The swine flu (H1N1) pandemic was confirmed on June 11th, 2009 by the World Health Organisation (WHO). The WHO declared the pandemic over by August 10th, 2010 [1
], by which time 214 countries had reported laboratory confirmed cases, which included 18
449 deaths [2
]. In contrast to seasonal influenza epidemics, in the 2009 H1N1 pandemic, younger age groups were disproportionately affected compared with older age groups [3
]. A large proportion of older adults had preexisting natural immunity, probably due to HIN1 strains circulating in earlier decades [4
]. Children under 5 years of age were most likely to be hospitalised if they contracted the H1N1 virus, and they also had high rates of admission to critical care with some fatalities [5
In order to tackle the pandemic, plans worldwide were based on a vaccination programme and education [6
]. In the UK, the vaccination programme officially started October 14th, 2009, with those in the “at risk” categories being offered the vaccination first. In December 2009, this was extended to children between the ages of six months and five years because of their increased level of risk [7
]. However, sero-epidemiological studies based on the first wave of the pandemic showed that the rates of infection were actually the highest amongst school-aged children, where in London and the West Midlands (the areas of highest incidence), children aged 5–14 years had infection rates of approximately 42%, followed by the under 5s with infection rates of 21.3% [4
]. This was approximately ten times the rate of people consulting with clinical influenza, highlighting the burden of mild and subclinical disease during the pandemic, and the importance of school children as vectors of transmission [4
]. An additional strategy for future pandemics might be to extend vaccination to school-aged children to protect both themselves and the population via herd immunity. In some countries, this strategy is also used for seasonal influenza epidemics [8
] as the evidence for the effectiveness of this strategy is beginning to accumulate.
There are few studies reporting likely uptake rates of this strategy among school-aged children, although a Mumsnet poll [9
] indicated that 46% of parents of healthy under 5s would refuse (although it did not report on older age groups), and recorded uptake in England for the under 5s during the pandemic was only 23.6% [10
]. In addition, most of the research about reasons for accepting/refusing influenza vaccine (either seasonal or pandemic) has been undertaken amongst healthcare workers [11
] and more recently healthy adults [16
]. Studies so far have revealed that there were low levels of anxiety towards the swine flu pandemic [19
]. This is believed to be due to early reports suggesting symptoms and prognosis of a similar severity to seasonal flu, encouraging the general population to consider themselves at low risk. Concerns about the safety of the swine flu vaccine and fear of adverse side effects have also been revealed to be important issues to address and this may be due to the misperception that the safety testing of such “fast-tracked” vaccines is insufficient, leaving a greater possibility of adverse health problems [20
]. These may have a particular effect when considering vaccinating children.
Given the threat of future pandemics, and also the high levels of H1N1 circulating in the subsequent 2010/11 influenza season, it is important to determine factors which might affect pandemic influenza vaccine uptake in young children in order to inform future vaccination policy decisions. We present a study undertaken during the 2009/10 influenza H1N1 pandemic among parents of primary school children to determine vaccine acceptance rates and factors affecting their decision to consent or not.