title: A Socio-Demographic Examination of Adults Responding to Governmental Vaccination Recommendations during the Japanese Rubella Outbreak of 2013.
abstract: BACKGROUND
  In 2013 a rubella outbreak occurred among Japanese people of working-age which resulted in 14,357 reported cases. The Japanese government subsequently recommended voluntary vaccination or rubella antibody testing for young women (15-49 years of age) who were planning to conceive and for adult men, children, and other persons in potential contact with pregnant women at home. However, the expense and time involved for vaccination, antibody testing and visiting a clinic may represent a major barrier to voluntary compliance among this busy demographic. The aim of the current study was, therefore, to examine potential relationships between the social background of Japanese working-age individuals affected by the 2013 voluntary vaccination campaign.
  
  
  METHODS
  A web-based survey of 1,889 Japanese men and women aged 20-49 years was conducted in early 2014. Statistical analyses were used to explore the associations between social background and testing for rubella antibody and / or vaccination uptake during the previous year.
  
  
  RESULTS
  Twenty-four percent of respondents who were planning a pregnancy had been tested for rubella antibody or vaccinated in 2013. However, among those without a current desire for pregnancy, 3% of men and 7% of women, respectively, were tested or vaccinated. Regardless of whether they were planning to conceive, testing for rubella antibodies or vaccination was statistically associated with having acquaintances who had been vaccinated, understanding the government recommendations, and being able to confirm their lack of rubella vaccination history using Maternal and Child Health Handbook records in both men and women.
  
  
  CONCLUSIONS
  To help eliminate rubella in Japan, additional initiatives need to target Japanese individuals who cannot envisage a direct benefit from vaccination. The results of this study suggest that disseminating the government recommendation to all potentially affected subpopulations, along with maintaining life-time vaccination records might offer a solution to encourage vaccination uptake among working-age adults in Japan, as elsewhere.
authors.affiliation: Department of Epidemiology and Prevention, Clinical Research Center, National Institute for Global Health and Medicine, Tokyo, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Hori
authors.affiliation: Bureau of International Health Cooperation, National Institute for Global Health and Medicine, Tokyo, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Wada
authors.affiliation: School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Ourimbah, Australia.
authors.forename: Derek R
authors.initials: DR
authors.lastname: Smith
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000276:immunology; D003710:Demography; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006076:Government; D006287:Health Planning Guidelines; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D012409:Rubella / Q000453:epidemiology* / Q000276:immunology*; D012411:Rubella Vaccine / Q000276:immunology; D014611:Vaccination; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D012411:Rubella Vaccine; C040901:rubella antibodies