Table 2.

Participants awareness and understandings of vaccine-preventable diseases.

Disease	Awareness of disease	Understanding of disease process and symptoms
Diseases viewed as most threatening:
Meningitis	Most had heard of meningitis, and perceived it as severe and quite prevalent. Not typically seen as a particular risk to teenagers; babies believed to be at greatest risk, due being the focus of a Men C public information campaign.	Almost half of participants described symptoms they associated with meningitis, including: skin lumps and rashes; throat problems; muscle pain; and blindness. Participants mentioned a television campaign promoting the “tumbler test” to identify whether a rash is suggestive of meningococcal septicaemia.
Hepatitis B	Participants had typically heard of hepatitis B but claimed no knowledge of it. They regarded it as causing debilitating, long-term damage. Commonly associated with drug abusers.	Participants offered relatively accurate descriptions of transmission when prompted, associating it with sexual transmission and infected blood from ‘sharing dirty needles’ and ‘bad tattoos’ (Stuart, FG6). Participants were reluctant to guess symptoms.
HPV	Girls typically demonstrated some awareness of HPV and many had recently been vaccinated against it. Boys demonstrated relatively little awareness. Participants typically perceived it as a prevalent infection, and many viewed it as a serious disease.	Boys commonly believed the virus only affects females. Some girls expressed similar beliefs: ‘I don’t think [boys] can catch HPV very easily’ (Tina, FG5). Doubts that HPV can infect males coexisted paradoxically with widespread recognition that it is transmitted sexually. Some demonstrated confusion about the association between HPV and cancer (see Box 3).
Diseases of uncertain threat:
Measles	Typically believed to be in circulation within the UK, but unlikely to be contracted. Participants evenly divided between those who believed measles can cause long-term damage and those who believed it to be mild.	Many offered accurate descriptions of symptoms: itchy red spots and rashes; swelling; and fever. Commonly confused with chickenpox; some suggested it may be a more severe form (see Box 4).
Mumps	Participants unsure whether mumps is in circulation in the UK. Some believed it to be extremely prevalent. One girl described mumps as an ‘old fashioned disease’ (Trisha, FG11) Participants evenly divided between those who believed mumps to be severe and those who did not.	Mumps was commonly correctly associated with glandular swelling. Some incorrectly suggested that it causes chickenpox-like rashes on the skin. One boy believed that mumps is primarily contracted by males.
Rubella	Few had heard of rubella or German measles.	Those who attempted to describe symptoms mentioned irritating spots, a chickenpox-like rash, muscular problems and swelling of the face and neck. Some believed it may be ‘like a severe case of chickenpox’ (Chloe FG6, Darren FG9, Christine FG12). No participants described the mode of transmission or acknowledged the risk of foetal damage.
Diseases viewed as least threatening:
Tetanus	Commonly viewed as a historical threat.	Few participants claimed to know the symptoms of tetanus. Two correctly associated it with lockjaw (Murray FG8, Douglas FG1). Participants accurately associated tetanus with wounds coming into contact with bacteria, but few knew the environmental conditions in which the organism lives. Suggested locations included rust and rusty metal, used needles, broken glass, and animal bites. Two correctly associated it with soil, but incorrectly linked it to rust.
Diphtheria	Most had heard of diphtheria. Typically perceived as an historical disease, but many were aware that they had been, or would in future be, vaccinated against it, and so wondered if it might still be in circulation.	None could describe its symptoms, and participants were particularly reticent to offer descriptions of its transmission.
Poliomyelitis	Most had heard of poliomyelitis, typically referring to it as ‘polio’. Awareness associated with having recently been vaccinated against it. Widely viewed as a historical threat, and associated with less developed countries.	It was generally associated with leg-related skeletal problems, including being wheelchair-bound and one leg being longer than the other. No participant mentioned respiratory muscle paralysis. Few could describe its transmission.
Whooping cough	Fewer than half were aware of being vaccinated against whooping cough. Generally not considered to be a threat to people living in the UK.	Commonly described as a severe cough and sometimes associated with coughing up blood or ‘black mucus’. No participants recognised that it can be fatal.
Chickenpox	Generally seen as a routine and trivial part of childhood, only problematic if contracted in adulthood. Participants who had not yet experienced chickenpox expressed anxiety about contracting it in future: ‘I’ve never had it. I don’t want to get it when I’m older, you can die.’ (Chris, FG9).	Participants tended to describe signs and symptoms of chickenpox accurately. It was seen as very contagious and mild, and associated with itchy red spots on the skin that can leave pock marks.