Vaccinations are one of the most successful public health achievements in dramatically reducing and even eradicating infectious diseases. This success is evident in the eradication of some of the most deadly infectious diseases such as smallpox worldwide and poliomyelitis in the Americas. High immunization coverage is needed to reduce and maintain a low incidence of vaccine-preventable diseases. However, despite the evident success of vaccines, there continues to be an inadequate coverage of many highly recommended vaccines for children worldwide, resulting in the occurrences of vaccine-preventable diseases. According to a recent study done by UNICEF measuring early childhood immunization rates among twenty nine countries, Canada was ranked twenty eight in comparison with other high income countries. The study reported an 84% immunization coverage rate in Canada whereas the rates in the United States were 93% and 96% in the United Kingdom. The low national immunization coverage is alarming as at least a 95% vaccination uptake is needed for herd immunity in the population to prevent endemic transmission of vaccine-preventable diseases.     In Canada, most jurisdictions do not require mandatory immunizations and even in those jurisdictions where it is mandatory, exemptions can be applied for religious beliefs, medical reasons, consciences, and parental refusal. In Ontario, children enrolled in schools and licensed child care centres are required to be immunized against measles, mumps, rubella (MMR) and diphtheria, polio and tetanus under the Immunization of School Pupils Act and The Day Nurseries Act.  However, the same exemptions mentioned above apply for these acts. According to the childhood National Immunization Coverage Survey in 2013, children up to the age of seven in Ontario had an 88.5% uptake of two doses of measles, 88.1 % uptake of two doses of mumps, and 95.9% uptake of one dose of rubella. Furthermore, an immunization report for the years 2013-2016 conducted by Public Health Ontario revealed that children up to the age of seven were not meeting the provincial recommended goal for MMR immunization. The report notes a significant variation between the thirty six public health units across Ontario where MMR immunization rates were only satisfactory in nine out of thirty six public health units. A number of factors can be used to explain the variability across Ontario’s public health units and more informative research is needed to increase MMR immunization rates in an effort to prevent and protect the population from outbreaks.This study aims to explore the influences on parental decisions for MMR vaccinations in order to advance Ontario’s MMR immunization uptake. Specifically, in understanding the role of information source on parental decision making covering vaccine safety concerns and beliefs is critical in addressing the low immunization uptake in Ontario. In a time where the media is a major source of information uptake for many Canadians, the dissemination of misinformation on vaccines can be easily accessed. Kata reports that seventy five to eighty percent of Canadians search health information online where seventy percent of these users report that the information found online does influence their health decisions. On the other hand, traditional sources of health information such as health practitioners still play a major role in the decision making process for immunization.  Previous studies have revealed that health practitioners are the most significant source of information on vaccine decision making. However, in modern day the internet is now competing with health practitioners as the top sources of health information. The emergence of the internet and social media has allowed for individuals to spread their unfiltered opinions on vaccines and create anti-vaccination groups that disseminate deceptive information on vaccines. Through anti-vaccination groups online, it can reinforce vaccine hesitancy and parents questioning vaccine safety due to anecdotal reports of adverse vaccine reactions portrayed in the media such as the link between MMR vaccine and autism. Although, there is no scientific evidence for the claims stated by anti-vaccinators, the strategies used to capture parental attention are very compelling. With more recent forms of media; social media, individuals can provide a personal view on vaccines by sharing their own experiences. Anti-vaccine groups have used this tactic to further spread their message to an even larger audience. A recent study has reported that browsing on an anti-vaccination website for five to ten minutes impacted perceived vaccination risks negatively. Currently, there is not enough research addressing the influence of information sources on MMR vaccination uptake. In a society where information on vaccine safety is sourced through various channels, there is very little data on which source of information is most effective in parental vaccine decision making. This study will address this gap in knowledge by examining Hamilton’s population for the years 2013-2016.

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