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      Attitudes of the General Public and General Practitioners in Five Countries towards Pandemic and Seasonal Influenza Vaccines during Season 2009/2010

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          Abstract

          Background

          Vaccination coverage rates for seasonal influenza are not meeting national and international targets. Here, we investigated whether the 2009/2010 A/H1N1 pandemic influenza affected the uptake of influenza vaccines.

          Methodology/Principal Findings

          In December 2009/January 2010 and April 2010, 500 randomly selected members of the general public in Germany, France, the United States, China, and Mexico were surveyed by telephone about vaccination for seasonal and A/H1N1 pandemic influenza. Also, in April 2010, 100 randomly selected general practitioners were surveyed. Adult vaccine coverage in December 2009/January 2010 for A/H1N1 pandemic and seasonal influenza were, respectively, 12% and 29% in France, 11% and 25% in Germany, 41% and 46% in the US, 13% and 30% in Mexico, and 12% and 10% in China. Adult uptake rates in April 2010 were higher in Mexico but similar or slightly lower in the other countries. Coverage rates in children were higher than in adults in the US, Mexico, and China but mostly lower in Germany and France. Germans and French viewed the threat of A/H1N1 pandemic influenza as low to moderate, whereas Mexicans, Americans, and Chinese viewed it as moderate to serious, opinions generally mirrored by general practitioners. The recommendation of a general practitioner was a common reason for receiving the pandemic vaccine, while not feeling at risk and concerns with vaccine safety and efficacy were common reasons for not being vaccinated. Inclusion of the A/H1N1 pandemic strain increased willingness to be vaccinated for seasonal influenza in the United States, Mexico, and China but not in Germany or France.

          Conclusions/Significance

          The 2009/2010 A/H1N1 influenza pandemic increased vaccine uptake rates for seasonal influenza in Mexico but had little effect in other countries. Accurate communication of health information, especially by general practitioners, is needed to improve vaccine coverage rates.

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          Most cited references19

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          Low Acceptability of A/H1N1 Pandemic Vaccination in French Adult Population: Did Public Health Policy Fuel Public Dissonance?

          Background In July 2009, French public health authorities embarked in a mass vaccination campaign against A/H1N1 2009 pandemic-influenza. We explored the attitudes and behaviors of the general population toward pandemic vaccination. Methodology/Principal Findings We conducted a cross-sectional online survey among 2,253 French representative adults aged 18 to 64 from November 17 to 25, 2009 (completion rate: 93.8%). The main outcome was the acceptability of A/H1N1 vaccination as defined by previous receipt or intention to get vaccinated (“Yes, certainly”, “Yes, probably”). Overall 17.0% (CI 95%, 15.5% to 18.7%) of respondents accepted A/H1N1 vaccination. Independent factors associated with acceptability included: male sex (p = .0001); older age (p = .002); highest or lowest level of education (p = .016); non-clerical occupation (p = .011); having only one child (p = .008); and having received seasonal flu vaccination in prior 3 years (p<.0001). Acceptability was also significantly higher among pregnant women (37.9%) and other at risk groups with chronic diseases (34.8%) (p = .002). Only 35.5% of respondents perceived A/H1N1 influenza illness as a severe disease and 12.7% had experienced A/H1N1 cases in their close relationships with higher acceptability (p<.0001 and p = .006, respectively). In comparison to 26.0% respondents who did not consult their primary care physician, acceptability was significantly higher among 8.0% respondents who were formally advised to get vaccinated, and lower among 63.7% respondents who were not advised to get vaccinated (respectively: 15.8%, 59.5% and 11.7%- p<.0001). Among respondents who refused vaccination, 71.2% expressed concerns about vaccine safety. Conclusions/Significance Our survey occurred one week before the peak of the pandemic in France. We found that alarming public health messages aiming at increasing the perception of risk severity were counteracted by daily personal experience which did not confirm the threat, while vaccine safety was a major issue. This dissonance may have been amplified by having not involved primary care physicians in the mass vaccination campaign.
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            Barriers to adult immunization.

            Our aim was to provide a better understanding of why many adults fail to receive recommended immunizations. Consumers (N = 2,002) and healthcare providers (N = 200) completed structured telephone interviews concerning their attitudes and knowledge about adult vaccines and factors affecting their vaccination decisions. Self-reported immunization rates for tetanus, influenza, and pneumococcal vaccines (which were emphasized in the surveys) were lower than goal rates set by national guidelines. Among the most common reasons consumers gave for not receiving immunizations were lack of physician recommendations and mistaken assumptions (e.g., healthy people do not need immunizations). Healthcare providers tended to cite concerns such as side effects, fear of needles, and lack of insurance coverage as reasons consumers forego vaccination. Providers also cited practice issues, such as lack of an effective reminder system, as barriers to increasing adult immunization rates. We conclude that a better understanding of why adults do not get vaccinated is important for efforts to increase immunization rates in this broad age group.
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              Influenza vaccination coverage against seasonal and pandemic influenza and their determinants in France: a cross-sectional survey

              Background Following the emergence of the influenza A(H1N1)2009 virus, the French ministry of health decided to offer free vaccination against pandemic influenza to the entire French population. Groups of people were defined and prioritised for vaccination. Methods We took a random sample of the population of mainland France and conducted a retrospective cross-sectional telephone survey to estimate vaccination coverage against seasonal and pandemic influenza and to identify determinants of these vaccinations. Results 10,091 people were included in the survey. Overall seasonal influenza vaccination coverage (IVC) remained stable in the population from the 2008-2009 season to the 2009-2010 season reaching 20.6% and 20.8% respectively. Overall pandemic IVC in the French population is estimated to be 11.1% (CI95%: 9.8 - 12.4). The highest pandemic IVC was observed in the 0-4 years age group. For individuals with health conditions associated with higher risk of influenza, pandemic IVC was estimated to be 12.2% (CI95%: 9.8 - 15.1). The main determinants associated with pandemic influenza vaccine uptake were: living in a household with a child 2 years), ORadj: 2.5 (CI95%: 1.5 - 4.1), or has a higher professional and managerial occupation, ORadj: 3.0 (CI95%: 1.5 - 5.5) and being vaccinated against seasonal influenza, ORadj: 7.1 (CI95%: 5.1 - 10.0). Being an individual with higher risk for influenza was not a determinant for pandemic influenza vaccine uptake. These determinants are not the same as those for seasonal influenza vaccination. Conclusions Overall A(H1N1)2009 influenza vaccine uptake remained low, particularly among individuals with higher risk for influenza and was lower than that observed for seasonal influenza. The reasons behind people's reluctance to be vaccinated need to be investigated further.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2012
                11 October 2012
                : 7
                : 10
                : e45450
                Affiliations
                [1 ]Institute of Social and Preventive Medicine, Medical Economics, University of Zurich, Zurich, Switzerland
                [2 ]Institute of Pharmaceutical Medicine, European Center of Pharmaceutical Medicine, University of Basel, Basel, Switzerland
                [3 ]Kantar Health, Montrouge, France
                University of Pittsburgh, United States of America
                Author notes

                Competing Interests: The study was funded by Sanofi Pasteur (Lyon, France), who paid for the scientific writing. Kantar Health received funding from Sanofi Pasteur (Lyon, France). GB and AD are employees of Kantar Health. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors. TDS and PRB declare no competing interests.

                Conceived and designed the experiments: GB AD. Performed the experiments: GB AD. Analyzed the data: PRB GB AD TDS. Contributed reagents/materials/analysis tools: PRB GB AD TDS. Wrote the paper: PRB TDS.

                Article
                PONE-D-12-04062
                10.1371/journal.pone.0045450
                3469560
                23071519
                8babd9d4-d5ff-45fb-a9fb-3bcdfb21e9d6
                Copyright @ 2012

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 6 February 2012
                : 21 August 2012
                Page count
                Pages: 8
                Funding
                The study was funded by Sanofi Pasteur (Lyon, France). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology
                Microbiology
                Virology
                Viral Vaccines
                Medicine
                Clinical Immunology
                Immunity
                Vaccination
                Vaccines
                Epidemiology
                Infectious Disease Epidemiology
                Global Health
                Infectious Diseases
                Viral Diseases
                Influenza
                Zoonoses
                Avian influenza A viruses
                Public Health
                Behavioral and Social Aspects of Health
                Immunizations

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                Uncategorized

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