Knowledge, Attitudes and Perceptions About Routine Childhood Vaccinations Among Jewish Ultra-Orthodox Mothers Residing in Communities with Low Vaccination Coverage in the Jerusalem District
- 503 Downloads
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.
KeywordsRoutine immunizations Children Infants Toddlers Qualitative study
Maternal and Child Health
Diphtheria-Tetanus-acellular Pertussis-Polio-Haemophilus influenza B vaccine
Hepatitis B vaccine
Hepatitis A vaccine
- Andre, F. E., Booy, R., Bock, H. L., Clemens, J., Datta, S. K., John, T. J., Lee, B. W., Lolekha, S., Peltola, H., Ruff, T. A., Santosham, M., & Schmitt, H. J. (2008). Vaccination greatly reduces disease, disability, death and inequity worldwide. Bulletin of the World Health Organization, 86(2), 140–146.Google Scholar
- Benin, A. L., Wisler-Scher, D. J., Colson, E., Shapiro, E. D., & Holmboe, E. S. (2006). Qualitative analysis of mothers’ decision-making about vaccines for infants: the importance of trust. Pediatrics, 117(5), 1532–1541.Google Scholar
- Central Bureau of Statistics (2014). Statistical Abstract of Israel 2014; No. 65. Chapter 2. Population. Table 2.15. Population, by Population Group, Religion, Age and Sex, District and Sub-District. Central Bureau of Statistics, Jerusalem. http://www.cbs.gov.il/.
- Choshen, M., Doron, I., Assaf-Shapira, Y., Israeli, Y. (eds.) (2014). Statistical Yearbook of Jerusalem 2014; No. 28. Chapter IV. Vital Statistics. Table IV/5. Live Births, Crude Birth Rate and Total Fertility Rate in Israel, Jerusalem, Tel Aviv-Yafo and Haifa, by Population Group, 2006–2012. Jerusalem. http://www.jiis.org.il/.
- Constable, C., Blank, N. R., & Caplan, A. L.. (2014) Rising rates of vaccine exemptions: problems with current policy and more promising remedies. Vaccine, 32(16):1793–1797.Google Scholar
- Dubé, E., Vivion, M., & MacDonald N. E. (2015). Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: influence, impact and implications. Expert Review of Vaccines, 14(1), 99–117.Google Scholar
- Glanz, J. M., Kraus, C. R., & Daley, M. F.. (2015) Addressing parental vaccine concerns: engagement, balance, and timing. PLoS Biology, 13(8):e1002227Google Scholar
- Henderson, L., Millett, C., & Thorogood, N. (2008). Perceptions of childhood immunization in a minority community: Qualitative study. Journal of the Royal Society of Medicine, 101(5), 244–251.Google Scholar
- Israel: WHO and UNICEF estimates of immunization coverage (2014) revision http://www.who.int/immunization/monitoring_surveillance/data/isr.pdf.
- Kaufman, J., Synnot, A., Ryan R., Hill, S., Horey, D., Willis, N, Lin, V., & Robinson P (2013). Face to face interventions for informing or educating parents about early childhood vaccination. Cochrane Database of Systematic Reviews, 5, CD 010038. doi: 10.1002/14651858.CD010038.pub2.
- Link-Gelles, R., Chamberlain, A. T., Schulkin, J., Ault, K., Whitney, E., Seib, K., & Omer, S. B. (2012). Missed opportunities: a national survey of obstetricians about attitudes on maternal and infant immunization. Maternal and Child Health Journal, 16 (9), 1743–1747.Google Scholar
- Mills, E., Jadad, A. R., Ross, C., & Wilson, K. (2005). Systematic review of qualitative studies exploring parental beliefs and attitudes toward childhood vaccination identifies common barriers to vaccination. Journal of Clinical Epidemiology, 58(11), 1081–1088.Google Scholar
- Muhsen K, Abed El-Hai R, Amit-Aharon A, Nehama H, Gondia M, Davidovitch N, Goren S, & Cohen D (2012). Risk factors of underutilization of childhood immunizations in ultraorthodox Jewish communities in Israel despite high access to health care services. Vaccine. 30 (12):2109–2015.Google Scholar
- Opel, D. J., Mangione-Smith, R., Taylor, J. A., Korfiatis, C., Wiese, C., Catz, S., & Martin, D. P. (2011). Development of a survey to identify vaccine-hesitant parents: the parent attitudes about childhood vaccines survey, Human Vaccines. 7 (4):419–425.Google Scholar
- Paltiel A, Sepulchre M, Kornilenko I, & Maldonado M. (2012). Long-Range Population Projections for Israel: 2009-2059. Central Bureau of Statistics, Jerusalem. http://www.cbs.gov.il/.
- Roberts L. ( 2013) Infectious disease. Israel’s silent polio epidemic breaks all the rules. Science, 342(6159):679–80.Google Scholar
- Saeterdal, I., Lewin, S., Austvoll-Dahlgren, A., Glenton, C., & Munabi-Babigumira, S. (2014). Interventions aimed at communities to inform and/or educate about early childhood vaccination. Cochrane Database of Systematic Reviews, 11:CD 010232. doi: 10.1002/14651858.CD010232.pub2.
- Shkedi, A. (2014) Qualitative Data Analysis with an Essential Software Tool. Tel Aviv: Contento de Semrik.Google Scholar
- Simhi, M., Shraga, Y., & Sarid, O. (2013). Vaccination of infants and health beliefs of ultra-orthodox Mothers. Journal of Vaccines & Vaccination, 5, 213. doi: 10.4172/2157-7560.1000213.
- Stein-Zamir, C., Abramson, N., Shoob, H., & Zentner, G.. (2008). An outbreak of measles in an ultra-orthodox Jewish community in Jerusalem, Israel, 2007–an in-depth report. Euro SurveillIance, 13 (8), 1854–1861.Google Scholar
- Stein-Zamir, C., Zentner, G., Tallen-Gozani, E., & Grotto, I. (2010). The Israel National Immunization Registry. The Israel Medical Association journal: IMAJ, 12(5), 296–300.Google Scholar
- Stein-Zamir, C., Shoob, H., Abramson, N., & Zentner, G. (2012). Who are the children at risk? Lessons learned from measles outbreaks. Epidemiology and Infection, 140(9), 1578–1588.Google Scholar
- Stein-Zamir, C., Schroeder, H., Shoob, H., Abramson, N., & Zentner, G. (2015). Characteristics of a large mumps outbreak: Clinical severity, complications and association with vaccination status of mumps outbreak cases. Human Vaccines & Immunotherapeutics, 11 (6), 1413–1417.Google Scholar
- Subaiya, S., Dumolard, L., Lydon, P., Gacic-Dobo, M., Eggers, R., & Conklin, L. (2015). Centers for Disease Control and Prevention (CDC)Global routine vaccination coverage 2014. MMWR The Morbidity and Mortality Weekly Report, 64(44): 1252–1255.Google Scholar
- Taylor, J. A., & Newman, R. D. (2000). Parental attitudes toward varicella vaccination. The Puget Sound Pediatric Research Network. Archives of Pediatrics and Adolescent Medicine, 154 (3), 302–306.Google Scholar
- Velan, B., Boyko, V., Lerner-Geva, L., Ziv, A., Yagar, Y., & Kaplan, G.. (2012) Individualism, acceptance and differentiation as attitude traits in the public’s response to vaccination. Human Vaccines & Immunotherapeutics, 8 (9):1272–82.Google Scholar
- Wallace, A. S., Ryman, T. K., & Dietz, V. (2012). Experiences integrating delivery of maternal and child health services with childhood immunization programs: systematic review update. The Journal of infectious Diseases, 205 (Suppl 1), S6–S19.Google Scholar
- Wu, A. C., Wisler-Sher, D. J., Griswold, K., Colson, E., Shapiro, E. D., Holmboe, E. S., & Benin, A. L. (2008). Postpartum mothers’ attitudes, knowledge, and trust regarding vaccination. Maternal and Child Health Journal, 12 (6), 766–773.Google Scholar