A Comparative Cross Sectional Study on the Awareness and Attitude towards Rubella Vaccine among the Medical and Non-Medical Students of Trichy District, Tamil Nadu

Rubella is a contagious, generally mild viral infection that occurs most often in children and young adults. The synonyms of Rubella are German Measles, 3 day measles etc. The pathogenic agent is Rubella virus of the genus of Rubivirus and belongs to the family of Togaviridae. The transmission of the virus is by airborne droplets when infected people sneeze or cough. Humans are the only known host. The symptoms include appearance of a rash all over the body, fever, swollen glands, joint pain, headache, conjunctivitis etc. Rubella infection in pregnant women may cause serious complications including fetal death or congenital defects known as Congenital Rubella Syndrome. When a woman is infected with the rubella virus early in pregnancy, she has a 90% chance of passing the virus on to her fetus. Worldwide, an estimated 110 000 babies are born with CRS every year (WHO, 2007) [14]. Some of the complications of CRS include miscarriage/still born baby, neonatal thrombocytopenia, low birth weight, severe heart disorders, autism, thyroid dysfunction, diabetes mellitus, hepatitis, anemia, eye defects and hearing impairment. No specific treatment is available, but preventable with vaccination. Largescale rubella vaccination during the past decade has practically eliminated rubella and CRS in many developed and in some developing countries. The WHO Region of the Americas has had no endemic (naturally-transmitted) cases of rubella infection since 2009. (WHO, 2012) [5]. Sero-epidemiological studies in India have shown susceptibility of 20-46 per cent in women of child bearing age, hence it is necessary to prevent the infection among women of child bearing age. (WHO, 2012). The best way to prevent rubella and CRS is vaccination, which has been applied all over the world. About a third of the world’s countries still lack rubella vaccination programs including India.


Introduction
Rubella is a contagious, generally mild viral infection that occurs most often in children and young adults. The synonyms of Rubella are German Measles, 3 day measles etc. The pathogenic agent is Rubella virus of the genus of Rubivirus and belongs to the family of Togaviridae. The transmission of the virus is by airborne droplets when infected people sneeze or cough. Humans are the only known host. The symptoms include appearance of a rash all over the body, fever, swollen glands, joint pain, headache, conjunctivitis etc. Rubella infection in pregnant women may cause serious complications including fetal death or congenital defects known as Congenital Rubella Syndrome. When a woman is infected with the rubella virus early in pregnancy, she has a 90% chance of passing the virus on to her fetus. Worldwide, an estimated 110 000 babies are born with CRS every year (WHO, 2007) [1][2][3][4]. Some of the complications of CRS include miscarriage/still born baby, neonatal thrombocytopenia, low birth weight, severe heart disorders, autism, thyroid dysfunction, diabetes mellitus, hepatitis, anemia, eye defects and hearing impairment. No specific treatment is available, but preventable with vaccination. Largescale rubella vaccination during the past decade has practically eliminated rubella and CRS in many developed and in some developing countries. The WHO Region of the Americas has had no endemic (naturally-transmitted) cases of rubella infection since 2009. (WHO, 2012) [5]. Sero-epidemiological studies in India have shown susceptibility of 20-46 per cent in women of child bearing age, hence it is necessary to prevent the infection among women of child bearing age. (WHO, 2012). The best way to prevent rubella and CRS is vaccination, which has been applied all over the world. About a third of the world's countries still lack rubella vaccination programs including India.

Aim of the study
To study the awareness and attitudes towards Rubella vaccine among the Medical students and Non-Medical students in Trichy.

Materials and Methods
The present study was designed as a comparative cross sectional study conducted among the medical students and nonmedical students in two reputed colleges in Trichy [6][7][8].

Ethical considerations
Approval from the Independent Ethical Committee of Holy Cross college, Trichy was obtained before conducting the study. The study did not involve any interventional or invasive procedures.
Informed consent was obtained from all the participants and they were informed about their right to opt out of the study any time and assured their confidentiality.

Participants
The participants were identified through the official rolls and enlisted for inclusion of the study.  Validity Check and Pilot study: The validity check was carried out by 3 Speech Language Pathologists and1 Physician. After making the recommended changes, pilot study was carried out in 10 medical and 10 non-medical students. The pilot study yielded expected results.

Data Collection:
The data collection was conducted through survey method. The questionnaire was distributed to the participants and collected back after completion. The completion of the questionnaire lasted for approximately for 10-15 minutes.
Data analysis: Data analysis was carried out using SPSS 16 software. Independent samples test was used wherever necessary. A p-value <0.05 was considered statistically significant.

Results and discussion
The General Awareness of Study Respondents (Figure 1 (Table 2) Suggestions to create awareness     All the medical students were well aware of Rubella disease, its causes and its vaccination where only 22% of the non-medical students were aware of the same (Figure 4). None of the non-medical students were aware about the availability of the vaccine in their area where 31% of the medical students were aware of the same. 99% of the non-medical students are unaware about the fact that Rubella can cause hearing loss where 47% of the medical students were aware of the same. 79% of the medical students opinioned that they are well aware of Rubella virus and its vaccination because it is included in their syllabus. When asked about the different ways in which we can create awareness about Rubella virus, its causes, complications and vaccination, the students suggested workshops, seminars, visual media, social media, street plays etc.

Conclusion
A.
The study delineates the difference in the knowledge of rubella and vaccination status in medical students and non medical students.

B.
There is quite high awareness about rubella disease and its vaccine among medical professionals when compared with the non medical students, because the topic is covered in their syllabus and due to the frequent interactions with gynecologists and pediatricians. C.
The study clearly shows the lack of awareness and nonseriousness of the issue in the society. D. Neither the media nor the government has taken appropriate measures to make the population aware about rubella vaccination.

E.
As "prevention and advocacy" is listed as a professional role and responsibility in Indain Speech and Hearing Association's scope of practice, it is the duty of all Speech Language Pathologists and Audiologists to frame and execute awareness programs about CRS and its vaccination in India.