World Journal of Pediatrics

, Volume 13, Issue 1, pp 84–90 | Cite as

Parental attitudes towards influenza vaccination for children in South India

  • Chethan Ramprasad
  • Rajeev Zachariah
  • Mark Steinhoff
  • Anna Simon
Original article



The rate of influenza vaccination is low for children in India. The purpose of this study is to assess parental attitudes towards influenza vaccination in South India.


Participants were parents who brought their children to the Well Baby Clinic of Christian Medical College Hospital, Vellore, India for routine immunization. Participants answered questions by written survey while waiting for their children’s vaccination.


A total of 456 surveys were completed (403 parents did not opt for trivalent influenza vaccination and 53 opted for influenza vaccination). The majority (53.60%) of those parents who did not accept influenza vaccination identified the lack of a doctor’s recommendation as the main reason. When asked separately, many non-acceptors (44.91%) indicated that they did not believe or were not sure that the influenza vaccine was effective. Nearly all non-acceptors (92.56%) stated that they would opt for influenza vaccination if a doctor recommended it.


The most common reason that parents not opting for influenza vaccination for their children was the lack of recommendation by a doctor. The results of this study suggest that recommendation by a doctor is a more important factor than belief in efficacy, cost, or convenience in parental decision-making regarding childhood influenza vaccination in India, unlike the United States where parents are less likely to follow recommendations.

Key words

doctor recommendation influenza immunization parental attitudes vaccination 


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We wish to thank the Christian Medical College Hospital Well Baby Clinic Staff. We would like to thank Dr. Rajiv Sarkar with help with statistical analysis as well as Mr. A.S. Bhagavan Doss, Mrs. Malar, and Mrs. Prema Hema Latha for their work with survey translation as well as Mr. Prakash, Mrs. Malar, Mrs. Rajula, Mrs. Backiavathy Rajesh, Mrs. Joy Navarathinam, Mrs. Karuna Karan, Mr. Ravi, Mr. Srinivasan, Miss Nirmala, and Mrs. Hepsibai Judsia Juliana for their time and efforts in helping to collect the data and to complete this study.


  1. 1.
    John TJ, Cherian T, Steinhoff MC, Simoes EA, John M. Etiology of acute respiratory infections in children in tropical southern India. Clin Infect Dis 1991;13 Suppl 6:S463–469.CrossRefGoogle Scholar
  2. 2.
    Mazumdar J, Chawla-Sarkar M, Rajendran K, Ganguly A, Sarkar UK, Ghosh S, et al. Burden of respiratory tract infections among paediatric in and out-patient units during 2010-11. Eur Rev Med Pharmacol Sci 2013;17:802–808.PubMedGoogle Scholar
  3. 3.
    Yeolekar LR, Damle RG, Kamat AN, Khude MR, Simha V, Pandit AN. Respiratory viruses in acute respiratory tract infections in Western India. Indian J Pediatr 2008;75:341–345.CrossRefPubMedGoogle Scholar
  4. 4.
    Broor S, Dawood FS, Pandey BG, Saha S, Gupta V, Krishnan A, et al. Rates of respiratory virus-associated hospitalization in children aged <5 years in rural northern India. J Infect 2014;68:281–289.CrossRefPubMedGoogle Scholar
  5. 5.
    Chadha MS, Broor S, Gunasekaran P, Potdar VA, Krishnan A, Chawla-Sarkar M, et al. Multisite virological influenza surveillance in India: 2004-2008. Influenza Other Respir Viruses 2012;6:196–203.CrossRefPubMedGoogle Scholar
  6. 6.
    Broor S, Krishnan A, Roy DS, Dhakad S, Kaushik S, Mir MA, et al. Dynamic patterns of circulating seasonal and pandemic A(H1N1)pdm09 influenza viruses from 2007-2010 in and around Delhi, India. PLoS One 2012;7:e29129.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Roy S, Patil D, Dahake R, Mukherjee S, Athlekar SV, Deshmukh RA, et al. Prevalence of influenza virus among the paediatric population in Mumbai during 2007-2009. Indian J Med Microbiol 2012;30:155–158.CrossRefPubMedGoogle Scholar
  8. 8.
    Broor S, Parveen S, Bharaj P, Prasad VS, Srinivasulu KN, Sumanth KM, et al. A prospective three-year cohort study of the epidemiology and virology of acute respiratory infections of children in rural India. PloS One 2007;2:e491.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Brooks WA, Goswami D, Rahman M, Nahar K, Fry AM, Balish A, et al. Influenza is a major contributor to childhood pneumonia in a tropical developing country. Pediatr Infect Dis J 2010;29:216–221.CrossRefPubMedGoogle Scholar
  10. 10.
    Henkle E, Steinhoff MC, Omer SB, Roy E, Arifeen SE, Raqib R, et al. Incidence of influenza virus infection in early infancy: a prospective study in South Asia. Pediatr Infect Dis J 2011;30:170–173.CrossRefPubMedGoogle Scholar
  11. 11.
    Bali NK, Ashraf M, Ahmad F, Khan UH, Widdowson MA, Lal RB, et al. Knowledge, attitude, and practices about the seasonal influenza vaccination among healthcare workers in Srinagar, India. Influenza Other Respir Viruses 2013;7:540–545.CrossRefPubMedGoogle Scholar
  12. 12.
    Suresh PS, Thejaswini V, Rajan T. Factors associated with 2009 pandemic influenza A (H1N1) vaccination acceptance among university students from India during the post-pandemic phase. BMC Infect Dis 2011;11:205.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Bhaskar E, Thobias S, Anthony S, Kumar V, Navaneethan. Vaccination rates for pandemic influenza among pregnant women: An early observation from Chennai, South India. Lung India 2012;29:232–235.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Koul PA, Bali NK, Ali S, Ahmad SJ, Bhat MA, Mir H, et al. Poor uptake of influenza vaccination in pregnancy in northern India. Int J Gynaecol Obstet 2014;127:234–237CrossRefPubMedGoogle Scholar
  15. 15.
    IAP 2012, Immunization Schedule 0-6 years. (accessed December 19, 2012)Google Scholar
  16. 16.
    Santibanez T, Singleton J, Greby S, Kennedy E, Clark S, Gebremariam A, 2012. “National Early Season Flu Vaccination Coverage.” Center for Disease Control. Available: (accessed March 9, 2013).Google Scholar
  17. 17.
    Rhorer J, Ambrose CS, Dickinson S, Hamilton H, Oleka NA, Malinoski FJ, et al. Efficacy of live attenuated influenza vaccine in children: a meta-analysis of nine randomized clinical trials. Vaccine 2009;27:1101–1110.CrossRefPubMedGoogle Scholar
  18. 18.
    Ferdinands JM, Olsho LE, Agan AA, Bhat N, Sullivan RM, Hall M, et al. Effectiveness of influenza vaccine against lifethreatening RT-PCR-confirmed influenza illness in US children, 2010-2012. J Infect Dis 2014;210:674–683.CrossRefPubMedGoogle Scholar
  19. 19.
    Sullender W, Fowler K, Krishnan A, Gupta V, Moulton LH, Lafond K, et al. Design and initiation of a study to assess the direct and indirect effects of influenza vaccine given to children in rural India. Vaccine 2012;30:5235–5239.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Chadha MS, Broor S, Gunasekaran P, Potdar VA, Krishnan A, Chawla-Sarkar M, et al. Multisite virological influenza surveillance in India: 2004-2008. Influenza Other Respir Viruses 2012;6:196–203.CrossRefPubMedGoogle Scholar
  21. 21.
    Janz NK, Becker MH. The health belief model: A decade later. Health Educ Q 1984;11:1–47.CrossRefPubMedGoogle Scholar
  22. 22.
    Szilagyi PG, Rodewald LE, Savageau J, Yoos L, Doane C. Improving influenza vaccination rates in children with asthma: a test of a computerized reminder system and an analysis of factors predicting vaccination compliance. Pediatrics 1992;90:871–875.PubMedGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine and Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Chethan Ramprasad
    • 1
  • Rajeev Zachariah
    • 2
  • Mark Steinhoff
    • 3
  • Anna Simon
    • 2
  1. 1.University of Miami Miller School of MedicineMiamiUSA
  2. 2.Christian Medical CollegeVelloreIndia
  3. 3.Cincinnati Children’s Hospital Medical CenterCincinnatiUSA

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