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Thèse d'exercice : Médecine. Médecine générale : Université de Nantes : 2005. / Bibliogr. f. 108-111 [43 réf.].

Introduction: Seasonal influenza is believed to be a common attribution of morbidity and mortality in the children population, and it causes huge disease burden worldwide. Although seasonal influenza vaccination is recommended as the most effective prevention by the World Health Organization and vaccination programs for children have been introduced in many countries, vaccination coverage remains low. Parents are primary decision makers for their children's immunization, therefore it is important to understand the determinants that influence parents' decision-making to provide important information for promoting vaccination uptake against seasonal influenza among children. Objective: To synthesize factors that influence parental decision on children's vaccination against seasonal influenza from published literature. Method: Literature reported factors that influenced parental decision on children's vaccination against seasonal influenza published before/on 31th May, 2013 were searched in PubMed and Web of Science databases. Manual searching was also performed for the citations of the retrieved papers. Both qualitative and quantitative articles consistent with the objective were searched from PubMed and Web of Science databases on 31th May, 2013. Records were screened in the sequence of title, abstract and full text to identify eligible studies, and references of eligible studies were also scrutinized to avoid missing important articles. Influencing factors were extracted from included papers, and the identified factors that influenced parental decision making were then discussed based on theoretical behavioral models. Results: Totally 32 articles met the inclusion criteria. Factors associated with parental decision included demographic factors, which consisted of parental and children’s age, parental gender, ethnicity, household income, residence, insurance status, family characters, parental education level, and children’s health history; psychological factors, including attitudes towards influenza vaccination, knowledge of influenza and vaccination, perceived risk of seasonal influenza, and emotional factors; past behaviors comprising previous frequency of using health care services, children’s seasonal influenza vaccination history, previous absenteeism from school or work, social norm referring cues to action and subjective norms; and environmental factors, meaning access to vaccination facilities. Discussion: An integrated framework based on the Health Belief Model, Triandis’ Theory of Interpersonal Behavior and the Theory of Reasoned Action was constructed to explain the findings. The framework proposes that the parents’ intention to vaccinate their children against seasonal influenza is influenced by demographic variables, attitude towards seasonal influenza vaccination, knowledge and perception of influenza/influenza vaccine, social norms (cues to action and subjective norms), emotion, and past behavior/experience; easy access to vaccination providers as a facilitating condition additionally determine the possibility of turning intention into actual behavior. Interventions such as providing positive knowledge relevant to seasonal influenza vaccination, targeting less intended and more influential decision-makers, ensuring sufficient access to vaccination, and creating action cues may be implemented to promote uptake of seasonal influenza vaccination among children. / published_or_final_version / Public Health / Master / Master of Public Health

Thesis (M.D.)--Columbia College, 1803. / Microform version available in the Readex Early American Imprints series.

L’impact des programmes de vaccination repose, en partie, sur la proportion des personnes ciblées qui reçoivent les vaccins recommandés, soit la couverture vaccinale. Au Québec dans les dix dernières années, le programme de vaccination chez les enfants avant l’âge de 24 mois a subi plusieurs changements, qui peuvent avoir eu un impact sur les couvertures vaccinales et les retards vaccinaux. Un retard vaccinal à une visite influence l’administration à temps des doses subséquentes. Plusieurs études ont documenté l’impact d’un retard à la première visite sur le statut vaccinal, mais l’impact des retards aux autres visites a été peu décrit. Depuis 2006, des enquêtes postales sont réalisées à tous les deux ans auprès d’enfants de 1 an et 2 ans afin d’évaluer la couverture vaccinale. Ces enquêtes prévoient jusqu’à 4 contacts auprès des participants potentiels pour maximiser la participation ainsi qu’une validation auprès des vaccinateurs des données vaccinales obtenues avec le carnet pour les enfants avec un statut vaccinal incomplet. Nous avons utilisé les données des enquêtes de 2006 à 2016 afin d’évaluer l’impact de l’ajout de nouveaux vaccins, des retards vaccinaux et des méthodes de collecte de l’information vaccinale sur l’estimation de la couverture vaccinale. Les analyses ont été réalisées auprès de 7183 enfants nés au Québec, dont 3508 enfants de la cohorte 2 ans. Nous avons observé que la couverture vaccinale à 24 mois pour les antigènes présents au calendrier depuis 2006 n’a pas diminué avec l’ajout des nouveaux antigènes et qu’elle a même augmenté pour les enquêtes réalisées en 2014 et 2016. En 2016, la couverture vaccinale à l’âge de 24 mois pour les antigènes déjà au programme était de 88,3 % et de 78,2 % lorsque tous les antigènes étaient considérés. La couverture vaccinale pour les nouveaux antigènes augmentait progressivement après leur introduction, mais demeurait inférieure à celle pour les antigènes déjà au programme. Nous avons également observé que la prévalence des retards vaccinaux augmentait selon les visites prévues à 2, 4, 6 et 12 mois et que l’impact des retards vaccinaux sur le statut vaccinal à l’âge de 24 mois était important pour les visites de vaccination après celle de 2 mois. Parmi les enfants avec un statut vaccinal incomplet à 24 mois, 16,1 % étaient attribuables à un retard à 2 mois, 10,6 % à un retard à 4 mois, 14,0 % à un retard à 6 mois et 31,8 % à un retard à 12 mois. Toutefois, environ les trois quarts des enfants qui présentaient un retard à la visite de 2 mois avaient un retard à une visite subséquente. Des facteurs associés à un statut vaccinal incomplet à 24 mois et à la présence de retards vaccinaux ont été identifiés afin de définir les populations les plus vulnérables qui pourraient bénéficier d’un suivi particulier. En se basant seulement sur les données du carnet, la couverture vaccinale aurait été sous-estimée de 5,5 % à 23,7 % dépendamment de l’année de l’enquête. Nous avons aussi comparé la couverture vaccinale à 24 mois entre les répondants à chacune des 4 étapes de la collecte des données. La proportion d’enfants complètement vaccinés était significativement plus élevée de 7,8 % chez les enfants des parents ayant répondu au 1er contact comparativement à ceux ayant répondu au 3e contact, mais seulement 2,1 % plus élevée que celle estimée parmi tous les répondants. L’ajout de répondants à chacune des étapes a permis d’augmenter le taux de réponse de l’enquête, mais a eu un impact limité sur la validité des estimés. Pour terminer, les enquêtes de couverture vaccinale sont essentielles pour évaluer la pénétration des programmes de vaccination et leur évolution dans le temps. L’évaluation des retards vaccinaux permet d’avoir un meilleur portrait de la vulnérabilité de la population. Il faudrait également considérer les autres visites dans la planification des interventions visant à réduire les délais dans l’administration des vaccins en plus de la visite de 2 mois. La validation des données de vaccination auprès d’autres sources doit être poursuivie afin de limiter la possibilité d’un biais d’information, mais peut être restreinte aux enfants avec un statut incomplet. Afin de mieux évaluer les bénéfices de réaliser plusieurs tentatives de contacts, il serait utile que les enquêtes de couverture vaccinales similaires à celle réalisée dans le cadre de ce projet présentent la couverture vaccinale estimée auprès des répondants à chacune des étapes. / The impact of vaccination programs depends upon the proportion of the target population who have received the recommended vaccines, i.e. vaccination coverage. In Quebec (Canada), during the last ten years, many new vaccines were added in the vaccination schedule for children under 24 months of age and this may have decreased the vaccination coverage and increased vaccine delays. Vaccine delay at one visit had an impact of on-time administration of subsequent doses. Many studies had shown that vaccine delays at first vaccines on the vaccination status, but there are scarce data regarding the impact of vaccine delays at other visits. Since 2006, vaccination coverage surveys are conducted every two years among children aged 1 and 2 years of age. These studies included up to four attemps to contact eligible individuals and data from vaccine booklets were supplemented by data from vaccine providers for children with missing doses. We used data collected from 2006 to 2016 to evaluate the impact of the addition of new vaccines in the early childhood schedule, the impact of vaccine delays and the impact of methods used to collect vaccination information. Analyses were realised with the 7183 children born in Québec; including 3508 children from the 2-year cohort. We observed that vaccination coverage by 24 months did not decrease with the addition of new vaccines for antigens included in the schedule since 2006 and was in fact higher in 2014 and 2016. In 2016, vaccination coverage for antigens in the schedule since 2006 was of 88.3% and of 78.2% including all recommended antigens. The vaccination coverage for new antigens increased rapidly after their introduction but remained lower than vaccination coverage for antigens in the schedule since 2006. We observed that the prevalence of vaccine delays increased by vaccination visits at 2, 4, 6 and 12 months and that the impact of vaccine delays on incomplete vaccination status by 24 months was important for delays after the 2-month visit. Among children with an incomplete vaccination status by 24 months, 16.1% were attributable with a first vaccine delay (2 mois), 10.6% at 4 months, 14.0% at 6 months and 31.8% at 12 months. However, about 75% of children with a vaccine delay at 2 months also had vaccine delays at later visits. Factors associated with an incomplete vaccination status by 24 months and with vaccine delays were assessed to identify more vulnerable populations who may required a particular follow-up. Without validation among vaccine providers in our study, the vaccination coverage by 24 months would have been underestimated from 5.5% to 23.7 depending on the survey year. We have compared vaccination coverage by 24 months between each contacts among potential respondents. We observed that the proportion fully vaccinated by 24 months of age was significantly 7.8% higher in children whose parents responded to the first rather than the third contact, but it was only 2.1% higher when comparing respondents to contact 1 and all respondents. Conducting multiple contact attempts increased the overall response rate, but had limited impact on the validity of estimates. To conclude, vaccination coverage studies are essential to evaluate the impact of vaccination programs and trends over the years. Monitoring of vaccine delays provide more information regarding the susceptibility of the population. Intervention to improve timeliness should address delays at each visit and not only focus on the first visit. In addition, validation of vaccination data among other sources is necessary to limit the presence of information bias in vaccination coverage studies, but may be restricted to children incompletely vaccinated. To better evaluate the benefit of multiple contacts it would be useful for future similar vaccination surveys to present the coverage obtained from respondants to each contact.

Thesis (Ph. D.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Dissertation Abstracts International, Volume: 68-10, Section: B, page: 6566. Adviser: Beatrice J. Selwyn. Includes bibliographical references.

As key members of the school environment, it is important for school employees to be vaccinated. Employees are in direct contact with children in close quarters for long periods of time and such an environment can easily serve as an outbreak center for vaccine-preventable communicable diseases such as measles. Despite the fact that most school employees believe vaccines are safe and effective and many school employees report they are up-to-date with their vaccines, a closer examination reveals discrepancy between belief and behavior. As a vaccine advocate, the school nurse can be influential in providing adult vaccination education for school employees, thus increasing awareness of the importance of adult vaccines and knowing one's vaccination status. Additionally, school nurses might need to meet with school district policymakers to promote vaccine mandates for school employees and to assist in the creation of containment plans in the event of a measles outbreak at school.

Schools are group settings where vaccine-preventable diseases can spread quickly, especially if vaccination rates are suboptimal. Vaccination of school children has been the subject of many studies; however, data are lacking regarding the vaccination status, vaccination perceptions, and potential barriers to vaccination for school employees. Method: A questionnaire was developed to measure school employees' perceptions,awareness of current vaccination status, and potential barriers to vaccinations. This study included a convenience sample of 277 employees from a small urban school district located in central Utah. Results: Adult vaccination knowledge is lacking in the school employee population, with over half believing they were fully vaccinated even though 57.8% had not had an influenza vaccination this season. Many school employees were unaware of their vaccination status for highly virulent diseases such as measles and pertussis. In addition, most subjects believed vaccinations were safe and effective, although they believed vaccinations were more important for children than adults. Almost half of respondents believed vaccine mandates should exist for school employees. Conclusion: Knowledge gaps regarding adult vaccines can be positively influenced by nurses, especially school nurses. These knowledge gaps may be especially important to bridge concerning adults working in the school setting, an environment ideal for the spreading of communicable diseases.

Thèse d'exercice : Médecine. Médecine générale : Paris 12 : 2006. / Titre provenant de l'écran-titre. Bibliogr. f. 138-155.

Reproduction de : Thèse d'exercice : Médecine. Médecine générale : Nantes : 2009. / Bibliogr.