Parental decision-making for the varicella vaccine

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.

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.

Knowledge, Attitude and Practice of Pregnant Women towards Varicella and Their Children's Varicella Vaccination: Evidence from Three Distrcits in Zhejiang Province, China

Background: The objectives of this study were to examine the knowledge, attitudes and practice (KAP) towards varicella and varicella vaccine (VarV) vaccination among pregnant women in three distrcits in Zhejiang Province, China. Methods: From 1 January to 31 March 2014, pregnant women with ≥12 gestational weeks were recruited and received a self-administrated questionnaire. The first dose of VarV (VarV1) vaccination status of children from present pregnancy was extracted at 24 months of age from Zhejiang provincial immunization information system (ZJIIS). Three variables was defined as the main outcomes, which included: (1) knowing about both the availability of VarV and the number of doses required; (2) positive attitude towards the utility of varicella vaccination; (3) the vaccination coverage of VarV1, which meant the proportion of children having received the VarV1. Counts and proportions were used to describe the socio-demographic characteristics of study participants, and their relationship with study outcomes were tested using chi-square tests in univariate analysis and logistic regression in multivariable analysis. Results: A total of 629 pregnant women participated in this study. The majority of the participants (68.0%) answered correctly about the transmission route of varicella. The proportion of participants who heard about varicella vaccination was 76.5% and 66.8% knew that VarV was currently available. Only 13.5% of the participants answered correctly that the complete VarV series needed two doses. Age, immigration status, education level, household income, and number of children of the pregnant women were significant predictors of the KAP regarding the VarV vaccination. Conclusions: The current survey indicated that optimal KAP levels and coverage on VarV vaccination were observed in three districts of Zhejiang Province. Health education programs on varicella and VarV vaccination directed towards both pre-natal and post-natal women are needed, which will result in a better attitude on vaccination of VarV and in a high coverage of VarV.

Knowledge, attitudes, and behaviors of parents towards varicella and its vaccination

BACKGROUND

The aims of this cross-sectional survey were to examine the knowledge, the attitudes, and the behavior regarding the varicella infection and its vaccination and to get insight into their determinants among parents of children in Italy.

METHODS

From May to June 2015 in the geographic area of Naples (Italy) a random sample of 675 parents of children aged 4-7 years received a self-administered anonymous questionnaire about socio-demographic characteristics, knowledge, attitudes, and behaviors towards varicella and its vaccination.

RESULTS

A total of 414 parents responded to the questionnaire, for a response rate of 61.3%. A history of varicella was reported in 163 children (39.6%). Only 26.6% parents knew that the vaccine was available and the number of doses and this knowledge was significantly higher in those who had a university degree, in those who had received information on the vaccination from a health care provider, and in those who had vaccinated their child. The perceived utility towards vaccination had a mean value of 5.7. The positive attitude towards the utility of the vaccination was higher in parents with a level of education not higher than middle school, in those who had vaccinated their child, in those who considered the varicella a dangerous disease, and in those who had received information from a health care provider. More than one-third had vaccinated their child. Immunization was more frequent in parents who had knowledge about the vaccination, who beliefs that the immunization was useful, who believed that the disease was not dangerous, and who had not a history of varicella among their children.

CONCLUSIONS

Educational programs are needed among parents as support to improve knowledge about vaccination and immunization coverage.

Parents' attitudes and behaviours towards recommended vaccinations in Sicily, Italy

Background

Since a long time, Italy has maintained a dual system to administer childhood immunisations, that is a certain number of mandatory vaccinations and a number of recommended vaccinations. The study aimed to explore the issues surrounding parental acceptance or non-acceptance of the recommended vaccinations for children.

Methods

Parents of children aged 3-5 years of day-care centres in Sicily were asked to fill out an anonymous questionnaire. Determinants of the attitude towards recommended vaccinations and social influence on the decision-making process were assessed using logistic regression analysis.

Results

Of the 1,500 selected parents, 81.0% participated in the study. Prior to the survey, the majority of children (97.6%) received recommended vaccines. Most parents (74.4%) received information about vaccinations from Family Paediatricians, showed a good knowledge about the side effects of the vaccines (73.1%), did not worry about their potential dangerousness (53.0%) and would have accepted their children to be vaccinated even if it was not required for day care (84.1%). The majority (79.9%) were not disposed to follow the advises of the anti-vaccination movements. Parents' background characteristics, sources of information and social influence were not significantly associated with parental acceptance of recommended vaccines for childhood.

Conclusions

This study suggests that health information by Family Paediatricians is significantly associated with parental acceptance of recommended vaccinations.

Predictive and Reactive Distribution of Vaccines and Antivirals during Cross-Regional Pandemic Outbreaks

As recently pointed out by the Institute of Medicine, the existing pandemic mitigation models lack the dynamic decision support capability. We develop a large-scale simulation-driven optimization model for generating dynamic predictive distribution of vaccines and antivirals over a network of regional pandemic outbreaks. The model incorporates measures of morbidity, mortality, and social distancing, translated into the cost of lost productivity and medical expenses. The performance of the strategy is compared to that of the reactive myopic policy, using a sample outbreak in Fla, USA, with an affected population of over four millions. The comparison is implemented at different levels of vaccine and antiviral availability and administration capacity. Sensitivity analysis is performed to assess the impact of variability of some critical factors on policy performance. The model is intended to support public health policy making for effective distribution of limited mitigation resources.

Two resource distribution strategies for dynamic mitigation of influenza pandemics

As recently pointed out by the Institute of Medicine, the existing pandemic containment and mitigation models lack the dynamic decision support capabilities. We present two simulation-based optimization models for developing dynamic predictive resource distribution strategies for cross-regional pandemic outbreaks. In both models, the underlying simulation mimics the disease and population dynamics of the affected regions. The quantity-based optimization model generates a progressive allocation of limited quantities of mitigation resources, including vaccines, antiviral, administration capacities, and social distancing enforcement resources. The budget-based optimization model strives instead allocating a total resource budget. Both models seek to minimize the impact of ongoing outbreaks and the expected impact of potential outbreaks. The models incorporate measures of morbidity, mortality, and social distancing, translated into the societal and economic costs of lost productivity and medical expenses. The models were calibrated using historic pandemic data and implemented on a sample outbreak in Florida, with over four million inhabitants. The quantity-based model was found to be inferior to the budget-based model, which was advantageous in its ability to balance the varying relative cost and effectiveness of individual resources. The models are intended to assist public health policy makers in developing effective distribution policies for mitigation of influenza pandemics.

A systematic review of decision support needs of parents making child health decisions

OBJECTIVE

To identify the decision support needs of parents attempting to make an informed health decision on behalf of a child.

CONTEXT

The first step towards implementing patient decision support is to assess patients' information and decision-making needs.

SEARCH STRATEGY

A systematic search of key bibliographic databases for decision support studies was performed in 2005. Reference lists of relevant review articles and key authors were searched. Three relevant journals were hand searched.

INCLUSION CRITERIA

Non-intervention studies containing data on decision support needs of parents making child health decisions.

DATA EXTRACTION AND SYNTHESIS

Data were extracted on study characteristics, decision focus and decision support needs. Studies were quality assessed using a pre-defined set of criteria. Data synthesis used the UK Evidence for Policy and Practice Information and Co-ordinating Centre approach.

MAIN RESULTS

One-hundred and forty nine studies were included across various child health decisions, settings and study designs. Thematic analysis of decision support needs indicated three key issues: (i) information (including suggestions about the content, delivery, source, timing); (ii) talking to others (including concerns about pressure from others); and (iii) feeling a sense of control over the process that could be influenced by emotionally charged decisions, the consultation process, and structural or service barriers. These were consistent across decision type, study design and whether or not the study focused on informed decision making.

Effects of maternal and provider characteristics on up-to-date immunization status of children aged 19 to 35 months

OBJECTIVES

We examined the effects of maternal and provider characteristics on the up-to-date immunization status of children.

METHODS

We used data from the 2003 National Immunization Survey to determine variations in children's up-to-date status in the 4:3:1:3 immunization series.

RESULTS

Low maternal educational levels and low socioeconomic status were associated with high 4:3:1:3 series completion rates. Also, completion rates were high in Hispanic and non-Hispanic Black families with low income-to-poverty ratios.

CONCLUSIONS

We found that children of less educated mothers and children in Hispanic and non-Hispanic Black families with low income-to-poverty ratios were more likely to have completed the 4:3:1:3 series. Although the reasons for these results need further exploration in other data sets, possible factors are Hispanics' positive cultural attitudes regarding the needs and importance of young children and provision of information on immunizations to low-income minority mothers who access government-subsidized health care programs.

Immediate and longer term impact of the varicella shortage on children 18 and 24 months of age in a community population

BACKGROUND

Little is known about the impact of the recent varicella vaccine shortage. To assess the temporal trend in varicella vaccine administration before 18 and 24 months of age in a community cohort of children prior to, during and after the recent varicella vaccine shortage. And to compare the temporal trends in varicella vaccinations to trends of an older, more widely accepted vaccine, the MMR.

METHODS

Community population-based birth cohorts were identified who were eligible for the varicella vaccination before, during and after the 2001 to 2002 varicella vaccine shortage. Only children (84% of all) who remained in the community through their second birthday were included. For each child in the cohort, the medical records and immunization registry records from both medical facilities in the county were reviewed to identify the dates and sites for all varicella immunizations given. In addition to varicella immunizations, the dates of all MMR vaccinations were recorded. Additional data abstracted included the child's birth date, gender and dates of any recognized cases of chickenpox up through age 24 months.

RESULTS

Of the 2,512 children in the birth cohorts, 50.8% were boys. In the three cohorts combined, 81.1% of the boys and 79.3% of the girls (p = 0.30) received the varicella vaccine by age 24 months. The pre-shortage community rate of varicella immunization was 79.7% by 24 months of age. During the varicella vaccine shortage, the rate of varicella immunization by 24 months fell to 77.2%. Only 6 additional children received a "catch-up" immunization by 36 months of age. In the post shortage period the community 24-month immunization rate rebounded to a level higher than the pre-shortage rate 84.0%. During the almost three years of observation, the MMR immunization rate by age 24 months was constant (87%).

CONCLUSION

The varicella shortage was associated with an immediate drop in the 24-month varicella immunizations rate but rebounded quickly to above pre-shortage rates. In this community the only long term impact of the varicella vaccine shortage may be on the small number of children who still had not received catch-up varicella immunizations by 36 months of age.