Canadian paediatricians’ opinions on rotavirus vaccination
Introduction
Rotavirus is a common infectious agent that is transmitted by the faecal–oral route, through both close person-to-person contact and through fomites. It produces a spectrum of disease that ranges from asymptomatic infection to vomiting and mild watery diarrhea to severe gastroenteritis (GE). Children with severe cases of GE are often hospitalized so that adequate intravenous or oral rehydration can be adequately provided. Globally, the viruses cause over 25 million outpatient visits, over 2 million hospitalizations and approximately half a million deaths each year among children under 5 years of age. More than 80% of deaths attributable to rotavirus occur in developing countries [1], [2]. Rotavirus-associated diarrhea is usually more severe than diarrhea with other etiologies and remains the leading cause of dehydration and hospitalization due to GE in young children [3], [4]. Virtually all children are infected by the time they reach 2–3 years of age [5]. Severe, dehydrating GE occurs primarily among children aged 4–23 months [2].
Existing epidemiologic data show that the burden of the rotaviral disease is substantial in Canada [6], [7]. Overall, 10–40% of all childhood GE are caused by rotavirus annually [8]. Rotavirus is associated with considerable health care utilization, with approximately 36% of children with rotavirus seeing a physician, 15% visiting an emergency department and 7% requiring hospitalization [9]. In Ontario and Quebec as much as 72% of childhood GE hospitalizations in children under 5 years of age were estimated to be due to rotavirus [3], [10]. Jacobs and collaborators estimated that societal costs of rotavirus-associated diarrhea varied from $396 per case treated in physician's office, to $809 per case treated in the emergency room (non hospitalized), and to $2690 per hospitalized case. In this study, mean cost due to work loss of parents was estimated at $565 per case [11]. In addition, rotavirus infection has a negative impact on the health-related quality of life of affected children and their families [12].
Vaccination appears to be the most effective way of rotavirus infection control and prevention of severe cases [8]. In 2006, the pentavalent human–bovine reassortant rotavirus vaccine (RotaTeq®, Merck) and, in 2008, the monovalent human reassortant rotavirus vaccine (Rotarix®, GlaxoSmithKline) were approved for clinical use in Canada [8], [13]. These vaccines have been shown to provide 90–100% protection against severe rotavirus disease and 74–85% protection against rotavirus disease of any severity. Both vaccines have an excellent safety profile [1].
The National Advisory Committee on Immunization in Canada (NACI) recommends to offer rotavirus vaccines to infants whose parents/guardians wish to reduce the risk of rotavirus infection. NACI also stated that the decision to include rotavirus vaccines in publicly funded programs will depend upon multiple factors including cost-benefit evaluations [14].
In the context where rotavirus vaccination is recommended, but not publicly funded, vaccine uptake depends largely upon whether health professionals recommend it to parents. In the United States, the withdrawal of the first rotavirus vaccine (RotaShield®, Wyeth–Lederle) more than one decade ago left long-lasting legacy and several studies have identified parents’ and physicians’ concerns about rotavirus vaccines safety as a potential major vaccine acceptance barrier [15], [16], [17], [18]. This vaccine has never been licensed in Canada.
We conducted a countrywide survey of paediatricians to assess their knowledge, attitudes and beliefs (KAB) about rotavirus diseases and its prevention by vaccination as well as to determine paediatricians’ intention to recommend rotavirus vaccination to their patients.
Section snippets
Materials and methods
A self-administered, anonymous, mail-based questionnaire was sent in summer of 2009 to all 1852 Canadian paediatricians, except subspecialists. The Canadian Medical Directory [19] was used to identify potential participants. During fall of 2009, two reminders were sent to paediatricians who had not responded to others mailings. To facilitate the sending of reminders and to maintain the anonymity of participants, a separate reply postcard was provided with each questionnaire. A multidisciplinary
Results
After exclusion of physicians no longer practicing, those with incorrect addresses or those who were subspecialists, the overall participation rate was 50% (912/1832). Overall participation rate was 50% (912/1832). Participation rates by country regions varied from 40.1% in Prairies to 57.7% in Quebec (p < 0.0001). Of the 912 paediatricians who completed the survey, 51% spent more than 21 h per week in outpatient consultation, 57% were women, 57% had been practicing for 15 years or longer, and 55%
Discussion
Several studies have identified health professionals’ knowledge and attitudes about vaccination as major factors in vaccine uptake [25], [26], [27]. Paediatricians consistently have been strong supporters of vaccination programs [28], [29]. In our study, more than 97% of respondent strongly agreed or agreed that vaccines routinely used in Canada are very useful. However, only 64% of respondents strongly agreed or agreed that rotavirus vaccines are effective and 59%, that a publicly funded
Conflict of interest
This study was financially supported by an unrestricted grant from GlaxoSmithKline. No private company or their employees were involved in study protocol/questionnaire designing, data collection or data analysis and interpretation.
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2018, Social Science and MedicineCitation Excerpt :Nonetheless, Gust et al., (2008, p. 574) found that the majority (89%) of paediatricians and family doctors whom they surveyed recommended all vaccinations for children. These studies and others found variation in health professionals’ anxieties about both vaccine refusal and vaccine acceptance (see Dubé et al., 2011, pp. 3178–3179; Loulergue et al., 2009, pp. 4242–4243; Smailbegovic et al., 2003). The question these studies did not answer is: how do health professionals explain their anxieties and uncertainties about specific vaccines?
Knowledge, attitudes, beliefs, and behaviors of parents and healthcare providers before and after implementation of a universal rotavirus vaccination program
2016, VaccineCitation Excerpt :However, a national recommendation, public funding, and support by professional organizations substantially increase the proportion of physicians who would recommend and provide the vaccine to their patients [19,23]. In both the US [24] and Canada [25,26], pediatricians tend to have more positive attitudes toward rotavirus vaccination than family physicians. In our study, the physicians surveyed were overwhelmingly family physicians, as pediatricians, in general, do not provide primary care in the jurisdictions studied.
Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007-2012
2014, VaccineCitation Excerpt :Interestingly, most of the other studies identifying aspects of knowledge as explanatory factors related to health providers responsible for vaccination. Specifically, a greater sense of confidence in personal knowledge and training in vaccination was found to act as a promoter, in terms of recommending vaccines, in France [74], Canada [66,75], New Zealand [76] and Pakistan [56]. Perceived medical severity of the VPD by health providers was also found as a promoter in USA [77], Canada [66,75] and The Netherlands [62], and when the VPD was considered less severe, it was reported as a barrier in the USA [57].
Maternal knowledge, attitudes and beliefs regarding gastroenteritis and rotavirus vaccine before implementing vaccination program: Which key messages in light of a new immunization program?
2012, VaccineCitation Excerpt :Consequently, the adoption of the new rotavirus vaccine by physicians should be a primary goal included in the promotion of the immunization program. In fact, in a Canadian survey only 53% of pediatricians professed a strong intention of recommending rotavirus vaccination and only 59% thought that it would be very useful to introduce a publicly funded rotavirus vaccination program [31]. Furthermore, Canadian nurses and family physicians have also shown a lower level of support for the rotavirus vaccines, with only 43% of nurses and 45% of family physicians admitting a strong intention of recommending rotavirus vaccines to their patients [31,32].