Acute otitis media and its prevention by immunization: a survey of Canadian pediatricians' knowledge, attitudes and beliefs.

INTRODUCTION: Acute otitis media (AOM) is one of the most common bacterial infectious diseases among children and is a leading cause of child healthcare visits and antibiotic prescriptions. Few vaccines have the potential to prevent AOM. The newer pneumococcal conjugate vaccines (PCV) offer a larger spectrum of protection against AOM, as well as preventing severe diseases. The main aim of this study was to assess pediatricians' opinions regarding AOM and its prevention by immunization. RESULTS: Response rate was 50%. Around 60% of respondents estimated that more than 50% of their patients under the age of 3 years would suffer from at least one episode of AOM in the following year. Most respondents (79%) rated consequences of AOM as moderate. Almost all physicians (99%) considered the newer PCV as safe and effective. Most respondents considered their knowledge of the new vaccines was sufficient. More than 90% had a firm intention to recommend newer PCV to their patients. Perceived benefits of AOM prevention by immunization were: reduction of antibiotic administration and reduction of post-AOM complications. More than half of respondents (53%) considered the risk of adverse events as a barrier to AOM prevention by immunization. In multivariate analysis, the main determinant of pediatricians' intention to recommend newer PCV was perceived safety and efficacy of the vaccines (partial R2 = 0.40, p < 0.0001). DISCUSSION: Results of this survey show that AOM is perceived as an important health problem by paediatricians. Information about the increased protection against AOM offered by newer PCV should be disseminated to physicians. MATERIALS AND METHODS: A self-administered, anonymous, mail-based questionnaire based upon the Health Belief Model and the Analytical framework for immunization programs was sent to all 1,852 Canadian pediatricians.

Burden of acute otitis media on Canadian families.

OBJECTIVE: To estimate the burden of acute otitis media (AOM) on Canadian families. DESIGN: Telephone survey using random-digit dialing. SETTING: All Canadian provinces between May and June 2008. PARTICIPANTS: Caregivers of 1 or more children aged 6 months to 5 years. MAIN OUTCOME MEASURES: Caregivers' reports on the number of AOM episodes experienced by the child in the past 12 months, as well as disease characteristics, health services and medication use, time spent on medical consultations (including travel), and time taken off from work to care for the sick children. RESULTS: A total of 502 eligible caregivers were recruited, 161 (32%) of whom reported at least 1 AOM episode for their children and 42 (8%) of whom reported 3 or more episodes during the past 12 months. Most children (94%, 151 of 161) visited with health professionals during their most recent AOM episodes. The average time required for medical examination was 3.1 hours in an emergency department and 1.8 hours in an outpatient clinic. Overall, 93% of episodes resulted in antibiotics use. A substantial proportion of caregivers (38%) missed work during this time; the average time taken off work was 15.9 hours. CONCLUSION: In Canada, episodes of AOM are still associated with substantial use of health services and indirect costs to the caregivers.

Cervical cancer prevention by vaccination: nurses' knowledge, attitudes and intentions.

AIM: This paper is a report of a survey: (1) to document nurses' knowledge, attitudes and information needs regarding human papillomavirus prevention and (2) to determine factors associated with their willingness to recommend human papillomavirus vaccines. BACKGROUND: Persistent infection with human papillomavirus has been causally linked to cervical cancer. Two human papillomavirus vaccines have recently been approved for use in more than 65 countries. Nurses' level of support for the prevention of human papillomavirus related diseases by vaccination has not been researched. METHODS: A survey was conducted in 2007. Self-administered questionnaires were mailed to 1799 randomly selected nurses. Descriptive statistics were generated for all variables. Multivariable logistic regression models were estimated to determine variables associated with the willingness to recommend human papillomavirus vaccines. RESULTS: A total of 946 questionnaires were analyzed and showed that: 97% of nurses perceived routinely recommended vaccines as very useful; 93% would support human papillomavirus vaccination if it is publicly funded; 85% would recommend human papillomavirus vaccines to their patients; 33%, 46% and 61% expect the vaccination to permit screening to begin later in life, reduction of the frequency of screening, and reduction of the number of postscreening interventions, respectively. Respondents' knowledge score was 3.8 out of 7. Several modifiable factors, including knowledge, perceived self-efficacy, and societal and colleagues support were associated with willingness to recommend vaccines. CONCLUSION: Most nurses' support human papillomavirus vaccination, but their active involvement should not be taken for granted. Targeted educational efforts are needed to ensure nurses' involvement in the prevention of human papillomavirus-related diseases.

Human papilloma virus vaccine and cervical cancer screening acceptability among adults in Quebec, Canada.

BACKGROUND: The Pap test has been used for cervical cancer screening for more than four decades. A human papillomavirus (HPV) vaccine has been approved for use in Canada and is commercially available now. These two preventive interventions should be considered simultaneously. General population support is an important factor for the successful combination of these interventions. The study had two objectives: 1) To assess practices, beliefs, and attitudes regarding Pap test screening and HPV immunization; 2) To identify socio-demographic factors for Pap screening and vaccine acceptability. METHODS: In 2006, 500 adults were invited to participate in a telephone survey in the region of Quebec City (urban and rural population, 600 000), Canada. Some neutral and standardized information on Pap test and HPV was provided before soliciting opinions. RESULTS: 471 adults (18-69 year-olds) answered the questionnaire, the mean age was 45 years, 67% were female, and 65% had college or university degree. Eighty-six percent of women had undergone at least one Pap-test in their life, 55% in the last year, and 15% from 1 to 3 years ago. Among screened women, the test had been performed in the last three years in 100% of 18-30 year-olds, but only in 67% of 60-69 year-olds (P < 0.0001). Only 15% of respondents had heard of HPV. Eighty-seven percent agreed that HPV vaccines could prevent cervical cancer, 73% that the vaccine has to be administered before the onset of sexual activity, 89% would recommend vaccination to their daughters and nieces. Among respondents < 25 years, 91% would agree to receive the vaccine if it is publicly funded, but only 72% would agree to pay $100/dose. CONCLUSION: There is an important heterogeneity in cervical cancer screening frequency and coverage. Despite low awareness of HPV infection, the majority of respondents would recommend or are ready to receive the HPV vaccine, but the cost could prevent its acceptability.

[Portrait of the formation in vaccination training offered to Quebec nurses in the workplace]. / Portrait de la formation en vaccination offerte aux infirmières dans les établissements de santé du Québec.

INTRODUCTION: Nurses carry out essential functions in the area of immunization in Québec and their role has broadened considerably since January 2003, following legislative modifications. However, the training received may not always allow nurses to fill this role satisfactorily. This study seeks to document the training in immunization offered to Québec nurses in the workplace. METHOD: A questionnaire was mailed to the directors or heads of nursing care (DSI/RSI) in 477 health care establishments in Québec in March 2003. RESULTS: Health care establishments in Québec offer more training to nurses on the job (68%) than at the moment of hiring (43%). These percentages vary widely according to the type of establishment. More than 90% of the local community service centres (CLSC) that responded offer training to their nurses. The indications/contraindications of immunization products and emergencies related to vaccination represent the themes most frequently dealt with. Only 38% of respondents affirm that the nurses in their institution are "very favourable" to vaccination. DISCUSSION: Almost all Québec CLSCs, which is where most immunization activities are carried out, offer training in vaccination to their nurses. On the other hand, few hospital centres (CH) and long-term care establishments (CHSLD) do so. Further documentation should be carried out on the impact of less than optimal training on the promotion of immunization programs by nurses.

[Why are some children incompletely vaccinated at the age of 2?]. / Pourquoi certains enfants sontincomplètement vaccinés à l'âgede 2 ans?

OBJECTIVE: A survey was conducted in the Province of Quebec to document the factors associated with an incomplete immunization status among 2-year-old children. METHODS: Parents of 430 completely and 266 partially vaccinated children selected from the computerized vaccination register agreed to participate. RESULTS: The non-simultaneous administration of the 2nd MMR and 4th DPT-P-Hib at 18 months of age was responsible for 46% of incompleteness. The following characteristics were significantly associated with an incomplete immunization status: being a single parent, > or = 2 children in the family, an older age at first immunization (> or = 3 months), parent's preference for postponing the second vaccine when two injections are scheduled for the same visit, perception of lack of information about vaccination, and disagreement with immunization recommendations. CONCLUSION: One of the key points of this study is the impact of the non-simultaneous administration of the two vaccines at 18 months. Factors such as being a single parent and older age at first immunization might be used to design an early intervention for children who are most likely to be incompletely immunized. Even if parents are favourable towards immunization, they need to be well informed about the associated risks and benefits.

Immunization services offered in Québec (Canada) pharmacies.

Canadian Pharmacists are easy to reach. Although Québec pharmacists are not allowed to administer vaccines, they can: (1) promote vaccination, (2) counsel patients on vaccination, (3) sell vaccines and (4) provide vaccine administration by a nurse. Our objectives were to describe immunization services given in Québec pharmacies and assess the potential relation between, on one hand, pharmacy characteristics and difficulties perceived by pharmacists and, on the other hand, vaccine administration. In 2008-09, an anonymous questionnaire was mailed to all Québec pharmacy owners (n = 1663). Among the 1102 (66%) respondents, 90% stated that vaccines were sold, 27% that a nurse administered vaccines in their pharmacy and 44% were planning to offer vaccine administration in the next five years. Three out of four stated they were doing vaccine promotion and 65%, vaccine counselling. Half of respondents said they would be willing to administer vaccines themselves if legislative modifications were made. Recommendations for cold chain maintenance were followed in 23% of pharmacies selling vaccines. Presence of another health professional in the pharmacy, higher number of opening hours, not being located in the same building than a medical clinic and having an agreement to collaborate with a public health unit or a medical clinic for immunization were positively associated with vaccine administration in multivariate analysis. Higher perceived difficulties with lack of demand from patients were negatively associated with vaccine administration. Most pharmacists are willing to increase their involvement in immunization. Collaboration between public health professionals and pharmacists should be reinforced.

Canadian family physicians' and paediatricians' knowledge, attitudes and practices regarding A(H1N1) pandemic vaccine.

BACKGROUND: One of the main determinants of public immunization success is health professionals' support and recommendations. Little is known about the physicians' level of support and intentions regarding A(H1N1) pandemic influenza vaccination. The aim of this survey was to document Canadian family physicians' and paediatricians' knowledge, attitudes and practices (KAP) as well as their intentions regarding A(H1N1) pandemic influenza vaccines right before the beginning of the largest immunization campaign in Canadian history. FINDINGS: A self-administered, anonymous, mail-based questionnaire was sent to a random sample of family physicians and to all paediatricians practicing in Canada. All 921 questionnaires received by October 29 2009 were included in the analysis. Between 72% and 92% of respondents agreed with the statements regarding vaccine safety, effectiveness and acceptability. More than 75% of respondents intended to recommend the A(H1N1) pandemic influenza vaccine to their patients and to get vaccinated themselves. The most significant factors associated with the intention to recommend A(H1N1) pandemic vaccines were physicians' intention to be vaccinated against influenza themselves and the perceived acceptability of the vaccine by the vaccinators. CONCLUSIONS: Most Canadian family physicians and paediatricians surveyed were supportive of the A(H1N1) pandemic influenza vaccination before its implementation and large media coverage.

New vaccines offering a larger spectrum of protection against acute otitis media: will parents be willing to have their children immunized?

OBJECTIVES: To examine parents' knowledge, attitudes and beliefs regarding acute otitis media (AOM) and parents' willingness to vaccinate their children with new vaccine offering larger spectrum of protection against AOM. METHODS: Telephone survey conducted in a stratified sample of household in 10 Canadian provinces using random-digit dialling methodology. Parents of children aged 6 months to 5 years were reached. RESULTS: 502 parents participated. Mean age of the child was 3 years and 32% have had at least one AOM episode during the last 12 months. The great majority of parents agreed that recommended vaccines are important (94%) and useful (94%) for children's health. Parents felt that their knowledge on AOM was very (27%) or somewhat (54%) sufficient. Most parents (73%) thought that antibiotics use was always useful to treat an AOM and 54% estimated that vaccination is an effective mean of preventing AOM. Sixty-four percent (64%) of the surveyed parents were willing to vaccinate their child with a new vaccine offering larger spectrum of protection against AOM. A higher proportion of parents whose child had experienced an AOM were willing to have their children vaccinated. The strongest predictor of parental willingness to vaccinate was subjective norm, or the perception that the other parent of the child and the doctor will approve/recommend the vaccination behaviour. CONCLUSIONS: When new vaccines are available, a key issue is the willingness of parents to adopt it. Health providers should be aware of their important role to inform parents and promote immunization.

Setting priorities for new vaccination programs by using public health officers and immunization managers opinions.

The objective of this work was to assess the opinions of public health professionals (PHPs) about routinely recommended and new vaccines, and to evaluate the feasibility of using a modified Basic Priority Rating System (BPRS) approach to prioritize new immunization programs. One hundred and thirty six PHPs were invited to participate in the survey and 101 responded. Ninty-eight percent of respondents agreed that "recommended vaccines are very useful" (mean score=9.5 out of 10). Between 47% and 100% of respondents agreed with statements about usefulness, safety, effectiveness and acceptability of seven new vaccines (mean scores 5.7-9.7). The highest BPRS scores were observed for MMRV (7.3), DTaP-IPV-HBV-Hib (7.0), and conjugate ACYW-135 (5.4), followed by HPV (4.8), HAV (4.4), rotavirus (1.6) and zoster vaccine (1.5%). The results demonstrate that PHPs perceive presently recommended vaccines as very useful tools in infection prevention. On the other hand, the perceived usefulness, safety, effectiveness, and acceptability of new vaccines are heterogeneous. This heterogeneity is indicative of the complexity of decision-making around implementation of new immunization programs and the need for tools facilitating program prioritization. The modified BPRS approach using survey responses to five statements on program usefulness, vaccine safety, effectiveness, and acceptance by vaccinators and the population is a simple, feasible and inexpensive method of prioritizing new immunization programs. The method we propose is flexible in choosing target groups and allows a large number of professionals to be involved in the decision-making process about new immunization programs.

Vaccination against human papillomavirus: a baseline survey of Canadian clinicians' knowledge, attitudes and beliefs.

We assessed Canadian obstetrician/gynaecologists', family physicians' and paediatricians' knowledge, attitudes, and beliefs about HPV infection and prevention, as well as factors associated with willingness to prescribe HPV vaccines. A self-administered, anonymous questionnaire was mailed to 2500 physicians. The participation rate was 51%. Overall, 95% of respondents indicated that the vaccine should be given to girls before the onset of sexual activity; 80% of respondents felt that the best age for an HPV vaccination program is <14 years; 88% of respondents intend to recommend HPV vaccines if they are publicly funded. Several predisposing, reinforcing, organizational, preventive activity and situational factors were independently associated with the intention to prescribe the HPV vaccines. Most physicians expect an important benefit from HPV vaccination and intend to prescribe HPV vaccines (86.7%). To achieve high rates of vaccination coverage, several modifiable factors should be taken in consideration during immunization program implementation.