Uptake of varicella vaccine—a cross sectional survey of parental attitudes to nationally recommended but unfunded varicella immunisation

The Influence of Introducing Free Vaccination against Streptococcus pneumoniae on the Uptake of Recommended Vaccination in Poland

Since 2017, pneumococcal vaccination has evolved from a recommended chargeable vaccination to a mandatory, and therefore free, vaccination for all children. While a 10-valent vaccine is commonly used, parents have the option to use a 13-valent vaccine for a fee. This study aimed to investigate whether and how the introduction of free pneumococcal vaccination affected the uptake of recommended vaccination and to assess the association of chargeable pneumococcal vaccination with recommended vaccination. Data from 1595 vaccination record cards kept by six primary care clinics in urban and rural areas of Poland were collected and analyzed for children born between 2015 and 2018. Belonging to the clinic and the year of birth were the only inclusion criteria. Following the introduction of free universal pneumococcal vaccination, more children were vaccinated with the recommended vaccination (61.2% vs. 66.6%, p = 0.026). The most significant change was in vaccination against rotavirus (48.5% vs. 54.4%, p = 0.018) and against meningococcal B bacteria (4.8% vs. 17.0%, p < 0.001). Children who received chargeable pneumococcal vaccination were also significantly more likely to be vaccinated with recommended vaccines (54.6% vs. 75.9%, p < 0.001). In particular, this was the case for multivalent vaccinations-against rotavirus, chickenpox, and meningococcal C bacteria. Reducing the impact of the economic factor, for example, by introducing free vaccinations, should have a positive impact on the uptake of other recommended vaccinations.

Parental Attitudes and Perceptions Towards Vaccines

Objective

Success of any vaccination program and uptake of children's vaccines largely depends upon the parents' perceptions and attitudes. This study provides a snapshot of parents' views towards vaccines included in the nationally-funded vaccination program, together with two unfunded vaccines in Kocaeli, Turkey.

Methods

Data were gathered from a convenience sample through a questionnaire that explored the socio-demographic factors of the parents and the vaccination status of their children. The survey content was based on Health Belief Model. Mann-Whitney test was used for comparisons as there is no prior information regarding data distribution and the dependent variable is represented on an ordinal scale. Out of 300 parents who brought their children into the pediatrics polyclinics, 262 parents responded positively and took part. The questionnaires were filled out by mothers alone 67.6 % (n=177), 28.6 % (n=75) by fathers and mothers (both present), 3.1% (n=8) by fathers alone and the remaining 0.8% (n=2) were filled by other relatives.

Results

While the majority of diseases prevented by the vaccines were perceived to be serious, pneumococcal infection and chickenpox were considered to be less serious and there was no strong opinion for the rotavirus vaccine. The main reasons that influenced parents' decisions towards unfunded vaccines were advice from a pediatrician and the cost. Lastly, demographic factors such as family income, mothers' education and job types of mothers were important in contrast to previously published studies.

Conclusions

The acceptance of a new vaccine depends on a complex interaction of factors, but parents' perceptions may vary considerably. The main factors influencing parental acceptance are the availability of information and the cost. Therefore, for a new vaccination program to succeed, it should be funded by the government and a specific public health education program should be undertaken.

Model-based assessment of public health impact and cost-effectiveness of dengue vaccination following screening for prior exposure

The tetravalent dengue vaccine CYD-TDV (Dengvaxia) is the first licensed vaccine against dengue, but recent findings indicate an elevated risk of severe disease among vaccinees without prior dengue virus (DENV) exposure. The World Health Organization currently recommends CYD-TDV only for individuals with serological confirmation of past DENV exposure. Our objective was to evaluate the potential health impact and cost-effectiveness of vaccination following serological screening. To do so, we used an agent-based model to simulate DENV transmission with and without vaccination over a 10-year timeframe. Across a range of values for the proportion of vaccinees with prior DENV exposure, we projected the proportion of symptomatic and hospitalized cases averted as a function of the sensitivity and specificity of serological screening. Scenarios about the cost-effectiveness of screening and vaccination were chosen to be representative of Brazil and the Philippines. We found that public health impact depended primarily on sensitivity in high-transmission settings and on specificity in low-transmission settings. Cost-effectiveness could be achievable from the perspective of a public payer provided that sensitivity and the value of a disability-adjusted life-year were both high, but only in high-transmission settings. Requirements for reducing relative risk and achieving cost-effectiveness from an individual perspective were more restricted, due to the fact that those who test negative pay for screening but receive no benefit. Our results predict that cost-effectiveness could be achieved only in high-transmission areas of dengue-endemic countries with a relatively high per capita GDP, such as Panamá (13,680 USD), Brazil (8,649 USD), México (8,201 USD), or Thailand (5,807 USD). In conclusion, vaccination with CYD-TDV following serological screening could have a positive impact in some high-transmission settings, provided that screening is highly specific (to minimize individual harm), at least moderately sensitive (to maximize population benefit), and sufficiently inexpensive (depending on the setting).

Burden of varicella in the Asia-Pacific region: a systematic literature review

INTRODUCTION

Varicella is a highly contagious infection that can lead to serious complications, particularly in high-risk groups; however, it is vaccine preventable. Disease awareness and understanding of the disease burden can strongly influence vaccine coverage. This review provides insight into the current epidemiology and the importance of varicella from both public health and economic perspectives across the Asia-Pacific (APAC) region. Areas covered: A systematic literature review was conducted to identify studies on the incidence, seroprevalence, fatality rate and complication rate of varicella. Economic burden studies were also captured. Altogether, 125 studies were identified across the region; these were supplemented by government reports (gray data). Reported vaccine coverage varied from 2.8% to 97%; a key influencing factor was inclusion of the varicella vaccine in national immunization programs. In general, varicella incidence in the unvaccinated population was highest in children ≤5 years old and seroprevalence increased with age. Economic analyses highlighted the cost-saving potential of vaccination programs, especially from a societal perspective. Expert opinion: Varicella-related data varied greatly across the APAC region, highlighting the need to better understand the burden of varicella in this area, and particularly identified the need for better surveillance and reporting.

'What have you HEARD about the HERD?' Does education about local influenza vaccination coverage and herd immunity affect willingness to vaccinate?

BACKGROUND

Vaccination protects individuals directly and communities indirectly by reducing transmission. We aimed to determine whether information about herd immunity and local vaccination coverage could change an individual's vaccination plans and concern about influenza.

METHODS

We surveyed Minnesota residents ≥18 years during the 2016 Minnesota State Fair. Participants were asked to identify the definition of herd immunity, to report their history of and plans to receive influenza vaccine, to report their concern about influenza, and to estimate the reported influenza vaccination coverage in their county. After providing educational information about herd immunity and local vaccination rates, we reassessed vaccination plans and concerns. We used logistic regression to estimate predicted percentages for those willing to be vaccinated, for concern about influenza, and for changes in these outcomes after the intervention. We then compared those individuals with and without prior knowledge of herd immunity, accounting for other characteristics.

RESULTS

Among 554 participants, the median age was 57 years; most were female (65.9%), white (91.0%), and non-Hispanic/Latino (93.9%). Overall, 37.2% of participants did not know about herd immunity and 75.6% thought that the influenza vaccination coverage in their county was higher than it was reported. Those not knowledgeable about herd immunity were significantly less likely than those knowledgeable about the concept to report plans to be vaccinated at baseline (67.8% versus 78.9%; p = 0.004). After learning about herd immunity and influenza vaccination coverage, the proportion of those not knowledgeable about herd immunity who were willing to be vaccinated increased significantly by 7.3 percentage points (p = 0.001). Educating participants eliminated the significant difference in the proportion planning to be vaccinated between these two groups (80.1% of those knowledgeable and 75.1% of those who were not initially knowledgeable became willing; p = 0.148).

CONCLUSIONS

Education about herd immunity and local vaccination coverage could be a useful tool for increasing willingness to vaccinate, generating benefits both to individuals and communities.

Rural-urban disparity in category II vaccination among children under five years of age: evidence from a survey in Shandong, China

Background

Compared with the Expanded Program on Immunization (EPI) vaccines, the coverage rate of the non-EPI vaccines is still low. The aim of this study is to explore the rural-urban disparity in category II vaccine and its determinants among children under 5 years old in China.

Methods

A cross-sectional study was conducted in 17 cities in Shandong province from August to October, 2013. A total of 1638 children were included in the analysis. Unadjusted and adjusted regression model were used to identify the rural-urban difference in vaccination of category II vaccine. Multivariate logistic regression models were employed to analyze the determinants associated with vaccination of category II vaccine in rural and urban areas respectively.

Results

The coverage rates of category II vaccine in rural and urban children were 81.5 and 69.4% respectively. Factors including age and satisfaction with vaccination services were associated with category II vaccination both in rural and urban children (Ρ < 0.05). It was also found that the households with four or less members are more likely to vaccinate category II vaccine in rural children.

Conclusions

There was a big difference between rural and urban children in the use of category II vaccine. The government should strengthen financial support and regulation for the category II vaccine. The identified at-risk factors, including age, satisfaction with the vaccination services, and family size should be taken into account when designing targeted vaccination policies for rural and urban children.

Perceptions of caregivers and providers regarding the potential introduction of the varicella vaccine to the childhood immunisation schedule in New Zealand: A qualitative exploratory study

AIM

The varicella vaccine has been proposed to be added to the childhood immunisation schedule in New Zealand as the fourth injectable at the 15-month event. We sought to understand the perceptions of caregivers and health-care providers regarding the potential introduction of routine varicella vaccination.

METHODS

A qualitative exploratory study was conducted using semi-structured interviews with caregivers and providers (N = 20) in Auckland. Key themes from the interviews were identified through thematic analysis using a combination of deductive and inductive coding.

RESULTS

All of the participants were aware of varicella but levels of awareness varied among caregivers regarding the varicella vaccine. Participants expressed positive support towards universal varicella vaccination and a high intention to vaccinate if available as a routine vaccine. However, many concerns were raised about multiple injections at a single immunisation visit, and participants suggested alternative scheduling options.

CONCLUSION

The results indicated a need to raise awareness among caregivers about the varicella vaccine, focusing on positive health beliefs about vaccination in terms of protecting the child's health and reducing the impact of a child getting varicella on the family. Health-care providers and government health authorities may play an important role in increasing positive health beliefs about the varicella vaccine. Should the varicella vaccine be introduced as proposed, our findings recommend an educational campaign to address both caregiver and provider concerns about multiple injections and how to manage alternative immunisation schedules. These insights may help inform national strategies for the proposed addition to increase acceptance of the varicella vaccination.

Receiving early information and trusting Swedish child health centre nurses increased parents' willingness to vaccinate against rotavirus infections

AIM

Rotavirus vaccines are effective against severe infections, but have a modest impact on mortality in high-income countries. Parental knowledge and attitudes towards vaccines are crucial for high vaccination coverage. This study aimed to identify why parents refused to let their infant have the vaccination or were unsure.

METHODS

This cross-sectional study was based on 1,063 questionnaires completed by the parents of newborn children in 2014. Stepwise logistic regression was used to identify the main predictors.

RESULTS

Most (81%) parents intended to vaccinate their child against the rotavirus, while 19% were unwilling or uncertain. Parents with less education and children up to five weeks of age were more likely to be unwilling or uncertain about vaccinating their child. Factors associated with a refusal or uncertainty about vaccinating were not having enough information about the vaccine, no intention of accepting other vaccines, paying little heed to the child health nurses' recommendations, thinking that the rotavirus was not a serious illness and not believing that the vaccine provided protection against serious forms of gastroenteritis.

CONCLUSION

Early information, extra information for parents with less education and close positive relationships between parents and child health nurses were important factors in high rotavirus vaccination rates.

Maternal uptake of pertussis cocooning strategy and other pregnancy related recommended immunizations

Maternal immunization is an important strategy to prevent severe morbidity and mortality in mothers and their offspring. This study aimed to identify whether new parents were following immunization recommendations prior to pregnancy, during pregnancy, and postnatally. A cross-sectional survey was conducted by a questionnaire administered antenatally to pregnant women attending a maternity hospital with a follow-up telephone interview at 8-10 weeks post-delivery. Factors associated with uptake of pertussis vaccination within the previous 5 y or postnatally and influenza vaccination during pregnancy were explored using log binomial regression models. A total of 297 pregnant women completed the questionnaire. For influenza vaccine, 20.3% were immunized during pregnancy and 3.0% postnatally. For pertussis vaccine, 13.1% were vaccinated within 5 y prior to pregnancy and 31 women received the vaccine postnatally, 16 (51.6%) received the vaccine >4 weeks after delivery. Receiving a recommendation from a healthcare provider (HCP) was an independent predictor for receipt of both pertussis (RR 2.07, p < 0.001) and influenza vaccine (RR 2.26, p = 0.001). Non-English speaking mothers were significantly less likely to have received pertussis vaccination prior to pregnancy or postnatally (RR 0.24, p = 0.011). Multiparous pregnant women were less likely to have received an influenza vaccine during their current pregnancy (p = 0.015). Uptake of pregnancy related immunization is low and likely due to poor knowledge of availability, language barriers and lack of recommendations from HCPs. Strategies to improve maternal vaccine uptake should include education about recommended vaccines for both HCPs and parents and written information in a variety of languages.

Approved but non-funded vaccines: accessing individual protection

Funded immunization programs are best able to achieve high participation rates, optimal protection of the target population, and indirect protection of others. However, in many countries public funding of approved vaccines can be substantially delayed, limited to a portion of the at-risk population or denied altogether. In these situations, unfunded vaccines are often inaccessible to individuals at risk, allowing potentially avoidable morbidity and mortality to continue to occur. We contend that private access to approved but unfunded vaccines should be reconsidered and encouraged, with recognition that individuals have a prerogative to take advantage of a vaccine of potential benefit to them whether it is publicly funded or not. Moreover, numbers of "approved but unfunded" vaccines are likely to grow because governments will not be able to fund all future vaccines of potential benefit to some citizens. New strategies are needed to better use unfunded vaccines even though the net benefits will fall short of those of funded programs. Canada, after recent delays funding several new vaccine programs, has developed means to encourage private vaccine use. Physicians are required to inform relevant patients about risks and benefits of all recommended vaccines, publicly funded or not. Likewise, some provincial public health departments now recommend and promote both funded and unfunded vaccines. Pharmacists are key players in making unfunded vaccines locally available. Professional organizations are contributing to public and provider education about unfunded vaccines (e.g. herpes zoster, not funded in any province). Vaccine companies are gaining expertise with direct-to-consumer advertising. However, major challenges remain, such as making unfunded vaccines more available to low-income families and overcoming public expectations that all vaccines will be provided cost-free, when many other recommended personal preventive measures are user-pay. The greatest need is to change the widespread perception that approved vaccines should be publicly funded or ignored.

Changes in patterns of hospitalized children with varicella and of associated varicella genotypes after introduction of varicella vaccine in Australia

BACKGROUND

Varicella in children, although usually mild, can cause hospitalization and rarely death. This study examined patterns of hospitalized children with varicella, and associated varicella genotypes, in 4 tertiary children's hospitals throughout Australia before and after varicella vaccine was introduced.

METHODS

We obtained coded data on discharge diagnoses from each hospital before (1999 to 2001) and after (2007 to 2010) varicella vaccine introduction in 2005, adding active surveillance to capture clinical features, complications and immunization history in the latter period. Varicella vesicles were swabbed, and genotyping of varicella strains was performed by real-time polymerase chain reaction amplification.

RESULTS

Overall, a 68% reduction in coded hospitalizations (varicella, 73.2% [P < 0.001]; zoster, 40% [P = 0.002]) occurred post-vaccine introduction. Of children with detailed clinical data (97 varicella and 18 zoster cases), 46 (40%) were immunocompromised. Only 6 of 32 (19%) age-eligible immunocompetent children were immunized. Complications, most commonly secondary skin infections (n = 25) and neurologic conditions (n = 14), occurred in 44% of children. There were no deaths; but 3 immunocompetent unimmunized children had severe multiple complications requiring intensive care. All strains genotyped were "wild-type" varicella, with Clade 1 (European origin) predominating.

CONCLUSIONS

After the introduction of varicella vaccine, coverage of greater than 80% at 2 years of age was achieved, with varicella hospitalizations reduced by almost 70%. Of hospitalized children age-eligible for varicella vaccine, 80% were unimmunized, including all cases requiring intensive care.

Knowledge, Attitudes, and Practices regarding Chickenpox Disease and its Prevention in Singapore: Comparison between Parents and Medical Students

Introduction:

The incidence of chickenpox in Singapore is steadily increasing despite the availability of effective preventive measures. To address the need for improvement in public education, a survey was conducted to establish if differences exist amongst parents and medical students with regards to their knowledge, attitudes, and practices regarding chickenpox and its prevention.

Methods:

Over a six-week period in 2010, an online survey involving parents who attended a paediatric clinic, and medical students from the National University of Singapore, was conducted.

Results:

Parents had a significantly greater lack of knowledge compared to medical students ( P <0.001). Family and friends were the main source of information for parents and junior medical students, unlike senior medical students who learnt more from physicians. A large majority of responders (85.2%) favoured vaccination for varying reasons, with parents and junior students being more concerned about the spread of disease and favouring its avoidance, and senior students fearing life-threatening complications. Parents who would not recommend the vaccine considered chickenpox a rite of passage and believed the vaccine lacks long-term benefits, while a perception that the disease is mild was more prevalent among medical students. A better understanding of the disease and vaccine was the most influential factor for changing decisions against vaccination.

Conclusion:

Greater efforts to disseminate information about chickenpox disease and its prevention are needed to address important deficits in public health and medical school education. Being aware that chickenpox can be more than just a mild disease with serious complications may increase the uptake of chickenpox vaccination.

The role of herd immunity in parents' decision to vaccinate children: a systematic review

BACKGROUND AND OBJECTIVE

Herd immunity is an important benefit of childhood immunization, but it is unknown if the concept of benefit to others influences parents' decisions to immunize their children. Our objective was to determine if the concept of "benefit to others" has been found in the literature to influence parents' motivation for childhood immunization.

METHODS

We systematically searched Medline through October 2010 for articles on parental/guardian decision-making regarding child immunization. Studies were included if they presented original work, elicited responses from parents/guardians of children <18 years old, and addressed vaccinating children for the benefit of others.

RESULTS

The search yielded 5876 titles; 91 articles were identified for full review. Twenty-nine studies met inclusion criteria. Seventeen studies identified benefit to others as 1 among several motivating factors for immunization by using interviews or focus groups. Nine studies included the concept of benefit to others in surveys but did not rank its relative importance. In 3 studies, the importance of benefit to others was ranked relative to other motivating factors. One to six percent of parents ranked benefit to others as their primary reason to vaccinate their children, and 37% of parents ranked benefit to others as their second most important factor in decision-making.

CONCLUSIONS

There appears to be some parental willingness to immunize children for the benefit of others, but its relative importance as a motivator is largely unknown. Further work is needed to explore this concept as a possible motivational tool for increasing childhood immunization uptake.

Factors influencing parental decision making when parents choose to deviate from the standard pediatric immunization schedule

PURPOSE

The purpose of this article is to present the results of a study focusing on the basis for parental decisions to refrain from the standard pediatric immunization schedule.

DESIGN AND METHODS

The study was based upon open-ended qualitative items that were subjected to content analysis to identify the prominent themes cited by parents.

RESULTS

The results of the study demonstrate the presence of a variety of continuing misperceptions regarding the risks represented by common pediatric immunizations.

PRACTICE IMPLICATIONS

The study demonstrates the need for intensive efforts designed to apprise families of the risks and benefits associated with pediatric immunization.

Acceptance on the move: public reaction to shifting vaccination realities

This review examines four events related to vaccination that have occurred in recent years: (a) the ongoing recovery from the MMR/Autism scare in the UK, (b) the upgrading of the Varicella vaccine to a universal childhood vaccine, (c) the major effort of authorities to provide a vaccine for A/H1N1 influenza and its rejection by the public, and, d) the current attempts to change the HPV vaccine target from girls only to boys and girls. All of these changes have been met with shifts in the public acceptance of the relevant vaccine. These shifts are characterized not only by the number of people willing to be vaccinated, but also by the attitudes and the motives related to acceptance. Examination of the interrelationship between changes in vaccination realities, and changes in acceptance patterns suggests that today, the public has a better understanding of vaccination, is acting in a more reflexive way, and is capable of changing attitudes and behavior. All together, changes in vaccination enhance debates and dialogues about vaccines, and lead to higher awareness and more conscious acceptance.

School-based vaccination in NSW

Over the past decade the number of recommended and funded vaccines for adolescents has increased, becoming a substantial part of the National Immunisation Program in Australia. In response, NSW has implemented disease-specific vaccination campaigns for both children and adolescents and more recently established a routine high school-based vaccination program to administer vaccines to this often hard to reach group. This paper outlines the history of school-based vaccination in NSW from its commencement in 1971 to coverage from early disease-specific programs, and describes the implementation of the current program of routine vaccination. Substantial coverage has been achieved across the age spectrum 5-17 years, highlighting the effectiveness of the school-based vaccination program in reaching large numbers of adolescents.

Herpes zoster in Australia: evidence of increase in incidence in adults attributable to varicella immunization?

Rates of herpes zoster (HZ) hospitalizations, antiviral prescriptions, and New South Wales emergency-department presentations for age groups <20, 20-39, 40-59 and ⩾60 years were investigated. Trends were analysed using Poisson regression to determine if rates increased following funding of varicella immunization in Australia in November 2005. The regression analysis revealed significantly increasing trends of between 2% and 6% per year in both antiviral prescriptions and emergency-department presentations in all except the <20 years age group. When considered together, the differential changes in rates observed by age group provides preliminary evidence to indicate that HZ incidence is increasing in adults aged >20 years. However, it is not possible to attribute the increasing trends in HZ observed directly to the varicella immunization programme, and continued monitoring and analyses of data for a longer duration, both pre- and post-vaccine introduction, is required.

Varicella vaccination coverage in Bavaria (Germany) after general vaccine recommendation in 2004

Since 2004, general varicella vaccination has been recommended for all children 11-14 months of age in Germany. The objective of this study was to examine vaccination coverage in children and factors associated with parental acceptance during the first years after recommendation. In a regional surveillance area, cross-sectional parent surveys were conducted in 2006, 2007 and 2008 in random samples (n=600) of children aged 18-36 months; data were obtained for 372, 364 and 352 children, respectively. Parents were questioned on their child's varicella disease history, and on varicella vaccination status as recorded in the child's vaccination booklet. Overall coverage increased from 38% in 2006 to 51% in 2007 and stagnated at 53% in 2008; in susceptible children (without previous varicella disease until vaccination or time of survey) coverage was 42%, 61% and 59%, respectively. Recommendation by the paediatrician as reported by the parents increased from 48% (2006) to 57% (2007) and 60% (2008), and was the main independent factor associated with parental acceptance. In 32-35% of unvaccinated children parents had not yet decided whether to vaccinate against varicella. Additional programmes targeting paediatricians' and parents' acceptance of varicella vaccination are needed to achieve the WHO-defined goal of at least 85% coverage.

A decline in varicella but an uncertain impact on zoster following varicella vaccination in Victoria, Australia

Varicella vaccine was licensed in Australia in 1999 and publicly funded in 2005. We examined trends in varicella and zoster hospitalisations and community consultations in Victoria during periods of no vaccine, private availability of vaccine and funded vaccination. Varicella hospitalisation rates declined 7% per year (95% CI 5-9%) from 2000 to 2007, predominately in children under five (12% per year, 95% CI 9-16%). A similar decline was seen in community data. The zoster hospitalisation rate increased from 1998 to 2007 (5% per year, 95% CI 3-6%), before introduction of varicella vaccine. Among those aged 80 and over the hospitalisation rate increased 5% per year (95% CI 3-7%) from 1998 to 2007. Zoster increased in community data from 2001.

Pandemic influenza and community preparedness

OBJECTIVES

We aimed to examine community knowledge about and attitudes toward the threat of pandemic influenza and assess the community acceptability of strategies to reduce its effect.

METHODS

We conducted computer-aided telephone interviews in 2007 with a cross-sectional sample of rural and metropolitan residents of South Australia.

RESULTS

Of 1975 households interviewed, half (50.2%) had never heard of pandemic influenza or were unaware of its meaning. Only 10% of respondents were extremely concerned about the threat of pandemic influenza. Respondents identified children as the highest priority for vaccination, if supplies were limited; they ranked politicians and teachers as the lowest priority. Although only 61.7% of respondents agreed with a policy of home isolation, 98.2% agreed if it was part of a national strategy. Respondents considered television to be the best means of educating the community.

CONCLUSION

s. Community knowledge about pandemic influenza is poor despite widespread concern. Public education about pandemic influenza is essential if strategies to reduce the impact of the disease are to be effective.

Varicella immunisation practice: Implications for provision of a recommended, non-funded vaccine

AIM

In Australia in 2003 a two-tiered immunisation schedule was introduced consisting of funded (National Immunisation Program) and non-funded but recommended vaccines (Best Practice Schedule), including varicella vaccine. The aim of this study was to examine immunisation practice when a vaccine is recommended but not funded by Government.

METHODS

A survey was sent to 600 randomly selected general practitioners (GPs) in South Australia between June and August 2005, prior to provision of Federal funding for varicella vaccine.

RESULTS

Although varicella was considered an important disease to prevent by 89% of GPs, only 25% of GPs always discussed the non-funded immunisation with parents at the time of a routine immunisation visit. Female GPs were more likely to discuss immunisation with recommended, non-funded vaccines than male GPs. Those who were supportive of varicella prevention were more likely to discuss immunisation with the non-funded vaccine. GPs who always provided information about the disease were more likely to have parents accept their advice about varicella vaccine (62.7%) than those who never provided information (40%). GPs reported parental refusal of varicella vaccine was due to the cost and perception that varicella is a mild disease.

CONCLUSIONS

The results of this study showed variability in prescribing practices for a non-funded vaccine. Recommending a vaccine without provision of funding may lead to 'mixed messages' for immunisation providers and parents with resultant low coverage. Funding a vaccine is likely to reduce variability in provision of the vaccine and improve coverage in the community.

Varicella vaccination in Australia and New Zealand

Varicella-zoster virus has been responsible for a significant disease burden, including hospitalizations and deaths in Australia and New Zealand. Varicella vaccine has been available in Australia since 1999 and, since November 2005, has been funded under the National Immunisation Program for use in all children as a single dose at 18 months of age and in a school-based catch-up program at 10-13 years of age. Recent hospitalization data from Australia show a decline in varicella hospitalizations in children 1-4 years of age, most likely related to vaccination. In New Zealand, varicella vaccine has been available since 1999 but is currently not recommended or funded on the New Zealand national immunization schedule. The anticipated licensure of combination measles-mumps-rubella-varicella vaccines in both countries may lead to future schedule changes.

A new challenge for Europe: introducing a pediatric quadrivalent vaccine for measles, mumps, rubella, and varicella

BACKGROUND

Varicella is often considered to be a benign disease of childhood. In fact, varicella is associated with serious complications and mortality even among healthy individuals.

DISCUSSION

Although the course of varicella can be uncomplicated, it can also be associated with serious complications such as pneumonia, fluid and electrolyte disturbances, skin and soft tissue infections and central nervous system disturbances. Worldwide studies have confirmed the high frequency of disease as well as the resultant morbidity, mortality and medical resource use. A quadrivalent vaccine is now available in certain countries to protect against measles, mumps, rubella and varicella (MMRV). Countries that have initiated routine vaccination pro- grams have reported substantial reductions in morbidity and mortality as well as improved health outcomes. The MMRV vaccine facilitates coverage against all four diseases, and would be expected to improve compliance as well as coverage of varicella.

CONCLUSIONS

Universal vaccination programs with MMRV should be considered as a way to reduce the medical and economic impact of varicella. The MMRV vaccine provides a means to achieve universal coverage.

A cross-sectional survey to assess community attitudes to introduction of Human Papillomavirus vaccine

OBJECTIVE

A vaccine to prevent human papilloma virus (HPV) infection has been licensed recently in the United States of America and Australia. The aim of this study was to assess community attitudes to the introduction of HPV vaccine in the State of South Australia.

METHODS

A cross-sectional survey was conducted by computer-aided telephone interviews in February 2006. The survey assessed adult and parental attitudes to the introduction of HPV vaccine to provide protection against a sexually transmitted disease caused by HPV and against cervical cancer. Two thousand interviews were conducted in metropolitan and rural households.

RESULTS

Two per cent of respondents knew that persistent HPV infection caused cervical cancer and a further 7% were aware that the cause was viral. The majority of adults interviewed (83%) considered that both men and women should receive HPV vaccine and 77% of parents agreed that they would have their child/children immunised. Parents were mainly concerned about possible side effects of the vaccine (66%), with only 0.2% being concerned about discussing a sexually transmitted disease with their children and 5% being concerned that use of the vaccine may lead to promiscuity.

IMPLICATIONS

Our findings suggest that public health education campaigns for HPV vaccination will find a majority of parents receptive to their children being vaccinated, but attention must be paid to appropriate explanation about HPV infection as the cause of cervical cancer and education about the safety of the HPV vaccine.

Factors underlying suboptimal childhood immunisation

This review considers possible reasons behind parents' missed vaccination opportunities in the context of the latest immunisation coverage rates for England. Suboptimal uptake is not exclusive to measles, mumps and rubella (MMR). A substantial proportion of children also miss diphtheria, tetanus and polio vaccination. For MMR and diphtheria, tetanus and polio, uptake of primary plus booster immunisation is lower than for the primary course alone. Several reasons for suboptimal uptake are identified from the international literature. These provide insights into parental decision-making and potential barriers to immunisation that may need to be addressed in efforts to improve coverage rates.