Hexavalent vaccines | NITAG RESOURCE CENTER

Perception of the target population on the risk of disease

Perception of the risk of diptheria, tetatnus, pertussis, hepatitis B, Hib and poliomyelitis among target populations varies significantly depending on local disease prevalence, cultural beliefs and awareness levels. ^{Go to footnote 11, Go to footnote 22, Go to footnote 33, Go to footnote 44, Go to footnote 55, Go to footnote 66, Go to footnote 77, Go to footnote 88}

For diphtheria, studies report that factual knowledge of the disease is generally low, yet the risk is often perceived as high during outbreaks or in regions with recent cases. In many high-income countries, diphtheria is considered a rare threat, leading to decreased awareness and sometimes lower perceived urgency to vaccinate. ^{Go to footnote 99}

Perception of the risk of tetanus tends to be higher than diphtheria due to its high case-fatality and association with wounds and childbirth, especially neonatal tetanus in low-resource settings. ^{Go to footnote 1010, Go to footnote 1111}

Parents of young infants and healthcare workers usually recognize pertussis as a serious illness, given its potential severity in infants. For instance, in Georgia 81% of women believed pertussis, would be serious during pregnancy while 92% believed pertussis would be serious to their infants. ^{Go to footnote 1212}

For hepatitis B, awareness and perceived risk vary greatly by region. In a study among pregnant women in Uganda, perceived risk was low. ^{Go to footnote 1313}

Haemophilus influenzae type b (Hib) disease is often under-recognized by the public, particularly in regions where widespread vaccination has nearly eliminated severe cases like meningitis and pneumonia. ^{Go to footnote 1414}

In regions where polio remains endemic, such as Afghanistan and Pakistan, the public is often more aware of the disease's dangers due to its ongoing presence. However, challenges like misinformation, cultural resistance, and distrust in vaccination programs can undermine risk perception, even in high-risk areas. Conversely, in polio-free regions, the perceived risk of polio is generally low, as the disease is no longer part of the collective memory. This complacency can lead to gaps in vaccination coverage, as seen in recent outbreaks of vaccine-derived poliovirus (cVDPV) in previously polio-free countries such as the United Kingdom and Israel. ^{Go to footnote 1515, Go to footnote 1616, Go to footnote 1717}

Sources

Go back to footnote reference 1
Centers for Disease Control and Prevention (CDC) (no date). Polio Vaccine Questions and Answers. Available at: https://www.cdc.gov/vaccines/vpd/polio/public/index.html (accessed 30 June 2025).
Go back to footnote reference 2
Babandi, Z.S., Suleiman, A.G., Darma, M.A., Indabo, U.H., Shehu, S., Hamza, A.S., Henry, J., Umar, U.M., Ojediran, S.L., Amadu, L., Ibrahim, M.S. & Ejembi, C.L. (2024). Knowledge and Perception of Diphtheria among Residents of a Rural Community in Kaduna State, Northwest Nigeria. Journal of Community Medicine and Primary Health Care, 36, pp.111–123. https://doi.org/10.4314/jcmphc.v36i2.9
Go back to footnote reference 3
Hilton, S., Hunt, K. & Petticrew, M. (2007). Gaps in parental understandings and experiences of vaccine-preventable diseases: a qualitative study. Child Care Health Dev., 33(2), pp.170–179. doi:10.1111/j.1365-2214.2006.00647.x.
Go back to footnote reference 4
Chamberlain, A.T., Seib, K., Ault, K.A., Orenstein, W.A., Frew, P.M., Malik, F., Cortés, M., Cota, P., Whitney, E.A.S., Flowers, L.C., Berkelman, R.L. & Omer, S.B. (2015). Factors Associated with Intention to Receive Influenza and Tetanus, Diphtheria, and Acellular Pertussis (Tdap) Vaccines during Pregnancy: A Focus on Vaccine Hesitancy and Perceptions of Disease Severity and Vaccine Safety. PLoS Currents. https://doi.org/10.1371/currents.outbreaks.d37b61bceebae5a7a06d40a301cfa819
Go back to footnote reference 5
Nankya-Mutyoba, J., Aizire, J., Makumbi, F., Ocama, P. & Kirk, G.D. (2019). Hepatitis B virus perceptions and health seeking behaviors among pregnant women in Uganda: implications for prevention and policy. BMC Health Services Research, 19, 760. https://doi.org/10.1186/s12913-019-4516-0
Go back to footnote reference 6
Global Polio Eradication Initiative (GPEI) (no date). Polio Today: Endemic Countries. Available at: https://polioeradication.org/where-we-work/polio-endemic-countries/ (accessed 30 June 2025).
Go back to footnote reference 7
Circulating vaccine-derived poliovirus count. In: Global Polio Eradication Initiative [website]. Geneva: Global Polio Eradication Initiative; no date (https://polioeradication.org/circulating-vaccine-derived-poliovirus-count/, accessed 24 June 2025).
Go back to footnote reference 8
Al Bashar, L., Dube, E., Kandasamy, T., Zaini, N., Abdul Rahman, H., et al. (2023) ‘Parents’ and healthcare professionals’ perception toward the introduction of a new fully liquid hexavalent vaccine in the Malaysian national immunization program: a cross-sectional study instrument development and its application’, Frontiers in Immunology, 14. https://doi.org/10.3389/fimmu.2023.1052450.
Go back to footnote reference 9
Babandi, Z.S., Suleiman, A.G., Darma, M.A., Indabo, U.H., Shehu, S., Hamza, A.S., Henry, J., Umar, U.M., Ojediran, S.L., Amadu, L., Ibrahim, M.S. & Ejembi, C.L. (2024). Knowledge and Perception of Diphtheria among Residents of a Rural Community in Kaduna State, Northwest Nigeria. Journal of Community Medicine and Primary Health Care, 36, pp.111–123. https://doi.org/10.4314/jcmphc.v36i2.9
Go back to footnote reference 10
Babandi, Z.S., Suleiman, A.G., Darma, M.A., Indabo, U.H., Shehu, S., Hamza, A.S., Henry, J., Umar, U.M., Ojediran, S.L., Amadu, L., Ibrahim, M.S. & Ejembi, C.L. (2024). Knowledge and Perception of Diphtheria among Residents of a Rural Community in Kaduna State, Northwest Nigeria. Journal of Community Medicine and Primary Health Care, 36, pp.111–123. https://doi.org/10.4314/jcmphc.v36i2.9
Go back to footnote reference 11
Hilton, S., Hunt, K. & Petticrew, M. (2007). Gaps in parental understandings and experiences of vaccine-preventable diseases: a qualitative study. Child Care Health Dev., 33(2), pp.170–179. doi:10.1111/j.1365-2214.2006.00647.x.
Go back to footnote reference 12
Chamberlain, A.T., Seib, K., Ault, K.A., Orenstein, W.A., Frew, P.M., Malik, F., Cortés, M., Cota, P., Whitney, E.A.S., Flowers, L.C., Berkelman, R.L. & Omer, S.B. (2015). Factors Associated with Intention to Receive Influenza and Tetanus, Diphtheria, and Acellular Pertussis (Tdap) Vaccines during Pregnancy: A Focus on Vaccine Hesitancy and Perceptions of Disease Severity and Vaccine Safety. PLoS Currents. https://doi.org/10.1371/currents.outbreaks.d37b61bceebae5a7a06d40a301cfa819
Go back to footnote reference 13
Nankya-Mutyoba, J., Aizire, J., Makumbi, F., Ocama, P. & Kirk, G.D. (2019). Hepatitis B virus perceptions and health seeking behaviors among pregnant women in Uganda: implications for prevention and policy. BMC Health Services Research, 19, 760. https://doi.org/10.1186/s12913-019-4516-0
Go back to footnote reference 14
Hilton, S., Hunt, K. & Petticrew, M. (2007). Gaps in parental understandings and experiences of vaccine-preventable diseases: a qualitative study. Child Care Health Dev., 33(2), pp.170–179. doi:10.1111/j.1365-2214.2006.00647.x.
Go back to footnote reference 15
Centers for Disease Control and Prevention (CDC) (no date). Polio Vaccine Questions and Answers. Available at: https://www.cdc.gov/vaccines/vpd/polio/public/index.html (accessed 30 June 2025).
Go back to footnote reference 16
Global Polio Eradication Initiative (GPEI) (no date). Polio Today: Endemic Countries. Available at: https://polioeradication.org/where-we-work/polio-endemic-countries/ (accessed 30 June 2025).
Go back to footnote reference 17
Circulating vaccine-derived poliovirus count. In: Global Polio Eradication Initiative [website]. Geneva: Global Polio Eradication Initiative; no date (https://polioeradication.org/circulating-vaccine-derived-poliovirus-count/, accessed 24 June 2025).