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Humiston SG, Szilagyi PG, Bender RG, Breck A, Albertin CS, Clark D, Rand CM. Perspectives on Maternal Vaccination from Obstetrical Clinicians: A Qualitative Multi-site Study. Matern Child Health J 2022; 26:2506-2516. [PMID: 36315315 PMCID: PMC9628390 DOI: 10.1007/s10995-022-03535-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Despite the seriousness of influenza and pertussis, availability of safe and effective vaccines against them, and long-standing maternal vaccination recommendations, US maternal influenza and Tdap vaccination rates have been low. To increase vaccination rates in obstetric offices, it is important to understand clinician perspectives and office processes. We conducted in-depth interviews with nurses and providers on these topics. METHODS Interviewees worked in obstetric offices in one-of-four participating health systems in NY and CA. We audio-recorded and transcribed 20-30-min interviews. We used predetermined categories to code interviews with Dedoose, then iteratively refined codes and identified themes. RESULTS We conducted 20 interviews between 4/2020 and 9/2020: 13 providers (physician or nurse midwife) (5 NY, 8 CA); 7 office nurses (6 NY, 1 CA). In almost all offices, patient refusal of influenza vaccine was considered the major vaccination barrier; Tdap was often deferred by patients until post-delivery. Nurse-only visits for either vaccine were rare. Vaccination outside the office was uncommon; few offices systematically documented vaccines given elsewhere in a retrievable manner. Participants emphasized patient education as key to prenatal care, but the number of topics left little time for immunizations. Few interviewees could identify an office "immunization champion," knew their office vaccination rates, or had participated in vaccination quality improvement. Several interviewees indicated that they or another provider were good at persuading hesitant patients, but their method had not been shared with other clinicians. CONCLUSIONS FOR PRACTICE Multiple practical barriers and maternal vaccine hesitancy limit maternal vaccination. Quality improvement strategies are needed.
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Affiliation(s)
- Sharon G. Humiston
- Department of Pediatrics, Children’s Mercy Kansas City, UMKC School of Medicine, 2401 Gillham Road, Kansas City, MO 64106 USA
| | - Peter G. Szilagyi
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California at Los Angeles, Los Angeles, CA USA
| | - Robin G. Bender
- Department of Pediatrics, University of Rochester Medical Center, University of Rochester, Rochester, NY USA
| | - Abigail Breck
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California at Los Angeles, Los Angeles, CA USA
| | - Christina S. Albertin
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California at Los Angeles, Los Angeles, CA USA
| | - Devin Clark
- Department of Pediatrics, University of Rochester Medical Center, University of Rochester, Rochester, NY USA
| | - Cynthia M. Rand
- Department of Pediatrics, University of Rochester Medical Center, University of Rochester, Rochester, NY USA
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152
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Humble RM, Sell H, Dubé E, MacDonald NE, Robinson J, Driedger SM, Sadarangani M, Meyer SB, Wilson S, Benzies KM, Lemaire-Paquette S, MacDonald SE. Canadian parents' perceptions of COVID-19 vaccination and intention to vaccinate their children: Results from a cross-sectional national survey. Vaccine 2021; 39:7669-7676. [PMID: 34688500 PMCID: PMC8500474 DOI: 10.1016/j.vaccine.2021.10.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Vaccinating children (≤17 years old) is important for controlling the COVID-19 pandemic. As parents are primary decision makers for their children, we aimed to assess parents' perceptions and intentions regarding COVID-19 vaccination for their children, including for some underserved populations (e.g., newcomers, Indigenous peoples, and visible minority groups). METHODS We conducted a cross-sectional national survey of Canadian parents in December 2020, just as COVID-19 vaccines were approved for adults, to assess intention to vaccinate their children (aged 0-17 years) against COVID-19, perceptions of COVID-19 disease and vaccines, previous uptake of influenza and routine vaccines, and sociodemographic characteristics. Binomial logistic regression was used to assess the association between parents' lack of COVID-19 vaccination intention for their children and various independent variables. RESULTS Sixty-three percent of parents (1074/1702) intended to vaccinate their children against COVID-19. Those employed part-time (compared to full-time) had lower intention to vaccinate their children (aOR = 1.73, 95% CI: 1.06-2.84), while those who spoke languages other than English, French, or Indigenous languages were less likely to have low intention (aOR = 0.55, 95% CI: 0.32-0.92). Low vaccination intention was also associated with children not receiving influenza vaccine pre-pandemic (aOR = 1.51, 95% CI: 1.04-2.21), parents having low intention to vaccinate themselves against COVID-19 (aOR = 9.22, 95% CI: 6.43-13.34), believing COVID-19 vaccination is unnecessary (aOR = 2.59, 95% CI: 1.72-3.91) or unsafe (aOR = 4.21, 95% CI: 2.96-5.99), and opposing COVID-19 vaccine use in children without prior testing (aOR = 3.09, 95% CI: 1.87-5.24). INTERPRETATION Parents' COVID-19 vaccination intentions for their children are better predicted by previous decisions regarding influenza vaccination than routine childhood vaccines, and other perceptions of COVID-19 vaccine-related factors. Public communication should highlight the safety and necessity of COVID-19 vaccination in children to support a return to normal activities. Further research should assess actual COVID-19 vaccination uptake in children, particularly for underserved populations.
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Affiliation(s)
- Robin M Humble
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Hannah Sell
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Eve Dubé
- Department of Anthropology, Laval University, Quebec City, Quebec, Canada
| | - Noni E MacDonald
- Department of Paediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Samantha B Meyer
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Sarah Wilson
- Public Health Ontario, ICES, Dalla School of Public Health, University of Toronto, Toronto, Ontario, Canada
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153
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Kuter BJ, Marshall GS, Fergie J, Schmidt E, Pawaskar M. Prevention of measles, mumps and rubella: 40 years of global experience with M-M-R II. Hum Vaccin Immunother 2021; 17:5372-5383. [PMID: 35130794 PMCID: PMC8903938 DOI: 10.1080/21645515.2021.2007710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/14/2021] [Indexed: 02/09/2023] Open
Abstract
Measles, mumps, and rubella are highly contagious diseases that caused significant global mortality and morbidity in the pre-vaccine era. Since its first approval in the United States over 40 years ago, M-M-RII has been used in >75 countries for prevention of these diseases. The vaccine has been part of immunization programs that have achieved dramatic global reductions in case numbers and mortality rates, as well as the elimination of measles and rubella in several countries and regions. This report summarizes over four decades of global safety, immunogenicity, efficacy, and effectiveness data for the vaccine. We include studies on the use of M-M-RII in different age groups, concomitant use with other routine childhood vaccines, administration via different routes, persistence of immunity, and vaccine effectiveness during outbreaks of measles and mumps. We conclude that M-M-RII is well tolerated and has shown consistently high performance during routine use in multiple countries, in randomized controlled trials with diverse designs, and in outbreak settings, including use as measles postexposure prophylaxis. Physicians, parents, and the public can continue to have a high degree of confidence in the use of M-M-RII as a vital part of global public health programs.
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Affiliation(s)
| | - Gary S. Marshall
- Norton Children’s and University of Louisville School of Medicine, Louisville, KY, USA
| | - Jaime Fergie
- Infectious Diseases, Driscoll Children’s Hospital, Corpus Christi, TX, USA
| | - Elvira Schmidt
- Certara Germany GmbH, Evidence and Access, Loerrach, Germany
| | - Manjiri Pawaskar
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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154
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Szilagyi PG, Thomas K, Shah MD, Vizueta N, Cui Y, Vangala S, Fox C, Kapteyn A. The role of trust in the likelihood of receiving a COVID-19 vaccine: Results from a national survey. Prev Med 2021; 153:106727. [PMID: 34280405 PMCID: PMC8284053 DOI: 10.1016/j.ypmed.2021.106727] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/03/2021] [Accepted: 07/13/2021] [Indexed: 12/30/2022]
Abstract
High acceptance of coronavirus disease 2019 (COVID-19) vaccines is instrumental to ending the pandemic. Vaccine acceptance by subgroups of the population depends on their trust in COVID-19 vaccines. We surveyed a probability-based internet panel of 7832 adults from December 23, 2020-January 19, 2021 about their likelihood of getting a COVID-19 vaccine and the following domains of trust: an individual's generalized trust, trust in COVID-19 vaccine's efficacy and safety, trust in the governmental approval process and general vaccine development process for COVID-19 vaccines, trust in their physician about COVID-19, and trust in other sources about COVID-19. We included identified at-risk subgroups: healthcare workers, older adults (65-74-year-olds and ≥ 75-year-olds), frontline essential workers, other essential workers, and individuals with high-risk chronic conditions. Of 5979 respondents, only 57.4% said they were very likely or somewhat likely to get a COVID-19 vaccine. More hesitant respondents (p < 0.05) included: women, young adults (18-49 years), Blacks, individuals with lower education, those with lower income, and individuals without high-risk chronic conditions. Lack of trust in the vaccine approval and development processes explained most of the demographic variation in stated vaccination likelihood, while other domains of trust explained less variation. We conclude that hesitancy for COVID-19 vaccines is high overall and among at-risk subgroups, and hesitancy is strongly tied to trust in the vaccine approval and development processes. Building trust is critical to ending the pandemic.
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Affiliation(s)
- Peter G Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, United States of America.
| | - Kyla Thomas
- Dornsife College of Letters Arts and Sciences Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States of America
| | - Megha D Shah
- Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, Los Angeles, CA, United States of America
| | - Nathalie Vizueta
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, United States of America
| | - Yan Cui
- Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, Los Angeles, CA, United States of America
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, United States of America
| | - Craig Fox
- UCLA Anderson School of Management, University of California at Los Angeles, Los Angeles, CA, United States of America
| | - Arie Kapteyn
- Dornsife College of Letters Arts and Sciences Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States of America
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155
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Francis JK, Rodriguez SA, Dorsey O, Blackwell JM, Balasubramanian BA, Kale N, Day P, Preston SM, Thompson EL, Pruitt SL, Tiro JA. Provider perspectives on communication and dismissal policies with HPV vaccine hesitant parents. Prev Med Rep 2021; 24:101562. [PMID: 34976628 PMCID: PMC8683895 DOI: 10.1016/j.pmedr.2021.101562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/16/2022] Open
Abstract
Parental vaccine hesitancy is a growing concern. Less is known about provider or practice characteristics that encounter HPV-specific vaccine-hesitant parents, the providers' confidence in responding to HPV vaccine concerns, and the attitudes and use of vaccine dismissal policies (i.e., removing patients from the practice). North Texas providers completed an online survey. Dependent variables assessed: (1) percentage of HPV vaccine-hesitant parents encountered in practice defined as substantive, or high (≥11%, or among more than one out of ten adolescent patient encounters) versus low (≤10%) levels; (2) confidence in responding to 11 HPV vaccine concerns; (3) attitudes and use of vaccine dismissal policies. Chi-square and Fisher's exact tests were conducted. Among 156 providers, 29% reported high HPV vaccine hesitancy (≥11% of patient population). Overall, providers reported being "very confident" in addressing vaccine concerns (mean: 3.37 out of 4, SD: 0.57). Mean confidence scores were significantly higher for white (vs. non-white) providers and for pediatricians (vs. family practitioners). Providers were least confident in responding to parents' religious/personal beliefs (69%). Some providers (25%) agreed with policies that dismissed vaccine-hesitant parents after repeated counseling attempts. More providers used dismissal policies for childhood (19%) than adolescent (10%) immunizations. Provider communication training should include parental religious/personal beliefs to effectively address HPV vaccine hesitancy. Other regions should examine their HPV-specific vaccine hesitancy levels to understand how the use of dismissal policies might vary between adolescent and childhood immunizations.
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Affiliation(s)
- Jenny K.R. Francis
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
- Children’s Health, Dallas, TX
| | - Serena A. Rodriguez
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Olivia Dorsey
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - James-Michael Blackwell
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Bijal A. Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Science, UTHealth School of Public Health, Houston, TX
| | - Neelima Kale
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, KY
| | - Philip Day
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA
| | - Sharice M. Preston
- Department of Health Promotion and Behavioral Science, UTHealth School of Public Health, Dallas, TX
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, TX
| | - Erika L. Thompson
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX
| | - Sandi L. Pruitt
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jasmin A. Tiro
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
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156
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Glanz JM, Clarke CL, Daley MF, Shoup JA, Hambidge SJ, Williams JT, Groom HC, Kharbanda EO, Klein NP, Jackson LA, Lewin BJ, McClure DL, Xu S, DeStefano F. The Childhood Vaccination Schedule and the Lack of Association With Type 1 Diabetes. Pediatrics 2021; 148:183391. [PMID: 34851413 PMCID: PMC9258424 DOI: 10.1542/peds.2021-051910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Safety studies assessing the association between the entire recommended childhood immunization schedule and autoimmune diseases, such as type 1 diabetes mellitus (T1DM), are lacking. To examine the association between the recommended immunization schedule and T1DM, we conducted a retrospective cohort study of children born between 2004 and 2014 in 8 US health care organizations that participate in the Vaccine Safety Datalink. METHODS Three measures of the immunization schedule were assessed: average days undervaccinated (ADU), cumulative antigen exposure, and cumulative aluminum exposure. T1DM incidence was identified by International Classification of Disease codes. Cox proportional hazards models were used to analyze associations between the 3 exposure measures and T1DM incidence. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were calculated. Models were adjusted for sex, race and ethnicity, birth year, mother's age, birth weight, gestational age, number of well-child visits, and study site. RESULTS In a cohort of 584 171 children, the mean ADU was 38 days, the mean cumulative antigen exposure was 263 antigens (SD = 54), and the mean cumulative aluminum exposure was 4.11 mg (SD = 0.73). There were 1132 incident cases of T1DM. ADU (aHR = 1.01; 95% CI, 0.99-1.02) and cumulative antigen exposure (aHR = 0.98; 95% CI, 0.97-1.00) were not associated with T1DM. Cumulative aluminum exposure >3.00 mg was inversely associated with T1DM (aHR = 0.77; 95% CI, 0.60-0.99). CONCLUSIONS The recommended schedule is not positively associated with the incidence of T1DM in children. These results support the safety of the recommended childhood immunization schedule.
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Affiliation(s)
- Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado;,Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | | | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | | | | | - Holly C. Groom
- Kaiser Permanente Center for Health Research, Northwest Kaiser Permanente, Portland, Oregon
| | | | - Nicola P. Klein
- Kaiser Permanente Division of Research, Kaiser Permanente of Northern California, Oakland, California
| | - Lisa A. Jackson
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | - Bruno J. Lewin
- Kaiser Permanente Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, California
| | - David L. McClure
- Marshfield Clinic Research Foundation Institute, Marshfield, Wisconsin
| | - Stanley Xu
- Kaiser Permanente Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, California
| | - Frank DeStefano
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
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157
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Han Y, Wang Q, Zhao S, Wang J, Dong S, Cui T, Liu M, Shi N, Yang L, Han Y, Xiu S, Wang X, Jin H. Parental category B vaccine hesitancy and associated factors in China: an online cross-sectional survey. Expert Rev Vaccines 2021; 21:145-153. [PMID: 34792433 DOI: 10.1080/14760584.2022.2008247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Vaccine hesitancy is one of the top ten health threats. We aimed to (1) assess parental Category B vaccines hesitancy and associated sociodemographic factors in China, and (2) explore the association between attitude toward vaccines and self-reported hesitant behavior. METHODS A cross-sectional study was performed through a web-based anonymous online questionnaire survey between 9 February and 7 April 2021. Chinese parents aged ≥ 18 years with one child aged < 6 years were included to assess vaccine hesitancy using the vaccine-hesitancy scale (VHS). Structural equation model was used to determine relationships between variables. RESULTS Of 2952 Chinese parents included in the analysis, 17.5% were highly hesitant in Category B vaccines. Parents who were younger, less educated, engaged in health-related occupations, and had been vaccinated against influenza in the past year were more hesitant when vaccinating their children (P < 0.001). VHS score accuracy to identify vaccine-hesitant behavior was acceptable, and the optimal cutoff was 37.50 (with 61.96% parental vaccine hesitancy). Parents who lack confidence or believe vaccines were risk were more likely to show vaccine hesitant behavior (P < 0.001). CONCLUSIONS In China, effective interventions need to be implemented to eliminate parental Category B vaccines hesitancy.
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Affiliation(s)
- Ying Han
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.,Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Ministry of Education, Nanjing, China
| | - Qiang Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.,Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Ministry of Education, Nanjing, China
| | - Shuangyu Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.,Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Ministry of Education, Nanjing, China
| | - Jianli Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.,Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Ministry of Education, Nanjing, China
| | - Shuheng Dong
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.,Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Ministry of Education, Nanjing, China
| | - Tingting Cui
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.,Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Ministry of Education, Nanjing, China
| | - Minqi Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.,Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Ministry of Education, Nanjing, China
| | - Naiyang Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.,Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Ministry of Education, Nanjing, China
| | - Liuqing Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.,Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Ministry of Education, Nanjing, China
| | - Yue Han
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.,Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Ministry of Education, Nanjing, China
| | - Shixin Xiu
- Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Xuwen Wang
- Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Hui Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.,Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Ministry of Education, Nanjing, China
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158
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Temsah MH, Alhuzaimi AN, Aljamaan F, Bahkali F, Al-Eyadhy A, Alrabiaah A, Alhaboob A, Bashiri FA, Alshaer A, Temsah O, Bassrawi R, Alshahrani F, Chaiah Y, Alaraj A, Assiri RA, Jamal A, Batais MA, Saddik B, Halwani R, Alzamil F, Memish ZA, Barry M, Al-Subaie S, Al-Tawfiq JA, Alhasan K. Parental Attitudes and Hesitancy About COVID-19 vs. Routine Childhood Vaccinations: A National Survey. Front Public Health 2021; 9:752323. [PMID: 34722451 PMCID: PMC8548678 DOI: 10.3389/fpubh.2021.752323] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To quantify parental acceptance of the COVID-19 vaccine and assess the vaccine hesitancy (VH) for COVID-19 vs. childhood vaccines. Methods: Eight vaccine hesitancy scale (VHS) items, adopted from WHO's Strategic Advisory Group of Immunization (SAGE), were used to assess VH for COVID-19 vaccine vs. routine childhood vaccines. We distributed the online survey to parents with the commence of the national childhood COVID-19 vaccination program in Saudi Arabia. Results: Among 3,167 parents, 47.6% are decided to vaccinate their children against COVID-19. The most common reasons for refusal were inadequate safety information (69%) and worry about side effects (60.6%). Parents have a significantly greater positive attitudes toward children's routine vaccines vs. the COVID-19 vaccine, with higher mean VHS (±SD) = 2.98 ± 0.58 vs. 2.63 ± 0.73, respectively (p-value < 0.001). Parents agreed more that routine childhood vaccines are more essential and effective as compared to the COVID-19 vaccine (Cohen's D: 0.946, and 0.826, consecutively; T-test p-value < 0.00). There is more parental anxiety about serious side effects of the COVID-19 vaccine vs. routine childhood vaccines (Cohen's D = 0.706, p-value < 0.001). Parents who relied on the Ministry of Health information were more predicted (OR = 1.28, p-value = 0.035) to intend to vaccinate as opposed to those who used the WHO website (OR = 0.47, −53%, p-value < 0.001). In a multivariate logistic regression analysis, the factors associated with intention to vaccinate children were parents who received COVID-19 vaccine, older parents, having children aged 12–18, and parents with lower education levels. Conclusions: Significant proportion of parents are hesitant about the COVID-19 vaccine because they are less confident in its effectiveness, safety, and whether it is essential for their children. Relying on the national official healthcare authority's website for the source of information was associated with increased acceptance of childhood COVID-19 vaccination. As parental intention to vaccinate children against COVID-19 is suboptimal, healthcare authorities could boost vaccine uptake by campaigns targeting hesitant parents.
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Affiliation(s)
- Mohamad-Hani Temsah
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah N Alhuzaimi
- Division of Pediatric Cardiology, Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Division of Pediatric Cardiology, Department of Cardiac Sciences, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Fadi Aljamaan
- Critical Care Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Feras Bahkali
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ayman Al-Eyadhy
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulkarim Alrabiaah
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ali Alhaboob
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad A Bashiri
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Alshaer
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Omar Temsah
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Rolan Bassrawi
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fatimah Alshahrani
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yazan Chaiah
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ali Alaraj
- Department of Medicine, College of Medicine, Qassim University, Qassim, Saudi Arabia.,Dr Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Rasha Assad Assiri
- Department of Basic Medical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Amr Jamal
- Department of Family and Community Medicine, King Saud University Medical City, Riyadh, Saudi Arabia.,Evidence-Based Health Care & Knowledge Translation Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed A Batais
- Department of Family and Community Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Basema Saddik
- Sharjah Institute of Medical Research, University of Sharjah, Sharjah, United Arab Emirates.,Department of Community and Family Medicine, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Rabih Halwani
- Sharjah Institute of Medical Research, University of Sharjah, Sharjah, United Arab Emirates.,Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Fahad Alzamil
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ziad A Memish
- Research and Innovation Center, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Mazin Barry
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
| | - Sarah Al-Subaie
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States.,Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Khalid Alhasan
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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159
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Day P, Strenth C, Kale N, Schneider FD, Arnold EM. Perspectives of primary care physicians on acceptance and barriers to COVID-19 vaccination. Fam Med Community Health 2021; 9:e001228. [PMID: 34740897 PMCID: PMC8573291 DOI: 10.1136/fmch-2021-001228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The purpose of this study was to examine the perspectives of primary care physicians in Texas around vaccine acceptance and potential patient barriers to vaccination. National surveys have shown fluctuating levels of acceptance for COVID-19 vaccination, and primary care physicians could play a crucial role in increasing vaccine uptake. DESIGN This study employed a cross-sectional anonymous survey design to collect data using an online questionnaire. Participants were asked about vaccination practices and policies at their practice site, perceptions of patient and community acceptance and confidence in responding to patient vaccine concerns. SETTING From November 2020 to January 2021, family medicine physicians and paediatricians completed an online questionnaire on COVID-19 vaccination that was distributed by professional associations. PARTICIPANTS The survey was completed by 573 practising physicians, the majority of whom identified as family medicine physicians (71.0%) or paediatricians (25.7%), who are currently active in professional associations in Texas. RESULTS About three-fourths (74.0%) of participants reported that they would get the vaccine as soon as it became available. They estimated that slightly more than half (59.2%) of their patients would accept the vaccine, and 67.0% expected that the COVID-19 vaccine would be accepted in their local community. The majority of participants (87.8%) reported always, almost always or usually endorsing vaccines, including high levels of intention to recommend COVID-19 vaccination (81.5%). Participants felt most confident responding to patient concerns related to education about vaccine types, safety and necessity and reported least confidence in responding to personal or religious objections to COVID-19 vaccination. CONCLUSIONS The majority of the physicians surveyed stated that they would receive the COVID-19 vaccination when it was available to them and were confident in their ability to respond to patient concerns. With additional education, support and shifting COVID-19 vaccinations into primary care settings, primary care physicians can use the trust they have built with their patients to address vaccine hesitancy and potentially increase acceptance and uptake.
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Affiliation(s)
- Philip Day
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Chance Strenth
- Department of Family and Community Medicine, UT Southwestern Medical School, Dallas, Texas, USA
| | - Neelima Kale
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - F David Schneider
- Department of Family and Community Medicine, The University of Texas Southwestern Medical Center Medical School, Dallas, Texas, USA
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160
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Woodall WG, Zimet G, Kong A, Buller D, Reither J, Chilton L, Myers V, Starling R. Vacteens.org: A Mobile Web app to Improve HPV Vaccine Uptake. Front Digit Health 2021; 3:693688. [PMID: 34713171 PMCID: PMC8521965 DOI: 10.3389/fdgth.2021.693688] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
U.S. HPV vaccine uptake remains below the Healthy People 2030 goal of 80% series completion. Parental concerns and misinformation about the efficacy and safety of the Human Papillomavirus (HPV) vaccine remain, and may be addressed by digital interventions tailored to their concerns. Reported here are results from a small scale randomized trial testing a mobile web app for parents and their adolescent daughters (ages 11–14 years) encouraging HPV vaccination in New Mexico, an ethnically-diverse U.S. state. Methods: A clinic-cluster randomized trial where pediatric clinics (n = 9) were recruited and randomized, and parent-adolescent pairs (n = 82) within clinics received either the Vacteens.org/Vacunadolescente.org mobile web app or Usual and Customary (UC) HPV Vaccination information. Parents completed online surveys at baseline and 3-months. Daughters' HPV vaccine data were collected from the New Mexico State Immunization Information System 1 year post baseline. Results: Three month survey results found Vacteens.org/Vacunadolescente.org parents to have higher positive HPV vaccine beliefs, informed decision making, intent to vaccinate and vaccine confidence outcomes than UC parents. HPV vaccine data found higher first dose HPV vaccination (Pearson χ2 = 6.13, p = 0.013, Vacteens.org/Vacunadolescente.org group 59.4%, UC group 40.6%), and higher HPV vaccination series completion (Pearson χ2 = 6.49, p = 0.011, Vacteens.org/Vacunadolescente.org group 68.4%, UC group 31.6%). Conclusions: The small trial results showed the Vacteens.org/Vacunadolescente.org web app prompted positive vaccine-related attitudes and beliefs, and more HPV vaccination initiation and series completion. Mobile web apps can make decision-making tools for HPV vaccination widely available on digital platforms, reducing vaccine hesitancy, and confusion and increase HPV vaccine uptake.
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Affiliation(s)
| | - Gregory Zimet
- Division of Adolescent Medicine, Department of Pediatrics, Indiana University-Purdue University Indianapolis (IUPUI) Center for HPV Research, Indiana University, Indianapolis, IN, United States
| | - Alberta Kong
- Department of Pediatrics, The University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | | | | | - Lance Chilton
- Department of Pediatrics, The University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | | | - Randall Starling
- Center on Alcohol, Substance Use and Addictions (CASAA), The University of New Mexico, Albuquerque, NM, United States
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161
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Abdul Kadir A, Noor NM, Mukhtar AF. Development and validation of the knowledge and attitude regarding childhood vaccination (KACV) questionnaire among healthcare workers: the Malay version. Hum Vaccin Immunother 2021; 17:5196-5204. [PMID: 34714713 DOI: 10.1080/21645515.2021.1989915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Health care workers play an important role in supporting childhood vaccination as they are the most trusted source of vaccine-related information for parents. However, there is limited validated tools to measure their knowledge and attitude on childhood vaccination. This study aims to develop and validate knowledge and attitude regarding childhood vaccination (KACV) questionnaire among healthcare workers. The questionnaire was developed based on literature reviews and underwent a sequential validation process, including content, face validity and exploratory factor analysis. However, the attitude section is unidimensional and has undergone reliability analysis only. The preliminary knowledge questionnaire contains 33 items and the attitude questionnaire consists of 17 items. The preliminary KACV showed a high item Content Validity Index and Face Validity Index. The final questionnaire consists of 10 items for knowledge and 15 items for attitude. The Cronbach alpha for the knowledge and attitude section were 0.896 and 0.861, respectively. KACV is a valid and reliable tool to measure healthcare workers' knowledge and attitude on childhood vaccination.
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Affiliation(s)
- Azidah Abdul Kadir
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Department of Family Medicine, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Norhayati Mohd Noor
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Department of Family Medicine, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ahmad Faiq Mukhtar
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Department of Family Medicine, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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162
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Abstract
PURPOSE OF REVIEW We reviewed the literature about parental vaccine hesitancy, focusing on publications from October 2019 to April 2021 to describe patterns and causes of hesitancy and interventions to address hesitancy. RECENT FINDINGS Recent studies expand understanding of the prevalence of vaccine hesitancy globally and highlight associated individual and contextual factors. Common concerns underlying hesitancy include uncertainty about the need for vaccination and questions about vaccine safety and efficacy. Sociodemographic factors associated with parental vaccine hesitancy vary across locations and contexts. Studies about psychology of hesitancy and how parents respond to interventions highlight the role of cognitive biases, personal values, and vaccination as a social contract or norm. Evidence-based strategies to address vaccine hesitancy include presumptive or announcement approaches to vaccine recommendations, motivational interviewing, and use of immunization delivery strategies like standing orders and reminder/recall programs. A smaller number of studies support use of social media and digital applications to improve vaccination intent. Strengthening school vaccine mandates can improve vaccination rates, but policy decisions must consider local context. SUMMARY Vaccine hesitancy remains a challenge for child health. Future work must include more interventional studies to address hesitancy and regular global surveillance of parental vaccine hesitancy and vaccine content on social media.
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Affiliation(s)
- Jessica R Cataldi
- Department of Pediatrics, University of Colorado School of Medicine
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Sean T O'Leary
- Department of Pediatrics, University of Colorado School of Medicine
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
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163
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Szilagyi PG, Shah MD, Delgado JR, Thomas K, Vizueta N, Cui Y, Vangala S, Shetgiri R, Kapteyn A. Parents' Intentions and Perceptions About COVID-19 Vaccination for Their Children: Results From a National Survey. Pediatrics 2021; 148:e2021052335. [PMID: 34344800 PMCID: PMC10116994 DOI: 10.1542/peds.2021-052335] [Citation(s) in RCA: 180] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Assess the degree to which US parents are likely to have their children get coronavirus disease 2019 (COVID-19) vaccines and identify parental concerns about the vaccines. METHODS In February 2021 to March 2021, we surveyed parent members of a nationally representative probability-based Internet panel of ∼9000 adults regarding their intent to have their children receive a COVID-19 vaccination, perceptions of COVID-19 vaccines for children, and trust in sources of information about COVID-19 vaccines for children. We used descriptive and multivariate analyses to evaluate parent-stated likelihood of having their children get a COVID-19 vaccine and to assess the association between likelihood of child COVID-19 vaccination and child age, parent demographics, and parental perceptions about COVID-19 vaccines. RESULTS Altogether, 1745 parents responded (87% of eligible parents, 3759 children). Likelihood of child COVID-19 vaccination was as follows: very likely (28%), somewhat likely (18%), somewhat unlikely (9%), very unlikely (33%), and unsure (12%). The stated likelihood of child vaccination was greater among parents of older children (P < .001) as well as among parents who had a bachelor's degree or higher education (P < .001), had already received or were likely to receive a COVID-19 vaccine (P < .001), or had Democratic affiliation (P < .001); variations existed by race and ethnicity (P = .04). Parental concerns centered around vaccine safety and side effects. A key trusted source of information about COVID-19 vaccines for children was the child's doctor. CONCLUSIONS Less than one-half of US participants report that they are likely to have their child receive a COVID-19 vaccine. Pediatric health care providers have a major role in promoting and giving COVID-19 vaccination for children.
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Affiliation(s)
- Peter G Szilagyi
- Department of Pediatrics, University of California, Los Angeles, UCLA Mattel Children's Hospital and University of California, Los Angeles, Los Angeles, California
| | - Megha D Shah
- Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, Los Angeles, California
| | - Jeanne R Delgado
- Department of Pediatrics, University of California, Los Angeles, UCLA Mattel Children's Hospital and University of California, Los Angeles, Los Angeles, California
| | - Kyla Thomas
- Dornsife College of Letters, Arts and Sciences and Center for Economic and Social Research, University of Southern California, Los Angeles, California
| | - Nathalie Vizueta
- Department of Pediatrics, University of California, Los Angeles, UCLA Mattel Children's Hospital and University of California, Los Angeles, Los Angeles, California
| | - Yan Cui
- Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, Los Angeles, California
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Rashmi Shetgiri
- Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, Los Angeles, California
| | - Arie Kapteyn
- Dornsife College of Letters, Arts and Sciences and Center for Economic and Social Research, University of Southern California, Los Angeles, California
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164
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Plans to Vaccinate Children for Coronavirus Disease 2019: A Survey of United States Parents. J Pediatr 2021; 237:292-297. [PMID: 34284035 PMCID: PMC8286233 DOI: 10.1016/j.jpeds.2021.07.021] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/04/2021] [Accepted: 07/13/2021] [Indexed: 02/07/2023]
Abstract
In a national survey of 2074 US parents of children ≤12 years of age conducted in March 2021, 49.4% reported plans to vaccinate their child for coronavirus disease 2019 when available. Lower income and less education were associated with greater parental vaccine hesitancy/resistance; safety and lack of need were primary reasons for vaccine hesitancy/resistance.
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165
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Goldman RD, Krupik D, Ali S, Mater A, Hall JE, Bone JN, Thompson GC, Yen K, Griffiths MA, Klein A, Klein EJ, Brown JC, Mistry RD, Gelernter R. Caregiver Willingness to Vaccinate Their Children against COVID-19 after Adult Vaccine Approval. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910224. [PMID: 34639527 PMCID: PMC8507940 DOI: 10.3390/ijerph181910224] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/19/2021] [Accepted: 09/23/2021] [Indexed: 12/20/2022]
Abstract
Vaccines against COVID-19 are likely to be approved for children under 12 years in the near future. Understanding vaccine hesitancy in parents is essential for reaching herd immunity. A cross-sectional survey of caregivers in 12 emergency departments (ED) was undertaken in the U.S., Canada, and Israel. We compared reported willingness to vaccinate children against COVID-19 with an initial survey and post-adult COVID-19 vaccine approval. Multivariable logistic regression models were performed for all children and for those <12 years. A total of 1728 and 1041 surveys were completed in phases 1 and 2, respectively. Fewer caregivers planned to vaccinate against COVID-19 in phase 2 (64.5% and 59.7%, respectively; p = 0.002). The most significant positive predictor of willingness to vaccinate against COVID-19 was if the child was vaccinated per recommended local schedules. Fewer caregivers plan to vaccinate their children against COVID-19, despite vaccine approval for adults, compared to what was reported at the peak of the pandemic. Older caregivers who fully vaccinated their children were more likely to adopt vaccinating children. This study can inform target strategy design to implement adherence to a vaccination campaign.
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Affiliation(s)
- Ran D. Goldman
- The Pediatric Research in Emergency Therapeutics (PRETx) Program, Department of Pediatrics, Division of Emergency Medicine, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC V6H 3N1, Canada
- Correspondence: ; Tel.: +1-604-875-2345 (ext. 7333)
| | - Danna Krupik
- Ziv Medical Center, Pediatric Emergency Unit, Azrieli Faculty of Medicine, Bar-Ilan University, Safed 5290002, Israel;
| | - Samina Ali
- Departments of Pediatrics, Faculty of Medicine & Dentistry, Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Ahmed Mater
- Pediatric Emergency Medicine, Jim Pattison Children’s Hospital, University of Saskatchewan, Saskatoon, SK S7N 5B5, Canada;
| | - Jeanine E. Hall
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA 90033, USA;
| | - Jeffrey N. Bone
- Biostatistical Lead, Research Informatics, BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada;
| | - Graham C. Thompson
- Pediatrics and Emergency Medicine, Alberta Children’s Hospital, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Kenneth Yen
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Texas Southwestern Children’s Health, Dallas, TX 75235, USA;
| | - Mark A. Griffiths
- Division of Pediatric Emergency Medicine, Children’s Healthcare of Atlanta, Emory School of Medicine, Atlanta, GA 30322, USA;
| | - Adi Klein
- Hillel Yaffe Medical Center, Department of Pediatrics, Hadera and Technion Faculty of Medicine, Haifa 38100, Israel;
| | - Eileen J. Klein
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA 98195, USA; (E.J.K.); (J.C.B.)
| | - Julie C. Brown
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA 98195, USA; (E.J.K.); (J.C.B.)
| | - Rakesh D. Mistry
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado Denver, Aurora, CO 80204, USA;
| | - Renana Gelernter
- Shamir Medical Center, Pediatric Emergency Medicine Unit, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
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166
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Bryan MA, Hofstetter AM, Ramos D, Ramirez M, Opel DJ. Facilitators and Barriers to Providing Vaccinations During Hospital Visits. Hosp Pediatr 2021; 11:1137-1152. [PMID: 34556537 DOI: 10.1542/hpeds.2020-004655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Many children are undervaccinated at the time of hospital admission. Our objective was to explore the facilitators and barriers to vaccinating during hospitalization. METHODS We conducted qualitative interviews of parents, primary care pediatricians, emergency department (ED) physicians, and pediatric hospitalists. Parents of undervaccinated hospitalized children who were admitted through the ED were invited to participate. We used purposive sampling to identify physician participants. Semistructured interviews querying participants' perspectives on hospital-based vaccination were audiorecorded and transcribed. Parent demographics and physician practice characteristics were collected. Transcripts were analyzed for facilitators and barriers to vaccinating during acute hospital visits by using inductive content analysis. A conceptual framework was developed on the basis of the social ecological model. RESULTS Twenty-one parent interviews and 10 physician interviews were conducted. Of parent participants, 86% were female; 76% were white. Physician participants included 3 primary care pediatricians, 3 ED physicians, and 4 hospitalists. Facilitators and barriers fell under 4 major themes: (1) systems-level factors, (2) physician-level factors, (3) parent-provider interactional factors, and (4) parent- and child-level factors. Parent participants reported a willingness to receive vaccines during hospitalizations, which aligned with physician participants' experiences. Another key facilitator identified by parent and physician participants was the availability of shared immunization data. Identified by parent and physician participants included the availability of shared immunization data. Barriers included being unaware that the child was vaccine-eligible, parental beliefs against vaccination, and ED and inpatient physicians' perceived lack of skills to effectively communicate with vaccine-hesitant parents. CONCLUSIONS Parents and physicians identified several key facilitators and barriers to vaccinating during hospitalization. Efforts to provide inpatient vaccines need to address existing barriers.
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Affiliation(s)
- Mersine A Bryan
- Department of Pediatrics, School of Medicine .,Seattle Children's Research Institute, Seattle, Washington
| | - Annika M Hofstetter
- Department of Pediatrics, School of Medicine.,Seattle Children's Research Institute, Seattle, Washington
| | - Daniela Ramos
- Seattle Children's Research Institute, Seattle, Washington
| | - Magaly Ramirez
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Douglas J Opel
- Department of Pediatrics, School of Medicine.,Seattle Children's Research Institute, Seattle, Washington
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167
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Hauge SH, de Blasio BF, Håberg SE, Oakley L. Influenza hospitalizations during childhood in children born preterm. Influenza Other Respir Viruses 2021; 16:247-254. [PMID: 34519431 PMCID: PMC8818812 DOI: 10.1111/irv.12908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022] Open
Abstract
Objective The objective is to determine if children born preterm were at increased risk of influenza hospitalization up to age five. Methods National registry data on all children born in Norway between 2008 and 2011 were used in Cox regression models to estimate adjusted hazard ratios (aHRs) for influenza hospitalizations up to age five in children born preterm (<37 pregnancy weeks). HRs were also estimated separately for very preterm (<32 weeks), early term (37–38 weeks), and post‐term (≥42 weeks) children. Results Among 238,628 children born in Norway from January 2008 to December 2011, 15,086 (6.3%) were born preterm. There were 754 (0.3%) children hospitalized with influenza before age five. The rate of hospitalizations in children born preterm was 13.8 per 10,000 person‐years (95% confidence interval [CI] [11.3, 16.7]), and 5.9 per 10,000 person‐years (95% CI [5.5, 6.4]) in children born at term (≥37 weeks). Children born preterm had a higher risk of influenza hospitalization before age 5: aHR 2.33 (95% CI [1.85, 2.93]). The risk increased with decreasing gestational age and was highest among those born extremely/very preterm; aHR 4.07 (95% CI [2.63, 6.31]). Compared with children born at 40–41 weeks, children born early term also had an elevated risk of influenza hospitalization; aHR (37 weeks) 1.89 (95% CI [1.43, 2.50]), aHR (38 weeks) 1.43 (95% CI [1.15, 1.78]). Conclusion Children born preterm had a higher risk of influenza hospitalizations before age five. An elevated risk was also present among children born at an early term. Children born preterm could benefit from influenza vaccinations.
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Affiliation(s)
- Siri H Hauge
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Birgitte Freiesleben de Blasio
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Laura Oakley
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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168
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Alfieri NL, Kusma JD, Heard-Garris N, Davis MM, Golbeck E, Barrera L, Macy ML. Parental COVID-19 vaccine hesitancy for children: vulnerability in an urban hotspot. BMC Public Health 2021; 21:1662. [PMID: 34517848 PMCID: PMC8436579 DOI: 10.1186/s12889-021-11725-5] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 08/29/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To compare hesitancy toward a future COVID-19 vaccine for children of various sociodemographic groups in a major metropolitan area, and to understand how parents obtain information about COVID-19. METHODS Cross-sectional online survey of parents with children < 18 years old in Chicago and Cook County, Illinois, in June 2020. We used logistic regression to determine the odds of parental COVID-19 vaccine hesitancy (VH) for racial/ethnic and socioeconomic groups, controlling for sociodemographic factors and the sources where parents obtain information regarding COVID-19. RESULTS Surveys were received from 1702 parents and 1425 were included in analyses. Overall, 33% of parents reported VH for their child. COVID-19 VH was higher among non-Hispanic Black parents compared with non-Hispanic White parents (Odds Ratio (OR) 2.65, 95% Confidence Interval (CI): (1.99-3.53), parents of publicly insured children compared with privately insured (OR 1.93, (1.53-2.42)) and among lower income groups. Parents receive information about COVID-19 from a variety of sources, and those who report using family, internet and health care providers as information sources (compared to those who don't use each respective source) had lower odds of COVID-19 VH for their children. CONCLUSIONS The highest rates of hesitancy toward a future COVID-19 vaccine were found in demographic groups that have been the most severely affected by the pandemic. These groups may require targeted outreach efforts from trusted sources of information in order to promote equitable uptake of a future COVID-19 vaccine.
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Affiliation(s)
- Nina L Alfieri
- Division of Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Box 162, Chicago, IL, 60611, USA.,Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer D Kusma
- Division of Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Box 162, Chicago, IL, 60611, USA. .,Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. .,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Nia Heard-Garris
- Division of Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Box 162, Chicago, IL, 60611, USA.,Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew M Davis
- Division of Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Box 162, Chicago, IL, 60611, USA.,Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Medicine, Medical Social Sciences, and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily Golbeck
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Leonardo Barrera
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Michelle L Macy
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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169
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Ugale JL, Spielvogle H, Spina C, Perreira C, Katz B, Pahud B, Dempsey AF, Robinson JD, Garrett K, O'Leary ST, Opel DJ. "It's Like 1998 Again": Why Parents Still Refuse and Delay Vaccines. Glob Pediatr Health 2021; 8:2333794X211042331. [PMID: 34471653 PMCID: PMC8404635 DOI: 10.1177/2333794x211042331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022] Open
Abstract
We conducted a qualitative study from 2018 to 2019 to update the reasons why US parents’ refuse or delay vaccines. Four focus groups and 4 semi-structured interviews involving 33 primary care pediatric providers were conducted in Washington and Colorado. A thematic analysis was conducted to identify themes related to reasons for parental refusal or delay. Five predominant themes were identified: (1) vaccine safety, (2) relative influence of information sources, decision-makers, and timing, (3) low perceived risk of contracting vaccine-preventable disease, (4) lack of trust, and (5) religious objection. Vaccine safety was the theme mentioned most frequently by providers (N = 45 times by 26 providers) and religious objection to vaccination was referred to the least (N = 6 times by 6 providers). Provider-reported reasons for parental refusal or delay of childhood vaccines in 2018 to 2019 remain similar to those reported in previous studies.
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Affiliation(s)
- Jiana L Ugale
- Seattle Children's Research Institute, Seattle, WA, USA
| | | | - Christine Spina
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Cathryn Perreira
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Ben Katz
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Barbara Pahud
- University of Missouri-Kansas City, Kansas City, MO, USA
| | - Amanda F Dempsey
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Kathleen Garrett
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Sean T O'Leary
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Douglas J Opel
- Seattle Children's Research Institute, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
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170
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Berenson AB, Chang M, Hirth JM, Kanukurthy M. Intent to get vaccinated against COVID-19 among reproductive-aged women in Texas. Hum Vaccin Immunother 2021; 17:2914-2918. [PMID: 34081572 PMCID: PMC8381790 DOI: 10.1080/21645515.2021.1918994] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/12/2021] [Indexed: 12/25/2022] Open
Abstract
Data are needed on the acceptability of Covid-19 vaccination among young, low-income, diverse populations. To assess this, we surveyed 18-45-year-old women on their intent to be vaccinated, experiences with Covid-19, and uptake of other vaccines. Among the 342 who completed the survey, only one-third were likely to accept the Covid-19 vaccine as soon as it was available. Less than half would accept it even if recommended by their doctor. Most (69%) wanted more information on its safety and 48% wanted proof it works. Likelihood of accepting the vaccine with a doctor's recommendation was associated with fear of catching Covid-19 and exposure to social media as well as HPV and annual flu vaccination. This demonstrates it will be necessary to help vaccine-hesitant individuals overcome their concerns to reach herd immunity in the US. Physician recommendation and social media may play important roles.
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Affiliation(s)
- Abbey B. Berenson
- Center for Interdisciplinary Research in Women’s Health (ABB, MC, JMH), Department of Obstetrics and Gynecology (ABB, MC, JMH), School of Medicine (MK), The University of Texas Medical Branch, Galveston, TX, USA
| | - Mihyun Chang
- Center for Interdisciplinary Research in Women’s Health (ABB, MC, JMH), Department of Obstetrics and Gynecology (ABB, MC, JMH), School of Medicine (MK), The University of Texas Medical Branch, Galveston, TX, USA
| | - Jacqueline M. Hirth
- Center for Interdisciplinary Research in Women’s Health (ABB, MC, JMH), Department of Obstetrics and Gynecology (ABB, MC, JMH), School of Medicine (MK), The University of Texas Medical Branch, Galveston, TX, USA
| | - Manasa Kanukurthy
- Center for Interdisciplinary Research in Women’s Health (ABB, MC, JMH), Department of Obstetrics and Gynecology (ABB, MC, JMH), School of Medicine (MK), The University of Texas Medical Branch, Galveston, TX, USA
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171
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Parental Vaccine Hesitancy and Risk of Pediatric Influenza Under-Vaccination in a Safety-Net Health Care System. Acad Pediatr 2021; 21:1126-1133. [PMID: 34023490 DOI: 10.1016/j.acap.2021.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To measure the risk of influenza under-vaccination in children of vaccine-hesitant parents, referent to children of nonhesitant parents, in a sample of disadvantaged families in one influenza season. STUDY DESIGN A prospective observational cohort study of English- and Spanish-speaking parents of 2-year-olds presenting at random for well, sick, or specialty visit care from August 1, 2019 to February 28, 2020. Parents answered demographic questions and the Parent Attitudes about Childhood Vaccines survey. We followed children until season's end, extracting vaccination data on April 30, 2020. We dichotomized vaccination status as unvaccinated or partially/fully vaccinated, analyzing data with multivariable Poisson regression; in secondary analyses, we conducted adjusted time-to-event analyses. RESULTS Overall, 263 parents consented (response rate: 90%); our final sample included 255 dyads. Thirty-three (13%) parents were vaccine hesitant. In adjusted analyses, children of hesitant parents (n = 33) had a 195% increased risk (adjusted Risk Ratio 2.95; 95% confidence interval 1.91, 4.56) of being unvaccinated at season's end, referent to children of nonhesitant parents (n = 222). In time-to-event analyses, children of vaccine-hesitant parents were also more likely to be unvaccinated before influenza activity peaked (P = .02). CONCLUSIONS Parental vaccine hesitancy tripled the risk of pediatric influenza nonvaccination in a sample of poor and minority families during the 2019 to 2020 influenza season. As parental vaccine hesitancy appears to exacerbate pediatric influenza vaccination disparities, future work should explore parental hesitancy with poor and minority stakeholders and tailor evidence-based interventions to benefit children from these communities who receive care at all practice sites.
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172
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Ruggiero KM, Wong J, Sweeney CF, Avola A, Auger A, Macaluso M, Reidy P. Parents' Intentions to Vaccinate Their Children Against COVID-19. J Pediatr Health Care 2021; 35:509-517. [PMID: 34217553 PMCID: PMC8245313 DOI: 10.1016/j.pedhc.2021.04.005] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION With the COVID-19 vaccine rollout is well underway now beginning in children ages 12 and over, it is unknown what percent of parents plan to vaccinate their children against COVID-19. METHOD The purpose of this descriptive correlational study was to examine parents' attitudes, beliefs, and behaviors in administering a COVID-19 vaccine. RESULTS Only 21.93% of the subjects reported overall VH. Half of parents (49.45%) say they want the COVID vaccine for their child, and 44.17% plan to vaccinate against COVID once the vaccine becomes available to them. Concern for vaccine side effects (61.5%) and vaccine safety (48.96%) were significant factors that increased VH. In addition, there was a significant correlation between parents who were planning to vaccinate their child against the flu and being less VH about a COVID-19 vaccine for their child. DISCUSSION This is the first known study to describe parental perceptions' of COVID-19 VH and identify factors that increase VH for parents.
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173
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Teasdale CA, Borrell LN, Shen Y, Kimball S, Rinke ML, Fleary SA, Nash D. Parental plans to vaccinate children for COVID-19 in New York city. Vaccine 2021; 39:5082-5086. [PMID: 34340854 PMCID: PMC8299285 DOI: 10.1016/j.vaccine.2021.07.058] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 11/22/2022]
Abstract
Once COVID-19 vaccines are approved for children < 12 years of age, high pediatric vaccination coverage will be needed to help minimize the public health threat from the SARS-CoV-2 epidemic. We conducted an online survey of 1,119 parents and caregivers of children ≤ 12 years in New York City from March 9 to April 11, 2021. Among parents surveyed, 61.9% reported plans to vaccinate their youngest child for COVID-19, 14.8% said they do not plan to vaccinate their child and 23.3% were unsure. Female and non-Hispanic Black parents were least likely to report plans to vaccinate their children. Safety, effectiveness and perceptions that children do not need vaccination were the primary reasons for vaccine hesitancy/resistance. Parents who have or will vaccinate themselves were significantly more likely to report they would vaccinate their children. Efforts to increase awareness about vaccine safety and education about the importance of vaccinating children are needed.
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Affiliation(s)
- Chloe A Teasdale
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy (SPH), New York, NY, United States; Institute for Implementation Science in Population Health, CUNY SPH, New York, NY, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.
| | - Luisa N Borrell
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy (SPH), New York, NY, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Yanhan Shen
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy (SPH), New York, NY, United States
| | | | - Michael L Rinke
- Department of Pediatrics, Children's Hospital of Montefiore and Albert Einstein College of Medicine, Bronx, NY, United States
| | - Sasha A Fleary
- Institute for Implementation Science in Population Health, CUNY SPH, New York, NY, United States; Department of Community Health and Social Sciences, CUNY SPH, New York, NY, United States
| | - Denis Nash
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy (SPH), New York, NY, United States; Institute for Implementation Science in Population Health, CUNY SPH, New York, NY, United States
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174
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Zhang MX, Lin XQ, Chen Y, Tung TH, Zhu JS. Determinants of parental hesitancy to vaccinate their children against COVID-19 in China. Expert Rev Vaccines 2021; 20:1339-1349. [PMID: 34376095 DOI: 10.1080/14760584.2021.1967147] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Vaccine hesitancy seriously hinders herd immunity. We explored the determinants of parental hesitancy to vaccinate children against Coronavirus Disease 2019 (COVID-19) in China.A population-based self-administered online questionnaire evaluating parental hesitancy in vaccinating their children against COVID-19 was conducted in Taizhou, China. Of the 2463 parents who received the invitation, 1788 (72.6%) responded to the survey.Of the repondents, 52.5% were hesitant. Mothers exhibited a greater proportion of vaccine hesitancy than fathers did (57.5% vs. 41.7%, P < 0.001). Multiple logistic regression analysis indicated that parents with children under 18 years of age (OR = 0.94, 95%CI: 0.90-0.99), lower knowledge scores about COVID-19 vaccination (Q1: OR = 1.92, 95%CI: 1.37-2.69; Q2: OR = 1.51, 95%CI: 1.10-2.08), lower awareness of the permission of vaccinating children (OR = 1.74, 95%CI: 1.36-2.23) and hesitancy to inoculate themselves (OR = 8.18, 95%CI: 6.48-10.33) were associated with parental hesitancy to inoculate their children. Results also revealed the disparity between fathers and mothers regarding associated factors.This study found that a substantial proportion of parents reported being hesitant to vaccinate children against COVID-19, implying the necessity of comprehensive assessment and health education programs for vaccination systems in China.
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Affiliation(s)
- Mei-Xian Zhang
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China.,Public Laboratory, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Xiao-Qing Lin
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Yan Chen
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Jian-Sheng Zhu
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
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175
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Tharpe NL, McDaniel L. Using a Harm Reduction Model to Reduce Barriers to Vaccine Administration. J Midwifery Womens Health 2021; 66:308-321. [PMID: 34166579 DOI: 10.1111/jmwh.13259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/07/2021] [Accepted: 05/13/2021] [Indexed: 12/22/2022]
Abstract
Vaccination is a strategic public health measure designed to reduce the adverse effects of many infectious diseases. Although national recommendations exist for vaccine administration across the life span, immunization rates are affected by barriers to vaccine access and hesitancy in vaccine acceptance. Midwives and women's health clinicians are optimally poised to assess their client's vaccination status and provide vaccinations during clinical encounters. In order to address client concerns about vaccine safety and administration, each clinician is expected to be knowledgeable about vaccine benefits, recommendations, side effects, and potential adverse reactions. Socioeconomic factors, social policies, and historic and continued experiences related to racism have been identified as barriers to ready access to vaccinations and vaccine acceptance. Midwives can act as leaders within their practice sites and communities through participation in projects that reduce barriers to vaccine access and uptake. Community vaccine outreach programs and relationship-based care can increase vaccine uptake through improved health literacy and associated behavioral changes including greater vaccine acceptance. This article focuses on identifying barriers to vaccine uptake and describing harm reduction measures designed to improve uptake of vaccines. A variety of leadership activities are discussed that can improve clinicians' understanding of their role in optimizing vaccination.
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Affiliation(s)
- Nell L Tharpe
- Perinatal Quality Collaborative for Maine, Augusta, Maine.,Midwife Workshops, East Boothbay, Maine
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176
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Oster NV, Williams EC, Unger JM, Newcomb PA, deHart MP, Englund JA, Hofstetter AM. A Risk Prediction Model to Identify Newborns at Risk for Missing Early Childhood Vaccinations. J Pediatric Infect Dis Soc 2021; 10:1080-1086. [PMID: 34402910 PMCID: PMC8719613 DOI: 10.1093/jpids/piab073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/02/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Approximately 30% of US children aged 24 months have not received all recommended vaccines. This study aimed to develop a prediction model to identify newborns at high risk for missing early childhood vaccines. METHODS A retrospective cohort included 9080 infants born weighing ≥2000 g at an academic medical center between 2008 and 2013. Electronic medical record data were linked to vaccine data from the Washington State Immunization Information System. Risk models were constructed using derivation and validation samples. K-fold cross-validation identified risk factors for model inclusion based on alpha = 0.01. For each patient in the derivation set, the total number of weighted adverse risk factors was calculated and used to establish groups at low, medium, or high risk for undervaccination. Logistic regression evaluated the likelihood of not completing the 7-vaccine series by age 19 months. The final model was tested using the validation sample. RESULTS Overall, 53.6% failed to complete the 7-vaccine series by 19 months. Six risk factors were identified: race/ethnicity, maternal language, insurance status, birth hospitalization length of stay, medical service, and hepatitis B vaccine receipt. Likelihood of non-completion was greater in the high (77.1%; adjusted odds ratio [AOR] 5.6; 99% confidence interval [CI]: 4.2, 7.4) and medium (52.7%; AOR 1.9; 99% CI: 1.6, 2.2) vs low (38.7%) risk groups in the derivation sample. Similar results were observed in the validation sample. CONCLUSIONS Our prediction model using information readily available in birth hospitalization records consistently identified newborns at high risk for undervaccination. Early identification of high-risk families could be useful for initiating timely, tailored vaccine interventions.
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Affiliation(s)
- Natalia V Oster
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA,Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Administration Puget Sound, Seattle, Washington, USA
| | - Joseph M Unger
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Polly A Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA,Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - M Patricia deHart
- Office of Immunization and Child Profile, Washington State Department of Health, Tumwater, Washington, USA
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle, Washington, USA,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Annika M Hofstetter
- Department of Pediatrics, University of Washington, Seattle, Washington, USA,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, USA,Corresponding Author: Annika M. Hofstetter, MD, PhD, MPH, Seattle Children’s Research Institute, M/S CURE-4, PO Box 5371, Seattle, WA 98145-5005, USA.
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177
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Thompson P. Incomplete Vaccinations: Considering What Comes Before the Model. J Pediatric Infect Dis Soc 2021:piab070. [PMID: 34343325 DOI: 10.1093/jpids/piab070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/22/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Peyton Thompson
- Department of Pediatrics, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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178
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Lerner C, Albertin C, Casillas A, Duru OK, Ong MK, Vangala S, Humiston S, Evans S, Sloyan M, Fox CR, Bogard JE, Friedman S, Szilagyi PG. Patient Portal Reminders for Pediatric Influenza Vaccinations: A Randomized Clinical Trial. Pediatrics 2021; 148:peds.2020-048413. [PMID: 34321338 PMCID: PMC8669575 DOI: 10.1542/peds.2020-048413] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In a large health system, we evaluated the effectiveness of electronic health record patient portal reminders in increasing pediatric influenza vaccination rates. METHODS We conducted an intention-to-treat randomized clinical trial of 22 046 children from 6 months to <18 years of age in 53 primary care practices. Patients (or parent and/or proxies) who were active portal users were randomly assigned to receive reminder messages framed as gains or losses or no messages. They were separately randomly assigned to receive a precommitment message before the influenza season. The primary outcome was receipt of ≥1 seasonal influenza vaccinations. Additionally, children 6 months to <3 years of age due for a second influenza vaccine were randomly assigned to receive a reminder or no reminder for the second vaccination. RESULTS First-dose influenza vaccination rates were 56.9% in the control group, 58.0% in the loss-frame reminders group (P = .07), and 58.0% in the gain-frame group (P = .47). Rates were 58.3% in the precommitment group versus 57.0% in the control group (P = .11). Adjusted risk ratios for first vaccination were 1.02 (95% confidence interval [CI]: 1.00-1.04) for loss-frame reminders, 1.01 (95% CI: 0.98-1.05) for gain-frame reminders, and 1.02 (95% CI: 1.00-1.04) for precommitment messages versus controls. Second-dose vaccination rates were 44.1% in the control group and 55.0% in the reminder group, with an adjusted risk ratio of 1.25 (95% CI: 1.07-1.45). CONCLUSIONS Patient portal reminders for influenza vaccines in children, whether framed as gains or losses, did not increase first-dose influenza vaccination rates but were highly effective for the second dose of the vaccine.
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Affiliation(s)
- Carlos Lerner
- Department of Pediatrics and Mattel Children's Hospital
| | | | | | | | - Michael K. Ong
- Department of Medicine, David Geffen School of Medicine,Department of Health Policy and Management, Jonathan and Karin
Fielding School of Public Health,Department of Medicine, Veterans Affairs Greater Los Angeles
Healthcare System, Los Angeles, California
| | | | - Sharon Humiston
- Department of Medicine, David Geffen School of Medicine,Department of Pediatrics, Children’s Mercy, Kansas City,
Missouri
| | - Sharon Evans
- Information Services and Solutions, University of California, Los
Angeles, Health, Los Angeles, California
| | - Michael Sloyan
- Information Services and Solutions, University of California, Los
Angeles, Health, Los Angeles, California
| | - Craig R. Fox
- Department of Medicine, David Geffen School of Medicine,Anderson School of Management,Department of Psychology, College of Life Sciences, University of
California, Los Angeles, Los Angeles, California
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179
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Adejumo OA, Ogundele OA, Madubuko CR, Oluwafemi RO, Okoye OC, Okonkwo KC, Owolade SS, Junaid OA, Lawal OM, Enikuomehin AC, Ntaji MI, Sokunbi A, Timothy AO, Abolarin OS, Ali EO, Ohaju-Obodo JO. Perceptions of the COVID-19 vaccine and willingness to receive vaccination among health workers in Nigeria. Osong Public Health Res Perspect 2021; 12:236-243. [PMID: 34289295 PMCID: PMC8408417 DOI: 10.24171/j.phrp.2021.0023] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/08/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The study aimed to examine health workers' perceptions of the coronavirus disease 2019 (COVID-19) vaccine in Nigeria and their willingness to receive the vaccine when it becomes available. METHODS This multi-center cross-sectional study used non-probability convenience sampling to enroll 1,470 hospital workers aged 18 and above from 4 specialized hospitals. A structured and validated self-administered questionnaire was used for data collection. Data entry and analysis were conducted using IBM SPSS ver. 22.0. RESULTS The mean age of respondents was 40±6 years. Only 53.5% of the health workers had positive perceptions of the COVID-19 vaccine, and only slightly more than half (55.5%) were willing to receive vaccination. Predictors of willingness to receive the COVID-19 vaccine included having a positive perception of the vaccine (adjusted odds ratio [AOR], 4.55; 95% confidence interval [CI], 3.50-5.69), perceiving a risk of contracting COVID-19 (AOR, 1.50; 95% CI, 1.25-3.98), having received tertiary education (AOR, 3.50; 95% CI, 1.40-6.86), and being a clinical health worker (AOR, 1.25; 95% CI, 1.01-1.68). CONCLUSION Perceptions of the COVID-19 vaccine and willingness to receive the vaccine were sub-optimal among this group. Educational interventions to improve health workers' perceptions and attitudes toward the COVID-19 vaccine are needed.
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Affiliation(s)
| | | | - Cynthia Roli Madubuko
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Nigeria
| | | | | | | | | | | | | | | | - Maureen Iru Ntaji
- Department of Community Medicine, Delta State University, Abraka, Nigeria
| | - Aisha Sokunbi
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Aina Omodele Timothy
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Nigeria
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180
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Cunningham RM, Guffey D, Minard CG, Opel DJ, Boom JA. The effect of screening for vaccine hesitancy on the subsequent development of hesitancy: a randomized controlled trial, Houston, TX. Hum Vaccin Immunother 2021; 17:1994-2000. [PMID: 33499719 DOI: 10.1080/21645515.2020.1859320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Vaccine hesitancy remains a global health threat. Addressing parental vaccine hesitancy is essential to maintaining high vaccine coverage levels and preventing disease outbreaks; however, it is unknown if administering a vaccine hesitancy screening tool negatively impacts parental vaccine beliefs. We conducted a stratified randomized controlled trial in pediatric primary care practices. English-speaking parents ≥18 years of age seeking routine care for infants <3 months of age were eligible. Participants were randomized to receive 1 of 2 surveys - the Parent Attitudes about Childhood Vaccines (PACV) survey or a placebo survey. Six months after initial enrollment, all participants were asked to complete the PACV, regardless of initial randomization group. Our primary outcome was the proportion of hesitant to non-hesitant parents at 6-months between randomization groups. We examined associations between vaccine hesitancy and participant characteristics. We also evaluated the change in the proportion of vaccine-hesitant parents in the PACV group between baseline and 6-month follow up. We enrolled 1705 parents at baseline. At 6-month follow up, 819 parents completed the PACV (50.2% from PACV group vs. 54.1% from placebo group). The proportion of hesitant parents at 6 months did not differ between PACV and placebo groups (6.6% vs. 6.1%; p = .78) and the odds of hesitancy among PACV group participants was not higher than those in the placebo group (OR = 1.10; 95% CI: 0.63-1.93; p = .743). Race was the only characteristic significantly associated with vaccine hesitancy at 6-month follow up (p = .003). Overall, administration of the PACV did not trigger vaccine hesitancy in this study population.
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Affiliation(s)
| | - Danielle Guffey
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Charles G Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Douglas J Opel
- Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA, USA
| | - Julie A Boom
- Immunization Project, Texas Children's Hospital, Houston, TX, USA.,Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
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181
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Daley MF, Reifler LM, Shoup JA, Narwaney KJ, Kharbanda EO, Groom HC, Jackson ML, Jacobsen SJ, McLean HQ, Klein NP, Williams JTB, Weintraub ES, McNeil MM, Glanz JM. Temporal Trends in Undervaccination: A Population-Based Cohort Study. Am J Prev Med 2021; 61:64-72. [PMID: 34148627 PMCID: PMC8899861 DOI: 10.1016/j.amepre.2021.01.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/28/2020] [Accepted: 01/20/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Monitoring the trends in undervaccination, including that because of parental vaccine refusal or delay, can inform public health responses directed at improving vaccine confidence and vaccination coverage. METHODS A retrospective cohort study was conducted in the Vaccine Safety Datalink. The cohort included all children born in 2004-2017 with ≥3 well-child visits between ages 2 and 23 months. Using electronic health record-based vaccination data, the average days undervaccinated was calculated for each child. Undervaccination patterns were assessed through age 23 months. Temporal trends were inspected for inflection points and were analyzed using linear regression. Nested within the cohort study, a survey was conducted to compare parent reports of vaccine refusal or delay with observed vaccination patterns. Data were analyzed in 2020. RESULTS The study cohort consisted of 808,170 children. The percentage of children with average days undervaccinated=0 (fully vaccinated, no delays) rose from a nadir of 47.1% for the birth year 2008 to 68.4% for the birth year 2017 (ptrend<0.001). The percentage with no vaccines rose from 0.35% for the birth year 2004 to 1.28% for the birth year 2017 (ptrend<0.001). Consistent vaccine limiting was observed in 2.04% for the birth year 2017. Omission of measles, mumps, and rubella vaccine peaked at 4.76% in the birth year 2007 and declined thereafter (ptrend<0.001). On the parent survey (response rate 60.2%), a high proportion of parents of the most undervaccinated children reported refusing or delaying vaccines. CONCLUSIONS In a 14-year cohort study, vaccination timeliness has improved. However, the small but increasing number of children who received no vaccines by age 23 months warrants additional attention.
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Affiliation(s)
- Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus Aurora, Colorado.
| | - Liza M Reifler
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Komal J Narwaney
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | | | - Holly C Groom
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | - Huong Q McLean
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, California
| | - Joshua T B Williams
- Department of General Pediatrics, Denver Health and Hospitals, Denver, Colorado
| | - Eric S Weintraub
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael M McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
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182
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Gidengil C, Goetz MB, Newberry S, Maglione M, Hall O, Larkin J, Motala A, Hempel S. Safety of vaccines used for routine immunization in the United States: An updated systematic review and meta-analysis. Vaccine 2021; 39:3696-3716. [PMID: 34049735 DOI: 10.1016/j.vaccine.2021.03.079] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Understanding the safety of vaccines is critical to inform decisions about vaccination. Our objective was to conduct a systematic review of the safety of vaccines recommended for children, adults, and pregnant women in the United States. METHODS We searched the literature in November 2020 to update a 2014 Agency for Healthcare Research and Quality review by integrating newly available data. Studies of vaccines that used a comparator and reported the presence or absence of key adverse events were eligible. Adhering to Evidence-based Practice Center methodology, we assessed the strength of evidence (SoE) for all evidence statements. The systematic review is registered in PROSPERO (CRD42020180089). RESULTS Of 56,603 reviewed citations, 338 studies reported in 518 publications met inclusion criteria. For children, SoE was high for no increased risk of autism following measles, mumps, and rubella (MMR) vaccine. SoE was high for increased risk of febrile seizures with MMR. There was no evidence of increased risk of intussusception with rotavirus vaccine at the latest follow-up (moderate SoE), nor of diabetes (high SoE). There was no evidence of increased risk or insufficient evidence for key adverse events for newer vaccines such as 9-valent human papillomavirus and meningococcal B vaccines. For adults, there was no evidence of increased risk (varied SoE) or insufficient evidence for key adverse events for the new adjuvanted inactivated influenza vaccine and recombinant adjuvanted zoster vaccine. We found no evidence of increased risk (varied SoE) for key adverse events among pregnant women following tetanus, diphtheria, and acellular pertussis vaccine, including stillbirth (moderate SoE). CONCLUSIONS Across a large body of research we found few associations of vaccines and serious key adverse events; however, rare events are challenging to study. Any adverse events should be weighed against the protective benefits that vaccines provide.
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Affiliation(s)
- Courtney Gidengil
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA 02116, United States; Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Matthew Bidwell Goetz
- VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90073, United States
| | - Sydne Newberry
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Margaret Maglione
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Owen Hall
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Jody Larkin
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Aneesa Motala
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States; Southern California Evidence Review Center, University of Southern California, Keck School of Medicine, 2001 N Soto Street, Los Angeles, CA 90033, United States
| | - Susanne Hempel
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States; Southern California Evidence Review Center, University of Southern California, Keck School of Medicine, 2001 N Soto Street, Los Angeles, CA 90033, United States
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183
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Rand CM, Humiston SG. Provider Focused Interventions to Improve Child and Adolescent Vaccination Rates. Acad Pediatr 2021; 21:S34-S39. [PMID: 33958090 DOI: 10.1016/j.acap.2021.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Cynthia M Rand
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry (CM Rand), Rochester, NY.
| | - Sharon G Humiston
- Department of Pediatrics, University of Missouri Kansas City School of Medicine and Children's Mercy Kansas City (SG Humiston), Mo
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184
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Hackell J, Edwards K. Encouraging Vaccine Confidence in Clinical Practice Settings. Acad Pediatr 2021; 21:S48-S49. [PMID: 33958092 DOI: 10.1016/j.acap.2020.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/26/2020] [Accepted: 10/31/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Jesse Hackell
- Department of Pediatrics (J Hackell), New York Medical College, Pomona Pediatrics, A Division of Boston Children's Health Physicians, Pomona, NY.
| | - Kathryn Edwards
- Division of Infectious Diseases (K Edwards), Vanderbilt University Medical Center, Nashville, Tenn
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185
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Limaye RJ, Opel DJ, Dempsey A, Ellingson M, Spina C, Omer SB, Dudley MZ, Salmon DA, Leary SO. Communicating With Vaccine-Hesitant Parents: A Narrative Review. Acad Pediatr 2021; 21:S24-S29. [PMID: 33958087 DOI: 10.1016/j.acap.2021.01.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/21/2021] [Accepted: 01/29/2021] [Indexed: 01/04/2023]
Abstract
Although vaccines are considered one of the most effective medical interventions to prevent vaccine preventable disease and associated morbidity and mortality, a number of recent outbreaks are threatening the gains made by vaccines. Vaccine hesitancy is a key driver of vaccine refusal and has been associated with vaccine preventable outbreaks. While parents seek information from many sources to inform their vaccine decision-making process, they continue to view their child's pediatric provider as a trusted source of vaccine information. The communication that occurs between a provider and parent with regards to vaccination is critical in reducing concerns and nudging parents toward vaccine acceptance. However, vaccine-hesitant parents raise issues in this encounter that many providers feel ill-equipped to answer, due to lack of training on evidence-based communication strategies. We focus on promising approaches related to patient-provider communication within the context of vaccination. We found empirical evidence that the use of a presumptive format to recommend vaccines, motivational interviewing, and tailoring information to increase message salience are approaches that can positively affect vaccine acceptance. As providers continue to serve as important influencers in the vaccine decision-making process, it is evident that there is a need to continue to identify evidence-based, and practically implementable approaches to mitigate parental vaccine hesitancy. Providers play a key role in improving coverage rates, and therefore it is paramount to seek ways to improve how providers communicate about vaccines.
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Affiliation(s)
- Rupali J Limaye
- Johns Hopkins Bloomberg School of Public Health (RJ Limaye, MZ Dudley, and DA Salmon), Baltimore, Md.
| | | | - Amanda Dempsey
- University of Colorado Denver (A Dempsey, C Spina, and SO Leary), Denver, Colo
| | | | - Christine Spina
- University of Colorado Denver (A Dempsey, C Spina, and SO Leary), Denver, Colo
| | - Saad B Omer
- Yale School of Medicine (M Ellingson and SB Omer), New Haven, Conn
| | - Matthew Z Dudley
- Johns Hopkins Bloomberg School of Public Health (RJ Limaye, MZ Dudley, and DA Salmon), Baltimore, Md
| | - Daniel A Salmon
- Johns Hopkins Bloomberg School of Public Health (RJ Limaye, MZ Dudley, and DA Salmon), Baltimore, Md
| | - Sean O Leary
- University of Colorado Denver (A Dempsey, C Spina, and SO Leary), Denver, Colo
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186
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Kempe A, Stockwell MS, Szilagyi P. The Contribution of Reminder-Recall to Vaccine Delivery Efforts: A Narrative Review. Acad Pediatr 2021; 21:S17-S23. [PMID: 33958086 DOI: 10.1016/j.acap.2021.02.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 12/27/2022]
Abstract
Reminders, alerting patients to the need for vaccines that will be due in the future, and recall messages, informing patients about vaccines that are overdue, have been shown to improve immunization rates for children and adolescents in numerous systematic reviews. Therefore, reminder and recall interventions (R/R) are recommended by the Task Force on Community Preventive Services for increasing immunization rates on the basis of strong evidence. R/R messages can be delivered by mail (letter or postcard), via personal or auto-dialer phone calls, by text or e-mail or via patient-portals and can simply be alerts to action or can include educational material with the aim of motivating patients to seek vaccination. R/R has also been shown to be a relatively low-cost intervention with high cost-effectiveness compared with other recommended strategies. However, although R/R as a strategy is consistently effective and cost-effective overall, there is wide variation in the impact of R/R by 1) modality of how it is delivered, 2) the targeted vaccine, 3) the age group, and 4) whether the R/R is conducted centrally by a health system or Immunization Information System or by individual practices. This narrative review summarizes the literature about effectiveness of R/R within each of these categories. We also discuss limitations of R/R, with a focus on the potential impact of parental vaccine hesitancy in blunting its effectiveness and problems with data integrity, on which R/R relies. We also discuss challenges to sustaining R/R efforts, including potential methods of funding for R/R efforts.
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Affiliation(s)
- Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe), Aurora, Colo; Department of Pediatrics, University of Colorado School of Medicine (A Kempe), Aurora, Colo.
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center (MS Stockwell), New York, NY; Department of Population and Family Health, Columbia University Irving Medical Center (MS Stockwell), New York, NY
| | - Peter Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles (P Szilagyi)
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187
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Daley MF, Glanz JM. Using Social Media to Increase Vaccine Acceptance. Acad Pediatr 2021; 21:S32-S33. [PMID: 33958089 DOI: 10.1016/j.acap.2020.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/19/2020] [Accepted: 10/31/2020] [Indexed: 10/21/2022]
Affiliation(s)
- Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado (MF Daley and JM Glanz), Aurora, Colo; Department of Pediatrics, University of Colorado School of Medicine (MF Daley), Aurora, Colo.
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado (MF Daley and JM Glanz), Aurora, Colo; Colorado School of Public Health, University of Colorado Denver (JM Glanz), Aurora, Colo
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188
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Bass SB, Wilson-Genderson M, Garcia DT, Akinkugbe AA, Mosavel M. SARS-CoV-2 Vaccine Hesitancy in a Sample of US Adults: Role of Perceived Satisfaction With Health, Access to Healthcare, and Attention to COVID-19 News. Front Public Health 2021; 9:665724. [PMID: 33996731 PMCID: PMC8116504 DOI: 10.3389/fpubh.2021.665724] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/06/2021] [Indexed: 01/17/2023] Open
Abstract
Understanding which communities are most likely to be vaccine hesitant is necessary to increase vaccination rates to control the spread of SARS-CoV-2. This cross-sectional survey of adults (n = 501) from three cities in the United States (Miami, FL, New York City, NY, San Francisco, CA) assessed the role of satisfaction with health and healthcare access and consumption of COVID-19 news, previously un-studied variables related to vaccine hesitancy. Multilevel logistic regression tested the relationship between vaccine hesitancy and study variables. Thirteen percent indicated they would not get vaccinated. Black race (OR 2.6; 95% CI: 1.38–5.3), income (OR = 0.64; 95% CI: 0.50–0.83), inattention to COVID-19 news (OR = 1.6; 95% CI: 1.1–2.5), satisfaction with health (OR 0.72; 95% CI: 0.52–0.99), and healthcare access (OR = 1.7; 95% CI: 1.2–2.7) were associated with vaccine hesitancy. Public health officials should consider these variables when designing public health communication about the vaccine to ensure better uptake.
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Affiliation(s)
- Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA, United States
| | - Maureen Wilson-Genderson
- Siminoff Research Group, Temple University College of Public Health, Philadelphia, PA, United States
| | - Dina T Garcia
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, United States
| | - Aderonke A Akinkugbe
- Department of Dental Public Health and Policy, Virginia Commonwealth University, Richmond, VA, United States
| | - Maghboeba Mosavel
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, United States
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189
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Reno C, Maietti E, Fantini MP, Savoia E, Manzoli L, Montalti M, Gori D. Enhancing COVID-19 Vaccines Acceptance: Results from a Survey on Vaccine Hesitancy in Northern Italy. Vaccines (Basel) 2021; 9:378. [PMID: 33924534 PMCID: PMC8070202 DOI: 10.3390/vaccines9040378] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/09/2021] [Accepted: 04/11/2021] [Indexed: 11/16/2022] Open
Abstract
In March 2021, the coronavirus disease 2019 (COVID-19) pandemic still poses a threat to the global population, and is a public health challenge that needs to be overcome. Now more than ever, action is needed to tackle vaccine hesitancy, especially in light of the availability of effective and safe vaccines. A cross-sectional online survey was carried out on a representative random sample of 1011 citizens from the Emilia-Romagna region, in Italy, in January 2021. The questionnaire collected information on socio-demographics, comorbidities, past vaccination refusal, COVID-19-related experiences, risk perception of infection, and likelihood to accept COVID-19 vaccination. Multiple logistic regression analyses and classification tree analyses were performed to identify significant predictors of vaccine hesitancy and to distinguish groups with different levels of hesitancy. Overall, 31.1% of the sample reported hesitancy. Past vaccination refusal was the key discriminating variable followed by perceived risk of infection. Other significant predictors of hesitancy were: ages between 35 and 54 years, female gender, low educational level, low income, and absence of comorbidities. The most common concerns about the COVID-19 vaccine involved safety (54%) and efficacy (27%). Studying the main determinants of vaccine hesitancy can help with targeting vaccination strategies, in order to gain widespread acceptance-a key path to ensure a rapid way out of the current pandemic emergency.
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Affiliation(s)
- Chiara Reno
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy; (C.R.); (M.P.F.); (M.M.); (D.G.)
| | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy; (C.R.); (M.P.F.); (M.M.); (D.G.)
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy; (C.R.); (M.P.F.); (M.M.); (D.G.)
| | - Elena Savoia
- Emergency Preparedness Research Evaluation & Practice (EPREP) Program, Division of Policy Translation & Leadership Development, Harvard T.H. Chan School of Public Health, Boston, MA 01451, USA;
| | - Lamberto Manzoli
- Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64B, 44121 Ferrara, Italy;
| | - Marco Montalti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy; (C.R.); (M.P.F.); (M.M.); (D.G.)
| | - Davide Gori
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy; (C.R.); (M.P.F.); (M.M.); (D.G.)
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190
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Would Parents Get Their Children Vaccinated Against SARS-CoV-2? Rate and Predictors of Vaccine Hesitancy According to a Survey over 5000 Families from Bologna, Italy. Vaccines (Basel) 2021; 9:vaccines9040366. [PMID: 33920109 PMCID: PMC8069076 DOI: 10.3390/vaccines9040366] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 12/24/2022] Open
Abstract
In the near future, COVID-19 vaccine efficacy trials in larger cohorts may offer the possibility to implement child and adolescent vaccination. The opening of the vaccination for these strata may play a key role in order to limit virus circulation, infection spreading towards the most vulnerable subjects, and plan safe school reopening. Vaccine hesitancy (VH) could limit the ability to reach the coverage threshold required to ensure herd immunity. The aim of this study was to investigate the prevalence and determinants of VH among parents/guardians toward a potentially available COVID-19 vaccination for children and adolescents. An online survey was performed in parents/guardians of children aged <18 years old, living in Bologna. Overall, 5054 questionnaires were collected. A vast majority (60.4%) of the parents/guardians were inclined to vaccinate, while 29.6% were still considering the opportunity, and 9.9% were hesitant. Highest vaccine hesitancy rates were detected in female parents/guardians of children aged 6–10 years, ≤29 years old, with low educational level, relying on information found in the web/social media, and disliking mandatory vaccination policies. Although preliminary, these data could help in designing target strategies to implement adherence to a vaccination campaign, with special regard to web-based information.
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191
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Sturm L, Kasting ML, Head KJ, Hartsock JA, Zimet GD. Influenza vaccination in the time of COVID-19: A national U.S. survey of adults. Vaccine 2021; 39:1921-1928. [PMID: 33715898 PMCID: PMC7931729 DOI: 10.1016/j.vaccine.2021.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Decisions about influenza vaccination for fall-winter 2020 were made against the backdrop of the COVID-19 pandemic. During May 2020, the authors examined intended vaccination in the next 12 months in relationship to demographic variables, healthcare attitudes, and personal COVID-19 experiences for two samples of adults--those who did not receive influenza vaccine during the prior 12 months, and those who did. METHODS In May 2020, a cross-sectional online survey was conducted with a national US sample. Participants reported prior influenza vaccination (yes/no during prior 12 months) and anticipated vaccination (yes/no during next 12 months). Covariates included demographic characteristics (e.g., gender, race-ethnicity, political ideology), general beliefs (e.g., benefits of vaccines, altruistic attitudes), and COVID-19 health beliefs and experiences (COVID-19 worry and severity, perception of COVID-19 as a community threat, knowing someone with COVID-19). For each group, hierarchical multivariable logistic regression was conducted with intent to vaccinate as the outcome. RESULTS Among participants (n = 3502), 47% did not receive influenza vaccine in the prior 12 months and 53% had; 25.5% of non-vaccinators and 91.9% of vaccinators intended future vaccination. For non-vaccinators, odds of intending vaccination was associated with race/ethnicity (Hispanics were more likely to intend than white-NH; AOR = 1.74; 95% CI = 1.23-2.4), greater perceived benefits of vaccination (AOR = 2.19; 95% CI = 1.88-2.54), and perception of COVID-19 as a community threat (AOR = 1.91; 95% CI = 1.49-2.45). For vaccinators, odds of intending vaccination was associated with age (AOR = 1.04; 95% CI = 1.03-1.05), race/ethnicity (Black-NH and Other-NH were less likely to intend than white-NH, AOR = 0.60; 95% CI = 0.36-0.999; and AOR = 0.45; 95% CI = 0.24-0.84, respectively), greater perceived benefits of vaccination (AOR = 1.88; 95% CI = 1.45-2.45) and greater perception of collective benefits of vaccines (AOR = 1.48; 95% CI = 1.15-1.90). CONCLUSIONS The COVID-19 pandemic may have served as a cue to action for influenza vaccination intention among some prior non-vaccinators whereas intention among prior vaccinators is more related to positive attitudes toward vaccination.
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Affiliation(s)
- Lynne Sturm
- Indiana University School of Medicine, Department of Pediatrics, Suite 3120 Riley Pediatric Care Center, 1002 Wishard Boulevard, Indianapolis, IN 46202, USA.
| | - Monica L Kasting
- Purdue University, Department of Public Health, Matthews Hall 216, 812 W. State Street, West Lafayette, IN 47907, USA.
| | - Katharine J Head
- Indiana University, Purdue University Indianapolis, Department of Communication Studies, 307C Cavanaugh Hall, 425 University Blvd, Indianapolis, IN, 46202 USA.
| | - Jane A Hartsock
- Indiana University Health, 1800 N. Capitol Ave., Noyes Pavilion Suite E644, Indianapolis, IN 46202, USA.
| | - Gregory D Zimet
- Indiana University School of Medicine, Department of Pediatrics, 410 W. 10th Street. Ste 1001, Indianapolis, IN 46202, USA.
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Hetherington E, Edwards SA, MacDonald SE, Racine N, Madigan S, McDonald S, Tough S. SARS-CoV-2 vaccination intentions among mothers of children aged 9 to 12 years: a survey of the All Our Families cohort. CMAJ Open 2021; 9:E548-E555. [PMID: 34021012 PMCID: PMC8177949 DOI: 10.9778/cmajo.20200302] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Acceptance of a vaccine against SARS-CoV-2 is critical to achieving high levels of immunization. The objectives of this study were to understand mothers' SARS-CoV-2 vaccine intentions to explore reasons for and against SARS-CoV-2 vaccination. METHODS Participants from the All Our Families pregnancy longitudinal cohort whose children had reached ages 9-12 years were invited in May-June 2020 to complete a survey on the impact of COVID-19. The survey covered topics about the impact of the pandemic and included 2 specific questions on mothers' intentions to vaccinate their child against SARS-CoV-2. Current responses were linked to previously collected data, including infant vaccine uptake. Multinomial regression models were run to estimate associations between demographic factors, past vaccination status and vaccination intention. Qualitative responses regarding factors affecting decision-making were analyzed thematically. RESULTS The response rate was 53.8% (1321/2455). A minority of children of participants had partial or no vaccinations at age 2 (n = 200, 15.1%). A total of 60.4% of mothers (n = 798) intended to vaccinate their children with the SARS-CoV-2 vaccine, 8.6% (n = 113) did not intend to vaccinate and 31.0% (n = 410) were unsure. Lower education, lower income and incomplete vaccination history were inversely associated with intention to vaccinate. Thematic analysis of qualitative responses showed 10 themes, including safety and efficacy, long-term effects and a rushed process. INTERPRETATION Within a cohort with historically high infant vaccination, a third of mothers remained unsure about vaccinating their children against SARS-CoV-2. Given the many uncertainties about future SARS-CoV-2 vaccines, clear communication regarding safety will be critical to ensuring vaccine uptake.
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Affiliation(s)
- Erin Hetherington
- Department of Obstetrics and Gynaecology (Hetherington), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Community Health Sciences (Edwards, Tough), Cumming School of Medicine, University of Calgary; Department of Pediatrics (MacDonald, McDonald, Tough), Cumming School of Medicine, University of Calgary; Faculty of Nursing (MacDonald), University of Alberta; Department of Psychology (Racine, Madigan, Tough), University of Calgary; Alberta Children's Hospital Research Institute (Racine, Madigan), Calgary, Alta.
| | - Sarah A Edwards
- Department of Obstetrics and Gynaecology (Hetherington), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Community Health Sciences (Edwards, Tough), Cumming School of Medicine, University of Calgary; Department of Pediatrics (MacDonald, McDonald, Tough), Cumming School of Medicine, University of Calgary; Faculty of Nursing (MacDonald), University of Alberta; Department of Psychology (Racine, Madigan, Tough), University of Calgary; Alberta Children's Hospital Research Institute (Racine, Madigan), Calgary, Alta
| | - Shannon E MacDonald
- Department of Obstetrics and Gynaecology (Hetherington), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Community Health Sciences (Edwards, Tough), Cumming School of Medicine, University of Calgary; Department of Pediatrics (MacDonald, McDonald, Tough), Cumming School of Medicine, University of Calgary; Faculty of Nursing (MacDonald), University of Alberta; Department of Psychology (Racine, Madigan, Tough), University of Calgary; Alberta Children's Hospital Research Institute (Racine, Madigan), Calgary, Alta
| | - Nicole Racine
- Department of Obstetrics and Gynaecology (Hetherington), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Community Health Sciences (Edwards, Tough), Cumming School of Medicine, University of Calgary; Department of Pediatrics (MacDonald, McDonald, Tough), Cumming School of Medicine, University of Calgary; Faculty of Nursing (MacDonald), University of Alberta; Department of Psychology (Racine, Madigan, Tough), University of Calgary; Alberta Children's Hospital Research Institute (Racine, Madigan), Calgary, Alta
| | - Sheri Madigan
- Department of Obstetrics and Gynaecology (Hetherington), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Community Health Sciences (Edwards, Tough), Cumming School of Medicine, University of Calgary; Department of Pediatrics (MacDonald, McDonald, Tough), Cumming School of Medicine, University of Calgary; Faculty of Nursing (MacDonald), University of Alberta; Department of Psychology (Racine, Madigan, Tough), University of Calgary; Alberta Children's Hospital Research Institute (Racine, Madigan), Calgary, Alta
| | - Sheila McDonald
- Department of Obstetrics and Gynaecology (Hetherington), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Community Health Sciences (Edwards, Tough), Cumming School of Medicine, University of Calgary; Department of Pediatrics (MacDonald, McDonald, Tough), Cumming School of Medicine, University of Calgary; Faculty of Nursing (MacDonald), University of Alberta; Department of Psychology (Racine, Madigan, Tough), University of Calgary; Alberta Children's Hospital Research Institute (Racine, Madigan), Calgary, Alta
| | - Suzanne Tough
- Department of Obstetrics and Gynaecology (Hetherington), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Community Health Sciences (Edwards, Tough), Cumming School of Medicine, University of Calgary; Department of Pediatrics (MacDonald, McDonald, Tough), Cumming School of Medicine, University of Calgary; Faculty of Nursing (MacDonald), University of Alberta; Department of Psychology (Racine, Madigan, Tough), University of Calgary; Alberta Children's Hospital Research Institute (Racine, Madigan), Calgary, Alta
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193
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Wei Z, Sun X, Yang Y, Zhan S, Fu C. Seasonal influenza vaccine hesitancy profiles and determinants among Chinese children's guardians and the elderly. Expert Rev Vaccines 2021; 20:601-610. [PMID: 33792476 DOI: 10.1080/14760584.2021.1908134] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Seasonal influenza vaccine coverage remains low in China due to possible influenza vaccine hesitancy (IVH) and practical issues. We sought to investigate IVH and its determinants among children's guardians and the elderly for a better understanding of the situation and for future intervention. METHODS We performed two cross-sectional studies to identify the profiles and determinants of IVH using stratified cluster random sampling in an eastern China province in 2019. RESULTS Of the 1564 guardians and 522 elders, 43.2% (95%CI: 40.4-46.0%) of guardians and 33.5% of elders (95%CI: 29.5-37.6%) had IVH. 'From rural area' (odds ratio: 1.36), 'don't know government recommendation for flu vaccination' (1.39), 'don't know flu vaccine is vaccinated annually' (1.93), and 'family members (0.22), friends and neighbors had positive attitude toward flu vaccine' (0.58) were related factors of the guardians' IVH. 'Aged 70-79 years' (0.46), 'had flu before' (0.35) and 'once had been vaccinated' (0.42) were related to the elderly's IVH. CONCLUSION Poor awareness of influenza and vaccination, relatives' negative/positive attitude, lack of government recommendations, anxiety about vaccine quality, and practical issues such as short supply are related to IVH in China. Precision education aimed at hesitancy in wider groups is anticipated to increase vaccine confidence and coverage in influenza-vulnerable groups.
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Affiliation(s)
- Zheng Wei
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiu Sun
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yingying Yang
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Siyi Zhan
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chuanxi Fu
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
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194
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Vaccine Hesitancy: COVID-19 and Influenza Vaccine Willingness among Parents in Wuxi, China-A Cross-Sectional Study. Vaccines (Basel) 2021; 9:vaccines9040342. [PMID: 33916277 PMCID: PMC8066309 DOI: 10.3390/vaccines9040342] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/11/2021] [Accepted: 03/22/2021] [Indexed: 12/21/2022] Open
Abstract
Objectives: We aimed to (1) assess parental hesitancy about category A (Expanded Program on Immunization (EPI)) and B (non-EPI) vaccines, (2) assess parental willingness for COVID-19 and influenza vaccinations, and (3) explore the association of vaccination hesitancy of parents and healthcare workers (HCWs). Methods: The study was performed in Wuxi, eastern China between 21 September 2020 and 17 October 2020. Parents of children aged <18 years and HCWs were recruited from the selected immunization clinics. Vaccine hesitancy was assessed using the Strategic Advisory Group of Experts (SAGE) vaccine hesitancy survey (VHS) by summing the total score for 10 items (maximum 50 points). Results: A total of 3009 parents and 86 HCWs were included in the analysis. The category A VHS scores were significantly higher than the category B VHS scores (p = 0.000). Overall, 59.3% and 52.4% of parents reported willingness to avail COVID-19 and influenza vaccination for their children, respectively; 51.2% of the HCWs wanted to be vaccinated against COVID-19. Parental category B VHS scores were associated with HCW category B VHS scores (r = 0.928, p = 0.008). Conclusions: In China, parents are more hesitant about category B vaccines than category A vaccines. More than 40% of parents showed hesitancy and a refusal to use COVID-19 and influenza vaccines.
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195
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Joining the herd? U.S. public opinion and vaccination requirements across educational settings during the COVID-19 pandemic. Vaccine 2021; 39:2375-2385. [PMID: 33810906 PMCID: PMC7985928 DOI: 10.1016/j.vaccine.2021.03.055] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 12/19/2022]
Abstract
With effective and safe COVID-19 vaccines beginning to be distributed across the United States, questions about who should receive the vaccine first have been the focus of public discussions. Yet, over the long-term, questions about the order of distribution will be displaced by questions about how to achieve high levels of vaccination rates. Historically, absent incentives or mandates, Americans have shown ambivalence, if not general antipathy, towards vaccinations, and vaccination rates have generally been low for many vaccines. There is evidence that vaccination requirements across educational settings are an effective policy instrument to increase vaccination rates. We administered a large national survey to assess American's attitudes towards vaccination requirements across three educational settings (daycare, K-12 schools, and universities) in general and for COVID-19 specifically. Partisanship, gender, race, rurality, and perceptions about the appropriate role schools should play in providing health services are substantive predictors of public opinion. While Americans generally support vaccination mandates across all three settings for both types of requirements, support is consistently and significantly lower for COVID19 requirements. The effect of partisanship is accentuated for COVID-19 requirements as compared to general requirements. Drop off in support between general and COVID-19 specific requirements are driven by partisanship, gender, political knowledge, rurality, and having children in the household. Nonetheless, mandates are supported by a majority of Americans. Assessing Americans' opinions of vaccination requirements in educational settings offers an important opportunity to explore the potential of mandates as policy instrument in the government's arsenal against COVID-19 and guide public policy on the issues.
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196
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A validated modification of the vaccine hesitancy scale for childhood, influenza and HPV vaccines. Vaccine 2021; 39:1831-1839. [PMID: 33676784 DOI: 10.1016/j.vaccine.2021.02.039] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Vaccine hesitancy contributes to outbreaks of preventable disease worldwide. The Vaccine Hesitancy Scale (VHS), developed by the international WHO SAGE Working Group, has been validated previously for measuring hesitancy towards childhood vaccines; some psychometric properties were suboptimal. METHODS We collected data using large, nationally-representative samples of parents in the U.S. We adapted the VHS items, and additional hesitancy items, to assess hesitancy towards influenza and HPV vaccines in addition to routine childhood vaccines. We then used exploratory and confirmatory factor analysis to identify latent constructs and create modified scales for childhood (VHS-child), influenza (VHS-flu) and HPV (VHS-HPV) vaccines with improved psychometric properties. Finally, we compared hesitancy scores on the VHS-child, VHS-flu, and VHS-HPV, to self-reported receipt of each vaccine category, and compared subscale scores to assess whether drivers of hesitancy differed by vaccine category. RESULTS 2052 parents of children <18 years old completed the VHS-child and VHS-flu while 2020 parents of adolescents completed the VHS-HPV. A two-factor structure of 'risks' and a 'lack of confidence' was found for each vaccine category. Slight modifications to the VHS improved psychometric properties. Hesitancy was strongly associated with vaccine receipt: e.g., 76% of parents not hesitant towards influenza vaccine had vaccinated their child the past season, versus 9% of hesitant parents (p < 0.0001). Subscale scores also differed significantly between vaccines: lack of confidence was greater towards influenza (Median (IQR): 2.0 (1.2, 3.3)) and HPV (2.0 (1.3, 3.0)) vaccines than childhood (1.2 (1.0, 1.8), p < 0.0001 for both) vaccines; perceived risks of HPV vaccines (2.7 (1.7, 3.7)) were greater than for childhood vaccines (2.0 (1.3, 3.0), p < 0.0001). CONCLUSIONS Our modified VHS scales perform well psychometrically and allow for consistent measurement of the extent and reasons for hesitancy between vaccine categories. We suggest that future work use these scales to examine hesitancy towards other vaccines and to monitor hesitancy over time.
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197
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Hamadah RE, Hussain AN, Alsoghayer NA, Alkhenizan ZA, Alajlan HA, Alkhenizan AH. Attitude of parents towards seasonal influenza vaccination for children in Saudi Arabia. J Family Med Prim Care 2021; 10:904-909. [PMID: 34041096 PMCID: PMC8138418 DOI: 10.4103/jfmpc.jfmpc_1602_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/05/2020] [Accepted: 11/24/2020] [Indexed: 01/28/2023] Open
Abstract
Introduction: The aim of this study is to assess attitudes, beliefs, and behavior towards seasonal influenza vaccination for children among parents in Saudi Arabia and to correlate parental demographic characteristics with hesitancy. Methodology: This is a cross-sectional study conducted in the Family Medicine clinics linked to a tertiary referral hospital in Riyadh. Inclusion criteria were: being a parent, having a child aged six months to 14 years whom is following at that hospital, and living in Saudi Arabia. The Parent Attitudes about Childhood Vaccines (PACV) survey was used for data collection. Demographic questions were added. Results: The number of participants was 388. Out of these, 298 (76.8%) parents were not hesitant for their child to get vaccinated. Whereas 90 (23.2%) parents were hesitant. Parental gender and age were the only demographic factors found to have a statistically significant impact on their hesitant behavior. For the influenza season of 2018–2019, 148 (38.14%) children received the influenza vaccine. The most common reason for not receiving it was the belief that the vaccine is not necessary. While 25 (27.78%) of the 90 parents who were hesitant allowed their child to get vaccinated, 123 (41.28%) of the 298 parents who were not hesitant allowed their child to get vaccinated, creating a statistically significant difference (p = 0.0255). Conclusion: Despite the overall positive attitude and low hesitancy, the vaccine uptake was low. Improving access, education about the importance of the vaccine, advocacy from doctors, and correction of misconceptions about it will facilitate an increase in the uptake.
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Affiliation(s)
- Reem E Hamadah
- Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Aneela N Hussain
- Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | | | - Haya A Alajlan
- College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Abdullah H Alkhenizan
- Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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198
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Goldman RD, McGregor S, Marneni SR, Katsuta T, Griffiths MA, Hall JE, Seiler M, Klein EJ, Cotanda CP, Gelernter R, Hoeffe J, Davis AL, Gualco G, Mater A, Manzano S, Thompson GC, Ahmed S, Ali S, Brown JC. Willingness to Vaccinate Children against Influenza after the Coronavirus Disease 2019 Pandemic. J Pediatr 2021; 228:87-93.e2. [PMID: 32771480 PMCID: PMC7410815 DOI: 10.1016/j.jpeds.2020.08.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 07/24/2020] [Accepted: 08/04/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To determine factors associated with parents who plan to vaccinate their children against influenza next year, especially those who did not vaccinate against influenza last year using a global survey. STUDY DESIGN A survey of caregivers accompanying their children aged 1-19 years old in 17 pediatric emergency departments in 6 countries at the peak of the coronavirus disease 2019 (COVID-19) pandemic. Anonymous online survey included caregiver and child demographic information, vaccination history and future intentions, and concern about the child and caregiver having COVID-19 at the time of emergency department visit. RESULTS Of 2422 surveys, 1314 (54.2%) caregivers stated they plan to vaccinate their child against influenza next year, an increase of 15.8% from the previous year. Of 1459 caregivers who did not vaccinate their children last year, 418 (28.6%) plan to do so next year. Factors predicting willingness to change and vaccinate included child's up-to-date vaccination status (aOR 2.03, 95% CI 1.29-3.32, P = .003); caregivers' influenza vaccine history (aOR 3.26, 95% CI 2.41-4.40, P < .010), and level of concern their child had COVID-19 (aOR 1.09, 95% CI 1.01-1.17, P = .022). CONCLUSIONS Changes in risk perception due to COVID-19, and previous vaccination, may serve to influence decision-making among caregivers regarding influenza vaccination in the coming season. To promote influenza vaccination among children, public health programs can leverage this information.
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Affiliation(s)
- Ran D. Goldman
- The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Sophie McGregor
- The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Shashidhar R. Marneni
- Division of Pediatric Emergency Medicine, Children's Medical Center of Dallas, UT Southwestern Medical Center, Dallas, TX
| | - Tomohiro Katsuta
- Division of Critical Care, Department of Pediatrics, St. Marianna University School of Medicine, Tokyo, Japan
| | - Mark A. Griffiths
- Division of Pediatric Emergency Medicine, Children's Healthcare of Atlanta, Emory School of Medicine, Atlanta, GA
| | - Jeanine E. Hall
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA
| | - Michelle Seiler
- Emergency Department, University Children's Hospital Zurich, Zurich, Switzerland
| | - Eileen J. Klein
- Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA
| | | | - Renana Gelernter
- Pediatric Emergency Medicine Unit, Shamir Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Julia Hoeffe
- Pediatric Emergency Medicine, Inselspital University Hospital of Bern, Bern, Switzerland
| | - Adrienne L. Davis
- Pediatric Emergency Medicine, Hospital for Sick Children and University of Toronto, Ontario, Canada
| | - Gianluca Gualco
- Pediatric Emergency Department, Pediatric Institute of Italian part of Switzerland, Ticino, Switzerland
| | - Ahmed Mater
- Pediatric Emergency Medicine, Jim Pattison Children's Hospital, and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sergio Manzano
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Graham C. Thompson
- Pediatrics and Emergency Medicine, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Sara Ahmed
- Department of Emergency Medicine, Mary Bridge Children's Hospital, Tacoma, WA
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Julie C. Brown
- Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA
| | - International COVID-19 Parental Attitude Study (COVIPAS) GroupAhmedSarahDrMDAliSaminaDrMDCM, FRCPCBrownJulie C.DrMDCraigSimonDrMBBS, FACEM, MPE, MPHDavisAdrienne L.DrMD, MScGaucherNathalieDrMD, FRCPC, PhDGianlucaGualcoDrMDGoldmanRanDrMDGriffithsMarkDrMDHallJeanine E.DrMDHansenMattDrMD, MCRHurtThomas L.DrMD, MEDKellyChristopherDrMDKleinEileen J.DrMD, MPHKozerEranDrMDMarneniShashidharDrMDMaterAhmedDrMD, FRCPC, FAAPMistryRakeshDrMD, MSParraCristinaDrPhDPoonaiNaveenDrMD, FRCPCRaoArjunDrMDSheridanDavidDrMD, MCRShimizuNaokiDrMD, PhDYueEsther L.DrMD
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199
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Fisher A, Mbaeyi S, Cohn A. Addressing Vaccine Hesitancy in the Age of COVID-19. Acad Pediatr 2021; 21:S3-S4. [PMID: 33753285 PMCID: PMC7977007 DOI: 10.1016/j.acap.2021.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Allison Fisher
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga.
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200
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Santibanez TA, Nguyen KH, Greby SM, Fisher A, Scanlon P, Bhatt A, Srivastav A, Singleton JA. Parental Vaccine Hesitancy and Childhood Influenza Vaccination. Pediatrics 2020; 146:peds.2020-007609. [PMID: 33168671 PMCID: PMC8097955 DOI: 10.1542/peds.2020-007609] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To quantify the prevalence of parental vaccine hesitancy (VH) in the United States and examine the association of VH with sociodemographics and childhood influenza vaccination coverage. METHODS A 6-question VH module was included in the 2018 and 2019 National Immunization Survey-Flu, a telephone survey of households with children age 6 months to 17 years. RESULTS The percentage of children having a parent reporting they were "hesitant about childhood shots" was 25.8% in 2018 and 19.5% in 2019. The prevalence of concern about the number of vaccines a child gets at one time impacting the decision to get their child vaccinated was 22.8% in 2018 and 19.1% in 2019; the prevalence of concern about serious, long-term side effects impacting the parent's decision to get their child vaccinated was 27.3% in 2018 and 21.7% in 2019. Only small differences in VH by sociodemographic variables were found, except for an 11.9 percentage point higher prevalence of "hesitant about childhood shots" and 9.9 percentage point higher prevalence of concerns about serious, long-term side effects among parents of Black compared with white children. In both seasons studied, children of parents reporting they were "hesitant about childhood shots" had 26 percentage points lower influenza vaccination coverage compared with children of parents not reporting hesitancy. CONCLUSIONS One in 5 children in the United States have a parent who is vaccine hesitant, and hesitancy is negatively associated with childhood influenza vaccination. Monitoring VH could help inform immunization programs as they develop and target methods to increase vaccine confidence and vaccination coverage.
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Affiliation(s)
| | - Kimberly H. Nguyen
- National Center for Immunization and Respiratory Diseases, Atlanta, Georgia
| | - Stacie M. Greby
- Centers for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison Fisher
- National Center for Immunization and Respiratory Diseases, Atlanta, Georgia
| | - Paul Scanlon
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Achal Bhatt
- National Center for Immunization and Respiratory Diseases, Atlanta, Georgia
| | - Anup Srivastav
- National Center for Immunization and Respiratory Diseases, Atlanta, Georgia;,Leidos Inc, Atlanta, Georgia
| | - James A. Singleton
- National Center for Immunization and Respiratory Diseases, Atlanta, Georgia
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