Volume 68, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Fear of injections may interfere with receipt of vaccines. The frequency, associations, and precipitators of fear-provoking factors of 400 travelers visiting a travel health clinic were evaluated. The median age of this group was 25, 7% were medical staff members, and 2.8% were regular injectors (insulin). Eighty-five (21.7%; 95% confidence interval, 17.3–25.6%) of the travelers indicated that they were afraid of injections, and in 8.2%, the fear was unreasonably intense. Multivariate analysis revealed that watching other people being vaccinated, fear of pain, needle size, and a history of fainting were highly and independently associated with injection phobia. The sensitivity, specificity, and discrimination accuracy of this model were 79.5%, 78.0%, and 78.3%, respectively. Injection phobia and a bad past vaccination experience were significantly associated with fainting. Perceived empathy, on the other hand, was a significant protective factor. Fear of injections was common in this cohort and was highly associated with past fainting after vaccination.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Hart PS, Yanny W, 1998. Needle phobia and malignant vasovagal syndrome. Anaesthesia 53 : 1002–1004. [Google Scholar]
  2. Hamilton JG, 1995. Needle phobia: a neglected diagnosis. J Fam Pract 41 : 169–175. [Google Scholar]
  3. Kleinknecht RA, 1994. Acquisition of blood, injury, and needle fears and phobias. Behav Res Ther 32 : 817–823. [Google Scholar]
  4. Fredrikson M, Annas P, Fischer H, Wik G, 1996. Gender and age differences in the prevalence of specific fears and phobias. Behav Res Ther 34 : 33–39. [Google Scholar]
  5. Ost LG, 1992. Blood and injection phobia: background and cognitive, physiological, and behavioral variables. J Abnorm Psychol 101 : 68–74. [Google Scholar]
  6. Bienvenu OJ, Eaton WW, 1998. The epidemiology of blood-injection-injury phobia. Psychol Med 28 : 1129–1136. [Google Scholar]
  7. Givens B, Oberle S, Lander J, 1993. Taking the jab out of needles. Can Nurse 89 : 37–40. [Google Scholar]
  8. Harrington PM, Woodman C, Shannon WF, 1999. Vaccine, yes; injection, no: maternal responses to the introduction of Haemophilus influenzae type b (Hib) vaccine. Br J Gen Pract 49 : 901–902. [Google Scholar]
  9. Burden AD, Whorwell PJ, 1991. Poor uptake of hepatitis B immunization amongst hospital-based health care staff. Postgrad Med J 67 : 256–258. [Google Scholar]
  10. Braun MM, Patriarca PA, Ellenberg SS, 1997. Syncope after immunization. Arch Pediatr Adolesc Med 151 : 255–259. [Google Scholar]
  11. Dobson S, Scheifele D, Bell A, 1995. Assessment of a universal, school-based hepatitis B vaccination program. JAMA 274 : 1209–1213. [Google Scholar]
  12. Jacobson RM, Swan A, Adegbenro A, Ludington SL, Wollan PC, Poland GA, Vaccine Research Group, 2001. Making vaccines more acceptable—methods to prevent and minimize pain and other common adverse events associated with vaccines. Vaccine 19 : 2418–2427 [journal not in library; checked e-journal]. [Google Scholar]
  13. World Tourism Organization, 2002. Tourism Highlights 2001. Madrid: World Trade Organization. http://www.world-tourism.org
  14. Schwartz E, Shlim DR, Eaton M, Jenks N, Houston R, 1990. The effect of oral and parenteral typhoid vaccination on the rate of infection with Salmonella typhi and Salmonella paratyphi A among foreigners in Nepal. Arch Intern Med 150 : 349–351. [Google Scholar]
  15. Domoto PK, Weinstein P, Melnick S, Ohmura M, Uchida H, Ohmachi K, Hori M, Okazaki Y, Shimamoto T, Matsumura S, 1988. Results of a dental fear survey in Japan: implications for dental public health in Asia. Community Dent Oral Epidemiol 16 : 199–201. [Google Scholar]
  16. Rao A, Sequeire PS, Peter S, 1997. Characteristics of dental fear amongst dental and medical students. Indian J Dent Res 8 : 111–114. [Google Scholar]
  17. World Health Organization, 2000. Injection Safety: Report by the Secretariat. World Health Organization Executive Board, 107th Session. Geneva: World Health Organization, Item 9.8, 5/12/2000 [book not in library; not checked].
  18. Luby S, 2001. Injection safety. Emerg Infect Dis 7(3 Suppl):535 [only one page] [journal not in library; checked in PubMed]. [Google Scholar]
  19. World Health Organization. Vaccines and Biologicals. URL: http://www.who.int/vaccines-documents/docsPDF00/www505.pdf
  20. Taha M-K, Achtman M, Alonso J-M, Greenwood B, Ramsay M, Fox A, Gray S, Kaczmarski E, 2000. Serogroup W135 meningococcal disease in Hajj pilgrims. Lancet 356 : 2159. [Google Scholar]
  21. Craig SC, Pittman PR, Lewis TE, Rossi CA, Henchal EA, Kuschner RA, Martinez C, Kohlhase KF, Cuthie JC, Welch GE, Sanchez JL, 1999. An accelerated schedule for tick-borne encephalitis vaccine: the American military experience in Bosnia. Am J Trop Med Hyg 61 : 874–878. [Google Scholar]
  22. O’Brien D, Tobin S, Brown GV, Torresi J, 2001. Fever in returned travelers: review of hospital admissions for a 3-year period. Clin Infect Dis 33 : 603–609. [Google Scholar]
  23. Oswalt RM, 1977. A review of blood donor motivation and recruitment. Transfusion 17 : 123–135. [Google Scholar]
  24. Willershausen B, Azrak A, Wilms S, 1999. Fear of dental treatment and its possible effect on oral health. Eur J Med Res 25 : 72–77. [Google Scholar]
  25. Briggs MJ, Thomas J, 1994. Obstacles to hepatitis B vaccine uptake by health care staff. Public Health 108 : 137–148. [Google Scholar]
  26. Ellis RW, 1999. Development of combination vaccines. Vaccine 17 : 1635–1642. [Google Scholar]
  27. Fendrick AM, Lee JH, LaBarge C, Glick HA, 1999. Clinical and economic impact of a combination Haemophilus influenzae and hepatitis B vaccine. Estimating cost-effectiveness using decision analysis. Arch Pediatr Adolesc Med 153 : 126–136. [Google Scholar]

Data & Media loading...

  • Received : 14 Mar 2002
  • Accepted : 22 Jul 2002

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error