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Day ME, Sucharew H, Burkhardt MC, Reyner A, Giles D, Beck AF, Schlaudecker EP, Klein M. High Caregiver Adverse Childhood Experiences Are Associated With Pediatric Influenza and COVID-19 Vaccination Uptake. J Pediatric Infect Dis Soc 2023; 12:595-601. [PMID: 37846858 PMCID: PMC10725238 DOI: 10.1093/jpids/piad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 10/16/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Factors surrounding vaccine uptake are complex. Although anxiety, which could influence vaccination decisions, has been associated with adverse childhood experiences (ACEs), little is known about links between caregiver ACEs and pediatric vaccine uptake. We evaluated associations between caregivers' ACEs and decisions to vaccinate their children with influenza and coronavirus disease (COVID-19) vaccines. METHODS A cross-sectional study of caregivers of patients ≥6 months at one pediatric primary care center (PPCC) was performed. Caregivers completed a 19-question survey examining caregiver ACEs, influenza vaccine acceptance and beliefs, and intention to vaccinate their child with the COVID-19 vaccine. Demographic characteristics, social risks (eg, housing and food insecurity), and vaccination data for children present with each caregiver were extracted from the electronic health record (EHR). Statistical analyses included χ2 tests for categorical variables and t-tests for continuous variables. RESULTS A total of 240 caregivers participated, representing 283 children (mean age of 5.9 years, 47% male). Twenty-four percent (n = 58) had high ACEs (≥4). Of those with high ACEs, 55% accepted pediatric influenza vaccination compared with 38% with low ACEs (P = .02). Those with high ACEs had more positive attitudes toward influenza vaccine safety and efficacy (P ≤ .02). Those with high, compared with low, ACEs were also more likely to accept COVID-19 vaccination (38% vs 24%; P = .04). CONCLUSIONS Pediatric influenza vaccination rates and intention to vaccinate children against COVID-19 differed between caregivers with high and low ACEs: those with more ACEs were more likely to vaccinate. Further studies assessing the role of caregiver ACEs on vaccine decision-making are warranted.
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Affiliation(s)
- Melissa E Day
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Heidi Sucharew
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mary Carol Burkhardt
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Allison Reyner
- James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Destiney Giles
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrew F Beck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Elizabeth P Schlaudecker
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Melissa Klein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Lin J, Li C, He W. Trends in influenza vaccine uptake before and during the COVID-19 pandemic in the USA. Public Health 2023; 225:291-298. [PMID: 37956641 DOI: 10.1016/j.puhe.2023.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/01/2023] [Accepted: 10/12/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVES To investigate trends of influenza vaccine uptake before and during the COVID-19 pandemic in the USA and explore the associated factors. STUDY DESIGN This was a cross-sectional study. METHODS Using self-reported data from the National Health Interview Survey during 2014-2021 (response rates ranging from 50.7 to 70.1%), we estimated influenza vaccine uptake. Log-binomial regression models were used to test uptake changes with adjustment for and stratification by demographic and health factors. RESULTS We included 58,249 children (mean age: 8.7 years; male: 51.1%) and 205,034 adults (mean age: 47.6 years; male: 48.2%). The prevalence ratio (PR) of uptake change comparing the intra- (2020-2021) to the pre-COVID-19 period (2014-2019) was 0.72 among children, with a 10.7% reduction. Uptake changes were found across subgroups, with higher reduction among those aged 0-2 years, non-Hispanic Black and Hispanic ethnicity, from South and West regions, and with lower household income. For adults, uptake increased before and during COVID-19 (PR = 1.15, 95% confidence interval [CI]: 1.12-1.18) but a 2.3% reduction was found among healthcare personnel (PR = 0.95, 95% CI: 0.90-0.997). CONCLUSIONS Influenza vaccination decreased during the COVID-19 pandemic among children and healthcare personnel. Structure inequality to influenza vaccination warrants measures to improve vaccine uptake among vulnerable groups.
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Affiliation(s)
- J Lin
- Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - C Li
- Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Australia
| | - W He
- Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, Australia.
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Irving SA, Groom HC, Belongia EA, Crane B, Daley MF, Goddard K, Jackson LA, Kauffman TL, Kenigsberg TA, Kuckler L, Naleway AL, Patel SA, Tseng HF, Williams JTB, Weintraub ES. Influenza vaccination coverage among persons ages six months and older in the Vaccine Safety Datalink in the 2017-18 through 2022-23 influenza seasons. Vaccine 2023; 41:7138-7146. [PMID: 37866991 PMCID: PMC10867768 DOI: 10.1016/j.vaccine.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND In the United States, annual vaccination against seasonal influenza is recommended for all people ages ≥ 6 months. Vaccination coverage assessments can identify populations less protected from influenza morbidity and mortality and help to tailor vaccination efforts. Within the Vaccine Safety Datalink population ages ≥ 6 months, we report influenza vaccination coverage for the 2017-18 through 2022-23 seasons. METHODS Across eight health systems, we identified influenza vaccines administered from August 1 through March 31 for each season using electronic health records linked to immunization registries. Crude vaccination coverage was described for each season, overall and by self-reported sex; age group; self-reported race and ethnicity; and number of separate categories of diagnoses associated with increased risk of severe illness and complications from influenza (hereafter referred to as high-risk conditions). High-risk conditions were assessed using ICD-10-CM diagnosis codes assigned in the year preceding each influenza season. RESULTS Among individual cohorts of more than 12 million individuals each season, overall influenza vaccination coverage increased from 41.9 % in the 2017-18 season to a peak of 46.2 % in 2019-20, prior to declaration of the COVID-19 pandemic. Coverage declined over the next three seasons, coincident with widespread SARS-CoV-2 circulation, to a low of 40.3 % in the 2022-23 season. In each of the six seasons, coverage was lowest among males, 18-49-year-olds, non-Hispanic Black people, and those with no high-risk conditions. While decreases in coverage were present in all age groups, the declines were most substantial among children: 2022-23 season coverage for children ages six months through 8 years and 9-17 years was 24.5 % and 22.4 % (14 and 10 absolute percentage points), respectively, less than peak coverage achieved in the 2019-20 season. CONCLUSIONS Crude influenza vaccination coverage increased from 2017 to 18 through 2019-20, then decreased to the lowest level in the 2022-23 season. In this insured population, we identified persistent disparities in influenza vaccination coverage by sex, age, and race and ethnicity. The overall low coverage, disparities in coverage, and recent decreases in coverage are significant public health concerns.
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Affiliation(s)
| | - Holly C Groom
- Kaiser Permanente Center for Health Research, Portland OR, USA
| | | | - Bradley Crane
- Kaiser Permanente Center for Health Research, Portland OR, USA
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver CO, USA
| | - Kristin Goddard
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland CA, USA
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle WA, USA
| | - Tia L Kauffman
- Kaiser Permanente Center for Health Research, Portland OR, USA
| | - Tat'Yana A Kenigsberg
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta GA, USA
| | | | | | - Suchita A Patel
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta GA, USA
| | - Hung Fu Tseng
- Kaiser Permanente Southern California, Pasadena CA, USA
| | | | - Eric S Weintraub
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta GA, USA
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Wang Q, Jia M, Jiang M, Cao Y, Dai P, Yang J, Yang X, Xu Y, Yang W, Feng L. Increased population susceptibility to seasonal influenza during the COVID-19 pandemic in China and the United States. J Med Virol 2023; 95:e29186. [PMID: 37855656 DOI: 10.1002/jmv.29186] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/25/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023]
Abstract
To the best of our knowledge, no previous study has quantitatively estimated the dynamics and cumulative susceptibility to influenza infections after the widespread lifting of COVID-19 public health measures. We constructed an imitated stochastic susceptible-infected-removed model using particle-filtered Markov Chain Monte Carlo sampling to estimate the time-dependent reproduction number of influenza based on influenza surveillance data in southern China, northern China, and the United States during the 2022-2023 season. We compared these estimates to those from 2011 to 2019 seasons without strong social distancing interventions to determine cumulative susceptibility during COVID-19 restrictions. Compared to the 2011-2019 seasons without a strong intervention with social measures, the 2022-2023 influenza season length was 45.0%, 47.1%, and 57.1% shorter in southern China, northern China, and the United States, respectively, corresponding to an 140.1%, 74.8%, and 50.9% increase in scale of influenza infections, and a 60.3%, 72.9%, and 45.1% increase in population susceptibility to influenza. Large and high-intensity influenza epidemics occurred in China and the United States in 2022-2023. Population susceptibility increased in 2019-2022, especially in China. We recommend promoting influenza vaccination, taking personal prevention actions on at-risk populations, and monitoring changes in the dynamic levels of influenza and other respiratory infections to prevent potential outbreaks in the coming influenza season.
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Affiliation(s)
- Qing Wang
- School of Population Medicine & Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education, Beijing, China
| | - Mengmeng Jia
- School of Population Medicine & Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education, Beijing, China
| | - Mingyue Jiang
- School of Population Medicine & Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education, Beijing, China
| | - Yanlin Cao
- School of Population Medicine & Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education, Beijing, China
| | - Peixi Dai
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiao Yang
- School of Population Medicine & Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education, Beijing, China
| | - Xiaokun Yang
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yunshao Xu
- School of Population Medicine & Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education, Beijing, China
| | - Weizhong Yang
- School of Population Medicine & Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education, Beijing, China
| | - Luzhao Feng
- School of Population Medicine & Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education, Beijing, China
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Shmueli L. Has the COVID-19 Pandemic Changed Parental Attitudes and Beliefs Regarding Vaccinating Their Children against the Flu? Vaccines (Basel) 2023; 11:1519. [PMID: 37896923 PMCID: PMC10611412 DOI: 10.3390/vaccines11101519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND This study assessed whether the COVID-19 pandemic has altered parents' attitudes toward vaccinating their children against the flu and barriers to school-based vaccination programs. METHODS A cross-sectional online survey was conducted with 975 parents of children aged 6 months to 11 years between 21-31 December 2022. A multivariate regression was performed to determine predictors of parents' willingness to vaccinate their children against the flu in the winter of 2023. RESULTS 45% of parents did not plan to vaccinate their children against the flu, citing concerns about side effects and vaccine effectiveness; 39% already vaccinated their children, and 41% of them reported an increased intention to vaccinate following the pandemic. Only 37% of parents chose school-based vaccination programs, mainly due to a preference for HMO clinics and a lack of available nurses at school. The Health Belief Model variables, namely, perceived susceptibility, severity, and benefits, displayed the largest effect sizes. CONCLUSIONS Healthcare providers and public health officials should address parents' concerns about flu vaccine safety and efficacy to improve vaccination rates among children. Notably, the pandemic has increased vaccine receptivity among some parents. Enhancing accessibility to nursing staff in student health facilities could help boost vaccine uptake.
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Affiliation(s)
- Liora Shmueli
- Department of Management, Bar-Ilan University, Ramat Gan 52900, Israel
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Fadl N, Elbarazi I, Saleeb MRA, Youssef N, Shaaban R, Ghazy RM. Parental intention to vaccinate children against seasonal influenza in the Eastern Mediterranean region: A cross-sectional study using the health belief model. Hum Vaccin Immunother 2023; 19:2238513. [PMID: 37527814 PMCID: PMC10395193 DOI: 10.1080/21645515.2023.2238513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/05/2023] [Accepted: 07/12/2023] [Indexed: 08/03/2023] Open
Abstract
Seasonal influenza vaccine is the most effective strategy for reducing influenza incidence and severity. Parental decision-making regarding childhood vaccination is influenced by one's vaccine-related beliefs. A cross-sectional study was conducted to determine the role of the Health Belief Model (HBM) in predicting parental intention to vaccinate their children against influenza in the Eastern Mediterranean Region (EMR). An anonymous online survey was distributed to parents of children aged 6 months to 18 years in 14 EMR countries. Out of the 5964 participants, 28.2% intended to vaccinate their children against influenza. Urban residents (OR = 0.55, 95%CI: 0.35-0.85), decision-making regarding child's health by the father alone (OR = 0.43, 95%CI: 0.34-0.55) or the mother alone (OR = 0.78, 95%CI: 0.65-0.93), having a child with a chronic illness (OR = 0.45, 95%CI: 0.38-0.53), reporting high perceived severity, susceptibility, and benefits (OR = 0.35, 95%CI: 0.30-0.40), and cues to action (OR = 0.45, 95%CI: 0.39-0.51) were inversely associated with parental unwillingness to vaccinate their children against influenza. While parents with a higher number of children in the household (OR = 1.08, 95%CI:1.03-1.12) and higher perceived barriers (OR = 2.92, 95%CI: 2.56-3.34) showed an increased likelihood of unwillingness to vaccinate their children. Interventions targeting parental beliefs and perceptions are necessary to improve influenza vaccination acceptance and coverage among children.
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Affiliation(s)
- Noha Fadl
- Family Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Iffat Elbarazi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, AlAin, Abu Dhabi, UAE
| | | | - Naglaa Youssef
- Department of Medical-Surgical Nursing, College of Nursing, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ramy Shaaban
- Department of Instructional Technology and Learning Sciences, Utah State University, Logan, UT, USA
| | - Ramy Mohamed Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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