title: Factors influencing laboratory workers' decisions to accept or decline anthrax vaccine adsorbed (AVA): results of a decision-making study in CDC's anthrax vaccination program.
abstract: BACKGROUND
  Laboratory technicians, laboratory supervisors, decontamination/remediation workers, and environmental investigators are at increased risk for repeated occupational exposure to Bacillus anthracis. In 2002, the Advisory Committee on Immunization Practices (ACIP) recommended pre-exposure vaccination for these occupational groups.
  
  
  OBJECTIVE
  To determine (1) the factors that influenced an individual's decision to either accept or decline Anthrax Vaccine Adsorbed (AVA), and (2) if laboratory workers' concern about AVA safety was related to their information needs and trust in the information provided.
  
  
  METHODS
  We conducted a decision-making survey of 404 participants at 44 Laboratory Response Network laboratories located throughout the United States. All participants were enrolled between October 2002 and December 2004, and all were eligible to receive AVA according to the 2002 ACIP recommendations. Chi-square tests and multivariate logistic regression were used in the analyses.
  
  
  RESULTS
  The response rate of eligible individuals at participating laboratories was 94% (404/430). Sixty-six percent of respondents accepted and 34% declined AVA. Laboratory workers who declined AVA were more likely to rate their risk of exposure to inhalation anthrax as low (OR = 6.9; 95%CI 1.7, 28.3), report being very concerned (OR = 4.1; 95%CI 1.8, 9.3) or concerned (OR = 2.0; 95%CI 1.3, 3.1) about the safety of the vaccine, report that they did not trust the information provided in the Vaccine Information Statement (VIS) (OR = 2.3; 95%CI 1.1, 4.5), and to be enrolled in the study during 2002 (OR = 24.7; 95%CI 6.4, 95.3) or 2003 (OR = 5.0; 95%CI 2.5, 9.8), the first 2 years of the study. Furthermore, we found a significant association between a participant's level of concern about the safety of AVA and their perception that they received enough information and/or trusted the information in the VIS.
  
  
  CONCLUSIONS
  Low perceived necessity, concern about the safety of the vaccine, and a lack of trust in the VIS were associated with the decision of laboratory workers to decline AVA. Results of this decision-making study may be used to try to improve acceptance rates of AVA among persons considered at high risk, and may inform educational efforts for other adult vaccines.
authors.affiliation: Immunization Safety Office, Office of the Chief Science Officer, Office of the Director, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: Gabrielle L
authors.initials: GL
authors.lastname: Fowler
authors.forename: James M
authors.initials: JM
authors.lastname: Baggs
authors.forename: Eric S
authors.initials: ES
authors.lastname: Weintraub
authors.forename: Stacey W
authors.initials: SW
authors.lastname: Martin
authors.forename: Michael M
authors.initials: MM
authors.lastname: McNeil
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Gust
mesh_terms: D000328:Adult; D000881:Anthrax / Q000517:prevention & control*; D022122:Anthrax Vaccines / Q000009:adverse effects; D001291:Attitude of Health Personnel; D003627:Data Interpretation, Statistical; D003657:Decision Making; D005260:Female; D006282:Health Personnel; D006801:Humans; D019570:Inhalation Exposure / Q000706:statistics & numerical data; D007753:Laboratories; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data; D012306:Risk; D012959:Socioeconomic Factors; D035502:Trust; D014481:United States; D014611:Vaccination
chemical_list: D022122:Anthrax Vaccines