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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) • Step1 : Proportional Stratified Sampling Occupations Physician Nurse Pharmacist Practical nurse Nurse aid Medical technologist Medical student Total • No. of Population 201 292 20 3 165 18 28 727 Proportion 27.65 40.17 2.75 0.41 22.70 2.48 3.85 100 No. of Samples 33 48 3 1 27 3 5 120 Step 2 : Simple Randomized Sampling RESULT 110 Medical Personnel 2 respondents answered half of the questions 58 vaccinated (53.70%) 50 not yet vaccinated (46.30%) 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) Table 1 : Baseline data (2) 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 (50.93) 39 (36.11) 14 (12.96) Table 1 : Baseline data (3) Baseline data 5) Perception of the news Yes No No. of medical personnel (N%) 92 (85.19) 16 (14.81) 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 (4) Baseline data 9) Vaccination in last one year dT Tdap Have not yet been vaccinated 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 No. of medical personnel (N%) 26 (24.07) 32 (29.63) 50 (46.30) 23 (46.00) 9 (18.00) 13 (26.00) 5 (10.00) 13 (26.00) The reasons they said no to vaccination (N=50) 50 45 46 40 35 30 26 25 26 18 20 15 10 10 5 0 Ignorance of the news Fear of side effects Lack of time Fear of pain Fear of expenses Table 2. Univariate analysis Variable Experience <5 yr* 5-10 yr >10 yr Perception of news yes no* OR p-value 30(54.55) 12(30.77) 2.70 0.02* 6(42.86) 8(57.14) 0.90 0.86 56(60.87) 2(12.50) 36(39.13) 14(87.50) 10.89 0.02* Vaccination Nonvaccination N(%) N(%) 25(45.45) 27(69.23) Baseline data No.4 Working experiences 35 30 25 54.55% 45.45% 69.23% vaccination 20 15 30.77% 10 57.14 % 42.86% 5 0 <5 years 5-10 years > 10 years nonvaccination Baseline data No.5 Perception of news 60 60.87% 50 40 39.13% 30 20 87.50% 10 12.50% 0 yes no vaccination non-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 10. Prevention of diphtheria infection in children is to be fully vaccinated three doses. 11. The booster is not required in the person who already received diphtheria vaccine since childhood. 20 (18.52) 88 (81.48) 0.713 83 (76.85) 25 (23.15) 0.267 12. Immunodeficiency is not the risk of diphtheria infection. 87 (80.56) 21 (19.44) 0.021* 13. 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? Mean = 11.537 (SD=2.28) 103 (95.37) 5 (4.63) 0.122 vaccination 11.74 Nonvaccination 11.3 0.159 T-test Knowledge No.3: Diphtheria can cause fever, cough, sore throat, difficult swallowing. correct incorrect Vaccination Non-vaccination P-value = 0.077, OR = 2.96 Knowledge No.13: Side effects of vaccine are swelling and redness at the injection site. Vaccine also cause severe allergy. right wrong Vaccination Non-vaccination P-value = 0.029, OR = 2.47 Table 5: Attitudes about diphtheria and vaccination (1) Questions N% P-value (n=108) agree not sure disagree 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 (2) Questions agree not sure disagree P-value (n=108) 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 10. 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 11. If a medical personnel encourages you to receive vaccination, you will get vaccinated. N% 71 28 9 0.020 (85.19) (12.04) (2.78) * 12. 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 13. 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 Attitude No.6 Everyone should be vaccinated against diphtheria because it easily spreads. Agree Disagree Not sure Vaccination Non-vaccination P-value = 0.038, OR = 2.97 Attitude No.11 If a medical personnel encourages you to receive vaccination, you will get vaccinated. Agree Disagree Not sure Vaccination Non-vaccination P-value = 0.020 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