Background
Methods
Study population and design
Public health professionals
-
Medical doctors and nurses (N = 269) of infectious disease control departments of all 28 RPHS in the Netherlands;
-
Medical doctors and nurses (N = 563) of 8 regional organisations executing CHC in the eastern part of the Netherlands, covering about 15–20 % of the Dutch population.
Parents
Data analysis
Attitude and intention to vaccinate against varicella
Determinants of attitude and intention to vaccinate against varicella
Results
Response and background characteristics
Professionals (RPHS & CHC combined) | Parents | |||||||
---|---|---|---|---|---|---|---|---|
Medical doctors (N = 162) | Nurses (N = 279) | Total (N = 441) | (N = 491) | |||||
Background characteristics | N | % | N | % | N | % | N | % |
Sex | ||||||||
Male | 37 | 22.8 | 13 | 4.7 | 50 | 11.3 | 90 | 18.3 |
Female | 125 | 77.2 | 266 | 95.3 | 391 | 88.7 | 401 | 81.7 |
Age | ||||||||
Younger than 30 years | 8 | 5.0 | 30 | 10.9 | 38 | 8.7 | 94 | 19.1 |
30–34 years | 16 | 9.9 | 32 | 11.6 | 48 | 11.0 | 189 | 38.5 |
35–39 years | 16 | 9.9 | 26 | 9.4 | 42 | 9.6 | 148 | 30.1 |
40 years or older | 121 | 75.2 | 188 | 68.1 | 309 | 70.7 | 60 | 12.2 |
Organisation | ||||||||
Regional Public Health Service (RPHS) | 74 | 45.7 | 107 | 38.4 | 181 | 41.0 | - | - |
Child Health Clinic (CHC) | 88 | 54.3 | 172 | 61.6 | 260 | 59.0 | - | - |
Educationc
| ||||||||
Low | n.a. | n.a. | n.a. | n.a. | n.a. | n.a. | 51 | 10.4 |
Middle | n.a. | n.a. | n.a. | n.a. | n.a. | n.a. | 166 | 33.8 |
High | n.a. | n.a. | n.a. | n.a. | n.a. | n.a. | 274 | 55.8 |
Ethnicity | ||||||||
Both parents born in the Netherlands | n.a. | n.a. | n.a. | n.a. | n.a. | n.a. | 423 | 86.3 |
At least one parent born in another country | n.a. | n.a. | n.a. | n.a. | n.a. | n.a. | 67 | 13.7 |
Net monthly household income | ||||||||
Low (≤ €1150) | n.a. | n.a. | n.a. | n.a. | n.a. | n.a. | 18 | 4.4 |
Middle (€1151–€3050) | n.a. | n.a. | n.a. | n.a. | n.a. | n.a. | 191 | 47.2 |
High (≥ €3051) | n.a. | n.a. | n.a. | n.a. | n.a. | n.a. | 196 | 48.4 |
No answer | n.a. | n.a. | n.a. | n.a. | n.a. | n.a. | 86 | |
Household size | ||||||||
< 4 persons | n.a. | n.a. | n.a. | n.a. | n.a. | n.a. | 163 | 33.2 |
4 persons | n.a. | n.a. | n.a. | n.a. | n.a. | n.a. | 228 | 46.4 |
> 4 persons | n.a. | n.a. | n.a. | n.a. | n.a. | n.a. | 100 | 20.4 |
Number of children | ||||||||
None | 31 | 19.1 | 73 | 26.2 | 104 | 23.6 | - | - |
One child | 15 | 9.3 | 30 | 10.8 | 45 | 10.2 | 160 | 32.6 |
Two children | 48 | 29.6 | 104 | 37.3 | 152 | 34.5 | 234 | 47.7 |
More than two children | 68 | 42.0 | 72 | 25.8 | 140 | 31.7 | 97 | 19.8 |
Participation of child(ren) in NIP? | ||||||||
Yes, fully immunised | 124 | 96.1 | 185 | 90.7 | 309 | 92.8 | 465 | 94.7 |
Yes, partially immunised | 4 | 3.1 | 19 | 9.3 | 23 | 6.9 | 13 | 2.6 |
No, not immunised | 1 | 0.8 | 0 | 0.0 | 1 | 0.3 | 10 | 2.0 |
Don’t know | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 3 | 0.6 |
Change in opinion on vaccination?a
| ||||||||
No | 126 | 77.8 | 231 | 83.1 | 357 | 81.1 | 420 | 85.5 |
Yes, more inclined | 14 | 8.6 | 16 | 5.8 | 30 | 6.8 | 9 | 1.8 |
Yes, less inclined | 11 | 6.8 | 14 | 5.0 | 25 | 5.7 | 47 | 9.6 |
Don’t know | 11 | 6.8 | 17 | 6.1 | 28 | 6.4 | 15 | 3.1 |
Influence on opinion on vaccination? | ||||||||
Anthroposophical philosophy | 1 | 0.6 | 7 | 2.6 | 8 | 1.9 | 8 | 1.6b
|
Homeopathic philosophy | 0 | 0.0 | 3 | 1.1 | 3 | 0.7 | 16 | 3.3b
|
Alternative medicine | 0 | 0.0 | 2 | 0.7 | 2 | 0.5 | 10 | 2.0b
|
Religion | 1 | 0.6 | 3 | 1.1 | 4 | 0.9 | 26 | 5.3b
|
Other | 13 | 8.3 | 19 | 6.9 | 32 | 7.4 | 29 | 5.9b
|
None of the above | 141 | 90.4 | 240 | 87.6 | 381 | 88.6 | 417 | 84.9b
|
Attitude and intention to vaccinate against varicella
Professionals (RPHS & CHC combined) | ||||||
---|---|---|---|---|---|---|
Medical doctors (N = 162) | Nurses (N = 279) | Total (N = 441) | ||||
Attitude towards universal varicella vaccination | N | % | N | % | N | % |
All infants | 45 | 28.0 | 46 | 17.0 | 91 | 21.1 |
Select groups | 108 | 67.1 | 204 | 75.3 | 312 | 72.2 |
- Risk groups (high risk of severe course)
|
76
|
70.4
|
156
|
76.5
|
232
|
74.4
|
- All susceptible 9-year olds
|
12
|
11.1
|
17
|
8.3
|
29
|
9.3
|
- Both
|
20
|
18.5
|
31
|
15.2
|
51
|
16.3
|
Nobody | 8 | 5.0 | 21 | 7.7 | 29 | 6.7 |
Missing answer | 1 | 8 | 9 |
Parents (N = 491) | ||
---|---|---|
Intention regarding vaccination of own child against varicella within the NIP (free of charge) | N | % |
Yes, definitely | 42 | 8.6 |
Probably yes | 96 | 19.6 |
Neutral | 101 | 20.6 |
Probably not | 152 | 31.0 |
No, never | 100 | 20.4 |
Determinants of attitude and intention to vaccinate against varicella
Knowledge about VZV
Professionals (RPHS & CHC combined) | Parents | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Medical doctors (N = 162) | Nurses (N = 279) | Total (N = 441) | (N = 491) | |||||||
Questionnaire item | N | % | N | % | N | % |
p-value*,** | N | % |
p-value*,*** |
If you never have had varicella, you can not get herpes zostera
| ||||||||||
Right (correct answer)
| 102 | 63.4 | 91 | 32.7 | 193 | 44.0 |
<0.0001
| 30 | 6.1 |
<0.0001
|
Wrong | 50 | 31.1 | 124 | 44.6 | 174 | 39.6 | 218 | 44.4 | ||
Don’t know | 9 | 5.6 | 63 | 22.7 | 72 | 16.4 | 243 | 49.5 | ||
If the blisters have dried up, you are no longer infectiousa
| ||||||||||
Right (correct answer)
| 155 | 95.7 | 264 | 95.3 | 419 | 95.4 | 1.000 | 430 | 87.6 |
<0.0001
|
Wrong | 6 | 3.7 | 9 | 3.2 | 15 | 3.4 | 21 | 4.3 | ||
Don’t know | 1 | 0.6 | 4 | 1.4 | 5 | 1.1 | 40 | 8.1 | ||
In general, you will get varicella only once in your lifea
| ||||||||||
Right (correct answer)
| 145 | 90.1 | 220 | 79.4 | 365 | 83.3 |
0.004
| 401 | 81.7 | 0.546 |
Wrong | 14 | 8.7 | 55 | 19.9 | 69 | 15.8 | 69 | 14.1 | ||
Don’t know | 2 | 1.2 | 2 | 0.7 | 4 | 0.9 | 21 | 4.3 | ||
What percentage of the Dutch population has had varicella before the age of 12 years?a
| ||||||||||
50 % | 3 | 1.9 | 15 | 5.4 | 18 | 4.1 | 92 | 18.7 | ||
75 % | 42 | 26.1 | 129 | 46.6 | 171 | 39.0 | 252 | 51.3 | ||
95 % (correct answer)
| 114 | 70.8 | 133 | 48.0 | 247 | 56.4 |
<0.0001
| 147 | 29.9 |
<0.0001
|
100 % | 2 | 1.2 | 0 | 0.0 | 2 | 0.5 | 0 | 0.0 | ||
How many people visit their general practitioner for varicella in the Netherlands each year? | ||||||||||
1 in 5 | 4 | 2.5 | 11 | 4.0 | 15 | 3.4 | 66 | 13.4 | ||
1 in 50 | 20 | 12.6 | 68 | 24.5 | 88 | 20.1 | 160 | 32.6 | ||
1 in 500 (correct answer)
| 76 | 47.8 | 128 | 46.0 | 204 | 46.7 | 0.765 | 175 | 35.6 |
0.001
|
1 in 5000 | 59 | 37.1 | 71 | 25.5 | 130 | 29.7 | 90 | 18.3 | ||
How many people are being hospitalised for varicella or its complications in the Netherlands each year? | ||||||||||
1 in 50 | 5 | 3.1 | 54 | 19.5 | 59 | 13.5 | 89 | 18.1 | ||
1 in 500 | 7 | 4.3 | 23 | 8.3 | 30 | 6.8 | 77 | 15.7 | ||
1 in 5000 | 27 | 16.8 | 59 | 21.3 | 86 | 19.6 | 139 | 28.3 | ||
1 in 50000 (correct answer)
| 122 | 75.8 | 141 | 50.9 | 263 | 60.0 |
<0.0001
| 186 | 37.9 |
<0.0001
|
How many people die due to varicella or its complications in the Netherlands each year?a
| ||||||||||
Less than 10 (correct answer)
| 142 | 88.2 | 237 | 85.6 | 379 | 86.5 | 0.471 | 344 | 70.1 |
<0.0001
|
10–100 | 17 | 10.6 | 33 | 11.9 | 50 | 11.4 | 129 | 26.3 | ||
100–1000 | 1 | 0.6 | 2 | 0.7 | 3 | 0.7 | 13 | 2.6 | ||
More than 1000 | 1 | 0.6 | 5 | 1.8 | 6 | 1.4 | 5 | 1.0 | ||
Knowledge score VZV**** (max. 5 points) |
<0.0001
|
<0.0001
| ||||||||
Limited knowledge (0–2 points) | 6 | 3.8 | 55 | 20.3 | 61 | 14.2 | 177 | 36.0 | ||
Moderate knowledge (3 points) | 31 | 19.6 | 90 | 33.2 | 121 | 28.2 | 209 | 42.6 | ||
Good knowledge (4–5 points) | 121 | 76.6 | 126 | 46.5 | 247 | 57.6 | 105 | 21.4 |
Beliefs about the disease varicella and varicella vaccination
Logistic regression analyses
Professionals (RPHS & CHC combined) | Parents | |||||||
---|---|---|---|---|---|---|---|---|
Potential determinants | N | Outcomea: positive attitude % [95 % CI] | Crude OR [95 % CI] | Adjusted OR [95 % CI] | N | Outcomea: positive intention % [95 % CI] | Crude OR [95 % CI] | Adjusted OR [95 % CI] |
Sex | ||||||||
Male | 40 | 22.5 [12.3–37.5] | Reference | Reference | 90 | 27.8 [19.6–37.8] | Reference | Reference |
Female | 364 | 20.6 [16.8–25.1] | 0.9 [0.4–2.0] | 1.7 [0.6–4.6] | 401 | 28.2 [24.0–32.8] | 1.0 [0.6–1.7] | 1.0 [0.5–2.0] |
Age | ||||||||
Younger than 30 years | 38 | 28.9 [17.0–44.8] | Reference | Reference | 94 | 23.4 [16.0–32.9] | Reference | Reference |
30–34 years | 48 | 29.2 [18.2–43.2] | 1.0 [0.4–2.6] | 0.7 [0.2–2.2] | 189 | 35.4 [29.0–42.5] | 1.8 [1.0–3.2]b
| 1.8 [0.8–3.8] |
35–39 years | 40 | 25.0 [14.2–40.2] | 0.8 [0.3–2.2] | 0.8 [0.2–2.9] | 148 | 20.3 [14.6–27.5] | 0.8 [0.4–1.6] | 1.1 [0.5–2.6] |
40 years or older | 278 | 17.6 [13.6–22.5] | 0.5 [0.2–1.1] | 0.4 [0.1–1.0] | 60 | 31.7 [21.3–44.2] | 1.5 [0.7–3.1] | 1.2 [0.4–3.4] |
Profession | ||||||||
Medical doctor | 151 | 27.8 [21.3–35.4] | Reference | Reference | - | |||
Nurse | 253 | 16.6 [12.5–21.7] | 0.5 [0.3–0.8]b
| 1.0 [0.5–1.9] | - | |||
Education level | ||||||||
High | 274 | 27.0 [22.1–32.6] | Reference | Reference | ||||
Medium | 166 | 27.1 [20.9–34.3] | 1.0 [0.7–1.6] | 0.9 [0.5–1.7] | ||||
Low | 51 | 37.3 [25.3–51.0] | 1.6 [0.9–3.0] | 1.0 [0.4–2.4] | ||||
Knowledge about VZV (max. 5 points) | ||||||||
Limited knowledge (0–2 points) | 56 | 17.9 [10.0–29.8] | Reference | Reference | 177 | 35.0 [28.4–42.3] | Reference | Reference |
Moderate knowledge (3 points) | 113 | 18.6 [12.5–26.7] | 1.1 [0.5–2.4] | 1.0 [0.4–2.9] | 209 | 23.0 [17.8–29.1] | 0.6 [0.4–0.9]b
| 0.9 [0.5–1.6] |
Good knowledge (4–5 points) | 235 | 22.6 [17.7–28.3] | 1.3 [0.6–2.8] | 1.1 [0.4–2.8] | 105 | 26.7 [19.1–35.8] | 0.7 [0.4–1.1] | 1.4 [0.7–3.0] |
Beliefs about the disease varicella and varicella vaccination | ||||||||
Varicella generally has a mild disease course in healthy children
| ||||||||
No agreement | 12 | 58.3 [32.0–80.7] | Reference | Reference | 22 | 54.5 [34.7–73.1] | Reference | Reference |
Neutral | 24 | 29.2 [14.9–49.2] | 0.3 [0.1–1.3] | 0.2 [0.03–1.3] | 76 | 51.3 [40.3–62.2] | 0.9 [0.3–2.3] | 0.7 [0.2–2.5] |
Agreement | 368 | 19.0 [15.3–23.3] | 0.2 [0.1–0.5]b
| 0.2 [0.04–0.9]b
| 393 | 22.1 [18.3–26.5] | 0.2 [0.1–0.6]b
| 0.5 [0.1–1.4] |
Varicella can cause serious complications
| ||||||||
No agreement | 42 | 16.7 [8.3–30.6] | Reference | Reference | 66 | 12.1 [6.3–22.1] | Reference | Reference |
Neutral | 98 | 8.2 [4.2–15.3] | 0.4 [0.2–1.3] | 0.6 [0.2–2.4] | 218 | 20.2 [15.4–26.0] | 1.8 [0.8–4.1] | 1.0 [0.4–2.7] |
Agreement | 264 | 26.1 [21.2–31.8] | 1.8 [0.8–4.2] | 1.5 [0.5–4.8] | 207 | 41.5 [35.0–48.4] | 5.2 [2.3–11.3]b
| 1.3 [0.4–3.5] |
Varicella is a disease one could better have been through
| ||||||||
No agreement | 22 | 59.1 [38.7–76.7] | Reference | Reference | 46 | 60.9 [46.5–73.6] | Reference | Reference |
Neutral | 73 | 23.3 [15.1–34.2] | 0.2 [0.1–0.6]b
| 0.3 [0.1–1.3] | 126 | 41.3 [33.1–50.0] | 0.5 [0.2–0.9]b
| 0.5 [0.2–1.3] |
Agreement | 309 | 17.5 [13.6–22.1] | 0.1 [0.1–0.4]b
| 0.3 [0.1–1.0] | 319 | 18.2 [14.3–22.8] | 0.1 [0.1–0.3]b
| 0.4 [0.1–0.9]b
|
I am worried about the side effects of varicella vaccination
| ||||||||
No agreement | 163 | 30.1 [23.5–37.5] | Reference | Reference | 115 | 27.0 [19.7–35.7] | Reference | Reference |
Neutral | 190 | 15.3 [10.8–21.1] | 0.4 [0.3–0.7]b
| 0.6 [0.3–1.1] | 196 | 29.1 [23.2–35.8] | 1.1 [0.7–1.9] | 0.5 [0.2–1.1] |
Agreement | 51 | 11.8 [5.5–23.4] | 0.3 [0.1–0.8]b
| 0.5 [0.1–1.4] | 180 | 27.8 [21.8–34.7] | 1.0 [0.6–1.8] | 0.7 [0.3–1.5] |
I think varicella is a disease serious enough to vaccinate against
| ||||||||
No agreement | 255 | 9.8 [6.7–14.1] | Reference | Reference | 289 | 8.3 [5.6–12.1] | Reference | Reference |
Neutral | 107 | 28.0 [20.4–37.2] | 3.6 [2.0–6.5]b
| 2.4 [1.2–4.7]b
| 102 | 32.4 [24.1–41.9] | 5.3 [2.9–9.5]b
| 4.9 [2.3–10.6]b
|
Agreement | 42 | 69.0 [54.0–80.9] | 20.5 [9.5–44.5]b
| 9.9 [3.9–24.9]b
| 100 | 81.0 [72.2–87.5] | 47.1 [24.5–90.3]b
| 26.2 [10.8–63.4]b
|
I think most parents will vaccinate their child against varicella
| ||||||||
No agreement | 225 | 9.8 [6.5–14.4] | Reference | Reference | 182 | 9.9 [6.3–15.1] | Reference | Reference |
Neutral | 96 | 26.0 [18.3–35.6] | 3.2 [1.7–6.1]b
| 2.3 [1.1–4.9]b
| 184 | 24.5 [18.8–31.1] | 3.0 [1.6–5.3]b
| 1.1 [0.5–2.4] |
Agreement | 83 | 44.6 [34.4–55.3] | 7.4 [4.0–13.8]b
| 4.2 [2.0–8.6]b
| 125 | 60.0 [51.2–68.2] | 13.7 [7.5–25.0]b
| 2.0 [0.8–4.6] |
Total | 404 | 20.8 [17.1–25.0] | 491 | 28.1 [24.3–32.2] |