PARENT AND HEALTHCARE PROVIDER (HCP) ATTITUDES TOWARD INTRODUCTION OF NEW VACCINES INTO NATIONAL IMMUNISATION SCHEDULES: ONLINE SURVEY RESULTS

P. Bakhache¹, C. Rodrigo², S. Davie³, A. Ahuja⁴, B. Sudovar⁴, T. Crudup⁵, M. Rose⁶

¹Infovac France Expert, French Association of Ambulatory Paediatrics (AFPA), St Quentin, France; ²Department of Paediatrics, Paediatric Infectious Disease and Immunodeficiencies Unit, Universidad Autónoma de Barcelona, Germans Trias i Pujol University Hospital, Barcelona, Spain; ³Meningitis Trust, Gloucestershire, UK; ⁴Novartis Vaccines and Diagnostics, Inc., Cambridge, MA, USA; ⁵Ipsos Healthcare, Plymouth Meeting, PA, USA; ⁶Paediatric Infectious Diseases, Children’s Hospital, Goethe University, Frankfurt/Main, Germany

INTRODUCTION• Adding any new vaccine in early infancy will require additional vaccination visits or co-administration with other routine vaccines.• Current practice typically involves co-administration of 2 or 3 (depending on country) vaccines concomitantly, and adding a vaccine to the routine schedule would increase this number to 3 or 4 injections per visit. An increasingly crowded vaccination calendar might lead to HCPs and/or parents having to decide whether to ensure that a child receives all necessary vaccines versus attempting to minimise potential discomfort and/or distress for both child and parent.• To further evaluate vaccination-related attitudes and concerns for parents and HCPs, the New Vaccinations of Infants in Practice (New VIP) survey was conducted online in Australia, Canada, France, Germany, Spain, Sweden, and United Kingdom between 5 September and 1 November, 2011. A novel vaccine against meningococcal serogroup B (MenB) is a likely candidate to be the next routine infant vaccination to be added to the immunisation schedules of many European countries. Thus a profile of this vaccine was used as an example to further delineate factors influencing parental decisions on co-administering a new vaccine.

METHOD• The survey involved HCPs who administer vaccines to infants 0–2 years and parents who were completely or closely involved with vaccination decisions of ≥1 infant between 0–23 months of age. Parents with multiple children responded with respect to their youngest child.• The 30-minute HCP and 20-minute parent surveys involved multisection questionnaires with 65 and 47 closed-ended questions, respectively.• Survey findings were generalised with respect to national populations by post-weighting (rim-weighting method) for each country using gender, age, and geography within specialty for healthcare providers, and age and geography for parents.• The maximum margin of error (95% confidence level) for estimates of simple percentages for the combined analysis was ± 3.6% and ± 2.0% for sample sizes of 725 HCPs and 2460 parents, respectively.• McNemar’s test was used to determine the statistical significance of differences in proportions, and the relative preference or importance of multiple factors was assessed using a maximum differential technique.¹

RESULTSDemographics• The number of parents and HCPs surveyed in each country is summarised in Table 1.

Parental Attitudes• Most parents (76%, 1869/2460) claimed to accept the vaccines included in their official immunisation schedules, and a similar number (75%, 1853/2460) stated that they trusted their HCP’s judgment about childhood vaccine choices (% rated a 5-6 on 6-point scale; 1=strongly disagree to 6=strongly agree).• Nearly 3 of 10 parents (680/2460) indicated that they were comfortable with following their HCPs recommendations for the number of injections during a single office visit. Overall, 42% (1039/2460) of parents were comfortable with up to 2 vaccine injections per visit, and another 13% (312/2460) would be comfortable with at least one additional injection.• As to the most notable reasons influencing parents’ acceptance of the number of injections per visit, the parents reported (i) avoiding too much pain and discomfort (64%, 1567/2460) and (ii) ensuring their child received all needed vaccines (61%, 1506/2460) as part of their top 3 reasons influencing their comfort level with the maximum number of injections per office visit for their child.

HCP Attitudes

• The most important reason among HCPs when making paediatric vaccine recommendations was the severity and/or lethality of the disease; inclusion on the official schedule was the second-most important factor. (Figure 1).

• HCPs were generally aligned with the official immunisation schedule for infants (0–11 months) with respect to the maximum number of injections per visit. At the time of survey fielding, approximately 62% (446/725) were administering a maximum of 2 injections per visit, and 25% (184/725) were administering up to 3 injections (which apparently depended upon immunisation schedules and vaccine combinations available in that country).• With respect to the factors influencing HCPs’ decision to administer multiple vaccines per visit (Figure 2), following the official immunisation schedule (83%, 601/725) was the top reason; and limiting the number of office visits (59%, 431/725) was the second-highest factor (as included among each HCPs top 3 rankings).

Use of a Novel MenB Vaccine as an Example• After exposure to meningococcal disease information, 68% (1672/2460) of parents predicted they would likely accept a MenB vaccine, if approved and HCP recommended (% rated 5-6 on 6-point scale; 1=extremely unlikely to 6=extremely likely).• Exposure to meningococcal disease information significantly increased parental acceptance in two ways: (i) it increased the percentage of parents who would likely accept co-administration of the investigational MenB vaccine with routine vaccines for their 0- to 6-month old infant as well as (ii) it increased the percentage of parents who would schedule a separate office visit for the new vaccine by itself.• The primary factor influencing parental decisions about MenB vaccine for 0- to 6-month olds was protection against disease (Figure 3); in contrast, post-vaccination fever was 6-times less influential (ratio-scaled probability 89/100 vs. 15/100, N=2460).

CONCLUSIONS• HCPs considered the disease severity/lethality as the most influential factor and the official immunisation schedules as the second-most influential factor when making decisions on the administration of vaccines to infants.• Furthermore, parents also trusted the recommendations of their HCP as well as the national immunisation schedule regarding the vaccines to be administered.• Parents (as well as HCPs) also felt most comfortable with the number of injections per visit that corresponded to official immunisation recommendations (currently 2-3, depending on the country), but parents value their child’s relative risk of disease far greater than the likelihood of fever.• Therefore, these survey findings should be useful for public health officials and policymakers as they revise existing infant immunisation schedules to accommodate new vaccines.

AcknowledgementsNovartis Vaccines and Diagnostics, Cambridge, MA, USA, provided funding for this research and poster. Ipsos Healthcare (Plymouth Meeting, PA, USA), on behalf of Novartis, developed both HCP and parent online questionnaires, coordinated the surveys, and tabulated the results. The authors were involved in all stages of the survey, including questionnaire development, data analysis and interpretation, and drafting or revising of the poster for important intellectual content. All authors approved the final version. The authors thank Jan S. Redfern, PhD, Redfern Strategic Medical Communications, Inc., Goshen, NY, USA, and Lisa de Tora, PhD, Novartis Vaccines and Diagnostics, for writing assistance. The poster was prepared according to International Society of Medical Publication Professionals’ Good Publication Practice for Communicating Company-Sponsored Medical Research—the GPP2 Guidelines.²

References1. Sawtooth Software Technical Paper Series: The MaxDiff/Web V6.0 Technical Paper available at www.sawtoothsoftware.com/download/techpap/maxdifftech.pdf accessed Jan 3, 2012.2. Graf C, Battisti WP, Bridges D, et al. Research Methods & Reporting. Good publication practice for communicating company sponsored medical research: the GPP2 guidelines. BMJ. 2009;339(339):b4330.

Vaccines and prevention