Acceptance and feasibility of school-based seasonal influenza vaccination in Singapore: A qualitative study

Abstract

Influenza is a major cause of disease in children. School-based seasonal influenza vaccination can be a cost-effective tool to improve vaccine uptake among children, and can bring substantial health and economic benefits to the broader community. The acceptance and feasibility of schoolbased influenza vaccination are likely to be highly context-specific, but limited data exist from tropical settings with year-round influenza transmission. We conducted a qualitative study to assess acceptability and feasibility of a school-based seasonal influenza vaccination programme in Singapore. MethodsWe conducted qualitative in-depth interviews with key stakeholders, including healthcare professionals, representatives of relevant ministries, preschool principals and parents to understand their perspectives on a proposed school-based seasonal influenza vaccination programme. Interviews were transcribed verbatim and analysed using thematic analysis. ResultsWe conducted 40 interviews. Although preschool-aged children are currently the recommended age group for vaccination, stakeholders suggested introducing the programme in primary and/or secondary schools, where existing vaccination infrastructure would facilitate delivery. However, more comprehensive evidence on the local influenza burden and transmission patterns among children is required to develop an evidence-based, locally relevant rationale for a school-based vaccination programme and effectively engage policy-makers, school staff, and parents. Extensive, age-appropriate public education and awareness campaigns would increase the acceptability of the programme among stakeholders. Stakeholders indicated that an opt-out programme with free or subsidised vaccination would be the most likely to achieve high vaccine coverage and make access to vaccination more equitable. of 27 ConclusionsOverall, participants were supportive of a free or subsidised school-based influenza vaccination programme in primary and/or secondary schools, although children in this age group are not currently a recommended group for vaccination. However, a better informed, evidence-based rationale to estimate the programme's impact in Singapore is currently lacking. Extensive, ageappropriate public education and awareness campaigns will help ensure full support across key stakeholder groups.

Schedule of pneumococcal conjugated vaccination and incidence of asthmatic exacerbation in children

“…However, a number of earlier studies that examined the multifaceted potential confounders of demographic, educational, geographic, genetic, environmental, residential, parenteral, pathological, psychological, and historical factors in addition to the annual flu shot and the three scheduled pneumococcal vaccinations have found evidence against the tendency for the completeness of standard immunisation schedules. [12][13] According to the previously mentioned studies, children who had previously been hospitalised for cough were 1.77 times more likely to receive the annual influenza vaccination than children who had never experienced a hospitalisation for cough. The yearly flu shot was also positively correlated with household income, housing type, smokers in the home, parental educational attainment, child age, and asthma.…”

Determinants of influenza and pneumococcal vaccine uptake among preschool children in Singapore

“…It is lower than coverage estimates from Taiwan with reported coverage of 55% in children aged six months to three years [ 14 ]. Quantitative and qualitative studies in Singapore point to the common misconception among both parents and healthcare providers that influenza vaccination is primarily required before travelling overseas [ 9 , 15 ]. This may reflect the common perception of influenza as a ‘winter disease’, despite year-round transmission in tropical settings.…”

Effectiveness of Multifaceted Strategies to Increase Influenza Vaccination Uptake

“…Participation in SLIV is influenced by individual-, intrapersonal-, organizational-, and system-level factors such as parental influenza vaccine hesitancy, 18 , 19 , 20 , 21 , 22 social norms, 23 SLIV program organization, 24 , 25 , 26 , 27 and COVID-19. 28 , 29 , 30 , 31 However, approaches to increase influenza vaccination uptake typically include traditional interventions, such as education and financial incentives, and behavioral interventions, such as setting default options, sending reminders, and creating implementation intentions, 32 , 33 , 34 , 35 , 36 , 37 , 38 with little focus on system-based approaches to improve the performance of SLIV.…”