title: Impact of physicians' attitude to vaccination on local vaccination coverage for pertussis and measles in Germany.
abstract: BACKGROUND
  Vaccination rates of children in Germany are unsatisfying and regional endemic outbreaks have been reported. Few studies have analysed physicians' attitude towards vaccination. We investigated whether there is an association between physicians' attitude and vaccination coverage on the regional level for Germany.
  
  
  METHODS
  In a representative cross-sectional survey, anonymized questionnaires were sent to random samples of all paediatricians (50%) and general practitioners (10%) in private practice in Germany. Attitude towards vaccination was operationalized in three scores. Measles and pertussis vaccination coverage rates were obtained from the 16 Federal States' Health Departments. Geographic methods and linear regression models were used for analysis.
  
  
  RESULTS
  A total of 2010 paediatricians (response proportion: 64.1%) and 1712 general practitioners (response proportion 39.1%) were included in the analysis. We found an association of physicians' attitude towards vaccination and vaccination coverage rate (P < 0.0001). There is also an important association between vaccination coverage and the geographic location, with lower coverage rates especially in the States of former Western Germany (compared with our reference State Mecklenburg-Western Pomerania; pertussis: maximum -5.86% in Bavaria, P < 0.0001; measles: maximum -20.20% in Berlin, P = 0.0002).
  
  
  CONCLUSIONS
  The regional association between vaccination coverage rates and physicians' attitude towards vaccination seems to be superposed by population-related variables. An increase of vaccination coverage requires better information and training of both, physicians and the general population.
authors.affiliation: 1 Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Weigel
authors.affiliation: 1 Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Weitmann
authors.affiliation: 1 Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Rautmann
authors.affiliation: 1 Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Judith
authors.initials: J
authors.lastname: Schmidt
authors.affiliation: 2 Department of Paediatrics, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Roswitha
authors.initials: R
authors.lastname: Bruns
authors.affiliation: 1 Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany wolfgang.hoffmann@uni-greifswald.de.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hoffmann
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002648:Child; D003430:Cross-Sectional Studies; D005858:Germany; D006302:Health Services Research; D006801:Humans; D008458:Measles Vaccine / Q000008:administration & dosage*; D008875:Middle Aged; D010567:Pertussis Vaccine / Q000008:administration & dosage*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
chemical_list: D008458:Measles Vaccine; D010567:Pertussis Vaccine