An assessment of parents’ childhood immunization beliefs,intentions, and behaviors using a smartphone panel

IntroductionIt is important to quickly identify parent beliefs, intentions, and behaviors toward childhood vaccination, especially parents of children 19 to 35 months. This paper describes parental immunization beliefs, intentions, and behaviors; assesses the relationships between beliefs and intentions regarding child immunization and actual behaviors; and assesses whether beliefs, intentions, and/or behaviors varied across demographic subgroups.MethodsA sample of parents, ages 18 and older, from a mobile panel with people residing in the U.S. were invited to answer immunization behavior, intention, and belief questions using a smartphone app that was not vaccine specific. 10,000 panel members with a child under 18 were sent invitations. 1029 surveys were completed by a respondent with a child 19 to 35 months. The survey instrument replicated many NIS questions and had similar sequencing.FindingsRespondents reported that most children received all recommended vaccines, except flu vaccine, suggesting some may not understand the immunization schedule. Demographics closely associated with immunization behaviors were respondents’ education and household income. There is strong agreement that vaccines are effective, important to community health, and the child’s health. There is concern about the number of shots received, disease prevention, and ingredient safety. Some belief remains about vaccines causing learning disabilities. Positive beliefs about the benefits of childhood vaccines and concomitant risks vary with demographics.ConclusionsThis survey provided insights into beliefs and behaviors of parents regarding childhood vaccination. It found evidence of differences in beliefs, particularly related to delaying or declining recommended childhood vaccinations. The survey was conducted in a few days and at lower cost than traditional methods. This serves as a model for health agencies where rapid results or inexpensive approaches are needed.     

Are providers’ recommendation and knowledge associated with uptake of optional vaccinations among children? A multilevel analysis in three provinces of China

BackgroundImmunization services providers play a crucial role in the successful implementation of immunization, particularly for new vaccines. Several childhood vaccinations that are important for public health are not included in the National Immunization Programme in China, although they are available as optional and self-paid vaccines. Their coverage remains low.ObjectiveTo examine the association between providers’ knowledge and recommendations of optional vaccines, as well as other supply- and demand-side factors, and their uptake among children.MethodsA cross-sectional study, that included an in-person questionnaire survey for parents of children under-3 years and a self-administrative questionnaire survey for their vaccination services providers, was conducted in 36 townships or sub-districts in three provinces of China in 2013. Using a sample of 1791 household from 30 townships or sub-districts, we applied multilevel logistic analyses to examine the factors associated with the uptake of optional vaccines based on a hierarchal framework that combined demand-side and supply-side factors.ResultsCoverage of optional childhood vaccinations varied across small areas. Supply- and demand-side factors were both associated with the uptake of these vaccines. Immunization services providers’ recommendations and their knowledge about optional vaccination were positively and significantly associated with uptake. Children were more likely to receive the vaccines if they lived in communities with higher immunization worker density or larger immunization clinics. Several demand-side psychological factors about childhood vaccination were also associated with optional vaccinations.ConclusionsPromoting immunization services providers to conduct evidence-based recommendations about some important childhood optional vaccinations and enhancing their knowledge regarding optional vaccinations and communication skills are useful strategies to increase the coverage of these vaccinations.     

Parents’ preferences for interventions to improve childhood immunization uptake in northern Nigeria

BackgroundRoutine childhood immunization coverage has been low in northern Nigeria. While local authorities and international partners have been working hard to improve coverage, population preferences for interventions have not been documented. This study aimed to understand parents’ preferences and identify possible interventions to improve uptake of childhood immunization.MethodsPreferences for immunization interventions were elicited using a best-worst scaling (BWS) instrument among parents with children under five. We explored the value of six program attributes (each varying across three levels) identified through a literature review and engagement with local stakeholders. In each of 18 hypothetical programs identified through a main effect orthogonal design, respondents selected the best and worst attributes that may facilitate vaccination of children. Assuming sequential best-worst responses, we used conditional logit to estimate preferences. We employed latent class analysis (LCA) to categorize and examine respondents’ preferences across interventions.Results97 men and 101 women in 198 households were surveyed. The most preferred level for each attribute included door-to-door vaccinations, free food supplements, bundling with nutritional support programs, involvement of religious leaders, information dissemination through media campaigns, and strengthening of health services by the government. Three types of preferences were recognized in the LCA. The value-driven group (14%) characterized by youngest age, predominantly female, and lower education perceived bundled services with food and nutritional programs as the most important feature of an intervention. Convenience and information seekers (28%) characterized by oldest age and the lowest employment preferred door-to-door vaccinations and media campaigns. The remaining complacent group (58%), characterized by highest education and highest employment, did not show strong preferences to any intervention compared to the other two groups.ConclusionsRoutine immunization programs should consider joining forces with food and nutritional programs to improve vaccination uptake. Incorporating door-to-door visits and media campaigns to target older and unemployed populations may increase childhood immunization uptake in northern Nigeria.     

Association of vaccine-related attitudes and beliefs between parents and health care providers

Objectives

Health care providers influence parental vaccination decisions. Over 90% of parents report receiving vaccine information from their child's health care provider. The majority of parents of vaccinated children and children exempt from school immunization requirements report their child's primary provider is a good source for vaccine information. The role of health care providers in influencing parents who refuse vaccines has not been fully explored. The objective of the study was to determine the association between vaccine-related attitudes and beliefs of health care providers and parents.

Methods

We surveyed parents and primary care providers of vaccinated and unvaccinated school age children in four states in 2002–2003 and 2005. We measured key immunization beliefs including perceived risks and benefits of vaccination. Odds ratios for associations between parental and provider responses were calculated using logistic regression.

Results

Surveys were completed by 1367 parents (56.1% response rate) and 551 providers (84.3% response rate). Parents with high confidence in vaccine safety were more likely to have providers with similar beliefs, however viewpoints regarding disease susceptibility and severity and vaccine efficacy were not associated. Parents whose providers believed that children get more immunizations than are good for them had 4.6 higher odds of holding that same belief compared to parents whose providers did not have that belief.

Conclusions

The beliefs of children's health care providers and parents, including those regarding vaccine safety, are similar. Provider beliefs may contribute to parental decisions to accept, delay or forgo vaccinations. Parents may selectively choose providers who have similar beliefs to their own.     

Health Information Sources,Perceived Vaccination Benefits,and Maintenance of Childhood Vaccination Schedules

ABSTRACT

Parental concerns over the safety or necessity of childhood vaccination have increased over the past decades. At the same time, there has been a proliferation of vaccine-related information available through a range of health information sources. This study investigates the associations between evaluations of health information sources, parental perceptions of childhood vaccination benefits, and the maintenance of vaccination schedules for their children. Specifically, this study aims to (a) incorporate social media into the battery of health information sources and (b) differentiate households with a childhood autism diagnosis and those without, given unsubstantiated but persistent concerns about vaccine safety and autism. Analyzing a sample of U.S. households, a total of 4,174 parents who have at least one child under the age of 18 were analyzed, including 138 of parents of households with a childhood autism diagnosis. Results show that the more the parents value interpersonal communication and magazines as sources of health information, the more they perceive vaccination benefits, and the more the value they put on television, the better they keep vaccination schedules up-to-date for their children. On the other hand, social media are negatively associated with their perceptions of vaccination benefits. Although parents of children diagnosed with autism are less likely to perceive vaccination benefits, no interaction effects with evaluations of health information sources are found on parental perceptions of vaccination benefits or maintenance of schedules.     

Attitudes and beliefs related to childhood vaccinations among parents of 6 years old children in Zagreb,Croatia

The Croatian Immunization Programme is a mandatory prevention programme in which vaccines are offered free of charge and little is known about parental vaccine-related beliefs and attitudes. We aimed to describe beliefs and attitudes towards childhood vaccination of parents in Zagreb, estimate the proportion of parents with positive attitudes towards vaccination, and to identify the possible predictors of positive attitudes. Using a self-administered questionnaire, we performed a cluster sampling survey among parents of 6-years-old children in Zagreb. In total 542 questionnaires were collected, 80% (n = 430/542) of respondents were mothers. Even though 72.6% (n = 385/531; 95%CI: 69–76) respondents feel that childhood vaccination should remain mandatory, 36.3% (n = 192/528; 95%CI: 58.3–65.3) considered that simultaneous administration of vaccines can have negative effect to their child’s health. In addition, 38% (n = 202/532; 95%CI: 33.2–43.1%) feared that vaccines may harm their child. Of total, parents mostly reported positive attitude towards vaccination (61.8%; 95% CI: 34.7–42). Parents with positive attitudes were more likely to state their child experienced mild or no adverse reaction after vaccination, report not delaying vaccination and provide additional non-mandatory vaccines to their child (p < 0.05). Gender, age, education and marital status of parent were not significantly associated with the positive attitude towards vaccination. Our results suggest the need for educational interventions and communication strategies that could foster better knowledge on immunization with a focus on parental misconceptions, perceived constraints and safety issues about vaccine.     

Midwives’ knowledge,attitudes and confidence in discussing maternal and childhood immunisation with parents: A national study

IntroductionDespite the enormous benefits of childhood and maternal immunisation to individual and population health, the uptake of maternal vaccines during pregnancy remains suboptimal. Midwives are a trusted information source for parents and play an important role in the provision of immunisation information. Understanding midwives’ attitudes and vaccine knowledge, along with their confidence to discuss maternal and childhood immunisation with parents, is key to reducing parental decisional conflict and achieving immunisation goals.MethodsAn online study was conducted to investigate midwives’ knowledge and attitudes towards maternal and childhood vaccination along with their confidence to answer parents' vaccine-related questions. Midwives were recruited by email via the midwifery peek body, the Australian College of Midwives.ResultsA total of 359 midwives completed the online survey. The majority of midwives supported maternal (influenza 83%, pertussis 90.5%) and childhood immunisation (85.8%); however, 69.4% of respondents wanted further training about immunisation. Midwives who felt their midwifery education adequately covered immunisation were more confident advising parents about maternal (p = 0.007) and childhood immunisation (p < 0.001). Similarly, Midwives were significantly more likely to confidently advise parents about maternal (p < 0.001) and childhood immunisations (p < 0.001) if they had completed a specific immunisation training course outside of their midwifery course.ConclusionMost midwives working in Australia support vaccination. However, access to contemporary, culturally appropriate education that enables midwives to engage confidently with parents about immunisation is lacking. Education based on a women-centred approach within the pre-registration curriculum along with continuing professional development programs could enable midwives to reduce the evidence to practice gap by increasing vaccine uptake.     

Vaccination coverage and factors associated with routine childhood vaccination uptake in rural Vellore,southern India, 2017

BackgroundVellore district in southern India was selected for intensified immunization efforts through India’s Mission Indradhanush campaign based on 74% coverage in the National Family Health Survey in 2015. As rural households rely almost entirely on the Universal Immunization Program (UIP), we assessed routine immunization coverage and factors associated with vaccination status of children in rural Vellore.MethodsWe conducted a cross-sectional household survey among parents or primary caretakers of children aged 12–23 months during August–September 2017 using two-stage, EPI cluster sampling. We verified vaccination histories from vaccination cards and collected data on sociodemographic and non-socio-demographic characteristics by using mobile data capture. Associations with vaccination status were examined with univariate and multivariate logistic regression models.ResultsA total of 643 children were included. Coverage of BCG, third dose pentavalent/DPT, measles/MR vaccines and full vaccination (BCG, three doses of polio and pentavalent/DPT and measles/MR vaccines) among children with vaccination cards (n = 606) was 94%, 96%, 93% and 84%, respectively. Of children with vaccination cards, 70.8% had received all recommended doses according to the UIP schedule. No socio-demographic differences were identified, but parents’ familiarity with the schedule (Adjusted Prevalence Odds Ratio (aPOR): 2.06, 95%CI = 1.26–3.38) and receiving information on recommended vaccinations during antenatal visits (aPOR: 2.16, 95% CI = 1.13–4.12) were significantly associated with full vaccination status of the children.ConclusionsWe found higher UIP antigen coverage and proportion of fully vaccinated children than previously reported from rural Vellore. However, adherence to the recommended schedule was still not optimal. Our study highlights the potential of improving parental awareness of vaccination schedule and targeting health education interventions at pregnant women during antenatal visits to sustain and improve routine immunization coverage.     

Changes in parents’ decisions pertaining to vaccination of their children after the Changchun Changsheng vaccine scandal in Guangzhou,China

A series of scandals involving the rabies vaccine and the diphtheria, tetanus, and pertussis combined vaccine (DTP) were reported in July 2018, in China. Our goal was to assess the effects of the vaccine scandal on parents’ attitudes and decisions regarding vaccination. A cross-sectional study was conducted by contacting kindergarteners’ parents through an online questionnaire from March 1 to 8, 2019. In total, 14,300 valid questionnaire responses were received, and 92.53% of respondents were aware of the recent vaccine scandal. Among parents who were aware of the vaccine scandal, 13.62% preferred that their children receive optional vaccines (optional vaccine group) or delay, stop or reject vaccinations (hesitate group) instead of receiving mandatory vaccines (mandatory vaccine group). Awareness of the vaccine scandal and self-reporting of vaccine-associated side effects in their children were more common among respondents in the optional vaccine and the hesitate groups (P < 0.001). Compared with the mandatory vaccine group, parents in the hesitate group were more likely to report having attempted to dissuade others from vaccinating their children (P < 0.001). Because the scandal changed parents’ decisions regarding vaccination of their children, efforts should be made to restore public confidence in vaccines and to boost immunization rates.     

Measuring vaccine acceptance among Canadian parents: A survey of the Canadian Immunization Research Network

Parental decision making about childhood vaccinations is complex and multidimensional. There is a perception that the number of parents having concerns regarding childhood vaccinations has been increasing in Canada. The aim of this study was to explore vaccine hesitancy among Canadian parents and to examine factors associated with a parent’s intention to vaccinate his/her child. Informed by the Theory of Planned Behaviour (TPB) this study assesses potential associations between parents’ knowledge, attitudes and beliefs toward vaccination and their intention to vaccinate their child in the future. A national sample of Canadian parents of children aged 24–59 months (N = 2013) was surveyed using an online survey methodology. Half of the surveyed parents strongly intended to have their child vaccinated in the future. Parents’ information needs and searches as well as parents’ trust in different institutions were associated with intention to vaccinate. Parents who reported having frequently looked for vaccine information, who considered that it was their role as parents to question vaccines, or who had previously experienced difficulty accessing vaccination services were less likely to strongly intend to vaccinate their child in the future. Parents who had a high level of trust in doctors and public health were most likely to strongly intend to vaccinate their child. Results of the multivariate analysis showed that positive attitudes (aOR = 8.0; 95% CI: 6.0, 10.4), higher perceived social support (aOR = 3.0; 95% CI: 2.3, 3.93), and higher perceived behavioural control (aOR = 1.8; 95% CI: 1.4, 2.43) were associated with parents’ intention to vaccinate their child. Findings of this study suggest that trust-building interventions that promote pro-vaccine social norms and that address negative attitudes toward vaccination could enhance vaccine acceptance among Canadian parents.     

Barriers to adolescent immunization: a survey of family physicians and pediatricians

BACKGROUND: Although early childhood vaccination rates have increased, many adolescents are not up to date on recommended vaccinations. We assessed attitudes and practices of family physicians and pediatricians regarding adolescent vaccination to identify provider-level barriers that may contribute to low immunization rates. METHODS: A 94-item self-report questionnaire was mailed to 400 physicians contracted with a managed care organization. Physicians were queried about demographic characteristics, source of vaccine recommendations, adolescent immunization practices, barriers to immunizing adolescents, and use of reminder/recall systems. RESULTS: Response rate was 59%. Most respondents reported routinely recommending vaccines for tetanus and diphtheria toxoids (98%), Hepatitis B (90%), and measles, mumps, and rubella (84%), whereas 60% routinely recommended varicella vaccine. Physicians reported that they were more likely to assess immunization status, administer indicated immunizations, and schedule return immunization visits to younger adolescents (11 to 13 years old) than to older adolescents (14 to 18 and 19 to 21 years old). CONCLUSION: Most respondents reported recommending the appropriate vaccinations during preventive health visits; however, older adolescents were least likely to be targeted for immunization assessment and administration of all recommended vaccines.     

Geographic proximity to immunization providers and vaccine series completion among children ages 0–24 months

ObjectivesIn the U.S., vaccination coverage is lower in rural versus urban areas. Spatial accessibility to immunization services has been a suspected risk factor for undervaccination in rural children. Our objective was to identify whether geographic factors, including driving distance to immunization providers, were associated with completion of recommended childhood vaccinations.MethodsWe analyzed records from Montana’s immunization information system for children born 2015–2017. Using geolocated address data, we calculated distance in road miles from children’s residences to the nearest immunization provider. A multivariable log-linked binomial mixed model was used to identify factors associated with completion of the combined 7-vaccine series by age 24 months.ResultsAmong 26,085 children, 16,503 (63.3%) completed the combined 7-vaccine series by age 24 months. Distance to the nearest immunization provider ranged from 0 to 81.0 miles (median = 1.7; IQR = 3.2), with the majority (92.1%) of children living within 10 miles of a provider. Long distances (>10 miles) to providers had modest associations with not completing the combined 7-vaccine series (adjusted prevalence ratio [aPR]: 0.97, 95% confidence interval [CI]: 0.96–0.99). After adjustment for other factors, children living in rural areas (measured by rural-urban commuting area) were significantly less likely to have completed the combined 7-vaccine series than children in metropolitan areas (aPR: 0.88, 95% CI: 0.85–0.92).ConclusionsLong travel distances do not appear to be a major barrier to childhood vaccination in Montana. Other challenges, including limited resources for clinic-based strategies to promote timely vaccination and parental vaccine hesitancy, may have greater influence on rural childhood vaccination.     

Missed Opportunities: A National Survey of Obstetricians About Attitudes on Maternal and Infant Immunization

The recent reoccurrence of several vaccine-preventable diseases demonstrates the need for new techniques to promote childhood vaccination. Many mothers make decisions regarding vaccination of their children during pregnancy. As a result, obstetricians have a unique opportunity to influence maternal decisions on this crucial component of child health. Our objective was to understand OB/GYNs?? attitudes, beliefs, and current practices toward providing vaccinations to pregnant patients and providing information about routine childhood immunizations during standard prenatal care. We surveyed OB/GYNs in the United States about their vaccination practices and perceptions during the 2009 H1N1 outbreak. Most (84%) respondents indicated their practice would be administering H1N1 vaccines to pregnant patients. While a majority (98%) of responding providers felt childhood vaccination is important, relatively few (47%) felt that they could influence mothers?? vaccination choices for their children. Discussion of routine childhood immunization between obstetricians and their patients is an area for future improvements in childhood vaccination.     

系统化健康教育在儿童计划免疫中的应用与效果

目的探讨系统化健康教育在儿童计划免疫中的应用和效果。方法选自2011年1月至2012年1月在我所进行免疫接种的儿童800名。经过伦理委员会批准及患者的知情同意，将800名儿童随机分为2组，观察组和对照组各400人。观察组的儿童采取常规接种教育，并在此基础上进行健康教育。对对照组的儿童只进行常规接种教育。结果观察组儿童395人完成接种，接种率为98．75％。对照组儿童371人完成接种，接种率为92．75％。观察组的接种率明显高于对照组。结论系统化健康教育能够有效的提高儿童计划免疫中的接种率。     

Measuring the timeliness of childhood vaccinations: Using cohort data and routine health records to evaluate quality of immunisation services

BackgroundTo achieve full benefits of vaccination programmes, high uptake and timely receipt of vaccinations are required.ObjectivesTo examine uptake and timeliness of infant and pre-school booster vaccines using cohort study data linked to health records.MethodsWe included 1782 children, born between 2000 and 2001, participating in the Millennium Cohort Study and resident in Wales, whose parents gave consent for linkage to National Community Child Health Database records at the age seven year contact. We examined age at receipt, timeliness of vaccination (early, on-time, delayed, or never), and intervals between vaccine doses, based on the recommended schedule for children at that time, of the following vaccines: primary (diphtheria, tetanus, pertussis (DTP), polio, Meningococcal C (Men C), Haemophilus influenzae type b (Hib)); first dose of measles, mumps and rubella (MMR); and pre-school childhood vaccinations (DTP, polio, MMR). We compared parental report with child health recorded MMR vaccination status at age three years.ResultsWhile 94% of children received the first dose of primary vaccines early or on time, this was lower for subsequent doses (82%, 65% and 88% for second and third doses and pre-school booster respectively). Median intervals between doses exceeded the recommended schedule for all but the first dose with marked variation between children. There was high concordance (97%) between parental reported and child health recorded MMR status.ConclusionsRoutine immunisation records provide useful information on timely receipt of vaccines and can be used to assess the quality of childhood vaccination programmes. Parental report of MMR vaccine status is reliable.     

Determinants of influenza vaccination among young Taiwanese children

ObjectiveAccording to the Health Belief Model (HBM), individual perceptions of susceptibility, severity, benefit, barrier, self-efficacy, and cues to action are associated with health actions. In this study, we investigated the perceptions and social factors that influence the intention to vaccinate children against influenza among parents of young Taiwanese children.MethodsA nationwide survey was performed using stratified random sampling to explore the beliefs, attitudes, and intentions of parents/main caregivers with regard to vaccinating children aged 6 months to 3 years against influenza. A questionnaire was developed based on the HBM and multivariate logistic regression analyses of 1300 eligible participants were used to identify significant predictors of the intention to vaccinate.ResultsGreater perceived benefit, cues to action, and self-efficacy of childhood vaccination against influenza were positively associated with the intention to vaccinate. Children's experience of influenza vaccinations in the past year was also a positive predictor. However, perceived susceptibility, perceived severity regarding influenza and perceived barriers to vaccination were not predictive of the intention to vaccinate.ConclusionIn addition to perceived benefits and cues to action, self-efficacy of parents/main caregivers was significantly predictive of their intention to accept influenza vaccination for their young children. These components of the HBM could be used in formulating strategies aimed at promoting the use of influenza vaccine.     

Childhood full and under-vaccination in Nigeria, 2013

BackgroundNigeria’s government is challenged with vaccinating the world’s third largest birth cohort within a culturally and socioeconomically diverse country. This study estimated full childhood immunization coverage in Nigeria and characterizes the association between vaccination status and urbanicity, region of residence, ethnicity, and other factors.MethodsIn 2013, households throughout Nigeria were enrolled in the Demographic and Health Survey which included questions about vaccination. We defined full vaccination of a child as having received a single dose of bacillus Calmete-Guerin (BCG), one dose of measles-containing vaccine (MCV), three doses of diphtheria, pertussis, tetanus (DPT), and four doses of oral polio vaccine (OPV). Using a multinomial logistic regression model, full vaccination and under-vaccination versus non-vaccination was regressed onto various demographic and socioeconomic characteristics.ResultsAmong 5759 children 1 year of age, 25.5% were fully vaccinated, 47.9% were under-vaccinated, and 26.6% had not received any vaccinations. Children were more likely to be fully vaccinated if they belonged to wealthier families, resided in southern regions of the country, were Christian, belonged to the Igbo or Yoruba ethnic group, had mothers who made ≥5 antenatal care visits, delivered at an institution, or were more highly educated.ConclusionsFull vaccination among children in Nigeria is exceptionally low by global standards and certain groups, such as Muslims and individuals in northern regions who are higher risk of non- or under-vaccination should be targeted by vaccination programs. Providing a wide range of health care services for mothers and pregnant women could improve full vaccination of children.     

Negative attitude of highly educated parents and health care workers towards future vaccinations in the Dutch childhood vaccination program

BACKGROUND: It is unknown whether further expansion of the Dutch childhood vaccination program with other vaccines will be accepted and whom should be targeted in educational strategies. AIM: To determine attitudes of parents towards possible future vaccinations for their children and the behavioural determinants associated with a negative attitude. DESIGN: Questionnaire study. METHODS: Parents of children aged between 3 months and 5 years of day-care centres were asked to fill out a questionnaire. Determinants of a negative attitude to comply with possible future vaccinations against example diseases such as pneumonia or influenza, hepatitis B, TBC, smallpox and SARS were assessed using polytomous logistic regression analysis. RESULTS: Of the 283 respondents, 123 (43%) reported a positive attitude towards all vaccinations, 129 (46%) reported to have a positive attitude to have their child vaccinated against some diseases and 31 (11%) had no intention to comply with any new vaccination. Determinants of a fully negative attitude were a high education of the parent (odds ratio [OR] 3.3, 95% confidence interval [95% CI]: 1.3-8.6), being a health care worker (OR 4.2, 95% CI: 1.4-12.6), absence of religion (OR 2.6, 95% CI: 1.0-6.7), perception of vaccine ineffectiveness (OR 6.9, 95% CI: 2.5-18.9) and the perception that vaccinations cause asthma or allergies (OR 82.4, 95% CI: 8.9-766.8). CONCLUSION: Modifiable determinants for a negative attitude to comply with new vaccinations are mainly based on lack of specific knowledge. These barriers to vaccinations might be overcome by improving health education in the vaccination program, especially when targeted at educated parents and health care workers.     

Factors that affect voluntary vaccination of children in Japan

Some important vaccinations are not included in the routine childhood immunization schedule in Japan. Voluntary vaccinations are usually paid as an out-of-pocket expense. Low voluntary vaccination coverage rates and high target disease incidence are assumed to be a consequence of voluntary vaccination. Therefore, this study aimed to explore factors associated with voluntary vaccination patterns in children. We conducted an online survey of 1243 mothers from a registered survey panel who had at least one child 2 months to <3 years of age. The voluntary vaccination mainly correlated positively with annual household income and mothers’ positive opinions about voluntary vaccinations, but negatively with number of children. Financial support, especially for low income households and households with more than one child, may motivate parents to vaccinate their children. Communication is also an important issue. More opportunities for education and information about voluntary vaccinations should be provided to mothers without distinguishing between voluntary and routine vaccination.     

High overall confidence in childhood vaccination in Norway,slightly lower among the unemployed and those with a lower level of education

In Norway, childhood immunisation is offered on voluntary basis, free of charge and is delivered through trained nurses at > 650 child health centres and school health services. Maintaining high confidence in the vaccination programme is key to sustaining high vaccine uptake. We aimed to investigate confidence in childhood vaccination in the general population and to identify determinants for lower confidence.In 2017 and 2018, Statistics Norway asked questions on confidence in childhood vaccination (to all respondents) and children’s vaccination history (to parents) in their routine cross-sectional survey. Respondents reported their level of agreement on a five-point Likert scale. Using a weighted analysis we calculated proportions agreeing [95% confidence interval] by respondent characteristics.Overall, 2169 individuals participated (54% response). 95.8% [94.8–96.7] answered that vaccination is important, 93.4% [92.2–94.4] thought that vaccines are safe, 96.0% [95.0–96.8] thought that vaccines are effective and for 93.4% [92.2–94.4] vaccination was compatible with their basic values. Those with lower level of education expressed lower confidence in vaccination due to conflict with their basic values (88.2% [84.7–91.0] answered positively). Those unemployed expressed lower confidence due to conflict with their basic values (81.9% [71.8–88.9]) and because of concerns about vaccines’ safety (83.5% [73.7–90.1]). 96.3% [94.3–97.6] of parents (n = 580) had their children fully vaccinated, despite that one fifth answered that they at least once have had doubts on whether or not to vaccinate their children.There is high confidence in childhood vaccination in Norway. Those with a lower level of education and the unemployed reported comparatively lower confidence. To maintain high confidence in childhood vaccination, we recommend maintaining the well-informed system with easily accessible vaccinations. Furthermore, we recommend maintaining surveillance of vaccine confidence, supplemented with targeted studies on subgroups who are less confident, express doubts and/or oppose vaccination. Those studies should inform communication strategies tailored to subgroups.