Knowledge and risk perception of measles in Ebonyi State, Nigeria
Measles is a vaccine-preventable disease caused by a RNA virus belonging to the Paramyxoviridae family. Despite introduction of the measles-mumps-rubella (MMR) vaccine into routine childhood vaccination programs more than 20 y ago, the disease is still present in Europe because of suboptimal immunization levels.1,2 Single-dose vaccination was introduced to childhood immunization programs in France in 1983, and a second injection was recommended in 1998, leading to a significant decrease in annual incidence, from 331 000 cases in 1986 to 44 cases in 2007.3 However, vaccine coverage for children at 2 y of age is still stuck at 89.4% for the first dose and 67.3% for the second dose, inadequate to eliminate circulation of the virus. As a consequence, France has a high proportion of susceptible children, adolescents, and young adults, which may explain disease resurgence and the large outbreak that occurred in 2008–2012.3 During this epidemic, adolescents and young adults accounted for more than half of cases. The highest incidence rates were observed among children less than age 1 y (135 cases/100 000). Median age of patients during the outbreak was found to be increased, from 12 to 16 y.3 The Rhône-Alpes region (6 million inhabitants) was one of the most affected areas, with an incidence rate of 97.9 cases per 100 000 inhabitants between September 2010 and October 2011.4 A total of 6,531 measles cases were reported (approximately 30% of cases nation-wide), including 853 hospitalizations, 9 encephalitis cases and 3 deaths.
We have determined previously that, during the Rhône-Alpes region outbreak, 78% of patients were not vaccinated, and 18% had received only 1 vaccine dose.4 Individual perception of disease is a combination of several determinants, such as beliefs and attitudes which together converge to subjective judgement.5,6 Personal knowledge of disease also plays an important role in the extent of an individual’s reactions to vaccination and can evolve over time and/or with direct disease confrontation. We investigated the reasons for non-vaccination and perception by conducting a retrospective epidemiological study of people who had consulted or had been hospitalized for measles in the Rhône-Alpes region between January 2010 and September 2012. Located in south-east France and bordering Italy and Switzerland, the Rhône-Alpes region has more than 6 million inhabitants. The study objectives were (1) to assess knowledge of the study population on measles and its consequences for patients and their families, (2) to evaluate measles vaccination awareness and practices, and (3) to gauge potential changes in opinion with regard to measles vaccination after disease onset.