Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
PLoS One. 2012;7(7):e41527. doi: 10.1371/journal.pone.0041527. Epub 2012 Jul 23.
Recent research in two cholera-endemic communities of Zanzibar has shown that a majority (∼94%) of the adult population was willing to receive free oral cholera vaccines (OCVs). Since OCV uptake in the 2009 campaign reached only ∼50% in these communities, an evaluation of social and cultural factors and of barriers was conducted to understand this difference for future cholera control planning.
METHODOLOGY/PRINCIPAL FINDINGS: A random sample of 367 adult peri-urban and rural community residents (46.6% immunized vs. 53.4% unimmunized) was studied with a semi-structured interview that inquired about social and cultural features of cholera depicted in a vignette and barriers to OCV uptake. Symptoms (rectal pain, loose skin only in rural community) and perceived causes (uncovered food, contact with contaminated water) specific for severe diarrhea were associated with uptake. Purchasing drugs from pharmacies to stop diarrhea and vomiting was negatively associated with uptake. Increasing household size, age and previous enteric illness episode were positively related to uptake, the latter only at the rural site. The most prominent barrier to uptake was competing obligations or priorities (reported by 74.5%, identified as most important barrier by 49.5%). Next most prominent barriers were lacking information about the campaign (29.6%, 12.2%), sickness (14.3%, 13.3%) and fear of possible vaccine side effects (15.3%, 5.6%). The majority of unvaccinated respondents requested repetition of the vaccination with free OCVs.
CONCLUSIONS/SIGNIFICANCE: Factors associated with uptake indicated a positive impact of the vaccination campaign and of sensitization activities on vaccine acceptance behavior. Unlike communities opposed to cholera control or settings where public confidence in vaccines is lacking, identified barriers to uptake indicated a good campaign implementation and trust in the health system. Despite prospects and demand for repeating the vaccination, local decision-makers should reconsider how careful logistical arrangements may improve community coverage and thus effectiveness of vaccination campaigns.
最近在桑给巴尔的两个霍乱流行社区开展的研究表明，大多数（约 94%）成年人口愿意接受免费口服霍乱疫苗（OCV）。由于在这些社区 2009 年的疫苗接种活动中，OCV 的接种率仅达到约 50%，因此需要对社会和文化因素以及障碍进行评估，以便为未来的霍乱控制规划提供依据。
方法/主要发现：对随机抽取的 367 名城市周边和农村社区成年居民（46.6%已接种疫苗，53.4%未接种疫苗）进行了半结构访谈研究，询问他们对一个病例中描述的霍乱的社会和文化特征以及接受 OCV 接种的障碍的看法。腹泻的特定症状（直肠疼痛，仅在农村社区皮肤松弛）和可感知的病因（食物未遮盖、接触受污染的水）与接种率相关。购买药物来停止腹泻和呕吐与接种率呈负相关。家庭规模增大、年龄增长和之前发生肠道疾病与接种率呈正相关，后者仅在农村社区存在。接种率最大的障碍是竞争的义务或优先事项（74.5%的人报告了这一点，49.5%的人认为这是最重要的障碍）。其次是缺乏关于疫苗接种运动的信息（29.6%，12.2%）、疾病（14.3%，13.3%）和对可能的疫苗副作用的担忧（15.3%，5.6%）。大多数未接种疫苗的受访者要求免费接种 OCV 疫苗。
结论/意义：与接种率相关的因素表明，疫苗接种运动和宣传活动对疫苗接受行为产生了积极影响。与反对霍乱控制的社区或公众对疫苗缺乏信心的环境不同，发现的接种障碍表明疫苗接种运动实施良好，对卫生系统信任度高。尽管有重复接种的前景和需求，地方决策者仍应重新考虑如何精心安排后勤工作，以提高社区的覆盖率，从而提高疫苗接种运动的效果。
