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Canadian Journal of Public Health

, Volume 97, Issue 2, pp 90–95 | Cite as

Uptake and Behavioural and Attitudinal Determinants of Immunization in an Expanded Routine Infant Hepatitis B Vaccination Program in British Columbia

  • M. BighamEmail author
  • V. P. Remple
  • K. Pielak
  • C. McIntyre
  • R. White
  • W. Wu
Research

Abstract

Introduction

British Columbia (BC) implemented a universal infant hepatitis B (HB) immunization program in 2001. The study objective was to evaluate HB immunization coverage among the first six-month cohort of eligible infants in the province outside of the Vancouver-Richmond health region and to assess parent/guardian behavioural and attitudinal determinants of HB immunization.

Methods

A cross-sectional survey of HB immunization was conducted using a random sample of eligible infants born between 1 January-30 June 2001. HB immunization coverage data were obtained from the provincial Public Health Information System, and through a telephone survey of 487 of eligible infants’ parents/guardians that was conducted between October 2002-January 2003. At this time, parents/guardians were also asked about behaviours and attitudes towards immunization, based on the Immunization Health Belief Model Scale.

Results

HB immunization coverage with at least one dose of HB vaccine was 89% and uptake of 3 doses of HB vaccine was 78%. HB immunization was significantly associated (p<0.001) with a recommendation for HB immunization from a health care professional. The main reason for non-HB immunization was parental concern about side effects.

Discussion

Seventy-eight percent of infants completed the 3-dose HB vaccination schedule. Parental behaviour regarding HB immunization of their children was strongly influenced by a supportive recommendation from either a nurse or doctor.

MeSH terms

Hepatitis B; immunization; program evaluation; health behavior 

résumé

Introduction

En 2001, la Colombie-Britannique a mis en place un programme d’immunisation infantile contre l’hépatite B (HB). L’objectif de cette étude était d’évaluer la couverture vaccinale d’une cohorte d’enfants britanno-colombiens résidant à l’extérieur de la région sanitaire de Vancouver-Richmond et admissibles à la vaccination lors des six premiers mois du programme. L’étude évaluait aussi les déterminants reliés à l’attitude et au comportement des parents ou tuteurs vis-à-vis l’immunisation contre l’HB.

Méthode

Nous avons mené une étude transversale auprès d’un échantillon aléatoire d’enfants nés entre le 1er janvier et le 30 juin 2001. Les données concernant la couverture vaccinale ont été obtenues en consultant le système d’information de la santé publique de la Colombie-Britannique (PHIS) et en menant un sondage téléphonique entre les mois d’octobre 2002 et de janvier 2003 auprès des parents ou tuteurs de 487 enfants admissibles. Pour le sondage, nous avons interrogé les parents ou tuteurs, en utilisant l’échelle du document «Immunization Health Belief Model», au sujet de leurs attitudes et comportements à l’égard de la vaccination.

Résultats

La couverture vaccinale incluant au moins une dose du vaccin contre l’HB était de 89 %, et celle incluant trois doses du vaccin était de 78 %. L’immunisation contre l’HB était significativement associée (p<0,001) à la recommandation d’un professionnel de la santé. La crainte des effets secondaires indésirables était la principale raison évoquée par les parents pour refuser de faire vacciner leur enfant.

Discussion

Soixante-dix-huit p. cent des enfants ont reçu les trois doses de vaccin nécessaires pour être protégés contre l’HB. Les conseils et recommandations d’un médecin ou d’une infirmière ont fortement influencé le comportement des parents concernant l’immunisation de leurs enfants contre l’HB.

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References

  1. 1.
    World Health Organization, Hepatitis B immunization. Introducing hepatitis B into national immunization services. (Fact sheet.) Geneva, 2001 unpublished document WHO/V&B/01.28. Available online at: https://doi.org/www.who.int/vaccines-documents/DocsPDF01/www598.pdf (Accessed March 20, 2005).Google Scholar
  2. 2.
    Centers for Disease Control and Prevention. Hepatitis B virus: A comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination. MMWR 1991;40:RR-13:1–25.Google Scholar
  3. 3.
    National Advisory Committee on Immunization. Canadian Immunization Guide, 6th, ed. Ottawa, ON: Canadian Medical Association, 2002;53.Google Scholar
  4. 4.
    Krahn M, Guasparini R, Sherman M, Detsky, AS. Costs and cost effectiveness of a universal schoolbased hepatitis B vaccination program. Am J Public Health 1998;88(11):1638–44.CrossRefGoogle Scholar
  5. 5.
    Wiebe T, Fergusson P, Horne D, Shanahan M, Macdonald A, Heise L, Roos, LL. Hepatitis B immunization in a low-incidence province of Canada: Comparing alternative strategies. Med Decision Making 1997;17(4):472–82.CrossRefGoogle Scholar
  6. 6.
    Margolis HS, Coleman PF, Brown RE, Mast EE, Sheingold SH, Arevalo, JA. Prevention of hepatitis B virus transmission by immunization. JAMA 1995;274(15):1201–8.CrossRefGoogle Scholar
  7. 7.
    Krahn M, Detsky, AS. Should Canada and the United States universally vaccinate infants against hepatitis B? A cost-effectiveness analysis. Med Decision Making 1993;13(1):4–20.CrossRefGoogle Scholar
  8. 8.
    Dobson S, Scheifele D, Bell A. Assessment of a universal, school-based hepatitis B vaccination program. JAMA 1995;274(15):1209–13.CrossRefGoogle Scholar
  9. 9.
    Patrick DM, Bigham M, Ng H, White R, Tweed A, Skowronski, DM. Elimination of acute hepatitis B among adolescents after one decade of an immunization program targeting Grade 6 students. Pediatr Infect Dis J 2003;22(10):874–77.CrossRefGoogle Scholar
  10. 10.
    British Columbia. Provincial Health Officer. A report on the health of British Columbians: Provincial Health Officer’s annual report 1998. Feature report: Immunization. Victoria, BC: Ministry of Health, 1999. Available online at: https://doi.org/www.healthplanning.gov.bc.ca/pho/pdf/ phoannual1998.pdf (Accessed March 20, 2005).Google Scholar
  11. 11.
    Dawar M, Dobson S, Kallos A, LaJeunesse C, Weatherill S, Daly P. Measuring hepatitis B uptake in a new universal infant program. Can J Public Health 2002;93(4):281–84.PubMedGoogle Scholar
  12. 12.
    Provincial Health Officer of British Columbia. The Health and Wellbeing of People in British Columbia: Provincial Health Officer’s Annual Report 2002. Victoria, BC: Ministry of Health and Ministry Responsible for Seniors, 2002;1000. Available online at: https://doi.org/www.healthplanning.gov.bc.ca/pho/pdf/phoannual2002.pdf (Accessed March 20, 2005).Google Scholar
  13. 13.
    Statistics Canada. Births and birth rate, by provinces and territories. Available online at: https://doi.org/www40.statcan.ca/101/cst01/demo04a.htm (Accessed May 3, 2005).Google Scholar
  14. 14.
    BC Stats. BC Municipal Population Estimates 1996–2004. Available online at: https://doi.org/www.bcstats.gov.bc.ca/data/pop/pop/mun/Mun9604a.htm (Accessed May 3, 2005).Google Scholar
  15. 15.
    Lynn, MR. Determination and quantification of content validity. Nurs Res 1986;35:382–85.CrossRefGoogle Scholar
  16. 16.
    Pielak KL, Hilton A. University students immunized and not immunized for measles: A comparison of beliefs, attitudes and perceived barriers and benefits. Can J Public Health 2003;94(3):193–96.PubMedGoogle Scholar
  17. 17.
    Haimes K, Schouten H, Harris T, Belzak I, Canadian Immunization Registry Network. National Standards for Immunization Coverage Assessment: Recommendations from the Canadian Immunization Registry Network. Can Commun Dis Rep 2005;31(9):93–97.Google Scholar
  18. 18.
    Scheifele DW, LaJeunesse C, Marty K, Chen L. Comparison of physicians and health department staff as timely providers of childhood vaccines. BC Med J 1996;38(7):372–74.Google Scholar
  19. 19.
    Watts J. Review of immunization delivery. A cost-effectiveness analysis report for the Deputy Provincial Health Officer and the Director, Public and Preventive Health. Victoria, BC: Ministry of Health and Ministry Responsible for Seniors, 1998.Google Scholar
  20. 20.
    Kolasa MS, Bisgard KM, Prevots DR, Desai SN, Dibling K. Parental attitudes toward multiple poliovirus injections following a provider recommendation. Public Health Rep 2001;116(4):282–88.CrossRefGoogle Scholar
  21. 21.
    Larcher VF, Bourne J, Aitken C, Jeffries D, Hodes D. Overcoming barriers to hepatitis B immunisation by a dedicated hepatitis B immunisation service. Arch Dis Child 2001;84:114–19.CrossRefGoogle Scholar
  22. 22.
    Taylor JA, Darden PM, Slora E, Hasemeier CM, Asmussen L, Wasserman R. The influence of provider behavior, parental characteristics, and a public health initiative on the immunization status of children followed by private pediatricians: A study from pediatric research in office settings. Pediatr 1997;99(2):209–15.Google Scholar
  23. 23.
    Richards A, Sheridan J. Reasons for delayed compliance with the childhood vaccination schedule and some failings of computerised vaccination registers. Aust N Z J Public Health 1999;23(3):315–17.CrossRefGoogle Scholar
  24. 24.
    Bigham M, Copes R. Thimerosal in vaccines–a trade-off between its contribution to overall mercury exposure and risk of adverse effects versus the risk of vaccine-preventable disease. Drug Safety 2005;28(2):89–101.CrossRefGoogle Scholar
  25. 25.
    Health Canada. Canadian National Report on Immunization, 1996 Can Commun Dis Rep 1997;23(S4). Available online at: https://doi.org/www.phac-aspc.gc.ca/publicat/ccdrrmtc/97vol23/23s4/23s4k_e.html#six (Accessed May 12, 2005).
  26. 26.
    Bigham M, Scheifele D, Dobson S. Impact of the media on vaccine uptake in British Columbia’s grade 6 hepatitis b immunization program. CCDR 1999;25(10):89–93.PubMedGoogle Scholar
  27. 27.
    Gangarosa E, Galazka A, Wolfe C, Phillips LM, Gangarosa RE, Miller E, Chen, RT. Impact of anti-vaccine movements on pertussis control: The untold story. Lancet 1998;351:356–61.CrossRefGoogle Scholar
  28. 28.
    Ball LK, Evans G, Bostrom A. Risky business: Challenges in vaccine risk communication. Pediatr 1998;101(3):453–58.CrossRefGoogle Scholar
  29. 29.
    Halperin, SA. How to manage parents unsure about immunization. Can J Continuing Med Education 2000;62–74.Google Scholar
  30. 30.
    Stoto MA, Evans G, Bostrom A. Vaccine risk communication. Am J Prev Med 1998;14(3):237–39.CrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2006

Authors and Affiliations

  • M. Bigham
    • 1
  • V. P. Remple
    • 2
  • K. Pielak
    • 2
  • C. McIntyre
    • 2
  • R. White
    • 2
  • W. Wu
    • 2
  1. 1.Department of Health Care and Epidemiology, Canadian Blood Services, BC & Yukon Blood CentreUniversity of British ColumbiaVancouverCanada
  2. 2.British Columbia Centre for Disease ControlVancouverCanada

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