[Hepatitis B vaccination: knowledge and acceptance by Swiss physicians]

Difficulties with the acceptance of immunization recommendations by physicians have been documented. A recommendation for universal hepatitis B vaccination was published in 1998 for Switzerland. We conducted a qualitative study of pediatricians and family physicians in the fall of 1996 with eight focus groups stratified by region of the country and medical specialty. Sixty-two physicians participated. Most participants felt that universal hepatitis B immunization would be useful. Pediatricians in the French-speaking part of the country were more willing to implement such a recommendation, while family physicians in the German-speaking regions were least willing. Before supporting universal hepatitis B immunization, physicians stated that they need more information about the epidemiology of the infection, the effectiveness and safety of the vaccine, and the perceived high cost of an immunization program. Participants felt that two injections per visit was the maximum tolerable for infants and young children. Many preferred to immunize older children or adolescents against hepatitis B, both because fewer injections are currently recommended at that age and because adolescence is a developmentally appropriate age to address sexuality and drug abuse. Physicians expected the population to be reluctant to accept universal hepatitis B vaccination, partly because of a lack of understanding of the disease and partly because of a feeling that children already receive more than enough immunizations. While the general sentiment for a universal hepatitis B immunization recommendation in Switzerland seems to be positive among physicians, concerns regarding its implementation linger. It remains to be seen how hepatitis B will be perceived in the population, and how willing parents and adolescents will be to get their children and themselves vaccinated. Helping physicians to understand the importance of this measure, in addition to convincing them to immunize their patients, will be an important first step towards achieving sufficient hepatitis B immunization coverage.