n = 544
The questionnaire was distributed to a varied group of respondents by social media services and via e-mailing. It consisted of the following parts:
Items requesting socio-demographic information, including gender, age and education;
Questions about Ebola and approach to Ebola vaccination if it existed, and about the attitude to participation in research on Ebola vaccination;
Questions about influenza and the attitude to immunization against it.
2.3 Data Analysis
The analyzed variables were qualitative in nature (nominal). Chi-squared tests were used to determine how selected categorical variables, including demographical factors, were related to the knowledge about Ebola and influenza and the attitude to vaccination. Chi-squared tests with Yates’ correction and Fisher’s exact test were also used. The odds ratio (OR) were calculated to show quantitatively how strong the association between the presence/absence of any two factors in the population was the correspondence analysis was used to determine the relationship between variables in multi-way tables. The level of statistical significance was set α = 0.05. Statistica 10.0 software (StatSoft; Tulsa, OK) was used for data elaboration.
3.1 Ebola Assessment
Ebola was perceived by 97.1% of respondents as a life-threatening condition and almost all of them (94.6% of healthcare professionals and 89.9% of others) considered traveling to the endemic regions of Ebola outbreak as dangerous because of infection risk. Medical education factored significantly in this perception (Chi2= 3.95; p = 0.047). In the general group, women answered more often than men that traveling to the endemic regions of Ebola is dangerous (94.2% vs. 86.4%, respectively; Chi2= 8.99; p < 0.003). A vast majority (88.1%) of respondents did not regard the Ebola virus as a real health threat to people living in Poland. Persons with a higher educational level disagreed more often about Ebola virus as a threat than those with lower education (primary or secondary school) (89.8% vs. 83.0%; Chi2 = 4.66; p < 0.031).
A second question tested the attitude to Ebola vaccination in a hypothetical situation of its existence. As many as 92.7% of respondents declared that they would get vaccinated before traveling to the endemic region, while 15.0% declared that they would also get vaccinated while staying in Poland. The individual’s age was connected with that decision as the youngest respondents were more inclined to get vaccinated while staying in the country than the older ones; 35.7% of persons aged <20 vs. no more than 16% of those in all the other age-groups (Chi2 = 11.20; p = 0.024). Well-educated persons more often disagreed about getting vaccinated while staying in the country than those with lower education (87.8% vs. 77.3% respectively, Chi2 = 9.15; p = 0.0025).
A third questions tested the attitude to vaccination (regardless of traveling or not to endemic regions) with regards to negative information about vaccination, including its adverse effects, were available. When, it was belived that, Ebola vaccine would cause intense pain in the arms and fever, only would 59.2% of all respondents (69.6% of healthcare workers/medical students and 50.0% of others) would get vaccinated. Medical education made a significant difference in this judgment (Chi2 = 21.35; p < 0.0001; OR = 2.3). When the vaccine cost were rather high (ca. 100 $), 60.9% of all respondents (68.8% of health care workers/students and 54.6% of others) would still get vaccinated. Medical education made again a significant difference in this judgment (Chi2 = 11.25; p = 0.001; OR = 1.83). When the effectiveness of vaccination was stated as being only 50%, only 48.2% of all respondents would get vaccinated (57.1% of health care workers/students and 40.4% of others; Chi2 = 14.80; p = 0.0001; OR = 1.96).
Further questions tested the attitude to participation in clinical trials on Ebola vaccination. Only 28.5% of respondents declare that they would take part in such trial. Age influenced that decision and persons from the extreme age-groups (<20 and >50 years of age) declared their consent for participation in such research more often (42.9% and 45.7%, respectively) than the others. Among the persons who would participate in clinical trials, 42.6% would take part regardless of the nature of organizer, 38.1% would participate only in the non-profit international trials, and 19.4% would take part in trials organized by a pharmaceutical company. This choice also was also influenced by age, as the trial was of no interest for people >50 years of age (23.9%). A majority of younger respondents, especially those <20 years of age, participated in the trials organized by the non-profit international organizations. Medical education influenced that decision as well. Healthcare workers/medical students more often declared a willingness to participate in trials organized by the non-profit international organizations – 13.8% vs. 8.8% of the others (Chi2 = 9.99; p = 0.019). The majority (72.4%) who answered that they did not consider Ebola as a real threat to persons living in Poland declared that they would not take part in a clinical trial on Ebola vaccination.
3.2 Influenza Assessment
The majority of respondents (81.1%, including 88.8% of healthcare workers and 74.8% of the others) considered influenza as dangerous for general health. Medical education had a significant bearing on the recognition of influenza danger (Chi2 = 16.91; p < 0.0001; OR = 2.66). Also, well-educated respondents agreed with that statement more often than the less educated (83.1% vs. 75.2% respectively; Chi2 = 4.30; p = 0.038). Likewise, the majority (84.2%, including 92.9% of healthcare workers/medical students and 76.8% of the others) were aware of the potential fatality of influenza. Medical education was an obvious differentiating factor in this regard (Chi2 = 25.74; p < 0.00001; OR = 2.66). The socio-demographic factors also influenced the knowledge on influenza fatality. Male vs. female gender (90.5% vs. 81.0% persons, respectively; Chi2 = 5.98; p = 0.014), older vs. younger persons (96% aged 41–50 vs. 93.5% aged > 50; Chi2 = 10.75; p = 0.029), and higher vs. lower education (86.6% vs. 77.3% of persons, respectively; Chi2 = 6.78; p = 0.01) were all predictors for the knowledge on influenza fatality.
The next question tested the perception of influenza as a real threat to people living in Poland. The majority of respondents (65.4%, including 73.3% healthcare workers/medical students and 58.3% of the others) regarded influenza as a threat. Medical education was a significant factor enhancing this knowledge (Chi2 = 13.27; p < 0.0003; OR = 1.97). Age was also a determining factor in providing a positive answer: 86.0% of persons aged 41–50 compared with 43.6% of those aged < 20, and 61.7% of those aged 21–30 (Chi2 = 13.41; p = 0.01). Likewise, a higher level of education was another factor in determining a positive answer (68.2% vs. 57.5% of those with low education; Chi2 = 5.38; p = 0.02).
A slight majority (53.3%) of respondents knew that Poland was an endemic region for influenza, but only 47.1% of healthcare workers/medical students were aware of this compared with the 57.6% of the others (Chi2 = 5.86; p = 0.015; OR=0.66). The most striking result was that only 23.0% of respondents (37.1% of health care workers/medical students and 10.4% of the others) declared that they were vaccinated against influenza in the 2014/2015 season. The medical education greatly influenced respondent answers (Chi2 = 54.31; p < 0.00001; OR = 5.06). Persons aged 41–50 and >50 were vaccinated more often (52.0% and 52.2%, respectively), while younger persons declared they were vaccinated less often (Chi2 = 56.25, p < 0.00001). Likewise, better educated persons were vaccinated more often than those with less education (26.1% vs. 14.2%, respectively; Chi2 = 8.31; p = 0.004).
The majority (67.5%) of respondents declared that they did not intend to be vaccinated in the current season. Age and medical education were the important factors. People aged < 40 intended to get vaccinated less often than the older ones (Chi2 = 64.87; p < 0.00001), while healthcare workers/medical students intended to receive vaccination more often than the others (16.3% vs. 7.7%, respectively; Chi2 = 73.28; p < 0.00001; OR = 2.66). Persons who considered influenza as a potentially deadly disease also were going to receive vaccination more often than the others (Chi2 = 11.34; p = 0.003).
Nearly all respondents (97.5%) who declared that they would not get vaccinated against Ebola before traveling to endemic regions, even if such vaccination existed, also declared they were not vaccinated against influenza (Chi2 = 10.23, p = 0.001). The vast majority of them (92.5%) also declared they were not going to get vaccinated against influenza (Chi2 = 11.96; p < 0.003).
Because of the rapid spread of an EVD and its significant negative life consequences, the WHO declared in August of 2014 the EVD outbreak a Public Health Emergency of International Concern (PHEIC) (IHR 2014). People in the endemic regions needed international support. There were also concerns about a possible wide spread of the epidemic, although the epidemiologic projections failed to directly envisage such a possibility, barring the cases in the epidemic regions (Bogoch et al. 2015). Indeed, only a few cases of EVD were brought to the US and Europe (four cases in the US, one in Italy, one in Spain, and one in the UK) via a commercial air travel in 2014. Even though the EVD was not a public threat in Europe or the US, it was considered in public debates as the most important health-related topic of the time (Gidado et al. 2015; Iliyasu et al. 2015; Lancet Editorial 2014). Social media, such as Twitter, played a huge role in the rapid worldwide spreading of information. During the initial 8 days of the Ebola epidemic in 2014 (from July 24 to August 1) an enormous number of 42,236 of English-language tweets (16,499 unique and 25,737 retweets) mentioning a word ‘Ebola’ were shared (Odlum and Yoon 2015). However, most Twitter-shared information was misleading and myth (Oyeyemi et al. 2014). Undoubtedly, mainstream and social media participated in creating a terrifying picture of Ebola in the public eye, enhancing fear.
To date, there are not many publications assessing the knowledge about EVD. Most of them have been conducted with healthcare workers and medical students and revealed that the knowledge about EVD is not conclusive especially outside the epidemiologic regions (Alfaki et al. 2015; Fazekas et al. 2015; Iliyasu et al. 2015; Lisk et al. 2015; Patiño-Barbosa et al. 2015) During the outbreak of EVD in 2014, the knowledge about the symptoms and ways of transmission was low in the general public, the level of fear was high, and in some situations labelled as a mass hysteria (Goldstone and Brown 2015; Kobayashi et al. 2015). In countries outside the epidemic regions a high level of fear and misperception of risk was conspicuous (Rübsamen et al. 2015). In the present survey, one in eight persons considered that EVD might be dangerous for people living in Poland. Similar observations have been made in the US where, despite health officials’ assurance that it was unlikely to happen, four in ten Americans were afraid that there might be a large outbreak of EVD in their country (McCarthy 2014). In another study, which compared the attitude to EVD and influenza in the US, similar results were obtained (Whiteside et al. 2016). The authors have reported that nearly one in five persons thought there was some likelihood they could come down with EVD, although there was no tangible risk to support this assumption. Concerning influenza, nearly two thirds of participants had a risk factor for complications, and only 48% of participants admitted they were vaccinated. The conclusion was that the perception of viral illness risk is incongruent with the risk of illness or the use of a preventive vaccination. In Germany, the general level of fear has not been shown as high, but 7% of people changed their behavior in response to the EVD outbreak. Among those, 68.8% avoided contact with African people in public places and 26.6% avoided using public transportation (Rübsamen et al. 2015).