title: Parental knowledge, attitudes and perception of pneumococcal disease and pneumococcal conjugate vaccines in Singapore: a questionnaire-based assessment.
abstract: Under the National Childhood Immunisation Schedule (NCIS) in Singapore most vaccines are provided free while some, including pneumococcal conjugate vaccines (PCV), added to the NCIS in October 2009, are not free. In contrast to ≥95 % coverage achieved for recommended childhood vaccines that are free, 2013 coverage of the PCV booster dose was 58.9 % (for unclear reasons). To date, no population impact on pneumococcal disease (PD) has been observed. We conducted a questionnaire-based study of parents of young children to assess the value of PCV to parents, and to quantify the extent to which vaccine cost is a barrier to PCV uptake in Singapore.
  
  
  
  A single, trained interviewer administered a questionnaire to 200 parents ≥21 years of age with young children attending the Singapore Sengkang Polyclinic. The questionnaire asked closed-ended questions on parents' knowledge about PD and PCV. A 5-point Likert scale measured perceived benefits and barriers to PCV vaccination.
  
  
  
  There were 162 parents whose children were either PCV-vaccinated or who intended to vaccinate their child with PCV (Vaccinated group), and 38 whose children were non-PCV vaccinated or who did not intend to vaccinate (Unvaccinated group). The odds ratio for PCV vaccination among parents who perceived cost as a barrier was 0.16 (95%CI 0.02-1.23). Compared to the Vaccinated group, parents in the Unvaccinated group were less willing to pay for PCV (50.0 %/94.4 %). Compared to the Vaccinated group, fewer parents in the Unvaccinated group had heard about PD (34.2 %/82.1 %) or PCV (36.8 %/69.1 %), or perceived that PD was a threat to their child. Fewer parents in the Unvaccinated group knew that vaccination could prevent PD (28.9 %/77.8 %), or reported that PCV vaccination was recommended to them by any source (63.2 % had no PCV recommendation, versus 20.4 %). When informed that PCV is included in the NCIS only 65.8 % of parents in the Unvaccinated group, versus 98.8 % in the Vaccinated group, indicated that they would be willing to vaccinate their child.
  
  
  
  Cost considerations, not having vaccination recommended to parents and a lack of knowledge among parents of the benefits of PCV to the child may adversely impact PCV uptake in Singapore.
authors: Changi General Hospital, Singapore, Singapore. Choon_How_How@cgh.com.sg.|Singhealth Polyclinics, Singapore, Singapore. Choon_How_How@cgh.com.sg.
authors: Choon How
authors: CH
authors: How
authors: GSK Vaccines, Singapore, Singapore.|Present: Abbott Laboratories Pte Ltd, Singapore, Singapore.
authors: Priscilla
authors: P
authors: Phua See Chun
authors: GSK Pharmaceuticals Limited, Bangalore, India.
authors: Fakrudeen
authors: F
authors: Shafi
authors: GSK Vaccines, Singapore, Singapore.
authors: Rupert W
authors: RW
authors: Jakes
mesh_terms: D000328:Adult; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D008297:Male; D010290:Parents / Q000523:psychology*; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D012846:Singapore; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000706:statistics & numerical data; D018074:Vaccines, Conjugate / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate
keywords: Cost; Invasive pneumococcal disease; Pneumococcal conjugate vaccine; Survey