BACKGROUND:
Many patients state they have not received recommended vaccines because they did not know vaccination was necessary or recommended.

OBJECTIVE:
We determined reasons that influenza (IV), pneumococcal (PPV), and hepatitis B (HBV) vaccines were refused in an urban public hospital emergency department (ED) where patients were educated about vaccine and were not charged for services.

METHOD:
A convenience sample of 104 patients between the ages of 18 and 65 years who were uninsured or Medicaid enrolled seeking care for non-life threatening health problems in an urban ED were assessed to determine if IV, PPV, or HBV was indicated. Patients were given reading material about the importance and safety of vaccination and asked if they would receive the indicated vaccine(s) at no charge. Those refusing vaccination were asked to indicate reasons for their refusal.

RESULT:
Influenza vaccine was recommended for 68% of all patients. Of those, 18% refused vaccination. PPV was recommended for 36, of whom 22% refused vaccination. The most common reasons for refusing IV and PPV were concerns about the vaccine or the injection causing pain, illness or side effects (62% and 38%, respectively) and the lack of need for the vaccine (23% and 25%, respectively). HBV was recommended for 42, of whom 12% refused vaccination. The most common reasons for refusing HBV was dislike of needles and the injection causing pain (60%) and no particular reason (40%).

CONCLUSION:
Despite an education intervention, in which free vaccine was offered, up to one-fifth of patients refused vaccination, with concerns about the pain of injection as a prominent reason. Efforts to develop interventions that target concerns about the vaccine will be necessary to convince patients such as these to accept these vaccines.

LEARNING OBJECTIVES:
Participants will be able to identify reasons patients refuse vaccination when it is strongly recommended by providers and there are no financial barriers.