Motivational interview training improves self-efficacy of GP interns in vaccination consultations: A study using the Pro-VC-Be to measure vaccine confidence determinants

Immunization-specific motivational interviewing (MI), a patient-centered communication style used to encourage internal motivation for attitudinal and behavioral change, can provide healthcare professionals (HCPs) with the skills and practice required to respond to patients' doubts and concerns related to vaccines. We sought to assess the impact of an MI-training of General Practitioner (GP) interns on the psychosocial determinants of their vaccine confidence and behaviors. French GP interns participated in a virtual three-day MI-workshop in southeastern France. We used the validated Pro-VC-Be questionnaire - before and after the MI-workshop spanning over three months - to measure the evolution of these determinants. Scores before and after workshop trainings were compared in pairs. Participants' scores for commitment to vaccination (+10.5 ± 20.5, P = .001), perceived self-efficacy (+36.0 ± 25.8, P < .0001), openness to patients (+18.7 ± 17.0, P < .0001), and trust in authorities (+9.5 ± 17.2, P = 0.01) significantly increased after the training sessions, but not the score for confidence in vaccines (+1.5 ± 11.9, P = .14). The effect sizes of the four score improvements were moderate to large, with self-efficacy and openness to patients having the largest effect sizes (P = .83 and 0.78, respectively). This study provides evidence that certain determinants of overall vaccine confidence in HCPs, reflected respectively in the openness to patients and self-efficacy scores of the Pro-VC-Be, improve after immunization MI-training workshops. Incorporating immunization-specific MI-training in the curriculum for HCPs could improve several necessary skills to improve HCP-patient relationships and be useful for vaccination and other healthcare services.

A postpartum intervention for vaccination promotion by midwives using motivational interviews reduces mothers' vaccine hesitancy, south-eastern France, 2021 to 2022: a randomised controlled trial

BackgroundDespite childhood vaccine mandates imposed in 2018 in France, parental vaccine hesitancy (VH) remains frequent. Interventions in Quebec, Canada, applying motivational interviewing (MI) techniques have successfully reduced parents' VH for childhood immunisations.AimTo determine whether MI intervention for mothers in maternity wards in the days after birth in France could significantly reduce VH, increase intentions to vaccinate (VI) their child at 2 months and reduce VH social inequalities.MethodsWe conducted a parallel-arm multicentre randomised controlled trial from November 2021 to April 2022 to compare impacts of MI performed by MI-trained midwives (intervention) vs a vaccination leaflet (control). We included 733 mothers from two maternity hospitals in south-eastern France, randomly assigned either arm. The validated Parents Attitudes about Childhood Vaccines questionnaire was used before and after MI or leaflet to assess mothers' VH (13 items, 0-100 score) and VI (1 item, 1-10 score). Difference-in-difference (D-I-D) models were used to estimate net impact of MI vs leaflet for the entire sample and stratified by VH and education level.ResultsMotivational interview intervention reduced mothers' VH score by 33% (p < 0.0001) and increased VI by 8% (p < 0.0001); the effect was largest for the highest initial VH levels. D-I-D analyses estimated net VH decrease at 5.8/100 points (p = 0.007) and net VI increase at 0.6/10 points (p = 0.005). Net VH decrease was highest for high initial VH levels and low education levels.ConclusionsOur results show positive effects of MI intervention, and means of its implementation should be investigated in France.

Motivational interview-based health mediator interventions increase intent to vaccinate among disadvantaged individuals

Coverage for recommended COVID-19 and diphtheria-tetanus-poliomyelitis (DTP) booster shots is often inadequate, especially among disadvantaged populations. To help health mediators (HMs) involved in outreach programs deal with the problems of vaccine hesitancy (VH) in these groups, we trained them in motivational interviewing (MI). We evaluated the effectiveness of this training among HMs on their MI knowledge and skills (objective 1) and among the interviewees on their vaccination readiness (VR) and intention to get vaccinated or accept a booster against COVID-19 and/or DTP (objective 2). Two MI specialists trained 16 HMs in a two-day workshop in May 2022. The validated MISI questionnaire evaluated HMs' acquisition of MI knowledge and skills (objective 1). Trained HMs offered an MI-based intervention on vaccination to people in disadvantaged neighborhoods of Marseille (France). Those who consented completed a questionnaire before and after the interview to measure VR with the 7C scale and intentions regarding vaccination/booster against COVID-19 and DTP (objective 2). The training resulted in HMs acquiring good MI skills (knowledge, application, self-confidence in using it). HMs enrolled 324 interviewees, 96% of whom completed both questionnaires. VR increased by 6%, and intentions to get vaccinated or update COVID-19 and DTP vaccination increased by 74% and 52% respectively. Nearly all interviewees were very satisfied with the interview, although 21% still had questions about vaccination. HMs assimilated MI principles well. MI use in outreach programs appears to show promise in improving vaccine confidence and intentions among disadvantaged people.

International adaptation and validation of the Pro-VC-Be: measuring the psychosocial determinants of vaccine confidence in healthcare professionals in European countries

BACKGROUND

Healthcare professionals (HCPs) play an important role in vaccination; those with low confidence in vaccines are less likely to recommend them to their patients and to be vaccinated themselves. The study's purpose was to adapt and validate long- and short-form versions of the International Professionals' Vaccine Confidence and Behaviors (I-Pro-VC-Be) questionnaire to measure psychosocial determinants of HCPs' vaccine confidence and their associations with vaccination behaviors in European countries.

RESEARCH DESIGN AND METHODS

After the original French-language Pro-VC-Be was culturally adapted and translated, HCPs involved in vaccination (mainly GPs and pediatricians) across Germany, Finland, France, and Portugal completed a cross-sectional online survey in 2022. A 10-factor multigroup confirmatory factor analysis (MG-CFA) of the long-form (10 factors comprising 34 items) tested for measurement invariance across countries. Modified multiple Poisson regressions tested the criterion validity of both versions.

RESULTS

2,748 HCPs participated. The 10-factor structure fit was acceptable to good everywhere. The final MG-CFA model confirmed strong factorial invariance and showed very good fit. The long- and short-form I-Pro-VC-Be had good criterion validity with vaccination behaviors.

CONCLUSION

This study validates the I-Pro-VC-Be among HCPs in four European countries; including long- and short-form tools for use in research and public health.

Assessment of training of general practice interns in motivational interviews about vaccination

The effectiveness of motivational interviewing (MI) for reducing vaccine hesitancy (VH) has been demonstrated in Quebec. We conducted a study to evaluate the acquisition of MI skills after MI training via videoconferencing for interns training as general practitioners (GPs) in southeastern France. A vaccination-specific MI training workshop was offered to interns in 2021, consisting of two separate Zoom videoconference sessions. Participants completed the Motivational Interviewing Skills in Immunization questionnaire before and after the training to measure skills acquisition. We used pairwise exact Wilcoxon-Pratt signed rank tests for the analysis. Among 45 GP interns enrolled in the first MI session, 34 (75.6%) attended both sessions and completed the questionnaire at 3 different time points. After the first session, MI knowledge scores improved significantly (+21.1 ± 21.6; P < .0001), as did application of MI skills (+36.8 ± 36.7; P < .0001), and MI practice confidence (+21.2 ± 11.1; P < .0001). The second MI session maintained the skills developed after the first session without further improvement. Participant satisfaction was high. This is the first study in France assessing the impact of a vaccination-specific MI training for GP interns. It shows a substantial improvement in knowledge, application of MI skills, and self-confidence in the practice of MI. GP interns were highly satisfied with the training despite the videoconference format. These promising results will allow the integration of MI training in GP medical curricula in order to prepare future GPs for communication in the field of vaccination.

Measuring psychosocial determinants of vaccination behavior in healthcare professionals: validation of the Pro-VC-Be short-form questionnaire

BACKGROUND

Vaccine confidence among health care professionals (HCPs) is a key determinant of vaccination behaviors. We validate a short-form version of the 31-item Pro-VC-Be (Health Professionals Vaccine Confidence and Behaviors) questionnaire that measures HCPs' confidence in and commitment to vaccination.

RESEARCH DESIGN AND METHODS

A cross-sectional survey among 2,696 HCPs established a long-form tool to measure 10 dimensions of psychosocial determinants of vaccination behaviors. Confirmatory factor analysis (CFA) models tested the construct validity of 69,984 combinations of items in a 10-item short form tool. The criterion validity of this tool was tested with four behavioral and attitudinal outcomes using weighted modified Poisson regressions. An immunization resource score was constructed from summing the responses of the dimensions that can influence HCPs' pro-vaccination behaviors: vaccine confidence, proactive efficacy, and trust in authorities.

RESULTS

The short-form tool showed good construct validity in CFA analyses (RMSEA = 0.035 [0.024; 0.045]; CFI = 0.956; TLI = 0.918; SRMR 0.027) and comparable criterion validity to the long-form tool. The immunization resource score showed excellent criterion validity.

CONCLUSIONS

The Pro-VC-Be short-form showed good construct validity and criterion validity similar to the long-form and can therefore be used to measure determinants of vaccination behaviors among HCPs.

COVID-19 vaccine uptake and intention during pregnancy in Canada

Objective

To investigate COVID-19 vaccine uptake and intent among pregnant people in Canada, and determine associated factors.

Methods

We conducted a national cross-sectional survey among pregnant people from May 28 through June 7, 2021 (n = 193). Respondents completed a questionnaire to determine COVID-19 vaccine acceptance (defined as either received or intend to receive a COVID-19 vaccine during pregnancy), factors associated with vaccine acceptance, and rationale for accepting/not accepting the vaccine.

Results

Of 193 respondents, 57.5% (n = 111) reported COVID-19 vaccine acceptance. Among those who did not accept the vaccine, concern over vaccine safety was the most commonly cited reason (90.1%, n = 73), and 81.7% (n = 67) disagreed with receiving a vaccine that had not been tested in pregnant people. Confidence in COVID-19 vaccine safety (aOR 16.72, 95% CI: 7.22, 42.39), Indigenous self-identification (aOR 11.59, 95% CI: 1.77, 117.18), and employment in an occupation at high risk for COVID-19 exposure excluding healthcare (aOR 4.76, 95% CI: 1.32, 18.60) were associated with vaccine acceptance. Perceived personal risk of COVID-19 disease was not associated with vaccine acceptance in the multivariate model.

Conclusion

Vaccine safety is a primary concern for this population. Safety information should be communicated to this population as it emerges, along with clear messaging on the benefits of vaccination, as disease risk is either poorly understood or poorly valued in this population.

Vaccine hesitancy in health-care providers in Western countries: a narrative review

INTRODUCTION

Vaccine hesitancy (VH) is a leading cause of suboptimal vaccine uptake rates worldwide. The interaction between patients and health-care providers (HCPs) is the keystone in addressing VH. However, significant proportions of HCPs, including those who administer vaccines, are personally and professionally vaccine-hesitant.

AREAS COVERED

This narrative review sought to characterize the nature, extent, correlates, and consequences of VH among HCPs. We included 39 quantitative and qualitative studies conducted in Western countries, published since 2015, that assessed VH among HCPs in general, for several vaccines. Studies were reviewed using the WHO 3Cs model - (lack of) confidence, complacency, and (lack of) convenience.

EXPERT OPINION

Despite the lack of validated tools and substantial heterogeneity in the methods used to measure VH among HCPs, this review confirms its presence in this population, at frequencies that vary by country, profession type, setting, and level of medical education. Lack of knowledge and mistrust in health authorities/pharmaceutical industry/experts were among its principal drivers. Improving the content about vaccination in HCPs' training programs, facilitating access to reliable information for use during consultations, and developing and validating instruments to measure HCPs' VH and its determinants are key to addressing VH among HCPs.

An instrument to measure psychosocial determinants of health care professionals' vaccination behavior: Validation of the Pro-VC-Be questionnaire

OBJECTIVES

The lack of validated instruments assessing vaccine hesitancy/confidence among health care professionals (HCPs) for themselves, and their patients led us to develop and validate the Pro-VC-Be instrument to measure vaccine confidence and other psychosocial determinants of HCPs' vaccination behavior among diverse HCPs in different countries.

METHODS

Cross-sectional survey in October-November 2020 among 1,249 GPs in France, 432 GPs in French-speaking parts of Belgium, and 1,055 nurses in Quebec (Canada), all participating in general population immunization. Exploratory and confirmatory factor analyses evaluated the instrument's construct validity. We used HCPs' self-reported vaccine recommendations to patients, general immunization activity, self-vaccination, and future COVID-19 vaccine acceptance to test criterion validity.

RESULTS

The final results indicated a 6-factor structure with good fit: vaccine confidence (combining complacency, perceived vaccine risks, perceived benefit-risk balance, perceived collective responsibility), trust in authorities, perceived constraints, proactive efficacy (combining commitment to vaccination and self-efficacy), reluctant trust, and openness to patients. The instrument showed good convergent and criterion validity and adequate discriminant validity.

CONCLUSIONS

This study found that the Pro-VC-Be is a valid instrument for measuring psychosocial determinants of HCPs' vaccination behaviors in different settings. Its validation is currently underway in Europe among various HCPs in different languages.

COVID-19 pandemic impact on childhood vaccination coverage in Quebec, Canada

Response measures to mitigate the coronavirus disease 2019 pandemic impacted access to routine vaccination services. We evaluate the impact of the pandemic on routine infant vaccination uptake by comparing vaccination coverage, vaccine delays and doses administered in 2019 and 2020, in Quebec, Canada. Using a population-based vaccination registry, we compared vaccination coverage at 3, 5, 13 and 19 months of age between 2019 and 2020 cohorts each month from January to November. For vaccine delays, we measured the cumulative proportion vaccinated in each targeted cohort monthly. We also compared the measles-containing vaccines administered before 24 months of age between the same period in 2019 and 2020. A decline in vaccination coverage and children vaccinated on time was observed in all cohorts during the first months of the pandemic. The greatest impact was observed for the 18-month vaccination visit with a difference in vaccination coverage between both cohorts of 30.9% in May. Measles-containing doses administered during the first months of the pandemic were lower in 2020 compared with 2019: −21.1% in March (95%CI-21.6;-20.4), and −39.2% in April (95%CI-40.0;-38.2). After May, the coverage increased for all cohorts to reach pre-pandemic levels after a few months for most target ages. Routine childhood vaccinations were affected during the first months of the pandemic, but catch-up occurred thereafter and vaccination coverage in affected cohorts were very close to levels of 2019 after a few months of follow-up. Real-time monitoring of childhood vaccination is essential but also for other vaccination programs, severely affected by the pandemic.

80 Archetypes of vaccine hesitant caregivers towards COVID-19 immunization during a global pandemic: A qualitative study

Primary Subject area

Public Health and Preventive Medicine

Background

As Canada embarks on its rollout of the COVID-19 vaccine, vaccine hesitancy has the potential to hamper success of the vaccination campaign. Multiple surveys show that the number of Canadians willing to take the vaccine is insufficient to achieve herd immunity. Therefore, governments and health agencies are looking for solutions to increase vaccination uptake. Obtaining a better understanding of the perspective of those who are vaccine-hesitant is critical to developing successful implementation strategies for COVID-19 vaccination.

Objectives

To explore COVID-19 vaccination determinants among hesitant caregivers and describe categories of COVID-19 vaccine hesitancy.

Design/Methods

We conducted 23 semi-structured telephone interviews with parents recruited from a tertiary pediatric care centre. Seventeen participants had previously attended a specialty clinic to discuss vaccine hesitancy; the remaining were recruited from an infectious diseases follow-up clinic. The interview guide was structured around the Theoretical Domains Framework, assessing 14 behavioural constructs to identify specific determinants that guide behaviour change. Interviews were audio-recorded, transcribed, and analyzed by two independent data coders using a pragmatic inductive approach. Recurring themes were noted among subgroups of participants, who were subsequently divided into categories based on their underlying concerns.

Results

Five archetypes of vaccine-hesitant caregivers emerged in our data (Table 1). 1). “Bubble Dwellers” perceive themselves to be safe by following public health recommendations, and distinguish themselves from higher-risk groups to whom the vaccine should first be offered. 2). “Worriers and Delayers” identify the pandemic as a threat and are generally supportive of vaccines, but are concerned about side effects and issues surrounding vaccine development and prefer to delay vaccination. 3). “Need-for-Normals” are more concerned about social isolation and the economy than the direct effects of the COVID-19 virus, but express that the idea of a “return to normal” may sway their opinions regarding the vaccine. 4). “Exceptionalists” hold personal misperceptions of vaccine contraindications due to comorbidities or previous experiences with vaccination, and are concerned that the current rollout invokes a “one size fits all” model that does not apply to their circumstances. 5. “Freedom Fighters” view the pandemic as a hoax, are anti-establishment, and believe the information they have been provided is not convincing for them to adopt the vaccine.

Conclusion

The evolving pandemic provides a unique opportunity to understand determinants of vaccination intention in the vaccine hesitant population. Our qualitative study is unique in that we were able to draw upon pre-identified vaccine hesitant individuals to explore their perspectives around COVID-19 immunization. We propose that rather than viewing these individuals as one homogenous group, policymakers and health professionals address these discrete subgroups with specific communication tools and information. We are hopeful that our results will help tailor implementation strategies that are targeted to different vaccine hesitancy archetypes, as the vaccine is made available to the general public in the coming year.

Continuity of routine immunization programs in Canada during the COVID-19 pandemic

INTRODUCTION

In Canada, the COVID-19 pandemic has interrupted many routine health services, placed additional strain on the health care system, and resulted in many Canadians being either unable or unwilling to attend routine immunization appointments. We sought to capture and synthesize information about changes to routine immunization programs in response to the pandemic and plans to catch-up any missed immunizations.

METHODS

Provincial/territorial (P/T) public health leaders were interviewed via teleconference between August-October 2020 to collect information on the following topics: how routine immunization delivery was affected during and after initial lockdown periods, plans to catch-up missed doses, and major challenges and achievements in continuing routine immunization programs. Data were coded and categorized according to common responses and descriptive analysis was performed.

RESULTS

Interviews occurred with participants from 11 of 13 P/Ts. School immunization programs were reported to be most negatively affected by the pandemic (n = 9). In the early pandemic period, infant, preschool, and maternal/prenatal programs were prioritized, with most P/Ts continuing these services with adaptations for COVID-19. After the initial lockdown period, all routine programs were continuing with adaptations in most P/Ts. Infant, preschool, and school programs were most often targeted for catch-up through measures such as appointment rebooking and making additional clinics and/or providers available. Major challenges included resource limitations (e.g., staff shortages, PPE shortages, limited infrastructure) (n = 11), public health restrictions (n = 8), and public hesitancy to attend appointments (n = 5).

CONCLUSIONS

Canadian routine immunization programs faced some disruptions due to the COVID-19 pandemic, particularly the school, adult, and older adult programs. Further research is needed to determine the measurable impact of the pandemic on routine vaccine coverage levels.

Increasing vaccine acceptance using evidence-based approaches and policies: Insights from research on behavioural and social determinants presented at the 7th Annual Vaccine Acceptance Meeting

BACKGROUND

In 2019, the World Health Organization (WHO) flagged vaccine hesitancy as one of the top 10 threats to global health. The drivers of and barriers to under-vaccination include logistics (access to and awareness of affordable vaccines), as well as a complex mix of psychological, social, political, and cultural factors.

INCREASING VACCINE UPTAKE

There is a need for effective strategies to increase vaccine uptake in various settings, based on the best available evidence. Fortunately, the field of vaccine acceptance research is growing rapidly with the development, implementation, and evaluation of diverse measurement tools, as well as interventions to address the challenging range of drivers of and barriers to vaccine acceptance.

ANNUAL VACCINE ACCEPTANCE MEETINGS

Since 2011, the Mérieux Foundation has hosted Annual Vaccine Acceptance Meetings in Annecy, France that have fostered an informal community of practice on vaccination confidence and vaccine uptake. Mutual learning and sharing of knowledge has resulted directly in multiple initiatives and research projects. This article reports the discussions from the 7th Annual Vaccine Acceptance Meeting held September 23-25, 2019. During this meeting, participants discussed emergent vaccine acceptance challenges and evidence-informed ways of addressing them in a programme that included sessions on vaccine mandates, vaccine acceptance and demand, training on vaccine acceptance, and frameworks for resilience of vaccination programmes.

Attitudes of healthcare workers towards COVID-19 vaccination: a survey in France and French-speaking parts of Belgium and Canada, 2020

In October and November 2020, we conducted a survey of 2,678 healthcare workers (HCWs) involved in general population immunisation in France, French-speaking Belgium and Quebec, Canada to assess acceptance of future COVID-19 vaccines (i.e. willingness to receive or recommend these) and its determinants. Of the HCWs, 48.6% (n = 1,302) showed high acceptance, 23.0% (n = 616) moderate acceptance and 28.4% (n = 760) hesitancy/reluctance. Hesitancy was mostly driven by vaccine safety concerns. These must be addressed before/during upcoming vaccination campaigns.

Vaccination during pregnancy: Canadian maternity care providers' opinions and practices

A number of countries have implemented vaccination in pregnancy as a strategy to reduce the burden of influenza and pertussis. The aim of this study was to assess the involvement of Canadian maternity care providers in administration of vaccines to their pregnant patients. A cross-sectional web-based survey was sent to family physicians, obstetricians-gynecologists, midwives, pharmacists, and nurses. A multivariable logistic regression model was used to determine variables independently associated with offering vaccination services in pregnancy in providers' practice. A total of 1,135 participants participated. Overall, 64% (n = 724) of the participants reported offering vaccines in their practice and 56% (n = 632) reported offering vaccines to pregnant patients. The main reasons reported for not offering vaccination services in pregnancy were the belief that vaccination was outside of the scope of practice; logistical issues around access to vaccines; or lack of staff to administer vaccines. In multivariable analysis, the main factors associated with vaccination of pregnant patients in practices where vaccination services were offered were: providers' confidence in counseling pregnant patients about vaccines, seeing fewer than 11 pregnant patients on average each week, and being a nurse or a family physician. Although the majority of participants expressed strong support for vaccination during pregnancy, half were not offering vaccination services in their practice. Many were not equipped to offer vaccines in their practice or felt that it was not their role to do so. To enhance vaccine acceptance and uptake in pregnancy, it will be important to address the logistical barriers identified in this study.

Motivational interviewing: A powerful tool to address vaccine hesitancy

According to the World Health Organization, vaccine hesitancy is among the top threats to global health and few effective strategies address this growing problem. In Canada, approximatively 20% of parents/caregivers are concerned about their children receiving vaccines. Trying to convince them by simply providing the facts about vaccination may backfire and make parents/caregivers even more hesitant. In this context, how can health care providers overcome the challenge of parental decision-making needs regarding vaccination of their children? Motivational interviewing aims to support decision making by eliciting and strengthening a person's motivation to change their behaviour based on their own arguments for change. This approach is based on three main components: the spirit to cultivate a culture of partnership and compassion; the processes to foster engagement in the relationship and focus the discussion on the target of change; and the skills that enable health care providers to understand and address the parent/caregiver's real concerns. With regard to immunization, the motivational interviewing approach aims to inform parents/caregivers about vaccinations, according to their specific needs and their individual level of knowledge, with respectful acceptance of their beliefs. The use of motivational interviewing calls for a respectful and empathetic discussion of vaccination and helps to build a strong relationship. Numerous studies in Canada, including multicentre randomized controlled trials, have proven the effectiveness of the motivational interviewing approach. Since 2018, the PromoVac strategy, an educational intervention based on the motivational interviewing approach, has been implemented as a new practice of care in maternity wards across the province of Quebec through the Entretien Motivationnel en Maternité pour l'Immunisation des Enfants (EMMIE) program.

Sample study protocol for adapting and translating the 5C scale to assess the psychological antecedents of vaccination

INTRODUCTION

Published in 2018, the 5C scale is psychometrically validated to assess five psychological antecedents of vaccination (confidence, complacency, constraints, calculation and collective responsibility). The original version offers a validated English and German scale to assess these determinants with a short 5-item scale (1 item per antecedent) and a long 15-item scale (3 items per antecedent). This sample study protocol provides a step-by-step guidance for the process of adapting the 5C scale to another country, language or cultural context. Data obtained from the 5C scale can support developing, implementing and evaluating an intervention and monitoring of general vaccine acceptance and demand.

METHODS AND ANALYSIS

Phase 1 comprises the adaptation of the 5C scale including the translation and back translation of the antecedents, an expert evaluation of the antecedents and the identification of new antecedents as well as a pretest. Phase 2 involves the validation of the translated and potentially expanded scale including the assessment of reliability, construct and concurrent validity of all items of the scale. Code for data analysis is provided.

ETHICS AND DISSEMINATION

The University of Erfurt's institutional review board provided ethical clearance (EV-201900416.2). The authors suggest and encourage publicly sharing all data obtained from the translated 5C scale (eg, on publication). The materials and the code for data analysis to support the process described in this protocol are available in https://osf.io/2agxe/. Sharing data on vaccine acceptance and demand is in the public and the scientific interest and will facilitate gaining a global overview of its current state and development over time. The authors of the original 5C scale are currently working on an online platform to facilitate publishing the data and to visualise the psychological antecedents across different countries.

Promoting vaccination in maternity wards ─ motivational interview technique reduces hesitancy and enhances intention to vaccinate, results from a multicentre non-controlled pre- and post-intervention RCT-nested study, Quebec, March 2014 to February 2015

BackgroundMany countries are grappling with growing numbers of parents who delay or refuse recommended vaccinations for their children. This has created a need for strategies to address vaccine hesitancy (VH) and better support parental decision-making regarding vaccination.AimTo assess vaccination intention (VI) and VH among parents who received an individual motivational-interview (MI) based intervention on infant immunisation during post-partum stay at a maternity ward between March 2014 and February 2015.MethodsThis non-controlled pre-/post-intervention study was conducted using the results from parents enrolled in the intervention arm of the PromoVaQ randomised control trial (RCT), which was conducted in four maternity wards across the Province of Quebec. Participants (n = 1,223) completed pre- and post-intervention questionnaires on VI and VH using Opel's score. Pre-/post-intervention measures were compared using McNemar's test for categorical variables and Wilcoxon signed-rank test for continuous variables.ResultsPre-intervention: overall VI was 78% and significantly differed across maternity wards (74%, 77%, 84%, 79%, p = 0.02). Post-intervention: VI rose significantly across maternity wards (89%, 85%, 95%, 93%) and the overall increase in VI was 12% (78% vs 90%, p < 0.0001). VH corroborated these observations, pre- vs post-intervention, for each maternity ward (28% vs 16%, 29% vs 21%, 27% vs 17%, 24% vs 13%). Overall, VH was curbed post-intervention by 40% (27% vs 16%; p < 0.0001).ConclusionsCompared with pre-intervention status, participants who received the MI-based intervention on immunisation displayed lower hesitancy and greater intention to vaccinate their infant at 2 months of age.

Development of motivational interviewing skills in immunization (MISI): a questionnaire to assess MI learning, knowledge and skills for vaccination promotion

Objective: Vaccine hesitancy is a complex problem. We previously demonstrated that motivational interviewing (MI) could be helpful to enhance parents' motivation to vaccinate their child. The aim of this study is to develop a new, simple and robust evaluation tool that is suitable for evaluating MI learning of vaccination health professionals. Methods: We designed the Motivational Interviewing Skills in Immunization (MISI), a short written questionnaire to evaluate the MI knowledge and skills of participants in an immunization context. It covers three key areas: knowledge of MI, ability to apply MI-related skills, participant self-confidence in using MI. Questionnaire content and face validity were assessed by MI experts and internal consistency, reliability and effect size were analyzed using a multiple pretest-posttest design. Results: Psychometric measures showed good to excellent internal consistency of the questionnaire for all three areas (Cronbach's and KR coefficient: 0.70 to 0.88). Test-retest reliability showed good measurement stability (ICC: 0.53). Good sensitivity to change was also obtained (Cohen's d: 0.80 to 1.66). Conclusion: The MISI questionnaire is the first paper/pencil evaluation method to assess MI training specific to immunization. Psychometric measures showed high reliability. Practice implications: This questionnaire could provide a convenient and inexpensive method to evaluate knowledge and competencies following immunization-specific MI training.

Determinants of vaccine hesitancy in Quebec: a large population-based survey

Objectives: Vaccine hesitancy is a global phenomenon that needs to be measured and addressed. This study aimed to identify the determinants of vaccine hesitancy among a large regional population.Methods: A structured telephone survey was administered to a random digit sample in Quebec's Eastern Townships region. In addition to socioeconomic information, respondents were asked questions on several health topics such as knowledge and beliefs about immunization, medical consultations, health status, and life habits. Data were weighted according to age, sex, and territories. Statistically significant variables in the univariate analysis were introduced into a multivariate logistic regression model to determine independent factors for vaccine hesitancy (adjusted odds ratios [aOR] and 95% confidence intervals).Results: A total of 8,737 interviews were conducted (participation rate 48.3%). Among all respondents, 32.2% were vaccine-hesitant. Several beliefs were significantly associated with vaccine hesitancy: belief that children receive too many vaccines (aOR = 2.72; 2.32-3.18), belief that a healthy lifestyle can eliminate the need for vaccination (aOR = 2.48; 2.09-2.93), and belief that the use of alternative medicine practices can eliminate the need for vaccination (aOR = 1.39; 1.16-1.68). Other determinants associated with vaccine hesitancy were having consulted a massage therapist (aOR = 2.34; 1.46-3.75), not being vaccinated against influenza (aOR = 1.80; 1.49-2.16), having a low (<$30,000) (aOR = 1.58; 1.24-2.02) or moderate ($30,000-$79,000) (aOR = 1.37; 1.12-1.67) household income, distrust in public health authorities (aOR = 1.40; 1.21-1.63), perceived insufficient knowledge about immunization (aOR = 1.26; 1.04-1.51), and smoking (aOR = 1.22; 1.01-1.47).Conclusions: Many determinants are related to vaccine hesitancy. These determinants should be taken into account when health professionals engage with vaccine-hesitant individuals.

A complementary approach to the vaccination promotion continuum: An immunization-specific motivational-interview training for nurses

AIM

To develop and validate immunization-specific motivational-interview (MI) training for immunization nurses.

BACKGROUND

We previously demonstrated that a MI-based intervention on immunisation, performed during postpartum by MI-trained healthcare workers at the hospital maternity ward, reduced parental vaccine hesitancy (VH) and increased vaccine coverage of their children. In this study, we propose immunization-specific MI training for immunization nurses. Together, MI-based training and interventions provide complementary approaches to existing strategies along the vaccination promotion continuum.

DESIGN

Multiple pretest/posttest design with questionnaires self-administered before and after each training days (4 time points).

METHODS

We developed an in-person immunization-specific MI-training workshop for immunization nurses, held on two days three months apart, with 7 h of MI-training dispensed on day 1, and 4 h on day 2. The self-administered Motivational Interviewing Skills in Immunization (MISI) questionnaire was used at four time points (before and after each of the 2 training days) to evaluate three core aspects of participant MI training: (1) MI-knowledge acquisition; (2) MI-skills application and (3) self-rated self-confidence in applying MI knowledge and skills in vaccination clinical practice. Between November 2016 to December 2017, 34 immunization nurses enrolled in our MI-training workshops.

RESULTS

The immunization-specific MI-training improved the three core areas evaluated in participants i.e. MI-knowledge acquisition, MI-skills application, and self-rated self-confidence in applying these in vaccination clinical practice.

CONCLUSIONS

Our immunization-specific MI-training enabled immunization nurses to significantly improve MI knowledge, skills and self-confidence in applying MI in the clinic. These results, taken together with those on the MI-based intervention for parents that we previously reported, support the notion of proposing validated immunization-specific MI training for immunization nurses in order to curb parental VH.

IMPACT

Immunization-specific MI-training would be easily amenable for the training of other health professionals in the field of immunization to help promote vaccination and curb parental VH.

Promoting vaccination in the province of Québec: the PromoVaQ randomized controlled trial protocol

Background

Vaccination has a huge public health impact. Maintaining vaccine coverage is key to avoid the devastating consequences of resurgence. In the Province of Québec, vaccine coverage in young children are sub-optimal, mostly due to ambivalence toward vaccine safety and efficacy. We previously conducted a regional study in the Québec’s Eastern Townships region, the PromoVac Study, to test a new educational intervention, based on motivational interviewing techniques, aimed at promoting infant vaccination. This first study evidenced that the intervention led to a marked increase in mothers’ intention to vaccinate, and vaccine coverage in their infants. The current study protocol aims at scaling up these results at a provincial level using a randomized controlled trial design.

Methods

This pragmatic, randomized, controlled, parallel-group clinical trial will compare the effectiveness of the motivational interviewing to an educational intervention, including the distribution of an information flyer as standard of care on vaccination coverage in four maternity wards across the Province of Québec (PromovaQ). Adult mothers of children born in participating maternity wards were recruited between March 2014 and February 2015. Vaccination coverage will be assessed at 3-years of age, thus the trial is expected to be completed in March 2019. Statistical analyses will be conducted under the intention-to-treat principle. Vaccine coverage will be analyzed using Chi-squared distribution testing and logistic regression to identify determinant factors. Secondary outcomes will include vaccine hesitation and intention scores, mother’s knowledge, attitudes and beliefs about immunization, and psychosocial determinants of intention to vaccinate.

Discussion

In the case results of this Provincial RCT be confirmed, serious consideration should then be given by Ministry of Health authorities to the possible implementation of MI-based strategies across provincial maternity wards. To ensure adequate input and secure implementation, study design and results will be reviewed with relevant stakeholders, including the children’s families, and provincial and regional decision-makers. Results will be adapted and shared with all stakeholders.

Trial registration

ClinicalTrials.gov NCT02666872 (Retrospectively registered as January 28, 2016).

Vaccine acceptance: Science, policy, and practice in a 'post-fact' world

Suboptimal vaccination uptake may be associated with outbreaks of vaccine-preventable diseases in many parts of the world. Researchers and practitioners working on improving vaccine acceptance and uptake gathered together for the fifth annual meeting on vaccine acceptance, organized by the Fondation Mérieux at its conference centre in Veyrier-du-Lac, France, to share their experiences in building, improving and sustaining vaccine confidence and uptake. The importance and value of truly listening to people and seeking to understand the perspectives of vaccine hesitant people was emphasized throughout the meeting. The benefits of social marketing, which can be used to influence behavior that benefit individuals and communities for the greater social good, and its integration into strategies aimed at improving vaccine acceptance and uptake, were discussed. Healthcare professionals (HCPs) need tools and training to help them engage effectively in vaccination acceptance conversations with parents and other patients. Two potential tools, motivational interviewing (MI) and AIMS (Announce, Inquire, Mirror, Secure), were presented. Examples of MI approaches that have successfully improved vaccination acceptance and uptake included a project in Canada aimed at parents just after the birth of their baby. The role of mandates to increase vaccination uptake in the short-term was discussed, but to achieve sustainable vaccination uptake this must be complemented with other strategies. These annual meetings have led to the creation of an informal community of practice that facilitates cross-pollination between the various disciplines and different settings of those involved in this area of research and implementation. It was agreed that we must continue our efforts to promote vaccine acceptance and thus increase vaccination uptake, by fostering more effective vaccination communication, monitoring of the media conversation on vaccination, designing and rigorously evaluating targeted interventions, and surveillance of vaccine acceptance and uptake with pertinent, reliable measures.

Impact of a vaccination promotion intervention using motivational interview techniques on long-term vaccine coverage: the PromoVac strategy

BACKGROUND

Delayed vaccinations at 2, 4, and 6 months are associated with a higher probability of delayed age-appropriate vaccination during childhood. This study aimed to assess the effectiveness of an information session on immunization during infancy.

METHODS

An individual educational information session with motivational interview techniques for immunization of infants was conducted (experimental group) or not conducted (control group) during postpartum stay in a quasi-experimental cohort study. Immunization data were collected from the Eastern Townships Public Health registry at 3, 5, 7, 13, 19, and 24 months of age. Logistic regressions with repeated measures were performed to assess the intervention's impact. Relative risks (RR) were estimated. A multivariate model was obtained adjusted for confounding factors.

RESULTS

The experimental and control groups included 1140 and 1249 families, respectively. In per protocol analysis, a significant increase in VC of 3.2, 4.9, 7.3, 6.7, 10.6, and 5.1% was observed at 3, 5, 7, 13, 19, and 24 months. Children from experimental group had 9% more chance at a complete vaccination status between 3 and 24 months compared to children from control group (RR (95% CI): 1.09 (1.05-1.13), p < .001). Children with complete vaccination status at 3 months were more likely to have a complete vaccination status at 24 months (82.3 vs. 48.1%, RR (95% CI): 2.72 (2.28-3.24), p < .001). After adjustment, the estimated RR of the intervention's impact was 1.05 (1.02-1.07), p < .001.

CONCLUSIONS

An educational information session about immunization based on motivational interview techniques conducted during postpartum hospitalization could improve immunization during infancy.

Vaccination Against Influenza in Pregnancy: A Survey of Canadian Maternity Care Providers

OBJECTIVE

Influenza vaccine uptake among Canadian pregnant individuals is suboptimal. Failure to incorporate vaccination into routine prenatal care and a lack of recommendations from healthcare providers are recognized as barriers to vaccination. The aim of this study was to assess Canadian maternity care providers' knowledge, attitudes, and practices regarding influenza vaccination in pregnancy.

METHODS

A cross-sectional Web-based questionnaire was sent during July and August 2017 to family physicians, obstetricians-gynaecologists, midwives, pharmacists, and nurses who care for pregnant individuals. A multivariable logistic regression model was used to determine variables independently associated with providers' recommendation of the influenza vaccine in pregnancy.

RESULTS

The analysis included 1061 providers. Most participants (85%) reported being vaccinated against influenza themselves, and 72% reported recommending the influenza vaccine to all of their pregnant patients during the previous influenza season. Participants' attitudes regarding influenza vaccination during pregnancy were generally positive: 64% strongly agreed that pregnant individuals are at an increased risk of complications from influenza, and 69% strongly agreed that it is safe to vaccinate pregnant individuals against influenza. The main determinants of participants' recommendations for influenza vaccination to all pregnant patients were following official recommendations on influenza vaccination, discussing vaccines with most or all pregnant individuals seen in their practice, and being vaccinated themselves during the previous influenza season.

CONCLUSION

Enhancing influenza vaccine uptake in pregnancy is largely dependent on maternity care providers' recommendations. This study provides valuable insight on providers' knowledge, attitudes, and practices.

Overview of knowledge, attitudes, beliefs, vaccine hesitancy and vaccine acceptance among mothers of infants in Quebec, Canada

BACKGROUND

Vaccine hesitancy (VH) is a growing problem. The first step in addressing VH is to have an understanding of who are the hesitant individuals and what are their specific concerns. The aim of this survey was to assess mothers' level of vaccine hesitancy and vaccination knowledge, attitudes, and beliefs.

METHODS

Mothers of newly-born infants in four maternity wards in Quebec (Canada) completed a self-administered questionnaire. The questionnaire included items to assess VH and intention to vaccinate. VH scores were calculated using the Parents Attitudes about Childhood Vaccines (PACV) survey. Multivariate logistic regression was performed to determine variables associated with intention to vaccinate (OR; 95% CI).

RESULTS

Overall, 2645 questionnaires were included in this analysis and 77.5% of respondents certainly intended to vaccinate their infant at 2 months of age. Based on the PACV 100-point scale, 56.4% of mothers had a 0 to ˂30 score (low level of VH); 28.6% had a 30 to ˂50 and 15.0% had a score of 50 and higher (high level of VH).The main determinants of mothers' intention to vaccinate were the perceived importance of vaccinating infants at 2 months of age (OR = 9.2; 5.9-14.5) and a low score of VH (OR = 7.4; 5.3-10.3).

DISCUSSION

Although the majority of mothers held positive attitudes toward vaccination, a large proportion were moderately or highly vaccine hesitant. Mothers' level of VH was strongly associated with their intention to vaccinate their infants, showing the potential detrimental impact of VH on vaccine uptake rates and the importance of addressing this phenomenon.

Determinants of influenza vaccination among a large adult population in Quebec

OBJECTIVES

Very low uptake has been noted for influenza vaccination in the province of Quebec. This study aimed to identify the determinants of influenza vaccination among a large regional population.

METHODS

A telephone survey was administered to a random digit sample in the Eastern Townships region (Quebec, Canada). Respondents were asked questions on several health topics such as perceived knowledge and beliefs about influenza immunization, medical consultations, perceived health status and life habits. Significant variables in the univariate analysis were introduced into a multivariate logistic regression model to determine independent factors for having received the influenza vaccine (aOR and 95% CI) among adults aged ≥60 years and younger adults with ≥1 chronic condition.

RESULTS

A total of 4,620 interviews were analyzed. Among the target groups, 55.4% of adults aged ≥60 and 32.2% of adults aged 18-59 with at least one chronic disease had received the influenza vaccine during the 2013-2014 season. Several determinants were significantly associated with influenza vaccination in both groups such as having received a recommendation from a healthcare professional. Among adults aged ≥60, not having consulted a chiropractor over the last 12 months (aOR = 2.37; 1.09-5.19), non-smokers (aOR = 1.78; 1.22-2.59) and self-perceived poor health status (aOR = 1.45; 1.01-2.06) were significantly linked to flu vaccination. In the younger group, influenza vaccination was independently associated to low alcohol consumption (aOR = 2.14; 1.13-4.05) and being overweight (aOR = 1.63; 1.12-2.38).

CONCLUSIONS

Many determinants influence the decision to get vaccinated against influenza. Specific messages should be tailored for high-risk groups to effectively increase influenza vaccine coverage.

A postpartum vaccination promotion intervention using motivational interviewing techniques improves short-term vaccine coverage: PromoVac study

BACKGROUND

Due to the increasing number of vaccine-hesitant parents, new effective immunization promotion strategies need to be developed to improve the vaccine coverage (VC) of infants. This study aimed to assess the impact of an educational strategy of vaccination promotion based on motivational interviewing (MI) techniques targeting parents and delivered at the maternity ward, for the VC of infants at 3, 5, and 7 months of age.

METHODS

An individual educational information session, administered using MI techniques, regarding immunization of infants aged 2, 4, and 6 months was (experimental group) or was not (control group) proposed to parents during the postpartum stay at the maternity ward. Immunization data were obtained through the Eastern Townships Public Health registry for infants at 3, 5, and 7 months of age. Absolute VC increases at 3, 5, and 7 months in the experimental group were calculated and the relative risks with the respective 95% confidence intervals were computed using univariate logistic regression with the generalized estimating equations (GEE) procedure. Multivariate regression using GEE was used to adjust for confounding variables.

RESULTS

In the experimental and control groups, 1140 and 1249 newborns were included, respectively. A significant increase in VC of 3.2, 4.9, and 7.3% was observed at 3, 5, and 7 months of age (P < 0.05), respectively. The adjusted relative risk of the intervention's impact on vaccination status at 7 months of age was 1.08 (95% confidence interval: 1.03-1.14) (P = 0.002).

CONCLUSIONS

An educational strategy using MI techniques delivered at the maternity ward may be effective in increasing VC of infants at ages 3, 5, and 7 months. MI could be an effective tool to overcome vaccine hesitancy.

Effectiveness of rotavirus vaccine in preventing severe gastroenteritis in young children according to socioeconomic status

In 2011, the monovalent rotavirus vaccine was introduced into a universal immunization program in Quebec (Canada). This retrospective cohort study assessed vaccine effectiveness (VE) in preventing acute gastroenteritis (AGE) and rotavirus gastroenteritis (RVGE) hospitalizations among children <3 y living in the Quebec Eastern Townships region according to socioeconomic status (SES). Data were gathered from a tertiary hospital database paired with a regional immunization registry. Three cohorts of children were followed: (1) vaccinated children born in post-universal vaccination period (2011-2013, n = 5,033), (2) unvaccinated children born in post-universal vaccination period (n = 1,239), and (3) unvaccinated children born in pre-universal vaccination period (2008-2010, n = 6,436). In each cohort, AGE and RVGE hospitalizations were identified during equivalent follow-up periods to calculate VE globally and according to neighborhood-level SES. Using multivariable logistic regression, adjusted odds ratios (OR) were computed to obtain VE (1-OR). Adjusted VE of 2 doses was 62% (95% confidence interval [CI]: 37%-77%) and 94% (95%CI: 52%-99%) in preventing AGE and RVGE hospitalization, respectively. Stratified analyses according to SES showed that children living in neighborhoods with higher rates of low-income families had significantly lower VE against AGE hospitalizations compared to neighborhoods with lower rates of low-income families (30% vs. 78%, p = 0.027). Our results suggest that the rotavirus vaccine is highly effective in preventing severe gastroenteritis in young children, particularly among the most well-off. SES seems to influence rotavirus VE, even in a high-income country like Canada. Further studies are needed to determine factors related to lower rotavirus VE among socioeconomically disadvantaged groups.

Immunization of preterm infants

Vaccinations of premature infants are often delayed despite being at an increased risk of contracting vaccine preventable diseases. This article reviews the current knowledge on the immune response to widely used vaccines, on the protection derived from routine immunization and on vaccine safety and tolerability in a population of preterm infants. Available data evaluating the immune response of preterm infants support early immunization without correction for gestational age. For a number of antigens, the antibody response to initial doses of vaccines may be lower than that of term infants, but protective concentrations are often achieved and memory successfully induced. Vaccines are immunogenic, safe and well tolerated in preterm infants. Preterm infants should be vaccinated using the same schedules as those usually recommended for full-term infants, with the exception of the hepatitis B vaccine, where additional doses should be administered in infants receiving the first dose during the first days of life if they weighed less than 2000 g because of a documented reduced immune response.

Trends in severe gastroenteritis among young children according to socio-economic characteristics before and after implementation of a rotavirus vaccination program in Quebec

OBJECTIVES

Following implementation of a publicly funded rotavirus immunization program in Quebec (Canada) in 2011, its impact on gastroenteritis hospitalization rates, a proxy for severe gastroenteritis, was assessed.

METHODS

Using a tertiary hospital database and a regional vaccination registry, temporal trends in rates of hospitalization for acute gastroenteritis (AGE) and rotavirus gastroenteritis before the age of five years and rotavirus vaccine coverage were examined from June 2004 through May 2014 in a large retrospective birth cohort in the Eastern Townships region. The mean annual AGE hospitalization rate in post-program years (2011/2012-2013/2014) was compared with that in pre-program years (2004/2005-2010/2011) overall and according to the characteristics of the children, families and residential neighbourhoods at birth.

RESULTS

The AGE hospitalization rate significantly decreased from 81/10,000 in the pre-program period to 46/10,000 in the post-program period (relative reduction = 43%). Following implementation of the program, vaccine coverage rapidly increased and reached 81%. All socio-economic categories showed a reduced hospitalization rate in the post-program period, but the lowest relative reductions were observed in children living in neighbourhoods with higher rates of unemployment, low-income families and single mothers. However, these disadvantaged subgroups did not have lower vaccine coverage.

CONCLUSIONS

Three years following its introduction in a universal vaccination program, rotavirus vaccine significantly reduced severe gastroenteritis in young children. Despite similar vaccine coverage among all children, disadvantaged socio-economic groups appeared to have a less pronounced AGE reduction, suggesting that factors other than vaccination could partially influence the reduction of gastroenteritis morbidity in young children.

Understanding Vaccine Hesitancy in Canada: Results of a Consultation Study by the Canadian Immunization Research Network

"Vaccine hesitancy" is a concept now frequently used in vaccination discourse. The increased popularity of this concept in both academic and public health circles is challenging previously held perspectives that individual vaccination attitudes and behaviours are a simple dichotomy of accept or reject. A consultation study was designed to assess the opinions of experts and health professionals concerning the definition, scope, and causes of vaccine hesitancy in Canada. We sent online surveys to two panels (1- vaccination experts and 2- front-line vaccine providers). Two questionnaires were completed by each panel, with data from the first questionnaire informing the development of questions for the second. Our participants defined vaccine hesitancy as an attitude (doubts, concerns) as well as a behaviour (refusing some / many vaccines, delaying vaccination). Our findings also indicate that both vaccine experts and front-line vaccine providers have the perception that vaccine rates have been declining and consider vaccine hesitancy an important issue to address in Canada. Diffusion of negative information online and lack of knowledge about vaccines were identified as the key causes of vaccine hesitancy by the participants. A common understanding of vaccine hesitancy among researchers, public health experts, policymakers and health care providers will better guide interventions that can more effectively address vaccine hesitancy within Canada.

"Nature Does Things Well, Why Should We Interfere?": Vaccine Hesitancy Among Mothers

Parents' decision to use vaccination services is complex and multi-factorial. Of particular interest are "vaccine-hesitant" parents who are in the middle of the continuum between vaccine acceptance and refusal. The objective of this qualitative longitudinal study was to better understand why mothers choose to vaccinate-or not-their newborns. Fifty-six pregnant mothers living in different areas of Quebec (Canada) were interviewed. These interviews gathered information on mothers' views about health and vaccination. Almost half of the mothers were categorized as vaccine-hesitant. A second interview was conducted with these mothers 3 to 11 months after birth to look at their actual decision and behavior concerning vaccination. Our results show the heterogeneity of factors influencing vaccine decision making. Although the majority of vaccine-hesitant mothers finally chose to follow the recommended vaccine schedule for their child, they were still ambivalent and they continued to question their decision.

Impact of a publicly funded monovalent rotavirus vaccination program in the Province of Quebec (Canada)

In November 2011, the province of Quebec, Canada implemented a publicly funded rotavirus (RV) vaccination program using the monovalent RV vaccine (RV1). To assess its impact, trends in passive RV laboratory detection and Emergency Department (ED) visits for gastroenteritis (GE) at two pediatric centers were evaluated.

METHODS

RV tests performed were extracted from the virology laboratory databases and ED visits for GE between July 1, 2006 and June 30, 2013, from the ED databases of The Montreal Children's Hospital (MCH) and Centre Hospitalier Universitaire de Sherbrooke (CHUS). The percent positive RV tests over time and season duration were assessed using 5-week moving averages. We defined season start and end as the first two and the last two consecutive weeks where the percent positive RV tests were ≥ 10%, respectively.

RESULTS

Comparing the pre- and post-vaccination program periods, a decrease in the proportion of positive RV tests was seen: 15.9% vs. 5.1% (p<0.001). Pre-vaccination program, RV seasons started between December and February, peaked in March or April and ended in May. In 2011-2012, the season started in March, peaked in April, and ended in May. In 2012-2013, the season lasted 3 weeks in May. ED visits for GE decreased post-introduction of the RV1 program: from 4.8% to 3.4% in 2011-2012, and 4.2% in 2012-13 (p<0.001). In children <2 years of age, ED GE visits decreased from 7.5% to 4.8% in 2011-2012, and 5.2% in 2012-2013 (p<0.001). Admissions for GE also decreased significantly from 0.41% of all ED visits to 0.14% in 2011-2012 and 0.22% in 2012-2013 (p<0.005).

CONCLUSION

Implementation of a publicly funded RV vaccination program had a major impact on the epidemiology of RV infections in Quebec: RV seasons have started later and been of shorter duration, peak positives were fewer, and ED visits for GE decreased.

How do Midwives and Physicians Discuss Childhood Vaccination with Parents?

Even if vaccination is often described as one of the great achievements of public health, results of recent studies have shown that parental acceptance of vaccination is eroding. Health providers' knowledge and attitudes about vaccines are important determinants of their own vaccine uptake, their intention to recommend vaccines to patients and the vaccine uptake of their patients. The purpose of this article is to compare how midwives and physicians address vaccination with parents during pregnancy and in postpartum visits. Thirty semi-structured interviews were conducted with midwives and physicians practicing in the province of Quebec, Canada. Results of our analysis have shown that physicians adopt an "education-information" stance when discussing vaccination with parents in the attempt to "convince" parents to vaccinate. In contrast, midwives adopted a neutral stance and gave information on the pros and cons of vaccination to parents while leaving the final decision up to them. Findings of this study highlight the fact that physicians and midwives have different views regarding their role and responsibilities concerning vaccination. It may be that neither of these approaches is optimal in promoting vaccination uptake.

Burden of rotavirus disease: A population-based study in Eastern Townships, Quebec

BACKGROUND

Since July 2010, the National Advisory Committee on Immunization of Canada has recommended rotavirus vaccination for all healthy infants. However, before implementing this vaccine in routine health programs, Canadian provinces need to establish current epidemiological data on rotavirus-associated acute gastroenteritis (AGE).

METHODS

A retrospective cohort study of children <5 years of age with AGE from 2002 to 2008 was performed in Eastern Townships, Quebec (population in 2006: 298,780). Data were collected on visits to outpatient clinics, emergency department (ED) visits, hospitalizations (standard and short-stay units) and nosocomial AGE. The winter residual estimation and Brandt methods were used to estimate the proportion of AGE attributable to rotaviruses.

RESULTS

During the six-year study period, a total of 1435 hospitalizations, 3631 ED visits and 6220 ambulatory care visits were attributed to AGE. The specific rotavirus burden was estimated to be 449 to 666 for hospitalizations, 1050 to 1361 for ED visits and 1633 to 1687 for outpatient visits. The epidemic curve showed a periodicity with higher incidence in March and April. Short-stay unit hospitalizations represented 58% of all hospitalizations. The annual incidence rate of rotaviruses was estimated to be 50 to 74 per 10,000 children for hospitalizations, 117 to 152 per 10,000 children for ED visits and 182 to 188 per 10,000 children for outpatient visits.

CONCLUSION

Most available retrospective studies probably underestimate rotavirus-associated hospitalizations because they do not take into account short-stay unit hospitalizations. Furthermore, these data on emergency and outpatient visits provide an exhaustive appraisal of the rotavirus burden, which serves as crucial information for the evaluation of immunization programs.

[Current events in vaccination]

The annual meeting of the Infectious Disease Society of America (IDSA) ; which brought together nearly 5000 participants from over 80 countries in Vancouver, Canada, October 21 to 24, 2010 ; provided a review of the influenza (H1N1) 2009 pandemic, evaluated vaccination programmes and presented new vaccines under development. With 12,500 deaths in the United States in 2009-2010, the influenza (H1N1) 2009 pandemic was actually less deadly than the seasonal flu. But it essentially hit the young, and the toll calculated in years of life lost is high. The monovalent vaccines, whether live attenuated or inactivated with or without adjuvants, were well tolerated in toddlers, children, adults and pregnant women. In order to protect infants against pertussis, family members are urged to get their booster shots. The introduction of the 13-valent Pneumococcal conjugated vaccine in the beginning of 2010 may solve - but for how long ? - the problem of serotype replacement, responsible for the re-increasing incidence of invasive Pneumococcal infections observed in countries that had introduced the 7-valent vaccine. The efficacy of a rotavirus vaccine has been confirmed, with a reduction in hospitalization in the United States and a reduction in gastroenteritis-related deaths in Mexico. In the United States, vaccination of pre-adolescents against human papillomavirus (HPV) has not resulted in any specific undesirable effects. Routine vaccination against chicken pox, recommended since 1995, has not had an impact on the evolution of the incidence of shingles. Vaccination against shingles, recommended in the United States for subjects 60 years and over, shows an effectiveness of 55 %, according to a cohort study (Kaiser Permanente, Southern California). Although some propose the development of personalized vaccines according to individual genetic characteristics, the priority remains with increasing vaccine coverage, not only in infants but also in adults and the elderly. Vaccine calendars that cover a whole lifetime should be promoted, since the vaccination of adults and seniors is a determining factor of good health at all ages.

Early waning of maternal measles antibodies: why immunization programs should be adapted over time

Primary protection against measles in the first months of life is provided by transferred maternal antibodies. Since the introduction of the measles vaccine, changes in epidemiology have had major effects on the transmission of protective antibodies. The majority of women of childbearing age are now vaccinated and transfer fewer antibodies than naturally immune mothers, conferring shorter protection to their offspring. This article reveals an early loss of maternal antibodies in infants of vaccinated mothers but also in infants of naturally immune women. This increasing susceptibility window between loss of maternal antibodies and vaccination should be taken into account for a timely administration of the first dose of measles vaccine, particularly in the current context of re-emerging measles in Europe. Additional programs are needed to improve vaccination coverage within the global population and to reduce the spread of measles.

Determinants of A (H1N1) vaccination: cross-sectional study in a population of pregnant women in Quebec

BACKGROUND

Because of the risk of complication, pregnant women were a priority target for vaccination during the A (H1N1) pandemic influenza. In Quebec, 63% of pregnant women were vaccinated, which is a higher rate than vaccination against seasonal influenza. However, the behaviour of pregnant women relative to the vaccination during the H1N1 pandemic is unknown. The present study was aimed at identifying factors influencing the decision-making of pregnant women regarding H1N1 vaccination.

METHODS

A cross-sectional survey was conducted in February 2010 in pregnant women or in early postpartum at the Sherbrooke University Hospital Centre using a self-administered questionnaire based on the Health Belief Model (HBM). Data items collected were: socio-demographic data, vaccination status, information sources consulted, knowledge on vaccination, and the HBM dimensions: effectiveness and risks of vaccination, severity and vulnerability towards the influenza. The associations between questionnaire variables and vaccination status were assessed by univariate and multivariate analysis.

RESULTS

Of the 250 women interviewed, 95% knew that the vaccination was recommended, but only 76% received the vaccine. Variables positively associated with vaccination were late vaccination during pregnancy (OR=7.3, 95% CI 2.1-25.3), belief in the efficacy of the vaccine (OR=7, 95% CI 2-23.4), and consultation of the Pandémie-Québec website (OR=4.5, 95% CI 1.5-13.4). However, the belief that the vaccine had not been adequately tested (OR=0.08, 95% CI 0.02-0.35) and consultation of mainstream websites (OR=0.22, 95% CI 0.06-0.81) were associated with lower vaccination rates.

CONCLUSIONS

The vast majority of pregnant women were aware of the recommendations relative to A (H1N1) vaccination. Internet media played an important role in their decision to get vaccinated. Better information on the safety of the vaccine must be prepared for future pandemics.