Maternal and Child Health Journal

, Volume 21, Issue 5, pp 1010–1017 | Cite as

Knowledge, Attitudes and Perceptions About Routine Childhood Vaccinations Among Jewish Ultra-Orthodox Mothers Residing in Communities with Low Vaccination Coverage in the Jerusalem District

  • Chen Stein ZamirEmail author
  • Avi Israeli
From the Field


Background and aims Childhood vaccinations are an important component of primary prevention. Maternal and Child Health (MCH) clinics in Israel provide routine vaccinations without charge. Several vaccine-preventable-diseases outbreaks (measles, mumps) emerged in Jerusalem in the past decade. We aimed to study attitudes and knowledge on vaccinations among mothers, in communities with low immunization coverage. Methods A qualitative study including focus groups and semi-structured interviews. Results Low immunization coverage was defined below the district’s mean (age 2 years, 2013) for measles-mumps-rubella-varicella 1st dose (MMR1\MMRV1) and diphtheria-tetanus-pertussis 4th dose (DTaP4), 96 and 89%, respectively. Five communities were included, all were Jewish ultra-orthodox. The mothers’ (n = 87) median age was 30 years and median number of children 4. Most mothers (94%) rated vaccinations as the main activity in the MCH clinics with overall positive attitudes. Knowledge about vaccines and vaccination schedule was inadequate. Of vaccines scheduled at ages 0–2 years (n = 13), the mean number mentioned was 3.9 ± 2.8 (median 4, range 0–9). Vaccines mentioned more often were outbreak-related (measles, mumps, polio) and HBV (given to newborns). Concerns about vaccines were obvious, trust issues and religious beliefs were not. Vaccination delay was very common and timeliness was considered insignificant. Practical difficulties in adhering to the recommended schedule prevailed. The vaccinations visits were associated with pain and stress. Overall, there was a sense of self-responsibility accompanied by inability to influence others. Conclusion Investigating maternal knowledge and attitudes on childhood vaccinations provides insights that may assist in planning tailored intervention programs aimed to increase both vaccination coverage and timeliness.


Routine immunizations Children Infants Toddlers Qualitative study 



Vaccine-Preventable Diseases


Maternal and Child Health


Diphtheria-Tetanus-acellular Pertussis-Polio-Haemophilus influenza B vaccine


Hepatitis B vaccine


Pneumococcal vaccine


Rotavirus vaccine


Measles-Mumps-Rubella-Varicella vaccine


Hepatitis A vaccine


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Faculty of medicine, the Hebrew University and Hadassah Braun School of Public and Community MedicineThe Hebrew University of JerusalemJerusalemIsrael
  2. 2.Jerusalem District Health OfficeMinistry of HealthJerusalemIsrael
  3. 3.Faculty of medicine, the Hebrew University and Hadassah Braun School of Public and Community Medicine, Department of Health Policy and ManagementThe Hebrew University of JerusalemJerusalemIsrael

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