1. Increasing Bordetella pertussis Vaccinations
Peyton Durflinger
Introduction
Purpose
Methods
Discussion/Recommendations
References
Results
The purpose of this review is to identify interventions or programs
designed to increase whooping cough vaccinations in the near future.
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(pertussis). Evidence-Based Child Health. http://doi.org/10.1002/ebch.1845
Amirthalingam, G. (2013). Strategies to control pertussis in infants. Archives of Disease in
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provider immunization knowledge and behaviors following a peer education intervention.
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practice-based intervention to increase vaccination rates and reduce missed opportunities.
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cough revisited. Journal of the Royal Society, Interface / the Royal Society, 5(21), 403–13
. http://doi.org/10.1098/rsif.2007.1168
Parch, L. (n.d.). Why Whooping Cough Is Rising Despite a New Vaccine. Retrieved February 13
, 2016, from http://www.webmd.com/children/vaccines/features/whooping-cough-rising-
despite-new-vaccine?page=2
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These studies all had many key similarities and differences that were presented during the
search through the literature that presented it to the researcher. Most of the studies that were
identified all focused on the attitudes of the parents on the immunizations of their kids and trying to
change the behavior of receiving vaccination especially pertussis (whooping cough). Some studies
focused directly on the parents and tried to have them change their behavior. Whereas other
studies focused on the primary care facility themselves to advocate more for the vaccinations. Both
of which had various advantages and disadvantages to them. The researcher analyzed 25 studies
and only 5 met the criteria that were needed for this systematic review. The specific intervention that
was needed to be analyzed had to be behavior based that needed to be changed towards whooping
cough vaccinations. The second study that was used in the matrix was the best by far because of
the significantly positive results. The major trends that were found was that some of the result were
inconclusive because of patients attitudes towards whooping cough vaccinations. There were also
some very good trends where the intervention showed an increase in vaccinations or would show
an increase in vaccinations if more funding was provided to advocate for vaccinations. What
seemed to work the best from these interventions was utilizing physician-based intervention where
they promoted vaccinations and really pushed for it. This study by (Lance, et. al., 1999) showed the
best results. Most of these interventions all utilized self-efficacy theory from what the researcher
could interpret and this seemed to be the best way to show results. Vaccinations are a tricky subject
because many individuals either believe in them or do not and there is really no in-between.
There are a few implications or further recommendations that could be used for future behavior change
interventions for whooping cough vaccinations. The biggest recommendation is to put more administrative pressure on
the physicians to push for vaccinations. This would increase vaccination rates for pertussis and create less missed
opportunities for vaccinations in young children where it is so very important. Another recommendation that should be
made is to allocate more funding for vaccination campaigns or advertising that helps promote them to the public
especially whooping cough since we have seen such an increase in prevalence. The gaps that were presented in this
research were a communication barrier between physicians and parents. Parents sometimes do not understand the
severity of certain diseases or do not think they are as important as others. Another issue that could present itself in
certain situations would be the price of pertussis vaccinations. Some parents might see pertussis less important that
another vaccinations and try to cut corners this way. The two biggest causes for these low vaccination rates for
whooping cough is lack of advocating for the vaccination and lack of funds allocated to put more pressure on
vaccinations.
The evidence that was found means that there has been some attempts to try and improve vaccination rates for
whooping cough. The limitations of the review was some of the studies that were found required payment which is
always a limitation in conducting research when some articles are not available to the researcher. Another limitation is
the lack of theory used in the programs/interventions. Health theory should be implemented because it is an effective
tool in changing health behavior and ensuring future programs/interventions on the topic are successful. The Health
Belief Model would be most appropriate for this topic because it addresses the main reasons why vaccinations rates are
lower than they should be. Perceived benefits must outweigh the perceived barriers for parents to want their kids
vaccinated. The most important construct would be perceived seriousness of the disease and perceived susceptibility of
contracting whooping cough. Future programs/interventions need to utilize this health theory to see a significant
increase in Pertussis vaccinations. The results support the current health practice that vaccination rates for whooping
cough have seen a decrease, which in turn has caused the prevalence of the disease itself to increase at an alarming
rate. The information that was found suggests that there could potentially be a change in vaccinations rate because it is
becoming more and more of a rising issue. Once the funding is allocated to this subject area there could be a change in
vaccination rates, which in turn could lower the prevalence in whooping cough.
There are many things that should be changed in the next 5 years if this review were to be completed again.
The number one thing that everyone would like to see in the future is a higher rate of vaccinations for whooping cough
and a lower prevalence of disease in these young children. There needs to be more health-theory based interventions to
ensure that vaccination rates increase. Physician offices could begin to offer incentives for the child or even the parent
to stress the importance of vaccinations. There could be a price cut or a treat so the is more likely to want to get
vaccinated. Health-theory should be the building block to increasing Pertussis vaccinations because this is a health
behavior that is being exhibited. For future interventions a big recommendation would be to focus on using physicians to
really push for vaccinations and utilize various strategies to encourage parents and stress the importance. People are
more willing to trust a health care professional that knows the importance of getting their child vaccinated at such a
young age. The next recommendation would be to focus on advocating for whooping cough vaccinations. Make the
public aware of the dangers and the vaccination rates are sure to increase as a result. Some people might not know the
severity of the disease and decide that it is not very important to receive the Pertussis vaccination.
Bordetella pertussis also known as whooping cough, has seen an increase in cases reported in the past few
years. This is very strange since there is actually a vaccine available for pertussis. Whooping cough is an acute
respiratory tract infection, first described in the 1500s and endemic in Europe by the 1600s (Altunaiji, Kukuruzovic,
Curtis, & Massie, 2012). Whooping cough is characterized by spasms of severe coughing (paroxysms) (Altunaiji ,
Kukuruzovic, Curtis, & Massie, 2012). Whooping cough is also known for being extremely contagious and can usually
infect other household members. Some simple signs of whooping cough is runny nose, sneezing, mild cough, and low-
grade fever. The target population is young children and infants in the United States. Ultimately if whooping cough goes
undiagnosed it could lead to death in more serious cases and which the prevalence on the rise this could cause the
mortality rate to increase.
During 2014, 32,971 cases of pertussis were reported to the CDC and this represents a 15% increase from
28,639 in 2013 (CDC, 2015). Also, the majority of deaths occurred in babies younger than 3 months old (CDC,2015).
The incidence rate of pertussis is still lead by babies more than any other age group. Many parents are beginning to
delay or even refuse getting their child vaccinated for various reasons, which could be the cause of this increase in
incidence. People who are opposed to vaccines may be creating a pocket where the disease can take hold (Parch,
2016).
The health behavior change that needs to be addressed is ensuring that children and infants get vaccinated
much sooner and the warning signs are more readily seen. The best way to solve this problem would be to use the
Health Belief Model to ensure vaccinations are seen in this population. Parents who do not let their kids get vaccinated
may be creating more opportunities for whooping cough outbreaks (Parch, 2016). The health belief model has several
constructs that will be vital to improving vaccinations. The four main perception constructs we will focus on is perceived
seriousness, perceived susceptibility, perceived benefits, and perceived barriers. Perceived seriousness for whooping
cough would be how serious the disease could be for my child if contracted. Whooping cough in some severe cases
could lead to death if undiagnosed. Perceived susceptibility is the chance my child could be infected. There has been a
15% increase in whooping cough in 2013, which means children and infants are more susceptible than ever. Perceived
benefits of the vaccine are great because the more children and infants vaccinated the better their chances are for not
developing whooping cough. Lastly, perceived barriers could be a number of things and I think that health
communication is the lacking force behind barriers. Also, self-efficacy theory would be a great option for specific
interventions or programs to perhaps see a rise in vaccination rates. Self-efficacy theory would be a great theory to use
because it helps people accomplish tasks that they have already done before. If vaccinations for whooping cough are
pushed more heavily self-efficacy could play a large role in this. Many intervention strategies for kids utilize self-efficacy
theory because it has been so successful in the past.
Several different databases were utilized to locate specific sources with proper information
about whooping cough in children and infants. The following databases were used CDC, World Health
Organization, Google scholar, Galileo, and Mendeley. Google Scholar was used to help find the
majority of these sources because it is a great source for peer-reviewed journals and articles. Google
Scholar and Galileo are the best sources to find peer reviewed articles for free.These databases are
excellent tools for combing through different interventions and programs by utilizing specific inclusion
and exclusion criteria. In Google Scholar and Galileo some of the search criteria was, “Whooping
Cough”, “Whooping Cough in Child and Infants”, “Pertussis health theory”, “Health theory based
vaccination programs”. There was also different combinations of inclusion criteria that were utilized to
try and get the best articles available while also searching through all of the articles that were actually
free. Such as, “Vaccination intervention”, “whooping cough vaccine programs”. The articles that were
searched used other inclusion criteria such as full text only and the articles were relatively new since
the rise in Whooping Cough has really become a hot topic in the last several years or so. Full-text
articles was the best way to find successful programs and interventions with the most materials. Some
exclusion criteria that was used, no experiments, no paid studies, anything that did not involve health
theory. The programs and interventions that were used had to utilize health theory of some sort in their
intervention. This systematic review hinged on the practice of health theory so it was pertinent to try
and find interventions that used these different health theories as a foundation.