Who knows more about immunization?: Survey of public health nurses and physicians.

OBJECTIVE: To report the findings of a knowledge survey of nurse and physician immunization providers. DESIGN: Cross-sectional postal survey assessing demographic characteristics and vaccine knowledge. SETTING: British Columbia (BC). PARTICIPANTS: Nurse and physician immunization providers in BC. MAIN OUTCOME MEASURES: Knowledge of vaccine-preventable diseases, vaccines in general, and vaccine administration and handling practices. RESULTS: Survey responses were received from 256 nurses and 292 physicians (response rates of 48.6% and 18.3%, respectively). Most nurses (98.4%) reported receiving immunization training outside of the academic setting compared with 55.6% of physicians. Overall, nurse immunizers scored significantly higher than physician immunizers on all 3 domains of immunization knowledge (83.7% vs 72.8%, respectively; P < .001). Physicians scored highest on the vaccine-preventable disease domain and least well on the general vaccine domain. Nurses with more experience as health care providers scored higher. Physicians scored higher if they were female, served patient populations predominantly younger than 5 years, or received immunization training outside of academic settings. CONCLUSION: In BC, nurse immunizers appear to have higher overall immunization knowledge than physicians and are more likely to receive immunization training when in practice. Physician immunizers might benefit most from further training on vaccines and vaccine administration and handling.

Implementation of a new clinical practice guideline regarding pain management during childhood vaccine injections.

OBJECTIVE: To determine the impact of a multifaceted knowledge translation strategy for a new vaccination pain management guideline on public health immunizers' attitudes, beliefs and use of pain-relieving strategies during childhood vaccination. METHOD: Using a randomized controlled pre-post study design, public health nurses (PHNs) at intervention sites received a multifaceted knowledge translation intervention about new pain management guidelines incorporated in the British Columbia Immunization Program Manual, including education, supplies and online support. Attitudes and beliefs of PHNs toward immunization pain and pain management, and use of pain-relieving strategies were compared for the intervention sites between the pre- and postimplementation phases. RESULTS: A total of 516 children were immunized by 31 PHNs pre- and postimplementation in the intervention sites. Postimplementation, satisfaction and confidence with ability to manage pain and willingness to use newly recommended strategies were significantly more positive (P<0.05) in the intervention sites, and overall use of at least one newly recommended strategy increased from 49.8% preintervention to 77.6% postimplementation (P<0.001). CONCLUSION: The knowledge translation intervention improved PHN immunizers' attitudes, beliefs and practices regarding paediatric vaccination pain management. Reducing pain may result in a better immunization experience for children, caregivers and immunizers.

OBJECTIF: Déterminer les conséquences d'une stratégie polyvalente de transfert du savoir contenu dans un nouveau guide de gestion de la douleur causée par la vaccination sur les attitudes et les croyances de vaccinateurs de la santé publique ainsi que sur leur utilisation des stratégies de soulagement de la douleur pendant la vaccination des enfants. MÉTHODOLOGIE: Au moyen d'une méthodologie d'étude avantaprès aléatoire et contrôlée, des infirmières de la santé publique (ISP) ont profité d'une démarche polyvalente de transfert du savoir à leur établissement d'intervention à l'égard de nouvelles directives sur la gestion de la douleur contenues dans le British Columbia Immunization Program Manual, y compris la formation, les fournitures et le soutien virtuel. Les chercheurs ont comparé les attitudes et les croyances des ISP à l'égard de la douleur et de la gestion de la douleur de la vaccination ainsi que les stratégies de soulagement de la douleur qu'elles utilisaient aux établissements d'intervention avant et après la mise en œuvre des directives. RÉSULTATS: Au total, 516 enfants ont été vaccinés par 31 ISP avant et après la mise en œuvre aux établissements d'intervention. Après la mise en œuvre, la satisfaction et la confiance en la capacité de gérer la douleur et la volonté d'utiliser les stratégies nouvellement recommandées étaient significativement plus positives (P<0,05). L'utilisation globale d'au moins une stratégie nouvellement recommandée est passée de 49,8 % avant la démarche à 77,6 % après la mise en œuvre (P<0,001). CONCLUSION: L'intervention de transfert du savoir a amélioré les attitudes, les croyances et les pratiques des ISP vaccinatrices au sujet de la gestion de la douleur des vaccins en pédiatrie. L'atténuation de la douleur peut susciter une meilleure expérience de vaccination pour les enfants, les personnes qui s'occupent d'eux et les vaccinateurs.

Method of administration affects adolescent post-immunization survey response rate: phone, paper, internet.

The recent introduction of new vaccines into the school-based immunization program in British Columbia (BC) included monitoring of adverse events following immunization (AEFI) for these new vaccines. This commentary discusses different methods used to collect AEFIs in school immunization campaigns and the effects on response rate. The results of a study using an internet-based tool inspired this paper. The study examined adverse events following human papillomavirus (HPV) vaccine given to grades 6 and 9 students. The low response rate of the internet survey resulted in insufficient findings regarding adverse events. Consequent to the analysis of the study's data, a literature review was conducted to examine survey methodologies used to collect adverse event data following school-based immunization of adolescents. A PubMed search used various combinations of the following terms: vaccine, immunization, immunization programs, reactogenicity, adverse reactions, safety, adolescent, schoolchildren, and survey. Potentially relevant papers were identified based upon the titles and abstracts and subsequently reviewed. Only four studies were deemed appropriate for comparison purposes: all were done in Canada.

Identifying attitudes, beliefs and reported practices of nurses and doctors as immunization providers.

AIM: This paper is a report of a study conducted to examine the attitudes, beliefs, behavioural intentions and self-reported behaviour of nurses and physicians relating to key immunization behaviours and compare the findings for nurses and physicians. BACKGROUND: Immunization is an important and effective public health intervention. Understanding immunization providers' attitudes and beliefs toward immunization has the potential to improve educational efforts and lead to behavioural change. METHOD: A postal survey was conducted with all immunization providers in British Columbia, Canada, in 2005. The survey elicited data on demographics, practice characteristics, attitudes, perceived social norms and perceived behavioural control related to key immunization behaviours. RESULTS: Responses were received from 344 nurses and 349 physicians. The response rate was 67% for nurses and 22% for physicians. More nurses than physicians thought that administering all recommended vaccines at one visit was important (89.2% vs. 63.2%P < 0.001); nurses felt more pressure from parents to administer all recommended vaccines (82.4% vs. 48.7%P < 0.001), and nurses were also more likely to intend to give all recommended vaccines at one visit (98.8% vs. 73.8%P < 0.001). Both nurses and physicians thought that their own receipt of influenza vaccine each year was important (88.9%, 87.1% respectively P = 0.65). CONCLUSION: The foundational work done to develop the survey tool can be used to modify it so that survey findings can be validated according to the Theory of Planned Behaviour. The results could inform the development of behavioural change interventions targeting the identified determinants of immunization provider behaviour.

One arm or two? Concurrent administration of meningococcal C conjugate and hepatitis B vaccines in pre-teens.

BACKGROUND: The purpose of this study was to: (a) compare rates of local reactions from meningococcal C conjugate (Neis Vac-C) and hepatitis B vaccines (Recombivax HB), and (b) compare local reactions when both injections were given in one arm versus one in each arm. METHODS: Schools were randomized to have grade six students receive both vaccines in one arm (One Arm Group), or one vaccine in each arm (Two Arm Group; MCC always given in left arm). Structured telephone interviews of parents were conducted, and respondents were asked about local and systemic reactions, interference with school or other activities, need for medical attention, and lost parental work time. FINDINGS: The Two Arm Group reported significantly more local redness >46 mm (6.5% vs. 0.5%, p < 0.001), moderate to severe tenderness (28% vs. 18%, p < 0.05), and drowsiness (14% vs. 7%, p < 0.05). When adjusted for sex, ethnicity, and town of residence, report of any tenderness was associated with town of residence only; moderate or severe tenderness was independently associated with the Two Arm Group (OR 1.4, 95% CI 1.1-1.85). There were no statistically significant differences between groups for interference with school attendance or other activities, need for medical attention, or lost parental work time. Among participants of the Two Arm Group (188 students), there was more redness (6% vs. 2%, p < 0.05) and tenderness (54% vs. 32%, p < 0.001) experienced with Neis Vac-C than with Recombivax HB, respectively. CONCLUSIONS: Injecting two vaccines in one arm did not cause more local reaction than one injection in each arm and remains an option for those who prefer it for logistical reasons, If vaccinating in two arms, Neis Vac-C should preferentially be given in the nondominant arm.

Adult tetanus, diphtheria and pertussis immunization: knowledge, beliefs, behavior and anticipated uptake.

BACKGROUND: Lifetime protection against pertussis has been adopted as a goal of immunization programs in Canada. To anticipate adult coverage with a combined product containing tetanus (T) and diphtheria (d) toxoids and acellular pertussis (aP) vaccine as a booster dose, we conducted a survey of households in British Columbia, Canada. METHODS: In a random telephone survey involving 800 adults, 25 years of age and older, we assessed current behaviors related to adult Td immunization and beliefs regarding pertussis vaccine under various scenarios relevant to adult decision-making. RESULTS: Forty-five percent of participants reported having received tetanus vaccine within the previous 10 years; this rate was lowest amongst elderly persons 65 years of age or more (28%). On multi-variate analysis, being up-to-date with tetanus immunization was independently associated with belief that an adult should be immunized against tetanus and perception that tetanus is life-threatening and inversely associated with being elderly. At baseline, 59% of respondents indicated willingness to receive pertussis immunization if provided free; this increased to 76% following sequential information about communicability and severity of pertussis illness and safety, efficacy and convenience of vaccine and up to 87% if accompanied by physician or nurse recommendation. Sixty-three percent of adults indicated they would receive the vaccine if required to pay $40.00 (Cdn) for it. CONCLUSIONS: Personal risk perception, public funding and physician recommendation are important to adults when considering tetanus and pertussis immunization. These factors may be relevant as immunization programs are expanded to include more adults generally.