Knowledge & Attitudes about Diphtheria Vaccination in 2012

of Naresuan University Hospital’s Medical Personnel

Kanyarat Jongpitakrat, Tipkamol Prajsuchanai Advisors: Bodin Bootthum, MD; Suwit Leartkajonsin,

MD.

Magnitude of problem (1)

• Diphtheria is one of vaccine preventable diseases that have been well controlled by high coverage of vaccination in children.

• However, since 2010-2012 diphtheria outbreaks occurred more frequently in Thailand.

• The recent data (6th  December 2012 ) showed that the total number of diphtheria cases is 40, 4 of these died.

Department of disease control . Ministry of public health, Thailand, 2012

Magnitude of problem (2)

• The Ministry of Public Health then stated the policy to give vaccine to medical personnel in the epidemic area. (goal of vaccine coverage = 90%)

• Infectious Control Committee of Naresuan University Hospital then arranged to give vaccination for personnel in November, 2012.

• Only 47.28% of medical personnel were participated.

Objectives• Primary objective

To determine knowledge and attitudes about diphtheria and diphtheria vaccination among Naresuan University Hospital’s medical personnel.

• Secondary objectives To explore the reasons why medical personnel did

not intend to be vaccinated. To assess the prevalence of the problem and the

factors associated with the immunization

Methodology (1)

• Cross-sectional study• Analytic study• Questionnaire

Methodology (2)

OccupationsNo. of

PopulationProportion

No. of Samples

Physician 201 2765 33

Nurse 292 4017. 48

Pharmacist 20 275. 3

Practical nurse 3 041. 1

Nurse aid 165 2270. 27

Medical technologist

18

248 3

Medical student 28 385. 5

Total 727 100 120

• Step1 : Proportional Stratified Sampling

• Step 2 : Simple Randomized Sampling

RESULT

Table 1 : Baseline data (1)

Baseline data No. of medical personnel (N%)

1) Gender male female

20 (18.52)88 (81.48)

2) Age < 20 years 20 – 30 years 31 – 40 years 41 – 50 years > 5o years

2 (1.85)65 (60.19)40 (37.04)

1 (0.93)0 (0)

Baseline data No. of medical personnel (N%)

3) Profession Physician * Nurse * Pharmacist Practical nurse Nurse aid * Medical technologist Medical student

19 (17.59)49 (45.37)

4 (3.70)1 (0.93)

27 (25.00)3 (2.78)5 (4.63)

4) Working experience < 5 years 5-10 years > 10 years

55 (5093 )39 (36.11)

14 (1296. )

Table 1 : Baseline data (2)

Baseline data No. of medical personnel (N%)

5) Perception of the news Yes No

9 2 ( 8519

16 1481( . )

6) The way to receive the news ( 92 people perceived) Television Radio Newspaper Internet Medical Colleagues Hospital

66 (71.74)5 (5.43)

18 (19.57)46 (50.00)50 (54.35)64 (69.57)

Table 1 : Baseline data (3)

Baseline data No. of medical personnel (N%)

9) Vaccination in last one year dT Tdap Have not yet been vaccinated

26 (24.07) 32 (29.63)50 (46.30)

10) The reasons cited by those who did not receive vaccination (N:50) Ignorance of the news Fear of side effects Lack of time Fear of pain Fear of expenses

23 ( 4600. )

9 (18 00. )13 (26.00) 5 (10.00)13 (26.00)

Table 1 : baseline data (4)

The reasons they said no to vaccination (N=50)

46

18

26

10

26

0

5

10

15

20

25

30

35

40

45

50

Ignorance of the news

Fear of side effects

Lack of time Fear of pain Fear of expenses

Variable Vaccination Non-vaccination

OR p-value

N(%) N(%)

Experience

<5 yr* 25(45.45) 30(54.55)

5-10 yr 27(69.23) 12(30.77) 2.70 0.02*

>10 yr 6(42.86) 8(57.14) 0.90 0.86

Perception of news

yes 56(60.87) 36(39.13) 10.89 0.02*

no* 2(12.50) 14(87.50)

Table 2. Univariate analysis

Baseline data No.4

Working experiences

45.45%69.23%

42.86%

54.55%

30.77%

57.14 %

0

5

10

15

20

25

30

35

<5 years 5-10 years > 10 years

vaccination

non-vaccination

Baseline data No.5

Perception of news60.87%

12.50%

39.13%

87.50%

0

10

20

30

40

50

60

yes no

vaccinationnon-vaccination

Table 3: knowledge about diphtheria and vaccination (1)

Questions Correct(N%)

Incorrect(N%)

P-value(n=108

)1. Diphtheria can be prevented by vaccination 101 (93.52) 7 (6.48) 0.552

2. Diphtheria is an acute infectious disease of the respiratory system.

99 (91.67) 9 (8.33) 0.201

3. Diphtheria can cause fever, cough, sore throat, and difficult swallowing.

95 (87.96)

13 (12.04)

0.077*

4 . The main complications of diphtheria are airway obstruction, myocarditis, and neuropathy.

98 (90.74) 10 (9.26) 0.362

5 . Diphtheria spreads when an infected person coughs or sneezes.

96 (88.89) 12 (11.11) 0.785

6 . It can’t be spread by handling used tissues or by drinking from a glass used by an infected person. 

67 (62.04) 41 (37.96) 0.685

7 . Diphtheria only occurs in children. 99 (91.67) 9 (8.33) 0.561

Table 3: knowledge about diphtheria and vaccination (2)

Questions Correct(N%)

Incorrect(N%)

P-value(n=108

)8 . Antibiotics can prevent diphtheria. 84 (77.78) 24 (22.22) 0.959

9 . Virus causes diphtheria. 51 (47.22) 57 (52.78) 0.881

1 0 . Prevention of diphtheria infection in children is to be fully vaccinated three doses.

20 (18.52) 88 (81.48) 0.713

11 . The booster is not required in the person who already received diphtheria vaccine since childhood.

83 (76.85) 25 (23.15) 0.267

1 2 . Immunodeficiency is not the risk of diphtheria infection.

87 (80.56)

21 (19.44)

0.021*

1 3 . Side effects of the vaccine are swelling and redness at the injection site. Vaccine can also cause severe allergy.

72 (66.67)

36 (33.33)

0.029*

14. Anyone who have fever shouldn’t receive vaccine.

91 (84.26) 17 (15.74) 0.645

15. As you are the medical personnel, should you get vaccination when there is an outbreak of diphtheria?

103 (95.37) 5 (4.63) 0.122

Mean = 11.537 (SD=2.28) vaccination

11.74

Non-vaccination

11.3

0.159T-test

Knowledge No.3:Diphtheria can cause fever, cough, sore throat, difficult

swallowing.

P-value = 0.077, OR = 2.96

Vaccination Non-vaccination

correct

incorrect

Knowledge No.13:Side effects of vaccine are swelling and redness at the injection

site. Vaccine also cause severe allergy.

P-value = 0.029, OR = 2.47

Vaccination Non-vaccination

right

wrong

Questions N% P-value(n=108

)agree not sure disagre

e

1.Healthy people cannot get diphtheria infection. 23 (21.30) 22 (20.37) 63 (58.33)

0.137

2. Diphtheria is not around us. We think we won’t get infected.

13 (12.04) 21 (19.44) 74 (68.52)

0.937

3 . Diphtheria is a disease that can be prevented. 95 (87.96) 9 (8.33) 4 (3.70) 0.380

4 . Diphtheria is not a serious disease that can cause death.

9 (8.33) 28 (25.93) 71 (65.74)

0.289

5 . Vaccinations are needed in young children. Adults do not need to be vaccinated against diphtheria.

7 (6.54) 14 (13.08) 86 (80.37)

0.330

6. Everyone should be vaccinated against diphtheria because it spreads easily.

82 (75.93)

17 (15.74)

9 (8.33)

0.081*

7. If there is diphtheria infected young children at your house, everyone who lived in that house should get vaccinated to protect themselves.

77 (71.30)

25 (23.15)

6 (5.56)

0.038*

Table 5: Attitudes about diphtheria and vaccination (1)

Questions N% P-value(n=108)agree not sure disagree

8 . Diphtheria vaccine has serious side effects.

17 (15.74) 33 (30.56 ) 58 (46.30) 0.427

9. There should have free vaccination against diphtheria to the medical personnel.

96 (88.89) 10 (9.26 ) 2 (1.85)

0.216

1 0. Getting into an epidemic area without protection is a risk factor to have diphtheria infection.

84 (77.78) 16 (14.81) 8 (7.41)

0.424

1 1. If a medical personnel encourages you to receive vaccination, you will get vaccinated.

71 (85.19

)

28 (12.04

)

9 (2.78)

0.020*

1 2. The medical personnel should be the ones who educate people how to protect themselves.

94 (87.04) 13 (12.04) 1 (0.93 )

0.337

1 3 . Medical personnel have more risk to have diphtheria infection, they should receive vaccine.

91 (84.26) 15 (13.89 ) 2(1.85 )

0.833

14. Everyone should be participated in preventing an outbreak of diphtheria.

98 (90.74 ) 10 (9.26) 0 (0)

0.278

Table 5: Attitudes about diphtheria and vaccination (2)

Attitude No.6Everyone should be vaccinated against diphtheria

because it easily spreads.

P-value = 0.038, OR = 2.97

Vaccination Non-vaccination

AgreeDisagreeNot sure

Attitude No.11If a medical personnel encourages you to receive

vaccination, you will get vaccinated.

P-value = 0.020

Vaccination Non-vaccination

AgreeDisagreeNot sure

Conclusion

• The medical personnel who had more knowledge and good attitude to the diphtheria vaccination would rather decide to receive a vaccination than the others.

• The perception of news and working experiences were also related to the vaccination.

• Therefore, institutional diphtheria vaccination campaigns should focus on the awareness of medical personnel and new recommendations for diphtheria vaccination.

Thank You