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Hijazi R, Gesser-Edelsburg A, Mesch GS. Vaccine communication strategies among healthcare workers as a reflection of the Israeli Ministry of Health's communication strategies before and after the COVID-19 pandemic. Front Public Health 2024; 12:1377393. [PMID: 38846621 PMCID: PMC11153784 DOI: 10.3389/fpubh.2024.1377393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Background Healthcare workers play a central role in communicating information to the public regarding vaccines. Most of the literature has focused on healthcare workers' hesitancy and doubts about getting the flu vaccine themselves. However, few studies have dealt with how they perceive their role in communicating information regarding vaccines, especially following the COVID-19 pandemic. Objectives (1) To identify the communication strategies used by the Israeli Ministry of Health regarding vaccines during epidemic crises (before and after the COVID-19 pandemic); (2) To identify the communication strategies used by healthcare workers regarding vaccines before and after the COVID-19 pandemic. Methods A qualitative study based on in-depth interviews was conducted among healthcare workers and used a semi-structured protocol as a research tool. A total of 18 healthcare workers were sampled using purposeful and snowball sampling. Results Despite healthcare workers' perception that there has been a decrease in trust in the Israeli Ministry of Health among the public following the COVID-19 outbreak, they still rely on the Israeli Ministry of Health as their primary source of information and use the same communication strategies (such as fear appeals and correcting information) as of the Israeli Ministry of Health to communicate with the public, healthcare providers, and other relevant stakeholders. Conclusion Healthcare workers have been shaped by the professional socialization processes within the health system, leading to a predominant reliance on established communication strategies and informational channels. This reliance underscores the importance of evolving these methods to better engage with the public. To address this, there is a compelling need to innovate and adopt new communication techniques that emphasize effective dialogue and transparent interactions. By doing so, healthcare professionals can ensure that their outreach is not only informative but also responsive to the diverse needs and preferences of the community.
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Affiliation(s)
- Rana Hijazi
- The Health and Risk Communication Lab, School of Public Health, University of Haifa, Haifa, Israel
| | - Anat Gesser-Edelsburg
- The Health and Risk Communication Lab, School of Public Health, University of Haifa, Haifa, Israel
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Kobashi Y, Yoshida M, Saito H, Yoshimura H, Nonaka S, Yamamoto C, Zhao T, Tsubokura M. Understanding Reasons for Vaccination Hesitancy and Implementing Effective Countermeasures: An Online Survey of Individuals Unvaccinated against COVID-19. Vaccines (Basel) 2024; 12:499. [PMID: 38793750 PMCID: PMC11125705 DOI: 10.3390/vaccines12050499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
This online survey of unvaccinated people living in Japan aimed to identify the reasons for declining vaccination and to develop effective countermeasures. We conducted a hierarchical class analysis to classify participants, examine factors influencing their classification, and provide the information they needed about coronavirus disease 2019 (COVID-19) and trusted sources of COVID-19 information for each group. A total of 262 participants were classified into three groups: Group 1 with no specific reason (28 participants, 10.69%); Group 2 with clear concerns about trust in the vaccine (85 participants, 32.44%), and Group 3 with attitudinal barriers, such as distrust of the vaccine and complacency towards COVID-19, and structural barriers, such as vaccination appointments (149 participants, 56.87%). For each group, females tended to be classified in Group 2 more than Group 1 (Odds ratio (OR) [95% confidential intervals (95%CI)] = 1.64 (0.63 to 2.66), p = 0.001) and in Group 3 more than Group 1 (OR [95%CI] = 1.16 (0.19 to 2.12), p = 0.019). The information that the participants wanted to know about COVID-19 was different among each group (Safety: p < 0.001, Efficacy: p < 0.001, Genetic effects: p < 0.001). Those who did not receive the COVID-19 vaccine also had lower influenza vaccination coverage (8.02%). Additionally, 38 participants (14.50%) were subject to social disadvantages because they had not received the COVID-19 vaccine. Countermeasures should be carefully tailored according to the target population, reasons for hesitancy, and specific context. The findings of this study may help develop individualized countermeasures to address vaccine hesitancy.
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Affiliation(s)
- Yurie Kobashi
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Fukushima 960-1295, Japan; (Y.K.); (M.Y.); (H.S.); (H.Y.); (C.Y.); (T.Z.)
- Department of Internal Medicine, Serireikai Group Hirata Central Hospital, Ishikawa Country, Fukushima 963-8202, Japan
| | - Makoto Yoshida
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Fukushima 960-1295, Japan; (Y.K.); (M.Y.); (H.S.); (H.Y.); (C.Y.); (T.Z.)
- Faculty of Medicine, Teikyo University School of Medicine, Itabashi-ku, Tokyo 173-8605, Japan
| | - Hiroaki Saito
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Fukushima 960-1295, Japan; (Y.K.); (M.Y.); (H.S.); (H.Y.); (C.Y.); (T.Z.)
- Department of Internal Medicine, Soma Central Hospital, Soma, Fukushima 976-0016, Japan
| | - Hiroki Yoshimura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Fukushima 960-1295, Japan; (Y.K.); (M.Y.); (H.S.); (H.Y.); (C.Y.); (T.Z.)
- School of Medicine, Hiroshima University, Hiroshima 739-8511, Japan
| | - Saori Nonaka
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Fukushima 960-1295, Japan; (Y.K.); (M.Y.); (H.S.); (H.Y.); (C.Y.); (T.Z.)
| | - Chika Yamamoto
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Fukushima 960-1295, Japan; (Y.K.); (M.Y.); (H.S.); (H.Y.); (C.Y.); (T.Z.)
| | - Tianchen Zhao
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Fukushima 960-1295, Japan; (Y.K.); (M.Y.); (H.S.); (H.Y.); (C.Y.); (T.Z.)
| | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Fukushima 960-1295, Japan; (Y.K.); (M.Y.); (H.S.); (H.Y.); (C.Y.); (T.Z.)
- Department of Internal Medicine, Serireikai Group Hirata Central Hospital, Ishikawa Country, Fukushima 963-8202, Japan
- Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima 975-0033, Japan
- General Incorporated Association for Comprehensive Disaster Health Management Research Institute, Minato-ku, Tokyo 108-0074, Japan
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Azhar S, Rashid L, Islam T, Akhtar S, Hopkins KL, Sommers T, Ikram A, Anwer N, Maqbool NA, Khan Z, Ahmed N, Akhtar H. Knowledge, attitudes, and practices of vaccinators about expanded programs on immunization: a cross-sectional study. Front Public Health 2024; 12:1366378. [PMID: 38510352 PMCID: PMC10953913 DOI: 10.3389/fpubh.2024.1366378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/16/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction The periodic evaluation of knowledge, attitudes, and practices (KAP) of healthcare workers, including vaccinators, concerning expanded programs on immunization (EPI) is very crucial for a better healthcare system. This study was carried out to assess the KAP of vaccinators about the EPI, including cold storage of vaccines and their practices related to vaccine cold chain management. Method A cross-sectional study was conducted from January 2022 to June 2022 among registered vaccinators in the twin cities (Islamabad and Rawalpindi) of Pakistan. A structured self-administered questionnaire (English and Urdu) was developed as per the Pakistan national EPI policy and strategic guidelines 2022 and World Health Organization (WHO) guidelines, as well as from earlier studies (Cronbach's alpha value of 0.734). The final questionnaire consisted of closed-ended questions in four sections, including sociodemographic information, knowledge (with dichotomous variables of yes/no), attitudes (with a 5-point Likert scale ranging from strongly agree to strongly disagree), and handling of vaccines and cold chain management. Completed questionnaires were entered into Microsoft Excel and then imported into SPSS version 25 for statistical analysis. Results A total of 186 vaccinators completely filled out their questionnaires, with a 97.9% response rate. More than half of the participants (57.5%) had no training related to EPI. Most of the respondents had a moderate to poor level of knowledge regarding EPI. The overall attitude was positive, and 57% of the participants strongly agreed that the national immunization programs can significantly contribute to the decrease in morbidity and mortality rates among children. In the current study, participants showed good practices toward EPI, vaccine storage, and cold chain management. The majority (93.5%) of the participants checked the expiry of vaccines at regular intervals to maintain the first expiry first out (FEFO) in their healthcare setting. Discussion In conclusion, most of the vaccinators had moderate to poor knowledge, a positive attitude, and good practices toward EPI, vaccine cold storage, and cold chain management. Lack of training among vaccinators on EPI was also observed. These findings have suggested that continuous training, education, and regular supervision of vaccinators in EPI are important for maximum immunization effectiveness and coverage.
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Affiliation(s)
- Sunia Azhar
- Yusra Institute of Pharmaceutical Sciences, Islamabad, Pakistan
| | - Laiba Rashid
- Yusra Institute of Pharmaceutical Sciences, Islamabad, Pakistan
| | - Taskeen Islam
- Communication and Media Studies, Fatima Jinnah Women University, Rawalpindi, Pakistan
| | - Samar Akhtar
- Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental College, Zaraj Housing Society, Islamabad, Pakistan
| | | | | | - Aamer Ikram
- Armed Forces Institute of Pathology, Rawalpindi, Pakistan
| | - Naveed Anwer
- Department of Pharmacy, Quaid.i.Azam University, Islamabad, Pakistan
| | - Nabeel Ahmed Maqbool
- Vaccines Preventable Infectious Diseases, Chemonics International Global Health Supply Chain – Procurement and Supply, Management (GHSC-PSM) Project, Islamabad, Pakistan
| | - Zakir Khan
- Department of Pharmacy Practice, Riphah Institute of Pharmaceutical Sciences (RIPS), Riphah International University Gulberg Green Campus, Islamabad, Pakistan
| | - Naveed Ahmed
- Department of Pharmacy, Quaid.i.Azam University, Islamabad, Pakistan
| | - Hashaam Akhtar
- Yusra Institute of Pharmaceutical Sciences, Islamabad, Pakistan
- Department of Global Health, Health Services Academy, Chak Shahzad, Islamabad, Pakistan
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Mudhune V, Ondeng’e K, Otieno F, Otieno DB, Bulinda CM, Okpe I, Nabia S, Bar-Zeev N, Otieno O, Wonodi C. Determinants of COVID-19 Vaccine Acceptability among Healthcare Workers in Kenya-A Mixed Methods Analysis. Vaccines (Basel) 2023; 11:1290. [PMID: 37631858 PMCID: PMC10459762 DOI: 10.3390/vaccines11081290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 08/27/2023] Open
Abstract
Healthcare workers (HCWs) were a priority group for COVID-19 vaccination. Adopting the World Health Organization's 3C and the expanded 5C vaccine hesitancy models, we assessed the factors associated with COVID-19 vaccine acceptability among HCWs in Kenya. In a mixed methods study, respondents were from eight selected counties across the country. An online survey (n = 746), key informant interviews (n = 18) and focus group discussions (n = 3) were conducted. The data were analyzed concurrently. Quantitative data showed that all the 3C antecedents were strong predictors of vaccine acceptability. The association of vaccine acceptability was strongest with convenience (aOR 20.13, 95% CI 9.01-44.96), then complacency (aOR 10.15, 95% CI 4.63-22.21) and confidence (aOR 6.37, 95% CI 2.90-14.02). Marital status was a significant independent factor associated with vaccine acceptability (aOR 2.70, 95% CI 1.20-6.08). Qualitatively, convenience presented as the no-cost availability of vaccines at the health facilities, whereas non-complacency manifested from the first-hand observed experience of COVID cases, and the need to protect oneself and family members. Confidence was mainly attributed to increased knowledge, resulting from multiple training sessions and trust in regulatory authorities. Other social factors including workplace pressure, religion and misinformation had a role in influencing HCW vaccination decisions. In the background of a pandemic, the 3C model is a strong predictor of vaccine acceptability, and making the vaccines easily available and convenient to HCWs significantly impacts their uptake.
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Affiliation(s)
- Victor Mudhune
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu P.O. Box 1578-40100, Kenya;
| | - Ken Ondeng’e
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu P.O. Box 1578-40100, Kenya;
| | - Fanuel Otieno
- Capacities for Health and Social Policy, Nairobi P.O. Box 32175-00800, Kenya; (F.O.); (D.B.O.); (C.M.B.); (O.O.)
| | - Derick B. Otieno
- Capacities for Health and Social Policy, Nairobi P.O. Box 32175-00800, Kenya; (F.O.); (D.B.O.); (C.M.B.); (O.O.)
| | - Collins M. Bulinda
- Capacities for Health and Social Policy, Nairobi P.O. Box 32175-00800, Kenya; (F.O.); (D.B.O.); (C.M.B.); (O.O.)
| | | | - Sarah Nabia
- International Vaccine Access Center, Johns Hopkins University, Baltimore, MD 21231, USA; (S.N.); (C.W.)
| | - Naor Bar-Zeev
- International Vaccine Access Center, Johns Hopkins University, Baltimore, MD 21231, USA; (S.N.); (C.W.)
| | - Omondi Otieno
- Capacities for Health and Social Policy, Nairobi P.O. Box 32175-00800, Kenya; (F.O.); (D.B.O.); (C.M.B.); (O.O.)
| | - Chizoba Wonodi
- International Vaccine Access Center, Johns Hopkins University, Baltimore, MD 21231, USA; (S.N.); (C.W.)
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Varbanova V, Verelst F, Hens N, Beutels P. Determinants of basic childhood vaccination coverage in European and OECD countries. Hum Vaccin Immunother 2022; 18:2123883. [PMID: 36173818 DOI: 10.1080/21645515.2022.2123883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Vaccination coverage varies between countries and over time. Using official databases, we extracted data on 50 national-level immunization, socio-economic, demographic, healthcare, and cultural factors, and the uptake of the third dose of diphtheria toxoid, tetanus toxoid, and pertussis vaccines (DTP3) and the first dose of measles-containing vaccines (MCV1) for 61 countries between 1990 and 2019. The main branch of the analysis included all covariates, while a secondary branch excluded life-expectancy and child mortality. The statistical analysis was completed in three stages: a variable-selection stage via random forests; multilevel multiple imputation for missing data in the reduced dataset; and generalized estimating equations (GEE) over all imputed datasets with pooled results. Less than 20 covariates were retained after variable-selection. Among a relatively small number of statistically significant (p-value <.05) effects in the pooled GEE results of our main branch, under-5 mortality and long-term orientation culture showed negative associations with both uptake outcomes and GDP per capita a positive association. For MCV1, whether a second dose was integrated into routine immunization appeared as the overall strongest negative correlate. In the secondary analytical branch, results were largely consistent, with a few additional statistically significant effects emerging, mainly related to immunization and healthcare system characteristics. These insights improve our understanding of the main factors influencing vaccine uptake, some of which are broadly contextual (e.g., GDP, socio-cultural factors), requiring bespoke vaccine program approaches, in order to maximize childhood vaccine uptake over time.
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Affiliation(s)
- Vladimira Varbanova
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Frederik Verelst
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Niel Hens
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.,Center for Statistics (CenStat, Interuniversity Institute of Biostatistics and statistical Bioinformatics (I-BioStat) and Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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Bester JC. A Clinician's Obligation to be Vaccinated: Four Arguments that Establish a Duty for Healthcare Professionals to be Vaccinated Against COVID-19. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:451-465. [PMID: 35362931 PMCID: PMC8972764 DOI: 10.1007/s11673-022-10182-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/11/2022] [Indexed: 05/14/2023]
Abstract
This paper defends four lines of argument that establish an ethical obligation for clinicians to be vaccinated against COVID-19. They are:(1) The obligation to protect patients against COVID-19 spread;(2) The obligation to maintain professional competence and remain available for patients;(3) Clinicians' role and place in society in relation to COVID-19;(4) The obligation to encourage societal vaccination uptake.These arguments stand up well against potential objections and provide a compelling case to consider acceptance of COVID-19 vaccination a duty for all clinicians. This duty brings with it the implication that vaccine refusal amounts to a dereliction of the professional's ethical obligations, which means such clinicians should be subject to disciplinary action. Furthermore, this duty provides grounding for mandatory vaccination policies for clinicians.
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Affiliation(s)
- Johan Christiaan Bester
- Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas 2040 W Charleston Blvd, Las Vegas, NV, 89102, USA.
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7
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Design and implementation of tailored intervention to increase vaccine acceptance in a Somali community in Stockholm, Sweden - based on the Tailoring Immunization Programmes approach. PUBLIC HEALTH IN PRACTICE 2022; 4:100305. [PMID: 36570400 PMCID: PMC9773050 DOI: 10.1016/j.puhip.2022.100305] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives Sweden has had a high and stable vaccination coverage for measles-mumps-rubella (MMR) vaccine (>96%) through the national immunization program (NIP), but coverage rates highlight local pockets of lower vaccination coverage. This project addressed low MMR vaccine acceptance among parents in a Somali community, in Stockholm. The objective of the intervention was to increase vaccine confidence and MMR-vaccine uptake and also to inform practices addressing vaccine acceptance. Study design This paper describes the design and implementation of a multi-component intervention based on the Tailoring Immunization Programmes (TIP) approach, developed by the WHO European Regional Office. Methods The theoretical underpinning of TIP is the Capability, Opportunity, and Motivation Model (COM-B model) and Behaviour Change Wheel framework (BCW), adapted for vaccination. The COM-model was used to identify barriers and drivers to vaccination and intervention types. The TIP-phases described in this paper are: pre-TIP (planning), three succeeding TIP phases (situational analysis, formative research, intervention design) and the post-TIP phase (implementation). Results The situation analysis and formative research revealed that parents feared the MMR vaccine due to autism or that their child would stop talking following vaccination, despite lack of scientific evidence for an association between autism and MMR vaccines. Barriers were linked to their associated COM-B factors and mapped to appropriate intervention types for two target groups: Somali parents and nurses at the Child Health Centres (CHC). Selected intervention types targeting parents were education, persuasion and modelling whereas education and training were selected for CHC nurses. The intervention activities included community engagement for parents, while the activities for nurses focused on improving encounters and dialogue with parents having low vaccine acceptance. Following the intervention design the activities were developed, pilot tested and implemented. Conclusion This study confirm that the TIP approach is valuable for guiding a stepwise working process for a thorough understanding of barriers and drivers for MMR vaccination among parents in this Somali community. It facilitated the design of a theory and evidence-informed intervention targeting parents and nurses.
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Redondo Margüello E, Trilla A, Munguira ILB, Jaramillo López-Herce A, Cotarelo Suárez M. Knowledge, attitudes, beliefs and barriers of healthcare professionals and adults ≥ 65 years about vaccine-preventable diseases in Spain: the ADult Vaccination drIverS and barriErs (ADVISE) study. Hum Vaccin Immunother 2022; 18:2025007. [PMID: 35172691 PMCID: PMC8993072 DOI: 10.1080/21645515.2021.2025007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Since 2018, Spanish National Immunization Guidelines include vaccination recommendations for adults ≥65 years. To determine whether health-care professionals and the ≥65 years target group value the need for these recommendations, a cross-sectional study was conducted to capture and describe their knowledge, attitudes, beliefs and behaviors about vaccination. Online surveys were administered to representative groups of general practitioners (GPs), primary care nurses and adults ≥65 years from six major cities (and surrounding rural areas) in Spain. Main topics were attitudes and awareness of vaccines, perceptions about vaccination in adults ≥65 years, and impact of the COVID-19 pandemic on vaccination uptake. A total of 286 health-care professionals (185 GPs, 101 nurses) and 400 adults aged ≥65 years participated in the survey. GP and nurse groups agreed strongly about the importance of influenza and pneumococcal vaccination in the target population. Longer patient visit times were identified as a key factor toward promoting vaccination. The ≥65 years sample group, especially those ≥75+ years and/or with chronic diseases, was reasonably positive about the effectiveness and benefits of vaccines. Lower vaccination rates for the pneumococcal than influenza vaccine (29% vs. 80%) in the ≥65 years sample group suggest that efforts are needed to improve pneumococcal vaccine uptake. Aligning with other published works, GPs have a key role in promoting vaccination in the target population. The COVID-19 pandemic appears to have heightened awareness about the importance of vaccination among health-care professionals and adults ≥65 years.
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Affiliation(s)
| | - Antoni Trilla
- Servicio de Medicina Preventiva del Hospital Clinic de Barcelona, Barcelona, Spain
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Lehner L, Gribi J, Hoffmann K, Paul KT, Kutalek R. Beyond the "information deficit model" - understanding vaccine-hesitant attitudes of midwives in Austria: a qualitative study. BMC Public Health 2021; 21:1671. [PMID: 34521378 PMCID: PMC8442326 DOI: 10.1186/s12889-021-11710-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/29/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Healthcare workers are considered key stakeholders in efforts to address vaccine hesitancy. Midwives' influence in advising expectant parents on early-childhood vaccinations is unquestioned, yet they remain an understudied group. The literature on midwives' attitudes towards vaccinations is also inconclusive. We therefore conducted an explorative qualitative study on midwives' vaccine-hesitant attitudes towards MMR (measles-mumps-rubella) vaccinations in Austria. METHODS We conducted 12 in-depth interviews on their knowledge, concerns, and beliefs with midwives who self-identified as hesitant or resistant towards early-childhood MMR vaccinations. We analyzed the data using a grounded theory approach to distill common themes and meanings. RESULTS Healthcare workers' stewardship to address vaccine hesitancy is commonly framed in terms of the "information deficit model": disseminate the right information and remedy publics' information deficits. Our findings suggest that this approach is too simplistic: Midwives' professional self-understanding, their notions of "good care" and "good parenthood" inflect how they engage with vaccine information and how they address it to their clients. Midwives' model of care prioritized good counseling rather than sharing scientific information in a "right the wrong"-manner. They saw themselves as critical consumers of that information and as promoting "empowered patients" who were free, and affluent enough, to make their own choices about vaccinations. In so doing, they also often promoted traditional notions of motherhood. CONCLUSIONS Research shows that, for parents, vaccine decision-making builds on trust and dialogue with healthcare professionals and is more than a technical issue. In order to foster these interactions, understanding healthcare professionals' means of engaging with information is key to understanding how they engage with their constituents. Healthcare workers are more than neutral resources; their daily praxis influenced by their professional standing in the healthcare system. Similarly, healthcare professionals' views on vaccinations cannot be remedied with more information either. Building better and more diverse curricula for different groups of healthcare workers must attend to their respective roles, ethics of care, and professional beliefs. Taken together, better models for addressing vaccine hesitancy can only be developed by espousing a multi-faceted view of decision-making processes and interactions of healthcare workers with constituents.
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Affiliation(s)
- Lisa Lehner
- grid.22937.3d0000 0000 9259 8492Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria ,grid.5386.8000000041936877XPresent Address: Department of Science & Technology Studies, Cornell University, Ithaca, New York USA ,grid.511277.7Konrad Lorenz Institute for Evolution and Cognition Research (KLI), Klosterneuburg, Austria
| | - Janna Gribi
- grid.22937.3d0000 0000 9259 8492Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Kathryn Hoffmann
- grid.22937.3d0000 0000 9259 8492Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Katharina T. Paul
- grid.10420.370000 0001 2286 1424Department of Political Science, Faculty of Social Sciences, University of Vienna, Vienna, Austria
| | - Ruth Kutalek
- grid.22937.3d0000 0000 9259 8492Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
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Trifunović V, Bach Habersaat K, Tepavčević DK, Jovanović V, Kanazir M, Lončarević G, Jackson C. Understanding vaccination communication between health workers and parents: a Tailoring Immunization Programmes (TIP) qualitative study in Serbia. Hum Vaccin Immunother 2021; 18:1913962. [PMID: 34033519 PMCID: PMC8920238 DOI: 10.1080/21645515.2021.1913962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Vaccine communication between health workers and parents affects parental acceptance, so understanding this is particularly important when vaccination rates drop. This paper presents the findings of a qualitative research study conducted in Serbia as part of a Tailoring Immunization Programmes (TIP) project. The aims were to explore the process of vaccination communication between health workers and parents (accepting, indecisive, delaying, refusing), and identify barriers and drivers to effective communication. In-depth interviews with 14 health workers were supplemented and qualified by observations of 40 consultations, using thematic analysis. Study sites were two community health centers in two Belgrade municipalities where a significant drop in childhood vaccination rates had occurred. Key findings were: (1) communication mainly took place between pediatricians and parents, while nurses focused on administering vaccines. (2) Health workers were confident in their skills to communicate and address concerns of accepting and indecisive parents, successfully applying specific strategies. (3) When interacting with delaying and refusing parents, they sometimes agreed to delay vaccination to maintain relationships, confident that most parents would vaccinate in due course. (4) Some refusing parents asked questions grounded in a socio-political agenda regarding vaccines or vaccination. Such questions exceeded the domain of health workers' expertise, which affected the communication between them. (5) Health workers' behavior in consultations was sometimes affected by parents' (dis) trust in their recommendations about vaccination. The study revealed that health workers in Serbia require additional skills and techniques to respond to parents who refuse and wish to delay vaccination, to secure timely vaccination.
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Affiliation(s)
| | | | - Darija Kisić Tepavčević
- Institute of Epidemiology, Visegradska 26a, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Institute of Public Health of Serbia "Dr Milan Jovanović Batut", Belgrade, Serbia
| | - Verica Jovanović
- Institute of Public Health of Serbia "Dr Milan Jovanović Batut", Belgrade, Serbia
| | - Milena Kanazir
- Institute of Public Health of Serbia "Dr Milan Jovanović Batut", Belgrade, Serbia
| | - Goranka Lončarević
- Institute of Public Health of Serbia "Dr Milan Jovanović Batut", Belgrade, Serbia
| | - Cath Jackson
- Valid Research Limited, Wetherby, West Yorkshire, UK
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Yoshioka N, Deguchi M, Hagiya H, Kagita M, Tsukamoto H, Takao M, Yoshida H, Hamaguchi S, Maeda I, Hidaka Y, Tomono K. 10-Year survey on serum antibody positivity rates and titers for measles and rubella in healthcare workers; an observational study at a Japanese university hospital. J Infect Chemother 2021; 27:1295-1299. [PMID: 33910777 DOI: 10.1016/j.jiac.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND We evaluated the effect of the two-dose vaccination strategy, which has been a widely adopted as childhood routine schedule worldwide to acquire herd immunity, on healthcare workers (HCWs) in Japan. METHODS Between 2010 and 2019, antibody titers for measles and rubella were measured annually among newly employed HCWs at Osaka University Hospital, Japan, using Enzygnost® assays (Siemens Healthcare Diagnostics Co. Ltd., Marburg, Germany). The data were categorized by age to compare the antibody positivity rates and antibody titers among no-vaccine, single-dose, and two-dose groups. RESULTS Over the 10-year period, the annual antibody positivity rates for measles and rubella were 84.0%-95.3% and 90.0%-94.5%, respectively, without any particular trend. The antibody titers for measles (median [interquartile range]: 8.4 [3.9, 20] vs. 6.1 [3.5, 12]) and rubella (11 [5.5, 20] vs. 6 [3.7, 11]) were statistically lower (p < 0.001) in the two-dose generation than in the single-dose generation. DISCUSSION A shift from single-dose to two-dose vaccination did not yield an increase in antibody positivity rates for both measles and rubella among HCWs. Notably, antibody titers were significantly lower in the two-dose generation. CONCLUSION Despite several limitations, our data suggests a paradoxical vulnerability in young HCWs who received the two-dose vaccination in a view of sero-positivity rates.
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Affiliation(s)
- Nori Yoshioka
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan; Laboratory for Clinical Investigation, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Matsuo Deguchi
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hideharu Hagiya
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan; Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
| | - Masanori Kagita
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan; Laboratory for Clinical Investigation, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hiroko Tsukamoto
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan; Laboratory for Clinical Investigation, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Miyuki Takao
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan; Laboratory for Clinical Investigation, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hisao Yoshida
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Shigeto Hamaguchi
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Ikuhiro Maeda
- Laboratory for Clinical Investigation, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Yoh Hidaka
- Laboratory for Clinical Investigation, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Kazunori Tomono
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Mohammed SA, Workneh BD, kahissay MH. Knowledge, attitude and practice of vaccinators and vaccine handlers on vaccine cold chain management in public health facilities, Ethiopia: Cross-sectional study. PLoS One 2021; 16:e0247459. [PMID: 33630946 PMCID: PMC7906400 DOI: 10.1371/journal.pone.0247459] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/07/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Effective management of the vaccine cold chain system at all levels is one of the crucial factors for maintaining vaccine potency. Vaccines require more complex handling and storage requirements due to increased temperature sensitivity and complicated immunization schedules. This urges adequate knowledge, attitude, and practice. This study assessed the knowledge, attitude, and practice of vaccinators and vaccine handlers' in public health facilities. METHODOLOGY An institutional-based cross-sectional study design was used to assess the knowledge, attitude, and practice of 127 vaccinators and vaccine handlers in public health facilities of Oromia Special Zone, from September 1 to 30, 2019. Data were collected using self-administered questionnaires and a structured observation checklist. Descriptive and inferential statistics were made using the statistical package for social sciences version 20. Variables with a p-value <0.05 were taken as statistically significant. RESULT The response rate was (96.94%). Sixty-eight (53.5%; 95% CI: 46.5%, 61.4%), 58 (45.7%; 95% CI: 37.8%, 53.5%) and 62 (48.8%: 95% CI; 41.7%, 56.7%) vaccinators and vaccine handlers had satisfactory knowledge, positive attitude and good practice respectively. Receiving training on cold chain management had a statistically significant association with the level of knowledge on cold chain management (AOR = 3.04, 95% CI: 1.04-8.88). CONCLUSIONS More than half of vaccinators and vaccine handlers had satisfactory knowledge, while below half of vaccinators and vaccine handlers had a positive attitude and good practice. The determinants of knowledge in cold chain management were receiving training on cold chain management. Providing regular technical support and on the job training on vaccine cold chain management will improve the knowledge, attitude, and practice of vaccinators and vaccine handlers.
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Affiliation(s)
- Solomon Ahmed Mohammed
- Department of Pharmacy, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Birhanu Demeke Workneh
- Department of Pharmacy, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Mesfin Haile kahissay
- Department of Pharmacy, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Baccolini V, Sindoni A, Adamo G, Rosso A, Massimi A, Bella A, Filia A, Magurano F, Marzuillo C, Villari P, De Vito C. Measles among healthcare workers in Italy: is it time to act? Hum Vaccin Immunother 2020; 16:2618-2627. [PMID: 32209017 PMCID: PMC7746257 DOI: 10.1080/21645515.2020.1737458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/27/2020] [Indexed: 12/22/2022] Open
Abstract
Vaccination of healthcare workers (HCWs) against measles is strongly recommended in Europe. In this study, we examined the impact of measles on Italian HCWs by systematically and quantitatively analyzing measles cases involving HCWs over time and by identifying the epidemiological characteristics of the respective measles outbreaks. We retrieved data on measles cases from the Italian national integrated measles and rubella surveillance system from January 2013 to May 2019. Additionally, we performed a systematic review of the literature and an analysis of the measles and rubella aggregate outbreaks reporting forms from 2014 to 2018. Our review suggests that preventing measles infection among HCWs in disease outbreaks may be crucial for the elimination of measles in Italy. National policies aiming to increase HCW immunization rates are fundamental to the protection of HCWs and patients, will limit the economic impact of outbreaks on the institutions affected and will help achieve the elimination goal.
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Affiliation(s)
- Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandro Sindoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giovanna Adamo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Annalisa Rosso
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Local Health Unit Roma 2, Rome, Italy
| | - Azzurra Massimi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Antonietta Filia
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Fabio Magurano
- Department of Infectious Parasitic and Immune-mediated Diseases, National Institute of Health, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Kreidl P, Breitwieser MM, Würzner R, Borena W. 14-year-old Schoolchildren can Consent to Get Vaccinated in Tyrol, Austria: What do They know about Diseases and Vaccinations? Vaccines (Basel) 2020; 8:vaccines8040610. [PMID: 33076305 PMCID: PMC7711586 DOI: 10.3390/vaccines8040610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 01/26/2023] Open
Abstract
In Austria, consent to receiving vaccines is regulated at the federal state level and in Tyrol, children aged 14 years are allowed to consent to receiving vaccination. In August 2017, we investigated determinants associated with vaccine hesitancy, having been vaccinated against measles and human papillomavirus (HPV) and the intention to vaccinate among schoolchildren born in 2002 and 2003. Those who consider measles and HPV a severe disease had a significantly higher intention to be vaccinated (prevalence ratio (PR) of 3.5 (95% CI 1.97–6.32) for measles and a PR of 3.2 (95% CI 1.62–6.35) for HPV). One-third of the participants (32.4%; 95% CI 27.8–37.4) were not aware that they are allowed to consent to receiving vaccines. The most common trusted source reported by respondents (n = 311) was the medical doctor (80.7%; 95% CI 75.7–84.7). The main finding related to the aim of the study was that the proportion of objectors is below 4% and therefore it should still be possible to reach measles elimination for which a 95% uptake is necessary. Although the proportion of objectors is not higher compared to adults, we recommend to intensify health education to increase health literacy.
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Affiliation(s)
- Peter Kreidl
- Department for Hygiene, Microbiology and Public Health, Medical University Innsbruck, 6020 Innsbruck, Austria; (P.K.); (R.W.)
| | | | - Reinhard Würzner
- Department for Hygiene, Microbiology and Public Health, Medical University Innsbruck, 6020 Innsbruck, Austria; (P.K.); (R.W.)
| | - Wegene Borena
- Institute of Virology, Department for Hygiene, Microbiology and Public Health, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Correspondence: ; Tel.: +43-512-9003-71737
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Aparicio Rodrigo M, Ruiz Canela J, Buñuel Álvarez JC, García Vera C, Esparza Olcina MJ, Barroso Espadero D, González Rodríguez P, Juanes Toledo B, Martínez Rubio V, Ortega Páez E. Paediatricians provide higher quality care to children and adolescents in primary care: A systematic review. Acta Paediatr 2020; 109:1989-2007. [PMID: 32311805 DOI: 10.1111/apa.15324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 02/26/2020] [Accepted: 04/17/2020] [Indexed: 11/29/2022]
Abstract
AIM The number of primary care paediatricians is decreasing in Europe without a justifiable reason. We aimed to compare the clinical practice of paediatricians and family doctors attending children and adolescents in primary care. METHODS MEDLINE, Embase, CENTRAL, TRIP and Google Scholar were searched from December 2008 to February 2018. No language or study design restrictions were applied. Three reviewers assessed eligibility of the studies. Seven pairs of reviewers performed the data extraction and assessed the methodological quality independently. Discrepancies were resolved by consensus. RESULTS Fifty-four, out of 1150 studies preselected, were included. We found that paediatricians show more appropriate pharmacology prescription patterns for the illness being treated; they achieve higher vaccination rates and have better knowledge of vaccines and fewer doubts about vaccine safety; their knowledge and implementation of different screening tests are better; they prescribe psychoactive drugs more cautiously and more in line with current practice guidelines; their evaluation and treatment of obesity and lipid disorders follow criteria more consistently with current clinical practice guidelines; and they perform fewer diagnostic test, show a more suitable use of the test and request fewer referrals to specialists. CONCLUSION According to published data, in developed countries, paediatricians provide higher quality care to children than family doctors.
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16
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Vrachnaki O, Vergadi E, Ioannidou E, Galanakis E. Determinants of low uptake of vaccination against influenza, measles, and hepatitis B among healthcare professionals in Greece: a multicenter cross-sectional study. Hum Vaccin Immunother 2020; 16:2663-2669. [PMID: 32401656 DOI: 10.1080/21645515.2020.1741311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Vaccination is recommended for healthcare professionals (HCPs) to protect them against vaccine-preventable diseases (VPDs); however, uptake rates are low. This study aimed to evaluate HCPs' influenza, hepatitis B, and measles vaccine uptake in all healthcare levels in Crete, Greece. We conducted a questionnaire-based, cross-sectional multicenter study in 2018, including HCPs employed at 18 primary care centers and 3 hospitals. Overall, 2,246 HCPs responded (57.2% of the target population). The influenza vaccine uptake rate was 36.1% (810/2,246), with the annual vaccination rate at 14.8% (332/2,246) over the previous 5 years. Concurrently, the hepatitis B 3-dose vaccine uptake rate was 60.3% (1,316/2,181). Among the participating HCPs, 70.7% (1,457/2,061) had measles immunity due to previous illness (959/2,061, 46.5%), a 2-dose vaccination scheme (461/2,061, 22.4%), or serological confirmation (37/2,061, 1.8%). Vaccine uptake rates differed between groups depending on age, profession, and workplace setting. Logistic regression analysis revealed that risk factors for no influenza vaccine uptake during the previous season were younger age (≤45 years; odds ratio [OR] 1.35, 95% confidence interval [CI]: 1.08-1.66), profession other than physician (OR 2.94, 95%CI: 2.09-4.12), and working in hospitals (OR 1.39, 95%CI 1.02-1.89). Older age (>45 years) was an independent risk factor for not receiving a measles (OR 26.74, 95%CI: 17.41-41.06) or hepatitis B vaccine (OR 1.36, 95%CI 1.09-1.7). Working in primary care was an independent risk factor for not getting a hepatitis B vaccine (OR 1.52, 95%CI: 1.15-2.1). Our findings indicate that individualized and targeted interventions should be implemented to increase vaccine uptake among HCPs.
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Affiliation(s)
- Olga Vrachnaki
- Department of Paediatrics, Heraklion University Hospital , Heraklion, Greece
| | - Eleni Vergadi
- Department of Paediatrics, Heraklion University Hospital , Heraklion, Greece.,Department of Paediatrics, Medical School, University of Crete , Heraklion, Greece
| | - Eleni Ioannidou
- Department of Internal Medicine, Rethymnon General Hospital , Rethymnon, Greece
| | - Emmanouil Galanakis
- Department of Paediatrics, Heraklion University Hospital , Heraklion, Greece.,Department of Paediatrics, Medical School, University of Crete , Heraklion, Greece
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Wiot F, Shirley J, Prugnola A, Di Pasquale A, Philip R. Challenges facing vaccinators in the 21 st century: results from a focus group qualitative study. Hum Vaccin Immunother 2019; 15:2806-2815. [PMID: 31116642 PMCID: PMC6930098 DOI: 10.1080/21645515.2019.1621147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Barriers to vaccination and the important role of healthcare professionals (HCPs) in influencing immunization decisions made by parents/patients have been well documented. Little information describes challenges that HCPs face in carrying out their role as vaccinators. Methods: We conducted a focus group study asking HCPs to describe their expectations as frontline vaccinators versus the day-to-day reality they faced. Participants described challenges impacting their ability and motivation as vaccinators, and proposed key solutions to the most important challenges. A total of 75 nurses and physicians (sixteen groups of frontline vaccinators) from the United Kingdom, United States, Germany and India participated in 2 hour focus-group discussions. Results: There was disconnect between how participants viewed their role in preserving population health when they started their career, and the reality of real-world practice today. Challenges experienced and reflected were similar across professional groups and countries. Low patient-level vaccine knowledge, patient miseducation, untimely vaccine information, frequently changing vaccine schedules, time pressures, lack of centralized record systems, pressure to achieve vaccination targets, and in some instances vaccine costs, all impacted the efficiency and enthusiasm of HCPs. Identified solutions by the same providers included improving patient-level information, equipping HCPs with effective information, and practical ways to reduce the vaccination burden by improved administrative processes and centralized recording coupled with delegating vaccinator roles. Conclusion: This focus group gives unique insights into needs of HCPs to fulfill their role as vaccinators. Supporting and equipping vaccinators is critical to the continuing success of vaccination programs and the proposed life-course immunization strategy. (Supplementary Appendix 1)
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Affiliation(s)
| | | | | | | | - Roy Philip
- Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland and the University Hospital Limerick & University Maternity Hospital Limerick, Limerick, Ireland
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18
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Maurici M, Arigliani M, Dugo V, Leo C, Pettinicchio V, Arigliani R, Franco E. Empathy in vaccination counselling: a survey on the impact of a three-day residential course. Hum Vaccin Immunother 2018; 15:631-636. [PMID: 30325260 PMCID: PMC6605730 DOI: 10.1080/21645515.2018.1536587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND In an era of hesitance to use vaccines, the importance of effective communication for increasing vaccine acceptance is well known. This study aimed to assess the impact of a three-day residential course concerning empathy and counselling abilities on patients' ratings of the level of empathy of physicians and nurses working in vaccination centers. METHODS The empathy of healthcare providers was evaluated using the Adapted Consultation and Relational Empathy (CARE) Measure. The survey involved 20 healthcare workers, doctors, and nurses in three immunization services of a Local Health Unit in South Italy. Before and after attending the course, all of them administered the questionnaire to 50 consecutive parents of vaccinated children. Statistical tests were used to assess the homogeneity of pre- and post -course samples, to measure the level of empathy perceived by parents in doctors and nurses in pre- and post-course evaluations, and to compare the average CARE Measure scores among groups. RESULTS Analysis of the questionnaires showed an increase of "excellent" scores and statistically significant differences between the pre- and post -course median values. Statistically significant differences between doctors and nurses were shown in almost all questions pre-course and in only four questions post-course. CONCLUSIONS This study demonstrated that a residential course is effective at improving patient-rated empathy of doctors and nurses working in vaccination centers and could result in an increase of parents' adherence to vaccination programs.
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Affiliation(s)
- Massimo Maurici
- a Department of Biomedicine and Prevention , University of Rome Tor Vergata , Italy
| | - Michele Arigliani
- b Department of Clinical and Experimental Medical Sciences , University Hospital of Udine , Italy
| | - Valentina Dugo
- c Department of Biomedicine and Prevention, Specialization School for Hygiene and Preventive Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Carlo Leo
- d Department of Clinical and Experimental Medical Sciences , University Hospital of Udine, Italy TO Department of Medicine , Udine , Italy
| | - Valentina Pettinicchio
- c Department of Biomedicine and Prevention, Specialization School for Hygiene and Preventive Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Raffaele Arigliani
- e Department of Biomedicine and Prevention , Specialization School for Hygiene and Preventive Medicine, University of Rome Tor Vergata , Rome , Italy
| | - Elisabetta Franco
- a Department of Biomedicine and Prevention , University of Rome Tor Vergata , Italy
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Affiliation(s)
- Johan C Bester
- 1 University of Nevada, Las Vegas (UNLV) School of Medicine, Las Vegas, NV, USA
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Attwell K, Wiley KE, Waddington C, Leask J, Snelling T. Midwives' attitudes, beliefs and concerns about childhood vaccination: A review of the global literature. Vaccine 2018; 36:6531-6539. [PMID: 29483029 DOI: 10.1016/j.vaccine.2018.02.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 12/20/2017] [Accepted: 02/02/2018] [Indexed: 11/24/2022]
Abstract
Vaccine hesitancy in industrialised countries is an area of concern. Health professionals play a significant role in parental vaccination decisions, however, to date the role of midwives has not been widely explored. This review sought to describe the attitudes and communication practices of midwives in developed countries towards childhood vaccines. Medline, Cinahl, PsychInfo, Embase and the grey literature were searched. Inclusion criteria were qualitative and quantitative studies reporting midwives' beliefs, attitudes and communication practices toward childhood vaccination. The search returned 366 articles, of which 359 were excluded by abstract. Two additional articles were identified from the grey literature and references, resulting in nine studies from five countries included in the review. Across the studies, the majority of midwives supported vaccination, although a spectrum of beliefs and concerns emerged. A minority expressed reservations about the scientific justification for vaccination, which focussed on what is not yet known rather than mistrust of current evidence. Most midwives felt that vaccines were safe; a minority were unsure, or believed they were unsafe. The majority of midwives agreed that childhood vaccines are necessary. Among those who expressed doubt, a commonly held opinion was that vaccine preventable diseases such as measles are relatively benign and didn't warrant vaccination against them. Finally, the midwifery model of care was shown to focus on providing individualised care, with parental choice being placed at a premium. The midwifery model care appears to differ in approach from others, possibly due to a difference in the underpinning philosophies. Research is needed to understand how midwives see vaccination, and why there appears to be a spectrum of views on the subject. This information will inform the development of resources tailored to the midwifery model of care, supporting midwives in advocating for childhood vaccination.
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Affiliation(s)
- K Attwell
- School of Social Science, University of Western Australia, 35 Stirling Hwy, Crawley, Australia; Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Western Australia, Australia.
| | - K E Wiley
- School of Public Health, Edward Ford Building A27, University of Sydney, Australia; National Centre for Immunisation Research & Surveillance, cnr Hawkesbury Rd & Hainsworth St, Westmead 2415, Australia
| | - C Waddington
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Western Australia, Australia
| | - J Leask
- School of Public Health, Edward Ford Building A27, University of Sydney, Australia
| | - T Snelling
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Western Australia, Australia; Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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Bester JC. Measles Vaccination is Best for Children: The Argument for Relying on Herd Immunity Fails. JOURNAL OF BIOETHICAL INQUIRY 2017; 14:375-384. [PMID: 28815434 DOI: 10.1007/s11673-017-9799-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/29/2016] [Indexed: 06/07/2023]
Abstract
This article examines an argument which may negatively influence measles vaccination uptake. According to the argument, an individual child in a highly vaccinated society may be better off by being non-vaccinated; the child does not risk vaccine adverse effects and is protected against measles through herd immunity. Firstly, the conclusion of the argument is challenged by showing that herd immunity's protection is unreliable and inferior to vaccination. Secondly, the logic of the argument is challenged by showing that the argument is inherently self-defeating and therefore logically inconsistent. In practice the argument cannot be used to protect children against measles. Measles vaccination is undoubtedly best for children, even in highly vaccinated societies. Only if a medical contraindication to vaccination exists should vaccination be waived in favour of reliance on herd immunity. This places obligations on those who stand in care relationships with the child: parents, healthcare providers, and the state.
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Affiliation(s)
- Johan Christiaan Bester
- University of Nevada, Las Vegas (UNLV) School of Medicine, 2040 W Charleston Blvd, Las Vegas, Nevada, 89102 and Center for Applied Ethics, University of Stellenbosch, Stellenbosch, South Africa.
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Abstract
BACKGROUND INFOVAC is a network providing information about immunization issues to health professionals. The aim of this study was to assess the attitude of INFOVAC subscribers toward the current Swiss immunization schedule, potential modifications, and current and hypothetical immunization practices regarding their own children. METHODS In March 2015, a Web-based survey was sent to 4260 physicians and pharmacists subscribed to INFOVAC. Participation was anonymous and voluntary. The following information was obtained: (1) current immunization status of own children; (2) which immunizations would currently be accepted for a hypothetical own child and (3) attitudes toward potential modifications of the Swiss immunization schedule. Descriptive methods and multivariate models to correct for covariables were used for data analysis. RESULTS Nine hundred and fifty-five valid questionnaires were received: 886/3704 (23.9%) from physicians and 69/556 (12.4%) from pharmacists. Current (>95%) and hypothetical (>99%) immunization rates were high for diphtheria, tetanus, pertussis, poliomyelitis and measles-mumps-rubella. Most pediatricians (61%) would support more vaccines for their children than currently recommended by the Swiss immunization advisory committee, whereas about 50% of other physicians and pharmacists would decline at least one of the recommended immunizations, most frequently varicella, pneumococcal or meningococcal C conjugate vaccines. Strong general support was expressed for the expansion of human papillomavirus immunization to males, acceleration of the measles-mumps-rubella schedule and a 2 + 1 instead of 3 + 1 diphtheria-tetanus-pertussis, acellular-inactivated poliomyelitis vaccine (DTPa-IPV)/Haemophilus influenzae type b ± hepatitis B virus (HBV) schedule. CONCLUSIONS Survey participants generally demonstrated a positive attitude toward immunization, with pediatricians being the most progressive subgroup with the largest percentage of participants (63.1%) neither declining nor postponing any recommended immunization.
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Ozisik L, Tanriover MD, Altınel S, Unal S. Vaccinating healthcare workers: Level of implementation, barriers and proposal for evidence-based policies in Turkey. Hum Vaccin Immunother 2017; 13:1198-1206. [PMID: 28059668 PMCID: PMC5443379 DOI: 10.1080/21645515.2016.1269992] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/29/2016] [Accepted: 12/05/2016] [Indexed: 11/02/2022] Open
Abstract
The role of healthcare workers in life-long vaccination is very important in the means of 2 sided infection, rising patient awareness and being a role model for the patients. Numerous organizations publish guidelines for vaccination of HCWs, while healthcare facilities develop vaccination policies according to the accreditation standards. Nevertheless, vaccination rates among HCWs are far below targets. The obstacles to getting vaccinated or recommending vaccination may include rather universal factors such as the vaccine paradox, however in the case of HCWs, probably a different set of factors are included. The aims of this article are to gain an overview of vaccination strategies for HCWs, to assess the coverage rates of HCWs and make in-depth analyses of the potential barriers to vaccination and potential factors to motivate HCWs for vaccination in Turkey and to compare them with the global picture to improve implementation of policies concerning vaccination of HCWs.
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Affiliation(s)
- Lale Ozisik
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Mine Durusu Tanriover
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | | | - Serhat Unal
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
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Knowledge, Attitude and Behaviours towards Recommended Vaccinations among Healthcare Workers. Healthcare (Basel) 2017; 5:healthcare5010013. [PMID: 28272332 PMCID: PMC5371919 DOI: 10.3390/healthcare5010013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 01/05/2023] Open
Abstract
Healthcare workers (HCWs) are an important group of professionals exposed to biological risk during their work activities. So, the aim of this study is to perform a survey on the knowledge, attitude and behaviour of Italian HCWs towards the vaccinations recommended by the Ministry of Health. A cross-sectional study was carried out during the period September 2014–August 2015 in the Lazio region. The study was conducted by recruiting HCWs and biomedical students. The sample was comprised of 571 responders, of whom 12.4% were physicians, 18.9% were nurses, 34.3% were other HCW, and 34.3% were biomedical students (medical and nurses students). Hepatitis B virus (HBV) is perceived as a risk for personal health by 457 (80%) participants; TB is also worrying (434; 76%). Moreover, HBV (70.9%) and tuberculosis (TB) (79.2%) are perceived as a risk for health, while influenza is not considered so by most participants (46.2%). There is an underestimation of the role of influenza, perceived as a risk for 137 respondents (24%). The vaccination rate among these HCWs is highest for Hepatitis B virus (HBV) (82%), and lowest for influenza (28.5%) and varicella (40.3%). The vast majority of responders are in favour of HBV (77.8%) and TB (64.8%) vaccines. For other vaccinations there is less interest (between 33% and 40% for measles, mumps, rubella, pertussis and influenza). This study shows that knowledge of recommended occupational vaccinations is insufficient in HCWs, with few exceptions represented by HBV and TB. There is a need for novel approaches in this field, with the aim of enhancing vaccine coverage among HCW.
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Crocker-Buque T, Edelstein M, Mounier-Jack S. Interventions to reduce inequalities in vaccine uptake in children and adolescents aged <19 years: a systematic review. J Epidemiol Community Health 2017; 71:87-97. [PMID: 27535769 PMCID: PMC5256276 DOI: 10.1136/jech-2016-207572] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/13/2016] [Accepted: 07/04/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND In high-income countries, substantial differences exist in vaccine uptake relating to socioeconomic status, gender, ethnic group, geographic location and religious belief. This paper updates a 2009 systematic review on effective interventions to decrease vaccine uptake inequalities in light of new technologies applied to vaccination and new vaccine programmes (eg, human papillomavirus in adolescents). METHODS We searched MEDLINE, Embase, ASSIA, The Campbell Collaboration, CINAHL, The Cochrane Database of Systematic Reviews, Eppi Centre, Eric and PsychINFO for intervention, cohort or ecological studies conducted at primary/community care level in children and young people from birth to 19 years in OECD countries, with vaccine uptake or coverage as outcomes, published between 2008 and 2015. RESULTS The 41 included studies evaluated complex multicomponent interventions (n=16), reminder/recall systems (n=18), outreach programmes (n=3) or computer-based interventions (n=2). Complex, locally designed interventions demonstrated the best evidence for effectiveness in reducing inequalities in deprived, urban, ethnically diverse communities. There is some evidence that postal and telephone reminders are effective, however, evidence remains mixed for text-message reminders, although these may be more effective in adolescents. Interventions that escalated in intensity appeared particularly effective. Computer-based interventions were not effective. Few studies targeted an inequality specifically, although several reported differential effects by the ethnic group. CONCLUSIONS Locally designed, multicomponent interventions should be used in urban, ethnically diverse, deprived populations. Some evidence is emerging for text-message reminders, particularly in adolescents. Further research should be conducted in the UK and Europe with a focus on reducing specific inequalities.
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Affiliation(s)
- Tim Crocker-Buque
- Health Protection Research Unit in Immunisation, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Edelstein
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, London, UK
| | - Sandra Mounier-Jack
- Health Protection Research Unit in Immunisation, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Haviari S, Bénet T, Saadatian-Elahi M, André P, Loulergue P, Vanhems P. Vaccination of healthcare workers: A review. Hum Vaccin Immunother 2016; 11:2522-37. [PMID: 26291642 DOI: 10.1080/21645515.2015.1082014] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Vaccine-preventable diseases are a significant cause of morbidity and mortality. As new vaccines are proving to be effective and as the incidence of some infections decreases, vaccination practices are changing. Healthcare workers (HCWs) are particularly exposed to and play a role in nosocomial transmission, which makes them an important target group for vaccination. Most vaccine-preventable diseases still carry a significant risk of resurgence and have caused outbreaks in recent years. While many professional societies favor vaccination of HCWs as well as the general population, recommendations differ from country to country. In turn, vaccination coverage varies widely for each microorganism and for each country, making hospitals and clinics vulnerable to outbreaks. Vaccine mandates and non-mandatory strategies are the subject of ongoing research and controversies. Optimal approaches to increase coverage and turn the healthcare workforce into an efficient barrier against infectious diseases are still being debated.
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Affiliation(s)
- Skerdi Haviari
- a Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon ; Lyon , France
| | - Thomas Bénet
- a Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon ; Lyon , France.,b Equipe Epidémiologie et Santé Publique, Université de Lyon, Université Lyon 1 ; Lyon , France.,c Institut National de la Santé et de la Recherche Médicale (INSERM), French Clinical Research Investigation Network (F-CRIN), Innovative Clinical Research Network in Vaccinology (I-REIVAC) ; Lyon , France
| | - Mitra Saadatian-Elahi
- a Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon ; Lyon , France
| | - Philippe André
- a Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon ; Lyon , France
| | - Pierre Loulergue
- c Institut National de la Santé et de la Recherche Médicale (INSERM), French Clinical Research Investigation Network (F-CRIN), Innovative Clinical Research Network in Vaccinology (I-REIVAC) ; Lyon , France.,d Université Paris Descartes, Sorbonne Paris Cité, INSERM, CIC 1417, Assistance Publique Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Broca Hôtel Dieu, CIC Cochin-Pasteur ; Paris , France.,e INSERM, F-CRIN, I-REIVAC, Cochin Center ; Paris , France
| | - Philippe Vanhems
- a Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon ; Lyon , France.,b Equipe Epidémiologie et Santé Publique, Université de Lyon, Université Lyon 1 ; Lyon , France.,c Institut National de la Santé et de la Recherche Médicale (INSERM), French Clinical Research Investigation Network (F-CRIN), Innovative Clinical Research Network in Vaccinology (I-REIVAC) ; Lyon , France
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27
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van Lier A, Tostmann A, Harmsen IA, de Melker HE, Hautvast JLA, Ruijs WLM. Negative attitude and low intention to vaccinate universally against varicella among public health professionals and parents in the Netherlands: two internet surveys. BMC Infect Dis 2016; 16:127. [PMID: 26979822 PMCID: PMC4793755 DOI: 10.1186/s12879-016-1442-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 02/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prior to introduction of universal varicella vaccination, it is crucial to gain insight into the willingness to vaccinate among the population. This is because suboptimal national vaccination coverage might increase the age of infection in children, which will lead to higher complication rates. We studied the attitude and intention to vaccinate against varicella among Dutch public health professionals who execute the National Immunisation Programme (NIP), and parents. METHODS Medical doctors and nurses of regional public health services (RPHS) and child health clinics (CHC), and a random sample of parents received an internet survey on varicella vaccination. Separate logistic regression models were used to identify determinants for a positive attitude (professionals) or a positive intention (parents) to vaccinate against varicella within the NIP (free of charge). RESULTS The questionnaire was completed by 181 RPHS professionals (67%), 260 CHC professionals (46%), and 491 parents (33%). Of professionals, 21% had a positive attitude towards universal varicella vaccination, while 72% preferred to limit vaccination to high-risk groups only. Of parents, 28% had a positive intention to vaccinate their child against varicella within the NIP. The strongest determinant for a positive attitude or intention to vaccinate against varicella among professionals and parents was the belief that varicella is a disease serious enough to vaccinate against. CONCLUSIONS We showed that a majority of the Dutch public health professionals and parents in this study have a negative attitude or low intention to vaccinate universally against varicella, as a result of the perceived low severity of the disease. Most participating professionals support selective vaccination to prevent varicella among high-risk groups.
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Affiliation(s)
- Alies van Lier
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1 (internal P.O. Box 75), 3720 BA, Bilthoven, The Netherlands.
| | - Alma Tostmann
- Academic Collaborative Centre AMPHI, Department of Primary and Community Care, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Irene A Harmsen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1 (internal P.O. Box 75), 3720 BA, Bilthoven, The Netherlands.,Department of Work & Social Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Hester E de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1 (internal P.O. Box 75), 3720 BA, Bilthoven, The Netherlands
| | - Jeannine L A Hautvast
- Regional Public Health Service 'GGD Gelderland-Zuid', P.O. Box 1120, 6501 BC, Nijmegen, The Netherlands.,Academic Collaborative Centre AMPHI, Department of Primary and Community Care, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Wilhelmina L M Ruijs
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1 (internal P.O. Box 75), 3720 BA, Bilthoven, The Netherlands.,Regional Public Health Service 'GGD Gelderland-Zuid', P.O. Box 1120, 6501 BC, Nijmegen, The Netherlands
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Bester JC. Vaccine Refusal and Trust: The Trouble With Coercion and Education and Suggestions for a Cure. JOURNAL OF BIOETHICAL INQUIRY 2015; 12:555-9. [PMID: 26626065 DOI: 10.1007/s11673-015-9673-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 08/29/2015] [Indexed: 05/09/2023]
Abstract
There can be little doubt about the ethical imperative to ensure adequate vaccination uptake against certain infectious diseases. In the face of vaccine refusal, health authorities and providers instinctively appeal to coercive approaches or increased education as methods to ensure adequate vaccine uptake. Recently, some have argued that public fear around Ebola should be used as an opportunity for such approaches, should an Ebola vaccine become available. In this article, the author describes the difficulties associated with coercion and education when addressing vaccine opposition. Both coercion and education can cause opposite effects than intended in certain circumstances. The correct area of focus is to address the breakdown in trust within clinical relationships. The author presents suggestions for an approach towards vaccine refusal that may be more promising.
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Affiliation(s)
- Johan Christiaan Bester
- Department for Ethics, Humanities & Spiritual Care, Cleveland Clinic, Cleveland and Centre for Applied Ethics, University of Stellenbosch, Stellenbosch, South Africa.
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29
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Byström E, Lindstrand A, Likhite N, Butler R, Emmelin M. Parental attitudes and decision-making regarding MMR vaccination in an anthroposophic community in Sweden – A qualitative study. Vaccine 2014; 32:6752-7. [DOI: 10.1016/j.vaccine.2014.10.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/07/2014] [Accepted: 10/08/2014] [Indexed: 11/16/2022]
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30
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Simone B, Balasegaram S, Gobin M, Anderson C, Charlett A, Coole L, Maguire H, Nichols T, Rawlings C, Ramsay M, Oliver I. Evaluation of the measles, mumps and rubella vaccination catch-up campaign in England in 2013. Vaccine 2014; 32:4681-8. [PMID: 24996125 DOI: 10.1016/j.vaccine.2014.05.077] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/27/2014] [Accepted: 05/31/2014] [Indexed: 11/26/2022]
Abstract
In January-March 2013 in England, confirmed measles cases increased in children aged 10-16 years. In April-September 2013, the National Health System and Public Health England launched a national measles-mumps-rubella (MMR) campaign based on data from Child Health Information Systems (CHIS) estimating that approximately 8% in this age group were unvaccinated. We estimated coverage at baseline, and, of those unvaccinated (target), the proportion vaccinated up to 20/08/2013 (mid-point) to inform further public health action. We selected a sample of 6644 children aged 10-16 years using multistage sampling from those reported unvaccinated in CHIS at baseline and validated their records against GP records. We adjusted the CHIS MMR vaccine coverage estimates correcting by the proportion of vaccinated children obtained through sample validation. We validated 5179/6644 (78%) of the sample records. Coverage at baseline was estimated as 94.7% (95% confidence intervals, CI: 93.5-96.0%), lower in London (86.9%, 95%CI: 83.0-90.9%) than outside (96.1%, 95%CI 95.5-96.8%). The campaign reached 10.8% (95%CI: 7.0-14.6%) of the target population, lower in London (7.1%, 95%CI: 4.9-9.3) than in the rest of England (11.4%, 95%CI: 7.0-15.9%). Coverage increased by 0.5% up to 95.3% (95% CI: 94.1-96.4%) but an estimated 210,000 10-16 year old children remained unvaccinated nationally. Baseline MMR coverage was higher than previously reported and was estimated to have reached the 95% campaign objective at midpoint. Eleven per cent of the target population were vaccinated during the campaign, and may be underestimated, especially in London. No further national campaigns are needed but targeted local vaccination activities should be considered.
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Affiliation(s)
- Benedetto Simone
- Field Epidemiology Service (Victoria Office), Public Health England, 151 Buckingham Palace Road, London SW1W 9SZ, United Kingdom; European Programme for Intervention Epidemiology Training (EPIET), ECDC, Sweden.
| | - Sooria Balasegaram
- Field Epidemiology Service (Victoria Office), Public Health England, 151 Buckingham Palace Road, London SW1W 9SZ, United Kingdom
| | - Maya Gobin
- Field Epidemiology Service (Bristol Office), Public Health England, 2 Rivergate Temple Quay, Bristol BS1 6EH, United Kingdom
| | - Charlotte Anderson
- Field Epidemiology Service (Victoria Office), Public Health England, 151 Buckingham Palace Road, London SW1W 9SZ, United Kingdom
| | - André Charlett
- Statistics, Modelling and Economics Dept, Centre for Infectious Disease Surveillance and Control, Public Health England, Health Protection Directorate, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Louise Coole
- Field Epidemiology Services (Leeds office), Public Health England, Quarry House, Quarry Hill, Leeds LS2 7UE, United Kingdom
| | - Helen Maguire
- Field Epidemiology Service (Victoria Office), Public Health England, 151 Buckingham Palace Road, London SW1W 9SZ, United Kingdom
| | - Tom Nichols
- Statistics, Modelling and Economics Dept, Centre for Infectious Disease Surveillance and Control, Public Health England, Health Protection Directorate, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Chas Rawlings
- Field Epidemiology Service (Victoria Office), Public Health England, 151 Buckingham Palace Road, London SW1W 9SZ, United Kingdom
| | - Mary Ramsay
- Health Protection Services, Immunisation, Hepatitis, and Blood Safety Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Isabel Oliver
- Field Epidemiology Service (Bristol Office), Public Health England, 2 Rivergate Temple Quay, Bristol BS1 6EH, United Kingdom; University of Bristol, School of Social and Community Medicine, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, United Kingdom
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31
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Genicon C, Meynard JB, Duron S, Haus-Cheymol R, Ollivier L, Le Goff C, Pollot E, Bel JC, De Laval F, Decam C, Migliani R, Mayet A. Feedback on the management of the 2011 measles outbreak by French military general practitioners: An evaluation study. Rev Epidemiol Sante Publique 2014; 62:119-26. [DOI: 10.1016/j.respe.2013.11.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 10/28/2013] [Accepted: 11/12/2013] [Indexed: 10/25/2022] Open
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Toure A, Saadatian-Elahi M, Floret D, Lina B, Casalegno JS, Vanhems P. Knowledge and risk perception of measles and factors associated with vaccination decisions in subjects consulting university affiliated public hospitals in Lyon, France, after measles infection. Hum Vaccin Immunother 2014; 10:1755-61. [PMID: 24637343 DOI: 10.4161/hv.28486] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 2011, a large number of European countries faced measles outbreaks, France accounting for more than half of the reported cases. The Rhône-Alpes region, located in south-east France, was one of the most affected provinces, with an incidence rate of 97.9 cases per 100 000 inhabitants. We conducted a retrospective survey of adults and parents of children consulting university affiliated public hospitals because of measles infections between January 1, 2010 and September 2012 in Lyon, France. Our main objectives were to evaluate (1) the level of study population knowledge of measles, (2) vaccination practices, and (3) changes in opinion with regard to measles vaccination after disease onset. Overall, 73.64% of patients were not vaccinated or partially vaccinated. The main reason for non-vaccination in children was inappropriate age while among non-vaccinated adults, 29.3% could not give any reason. In total, 29.1% of the responding parents and 24.2% of adult cases were opposed to vaccination "in principle." A large number of patients did not recognize measles as a serious illness and were unaware of its complications. Among parents of infected children, knowledge of transmission mode (odds ratio [OR] = 5.9; 95% confidence interval [95% CI]: 1.64-21.26), perceived severity of measles (OR = 1.5; 95% CI: 1.06-2.13), and absence of hepatitis B vaccination (OR = 0.17; 95% CI: 0.04-0.65) were independently associated with a more positive opinion about measles vaccination after disease onset. In adult patients, low education level (OR = 3.39; 95% CI: 1.03-11.11) and lack of knowledge of sequelae (OR = 10.19; 95% CI: 1.14-91.31) were linked with a more positive opinion. Individuals affected by vaccine-preventable diseases are interesting populations to study disease impact on vaccine perception.
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Affiliation(s)
- Abdoulaye Toure
- Hospices Civils de Lyon; Service d'Hygiène; Epidémiologie et Prévention; Unité Epidémiologie et Biomarqueurs de l'Infection; Lyon, France
| | - Mitra Saadatian-Elahi
- Hospices Civils de Lyon; Service d'Hygiène; Epidémiologie et Prévention; Unité Epidémiologie et Biomarqueurs de l'Infection; Lyon, France
| | | | - Bruno Lina
- Hospices Civils de Lyon ; Laboratoire de Virologie Est; Groupement Hospitalier Est; Bron, France
| | | | - Philippe Vanhems
- Hospices Civils de Lyon; Service d'Hygiène; Epidémiologie et Prévention; Unité Epidémiologie et Biomarqueurs de l'Infection; Lyon, France; Université de Lyon; Lyon, France; Université Lyon I; Villeurbanne, France; CNRS, UMR5558; Laboratoire de Biométrie et Biologie Evolutive ; Equipe d'Épidémiologie et Santé Publique; Villeurbanne, France
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Houle SKD, Grindrod KA, Chatterley T, Tsuyuki RT. Publicly funded remuneration for the administration of injections by pharmacists: An international review. Can Pharm J (Ott) 2013; 146:353-64. [PMID: 24228051 DOI: 10.1177/1715163513506369] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The administration of injections has become an increasingly common addition to pharmacists' scope of practice. Four Canadian provinces, all US states and a number of other countries have regulations allowing pharmacists to administer injections. However, the extent to which such services are remunerated is unknown. METHODS We contacted regulatory and advocacy organizations within those jurisdictions where pharmacists are authorized to administer injections to identify publicly funded programs that pay pharmacists for these services, as well as details of the eligible drugs/vaccines. Patient or private insurer payment programs were excluded. RESULTS Of the 281 organizations we contact-ed, 104 provided information on a total of 34 pharmacist vaccination programs throughout Canada, the United States, England, Wales and Ireland. Converted to 2013 Canadian dollars, remuneration averages $13.12 (SD $4.63) per injection (range, $4.14-$21.21). All regions allow pharmacists to bill for administration of the influenza vaccine, while some states allow for a number of other vaccines. Alberta has the broadest range of injections eligible for remuneration. DISCUSSION Despite evidence of increased vaccination rates in areas allowing pharmacist administration of injections, the availability of publicly funded remuneration programs and the fee offered vary by more than 5-fold across North America and the United Kingdom. CONCLUSION Pharmacist-administered injections have great public health potential. The range of injections eligible for remuneration should be expanded to include a wide range of vaccines and other injectable drugs, and remuneration should be sufficient to encourage more pharmacists to provide this service.
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Affiliation(s)
- Sherilyn K D Houle
- EPICORE Centre/COMPRIS (Houle, Tsuyuki), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
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Vaccination policies for healthcare workers in Europe. Vaccine 2013; 32:4876-80. [PMID: 24161573 DOI: 10.1016/j.vaccine.2013.10.046] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 10/04/2013] [Accepted: 10/08/2013] [Indexed: 01/05/2023]
Abstract
Health-care workers (HCWs) are at increased risk for acquisition of vaccine-preventable diseases (VPDs) and vaccination is justified in order to protect them from occupational exposure and to prevent the spread of VPDs that pose a threat to susceptible patients. Review of European vaccination policies for HCWs revealed significant differences between countries in terms of recommended vaccines, implementation frame (mandatory or recommendation), target HCW groups and health-care settings. Further, the few published studies available identified indicate significant immunity gaps among HCWs against VPDs in Europe. In order to achieve higher vaccination coverage against VPDs stronger recommendations are needed. The issue of mandatory vaccination should be considered for diseases that can be transmitted to susceptible patients (influenza, measles, mumps, rubella, hepatitis B, pertussis, varicella). The acceptance of vaccinations and of mandatory vaccinations by HCWs is a challenge and appears to be VPD-specific.
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Prospero E, Barbadoro P, Marigliano A, D’Errico MM. Health care workers, immunization and safety issues: reflections from Italy. Am J Infect Control 2013; 41:664. [PMID: 23398771 DOI: 10.1016/j.ajic.2012.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 09/04/2012] [Indexed: 10/27/2022]
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Hardt K, Schmidt-Ott R, Glismann S, Adegbola RA, Meurice FP. Sustaining Vaccine Confidence in the 21st Century. Vaccines (Basel) 2013; 1:204-24. [PMID: 26344109 PMCID: PMC4494231 DOI: 10.3390/vaccines1030204] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/17/2013] [Accepted: 05/27/2013] [Indexed: 11/18/2022] Open
Abstract
Vaccination provides many health and economic benefits to individuals and society, and public support for immunization programs is generally high. However, the benefits of vaccines are often not fully valued when public discussions on vaccine safety, quality or efficacy arise, and the spread of misinformation via the internet and other media has the potential to undermine immunization programs. Factors associated with improved public confidence in vaccines include evidence-based decision-making procedures and recommendations, controlled processes for licensing and monitoring vaccine safety and effectiveness and disease surveillance. Community engagement with appropriate communication approaches for each audience is a key factor in building trust in vaccines. Vaccine safety/quality issues should be handled rapidly and transparently by informing and involving those most affected and those concerned with public health in effective ways. Openness and transparency in the exchange of information between industry and other stakeholders is also important. To maximize the safety of vaccines, and thus sustain trust in vaccines, partnerships are needed between public health sector stakeholders. Vaccine confidence can be improved through collaborations that ensure high vaccine uptake rates and that inform the public and other stakeholders of the benefits of vaccines and how vaccine safety is constantly assessed, assured and communicated.
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Affiliation(s)
- Karin Hardt
- GlaxoSmithKline Vaccines, Global Scientific Affairs & Medical Education, 20 Avenue Fleming, 1300 Wavre, Belgium.
| | - Ruprecht Schmidt-Ott
- GlaxoSmithKline Vaccines, Global Scientific Affairs & Medical Education, Prinzregentenplatz 9, 81675 Munich, Germany.
| | - Steffen Glismann
- GlaxoSmithKline Vaccines, Global Scientific Affairs & Medical Education, 68 Nykaer, DK-2605 Broendby, Denmark.
| | - Richard A Adegbola
- GlaxoSmithKline Vaccines, Global Scientific Affairs & Medical Education, 20 Avenue Fleming, 1300 Wavre, Belgium.
| | - François P Meurice
- GlaxoSmithKline Vaccines, Global Scientific Affairs & Medical Education, 20 Avenue Fleming, 1300 Wavre, Belgium.
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Pulcini C, Massin S, Launay O, Verger P. Knowledge, attitudes, beliefs and practices of general practitioners towards measles and MMR vaccination in southeastern France in 2012. Clin Microbiol Infect 2013; 20:38-43. [PMID: 23517454 DOI: 10.1111/1469-0691.12194] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/31/2013] [Accepted: 02/11/2013] [Indexed: 11/30/2022]
Abstract
As a result of sub-optimal immunization levels, measles has re-emerged in the EU since 2008 (30 ,567 cases in 2011), and nearly half of the cases reported are in France. Our objectives were to assess knowledge, attitudes, beliefs and practices of French general practitioners (GPs) towards measles and measles-mumps-rubella (MMR) vaccination. In 2012, we surveyed 329 GPs in southeastern France. Forty-five percent reported that they saw patients with measles in 2011. They considered the risk of complications low among 2-5-year-old children and young adults without co-morbidity. Twenty percent knew that two MMR doses are 99% effective in preventing measles. Nearly all (95%) GPs stated that they verified the MMR status for patients <30 years old in 2011 (42% systematically, 37% often, 15% sometimes). Seventy-nine percent reported proposing MMR vaccination to non-immune relatives in contact with a patient with measles. Participation in continuing medical education courses and considering measles to be a serious disease were independently associated with such post-exposure vaccination. GPs considered the following were potential barriers to the second dose of MMR (MMR2): parents/patients' belief that measles is harmless (80%), parents/patients' fear of the vaccine's side effects (50%), difficulty in documenting vaccination (48%) and lack of reminders for MMR2 (16%). Finally, some GPs also had misconceptions about the severity of measles (13%) and the usefulness of MMR2 (12%), which also served as barriers. In conclusion, it is essential to raise GPs' awareness of this disease and fill any gaps in their knowledge, by providing them with evidence-based information on measles and MMR vaccination.
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Affiliation(s)
- C Pulcini
- UMR912 (SESSTIM), INSERM, Marseille, France; Service d'Infectiologie, CHU de Nice, Nice, France; Faculté de Médecine, Université Nice-Sophia Antipolis, Nice, France
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