Examination of parents refusing administration of childhood vaccinations: Turkey example





immunization schedule, vaccine refusal, parents, children, persuasion


Background. Vaccination is an important health service that reduces the morbidity and mortality of infectious diseases. In our study, it was aimed to examine the knowledge, attitude, risk perception of parents about vaccine refusal, and the vaccination status of their children in a province of Turkey with a low socioeconomic level. Materials and methods. In the study designed in a cross-sectional type, 105 parents (participation rate: 80.2 %) who rejected the vaccine were reached. Results. The most refused vaccine by the parents is DaBT-İPA-Hib (90.5 %) and the least rejected vaccine is BCG (58.1 %). It was determined that who thought vaccines have no benefits (p = 0.003), those who were doubtful about the content of the vaccine (p = 0.001), those who did not want the vaccine due to their religious beliefs (p = 0.006), and those who believed in natural immunity (p = 0.002) were less convinced about vaccinating their children at a statistically significant level than the other group. The vaccine with the highest rate is HAV (35.0 %, n = 7), and the vaccine with the lowest rate is BCG (8.3 %, n = 1) in terms of the rate of vaccination that they declare to be convinced to have it. Conclusions. When evaluated on the causes of vaccine refusal and persuasion, the primary source of information is provided by health workers with scientific evidence through different communication methods (social media, etc.) should be reached.


Facciolà A, Visalli G, Orlando A, et al. Vaccine hesitancy: An overview on parents' opinions about vaccination and possible reasons of vaccine refusal. J Public Health Res. 2019 Mar 11;8(1):1436. doi: 10.4081/jphr.2019.1436.

Glanz JM, Newcomer SR, Narwaney KJ, et al. A population-based cohort study of undervaccination in 8 managed care organizations across the United States. JAMA Pediatr. 2013 Mar 1;167(3):274-81. doi: 10.1001/jamapediatrics.2013.502.

Eskiocak M, Marangoz B. Türkiye ’ de Bağışıklama Hizmetlerinin Durumu 2019 [Status of Immunization Services in Turkey 2019]. Available from: https://www.ttb.org.tr/kutuphane/turkiyede_bagisiklama.pdf.

United Nations International Children's Emergency Fund (UNICEF). Research Knowledge, Attitudes and Practices in Relation to Immunization of Children In Serbia 2018. Available from: https://www.unicef.org/serbia/en/reports/knowledge-attitudes-and-practices. Accesed 5 February 2021.

Naafs MAB. Herd Immunity: A Realistic Target? Biomed J Sci Tech Res 2018;9(2):1-5. doı: 10.26717/BJSTR.2018.09.001779.

Kanra G, Tezcan S, Badur S; Turkish National Study Team. Hepatitis A seroprevalence in a random sample of the Turkish population by simultaneous EPI cluster and comparison with surveys in Turkey. Turk J Pediatr. 2002 Jul-Sep;44(3):204-10.

Kanra G, Tezcan S, Badur S; Turkish National Study Team. Hepatitis B and measles seroprevalence among Turkish children. Turk J Pediatr. 2005 Apr-Jun;47(2):105-10.

Soysal A. Anti-Vaccine. Madde, Diyalektik ve Toplum. 2018;3:263-271.

Larson HJ, Jarrett C, Schulz WS, et al; SAGE Working Group on Vaccine Hesitancy. Measuring vaccine hesitancy: The development of a survey tool. Vaccine. 2015 Aug 14;33(34):4165-75. doi: 10.1016/j.vaccine.2015.04.037.

Badur S. Anti-Vaccine Groups and Unfair Accusations Against Vaccines. ANKEM Journal 2011;25(Ek 2):82-86.

Sarp Üner, Kezban Çelik ST. Çocuk Aşılarında Artan Kararsızlık: Nedenleri Farklı Aktörlerin Deneyiminden Anlamak. Ankara: Hipokrat Press; 2020. 30-122 pp.

Aker AA.Vaccine Refusal . Community And Physician 2018;33(3):175-186.

McKee C, Bohannon K. Exploring the Reasons Behind Parental Refusal of Vaccines. J Pediatr Pharmacol Ther. 2016 Mar-Apr;21(2):104-9. doi: 10.5863/1551-6776-21.2.104.

Chirumbolo S, Bjørklund G. Evaluation of Childhood Vaccine Refusal and Hesitancy Intentions in Turkey: Correspondence. Indian J Pediatr. 2019 Mar;86(3):315-317. doi: 10.1007/s12098-018-2772-3.

Çıklar S, Güner PD. Knowledge, Behavior and Attitude of Mother’s about Childhood Immunization and Reasons of Vaccination Rejection and Hesitancy: A Study of Mixt Methodology. Ankara Med J. 2020;20(1):180-195. doi: 10.5505/amj.2020.80148.

Dáňová J, Šálek J, Kocourková A, Čelko AM. Factors Associated with Parental Refusal of Routine Vaccination in the Czech Republic. Cent Eur J Public Health. 2015 Dec;23(4):321-3. doi: 10.21101/cejph.a4395.

Cataldi JR, Dempsey AF, O'Leary ST. Measles, the media, and MMR: Impact of the 2014-15 measles outbreak. Vaccine. 2016 Dec 7;34(50):6375-6380. doi: 10.1016/j.vaccine.2016.10.048.

Kürtüncü M , Alkan I, Bahadır Ö. The Knowledge Levels Of Mothers About The Vaccination Status Of Children Living In A Rural Area Of Zonguldak. Electronic Journal of Vocational Colleges. 2017;7(1):8-17.

Hasar M, Özer ZY. Reasons for vaccine rejection and opinions on vaccines. Cukurova Medical Journal. 2021;46(1):166-76. doi: 10.17826/cumj.790733.

Byström E, Lindstrand A, Bergström J, Riesbeck K, Roth A. Confidence in the National Immunization Program among parents in Sweden 2016 - A cross-sectional survey. Vaccine. 2020 May 8;38(22):3909-3917. doi: 10.1016/j.vaccine.2020.01.078.

Vonasek BJ, Bajunirwe F, Jacobson LE, et al. Do Maternal Knowledge and Attitudes towards Childhood Immunizations in Rural Uganda Correlate with Complete Childhood Vaccination? PLoS One. 2016 Feb 26;11(2):e0150131. doi: 10.1371/journal.pone.0150131.

Seleker F. Multiple Sclerosis Diagnosis and Treatment Guide. İstanbul: Galenos Press; 2016. 75-78 pp.

Miller L, Reynolds J. Autism and vaccination-the current evidence. J Spec Pediatr Nurs. 2009 Jul;14(3):166-72. doi: 10.1111/j.1744-6155.2009.00194.x.

Offit PA. Thimerosal and vaccines--a cautionary tale. N Engl J Med. 2007 Sep 27;357(13):1278-9. doi: 10.1056/NEJMp078187.

Gür E. Vaccine hesitancy - vaccine refusal. Turk Pediatri Ars. 2019 Mar 1;54(1):1-2. doi: 10.14744/TurkPediatriArs.2019.79990.

Shah SFA, Ginossar T, Weiss D. "This is a Pakhtun disease": Pakhtun health journalists' perceptions of the barriers and facilitators to polio vaccine acceptance among the high-risk Pakhtun community in Pakistan. Vaccine. 2019 Jun 19;37(28):3694-3703. doi: 10.1016/j.vaccine.2019.05.029.

Chang K, Lee SY. Why do some Korean parents hesitate to vaccinate their children? Epidemiol Health. 2019;41:e2019031. doi: 10.4178/epih.e2019031.

Smith TC. Vaccine Rejection and Hesitancy: A Review and Call to Action. Open Forum Infect Dis. 2017 Jul 18;4(3):ofx146. doi: 10.1093/ofid/ofx146.






Clinical Pediatrics