Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
Hum Vaccin Immunother. 2012 Sep;8(9):1223-9. doi: 10.4161/hv.20901. Epub 2012 Aug 16.
Effectiveness of mass cholera vaccination campaigns requires not only technical and financial capacity but also consideration of social and cultural factors affecting vaccine acceptance. This study examined the influence of local community views of cholera on oral cholera vaccine (OCV) uptake in a mass vaccination campaign in 2009 in peri-urban and rural areas of Zanzibar. It used data from interviews conducted before the campaign and followed previous research assessing determinants of anticipated OCV acceptance. OCV uptake was lower than the reported anticipated acceptance. Less than half of the 356 adult respondents (49.7%) drank the required two doses of OCV. Variables referring to socio-cultural features of diarrheal illness that respondents identified with a cholera case vignette explained uptake better than analysis only of socio-demographic characteristics. Somatic features of illness not specific for cholera were negative determinants. Recognition of unconsciousness as a serious sign of dehydration and concern that cholera outbreaks would overwhelm the local healthcare system in the rural area were positive determinants of acceptance. Female gender, rural residence and older age were also positive determinants of OCV uptake. For further vaccine action with OCVs, cholera as a cause of severe dehydration should be distinguished from other causes of diarrhea. Planning should acknowledge rural concern about the relationship of limited capacity of the healthcare system to cope with cholera outbreaks and the priority of a cholera vaccine. Findings recommend particular efforts to increase cholera immunization coverage among young adults, in peri-urban areas and for men.
大规模霍乱疫苗接种活动的有效性不仅需要技术和财务能力，还需要考虑影响疫苗接种接受度的社会和文化因素。本研究调查了当地社区对霍乱的看法对 2009 年在桑给巴尔城乡地区开展的大规模疫苗接种活动中口服霍乱疫苗（OCV）接种率的影响。该研究利用了在疫苗接种活动前进行的访谈数据，并遵循了先前评估预期 OCV 接种接受度决定因素的研究。OCV 接种率低于报告的预期接受率。在 356 名接受采访的成年受访者中（49.7%），只有不到一半的人饮用了所需的两剂 OCV。受访者在霍乱病例情景中识别出的与腹泻病社会文化特征相关的变量比仅分析社会人口特征能更好地解释接种率。非霍乱特异性疾病的躯体特征是负面决定因素。将无意识识别为严重脱水的严重迹象，以及对霍乱疫情将使农村地区当地医疗系统不堪重负的担忧，是接受疫苗的积极决定因素。女性、农村居住和年龄较大也是 OCV 接种率的积极决定因素。为了进一步使用 OCV 进行疫苗接种活动，应将霍乱引起的严重脱水与其他腹泻病因区分开来。规划应承认农村地区对医疗系统应对霍乱疫情能力有限的担忧，以及霍乱疫苗的优先地位。研究结果建议特别努力提高年轻人、城乡地区和男性的霍乱免疫接种率。
