title: Determinants of refusal of A/H1N1 pandemic vaccination in a high risk population: a qualitative approach.
abstract: BACKGROUND
  Our study analyses the main determinants of refusal or acceptance of the 2009 A/H1N1 vaccine in patients with cystic fibrosis, a high-risk population for severe flu infection, usually very compliant for seasonal flu vaccine.
  
  
  RESULTS
  We conducted a qualitative study based on semi-structured interviews in 3 cystic fibrosis referral centres in Paris, France. The study included 42 patients with cystic fibrosis: 24 who refused the vaccine and 18 who were vaccinated. The two groups differed quite substantially in their perceptions of vaccine- and disease-related risks. Those who refused the vaccine were motivated mainly by the fears it aroused and did not explicitly consider the 2009 A/H1N1 flu a potentially severe disease. People who were vaccinated explained their choice, first and foremost, as intended to prevent the flu's potential consequences on respiratory cystic fibrosis disease. Moreover, they considered vaccination to be an indirect collective prevention tool. Patients who refused the vaccine mentioned multiple, contradictory information sources and did not appear to consider the recommendation of their local health care provider as predominant. On the contrary, those who were vaccinated stated that they had based their decision solely on the clear and unequivocal advice of their health care provider.
  
  
  CONCLUSIONS
  These results of our survey led us to formulate three main recommendations for improving adhesion to new pandemic vaccines. (1) it appears necessary to reinforce patient education about the disease and its specific risks, but also general population information about community immunity. (2) it is essential to disseminate a clear and effective message about the safety of novel vaccines. (3) this message should be conveyed by local health care providers, who should be involved in implementing immunization.
authors.affiliation: CNRS, UMI 3189, Faculté de Médecine Secteur Nord, Université de la Méditerranée, Marseille, France.
authors.forename: Eugenie
authors.initials: E
authors.lastname: d'Alessandro
authors.forename: Dominique
authors.initials: D
authors.lastname: Hubert
authors.forename: Odile
authors.initials: O
authors.lastname: Launay
authors.forename: Laurence
authors.initials: L
authors.lastname: Bassinet
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.forename: Yannick
authors.initials: Y
authors.lastname: Jaffre
authors.forename: Isabelle
authors.initials: I
authors.lastname: Sermet-Gaudelus
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003550:Cystic Fibrosis / Q000276:immunology / Q000523:psychology / Q000821:virology; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology*; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000276:immunology; D007251:Influenza, Human / Q000276:immunology / Q000517:prevention & control* / Q000523:psychology; D008875:Middle Aged; D058873:Pandemics / Q000517:prevention & control*; D010297:Paris; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010353:Patient Education as Topic; D014611:Vaccination / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines