25394 A Qualitative Assessment: Understanding Delays In Childhood Measles, Mumps and Rubella (MMR) Vaccination In Orthodox Jewish Communities In Brooklyn

Tuesday, March 29, 2011
Columbia Hall
Jane Zucker, MD, MSc , Assistant Commissioner, on behalf of New York City Department of Health and Mental Hygiene

Background: In 2008 and 2009, New York City had measles outbreaks primarily affecting pre-school aged children in two orthodox Jewish neighborhoods in Brooklyn. Case investigations indicated that many parents in these communities were delaying MMR vaccination.

Objectives: Through focus groups, identify reasons for vaccine hesitancy among mothers in these communities and trusted sources of health information.

Methods: Women were recruited through a Jewish organization. To be eligible, they had to self identify as orthodox Jewish, reside in target neighborhoods, and have at least one child ages 2-5 years. Post-discussion, participants filled out a survey on demographics, health care and primary information sources. Groups were transcribed by one individual and checked by another for accuracy. Two researchers coded the scripts and compared findings to achieve consensus on main themes.

Results:  Twenty-one women participated; median age 29 (range 21 to 38). Participants had 2-9 children, ages 0-18. Most mothers trusted providers significantly, turning to them for advice and medical care. Additionally, they relied upon community members and local Jewish media for advice and information. Participants varied in vaccination practices; some delayed and others vaccinated on time. Concerns included the belief that immune systems of young children cannot handle vaccine, giving many vaccines simultaneously is deleterious, MMR can cause autism, and promoters of vaccination have financial conflicts of interest. Some mothers felt guilty vaccinating due to short-term side effects, even when aware of long-term benefits. Reasons for supporting vaccination included personal experience with vaccine-preventable diseases, confidence in vaccine-effectiveness, and appreciation for available medical technology.

Conclusions: Public health practitioners can improve strategies for vaccine promotion by exploring the cultural context of specific communities.  To address vaccine hesitancy in orthodox Jewish communities, the New York City Health Department should work with providers and local media since they are trusted and established channels for information.