Comparison of parental and health care professional preferences for the acellular or whole cell pertussis vaccine

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Abstract
To compare the preferences of mothers, physicians and nurses for use of a new generic acellular pertussis vaccine which is less reactogenic than and as effective as a conventional whole cell vaccine, but which would require multiple injections rather than a single injection to deliver all other recommended vaccines. A convenience sample of 400 mothers of 1-month-old infants, 100 immunizing physicians and 100 immunizing nurses were surveyed over a 2 1/2-month period. Information about pertussis and both whole cell and acellular pertussis vaccines was provided, and a questionnaire was used to assess knowledge and attitudes about pertussis vaccine, vaccine preference and reasons for selection. In addition to their own preferences health care professionals were asked to predict which vaccine mothers would prefer and to predict why mothers would choose a particular vaccine. Mothers preferred the acellular vaccine over the whole cell vaccine by a nearly 2:1 margin (57.3% vs. 29.5%). Health care professionals preferred the whole cell vaccine by the same 2:1 margin (61.1% vs. 29.3%). Only 19.1% of health care professionals predicted that mothers would accept the acellular vaccine if it meant multiple injections. More mothers were concerned by the common reactions caused by the whole cell vaccine(75.8% vs. 52%; P = 0.001); more health care professionals felt that multiple injections were stressful (89% vs. 70%; P= 0.001) and that they could be associated with long term effects (17% vs. 8.8%; P = 0.003). More health care professionals than mothers said that the need for multiple injections would influence their decision to accept the acellular vaccine (76.5% vs. 38.3%; P = 0.001). Mothers prefer a less reactogenic vaccine product even if it requires multiple injections. Health care professionals are more concerned about multiple injections and are poor predictors of mothers' vaccine preference. Multiple injections may be more a barrier to immunization for health care professionals than for mothers.
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