Knowledge, Attitude, and Practice toward Varicella Vaccine among Families: A Systematic Review

Authors

  • Syifa Mediati Firdausya Universitas Gadjah Mada
  • Anna Wahyuni Widayanti Universitas Gadjah Mada
  • Susi Ari Kristina Universitas Gadjah Mada

DOI:

https://doi.org/10.35451/xg7h4e92

Keywords:

Knowledge, Attitude, Practice, Varicella, Vaccine

Abstract

Background: The World Health Organization (WHO) recommends implementing universal varicella vaccination in countries where varicella provides an important burden under conditions that can ensure reaching and sustaining high coverage of more than 80%. Parents and caregivers play a crucial role in improving vaccine uptake and protecting children from varicella infection. Objective: This review aimed to provide a comprehensive overview of knowledge, attitudes, and practices regarding varicella and its vaccination among parents and caregivers. Understanding these factors is important for identifying determinants of vaccine hesitancy and strategies to improve vaccination coverage. Methods: A systematic literature search was conducted using relevant keywords in ScienceDirect, Scopus, PubMed, and SpringerLink for studies published between 2015 and 2024. Data from eligible studies were reported descriptively Results: Ten studies were included in the review. Six studies were conducted in high-income countries. Most participants were parents or expectant parents, and data were primarily collected through self-administered surveys. Overall, studies reported low levels of knowledge regarding varicella and its vaccination, while approximately half demonstrated positive attitudes toward vaccination. Several countries also showed a low varicella vaccination coverage. Factors most commonly associated with knowledge, attitudes, and practices included caregiver education level, information sources, personal beliefs, and healthcare provider recommendations. Conclusion: Caregivers generally demonstrated limited knowledge, moderately positive attitudes, and moderate vaccination coverage. Strengthening public health campaigns and healthcare communication regarding the risks of varicella may improve knowledge, attitudes, and vaccination practices.

Downloads

Download data is not yet available.

References

[1] CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases [Internet]. 2024 [cited 2024 Nov 25]. Chapter 22: Varicella. Available from: https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-22-varicella.html

[2] Shah HA, Meiwald A, Perera C, Casabona G, Richmond P, Jamet N. Global Prevalence of Varicella-Associated Complications: A Systematic Review and Meta-Analysis. Infect Dis Ther. 2024 Jan 1;13(1):79–103. doi:10.1007/s40121-023-00899-7

[3] Dooling K, Marin M, Gershon AA. Clinical Manifestations of Varicella: Disease Is Largely Forgotten, but It’s Not Gone. J Infect Dis. 2022 Oct 21;226(Suppl 4):S380–4. doi:10.1093/infdis/jiac390 PubMed PMID: 36265857; PubMed Central PMCID: PMC10205892.

[4] Kim EY, Park C, Lee G, Jeong S, Song J, Lee DH. Epidemiological characteristics of varicella outbreaks in the Republic of Korea, 2016–2020. Osong Public Health Res Perspect. 2022 Apr;13(2):133–41. doi:10.24171/j.phrp.2022.0087 PubMed PMID: 35538685; PubMed Central PMCID: PMC9091637.

[5] Wang M, Li X, You M, Wang Y, Liu X, Li Z, et al. Epidemiological Characteristics of Varicella Outbreaks — China, 2006–2022. China CDC Wkly. 2023 Dec 29;5(52):1161–6. doi:10.46234/ccdcw2023.218 PubMed PMID: 38164468; PubMed Central PMCID: PMC10757729.

[6] Goh AEN, Choi EH, Chokephaibulkit K, Choudhury J, Kuter B, Lee PI, et al. Burden of varicella in the Asia-Pacific region: a systematic literature review. Expert Rev Vaccines. 2019 May 4;18(5):475–93. doi:10.1080/14760584.2019.1594781 PubMed PMID: 30869552.

[7] Jordan Z, Rowland E. Parental perceptions of chickenpox and the varicella vaccine: A qualitative systematic review. Vaccine. 2024 Jan;42(2):75–83. doi:10.1016/j.vaccine.2023.12.045

[8] Foley E, Breit S, Marsh C, Ault K, Lydic M. Attitudes toward Rubella and Varicella Vaccination during Preconception Care. Kans J Med. 2021 Sep 1;14:215. doi:10.17161/kjm.vol1415205 PubMed PMID: 34540135.

[9] Khalifa E, Musa H, Benrween A, Alnaami M, Areebi A. Knowledge, Perception, and Practice of Libyan Mothers towards Varicella and Its Vaccination Tripoli, Libya. AlQalam J Med Appl Sci. 2024 Jan 15;56–64.

[10] Sherman SM, Lingley-Heath N, Lai J, Sim J, Bedford H. Parental acceptance of and preferences for administration of routine varicella vaccination in the UK: A study to inform policy. Vaccine. 2023 Feb 17;41(8):1438–46. doi:10.1016/j.vaccine.2023.01.027

[11] Hu Y, Chen Y, Wang Y, Liang H. Knowledge, Attitude and Practice of Pregnant Women towards Varicella and Their Children’s Varicella Vaccination: Evidence from Three Distrcits in Zhejiang Province, China. Int J Environ Res Public Health. 2017 Oct;14(10):10. doi:10.3390/ijerph14101110

[12] Rosso A, Massimi A, De Vito C, Adamo G, Baccolini V, Marzuillo C, et al. Knowledge and attitudes on pediatric vaccinations and intention to vaccinate in a sample of pregnant women from the City of Rome. Vaccine. 2019 Mar 28;37(14):1954–63. doi:10.1016/j.vaccine.2019.02.049

[13] Vezzosi L, Santagati G, Angelillo IF. Knowledge, attitudes, and behaviors of parents towards varicella and its vaccination. BMC Infect Dis. 2017 Feb 27;17(1):172. doi:10.1186/s12879-017-2247-6

[14] Arnheim-Dahlström L, Zarabi N, Hagen K, Bencina G. Parental acceptance and knowledge of varicella vaccination in relation to socioeconomics in Sweden: A cross-sectional study. PLOS ONE. 2021 Oct 21;16(10):e0256642. doi:10.1371/journal.pone.0256642

[15] World Bank. World Bank Country and Lending Groups – World Bank Data Help Desk [Internet]. 2025 [cited 2025 Feb 21]. Available from: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lendinggroups

[16] Garett R, Young SD. Online misinformation and vaccine hesitancy. Transl Behav Med. 2021 Dec 1;11(12):2194–9. doi:10.1093/tbm/ibab128

[17] Solar O, Irwin A. A Conceptual Framework for Action on The Social Determinants of Health [Social Determinants of Health Discussion Paper 2 (Policy and Practice)]. Geneva: World Health Organization; 2010.

[18] CDC. Chickenpox (Varicella) [Internet]. 2024 [cited 2024 Nov 27]. Clinical Overview of Chickenpox (Varicella). Available from: https://www.cdc.gov/chickenpox/hcp/clinical-overview/index.html

[19] Al Kaabi N, Al Olama FMAS, Al Qaseer M, Al Ubaidani I, Dinleyici EC, Hayajneh WA, et al. The clinical and economic burden of varicella in the Middle East: a systematic literature review. Hum Vaccines Immunother. 2020 Jan 2;16(1):21–32. doi:10.1080/21645515.2019.1638726 PubMed PMID: 31373864.

[20] Arlant LHF, Garcia MCP, Avila Aguero ML, Cashat M, Parellada CI, Wolfson LJ. Burden of varicella in Latin America and the Caribbean: findings from a systematic literature review. BMC Public Health. 2019 May 8;19(1):528. doi:10.1186/s12889-019-6795-0

[21] Mészner Z, Wysocki J, Richter D, Zavadska D, Ivaskeviciene I, Usonis V, et al. Burden of varicella in Central and Eastern Europe: findings from a systematic literature review. Expert Rev Vaccines. 2019 Mar 4;18(3):281–93. doi:10.1080/14760584.2019.1573145 PubMed PMID: 30810402.

[22] Marin M. Prevention of varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Centers for Disease Control and Prevention. MMWR Recomm Rep Morb Mortal Wkly Rep Recomm Rep. 1996 Jul 12;45(RR-11):1–36. PubMed PMID: 8668119.

[23] Shapiro ED, Marin M. The Effectiveness of Varicella Vaccine: 25 Years of Postlicensure Experience in the United States. J Infect Dis. 2022 Nov 1;226(Supplement_4):S425–30. doi:10.1093/infdis/jiac299

[24] Tam WWS, Chan J, Lo KKH, Lee A, Chan PKS, Chan D, et al. Parental attitudes and factors associated with varicella vaccination in preschool and schoolchildren in Hong Kong: A cross-sectional study. Med U S. 2015;94(36). Located at: Scopus. doi:10.1097/MD.0000000000001519

[25] Cheng LN, Kong J, Xie XF, Zhang FY. What factors affect acceptance attitudes towards vaccination amidst a major public health crisis? A national cross-sectional study [Internet]. 2024 Dec 1. doi:10.1136/bmjopen-2024-088245

[26] Lee YH, Choe YJ, Lee J, Kim E, Lee JY, Hong K, et al. Global varicella vaccination programs. Clin Exp Pediatr. 2022 Nov 2;65(12):555–62. doi:10.3345/cep.2021.01564 PubMed PMID: 36457198; PubMed Central PMCID: PMC9742762.

[27] Disease Prevention and Control DG. Annual Report Immunization 2022. Ministry of Health RI; 2023.

[28] IZZAH, Fatiya Nurul, et al. Evaluation of Vaccine Cold Chain Storage at Karangrejo Public Health Center in Tulungagung Regency in 2025. JURNAL FARMASIMED (JFM), 2026, 8.2: 573-582.

[29] ANBEO, Zelalem Gebretsadik; ABACIOĞLU, Nurettin. A systematic review of healthcare professionals’ knowledge, attitudes, and practices regarding adverse drug reaction reporting in Ethiopia. Turkish journal of pharmaceutical sciences, 2023, 20.3: 198.

Downloads

Published

2026-10-30

How to Cite

Knowledge, Attitude, and Practice toward Varicella Vaccine among Families: A Systematic Review. (2026). JURNAL FARMASIMED (JFM), 9(1), 533-542. https://doi.org/10.35451/xg7h4e92