Perceptions and Beliefs of Healthcare Professionals and Patients About Vaccination During a Non-Severe Febrile Illness: A Qualitative Study

Background Missed opportunities for vaccination (MOV) are concerning, they are associated with the risk of low vaccine coverage and re-emergence of vaccine-preventable diseases. Among the reasons for MOVs, acute febrile illness (FI) is a common cause since it is frequently misperceived as a contra-indication to vaccination. This study aimed to explore the perceptions of recently febrile patients and healthcare professionals (HCPs), regarding vaccination during a non-severe acute FI. Methods We used purposive and snowball sampling to recruit participants. Semi-structured interviews were conducted between February 2023 and October 2023. Results We interviewed 15 patients and 15 HCPs. Interviews lasted on average 36m14s for patients and 22m49s for HCPs. Although patients acknowledge vaccination benefits, they perceive it as risky during FI and worry about overloading their immune system. However, they would consider it if recommended by their general practitioner. HCPs, poorly informed about the possibility of vaccination during FI, often delay immunization as they consider fever a contraindication. Their decision depends on the type of vaccine, fever etiology and patient's attitude. Postponements aimed to preserve the doctor-patient relationship and avoid an exacerbated immune response or diagnostic uncertainties in case of persistent fever. HCPs emphasized the need for clear, official recommendations before considering changing their practice, even if for some HCPs change would not be systematic. Conclusions Patients and HCPs considered that a FI required postponing vaccination, and shared the fear of immune overload in this context, overlooking that a MOV could have possible consequences. Improving evidence with safety and efficacy studies about vaccination during FI in adults and communicating about reassuring findings currently available could help tackle MOVs.