Figure 1. Serogroups of Neisseria meningitidis invasive infection cases in the province of Québec, Canada,

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3 Context Figure 1. Serogroups of Neisseria meningitidis invasive infection cases in the province of Québec, Canada, In Gilca R, Lefebvre B, Bourgault AM, Deceuninck G, Gilca V, Tsang SWR, et al. Invasive Meningococcal disease in Quebec 8 years after the implementation of a public serogroup C Meningococcal immunization program. 29th annual meeting for paediatric infectious disease (ESPID), the Hague, the Netherlands, 7-11 June, 2011.

4 Context Quebec Immunization Committee has recommended to vaccinate all people aged between 2 months and 20 years old living or studying in the region Figure 3. Incidence rates of IMD-B/ p.-y with 95% confidence intervals according age groups and socio-sanitary region, Quebec In De Wals P, Deceuninck G, Dubé E, Gagnon D, Gilca V, Kiely M, et al. Avis sur la pertinence d'une intervention visant à contrôler une incidence élevée d'infections invasives à méningocoque de sérogroupe B dans l'est du Québec. Québec: Institut national de santé publique du Québec, 2014:107 p.

5 Vaccine Acceptance: one aspect of the evaluation of the campaign Enabling factors Barriers Meningitis = unpredictable and potentially fatal high perceived risk and desire for preventive measure Media attention to IMD cases in the region New vaccine vaccine safety concerns Reactogenecity of the vaccine vaccine safety concerns 2-4 doses required High uptake for most vaccines Bakhache P., Rodrigo C., Davie S., Ahuja A,. Sudovar B,. Crudup T., et al. Health Care Providers' and Parents' Attitudes Toward Administration of New Infant Vaccines - A Multinational Survey. European Journal of Pediatrics 172: (2013). Fisher W., Bettinger J., Gilca V., Sampalis J., Brown V., Yaremko J., et al. Understanding Parental Acceptance of a Novel Meningococcal Serogroup B Vaccine for Infants, Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID), Milan, Italy, May 28-June 1, 2013.

6 Objective To assess the knowledge, attitudes and intention of parents of eligible children and of adolescents targeted to receive the 4CMenB vaccine over time

7 Methods

8 Descriptive results Announcement of the campaign: April 22 th 2014 Start of the campaign: May 4 th 2014 Response rate: 72% (887 interviews) 703 parents of children between 2 months and 16 years-old 92% reported that their child had received all recommended vaccines (<1% completely non vaccinated) 99% knew that a vaccination campaign was launched in their region. 184 adolescents 66% of adolescents reported having received all recommended vaccines (<1% completely non vaccinated) 90% of adolescents knew that a vaccination campaign was launched in their region More girls than boys were aware of the campaign (98 % vs. 83%, p=0.0001)

9 Intention to vaccinate 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Adolescents main 4.8 reasons to Parents main reason 4.3 to intend not to 1.5 intend not to be vaccinated 3.4 vaccinate their child 4.5 with 4CMenB 2.1 with 4CMenB vaccine vaccine 22.1 Lack of interest, time or information about the vaccine 34.9 General opposition to vaccination Low perceived risk 22.4 Parents and adolescents main reasons to intend / having received the 4CMenB vaccine Protection from meningitis General trust in vaccines 54.5 Parents of children between 2 months to <5 years Parents of children between 5 years to <12 years Parents of children between 12 years to <16 years 50.7 Perception that the benefits of the 4CMenB outweighed the risks Knowing someone who suffered from meningitis Ease of access and free vaccine (adolescent only) Adolescents Intend to receive Vaccinated with 4CMenB vaccine Do not intend to receive Do not know

10 Knowledge, beliefs and attitudes % % Parents' knowledge, attitdes and beliefs regarding IMD and the 4CMenB vaccine Catching Meningitis is dangerous for my child Catching Meningitis is dangerous for me I am worried about my child catching Meningitis I am worried about catching Meningitis. Parents with a high school degree or less = more worried than parents with 59 a college or 45 university degree (78%, 63% and 57%, p<0.0001) Someone who is vaccinate against Meningitis presents very little risk of catching this disease. The vaccine against Meningitis is safe Someone who is vaccinate against Meningitis presents very little risk of catching this disease. The vaccine against Meningitis is safe It is my duty to have my child vaccinated in order not to spread the disease to other people in my community. Adolescents' knowledge, attitdes and beliefs regarding IMD and the 4CMenB vaccine More girls than boys (57%, 29%, p=0.0002) It is my duty to be vaccinated in order not to spread the disease to other people in my community. Somewhat agree Totally agree

11 Multivariate analyses (adolescents) Intention not to be vaccinated Have you heard about a vaccination campaign against Meningitis that is ongoing in your region. (NO) Catching Meningitis is dangerous for me. (Disagree) I am worried about catching Meningitis. (Disagree) Someone who is vaccinated against Meningitis presents very little risk of catching this disease. (Disagree) The vaccine against Meningitis is safe. (Disagree) It is my duty to be vaccinated in order no to spread the disease to other people in my community. (Disagree) 1 Adjusted odds ratio with all items in the model. 2 95% Confidence Intervals. Adjusted OR 1 95% CI 2 P value 18,45 4,79 ; 71,13 <0,0001 1,72 0,35 ; 8,45 0,5045 2,91 0,95 ; 8,92 0,0617 1,20 0,16 ; 8,90 0, ,17 5,13 ;123,46 <0,0001 9,41 2,11 ; 42,09 0,0033

12 Objective To describe health professionals opinions regarding the mass vaccination campaign

13 Methods See poster #103 Formation des infirmières dans le cadre de la campagne de vaccination [ ]

14 Results Participants 11 front-line vaccine providers 3 managers 6 physicians and public health professionals The majority was informed and worried about IMD in Saguenay Lac-St-Jean. Some front-line vaccine providers were not aware of the high prevalence of IMD before the launch of the campaign - All were in favour of the campaign

15 Results - The majority thought that: The 4CMenB was safe and effective That parents would be willing to have their child vaccinated if informed about the campaign There was a great collaboration between the provincial, regional and local levels in organizing the campaign - Most considered that their level of knowledge on the 4CMenB vaccine was sufficient - The majority were at ease to recommend the vaccine AND anti-pyretic for parents of young children after the vaccination

16 Results - Participants have noted barriers to the campaign At their own level Rapid roll-out of the campaign lack of time for preparation Issues with the informed consent form Lack of support for novice nurses At the population level Lack of time to organize communication with the public low awareness (lack of demand) and misinformation ( my child already has received the meningococcal vaccine!) Internet and negative information on the vaccine (fears of adverse events) Difficulties anticipated in reaching young adults (17-20 years of age) 4CMenB and pain

17 Discussion

18 Vaccine uptake (first dose) % months to 5 months 6 months to 11 months 1 year to 4 years 5 years to 11 years 12 years to 16 years 17 years to 20 years *Source: V09 Vaccination File, Quebec Ministry of Health and social Services. Report from Vaccine Uptake tab produced by the Infocentre of Public Health at the Institut national de santé publique du Québec, November 17 th 2014 at 14:09. Data transmitted by Eveline Toth et France Markowski, Bureau de surveillance et de vigie, DGSP, MSSS TOTAL

19 Conclusion After the end of the campaign (March - April 2015) Second questionnaire to parents and adolescents Additional information on the perception of the targeted campaign and the determinants of acceptance of the vaccine (all doses or not) Assess potential impact of adverse events after the first dose on the acceptability of the subsequent doses and of other scheduled vaccines Second interviews with health professionals Additional information on knowledge, attitudes, beliefs and practices regarding the 4CMenB vaccine and the campaign

20 Acknowledgements Quebec Ministry of Health for their financial support for this study Research team Dominique Gagnon, INSPQ Denis Hamel, INSPQ Zhou Zhou, Centre de recherche du CHU de Québec Nicole Boulianne, INSPQ Hélène Gagné, DSP du Saguenay-Lac-St-Jean Sylvie Belley, DPS du Saguenay-Lac-St-Jean Monique Landry, MSSS Thanks to the Bureau de Surveillance et de Vigie of Quebec Ministry of Health for providing data on 4CMenB vaccine uptake

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