title: What a pandemic teaches us about vaccination attitudes of parents of children with asthma.
abstract: BACKGROUND
  During the recent pandemic, Influenza A/H1N1 vaccine uptake remained far below the targeted rates. Associated factors regarding vaccine refusal in the general population have been reported in many studies, however the reasons behind refusals for asthmatic children have not yet been identified. We aimed to investigate Influenza A/H1N1 virus vaccine acceptance for children with asthma, to determine the attitudes and beliefs of parents concerning Influenza A/H1N1 disease and vaccine and to identify the association of asthma control parameters with vaccination.
  
  
  METHODS
  The parents of asthmatic children aged 6-18 years participated in a cross-sectional survey study in three pediatric allergy outpatient clinics. The survey measured demographic factors, asthma control parameters, vaccination rates, and beliefs and attitudes regarding Influenza A/H1N1 vaccine.
  
  
  RESULTS
  Of the 625 asthmatic children, 16.8% (n=105) were immunized with Influenza A/H1N1 and 45.7% (n=286) with seasonal influenza vaccine. Educational background of parents (p<0.001 and p=0.002, for father's and mother's educational level, respectively), previous vaccination with seasonal influenza (p<0.001), and having a family member vaccinated against Influenza A/H1N1 (p<0.001) had a significant influence on vaccine acceptance, while fear of side effects (88.6%) was the major parental reason for refusing the vaccine. Asthma control parameters had no influence on uptake of the vaccine. Physician recommendation (84.8%) was important in the decision-making process for immunization. The statement "Children with asthma should receive swine flu vaccine" increased the likelihood of being vaccinated [OR: 2.160, (95%CI 1.135-4.111), p=0.019].
  
  
  CONCLUSIONS
  Although asthmatic children are considered to be a high-priority group for Influenza A/H1N1 vaccination, we found low uptake of vaccine among our patients. Beliefs and attitudes rather than asthma control parameters influenced parental decisions for immunization. Understanding the underlying determinants for refusing the vaccine will help to improve vaccine campaigns in advance of a future outbreak.
authors.affiliation: Hacettepe University, School of Medicine, Pediatric Allergy and Asthma Unit, Ankara, Turkey.
authors.forename: Betul
authors.initials: B
authors.lastname: Buyuktiryaki
authors.affiliation: Ministry of Health, Ankara Education and Research Hospital, Ankara, Turkey.
authors.forename: Ozge Uysal
authors.initials: OU
authors.lastname: Soyer
authors.affiliation: Ministry of Health, Ankara Hematology and Oncology Education and Research Hospital, Pediatric Allergy Clinic, Ankara, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Erkocoglu
authors.affiliation: Ministry of Health, Ankara Education and Research Hospital, Ankara, Turkey.
authors.forename: Ayse
authors.initials: A
authors.lastname: Dogan
authors.affiliation: Ministry of Health, Ankara Hematology and Oncology Education and Research Hospital, Pediatric Allergy Clinic, Ankara, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Azkur
authors.affiliation: Ministry of Health, Ankara Hematology and Oncology Education and Research Hospital, Pediatric Allergy Clinic, Ankara, Turkey.
authors.forename: Can Naci
authors.initials: CN
authors.lastname: Kocabas
authors.affiliation: Ministry of Health, Ankara Education and Research Hospital, Ankara, Turkey.
authors.forename: Yildiz
authors.initials: Y
authors.lastname: Dallar
authors.affiliation: Hacettepe University, School of Medicine, Pediatric Allergy and Asthma Unit, Ankara, Turkey.
authors.forename: Ayfer
authors.initials: A
authors.lastname: Tuncer
authors.affiliation: Hacettepe University, School of Medicine, Pediatric Allergy and Asthma Unit, Ankara, Turkey. Electronic address: b_sekerel@yahoo.com.
authors.forename: Bulent Enis
authors.initials: BE
authors.lastname: Sekerel
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000453:epidemiology*; D002648:Child; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control; D008297:Male; D010290:Parents / Q000523:psychology*; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000523:psychology* / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines
keywords: Asthma; Attitude; Influenza A/H1N1; Survey; Vaccine