How do adolescents and their parents decide on meningococcal ACWY vaccination: lessons to learn for communication and organisation of a vaccination programme

The Netherlands currently experiences an ongoing increase of serogroup W invasive meningococcal disease (IMD). Starting in 2015, the incidence rate increased from 0.03 per 100,000 before 2015 to 0.5 per 100,000 in 2017 and 0.77 per 100,000 in the first quarter of 2018. In the period October 2015-March 2018 173 MenW patients were reported. The case fatality amounted to 16%. The incidence rate was highest in children <5 years of age and 15–24 year-olds. To control the increase in serogroup W IMD, the MenC vaccine given in the National Immunization Program (NIP) at 14 months of age is replaced by a MenACWY vaccine. Moreover, 13–14 year-olds will be offered an additional MenACWY vaccination. High MenACWY vaccine uptake in this age group is important, not only to protect themselves but also to achieve group protection. Meningococcal carriage is highest among adolescents and it is expected that vaccination of 13-14 year-olds will reduce MenW IMD in other age groups as well. It is difficult to predict the vaccine uptake by adolescents, as in the Dutch NIP no MenC vaccinations are offered at this age. Currently, little is known about factors influencing acceptance of Men ACWY vaccination in this age group and even less about how adolescents and their parents make their decision. Different factors may play the most important role in the decision making processes of adolescents and parents. Therefore, one may have to use different strategies to provide both adolescents and parents with adequate information and support to enable them to make a decision on Men ACWY vaccination. This project aims to get insight in the processes and factors associated with decision making regarding MenACWY vaccination among both adolescents and their parents, and to evaluate what they need in order to make a decision. We will conduct qualitative and quantitative assessments to identify how decision making concerning MenACWY vaccination occurs within a family, what the differences are between adolescents and their parents and between those who accept and those who do not accept MenACWY-vaccination, and what their needs are to make a decision. In the qualitative study, interviews will be conducted with ~30 dyads of adolescents and their parents (dyad members will be interviewed separately resulting in ~60 interviews). The results of the qualitative study will be used to develop a questionnaire for the quantitative study. In the quantitative study ~1000 dyads of adolescents and their parents will be included to answer the online questionnaire (separate questionnaires for adolescents and parents), ~500 dyads who accepted the Men ACWY vaccination and ~500 dyads who did not accept the Men ACWY vaccination. The study will result in knowledge on the most important needs for information and support in decision making of four different target groups: adolescents accepting Men ACWY-vaccination, parents accepting Men ACWY-vaccination (for their child), adolescents not accepting Men ACWY-vaccination and parents not accepting Men ACWY-vaccination (for their child). This knowledge can be used to adapt the communication on Men ACWY-vaccination and –if feasible- to adapt the organization of the present vaccination campaign. As the Health Council is currently preparing an advice on meningococcal vaccination in the NIP, including MenACWY vaccination of adolescents, the results might also be used for communication and organization of Men ACWY vaccination in the NIP.