| Id |
Subject |
Object |
Predicate |
Lexical cue |
| T1 |
467-632 |
Epistemic_statement |
denotes |
3 The mortality from A/H1N1 appears moderate, although the virus does seem to be more infectious than seasonal influenza 4 and children are particularly susceptible. |
| T2 |
806-905 |
Epistemic_statement |
denotes |
The development of A/H1N1 vaccines would be one of the most effective ways to control the pandemic. |
| T3 |
1000-1316 |
Epistemic_statement |
denotes |
On 19 June 2009 the government of Hong Kong passed legislation to purchase five million doses of influenza A/H1N1 vaccine and indicated that a large scale vaccination campaign would be launched at the end of the year, 8 9 with an acknowledgement that the vaccine might not have gone through complete clinical trials. |
| T4 |
1317-1625 |
Epistemic_statement |
denotes |
The government announced that the vaccine would be provided to a high risk group of two million people, including healthcare workers, people aged more than 65, children aged 6 months to 6 years, and those with particular health conditions, along with 500 000 people who would voluntarily pay for the service. |
| T5 |
1699-1747 |
Epistemic_statement |
denotes |
The cost of vaccination has not yet been agreed. |
| T6 |
1850-2279 |
Epistemic_statement |
denotes |
A recent study reported that 48% of healthcare workers in Hong Kong were willing to accept vaccination at the prepandemic phase of the influenza A/H1N1 epidemic and that the perceived risk of contracting the virus and history of vaccination against seasonal influenza were associated with the willingness to take up vaccination, whereas fear of side effects and doubts about vaccine efficacy were major reasons for unwillingness. |
| T7 |
3207-3383 |
Epistemic_statement |
denotes |
Study methods were similar to those used in local studies related to severe acute respiratory syndrome, [15] [16] [17] [18] [19] avian flu, [20] [21] [22] and influenza A/H1N1. |
| T8 |
4317-4619 |
Epistemic_statement |
denotes |
23 Participants were asked sequentially about intentions to take up vaccination against influenza A/H1N1 under five hypothetical scenarios: vaccination is free; vaccination per dosage costs less than $HK100, $HK101-200, or more than $HK200; and clinical data are lacking on vaccine efficacy and safety. |
| T9 |
4620-4737 |
Epistemic_statement |
denotes |
Response categories included unlikely (certainly not, mostly not), unsure, and highly likely (mostly and definitely). |
| T10 |
4823-4959 |
Epistemic_statement |
denotes |
28 Participants were asked whether clinical evidence on the safety and efficacy of the influenza A/H1N1 vaccine was currently available. |
| T11 |
4960-5107 |
Epistemic_statement |
denotes |
Other questions were related to knowledge about different modes of transmissions of the virus and perceptions related to the virus and its vaccine. |
| T12 |
5525-5803 |
Epistemic_statement |
denotes |
Intentions-When the participants were asked about their intention to take up free vaccination against influenza A/H1N1, 45% (n=135) thought it highly likely (that is, mostly or certainly) and 55% (n=166) thought it unlikely or were unsure (mostly not, certainly not, or unsure). |
| T13 |
5804-6124 |
Epistemic_statement |
denotes |
The prevalence of intention (highly likely to take up the vaccine), however, decreased with increasing cost in the hypothetical scenarios where a charge was levied for vaccination: 36% (n=108) were highly likely to take up vaccination for less than $HK100, 24% (n=72) for $HK101-200, and 15% (n=45) for more than $HK200. |
| T14 |
6222-6673 |
Epistemic_statement |
denotes |
Positive and negative attitudes-39% (n=117) of participants believed that vaccination would be effective at preventing influenza A/H1N1, 63% (n=189) erroneously believed that efficacy of influenza A/H1N1 vaccine had been confirmed by clinical trials, and 16% (n=49) believed that it is necessary for everyone in Hong Kong to take up vaccination against influenza A/H1N1 (49%, n=146, not quite necessary and 32%, n=95, completely unnecessary; table 2). |
| T15 |
6674-6907 |
Epistemic_statement |
denotes |
Overall, 27% (n=81) of the participants believed vaccination against influenza A/H1N1 would be inconvenient and 16% (n=49) believed that it would cause quite a lot of side effects or that side effects would be very severe (table 2) . |
| T16 |
7145-7614 |
Epistemic_statement |
denotes |
Perceived severity-30% (n=90) of the participants erroneously believed that the fatality associated with A/H1N1 among adults exceeded 1%; 14% (n=41) believed that A/H1N1 results in severe and irreversible damage to the body among adults; 13% (n=37) believed that more than 10 deaths related to A/H1N1 infection would occur in Hong Kong, and 40% (n=118) believed that there are quite a lot or many hidden H1N1 cases of influenza A/H1N1 in the local community (table 2) . |
| T17 |
7615-7836 |
Epistemic_statement |
denotes |
Compared with seasonal flu, less than half of the participants believed that A/H1N1 would result in a higher fatality rate (36%, n=108), higher infectivity (42%, n=126), and more severe bodily damage (33%, n=95; table 2). |
| T18 |
8545-8650 |
Epistemic_statement |
denotes |
32 It is uncertain whether the early production of vaccine could meet the demands of different countries. |
| T19 |
8769-9008 |
Epistemic_statement |
denotes |
A few countries are more conservative-the US government will confirm the proportion of citizens who need to be vaccinated after the completion of clinical trials, 7 whereas mainland China plans to provide vaccines for 5% of its population. |
| T20 |
9245-9353 |
Epistemic_statement |
denotes |
Lack of data on safety and efficacy was the reason for health workers' unwillingness to take up vaccination. |
| T21 |
9423-9600 |
Epistemic_statement |
denotes |
Our results show that intention to take up A/H1N1 vaccination would be highly sensitive to cost as well as to the availability of scientific evidence on its efficacy and safety. |
| T22 |
9736-9863 |
Epistemic_statement |
denotes |
The actual demand would depend on the cost and, more importantly, the availability of clinical evidence on efficacy and safety. |
| T23 |
9864-9979 |
Epistemic_statement |
denotes |
Without such an assurance the prevalence of uptake of vaccination in the general population would be lower than 5%. |
| T24 |
9980-10226 |
Epistemic_statement |
denotes |
It is not known whether the prevalence for high risk groups would be different but previous data showed that, except for elderly people, the prevalence of vaccination against seasonal influenza for other risk groups in Hong Kong tended to be low. |
| T25 |
10227-10395 |
Epistemic_statement |
denotes |
12 There are reasons to speculate that in the absence of scientific evidence, the prevalence of uptake of A/H1N1 vaccination in these high risk groups would remain low. |
| T26 |
10396-10640 |
Epistemic_statement |
denotes |
The intention to take up free vaccination might, however, be an over-estimation as most of the participants (63%) erroneously believed that at the time of the survey clinical evidence on the efficacy and safety of A/ H1N1 vaccine was available. |
| T27 |
10641-10773 |
Epistemic_statement |
denotes |
Many of these participants may change their mind if clinical evidence remains unavailable when the vaccination campaign is launched. |
| T28 |
10774-10952 |
Epistemic_statement |
denotes |
The publicity that less than half of the local healthcare workers were willing to take up A/ H1N1 vaccination 11 might also undermine the public's confidence in being vaccinated. |
| T29 |
10953-11158 |
Epistemic_statement |
denotes |
The relatively low levels of positive intention to take up A/H1N1 vaccination in the general population may be partially explained by the confusion between different types of influenza related vaccination. |
| T30 |
11344-11578 |
Epistemic_statement |
denotes |
23 Without clarifying such a misconception, people may resort to seasonal influenza vaccination, which has passed clinical trials on efficacy and safety, rather than receiving a new vaccine, especially if it has not been fully tested. |
| T31 |
11579-11829 |
Epistemic_statement |
denotes |
Although about one third of participants believed that A/H1N1 has a fatality of more than 1%, that A/H1N1 is more severe than seasonal flu, and that many hidden cases of A/H1N1 exist in the community, over half of the participants believed otherwise. |
| T32 |
11926-12172 |
Epistemic_statement |
denotes |
Therefore in the context of the study influenza A/H1N1 was seen by the participants as a relatively mild disease and that it might not be worth the risk to be vaccinated against A/H1N1 as it has not been thoroughly tested for safety and efficacy. |
| T33 |
12339-12502 |
Epistemic_statement |
denotes |
It is expected that such sensitivity would be even higher in developing countries and in those countries where people may feel less anxious about influenza A/H1N1. |
| T34 |
12611-12927 |
Epistemic_statement |
denotes |
In developed countries such as the United Kingdom and the United States, the strength of governmental measures to control influenza A/H1N1 has been much weaker that in Hong Kong-Hong Kong had exercised quarantine measures and still recommends closure of schools with the rate of sick leave reaching or exceeding 10%. |
| T35 |
12928-13107 |
Epistemic_statement |
denotes |
33 The results also suggest that as the scientific evidence is not available, expected uptake of A/H1N1 vaccination in the general populations of different countries would be low. |
| T36 |
13403-13538 |
Epistemic_statement |
denotes |
From our results it seems that free or low cost vaccination needs to be provided to achieve a high rate of vaccination against A/ H1N1. |
| T37 |
13539-13700 |
Epistemic_statement |
denotes |
More importantly, the general public has to be convinced about the vaccine's efficacy and safety as misconceptions may exist about what the scientific data show. |
| T38 |
13866-13960 |
Epistemic_statement |
denotes |
Acceptability studies and real time monitoring are crucial for the success of such programmes. |
| T39 |
13961-13993 |
Epistemic_statement |
denotes |
This study has some limitations. |
| T40 |
14437-14638 |
Epistemic_statement |
denotes |
Secondly, Hong Kong went through a unique experience with the outbreak of severe acute respiratory syndrome, the results of the current study may not be applicable to the situations in other countries. |
| T41 |
14639-14722 |
Epistemic_statement |
denotes |
Some observations about A/H1N1 vaccination may, however, be shared among countries. |
| T42 |
14723-14894 |
Epistemic_statement |
denotes |
Thirdly, this study could only document the willingness of people to accept vaccination against influenza A/H1N1, which may not necessarily reflect their actual behaviour. |
| T43 |
14895-15058 |
Epistemic_statement |
denotes |
Fourthly, we did not record participants' chronic disease status; those with chronic disease may have different intentions from the rest of the general population. |
| T44 |
15143-15197 |
Epistemic_statement |
denotes |
Efficacy and safety data are needed to enhance uptake. |
| T45 |
15198-15317 |
Epistemic_statement |
denotes |
Cost is important although our study suggests that most of the population would not take up vaccination against A/H1N1. |
| T46 |
15318-15449 |
Epistemic_statement |
denotes |
As the A/H1N1 vaccine is new and major plans regarding the vaccine have been made in many countries, further research is warranted. |
| T47 |
15450-15634 |
Epistemic_statement |
denotes |
Further studies should also monitor the level and factors predicting intentions towards A/H1N1 vaccination longitudinally in different risk groups as well as in the general population. |
| T48 |
15681-15795 |
Epistemic_statement |
denotes |
Such studies would improve the understanding of vaccination against different types of influenza related diseases. |
| T49 |
16414-16485 |
Epistemic_statement |
denotes |
SG made suggestions to improve the manuscript and revised later drafts. |
