Abstract
Negative perception towards vaccination is one of the reasons for low coverage of diphtheria immunization in Indonesia. Perception, which is difficult to change, is related to stress level, possibly influences outcome of diseases, and also vaccination. This study aims to identify the correlation between perception of diphtheria vaccination and antibody response after vaccination.This study used secondary data from two unpublished studies on 30 medical interns in Hasan Sadikin Hospital, Bandung, West Java, after diphtheria outbreak, from June to July 2019. Antibody level after diphtheria emergency vaccination was measured using ELISA and perception towards vaccination was measured using a questionnaire. Perception towards vaccination was expressed as perception score and was divided into 4 components: perceived threat, benefit, barrier, and cues to action. Higher perception score indicated more positive perception towards vaccination. Diphtheria antibody level was grouped into reliable protection (≥0,10 IU/mL) or unreliable protection (<0,10 IU/mL). Statistical correlation analysis was done with GraphPad Prism version 7.0.Most of our subjects were female. Median age was 22 (20–24) years old. Median time elapsed between vaccination date and measurement of antibody level was 18 (6–18) months. Median antibody level was 0,28 (0,09–3,47) IU/mL. Twenty-three subjects (82,1%) had reliable protection. Subjects with reliable protection had more positive perception compared to unreliable protection (perception score 80,6 ± 5,4 vs 69,0 ± 1,8, p = 0,0001). Subjects with reliable protection had less perceived barrier for vaccination (15,6 ± 2,1 vs 13,0 ± 1,8, p = 0,0083). Perception score showed strong, positive correlation to reliable protection against diphtheria (R = 0,705, p < 0,001). Perceived barrier and threat showed positive correlation to reliable protection (R = 0,489, p = 0,008 and R = 0,402, p = 0,034).In conclusion, perception towards diphtheria vaccination is strongly correlated to protective antibody. Improving perception of vaccination are needed to overcome vaccine hesitancy.
Highlights
One of the reasons for diphtheria outbreak in 2017–2018 in Indonesia was poor coverage of diphtheria immunization (Tosepu et al, 2018)
Perception on diphtheria vaccination is strongly correlated to protective antibody among medical interns
Health care workers need to understand the benefits of positive perception toward vaccination and its association with antibody response after vaccination to encounter vaccine hesitancy, because health care workers have an important role as educator of patients and their families
Summary
One of the reasons for diphtheria outbreak in 2017–2018 in Indonesia was poor coverage of diphtheria immunization (Tosepu et al, 2018). The 2017–2018 outbreak observed an exponential increase in the number of cases as well as death. This prompted the Government to launch outbreak response immunization (Tosepu et al, 2018). The country is made up of myriad of cultures, beliefs, and religions, each with their own beliefs about vaccination (Pronyk et al, 2019) This created obstacle in convincing parents for vaccinating their children as parents were influenced by religious leaders and cultural norms rather than healthcare providers only (Pronyk et al, 2019; Syiroj et al, 2019). Vaccine hesitancy was found in health care workers in Indonesia, further compounding the problem (Harjaningrum et al, 2013). Vaccine hesitancy probably arose due to misperceptions about vaccination (Syiroj et al, 2019; Yufika et al, 2020; Harapan et al, 2018)
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