza, Guwahati 781125, Assam, India
| | - Tutumoni Kalita
- Department of Pharmaceutical Chemistry, Girijananda Chowdhury Institute of Pharmaceutical Sciences, Azara, Guwahati 781017, Assam, India
| | - Farak Ali
- Department of Pharmaceutical Sciences, Faculty of Science and Engineering, Dibrugarh University, Dibrugarh 786004, Assam, India
- Department of Pharmaceutical Chemistry, Girijananda Chowdhury Institute of Pharmaceutical Science-Tezpur, Sonitpur 784501, Assam, India
| | - Bedanta Bhattacharjee
- Department of Pharmacology, Girijananda Chowdhury Institute of Pharmaceutical Science-Tezpur, Sonitpur 784501, Assam, India
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Gllareva BB, Humolli I, Rudhani I, Jakupi X, Rexhepi J, Metaj T, Kafexholli A, Sopi V. A National Cross-Sectional Study from the Republic of Kosovo on Lot Quality Assurance Sampling (LQAS) to Evaluate the Vaccination Status of Children Between 12 and 24 Months of Age During 2018 to 2020. Med Sci Monit Basic Res 2021; 27:e934194. [PMID: 34955529 PMCID: PMC8719424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/02/2021] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND In the Republic of Kosovo, full vaccination status in children under age 2 years includes: 1 dose of Bacillus Calmette-Guerin (BCG) hepatitis B virus (HBV) vaccine; 3 doses of diphtheria, tetanus, pertussis, hepatitis B, polio, and Haemophilus influenzae type b (DTaP-HB-IPV-Hib) vaccine; 3 doses of inactivated polio vaccine (IPV); and 1 dose of measles, mumps, and rubella (MMR) vaccine. Lot quality assurance sampling (LQAS) is a method used to assess the performance of health quality indicators. MATERIAL AND METHODS A national cross-sectional study with children aged between 12 and 24 months from Kosovo was performed between 2018 and 2020. The vaccination status of children was assessed with lot quality assurance sampling (LQAS) using randomized samples. RESULTS Among 430 children, more than 90% had completed the full immunization schedule. Delays in children's immunizations were observed. Most vaccinations showed short delays of less than 1 month, followed by delays of up to 3 months. The main reason for vaccination delay was the COVID-19 pandemic, following by child's illness at the scheduled time of vaccination or the parents were too busy to take the child to the vaccination site. Meanwhile, child age was the only parameter that showed difference among non-vaccinated and fully vaccinated (P<0.001). CONCLUSIONS LQAS analysis showed that between 2018 and 2020 lack of full immunization was due to delay caused by the parent not taking the child to the vaccination site, which may be prevented by improving information given to parents and the use of vaccination reminders.
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Affiliation(s)
- Bashkim Bejtë Gllareva
- Department fo Family Medicine, Social Medicine and Occupational Medicine, University of Prishtina, Faculty of Medicine, Prishtina, Kosovo
| | - Isme Humolli
- Department of Epidemiology, University of Prishtina, Faculty of Medicine, Prishtina, Kosovo
| | - Ibrahim Rudhani
- Department of Internal Medicine, University of Prishtina, Faculty of Medicine, Prishtina, Kosovo
| | - Xhevat Jakupi
- Department of Microbiology, University of Prishtina, Faculty of Medicine, Prishtina, Kosovo
| | - Jon Rexhepi
- Department of Biochemistry, Clinical Hospital Service University of Kosovo (SHSKUK), Prishtina, Kosovo
| | - Tringa Metaj
- Department of Anesthesiology and Reanimation , Clinical Hospital Service University of Kosovo (SHSKUK), Prishtina, Kosovo
| | - Ardita Kafexholli
- Department of Family Medicine, Main Center of Family Medicine (QKMF-Prishtine), Prishtina, Kosovo
| | - Vlora Sopi
- Department of Pediatrics, Clinical Hospital Service University of Kosovo (SHSKUK), Prishtina, Kosovo
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Kyprianidou M, Tzira E, Galanis P, Giannakou K. Knowledge of mothers regarding children's vaccinations in Cyprus: A cross-sectional study. PLoS One 2021; 16:e0257590. [PMID: 34543326 PMCID: PMC8452034 DOI: 10.1371/journal.pone.0257590] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/03/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Vaccine hesitancy is identified as one of the top threats to global health. A significant drop of childhood vaccine coverage is reported worldwide. One of the key reasons that influenced mothers' choice to postpone, or avoid children's vaccination, is knowledge. This study aimed to assess the level of Cypriot mothers' knowledge on certain aspects of vaccination of their children, examine the association between vaccination knowledge and selected socio-demographic factors, and lastly assess the association of mothers' knowledge about vaccination with vaccination coverage and delay, compliance to the recommended schedules, vaccination during pregnancy and mother-pediatrician relationship. METHODS An online-based cross-sectional study conducted to collect information about socio-demographic characteristics, child's characteristics, vaccination, and vaccine knowledge, using a self-administered questionnaire. The survey was conducted between April 2020 and June 2020 and the study population included mothers over 18 years old with at least one child (<18 years old) living in Cyprus. RESULTS A total of 703 Cypriot mothers participated in the study. Most of the participants stated that they vaccined their children (97%) and the most popular source of information about vaccination was their pediatrician (90%). More than half of the participants (57%) have delayed their child/children vaccination with their pediatrician's suggestion being the main reason. 36% of mothers had low knowledge while the overall correct rate was 13.6% and the median (IQR) knowledge score was 11 (9-12). Having a medium knowledge about vaccination was associated with having a medium or high income, whilst high knowledge compared to low knowledge was associated with completed a higher education and having a high income. Our analysis showed that the correct knowledge by mothers with regards to vaccination increases the probability of vaccinating their children, following the local recommendations for vaccine dosages, and acquiring and trusting vaccination-related information from their children's pediatrician. CONCLUSION Our findings show that the majority of mothers in Cyprus had positives perceptions regarding childhood vaccination, as reflected with the high vaccination rate, however, some aspects of mothers' knowledge of vaccination need to be improved. Public health strategies to promote vaccination, education programs as well as improved communication tools between pediatricians and mothers need to be considered to achieve favorable vaccination attitudes and practices for all mothers in Cyprus.
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Affiliation(s)
- Maria Kyprianidou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Eleana Tzira
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Petros Galanis
- Faculty of Nursing, Centre for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
- * E-mail:
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Ho W, Gao M, Li F, Li Z, Zhang X, Xu X. Next-Generation Vaccines: Nanoparticle-Mediated DNA and mRNA Delivery. Adv Healthc Mater 2021; 10:e2001812. [PMID: 33458958 PMCID: PMC7995055 DOI: 10.1002/adhm.202001812] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/06/2020] [Indexed: 01/07/2023]
Abstract
Nucleic acid vaccines are a method of immunization aiming to elicit immune responses akin to live attenuated vaccines. In this method, DNA or messenger RNA (mRNA) sequences are delivered to the body to generate proteins, which mimic disease antigens to stimulate the immune response. Advantages of nucleic acid vaccines include stimulation of both cell-mediated and humoral immunity, ease of design, rapid adaptability to changing pathogen strains, and customizable multiantigen vaccines. To combat the SARS-CoV-2 pandemic, and many other diseases, nucleic acid vaccines appear to be a promising method. However, aid is needed in delivering the fragile DNA/mRNA payload. Many delivery strategies have been developed to elicit effective immune stimulation, yet no nucleic acid vaccine has been FDA-approved for human use. Nanoparticles (NPs) are one of the top candidates to mediate successful DNA/mRNA vaccine delivery due to their unique properties, including unlimited possibilities for formulations, protective capacity, simultaneous loading, and delivery potential of multiple DNA/mRNA vaccines. This review will summarize the many varieties of novel NP formulations for DNA and mRNA vaccine delivery as well as give the reader a brief synopsis of NP vaccine clinical trials. Finally, the future perspectives and challenges for NP-mediated nucleic acid vaccines will be explored.
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Affiliation(s)
- William Ho
- Department of Chemical and Materials EngineeringNew Jersey Institute of TechnologyNewarkNJ07102USA
| | - Mingzhu Gao
- Engineering Research Center of Cell & Therapeutic AntibodyMinistry of Educationand School of PharmacyShanghai Jiao Tong University800 Dongchuan RoadShanghai200240P. R. China
| | - Fengqiao Li
- Department of Chemical and Materials EngineeringNew Jersey Institute of TechnologyNewarkNJ07102USA
| | - Zhongyu Li
- Department of Chemical and Materials EngineeringNew Jersey Institute of TechnologyNewarkNJ07102USA
| | - Xue‐Qing Zhang
- Engineering Research Center of Cell & Therapeutic AntibodyMinistry of Educationand School of PharmacyShanghai Jiao Tong University800 Dongchuan RoadShanghai200240P. R. China
| | - Xiaoyang Xu
- Department of Chemical and Materials EngineeringNew Jersey Institute of TechnologyNewarkNJ07102USA
- Department of Biomedical EngineeringNew Jersey Institute of Technology323 Dr Martin Luther King Jr BlvdNewarkNJ07102USA
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Matos CCDSA. Mídia e saúde. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2020. [DOI: 10.5712/rbmfc15(42)2211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: A mídia é um importante elemento na construção de significados sobre os acontecimentos de saúde, influenciando nas crenças e na formação da opinião popular, tendo especial papel nos processos epidêmicos. No atual cenário epidemiológico do Brasil, que está vivenciando o recrudescimento do sarampo, reintroduzido no país em 2018, os profissionais da Atenção Primária à Saúde (APS) devem estar instrumentalizados sobre os sentidos que estão sendo construídos pelos veículos de comunicação. Objetivo: Avaliar o conteúdo midiático que está sendo produzido acerca do atual cenário epidemiológico do sarampo no Brasil, observando que sentidos estão sendo construídos e analisando-os criticamente, traçando um paralelo com o papel que a APS ocupa neste cenário, principalmente no que diz respeito à educação em saúde. Métodos: Trata-se de pesquisa qualitativa, exploratória, na qual realizou-se duas buscas através da ferramenta de busca online Google Notícias. Buscou-se pelo termo ‘sarampo’ e pelos termos ‘sarampo’ e ‘autismo’. Foram catalogados os 50 primeiros resultados, sendo o critério de inclusão que fossem notícias. Utilizou-se a análise de conteúdo, inicialmente, para categorização e inferência, porém foi necessário utilizar instrumentos da análise de discurso para aprofundar algumas subjetividades encontradas. Resultados: A busca retornou resultados das cinco regiões do país, todos com postura pró-vacina. A APS foi citada em praticamente todos os resultados encontrados, que frisavam a disponibilidade da vacina gratuitamente neste nível de atenção. As três áreas temáticas encontradas a partir da análise do material foram: “gravidade, sequelas e morte: a produção do sentido do medo”; “vacinação, medidas e ações; e “justificativas para a queda da cobertura vacinal, responsabilização do indivíduo e atribuição do cenário ao movimento antivacina”. Conclusão: Conclui-se que o atual cenário epidemiológico do sarampo tem sido encarado como unicausal, o que precisa ser revisto para que as campanhas governamentais e as ações das Equipes de Saúde da Família tornem-se mais efetivas. A estratégia do convencimento pelo medo ou pela obediência mostra-se ineficaz. Pouco ou nada se discute sobre as recentes políticas de desmonte do Sistema Único de Saúde, que têm impacto direto na cobertura da Estratégia de Saúde da Família. Também pouco foi discutido sobre questões de acesso. A compreensão deste cenário sob uma ótica multifacetada e contextualizada ao momento sociocultural e histórico é o ponto central para o sucesso do desfecho.
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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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Porat T, Garaizar P, Ferrero M, Jones H, Ashworth M, Vadillo MA. Content and source analysis of popular tweets following a recent case of diphtheria in Spain. Eur J Public Health 2019; 29:117-122. [PMID: 30084926 DOI: 10.1093/eurpub/cky144] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Despite major progress in global vaccination coverage, immunization rates are falling, resulting in outbreaks of vaccine-preventable diseases. This study analyses content and source of the most popular tweets related to a recent case in Spain where an unvaccinated child contracted and later died from diphtheria. Understanding the characteristics of these tweets in the context of vaccination could inform efforts by health promotion professionals to increase their reach and impact. Methods We extracted tweets containing keywords related to the diphtheria case (from 1 May to 15 July 2015). We explored the prevalence of terms relating to policy and misinformation and manually coded the 194 most popular tweets (retweeted 100 or more times) with regard to source, topic, tone and sentiment. Results A total of 722 974 tweets were collected. Prevalence of terms relating to policy and misinformation increased at the onset of the case and after the death of the child. Popular tweets (194) were either pro-vaccination (58%) or neutral, with none classified as anti-vaccination. Popular topics included criticism towards anti-vaccination groups (35%) and effectiveness of immunization (22%). Popular tweets were informative (47%) or opinions (53%), which mainly expressed frustration (24%) or humour/sarcasm (23%). Popular Twitter accounts were newspaper and TV channels (15%), as well as individual journalists and authors of popular science (13.4%). Conclusions Healthcare organizations could collaborate with popular journalists or news outlets and employ authors of popular science to disseminate health information on social media, while addressing public concerns and misinformation in accessible ways.
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Affiliation(s)
- Talya Porat
- Dyson School of Design Engineering, Imperial College London, London, UK.,School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Pablo Garaizar
- Department of Computer Engineering, University of Deusto, Bilbao, Spain
| | - Marta Ferrero
- Department of Experimental Psychology, University College London, London, UK
| | - Hilary Jones
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Mark Ashworth
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Miguel A Vadillo
- School of Population Health & Environmental Sciences, King's College London, London, UK.,Departamento de Psicología Básica, Universidad Autónoma de Madrid, Madrid, Spain
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Hagemeister MH, Stock NK, Ludwig T, Heuschmann P, Vogel U. Self-reported influenza vaccination rates and attitudes towards vaccination among health care workers: results of a survey in a German university hospital. Public Health 2017; 154:102-109. [PMID: 29220709 DOI: 10.1016/j.puhe.2017.10.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/12/2017] [Accepted: 10/26/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The objective of this survey was to analyse vaccination rates and attitudes towards vaccination among health care workers (HCWs). The period prevalence of self-reported acute respiratory infections in the influenza season 2014/2015 was examined. STUDY DESIGN A cross-sectional study was conducted among HCWs of a German university hospital using an anonymised questionnaire. Recruitment was performed by providing all medical and nursing staff a paper questionnaire with an invitation to participate. METHODS Descriptive aggregated data were generated from digitalised questionnaires for all variables. Differences in categorical variables were analysed by Chi-squared test. Textual data were analysed by an iterative process based on the grounded theory by Glaser and Strauss. RESULTS The response rate was 31% (677/2186). Probable influenza was described by 9% (64/677) of the participants. The overall self-reported vaccination rate was 55% (366/666). Self-reported vaccination rate was higher in physicians (172/239, 72%) than in nursing staff (188/418, 45%). HCWs in paediatrics (103/148, 70%) more likely received vaccines than HCWs in surgery (31/84, 37%). Most vaccinations were provided by medical staff on the wards (164/368, 45%). Self-reported lost work-time due to adverse events after vaccination was low (6/336, 2%). Eight categories for vaccine refusal were identified, whereof doubts about effectiveness and indication of the vaccine was most frequently mentioned (72/202, 36%). CONCLUSIONS Efforts to promote vaccination should focus on nursing staff and should provide scientific evidence on effectiveness, adverse effects, and the benefits of health care workers' vaccination for patients. Administering vaccines at the workplace proved to be a successful strategy in our setting. Studies are needed to assess the frequency of influenza causing disease in HCWs.
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Affiliation(s)
- M H Hagemeister
- Public Health Authority, District Office Kitzingen, Bavaria, Germany; Infection Control, University Hospital Würzburg, Bavaria, Germany.
| | - N K Stock
- Institute for Hygiene and Microbiology, University of Würzburg, Bavaria, Germany
| | - T Ludwig
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Bavaria, Germany
| | - P Heuschmann
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Bavaria, Germany; Clinical Trial Centre, University Hospital Würzburg, Bavaria, Germany
| | - U Vogel
- Infection Control, University Hospital Würzburg, Bavaria, Germany; Institute for Hygiene and Microbiology, University of Würzburg, Bavaria, Germany
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Lehmann BA, de Melker HE, Timmermans DRM, Mollema L. Informed decision making in the context of childhood immunization. PATIENT EDUCATION AND COUNSELING 2017; 100:2339-2345. [PMID: 28688731 DOI: 10.1016/j.pec.2017.06.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/11/2017] [Accepted: 06/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We aimed to assess informed decision making about childhood immunization by measuring knowledge, deliberation and value-consistency. Additionally, we investigated whether informed decision making is different for parents who accept and parents who decline vaccination. METHODS Parents of at least one child between 3 months and 3,5 years of age were randomly selected from a vaccination register and were asked to fill in an online questionnaire measuring informed decision making. RESULTS In total, 1615 parents completed the questionnaire (16.2%). 77.6% of the parents were classified as having sufficient knowledge, 34.3% of the decisions were deliberate, and 94% were value-consistent. This resulted in 21% of parents who were classified as making an informed decision. Vaccination decliners more often made a decision classified as informed than vaccination acceptors (34.3% vs. 19.7%). When decliners made a decision classified as uninformed, this was mainly due to insufficient knowledge, while uninformed decisions among acceptors were mainly due to a low level of deliberation. CONCLUSION AND PRACTICE IMPLICATIONS Most parents made an uninformed decision about childhood vaccinations. Decision aids and counseling by child vaccine providers could improve the knowledge of decliners and motivate acceptors to deliberate about their decision, and by that promote informed decision making.
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Affiliation(s)
- Birthe A Lehmann
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Hester E de Melker
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Daniëlle R M Timmermans
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Liesbeth Mollema
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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13
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Eizayaga JE, Waisse S. What do homeopathic doctors think of vaccines? An international online survey. HOMEOPATHY 2016; 105:180-5. [PMID: 27211325 DOI: 10.1016/j.homp.2015.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Parental refusal to vaccinate is a cause of serious concern. Use of homeopathy is believed to be a relevant reason for parents to refuse to vaccinate. However, vaccination is one of the main gaps dividing between medically qualified or not homeopathic practitioners. The present study sought to investigate the attitude of homeopathic doctors towards vaccination and associated variables. METHODS An international online survey was conducted with homeopathic doctors by means of an anonymous self-reported questionnaire in Portuguese or Spanish. Questions investigated sociodemographic and professional characteristics, overall opinion on vaccination and on some specific vaccines. RESULTS A total of 512 responses were obtained, 77.5% of respondents were from Latin American countries, 16.8% from Spain, with small numbers from several other countries. About 75.6% of the respondents considered vaccination safe, effective and necessary, while 12.5% stated they would not recommend vaccination under any circumstance. The variables significantly correlated with positive attitude towards vaccination were: working in the public health system (p=0.04) and homeopathy not the main medical activity (p=0.005). Homeopaths from Brazil, where homeopathy is officially accredited, were more favorable to vaccination compared to respondents from countries where homeopathy has inferior status (p<0.001). CONCLUSION The results show that there is no contradiction between homeopathy and primary prevention by means of vaccination.
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Affiliation(s)
- José Enrique Eizayaga
- Department of Homeopathy, Maimonides University, Hidalgo 775, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Silvia Waisse
- Outpatient Clinic, São Paulo Homeopathic Association, Rua Diogo de Faria 839, São Paulo, SP, Brazil.
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Dáňová J, Šálek J, Kocourková A, Čelko AM. Factors Associated with Parental Refusal of Routine Vaccination in the Czech Republic. Cent Eur J Public Health 2016; 23:321-3. [PMID: 26841145 DOI: 10.21101/cejph.a4395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 10/13/2015] [Indexed: 11/15/2022]
Abstract
AIM Routine vaccination is one of the most important preventive methods which is responsible for the decreasing trend of morbidity and mortality of vaccine preventable infectious diseases, their complications and sequelae. The impact of vaccination on declining trend of these diseases is well known and confirmed by a large number of epidemiological studies. In the Czech Republic, there is high vaccination coverage in regards to most vaccine preventable diseases. However, during the last decade proportion of parents refusing routine vaccination of their children due to different factors is increasing. The presented study evaluates current situation in the Czech Republic and describes the most significant factors in parents decision making. METHODS The study was conducted between 1 July 2013 and 31 March 2014 as a questionnaire based survey (cross-sectional study). The questionnaire was created with multiple choice answers. Questions were addressed to parents or legal representatives of children aged 0-18 years. Types of questions were divided into several subgroups. The study was performed in the Czech Republic in two different districts of Prague and Zlín. RESULTS In the sample size (n=480) we detected 11 parents who refused vaccination of 11 children (2.29%). The most often refused vaccines in the prevalence study were hexavaccine (1st dose) and measles, mumps and rubella vaccine (1st dose). The hexavaccine includes tetanic anatoxin, diphtheric anatoxin, acellular pertussis vaccine, conjugate vaccine against Haemophilus influenzae b, inactivated polio vaccine, and recombinant vaccine against viral hepatitis B. The measles, mumps, rubella vaccine contains live attenuated viruses of measles, mumps, rubella. CONCLUSION We observed increasing trend of routine vaccination refusal in children during the last ten years (compared to situation in the year 2004, p<0.001). The most important factors associated with this progression were distrust to vaccination, fear of some vaccine components and fear of adverse reactions.
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Affiliation(s)
- Jana Dáňová
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Šálek
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Aneta Kocourková
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alexander M Čelko
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Exposing concerns about vaccination in low- and middle-income countries: a systematic review. Int J Public Health 2015; 60:767-80. [DOI: 10.1007/s00038-015-0715-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 07/02/2015] [Accepted: 07/03/2015] [Indexed: 10/23/2022] Open
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Le Ngoc Tho S, Ader F, Ferry T, Floret D, Arnal M, Fargeas S, Chidiac C, Valour F. Vaccination against serogroup B Neisseria meningitidis: Perceptions and attitudes of parents. Vaccine 2015; 33:3463-70. [PMID: 26055293 DOI: 10.1016/j.vaccine.2015.05.073] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 05/16/2015] [Accepted: 05/26/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND A vaccine against serogroup B Neisseria meningitidis, major cause of bacterial meningitis in children and adults, has recently been developed. In a context of an increasing parental mistrust against vaccinations, understanding the reason for their choices is crucial in order to improve immunization coverage. Our study aimed at evaluating parental attitudes and perceptions towards serogroup B meningococcal invasive disease vaccination. METHODS A prospective observational study was conducted in different French independent-practice medical offices (general practitioners and paediatricians) and nurseries between May 1 and December 31, 2013, using a questionnaire distributed in electronic and paper forms to parents having at least one child between the ages of 2 months and 16 years old. RESULTS 1270 parents were included, of whom 671 (52.8%) spontaneously stated to be in favour of this vaccination. Their choice was mainly justified by the severity of the disease (63.8%) and the desire to protect their child (51.7%). In multivariate analysis, the young age of parents (OR 0.949 per additional year; p<10(-3)), the history of vaccination against serogroup C meningococcal invasive diseases (OR 6.755; p<10(-3)), and the prior knowledge of the vaccine (OR 2.081; p=0.001) were associated with vaccination acceptance. The main reasons for refusal were the lack of hindsight on this new vaccine (50.6%) and the fear of side effects (45.5%). After objective information on the disease and the vaccine, only 6.3% of the entire responding population would refuse to consider vaccination. CONCLUSIONS The spontaneous acceptance rate of vaccination against serogroup B meningococcal invasive disease is insufficient. However, after objective information by their physician or public health authorities, only a few parents would in the end be completely resistant.
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Affiliation(s)
- Sandra Le Ngoc Tho
- Department of Infectious Diseases, Hospices Civils de Lyon, Lyon, France; Department of General Medicine, Claude Bernard Lyon 1 University, Lyon, France
| | - Florence Ader
- Department of Infectious Diseases, Hospices Civils de Lyon, Lyon, France; INSERM U1111, International Centre for Research in Infectiology, Claude Bernard Lyon 1 University, Lyon, France
| | - Tristan Ferry
- Department of Infectious Diseases, Hospices Civils de Lyon, Lyon, France; INSERM U1111, International Centre for Research in Infectiology, Claude Bernard Lyon 1 University, Lyon, France
| | - Daniel Floret
- Paediatric Department of Emergency and Intensive Care, Hospices Civils de Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Maximilien Arnal
- Paediatric Orthopaedic Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Simone Fargeas
- Department of General Medicine, Claude Bernard Lyon 1 University, Lyon, France
| | - Christian Chidiac
- Department of Infectious Diseases, Hospices Civils de Lyon, Lyon, France; INSERM U1111, International Centre for Research in Infectiology, Claude Bernard Lyon 1 University, Lyon, France
| | - Florent Valour
- Department of Infectious Diseases, Hospices Civils de Lyon, Lyon, France; INSERM U1111, International Centre for Research in Infectiology, Claude Bernard Lyon 1 University, Lyon, France.
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Barbieri CLA, Couto MT. Decision-making on childhood vaccination by highly educated parents. Rev Saude Publica 2015; 49:18. [PMID: 25830870 PMCID: PMC4390069 DOI: 10.1590/s0034-8910.2015049005149] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 10/20/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To analyze the sociocultural aspects involved in the decision-making process of vaccination in upper-class and highly educated families. METHODS A qualitative approach based on in-depth interviews with 15 couples from the city of Sao Paulo, Southeastern Brazil, falling into three categories: vaccinators, late or selective vaccinators, and nonvaccinators. The interpretation of produced empirical material was performed through content analysis. RESULTS The study showed diverse and particular aspects surrounding the three groups’ decisions whether to vaccinate their children. The vaccinators’ decision to vaccinate their children was spontaneous and raised no questions. Most late or selective vaccinators experienced a wide range of situations that were instrumental in the decision to delay or not apply certain vaccines. The nonvaccinator’s decision-making process expressed a broader context of both criticism of hegemonic obstetric practices in Brazil and access to information transmitted via social networks and the internet. The data showed that the problematization of vaccines (culminating in the decision to not vaccinate their children) occurred in the context of humanized birth, was protagonized by women and was greatly influenced by health information from the internet. CONCLUSIONS Sociocultural aspects of the singular Brazilian context and the contemporary society were involved in the decision-making on children’s vaccination. Understanding this process can provide a real basis for a deeper reflection on health and immunization practices in Brazil in light of the new contexts and challenges of the world today.
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Couto MT, Barbieri CLA. Cuidar e (não) vacinar no contexto de famílias de alta renda e escolaridade em São Paulo, SP, Brasil. CIENCIA & SAUDE COLETIVA 2015; 20:105-14. [DOI: 10.1590/1413-81232014201.21952013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 02/12/2014] [Indexed: 11/22/2022] Open
Abstract
O trabalho analisa a dimensão do cuidado parental e suas relações com as decisões de (não) vacinar os filhos no contexto de famílias de alta renda e escolaridade de São Paulo, SP. A pesquisa se orienta pela abordagem qualitativa, com uso de entrevista em profundidade, realizada com 15 casais alocados em três grupos: vacinadores, vacinadores seletivos e não vacinadores. O percurso analítico-interpretativo dos dados foi realizado por meio da análise de conteúdo e segundo os referenciais de cuidado em saúde e família. Para todos os casais do estudo, a escolha da (não) vacinação dos filhos é concebida como um cuidado parental e proteção ao filho, porém, para os vacinadores, proteger é vacinar os filhos; para os vacinadores seletivos, proteger é singularizar cada caso; e para os não vacinadores, proteger é não vacinar os filhos, é proteger contra os riscos da vacinação. O estudo revelou, também, que as justificativas da não vacinação e da seleção e/ou postergação do calendário vacinal foram semelhantes às encontradas na literatura internacional. O estudo aponta a importância da compreensão sociocultural da (não) aceitabilidade da vacinação no contexto do cuidado parental.
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Lorenz V, Karanis G, Karanis P. Malaria vaccine development and how external forces shape it: an overview. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:6791-807. [PMID: 24983392 PMCID: PMC4113845 DOI: 10.3390/ijerph110706791] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 11/16/2022]
Abstract
The aim of this paper is to analyse the current status and scientific value of malaria vaccine approaches and to provide a realistic prognosis for future developments. We systematically review previous approaches to malaria vaccination, address how vaccine efforts have developed, how this issue may be fixed, and how external forces shape vaccine development. Our analysis provides significant information on the various aspects and on the external factors that shape malaria vaccine development and reveal the importance of vaccine development in our society.
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Affiliation(s)
- Veronique Lorenz
- Center of Anatomy, Medical School, University of Cologne, Cologne 50937, Germany.
| | - Gabriele Karanis
- National Research Center for Protozoan Diseases, Obihiro University for Agriculture and Veterinary Medicine, Hokkaido 080-8555, Japan.
| | - Panagiotis Karanis
- Center of Anatomy, Medical School, University of Cologne, Cologne 50937, Germany.
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Hong JY, Ki MR, Hwang HJ, Sinny D, Park YJ, Bae GR, Lee MS. Factors related to completed status and seropositivity of hepatitis a immunization among children aged 1-3 years and 6-8 years in South Korea. Osong Public Health Res Perspect 2013; 4:93-8. [PMID: 24159538 PMCID: PMC3767099 DOI: 10.1016/j.phrp.2013.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 02/21/2013] [Accepted: 02/21/2013] [Indexed: 11/28/2022] Open
Abstract
This study was designed to identify factors associated with hepatitis A immunization status and seropositivity in Korean children. In-person interviews, reviewing their vaccination cards and testing hepatitis A antibody were conducted with 389 children aged 1–3 years and 544 children aged 6–8 years. In all age groups, earlier birth order was the only significant factor in children receiving either single or both doses of the vaccination. And completion of the second dose of vaccination was a prerequisite for increased seropositivity. Additionally, household income had a positive impact on seropositivity only in children aged 6–8 years. Our findings suggest that presence of an economic barrier is the underlying cause of the decreased hepatitis A vaccination services in Korea. Therefore, hepatitis A vaccine should be included in the essential National Immunization Program.
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Affiliation(s)
- Jee-Young Hong
- Department of Preventive Medicine, College of Medicine, Konyang University, Daejeon, Korea
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Sadaf A, Richards JL, Glanz J, Salmon DA, Omer SB. A systematic review of interventions for reducing parental vaccine refusal and vaccine hesitancy. Vaccine 2013; 31:4293-304. [PMID: 23859839 DOI: 10.1016/j.vaccine.2013.07.013] [Citation(s) in RCA: 252] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/29/2013] [Accepted: 07/02/2013] [Indexed: 10/26/2022]
Abstract
Unvaccinated individuals pose a public health threat to communities. Research has identified many factors associated with parental vaccine refusal and hesitancy toward childhood and adolescent immunizations. However, data on the effectiveness of interventions to address parental refusal are limited. We conducted a systematic review of four online databases to identify interventional studies. We used criteria recommended by the WHO's Strategic Advisory Group of Experts on immunization (SAGE) for the quality assessment of studies. Intervention categories and outcomes were evaluated for each body of evidence and confidence in overall estimates of effect was determined. There is limited evidence to guide implementation of effective strategies to deal with the emerging threat of parental vaccine refusal. There is a need for appropriately designed, executed and evaluated intervention studies to address this gap in knowledge.
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Affiliation(s)
- Alina Sadaf
- Medical College, Aga Khan University, Karachi, Pakistan
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Herzog R, Álvarez-Pasquin MJ, Díaz C, Del Barrio JL, Estrada JM, Gil Á. Are healthcare workers' intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health 2013; 13:154. [PMID: 23421987 PMCID: PMC3602084 DOI: 10.1186/1471-2458-13-154] [Citation(s) in RCA: 1001] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 01/31/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The Summit of Independent European Vaccination Experts (SIEVE) recommended in 2007 that efforts be made to improve healthcare workers' knowledge and beliefs about vaccines, and their attitudes towards them, to increase vaccination coverage. The aim of the study was to compile and analyze the areas of disagreement in the existing evidence about the relationship between healthcare workers' knowledge, beliefs and attitudes about vaccines and their intentions to vaccinate the populations they serve. METHODS We conducted a systematic search in four electronic databases for studies published in any of seven different languages between February 1998 and June 2009. We included studies conducted in developed countries that used statistical methods to relate or associate the variables included in our research question. Two independent reviewers verified that the studies met the inclusion criteria, assessed the quality of the studies and extracted their relevant characteristics. The data were descriptively analyzed. RESULTS Of the 2354 references identified in the initial search, 15 studies met the inclusion criteria. The diversity in the study designs and in the methods used to measure the variables made it impossible to integrate the results, and each study had to be assessed individually. All the studies found an association in the direction postulated by the SIEVE experts: among healthcare workers, higher awareness, beliefs that are more aligned with scientific evidence and more favorable attitudes toward vaccination were associated with greater intentions to vaccinate. All the studies included were cross-sectional; thus, no causal relationship between the variables was established. CONCLUSION The results suggest that interventions aimed at improving healthcare workers' knowledge, beliefs and attitudes about vaccines should be encouraged, and their impact on vaccination coverage should be assessed.
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Affiliation(s)
- Raúl Herzog
- Primary Healthcare Service, Madrid Health Service, Santa Hortensia 14, Madrid, Spain
| | - Mª José Álvarez-Pasquin
- Primary Healthcare Service, Madrid Health Service, Santa Hortensia 14, Madrid, Spain
- Spanish Association of Vaccinology, Madrid, Spain
| | - Camino Díaz
- Primary Healthcare Service, Madrid Health Service, Santa Hortensia 14, Madrid, Spain
| | - José Luis Del Barrio
- Department of Preventive Medicine, Public Health, Medical Immunology and Microbiology, Rey Juan Carlos University, Avenida de Atenas s/n, Alcorcón, Spain
| | | | - Ángel Gil
- Department of Preventive Medicine, Public Health, Medical Immunology and Microbiology, Rey Juan Carlos University, Avenida de Atenas s/n, Alcorcón, Spain
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Affiliation(s)
- Helen Bedford
- Children's Health, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health
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Pearce A, Mindlin M, Cortina-Borja M, Bedford H. Characteristics of 5-year-olds who catch-up with MMR: findings from the UK Millennium Cohort Study. BMJ Open 2013; 3:bmjopen-2013-003152. [PMID: 23864213 PMCID: PMC3717465 DOI: 10.1136/bmjopen-2013-003152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine predictors of partial and full measles, mumps and rubella (MMR) vaccination catch-up between 3 and 5 years. DESIGN Secondary data analysis of the nationally representative Millennium Cohort Study (MCS). SETTING Children born in the UK, 2000-2002. PARTICIPANTS 751 MCS children who were unimmunised against MMR at age 3, with immunisation information at age 5. MAIN OUTCOME MEASURES Catch-up status: unimmunised (received no MMR), partial catch-up (received one MMR) or full catch-up (received two MMRs). RESULTS At age 5, 60.3% (n=440) children remained unvaccinated, 16.1% (n=127) had partially and 23.6% (n=184) had fully caught-up. Children from families who did not speak English at home were five times as likely to partially catch-up than children living in homes where only English was spoken (risk ratio 4.68 (95% CI 3.63 to 6.03)). Full catch-up was also significantly more likely in those did not speak English at home (adjusted risk ratio 1.90 (1.08 to 3.32)). In addition, those from Pakistan/Bangladesh (2.40 (1.38 to 4.18)) or 'other' ethnicities (such as Chinese) (1.88 (1.08 to 3.29)) were more likely to fully catch-up than White British. Those living in socially rented (1.86 (1.34 to 2.56)) or 'Other' (2.52 (1.23 to 5.18)) accommodations were more likely to fully catch-up than home owners, and families were more likely to catch-up if they lived outside London (1.95 (1.32 to 2.89)). Full catch-up was less likely if parents reported medical reasons (0.43 (0.25 to 0.74)), a conscious decision (0.33 (0.23 to 0.48)), or 'other' reasons (0.46 (0.29 to 0.73)) for not immunising at age 3 (compared with 'practical' reasons). CONCLUSIONS Parents who partially or fully catch-up with MMR experience practical barriers and tend to come from disadvantaged or ethnic minority groups. Families who continue to reject MMR tend to have more advantaged backgrounds and make a conscious decision to not immunise early on. Health professionals should consider these findings in light of the characteristics of their local populations.
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Affiliation(s)
- Anna Pearce
- MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK
| | - Miranda Mindlin
- MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK
- Kent, Surrey, Sussex Public Health England Centre, Horsham, West Sussex, UK
| | - Mario Cortina-Borja
- MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK
| | - Helen Bedford
- MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK
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Sardy R, Ecochard R, Lasserre E, Dubois JP, Floret D, Letrilliart L. Représentations sociales de la vaccination chez les patients et les médecins généralistes : une étude basée sur l'évocation hiérarchisée. SANTE PUBLIQUE 2012. [DOI: 10.3917/spub.126.0547] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Bond L, Nolan T. Making sense of perceptions of risk of diseases and vaccinations: a qualitative study combining models of health beliefs, decision-making and risk perception. BMC Public Health 2011; 11:943. [PMID: 22182354 PMCID: PMC3260331 DOI: 10.1186/1471-2458-11-943] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 12/20/2011] [Indexed: 11/11/2022] Open
Abstract
Background Maintaining high levels of childhood vaccinations is important for public health. Success requires better understanding of parents' perceptions of diseases and consequent decisions about vaccinations, however few studies have considered this from the theoretical perspectives of risk perception and decision-making under uncertainty. The aim of this study was to examine the utility of subjective risk perception and decision-making theories to provide a better understanding of the differences between immunisers' and non-immunisers' health beliefs and behaviours. Methods In a qualitative study we conducted semi-structured in-depth interviews with 45 Australian parents exploring their experiences and perceptions of disease severity and susceptibility. Using scenarios about 'a new strain of flu' we explored how risk information was interpreted. Results We found that concepts of dread, unfamiliarity, and uncontrollability from the subjective perception of risk and ambiguity, optimistic control and omission bias from explanatory theories of decision-making under uncertainty were useful in understanding why immunisers, incomplete immunisers and non-immunisers interpreted severity and susceptibility to diseases and vaccine risk differently. Immunisers dreaded unfamiliar diseases whilst non-immunisers dreaded unknown, long term side effects of vaccines. Participants believed that the risks of diseases and complications from diseases are not equally spread throughout the community, therefore, when listening to reports of epidemics, it is not the number of people who are affected but the familiarity or unfamiliarity of the disease and the characteristics of those who have had the disease that prompts them to take preventive action. Almost all believed they themselves would not be at serious risk of the 'new strain of flu' but were less willing to take risks with their children's health. Conclusion This study has found that health messages about the risks of disease which are communicated as though there is equality of risk in the population may be unproductive as these messages are perceived as unbelievable or irrelevant. The findings from this study have implications beyond the issue of childhood vaccinations as we grapple with communicating risks of new epidemics, and indeed may usefully contribute to the current debate especially in the UK of how these theories of risk and decision-making can be used to 'nudge' other health behaviours.
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Affiliation(s)
- Lyndal Bond
- MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK.
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Abstract
Vaccines--often lauded as one of the greatest public health interventions--are losing public confidence. Some vaccine experts have referred to this decline in confidence as a crisis. We discuss some of the characteristics of the changing global environment that are contributing to increased public questioning of vaccines, and outline some of the specific determinants of public trust. Public decision making related to vaccine acceptance is neither driven by scientific nor economic evidence alone, but is also driven by a mix of psychological, sociocultural, and political factors, all of which need to be understood and taken into account by policy and other decision makers. Public trust in vaccines is highly variable and building trust depends on understanding perceptions of vaccines and vaccine risks, historical experiences, religious or political affiliations, and socioeconomic status. Although provision of accurate, scientifically based evidence on the risk-benefit ratios of vaccines is crucial, it is not enough to redress the gap between current levels of public confidence in vaccines and levels of trust needed to ensure adequate and sustained vaccine coverage. We call for more research not just on individual determinants of public trust, but on what mix of factors are most likely to sustain public trust. The vaccine community demands rigorous evidence on vaccine efficacy and safety and technical and operational feasibility when introducing a new vaccine, but has been negligent in demanding equally rigorous research to understand the psychological, social, and political factors that affect public trust in vaccines.
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Affiliation(s)
- Heidi J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
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Provencher C. Towards A Better Understanding of Cognitive Polyphasia. JOURNAL FOR THE THEORY OF SOCIAL BEHAVIOUR 2011. [DOI: 10.1111/j.1468-5914.2011.00468.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bunn F, Kendall S. Does nursing research impact on policy? A case study of health visiting research and UK health policy. J Res Nurs 2011. [DOI: 10.1177/1744987110392627] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to critically examine the impact of nursing research on the development of health care policy using UK health visiting research as an example. We used established methods to evaluate research impact. This included a documentary review of over 30 policy documents, citation analyses on 19 papers and interviews with health visiting researchers. Although there were examples of policy documents being informed by health visiting research it was not always clear what role research had played in the development of recommendations. Information from researchers provided examples of local, national and international impact, although the extent to which papers may have impacted upon policy was less clear from the citation analyses. Many of the UK studies cited in policy documents were qualitative, observational or reflexive and a lack of evaluative research, in particular randomised controlled trials and other controlled evaluations, may limit the impact of health visiting research on health care policy in the UK. There is evidence that health visiting research has influenced health care policy but this has been limited and there is a need for more research to underpin and inform the role of the health visitor.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, UK,
| | - Sally Kendall
- Centre for Research in Primary and Community Care, University of Hertfordshire, UK,
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Danis K, Georgakopoulou T, Stavrou T, Laggas D, Panagiotopoulos T. Socioeconomic factors play a more important role in childhood vaccination coverage than parental perceptions: a cross-sectional study in Greece. Vaccine 2010; 28:1861-9. [DOI: 10.1016/j.vaccine.2009.11.078] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2009] [Revised: 11/29/2009] [Accepted: 11/30/2009] [Indexed: 10/20/2022]
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Noula M, Raftopoulos V, Gesouli E, Tsaprounis T, Deltsidou A. Greek nursing students' immunization coverage: Data from central continental Greece. Nurs Health Sci 2008; 10:169-74. [DOI: 10.1111/j.1442-2018.2008.00385.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Wilson K, Barakat M, Vohra S, Ritvo P, Boon H. Parental views on pediatric vaccination: the impact of competing advocacy coalitions. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2008; 17:231-243. [PMID: 19391379 DOI: 10.1177/0963662506067662] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The debate on pediatric vaccination policy has been characterized by the presence of two distinct coalitions: those in favor of current vaccination policies and those expressing concern about these policies. The target of these coalitions is the vaccination decision of parents. To determine their influence, we conducted four focus groups in Toronto, Canada examining parental decision-making concerning pediatric vaccination. Our focus groups consisted of both fathers and mothers and parents who fully vaccinated and those who did not. Using the Advocacy Coalition Framework as an analytic guide, we identified several themes that provided insights into how effective the two coalitions have been in conveying their viewpoints. In general, we identified a variety of levels of belief systems existing amongst parents concerned about vaccination, some more amenable to change than others. We found that the choice to not vaccinate was largely a result of concerns about safety and, to a lesser extent, about lack of effectiveness. These parental views reflected the ability of the coalition concerned about vaccination to challenge parents' trust in traditional public health sources of information. In contrast, the parental decision to vaccinate was due to recognizing the importance of preventing disease and also a consequence of not questioning recommendations from public health and physicians and feeling pressured to because of school policies. Importantly, parents who fully vaccinate appear to have weaker belief systems that are potentially susceptible to change. While current policies appear to be effective in encouraging vaccination, if trust in public health falters, many who currently support vaccination may reevaluate their position. More research needs to be conducted to identify approaches to communicate the risks and benefits of vaccination to parents.
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Moran N, Shickle D, Richardson E. European citizens' opinions on immunisation. Vaccine 2008; 26:411-8. [PMID: 18093700 PMCID: PMC7131435 DOI: 10.1016/j.vaccine.2007.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2006] [Revised: 08/14/2007] [Accepted: 11/04/2007] [Indexed: 11/28/2022]
Abstract
As part of a larger study exploring how European citizens' balance issues of public and private interest and the extent to which they are prepared to accept State intervention on a range of public health issues, focus group participants were asked whether childhood immunisation should be a matter of parental choice or State compulsion. The question was debated in 66 (of 96) focus groups held across 16 European countries in 2003. Discussions focused on the concept of risk, trust in health professionals and the State, upholding the status quo, fears over vaccine safety and perceptions of infectious disease as a 'foreign threat'.
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Affiliation(s)
- Nicola Moran
- Social Policy Research Unit, University of York, Heslington, York YO10 5DD, United Kingdom.
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Abhyankar P, O'connor DB, Lawton R. The role of message framing in promoting MMR vaccination: Evidence of a loss-frame advantage. PSYCHOL HEALTH MED 2008; 13:1-16. [DOI: 10.1080/13548500701235732] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dannetun E, Tegnell A, Giesecke J. Parents' attitudes towards hepatitis B vaccination for their children. A survey comparing paper and web questionnaires, Sweden 2005. BMC Public Health 2007; 7:86. [PMID: 17511891 PMCID: PMC1887530 DOI: 10.1186/1471-2458-7-86] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Accepted: 05/21/2007] [Indexed: 11/19/2022] Open
Abstract
Background The World Health Organisation, WHO, recommends that most countries should vaccinate all children against hepatitis B. Sweden has chosen not to do so, but the issue is reassessed regularly. The objective of this survey was to assess knowledge and attitudes towards hepatitis B vaccine for children among parents living in Sweden, and to compare distribution of responses and response rate between parents answering a postal questionnaire and those responding via the Internet. Methods A population-based cross-sectional survey, where the sampling frame consisted of all parents to a child born 2002 living in Sweden. Two independent samples of 1001 parents in each sample were drawn. All parents were contacted by postal mail. The parents in the first sample were invited to participate by answering a paper questionnaire. The parents in the second sample were given an individual user name along with a password, and asked to log on to the Internet to answer an identical electronic questionnaire. Results A total of 1229 questionnaires were analysed. The overall response rate for paper questionnaires was 55%, and 15% for the web version. Knowledge of the disease hepatitis B was overall high (90%). A higher degree of knowledge was seen among parents with education beyond high school (p = 0.001). This group of parents also had a higher tendency to reply via the Internet (p = 0.001). The willingness to accept hepatitis B vaccine for their child was correlated to the acceptance of the present childhood vaccination programme (p = 0.001). Conclusion The results reveal a high level of knowledge of the disease and a positive attitude to having their children vaccinated. This study also displays that the conventional postal method of surveying still delivers a higher response rate than a web-based survey.
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Affiliation(s)
- Eva Dannetun
- Department of Communicable Disease Control, Landstinget i Östergötland, SE-581 91 Linköping, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, SE-171 77 Stockholm, Sweden
| | - Anders Tegnell
- Communicable Disease Unit, National Board of Health and Welfare, SE-106 30 Stockholm, Sweden
| | - Johan Giesecke
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, SE-171 77 Stockholm, Sweden
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Danova J, Gopfertova D, Bobak M. Rates of contraindications and use of alternative vaccines in routine immunisation of children: a population based study in the Czech Republic. Vaccine 2007; 25:3890-5. [PMID: 17316928 DOI: 10.1016/j.vaccine.2007.01.099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Revised: 01/15/2007] [Accepted: 01/17/2007] [Indexed: 11/30/2022]
Abstract
Contraindications and requests for alternative vaccines can have important implications on vaccination coverage but population rates of contraindications and alternative vaccination occurring in routine immunisation programmes have not been reported. We investigated the rates of contraindications, the proportion of children who fail to complete regular vaccination, and the use of alternative vaccines within the compulsory immunisation of children in the Czech Republic. We conducted a retrospective review of medical records of all 5038 children born between 1 January 2000 and 31 December 2004 and registered in 24 primary paediatric practices. Contraindications against at least one vaccine were found in 291 (5.8%) children. Contraindications were most commonly reported for the DTP-Hib vaccine (263 children, 5.2%), and the most frequent type were central nervous system disorders (171 cases). Contraindications resulted in 181 (3.6%) of incomplete immunisations by at least 1 vaccine, with 80 children (1.6%) remaining unprotected. Alternative vaccines were administered to 935 (18.6%) children; of these, 271 were due to contraindication and 664 on parental request. The rates of contraindications, incomplete immunisations and alternative vaccine use more than tripled over the study period. This study suggests that within the routine immunisation programme, contraindications occur in approximately 6% of children, and many of these children remain incompletely vaccinated.
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Affiliation(s)
- Jana Danova
- Department of Epidemiology, 3rd Medical School, Charles University, Prague, Czech Republic.
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Hilton S, Hunt K, Petticrew M. Gaps in parental understandings and experiences of vaccine-preventable diseases: a qualitative study. Child Care Health Dev 2007; 33:170-9. [PMID: 17291321 DOI: 10.1111/j.1365-2214.2006.00647.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore parents' understandings of the diseases included in the current UK Childhood Immunization Programme (CIP), and the role of first- and second-hand experiences of these diseases in assessments of their severity. METHODS A qualitative study in which 66 parents (58 mothers and 8 fathers) of children aged 6 years and below, and six mothers of immuno-compromised children, took part in 18 focus group discussions between November 2002 and March 2003. RESULTS There were many gaps in parents' knowledge about some vaccine-preventable diseases, most notably diphtheria, tetanus and haemophilus influenzae type b, three of the diseases covered by the pentavalent vaccine (introduced into the UK CIP in 2004). These gaps led some parents to question the need for vaccination. First-hand experiences of the diseases reinforced the need for vaccination in some cases (e.g. Men C), but undermined it in others (e.g. pertussis, measles, rubella, mumps). Poliomyelitis and diphtheria were no longer seen as a threat to children's health in Britain. Some parents saw mumps as only a threat to boys' health and rubella as only having relevance to girls'. CONCLUSIONS As fewer parents have direct experiences of vaccine-preventable diseases, there is an increasing need to provide parents with accessible information about these diseases. It is also important to recognize that direct or indirect experiences of any of the diseases may either heighten or diminish parents' assessments of the severity of these diseases.
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Affiliation(s)
- S Hilton
- MRC Social and Public Health Sciences Unit, Glasgow, UK
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Mickle KJ, Steele JR, Munro BJ. The feet of overweight and obese young children: are they flat or fat? Obesity (Silver Spring) 2006; 14:1949-53. [PMID: 17135610 DOI: 10.1038/oby.2006.227] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether the flat feet displayed by young obese and overweight children are attributable to the presence of a thicker midfoot plantar fat pad or a lowering of the longitudinal arch relative to that in non-overweight children. RESEARCH METHODS AND PROCEDURES Foot anthropometry, an arch index derived from plantar footprints, and midfoot plantar fat pad thickness measured by ultrasound were obtained for 19 overweight/obese preschool children (mean age, 4.3 +/- 0.9 years; mean height, 1.07 +/- 0.1 m; mean BMI, 18.6 +/- 1.2 kg/m(2)) and 19 non-overweight children matched for age, height, and sex (mean age, 4.3 +/- 0.7 years; mean height, 1.05 +/- 0.1 m; mean BMI, 15.7 +/- 0.7 kg/m(2)). RESULTS Independent t tests revealed no significant between-subject group differences (p = 0.39) in the thickness of the midfoot plantar fat pad. However, the overweight/obese children had a significantly lower plantar arch height (0.9 +/- 0.3 cm) than their non-overweight counterparts (1.1 +/- 0.2 cm; p = 0.04). DISCUSSION The lower plantar arch height found in the overweight/obese children suggests that the flatter feet characteristic of overweight/obese preschool children may be caused by structural changes in their foot anatomy. It is postulated that these structural changes, which may adversely affect the functional capacity of the medial longitudinal arch, might be exacerbated if excess weight bearing continues throughout childhood and into adulthood.
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Affiliation(s)
- Karen J Mickle
- Biomechanics Research Laboratory, Department of Biomedical Science, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia.
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Leask J, Chapman S, Hawe P, Burgess M. What maintains parental support for vaccination when challenged by anti-vaccination messages? A qualitative study. Vaccine 2006; 24:7238-45. [PMID: 17052810 DOI: 10.1016/j.vaccine.2006.05.010] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Revised: 05/09/2006] [Accepted: 05/09/2006] [Indexed: 11/15/2022]
Abstract
This study sought to explore how parents respond to competing media messages about vaccine safety. Six focus groups with mothers of infants were shown television vignettes of typical pro- and anti-vaccination claims. Thematic analysis of transcripts was undertaken. Mothers expressed surprise and concern about alleged vaccine risks but quickly reinstated their support for vaccination by deference to authority figures; type-casting immunisation opponents; and notions of anticipatory regret, good parenting and social responsibility. We conclude that personal experiences, value systems and level of trust in health professionals are fundamental to parental decision making about vaccination. Vaccination advocacy should increase the focus on matters of process such as maintaining trust and public confidence, particularly in health professionals. Stories about people affected by vaccine-preventable diseases need to re-enter the public discourse.
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Affiliation(s)
- Julie Leask
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Australia.
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Addressing the emergence of pediatric vaccination concerns: recommendations from a Canadian policy analysis. Canadian Journal of Public Health 2006. [PMID: 16620003 DOI: 10.1007/bf03405334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ever since the advent of pediatric vaccination, individuals have expressed concerns about both its risks and benefits. These concerns have once again resurfaced among some segments of the population and could potentially undermine national vaccination programs. The views of the public, however, must be considered and respected in the formulation of vaccination policy. We have conducted an analysis of the pediatric vaccination "debate" in the Canadian context. We believe that there is common ground between those who support pediatric vaccination and those who are concerned about these programs. Based on our findings, we believe that the goal of public health authorities should be to maintain trust in vaccines by continuing to meet certain reciprocal responsibilities. To do so, we recommend the following: 1) increased investment in adverse event reporting systems; 2) request for proposals for consideration of a no-fault compensation program; 3) developing pre-emptive strategies to deal with potential vaccine risks; 4) further examination of mechanisms to improve communication between physicians and parents concerned about vaccination. All of these approaches would require additional investment in pediatric vaccination. However, such an investment is easy to justify given the benefits offered by pediatric vaccination and the ramifications of failing to maintain confidence in vaccination programs or missing a vaccine-related adverse event.
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Wilson K, Barakat M, Mills E, Ritvo P, Boon H, Vohra S, Jadad AR, McGeer A. Addressing the emergence of pediatric vaccination concerns: recommendations from a Canadian policy analysis. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2006; 97:139-41. [PMID: 16620003 PMCID: PMC6976188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Ever since the advent of pediatric vaccination, individuals have expressed concerns about both its risks and benefits. These concerns have once again resurfaced among some segments of the population and could potentially undermine national vaccination programs. The views of the public, however, must be considered and respected in the formulation of vaccination policy. We have conducted an analysis of the pediatric vaccination "debate" in the Canadian context. We believe that there is common ground between those who support pediatric vaccination and those who are concerned about these programs. Based on our findings, we believe that the goal of public health authorities should be to maintain trust in vaccines by continuing to meet certain reciprocal responsibilities. To do so, we recommend the following: 1) increased investment in adverse event reporting systems; 2) request for proposals for consideration of a no-fault compensation program; 3) developing pre-emptive strategies to deal with potential vaccine risks; 4) further examination of mechanisms to improve communication between physicians and parents concerned about vaccination. All of these approaches would require additional investment in pediatric vaccination. However, such an investment is easy to justify given the benefits offered by pediatric vaccination and the ramifications of failing to maintain confidence in vaccination programs or missing a vaccine-related adverse event.
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Affiliation(s)
- Kumanan Wilson
- Department of Medicine, University of Toronto, Toronto, ON.
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Nagaraj A. Does qualitative synthesis of anecdotal evidence with that from scientific research help in understanding public health issues: a review of low MMR uptake. Eur J Public Health 2006; 16:85-8. [PMID: 16446303 DOI: 10.1093/eurpub/cki058] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVE To explore the professional and parental factors underlying low MMR uptake by qualitative synthesis of evidence from technical and non-technical anecdotal literature. METHODS An intensive investigation of literature covering research, press, online, E groups and grey literature was carried out using devised search strategies. Key themes were identified from both the research and anecdotal evidence, which were merged to form common themes. RESULTS The review of technical literature identified media scare and inadequate information from health professionals as the main reasons for non-uptake of MMR. The non-technical anecdotal evidence showed that professionals' belief in parental right to choose, target payments and fear of autism were the major factors. CONCLUSIONS Anecdotal evidence may contribute to evidence-based public health practice, especially in widely debated public health issues.
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Al-Ayed IH, Sheik S. Knowledge & practices of childhood immunization among primary health care providers in riyadh city: part ii - precautions and contraindications to vaccination. J Family Community Med 2006; 13:19-24. [PMID: 23012098 PMCID: PMC3410073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To assess 1) how aware those who administer vaccines in the primary health care centres (PHCs) are of the appropriate precautions and contraindicaitons of vaccines and 2) the extent to which their practice complies with standards, and 3) the correlation between the levels of knowledge and practice on one hand with the duration of practice and attendance at a training course on vaccination on the other hand, for physicians and nurses separately. METHODS A self-adminstered questionnaire including 16 statements related to knowledge and practice of precautions and contraindications of vaccines was distributed among workers in 50 MOH PHCs in Riyadh. RESULTS 506 questionnaires were returned, only 331 were completed for this part of the study giving a response rate of almost 65%. However, the statement-specific response rate varied. Except for a few, most statements were correctly responded to by a majority of the respondents reflecting adequate knowlegde and appropriate practice. Experience in dealing with vaccination, and formal training in vaccination were not statistically significantly associated with the responses of both physicians and nurses. CONCLUSION Inspite of the limitations of this study it could be fairly concluded that the overall knowledge and practices regarding precautions and contraindications of childhood immunizations among the primary care providers surveyed was good. Significant gaps still exist. This underlines the need for continuous training and supervision of health care providers who deal with the immunization of children.
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Affiliation(s)
- Ibrahim H Al-Ayed
- Department of Pediatrics, College of Medicine & King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia,Correspondence to: Dr. Ibrahim H. Al-Ayed, Department of Pediatrics (39), College of Medicine & KKUH, King Saud University, P.O. Box 2925, Riyadh 11461, Saudi Arabia E-mail:
| | - Shaffi Sheik
- Department of Family and Community Medicine, College of Medicine & King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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François G, Duclos P, Margolis H, Lavanchy D, Siegrist CA, Meheus A, Lambert PH, Emiroğlu N, Badur S, Van Damme P. Vaccine safety controversies and the future of vaccination programs. Pediatr Infect Dis J 2005; 24:953-61. [PMID: 16282928 DOI: 10.1097/01.inf.0000183853.16113.a6] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In the years following the hepatitis B vaccination/multiple sclerosis controversy, a number of new issues regarding vaccine safety have been raised, in some cases leading to more debate and confusion. Against this background, an international group of experts was convened to review the current points of view concerning the use of thimerosal as a preservative and its potential risks; the suggested link between thimerosal-containing vaccines and acute lymphoblastic leukemia; the alleged association between aluminum-containing vaccines/macrophagic myofasciitis and general systemic complaints; a possible link between vaccination and autoimmune pathology; and a hypothetical link between measles-mumps-rubella vaccination and autism. At present, there are no data to conclude that childhood vaccines, and in particular hepatitis B vaccine, pose a serious health risk or justify a change in current immunization practice. However, vaccine "scares" continue to have an international impact on immunization coverage. Creating a positive environment for immunization can be achieved by repositioning the value of vaccines and vaccination, supported by evidence-based information. The role of international organizations, the media, and the industry in the implementation of communication strategies was discussed and the impact of litigation issues on vaccination was evaluated. The Viral Hepatitis Prevention Board confirms its commitment to current recommendations for universal and risk group hepatitis B vaccination and further encourages the conduct of vaccine safety studies and the dissemination of their results.
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Affiliation(s)
- Guido François
- Viral Hepatitis Prevention Board, WHO Collaborating Centre for Prevention and Control of Viral Hepatitis, Department of Epidemiology and Social Medicine, University of Antwerpen, Antwerp, Belgium.
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Mills E, Jadad AR, Ross C, Wilson K. Systematic review of qualitative studies exploring parental beliefs and attitudes toward childhood vaccination identifies common barriers to vaccination. J Clin Epidemiol 2005; 58:1081-8. [PMID: 16223649 DOI: 10.1016/j.jclinepi.2005.09.002] [Citation(s) in RCA: 261] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine whether a systematic review of qualitative studies can lead to identification of consistent themes across studies, using barriers toward childhood vaccination as an example. STUDY DESIGN AND SETTING We performed a systematic literature search of studies identified in 10 electronic databases. Two independent reviewers selected the relevant abstracts and articles, then extracted information. Content analysis methodology was used to create a coding template for barriers and then to identify how many studies identified specific barriers. RESULTS Fifteen studies were included in this overview. Eight studies used semistructured interviews, five used focus groups, and two used both methodologies. Themes fell under four major headings: issues of harm, issues of distrust, access issues, and other issues. Barriers identified in more than half of the studies included concern about the risk of adverse effects, concern that vaccinations are painful, distrust of by those advocating vaccines (including belief in conspiracy), belief that vaccination should not occur when the child has a minor illness, unpleasant staff or poor communication, and lack of awareness of the vaccination schedule. CONCLUSION Systematically reviewing qualitative studies on barriers to childhood vaccination provided important information on barriers that are consistently identified by parents in several different studies.
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Wilson K, Mills EJ, Norman G, Tomlinson G. Changing attitudes towards polio vaccination: a randomized trial of an evidence-based presentation versus a presentation from a polio survivor. Vaccine 2005; 23:3010-5. [PMID: 15811647 DOI: 10.1016/j.vaccine.2004.12.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2004] [Revised: 12/04/2004] [Accepted: 12/06/2004] [Indexed: 10/26/2022]
Abstract
We compared the impact of epidemiological evidence and anecdotal evidence on changing vaccination attitudes amongst alternative medical students. Ninety-seven students were randomized to either an evidence-based lecture on the benefits of the polio vaccine on population health or a presentation from a visibly affected victim of polio. We compared change in responses to a survey measuring vaccination attitudes between the two groups. The follow-up rate was 73%. There was no statistically significant difference between the two groups in change in response to any of the survey questions. In a post hoc analysis we found that 25% of students were less likely to recommend the vaccine after being provided with evidence supporting vaccination. These findings suggest that confronting deeply held beliefs regarding vaccination may paradoxically strengthen these belief systems.
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Moore DL, Le Saux N, Scheifele D, Halperin SA. Lack of evidence of encephalopathy related to pertussis vaccine: active surveillance by IMPACT, Canada, 1993-2002. Pediatr Infect Dis J 2004; 23:568-71. [PMID: 15194842 DOI: 10.1097/01.inf.0000130075.56368.02] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To assess whether pertussis-containing vaccines cause encephalitis or encephalopathy, the IMPACT network of Canadian pediatric centers screened more than 12,000 admissions for neurologic disorders between 1993 and 2002. Seven cases of encephalopathy began within 7 days after pertussis vaccination, but a more likely cause was found in each instance. No attributable case followed administration of >6.5 million doses of vaccine.
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Affiliation(s)
- Dorothy L Moore
- Montreal Children's Hospital, McGill University Health Centre, Quebec, Canada.
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48
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Abstract
Opposition to mass childhood vaccination is a world-wide phenomenon, particularly in industrialised countries. Unfounded claims about vaccination are perpetuated by parental lobby groups and individual spokespeople, some of whom have a medical or scientific background. This article focuses on one such spokesperson who has achieved particular notoriety. Dr. Viera Scheibner is a retired micropalaeontologist, without any formal training in health-related sciences, who tours the world claiming that vaccines are ineffective and dangerous and lead to a host of ills such as cancer and asthma. Professionals in public health or the clinical arena are from time to time called upon to publicly respond to her, or similar, claims disseminated during tours of Europe, North America or Australasia and in books and articles. Health professionals have expressed at how such spokespersons misrepresent the evidence on vaccine safety, resulting in the potential to undermine public confidence in immunisation. Media coverage, or proposed coverage, particularly of her more extreme claims, often makes health professionals engaged in immunisation feel obliged to respond. This paper describes Viera Scheibner's approach, which follows a repetitious path and is representative of that taken by other public opponents of immunisation. We conclude by suggesting how health professionals might respond in the public arena.
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Affiliation(s)
- Julie Leask
- National Centre for Immunisation Research & Surveillance, Children's Hospital at Westmead, University of Sydney, Locked Bag 4001, Westmead 2145, Australia.
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49
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Wroe AL, Turner N, Salkovskis PM. Understanding and Predicting Parental Decisions About Early Childhood Immunizations. Health Psychol 2004; 23:33-41. [PMID: 14756601 DOI: 10.1037/0278-6133.23.1.33] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This research investigated the factors that influence decisions about immunizations. Women in the third trimester of pregnancy (N=195) rated their likelihood of immunizing their child; stated their reasons for and against immunizing; and rated their perceptions of the benefits and risks of immunization, feelings of responsibility, and anticipated regret if harm occurred. Immunization status was determined at follow-up. Stepwise regression analyses demonstrated that immunization decisions are strongly influenced by omission bias factors such as anticipated responsibility and regret variance (which explained more than 50% of variance). It is suggested that parents may benefit from antenatal decision aids that address omission bias and encourage them to assess benefits and risks of immunizations on the basis of scientific evidence.
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Affiliation(s)
- Abigail L Wroe
- Department of Psychology, University of Auckland, Auckland, New Zealand.
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50
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Gust DA, Woodruff R, Kennedy A, Brown C, Sheedy K, Hibbs B. Parental perceptions surrounding risks and benefits of immunization. SEMINARS IN PEDIATRIC INFECTIOUS DISEASES 2003; 14:207-12. [PMID: 12913833 DOI: 10.1016/s1045-1870(03)00035-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In recent years, parental concerns about vaccine safety have increased as the threat of disease has decreased. A national survey showed that, in general, parents agree that vaccines benefit their children and that their children may be at risk for contracting a disease if unvaccinated. When asked about understanding the benefits and risks of vaccines, most parents (57%) found numbers and statistics most helpful. A substantial minority (17%) of parents were somewhat or not confident in vaccine safety. Parents less confident in vaccine safety agreed less with the statement that they usually followed the advice of their child's doctor. Incomes and education levels affected responses. This positive relationship between confidence in vaccine safety and reliance on doctors for advice may indicate the need for healthcare providers to identify opportunities to (1) solicit questions about vaccine safety, (2) address vaccine safety-related questions in a way meaningful to parents, and (3) strengthen doctor-patient relationships. A parent communication tool is proposed.
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Affiliation(s)
- D A Gust
- Epidemiology and Surveillance Division, Data Management Division, National Immunization Program, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-61, Atlanta, GA 30333, USA.
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