title: Predictors of optional immunization uptake in an urban south Indian population.
abstract: BACKGROUND
  In Tamil Nadu, India, bacille Calmette-Guérin, diphtheria-tetanus-pertussis, oral poliomyelitis, hepatitis B, and measles vaccines are part of the routine immunization schedule and are available free from government health centers. All other vaccines are optional and available in the private sector at a cost to families. This study assesses immunization rates of routine and optional vaccines and examines parental attitudes toward vaccines in Pallavapuram, Tamil Nadu.
  
  
  METHODS
  The cluster sampling method was used to estimate immunization coverage. Seven children 18 to 36 months old were selected from 30 clusters for a total sample of 210 children. Demographics and vaccination data were collected from interviews and immunization records. Predictors of vaccination status were identified with logistic regression models. In addition, 21 parents participated in semi-structured interviews regarding their attitudes toward vaccination. Interviews were analyzed qualitatively for themes.
  
  
  RESULTS
  Eighty one percent of children were fully immunized with routine vaccines. However, only 21% received all "major" optional vaccines, defined as 3 doses of Haemophilus influenzae type b vaccine, one dose of measles, mumps, rubella vaccine, and one dose of varicella zoster virus vaccine. Birth in a private hospital (OR 5.6, 95% CI 1.3 to 22.9, P<0.01), higher income (P=0.03), and maternal completion of high school (OR 6.4, 95% CI 1.5 to 27.6, P<0.01) were significant predictors of receiving all major optional vaccines. Elucidated themes from interviews included (1) strong parental support for immunizations, (2) low concern for side effects, and (3) low uptake of optional vaccines due to high cost and lack of awareness.
  
  
  CONCLUSIONS
  Coverage of optional vaccines is low despite positive attitudes toward immunizations. Efforts to reduce cost and increase awareness of these vaccines particularly among low-income families or to include these vaccines in the routine schedule may increase uptake and reduce morbidity and mortality from vaccine-preventable diseases.
authors.affiliation: Division of Pediatric Infectious Disease, Vanderbilt University Medical Center, Nashville, TN, United States. Electronic address: Kalpana.manthiram@vanderbilt.edu.
authors.forename: Kalpana
authors.initials: K
authors.lastname: Manthiram
authors.affiliation: Division of Adolescent Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Clinical Research Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Blood
authors.affiliation: Medical University of South Carolina, Charleston, SC, United States.
authors.forename: Vasanthan
authors.initials: V
authors.lastname: Kuppuswamy
authors.affiliation: Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, United States.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Martins
authors.affiliation: Department of Neonatalogy, Emory Johns Creek Hospital, Johns Creek, GA, United States.
authors.forename: Athi
authors.initials: A
authors.lastname: Narayan
authors.affiliation: Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, United States.
authors.forename: Kelly
authors.initials: K
authors.lastname: Burmeister
authors.affiliation: Pallavaram Children's Medical Centre, Pallavaram, Tamil Nadu, India.
authors.forename: K
authors.initials: K
authors.lastname: Parvathy
authors.affiliation: Division of Adolescent Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Areej
authors.initials: A
authors.lastname: Hassan
mesh_terms: D002675:Child, Preschool; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D010290:Parents / Q000523:psychology*; D036301:Qualitative Research; D066252:Sociological Factors; D014505:Urban Population; D014611:Vaccination / Q000523:psychology / Q000706:statistics & numerical data*; D014612:Vaccines / Q000008:administration & dosage*
chemical_list: D014612:Vaccines
keywords: Immunization coverage; Optional immunizations; Parental attitudes
references.citation: Lancet. 2010 Aug 21;376(9741):615-23
references.pmid: 20692031
references.citation: Vaccine. 2006 Nov 30;24(49-50):7030-6
references.pmid: 16890330
references.citation: Pediatrics. 2004 Sep;114(3):755-61
references.pmid: 15342850
references.citation: Lancet. 2009 Sep 12;374(9693):893-902
references.pmid: 19748398
references.citation: Hum Vaccin Immunother. 2012 Sep;8(9):1213-7
references.pmid: 22894966
references.citation: Health Care Women Int. 2014;35(10):1148-61
references.pmid: 23611111
references.citation: Clin Infect Dis. 2011 Jan 15;52(2):171-7
references.pmid: 21288839
references.citation: J Health Popul Nutr. 2010 Jun;28(3):300-4
references.pmid: 20635642
references.citation: Pediatrics. 2007 Oct;120(4):e783-7
references.pmid: 17908736
references.citation: J Paediatr Child Health. 2011 May;47(5):276-81
references.pmid: 21244560
references.citation: Bull World Health Organ. 1982;60(2):253-60
references.pmid: 6980735
references.citation: Lancet. 2007 Feb 3;369(9559):389-96
references.pmid: 17276779
references.citation: N Engl J Med. 2010 Jan 28;362(4):299-305
references.pmid: 20107215
references.citation: Lancet. 2008 Apr 5;371(9619):1181-9
references.pmid: 18395579
references.citation: Indian J Pediatr. 2007 Jan;74(1):47-50
references.pmid: 17264453
references.citation: Nat Med. 2005 Apr;11(4 Suppl):S12-5
references.pmid: 15812482
references.citation: Bull World Health Organ. 2012 Oct 1;90(10):720-7
references.pmid: 23109739
references.citation: Vaccine. 2003 Jan 30;21(7-8):596-600
references.pmid: 12531324
references.citation: N Engl J Med. 2013 Jul 11;369(2):155-63
references.pmid: 23841730
references.citation: Am J Public Health. 1992 Jan;82(1):120-2
references.pmid: 1536315
references.citation: Indian Pediatr. 2012 Mar;49(3):203-23
references.pmid: 22484740
references.citation: Vaccine. 2013 Apr 18;31 Suppl 2:B43-53
references.pmid: 23598492
references.citation: Vaccine. 2012 May 21;30(24):3541-5
references.pmid: 22475859
references.citation: Public Health. 2003 Jan;117(1):54-61
references.pmid: 12802906
references.citation: Vaccine. 2011 Oct 26;29(46):8215-21
references.pmid: 21893149
references.citation: Lancet. 2010 Nov 27;376(9755):1853-60
references.pmid: 21075444
references.citation: Trop Med Int Health. 2010 Nov;15(11):1326-32
references.pmid: 20955496
references.citation: Soc Sci Med. 1998 May;46(9):1205-12
references.pmid: 9572610
references.citation: Soc Sci Med. 2012 Jul;75(2):331-9
references.pmid: 22531572
references.citation: Vaccine. 2005 Dec 1;23(48-49):5670-87
references.pmid: 16243412
references.citation: Public Health. 2005 Oct;119(10):862-9
references.pmid: 15949829
references.citation: Vaccine. 2007 May 16;25(20):4003-11
references.pmid: 17363119
references.citation: Indian J Pediatr. 2007 Feb;74(2):131-4
references.pmid: 17337823
references.citation: Arch Public Health. 2013 Jul 13;71(1):19
references.pmid: 23848348
references.citation: BMC Public Health. 2011 May 23;11:372
references.pmid: 21605408