The public acceptance of smallpox vaccination to fight bioterrorism in Japan: results of a large-scale opinion survey in Japan
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
This study examines the public acceptance of smallpox vaccinations in the event of a terrorist attack using smallpox. The article also provides public health professionals with the information necessary for such smallpox management.
A questionnaire survey was conducted in a city in Japan asking about prospective action when smallpox vaccination is advised after a terrorist attack and factors that could influence individual decisions about such vaccination.
Only a tiny fraction of people (0.12%) expressed their rejection of vaccination. Of the respondents, 63.6% showed their intent to be vaccinated promptly when such a measure was required; 28.6% wanted to decide for themselves, having some reservations. Those in the younger age group, those suffering from hypertension/cardiac diseases, and those who considered the threat of smallpox terrorism less seriously were likely to reserve their vaccination decisions until after examining information.
Communication programs regarding smallpox vaccination should be well planned beforehand and should especially target those people who reserve their decisions at such times. Health professionals should also be well equipped with all information necessary for appropriate and effective smallpox management in the face of such a bioterrorism attack or the strong potential of one.
- Tucker JB. Scourge: the once and future threat of smallpox. New York: Atlantic Monthly Press; 2001.
- Wharton M, Strikas RA, Harpaz R. Recommendations for using smallpox vaccine in a pre-event vaccination program. Morb Mortal Wkly Rep. 2003;52:1–16.
- Fenner F, Henderson DA, Arita I, Jezek Z, Landnyi ID. Smallpox and its eradication. Geneva: World Health Organization; 1988.
- Blendon RJ, DesRoches CM, Benson JM, Herrmann MJ, Taylor-Clark K, Weldon KJ. The public and the smallpox vaccination: a national survey of emergency health care providers. N Engl J Med. 2003;348:426–32. CrossRef
- Hull HF, Danila R, Ehresmann K. Smallpox and bioterrorism: public health responses. J Lab Clin Med. 2003;142(4):221–8. CrossRef
- Mack TM. Smallpox in Europe, 1950–71. J Infect Dis. 1972;125:161–9. CrossRef
- Mack TM, Thomas DB, Khan MM. Epidemiology of smallpox in West Pakistan, II: determinants of intravillage spread other than acquired immunity. Am J Epidemiol. 1972;95:157–68.
- Breman JG, Henderson DA. Diagnosis and management of smallpox. N Engl J Med. 2002;346:1300–8. CrossRef
- Section for Tuberculosis and Infectious Diseases, Ministry of Health, Labor and Welfare, Japan. Guidelines on smallpox vaccination. Tokyo: MHLW; 2004.
- Cohen LM, McChargue DE, Collins FL. The health psychology handbook: practical issues for the behavioral medicine specialist. Thousand Oaks: Sage Publications; 2003.
- Hamilton-West K. Factors influencing MMR vaccination decisions following a mumps outbreak on a university campus. Vaccine. 2006;24(24):5183–91. CrossRef
- Smedley J, Poole J, Waclawski E, Stevens A, Harrison J, Watson J, et al. Influenza immunization: attitudes and beliefs of UK healthcare workers. Occup Environ Med. 2007;64(4):223–7. CrossRef
- Heimberger T, Chang HG, Shaikh M, Crotty L, Morse D, Birkhead G. Knowledge and attitudes of healthcare workers about influenza: why are they not getting vaccinated? Infect Control Hosp Epidemiol. 1995;16(7):412–5. CrossRef
- Takayama N, Washio S, Imamura M, Nogushi F, Ozasa K, Ide S. Status of influenza vaccination and factors affecting vaccination in elderly residents. Jpn J Clin Exp Med (Rinsho to Kenkyu). 2008;85(2):129–32.
- Porter CK, Tribble DR, Halvorson H, Putnam SD, Sanders JW, Riddle MS. Cross-sectional survey of anthrax vaccine coverage and KAP among deployed US military. Hum Vaccin. 2009;5(11):765–9. CrossRef
- Ii M, Ohkusa Y. An empirical research for demand of influenza vaccination. Jpn J Public Health. 2001;48(1):16–27.
- Watanakunakorn C, Ellis G, Gemmel D. Attitude of healthcare personnel regarding influenza immunization. Infect Control Hosp Epidemiol. 1993;14(1):17–20. CrossRef
- Fernandez WG, Oyama L, Mitchell P, Edwards EM, George J, Donovan J, Feldman JA. Attitudes and practices regarding influenza vaccination among emergency department personnel. J Emerg Med. 2009;36(2):201–6. CrossRef
- LaVela SL, Smith B, Weaver FM, Legro MW, Goldstein B, Nichol K. Attitudes and practices regarding influenza vaccination among healthcare workers providing services to individuals with spinal cord injuries and disorders. Infect Control Hosp Epidemiol. 2004;25:933–40. CrossRef
- Winston CA, Wortley PM, Lees KA. Factors associated with vaccination of Medicare beneficiaries in five US communities: results from the Racial and Ethnic Adult Disparities in Immunization Initiative Survey, 2003. J Am Geriatr Soc. 2006;54:303–10. CrossRef
- Timmermans DR, Henneman L, Hirasing RA, van der Wal G. Attitudes and risk perception of parents of different ethnic backgrounds regarding meningococcal C vaccination. Vaccine. 2005;23(25):3329–35. CrossRef
- Oestbye T, Taylor DH, Lee AMM, Greenberg G, van Scoyoc L. Racial differences in influenza vaccination among older Americans, 1996–2000: longitudinal analysis of the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey. BMC Public Health. 2003;3:41. CrossRef
- Lindley MC, Worley PM, Winston CA, Bardenheier BH. The role of attitudes in understanding disparities in adult influenza vaccination. Am J Prev Med. 2006;31(4):281–5. CrossRef
- Hayashi Y, Suzuki K, Tonegawa K. Studies of influenza vaccination among elderly nursing home residents. J Jpn Assoc Infect Dis. 2007;81(4):408–13.
- Rachiotis G, Mouchtouri VA, Kermastinou J, Gourgoulianis K, Hadjichristodoulou C. Low acceptance of vaccination against the 2009 pandemic influenza (H1N1) among healthcare workers in Greece. Euro Surveill. 2010;15(6):1–52.
- Apisarnthanarak A, Phattanakeitchai P, Warren DK, Fraser VJ. Impact of knowledge and positive attitudes about avian influenza (H5N1 virus infection) on infection control and influenza vaccination practices of Thai healthcare workers. Infect Control Hosp Epidemiol. 2008;29(5):472–4. CrossRef
- Katsuno S, Tobusawa C, Tanaka K, Nakajima E, Takahashi H, Saito H. Attitude survey on influenza prepandemic vaccination of hospital staff. Jpn J Environ Infect. 2009;24(3):189–94. CrossRef
- O’Reilly FW, Cran GW, Stevens AB. Factors affecting influenza vaccine uptake among health care workers. Occup Med. 2005;55(6):474–9. CrossRef
- Horby PW, Williams A, Burgess MA, Wang H. Prevalence and determinants of influenza vaccination in Australians aged 40 years and over: a national survey. Aust N Z J Public Health. 2005;29(1):35–7. CrossRef
- Wortley PM, Levy PS, Quick L, Shoemaker TR, Dahlke MA, Evans B, Burke B, Schwartz B. Predictors of smallpox vaccination among healthcare workers and other first responders. Am J Prev Med. 2007;32(6):538–41. CrossRef
- Ching P, Tynan WP, Raymond D, Bresnitz E, Craig AS. Hospital recruitment for the smallpox pre-event vaccination program: Experiences from Florida, Nebraska, New Jersey and Tennessee, December, 2002–June, 2003. Public Health Rep. 2004;119:552–6. CrossRef
- Ault A. US smallpox vaccine programme stalls as volunteers balk. Lancet. 2003;361:1626. CrossRef
- Wortley PM, Schwartz B, Levy PS, Quick LM, Evans B, Burke B. Healthcare workers who elected not to receive smallpox vaccination. Am J Prev Med. 2006;30(3):258–65. CrossRef
- Yih WK, Lieu TA, Rego VH, O’Brian MA, Shay MA, Yokoe DS. Attitudes of healthcare workers in US hospitals regarding smallpox vaccination. BMC Public Health. 2003;3:20–8. CrossRef
- Centers for Disease Control and Prevention. Recommendations for using smallpox vaccine in pre-event vaccination program. Mortal Morb Wkly Rep. 2003;52:1–16.
- Benin AL, Dembry L, Shapiro ED, Holmboe ES. Reasons physicians accepted or declined smallpox vaccine, February through April, 2003. J Gen Intern Med. 2004;19:85–9. CrossRef
- Cameron LD, Leventhal H. The self-regulation of health and illness behavior. London: Routledge; 2003.
- Danes JE, Hunter JE, Woelfel J. Belief change and accumulated information. In: Hunter JE, Danes JD, Cohen SH, editors. Mathematical models of attitude change. New York: Academic Press; 1985. p. 204–16.
- Bass SB, Gordon TF, Ruzek SB, Hausman AJ. Mapping perceptions related to acceptance of smallpox vaccination by hospital emergency room personnel. Biosecur Bioterror. 2008;6(2):179–89. CrossRef
- Wright JA, Polack C. Understanding variation in measles–mumps–rubella immunization coverage: a population-based study. Eur J Pub Health. 2005;16(2):137–42. CrossRef
- Madjid M, Alfred A, Sahai A, Conyers JL, Casscells SW. Factors contributing to suboptimal vaccination against influenza: results of a nationwide telephone survey of persons with cardiovascular disease. Tex Heart Inst J. 2009;36(6):546–52.
- Tsutsi Y, Benzion U, Shahrabani S, Din GY. A policy to promote influenza vaccination: a behavioral economic approach. Health Policy. 2010;97:238–49. CrossRef
- Coelho FC, Codeco CT. Dynamic modeling of vaccinating behavior as a function of individual beliefs. PLoS Comput Biol. 2009;5(7):e1000425. CrossRef
- Lipkus IM, Hollands JG. The visual communication of risk. J Natl Cancer Inst Monogr. 1999;25:149–63.
- Paling J. Strategies to help patients understand risks. Br Med J. 2003;327:745–8. CrossRef
- McMurray R, Cheater FM, Weighall A, Nelson C, Schweiger M, Mukherjee S. Managing controversy through consultation: a qualitative study of communication and trust around MMR vaccination decisions. Br J Gen Pract. 2004;54:520–5.
- Manfredi P, Posta PD, d’Onofrio A, Salineli E, Centrone F, Meo C, Poletti P. Optimal vaccination choice, vaccination games, and rational exemption: an appraisal. Vaccine. 2010;28:98–109. CrossRef
- Perisic A, Bauch CT. Social contact networks and disease eradicability under voluntary vaccination. PLoS Comput Biol. 2009;5(2):e1000280. CrossRef
- Keselman A, Slaughter L, Patel VL. Toward a framework for understanding lay public’s comprehension of disaster and bioterrorism information. J Biomed Inform. 2005;38:331–44. CrossRef
- Sandman PM. Responding to community outrage: strategies for effective risk communication. Fairfax: American Industrial Hygiene Association; 1993. CrossRef
- Selgelid MJ. Bioterrorism and smallpox planning: information and voluntary vaccination. J Med Ethics. 2004;30:558–60. CrossRef
- Madar R, Repkova L, Baska T, Straka S. Influenza vaccination: knowledge, attitudes, cover rate—can they be improved? Bratislavske Lekarske Listy. 2003;104(7–8):232–5.
- Dannetun E, Tegnell A, Hermansson G, Glesecke J. Parents’ reported reasons for avoiding MMR vaccination: a telephone survey. Scand J Prim Health Care. 2005;23(3):149–53. CrossRef
- Pollard WE. Public perceptions of information sources concerning bioterrorism before and after anthrax attacks: an analysis of national survey data. J Health Commun. 2003;8:93–103.
- United States Government Accountability Office. Bioterrorism: Public health response to anthrax incidents of 2001. Report to the Honorable Bill Frist, Majority Leader, US Senate. Washington DC: GAO; 2003.
- McKenna VB, Gunn JE, Auerbach J, Brinsfield KH, Dyer KS, Barry MA. Local collaborations: development and implementation of Boston’s bioterrorism surveillance system. J Public Health Manage Pract. 2003;9(5):384–93.
- Donna PG, Ardene RV, Sarla S. Influenza vaccination by registered nurses: a personal decision. Can J Infect Control. 2009;24(1):18–26.
- Schoch-Spana M. Educating, informing, and mobilizing the public. In: Levy BS, Sidel VW, editors. Terrorism and public health: a balanced approach to strengthening systems and protecting people. Oxford University Press, Oxford; 2003. p. 118–35.
- Kaltman S, Tractenberg RE, Taylor K, Green BL. The smallpox vaccine: a multidimensional model of choice. Biosecur Bioterror. 2006;4(1):64–73. CrossRef
- Dellavalle RP, Heilig LF, Francis SO, Johnson KR, Hester EJ, McNealy KM. What dermatologists do not know about smallpox vaccination: results from a worldwide electronic survey. J Invest Dermatol. 2006;126:986–9. CrossRef
- The public acceptance of smallpox vaccination to fight bioterrorism in Japan: results of a large-scale opinion survey in Japan
Environmental Health and Preventive Medicine
Volume 16, Issue 5 , pp 290-298
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- Public acceptance
- Author Affiliations
- 1. Department of Public Health, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-0033, Japan
- 2. Department of Preventive Medicine, St. Marianne University School of Medicine, Kanagawa, Japan
- 3. Takenotsuka Health Center, Adashi City Government, Tokyo, Japan
- 4. Sendai City Government, Miyagi, Japan