Page 122 - Preventing pertussis in early infancy - Visser

Summary
Summary
Despite an overall high uptake of childhood vaccinations, pertussis has changed in the last two decades from a marginalised childhood disease to an endemic disease among adolescents and young adults. This increase of pertussis circulation puts young infants at risk, who are too young to be fully protected by their own childhood vaccinations. While for adults pertussis is mostly a nuisance, it can be a dangerous disease for infants. They have an increased risk for serious complications - such as apnoea, pneumonia or convulsions – and even death.
To reduce the burden of pertussis in infants, several policies have been evaluated and proposed. Pertussis cocooning (i.e. vaccination of all adults surrounding an infant) and selective pertussis vaccination of healthcare workers (HCWs) who work with infants are such strategies. These strategies contribute to the prevention of pertussis transmission to newborn babies. For an effective implementation of these strategies, most theories on behavioural change emphasise that it is essential to recognise that individuals act in a complex environment, where in addition to their personal determinants, different social and physical conditions influence their behaviour. Consequently, a vaccination programme should take account of a broad array of determinants that influence the vaccination acceptance in the target groups. In this thesis, we set out to explore these determinants by qualitatively and quantitatively assessing the potential factors influencing the pertussis cocooning acceptance among envisioned target groups in the Netherlands. Using an Intervention Mapping (IM) approach, we subsequently designed a pilot vaccination programme by taking the most relevant and changeable determinants into account.
In chapter 2 we describe a qualitative study, where we aimed to explore the perceived determinants (barriers and enablers) of the acceptance among the possible target groups of pertussis vaccination for cocooning. We conducted 13 focus group meetings and six individual semi-structured interviews with members of possible target groups for pertussis cocooning (i.e. parents, maternity assistants, midwives, and paediatric nurses) in the Netherlands. The participants’ risk perception, outcome expectations, general vaccination beliefs, moral norms, opinion of others, perceived autonomy, anticipated regret, decisional uncertainty, and perceived organisational barriers were all factors that influenced the intention to accept pertussis vaccination for cocooning. Experience, information and trust emerged as predominant themes within these determinants.
In chapter 3 we first sketch the contours of the ethical debate by describing the main normative arguments used to defend voluntary and mandatory vaccination. After that we further elaborate on the arguments found in the qualitative study, which impact the ethical debate on voluntary and mandatory vaccination. These arguments enrich the ethical discussion, because they reflect what people in concrete societal contexts think and feel about mandatory or voluntary vaccination. Based on these arguments, we argued that voluntary vaccination continues to be the better alternative in contexts where people (a) show broad support for voluntary vaccination, (b) do considerable effort to collect sufficient
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