medlitГигиена и санитарияHygiene and Sanitation0016-99002412-0650Federal Scientific Center of Hygiene named after F.F. Erisman10.47470/0016-9900-2018-97-7-664-670medlit-607Research ArticleМЕТОДЫ ГИГИЕНИЧЕСКИХ ИССЛЕДОВАНИЙMETHODS OF HYGIENIC AND EXPERIMENTAL INVESTIGATIONSСистематический обзор эмпирических исследований факторов отказа от вакцинацииThe systematic review of empirical research of factors of refusal from vaccinationАнтоноваНаталья АлександровнаAntonovaNatalia A.

Канд. психол. наук, ст. научный сотрудник Института психологии РГПУ им. А.И. Герцена.

e-mail: antonova.natalia11@gmail.com

MD, Ph.D., senior researcher, Institute of Psychology of Herzen State Pedagogical University of Russia, St. Petersburg, 191186, Russian Federation.

e-mail: antonova.natalia11@gmail.com

antonova.natalia11@gmail.comЕрицянК. Ю.YeritsyanK. Yu.noemail@neicon.ruФГБОУ ВО «Российский Государственный Педагогический Университет им. А.И. Герцена» (РГПУ им. А.И. Герцена), Институт психологииRussian State Pedagogical University named after A.I. Herzen ", Institute of PsychologyНациональный исследовательский университет «Высшая школа экономики», Санкт-Петербургская школа социальных и гуманитарных наукNational Research University "Higher School of Economics", St. Petersburg School of Social and Human Sciences201820102020977664670Copyright © Антонова Н.А., Ерицян К.Ю., 20202020Антонова Н.А., Ерицян К.Ю.Antonova N.A., Yeritsyan K.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rjhas.ru/jour/article/view/607

Снижение уровня вакцинации в мире, обусловленное добровольным отказом определённых слоёв населения от данного профилактического вмешательства, представляет угрозу общественному здоровью. Целью исследования стали систематизация и описание факторов формирования установок или поведения, связанных с полным отказом от вакцинации. Систематический обзор осуществлён в 2015 г. с использованием базы данных Web of Science. В анализ включались англоязычные статьи, опубликованные с 1980 по 2015 гг., содержащие результаты оригинальных эмпирических исследований феномена отказа от вакцинации среди любых групп населения. Из найденных 679 записей критериям включения соответствовали 30 публикаций. Результаты показали, что детерминация отказа от вакцинации крайне вариабельна. Все факторы отказа от вакцинации, обнаруженные в исследованиях, нами были подразделены на 4 содержательных блока: 1) социально-статусные, 2) когнитивные, 3) поведенческие и 4) иные факторы (вакцино-специфические факторы, характеристики состояния здоровья и опыт переживания болезни, а также медицинские противопоказания, характеристики социального окружения, информационное воздействие). Период активного изучения отказа от вакцинации как социально-психологического феномена составляет порядка 15 лет, и большинство исследований выполняется в США и Канаде. Достаточно подтверждённым является взаимосвязь отказа от вакцинации со следующими факторами: низкой воспринимаемой эффективностью вакцин (когнитивный фактор); представлением о высокой вероятности серьёзных побочных эффектов вакцинации и в целом небезопасности вакцин (когнитивный фактор); низким уровнем доверия «официальной» медицине и государственным структурам (когнитивный фактор); использованием комплиментарной и альтернативной медицины членами семьи (поведенческий фактор). Потенциально важными факторами являются: низкая воспринимаемая опасность непосредственно вакцинопрофилактируемых заболеваний и воспринимаемый потенциальный вред иммунной системе ребенка (когнитивные факторы). Систематический обзор вскрыл общую недооценку социально-психологических факторов при изучении феномена отказа от вакцинации и акцент на когнитивных факторах.

The worldwide reduction of vaccination uptake due to the voluntary refusal by some subpopulations constitutes a significant threat to public health. The study aims to provide systematic description of the factors which influence attitudes or behaviors associated with a vaccination rejection. A systematic review was carried out in 2015 using the Web of Science database. The analysis included English-language articles published from 1980 to 2015 containing the results of original empirical research of the phenomenon of refusal of vaccination. Of the 679 records found 30 publications met the inclusion criteria. The results showed that the determination of non-vaccination is extremely variable. All factors refusal of vaccination discovered in the research were divided into four content blocks: 1) demographics and socioeconomic status; 2) cognitive; 3) behavioral and 4) other factors (a) vaccine-specific, b) health and medical conditions, c) social environment, d) informational influence. The active studying the vaccination refusal as a socio-psychological phenomenon last for about 15 years, the majority of studies performed in the United States and Canada. In more than 5 independent studies there were found links of non-vaccination attitudes or behavior to the following factors: the perceived low vaccine efficacy (cognitive factor); the idea of a high probability of serious side effects of vaccination and general vaccines unsafety (cognitive factor); low level of trust to "official" medicine and public entities (cognitive factor); use of complementary and alternative medicine by family members (behavioral factors). Other potentially important factors found in 5 studies were: low perceived risk of vaccine preventable diseases and the perceived potential harm of vaccination to the immune system of the child (cognitive factors). The systematic review revealed a general underestimation of the social and psychological factors in the study of the phenomenon of non-vaccination and an emphasis on cognitive factors.

вакцинацияотказ от вакцинацииповедение в сфере здоровьяфакторыустановки к профилактическим вмешательствамсистематический обзорсанитарно-эпидемиологическое благополучиеvaccinationnon-vaccinationhealth behaviorvaccination attitudesfactorssystematic reviewsanitary and epidemiological wellbeingReferencesАнтонова Н.А., Ерицян К.Ю., Дубровский Р.Г., Спирина В.Л. Отказ от вакцинации: качественный анализ биографических интервью. Теория и практика общественного развития. 2014. №20. URL: http://teoria-practica.ru/rus/files/arhiv_zhurnala/2014/20/psychology/antonova-eritsyan-dubrovsky-spirina.pdf (Дата обращения: 20.08.2016).Antonova N.A., Eritsyan K.Yu., Dubrovskiy R.G., Spirina V.L. Refusal of vaccination: a qualitative analysis of biographical interviews. Teoriya i praktika obshchestvennogo razvitiya. 2014: 20.Елукова А.П. Причины отказов от вакцинации. Бюллетень Северного государственного медицинского университета: II Международный молодежный медицинский форум “Медицина будущего - Арктике” Выпуск XXXIV. Архангельск; 2015: 29-30.Elukova A.P. The reasons for non-vaccination. Byulleten’ Severnogo gosudarstvennogo meditsinskogo universiteta: II Mezhdunarodnyy molodezhnyy meditsinskiy forum “Meditsina budushchego – Arktike” Vypusk XXXIV. Arkhangel’sk; 2015: 29–30.Ерицян К.Ю. Когнитивные факторы различий в паттернах вакцинации: воспринимаемый риск действия и бездействия. Вестник СПбГУ. Сер. 16. Психология. Педагогика. 2016; 2: 98-106.Eritsyan K.Yu. Cognitive factors of differences in patterns of vaccination: the perceived risks of action and inaction. Vestnik SPbU. Ser. 16. 2016; 2: 98–106.Кригер Е.А, Самодова О., Рогушина Н., Борисова Т. Отношение родителей к вакцинации детей и факторы, связанные с отказом от прививок. Педиатрия. 2016; 95(2): 91-5.Kriger E.A, Samodova O., Rogushina N., Borisova T. The parents attitude to children vaccination and factors associated with non-vaccination. Pediatriya. 2016; 95(2): 91–5.Солондаев В.К., Конева Е.В., Черная Н.Л. Психологические факторы принятия решения о вакцинации. Сибирский психологический журн. 2016; 59: 125-36.Solondaev V.K., Koneva E.V., Chernaya N.L. Psychological factors of vaccination decision-making. Sibirskiy psikhologicheskiy zhurn. 2016; 59: 125–36.Benin A.L., Wisler-Scher D.J., Colson E., Shapiro E.D., Holmboe E.S. Qualitative analysis of mothers’ decision-making about vaccines for infants: the importance of trust. Pediatrics. 2006; 117 (5): 1532-41.Benin A.L., Wisler-Scher D.J., Colson E., Shapiro E.D., Holmboe E.S. Qualitative analysis of mothers’ decision-making about vaccines for infants: the importance of trust. Pediatrics. 2006; 117 (5): 1532–41.Busse J.W., Kulkarni A.V., Campbell J.B., Injeyan H.S. Attitudes toward vaccination: a survey of Canadian chiropractic students. Canadian Medical Association Journ. 2002; 166 (12): 1531-4.Busse J.W., Kulkarni A.V., Campbell J.B., Injeyan H.S. Attitudes toward vaccination: a survey of Canadian chiropractic students. Canadian Medical Association Journ. 2002; 166 (12): 1531–4.Coniglio M.A., Platania M., Privitera D., Giammanco G., Pignato S. Parents’ attitudes and behaviours towards recommended vaccinations in Sicily, Italy. BMC public health. 2011; 11(1): 305.Coniglio M.A., Platania M., Privitera D., Giammanco G., Pignato S. Parents’ attitudes and behaviours towards recommended vaccinations in Sicily, Italy. BMC public health. 2011; 11(1): 305.Connolly T., Reb J. Omission bias in vaccination decisions: where’s the “omission”? Where’s the “bias”? Organizational Behavior and Human Decision Processes. 2003; 91(2): 186-202.Connolly T., Reb J. Omission bias in vaccination decisions: where’s the “omission”? Where’s the “bias”? Organizational Behavior and Human Decision Processes. 2003; 91(2): 186–202.Daniels D., Jiles R.B., Klevens R.M., Herrera G.A. Undervaccinated African-American preschoolers: A case of missed opportunities. American journ. of preventive medicine. 2001; 20(4): 61-8.Daniels D., Jiles R.B., Klevens R.M., Herrera G.A. Undervaccinated African-American preschoolers: A case of missed opportunities. American journ. of preventive medicine. 2001; 20(4): 61–8.Dempsey A.F., Schaffer S., Singer D., Butchart A., Davis M., Freed G.L. Alternative vaccination schedule preferences among parents of young children // Pediatrics. 2011. № 128(5). P. 848-56.Dempsey A.F., Schaffer S., Singer D., Butchart A., Davis M., Freed G.L. Alternative vaccination schedule preferences among parents of young children // Pediatrics. 2011. № 128(5). P. 848–56.Downey L., Tyree P.T., Huebner C.E., Lafferty W.E. Pediatric vaccination and vaccine-preventable disease acquisition: associations with care by complementary and alternative medicine providers. Maternal and child health journ. 2010; 14 (6): 922-30.Downey L., Tyree P.T., Huebner C.E., Lafferty W.E. Pediatric vaccination and vaccine-preventable disease acquisition: associations with care by complementary and alternative medicine providers. Maternal and child health journ. 2010; 14 (6): 922–30.Enriquez R., Addington W., Davis F., Freels S., Park C.L., Hershow R.C., Persky V. The relationship between vaccine refusal and self-report of atopic disease in children. Journ. of allergy and clinical immunology. 2005; 115(4): 737-44.Enriquez R., Addington W., Davis F., Freels S., Park C.L., Hershow R.C., Persky V. The relationship between vaccine refusal and self-report of atopic disease in children. Journ. of allergy and clinical immunology. 2005; 115(4): 737–44.Eritsyan, K., Antonova N. Factors of differences in child vaccination patterns: the test of Health Behavior model on Russian sample. International Journ. of Psychology. 2016. 51(S1): 676-7.Eritsyan K., Antonova N. Factors of differences in child vaccination patterns: the test of Health Behavior model on Russian sample. International Journ. of Psychology. 2016. 51(S1): 676–7.Eritsyan K.Yu, Antonova N.A., Tsvetkova L.A. Studying the anti-vaccination behavior and attitudes: a systematic review of methods. International Journ. of Psychology. 2016; 51(S1): 676.Eritsyan K.Yu, Antonova N.A., Tsvetkova L.A. Studying the anti-vaccination behavior and attitudes: a systematic review of methods. International Journ. of Psychology. 2016; 51(S1): 676.Fredrickson D.D., Davis T.C., Arnould C.L., Kennen E.M., Humiston S.G., Cross J.T., Bocchini J.A. Childhood immunization refusal: provider and parent perceptions. Family Medicine-Kansas City. 2004; 6: 431-9.Fredrickson D.D., Davis T.C., Arnould C.L., Kennen E.M., Humiston S.G., Cross J.T., Bocchini J.A. Childhood immunization refusal: provider and parent perceptions. Family Medicine-Kansas City. 2004; 6: 431–9.Freed G.L., Clark S.J., Butchart A.T., Singer D.C., Davis M.M. Parental vaccine safety concerns in 2009. Pediatrics. 2010; 125(4): 654-9.Freed G.L., Clark S.J., Butchart A.T., Singer D.C., Davis M.M. Parental vaccine safety concerns in 2009. Pediatrics. 2010; 125(4): 654–9.Gaudino J.A., Robison S. Risk factors associated with parents claiming personal-belief exemptions to school immunization requirements: community and other influences on more skeptical parents in Oregon, 2006. Vaccine. 2012; 30(6): 1132-42.Gaudino J.A., Robison S. Risk factors associated with parents claiming personal-belief exemptions to school immunization requirements: community and other influences on more skeptical parents in Oregon, 2006. Vaccine. 2012; 30(6): 1132–42.Glanz J.M., Newcomer S.R., Narwaney K.J., Hambidge S.J., Daley M.F., Wagner N.M., Nelson J.C. A population-based cohort study of undervaccination in 8 managed care organizations across the United States. JAMA pediatrics. 2013; 167(3): 274-81.Glanz J.M., Newcomer S.R., Narwaney K.J., Hambidge S.J., Daley M.F., Wagner N.M., Nelson J.C. A population-based cohort study of undervaccination in 8 managed care organizations across the United States. JAMA pediatrics. 2013; 167(3): 274–81.Gullion J.S., Henry L., Gullion G. Deciding to opt out of childhood vaccination mandates. Public health nursing. 2008; 25 (5): 401-8.Gullion J.S., Henry L., Gullion G. Deciding to opt out of childhood vaccination mandates. Public health nursing. 2008; 25 (5): 401–8.Gust D.A., Darling N., Kennedy A., Schwartz B. Parents with doubts about vaccines: which vaccines and reasons why. Pediatrics. 2008; 122(4); 718-25.Gust D.A., Darling N., Kennedy A., Schwartz B. Parents with doubts about vaccines: which vaccines and reasons why. Pediatrics. 2008; 122(4); 718–25.Harmsen I.A., Mollema L., Ruiter R.A., Paulussen T.G., de Melker H.E., Kok G. Why parents refuse childhood vaccination: a qualitative study using online focus groups. BMC public health. 2013; 13(1): 1183.Harmsen I.A., Mollema L., Ruiter R.A., Paulussen T.G., de Melker H.E., Kok G. Why parents refuse childhood vaccination: a qualitative study using online focus groups. BMC public health. 2013; 13(1): 1183.Jolley D., Douglas K.M. The effects of anti-vaccine conspiracy theories on vaccination intentions. PLoS One. 2014; 9(2): e89177.Jolley D., Douglas K.M. The effects of anti-vaccine conspiracy theories on vaccination intentions. PLoS One. 2014; 9(2): e89177.Kareklas I., Muehling D.D., Weber T.J. Reexamining health messages in the digital age: a fresh look at source credibility effects. Journ. of Advertising. 2015; 44(2): 88-104.Kareklas I., Muehling D.D., Weber T.J. Reexamining health messages in the digital age: a fresh look at source credibility effects. Journ. of Advertising. 2015; 44(2): 88–104.Larson H.J., Jarrett C., Eckersberger E., Smith D.M., Paterson P. Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007-2012. Vaccine. 2014; 32(19): 2150-9.Larson H.J., Jarrett C., Eckersberger E., Smith D.M., Paterson P. Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007–2012. Vaccine. 2014; 32(19): 2150–9.Leask J., Kinnersley P., Jackson C., Cheater F., Bedford H., Rowles G. Communicating with parents about vaccination: a framework for health professionals. BMC pediatrics. 2012; 12(1): 154.Leask J., Kinnersley P., Jackson C., Cheater F., Bedford H., Rowles G. Communicating with parents about vaccination: a framework for health professionals. BMC pediatrics. 2012; 12(1): 154.Luthy K.E., Beckstrand R.L., Callister L.C., Cahoon S. Reasons parents exempt children from receiving immunizations. The Journ. of School Nursing. 2012: 8(2): 153-160.Luthy K.E., Beckstrand R.L., Callister L.C., Cahoon S. Reasons parents exempt children from receiving immunizations. The Journ. of School Nursing. 2012: 8(2): 153–160.Mergler M.J., Omer S.B., Pan W.K., Navar-Boggan A.M., Orenstein W., Marcuse E.K., Halsey N. Association of vaccine-related attitudes and beliefs between parents and health care providers. Vaccine. 2013; 31(41): 4591-5.Mergler M.J., Omer S.B., Pan W.K., Navar-Boggan A.M., Orenstein W., Marcuse E.K., Halsey N. Association of vaccine-related attitudes and beliefs between parents and health care providers. Vaccine. 2013; 31(41): 4591–5.Mollema L., Wijers N., Hahné S.J., van der Klis F.R., Boshuizen H.C., de Melker H.E. Participation in and attitude towards the national immunization program in the Netherlands: data from population-based questionnaires. BMC public health. 2012; 12 (1): 57.Mollema L., Wijers N., Hahné S.J., van der Klis F.R., Boshuizen H.C., de Melker H.E. Participation in and attitude towards the national immunization program in the Netherlands: data from population-based questionnaires. BMC public health. 2012; 12(1): 57.Omer S.B., Pan W.K., Halsey N.A., Stokley S., Moulton L.H., Navar A.M., Salmon D.A. Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence. Jama. 2006; 296 (14):1757-63.Omer S.B., Pan W.K., Halsey N.A., Stokley S., Moulton L.H., Navar A.M., Salmon D.A. Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence. Jama. 2006; 296 (14): 1757–63.Perestelo-Pérez L. Standards on how to develop and report systematic reviews in Psychology and Health. International Journ. of Clinical and Health Psychology. 2013; 13(1): 49-57.Perestelo-Pérez L. Standards on how to develop and report systematic reviews in Psychology and Health. International Journ. of Clinical and Health Psychology. 2013; 13(1): 49–57.Quadri-Sheriff M., Hendrix K.S., Downs S.M., Sturm L.A., Zimet G.D., Finnell S.M.E. The role of herd immunity in parents’ decision to vaccinate children: a systematic review. Pediatrics. 2012; 130 (3): 522-30.Quadri-Sheriff M., Hendrix K.S., Downs S.M., Sturm L.A., Zimet G.D., Finnell S.M.E. The role of herd immunity in parents’ decision to vaccinate children: a systematic review. Pediatrics. 2012; 130 (3): 522–30.Quaiyum M.A., Gazi R., Khan A.I., Uddin J., Islam M., Ahmed F., Saha N.C. Programmatic aspects of dropouts in child vaccination in Bangladesh: findings from a prospective study. Asia-Pacific Journ. of Public Health. 2011: 23 (2): 141-50.Quaiyum M.A., Gazi R., Khan A.I., Uddin J., Islam M., Ahmed F., Saha N.C. Programmatic aspects of dropouts in child vaccination in Bangladesh: findings from a prospective study. Asia-Pacific Journ. of Public Health. 2011: 23 (2): 141–50.Reich J.A. Neoliberal Mothering and Vaccine Refusal Imagined Gated Communities and the Privilege of Choice. Gender and Society. 2014: 0891243214532711.Reich J.A. Neoliberal Mothering and Vaccine Refusal Imagined Gated Communities and the Privilege of Choice. Gender and Society. 2014: 0891243214532711.Rosenstock I.M. Historical origins of the health belief model. Health Education and Behavior. 1974; 2(4): 328-35.Rosenstock I.M. Historical origins of the health belief model. Health Education and Behavior. 1974; 2(4): 328–35.Rogers R.W. A protection motivation theory of fear appeals and attitude change. The journ. of psychology. 1975; 91(1): 93-114.Rogers R.W. A protection motivation theory of fear appeals and attitude change. The journ. of psychology. 1975; 91(1): 93–114.Ruijs W.L., Hautvast J.L., Kerrar S., Van der Velden K., Hulscher M.E. The role of religious leaders in promoting acceptance of vaccination within a minority group: a qualitative study. BMC public health. 2013; 13(1): 511.Ruijs W.L., Hautvast J.L., Kerrar S., Van der Velden K., Hulscher M.E. The role of religious leaders in promoting acceptance of vaccination within a minority group: a qualitative study. BMC public health. 2013; 13(1): 511.Russell M.L., Injeyan H.S., Verhoef M.J., Eliasziw M. Beliefs and behaviours: understanding chiropractors and immunization. Vaccine. 2004; 23(3): 372-9.Russell M.L., Injeyan H.S., Verhoef M.J., Eliasziw M. Beliefs and behaviours: understanding chiropractors and immunization. Vaccine. 2004; 23(3): 372–9.Saada A., Lieu T.A., Morain S.R., Zikmund-Fisher B.J., Wittenberg E. Parents’ Choices and Rationales for Alternative Vaccination Schedules A Qualitative Study. Clinical pediatrics. 2015: 54 (3): 236-43.Saada A., Lieu T.A., Morain S.R., Zikmund-Fisher B.J., Wittenberg E. Parents’ Choices and Rationales for Alternative Vaccination Schedules A Qualitative Study. Clinical pediatrics. 2015: 54 (3): 236–43.Salmon D.A., Moulton L.H., Omer S.B., Patricia deHart M., Stokley S., Halsey N.A. Factors associated with refusal of childhood vaccines among parents of school-aged children: a case-control study. Archives of pediatrics and adolescent medicine. 2005; 159 (5): 470-6.Salmon D.A., Moulton L.H., Omer S.B., Patricia deHart M., Stokley S., Halsey N.A. Factors associated with refusal of childhood vaccines among parents of school-aged children: a case-control study. Archives of pediatrics and adolescent medicine. 2005; 159 (5): 470–6.Senier L. “It’s Your Most Precious Thing”: Worst Case Thinking, Trust, and Parental Decision Making about Vaccinations. Sociological Inquiry. 2008.; 78(2): 207-29.Senier L. “It’s Your Most Precious Thing”: Worst Case Thinking, Trust, and Parental Decision Making about Vaccinations. Sociological Inquiry. 2008.; 78(2): 207–29.Shoup J.A., Wagner N.M., Kraus C.R., Narwaney K.J., Goddard K.S., Glanz J.M. Development of an Interactive Social Media Tool for Parents With Concerns About Vaccines. Health Education and Behavior. 2015; 42(3): 302-12.Shoup J.A., Wagner N.M., Kraus C.R., Narwaney K.J., Goddard K.S., Glanz J.M. Development of an Interactive Social Media Tool for Parents With Concerns About Vaccines. Health Education and Behavior. 2015; 42(3): 302–12.Smith P.J., Humiston S.G., Marcuse E.K., Zhao Z., Dorell C.G., Howes C., Hibbs B. Parental delay or refusal of vaccine doses, childhood vaccination coverage at 24 months of age, and the Health Belief Model. Public Health Reports. 2011; 126 (2): 135.Smith P.J., Humiston S.G., Marcuse E.K., Zhao Z., Dorell C.G., Howes C., Hibbs B. Parental delay or refusal of vaccine doses, childhood vaccination coverage at 24 months of age, and the Health Belief Model. Public Health Reports. 2011; 126 (2): 135.Sobo E.J. Social Cultivation of Vaccine Refusal and Delay among Waldorf (Steiner) School Parents. Medical anthropology quarterly. 2015; 29(3): 381-99.Sobo E.J. Social Cultivation of Vaccine Refusal and Delay among Waldorf (Steiner) School Parents. Medical anthropology quarterly. 2015; 29(3): 381–99.Teich N., Klugmann T., Tiedemann A., Holler B., Mössner J., Liebetrau A., Schiefke I. Vaccination coverage in immunosuppressed patients: results of a regional health services research study. Deutsches Ärzteblatt International. 2011: 108 (7): 105.Teich N., Klugmann T., Tiedemann A., Holler B., Mössner J., Liebetrau A., Schiefke I. Vaccination coverage in immunosuppressed patients: results of a regional health services research study. Deutsches Ärzteblatt International. 2011: 108 (7): 105.Wei F., Mullooly J.P., Goodman M., McCarty M.C., Hanson A.M., Crane B., Nordin J.D. Identification and characteristics of vaccine refusers. BMC pediatrics. 2009; 9(1): 18.Wei F., Mullooly J.P., Goodman M., McCarty M.C., Hanson A.M., Crane B., Nordin J.D. Identification and characteristics of vaccine refusers. BMC pediatrics. 2009; 9(1): 18.Wilson K., Mills E., Boon H., Tomlinson G., Ritvo P. A survey of attitudes towards paediatric vaccinations amongst Canadian naturopathic students. Vaccine. 2004; 22 (3): 329-34.Wilson K., Mills E., Boon H., Tomlinson G., Ritvo P. A survey of attitudes towards paediatric vaccinations amongst Canadian naturopathic students. Vaccine. 2004; 22 (3): 329–34.Zuzak T.J., Zuzak-Siegrist I., Rist L., Staubli G., Simoes-Wust A.P. Attitudes towards vaccination: users of complementary and alternative medicine versus non-users. Swiss medical weekly. 2008; 138 (47): 713.Zuzak T.J., Zuzak-Siegrist I., Rist L., Staubli G., Simoes-Wust A.P. Attitudes towards vaccination: users of complementary and alternative medicine versus non-users. Swiss medical weekly. 2008; 138 (47): 713.

The authors declare that there are no conflicts of interest present.