Abstract
BackgroundJapan’s National Immunization Program does not cover rotavirus vaccine and no government subsidies are available. This study aimed to measure the uptake of and determinants that influenced self-paid rotavirus vaccination, including socioeconomic status and relative poverty.MethodsWe conducted a cross-sectional study at health check-ups for all children aged 18 months in Kanazawa, Japan, between December 2017 and July 2018. Community nurses collected information on self-paid vaccination history, parents’ perceptions of and recommendations for rotavirus vaccine, and socioeconomic status in interviews using a unified questionnaire. We used multivariable logistic regression to assess vaccine uptake and possible determinants.ResultsIn total, 1282 participants were enrolled. The estimated rotavirus vaccine coverage was 72.9%. Perceptions that rotavirus gastroenteritis was serious and that the rotavirus vaccine was effective, pediatricians’ recommendations, information from the city office, magazine and Internet articles, and higher parental education level were associated with higher rotavirus vaccine uptake. Lower household income was associated with decreased rotavirus vaccine uptake. Vaccine expense, fear of adverse reactions to the vaccine, number of household members and siblings, and children’s characteristics were not correlated with rotavirus vaccination. Poverty was associated with decreased rotavirus vaccine uptake, even after adjustment for other determinants (adjusted odds ratio 0.49, 95% confidence interval: 0.26–0.90).ConclusionParents’ perceptions, socioeconomic status, relative poverty, and pediatricians’ recommendations are determinants of vaccination. This study suggests that appropriate information about rotavirus vaccine, subsidies for those of lower socioeconomic status, and national recommendations are necessary to achieve higher coverage.
Highlights
Japan’s National Immunization Program does not cover rotavirus vaccine and no government subsidies are available
A Canadian study reported that increased knowledge and more positive attitudes toward the vaccine among parents increased the coverage of rotavirus vaccine [9]
We found that 73% of parents believed rotavirus gastroenteritis (RVGE) was a serious disease, 66% believed rotavirus vaccine was effective, 36% worried about adverse reactions to the rotavirus vaccine, and most (90%) thought that the rotavirus vaccine was expensive
Summary
Japan’s National Immunization Program does not cover rotavirus vaccine and no government subsidies are available. It is difficult to prevent infection by hand washing or hygiene, and it is the leading etiology for diarrhea mortality among children aged 5 years and under [1]; the World Health Organization (WHO) recommended inclusion of rotavirus vaccines in national immunization programs (NIP) in 2009 [2]. Qualitative research reported that safety concerns and lack of knowledge about rotavirus gastroenteritis (RVGE) were barriers to vaccination when the new rotavirus vaccine (RotaTeq®) was approved in 2006 [8]. A Canadian study reported that increased knowledge and more positive attitudes toward the vaccine among parents increased the coverage of rotavirus vaccine [9]. Few previous studies have evaluated the influence of parents’ socioeconomic factors on vaccine uptake, one study reported lower parental socioeconomic status and lower parental concerns about vaccine were determinants of not being vaccinated [10]
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