Vaccine hesitancy and influenza beliefs among parents of children requiring a second dose of influenza vaccine in a season: An American Academy of Pediatrics (AAP) Pediatric Research in Office Settings (PROS) study

Gap between cognitions and behaviors among children's guardians of influenza vaccination: The role of social influence and vaccine-related knowledge

The seasonal influenza vaccine coverage remains suboptimal among children even though guardians expressed high willingness to vaccinate their children. This study aimed to determine the association between vaccine hesitancy and uptake to facilitate vaccination; thus, bridging the gap. A cross-sectional design, using stratified cluster random sampling, was conducted among guardians of 0-59-month-old Chinese children from July to October in 2019. A structural equation model was applied to explore the interrelationships between factors including vaccine hesitancy, vaccination, social influence, and relative knowledge among guardians. Of the 1,404 guardians, 326 were highly hesitant to vaccinate their children, 33.13% (108/326) of whom had vaccinated their children. Moreover, 517 and 561 guardians had moderate and low vaccine hesitancy, with corresponding vaccine coverage of 42.75% (221/517) and 47.95% (269/516). Guardians' gender, age, and education level were demographic variables with significant moderating effects. Social influence considered impact of communities, family members, friends, neighbors, healthcare workers, bad vaccination experience and sense on price. Actual vaccine uptake was negatively significantly associated with hesitancy (β = -0.11, p < .001) with positive association with social influence (β = 0.61, p < .001). Vaccine hesitancy was negatively significantly associated with relative knowledge (β = -2.14, p < .001) and social influence (β = -1.09, p < .001). A gap is noted between cognitions and behaviors among children's guardians regarding influenza vaccination. A comprehensive strategy including emphasizing benefits of the influenza vaccination, risk of infection, and ensuring high vaccine confidence among healthcare workers can help transform the willingness to engage in the behavior of vaccination.

The COVID-19 Pandemic and Parental Attitudes Toward Routine Childhood Vaccines

BACKGROUND AND OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic may have impacted parental attitudes toward childhood vaccines. However, few data sources followed attitudes before and after onset of the pandemic. We used data from a parental survey to describe the effect of the pandemic on parental attitudes toward childhood vaccines.

METHODS

Data were analyzed from the Health eMoms survey which randomly sampled birthing parents in Colorado from 2018 to 2021 on several health topics including vaccine hesitancy. Population weighted multivariable regression was used to measure the association between overall vaccine hesitancy and 5 individual hesitancy questions and different COVID-19 pandemic periods: prepandemic (April 2018-February 2020); pandemic prevaccine (April 2020-December 2020); and pandemic postvaccine (January 2021-August 2021), adjusting for demographic factors.

RESULTS

Overall, 20.4% (726/3553) of respondents were vaccine hesitant. Vaccine hesitancy during pandemic time periods was not different from the prepandemic period (prevaccine adjusted odds ratio [aOR] = 0.82, 95% confidence interval [CI] = 0.65-1.04; postvaccine aOR = 1.07, 95% CI = 0.85-1.34). In analyses of individual hesitancy questions, parents were more likely to be unsure about trusting vaccine information in the pandemic postvaccine time period compared with the prepandemic period (aOR = 2.14; 95% CI = 1.55-2.96), and less likely to be unsure about their hesitancy toward childhood vaccines (aOR = 0.48; 95% CI = 0.27-0.84).

CONCLUSIONS

The COVID-19 pandemic was not associated with changes in parental vaccine hesitancy overall, although there were changes in trust about vaccine information and a polarization of vaccination attitudes.

Attitudes of parents towards influenza vaccine in the Eastern Mediterranean Region: A multilevel analysis

BACKGROUND

Seasonal influenza vaccines (SIVs) can protect against influenza and substantially reduce the risk of influenza-related hospitalizations and fatalities in children. This study aimed to assess parental attitudes towards SIVs in the Eastern Mediterranean region (EMR).

METHODS

Through an anonymous online survey conducted in 19 countries in the EMR, parents or caregivers over 18 years who had at least one child above 6 months filled out the Parent Attitudes about Childhood Vaccines questionnaire. As data had two levels; country and individual factors, we utilized multilevel binary logistic regression models.

RESULTS

In total, 6992 respondents filled out the questionnaire. Of them, 47.4 % were residents of middle-income countries, 72.4 % of the mothers were between 26 and 45 years old, 56.5 % had at least a university degree, and approximately 51.6 % were unemployed. Nearly 50.8 % of the respondents were hesitant to vaccinate their children against seasonal influenza. Parental attitudes towards seasonal influenza vaccination differed significantly between countries, p < 0.001. The main predictors of parental seasonal influenza vaccine hesitancy (VH) were parents vaccination (odds ratio (OR) = 0.42, 95 % CI = 0.32-0.55, p < 0.001)), the mother's education if mother educated vs. who did not receive any education (OR ranged from 0.48 to 0.64, p < 0.05), living in low-income countries (OR = 0.52, 95 % CI = 0.35-0.77, p < 0.01), mountain residence (0.69, 95 % CI = 0.49-0.99, p < 0.05), health workers as a source of information (OR = 0.70, 95 % CI = 0.58-0.85, p < 0.001), children vaccination against COVID-19 (OR = 0.52, 95 % CI = 0.41-0.65, p < 0.001), not receiving routine vaccinations (OR = 1.93, 95 % CI = 1.09-3.44, p = 0.025), and if parents respondents could not remember whether their child had suffered from seasonal influenza in the previous year (OR = 1.57, 95 % CI = 1.33-1.84, p < 0.001).

CONCLUSION

A high seasonal influenza VH rate was found in the EMR. Health authorities should implement different interventions targeting the identified modifiable risk factor to increase vaccine uptake among children, especially those at risk of complication from seasonal influenza infection.

A systematic literature review to clarify the concept of vaccine hesitancy

Vaccine hesitancy (VH) is considered a top-10 global health threat. The concept of VH has been described and applied inconsistently. This systematic review aims to clarify VH by analysing how it is operationalized. We searched PubMed, Embase and PsycINFO databases on 14 January 2022. We selected 422 studies containing operationalizations of VH for inclusion. One limitation is that studies of lower quality were not excluded. Our qualitative analysis reveals that VH is conceptualized as involving (1) cognitions or affect, (2) behaviour and (3) decision making. A wide variety of methods have been used to measure VH. Our findings indicate the varied and confusing use of the term VH, leading to an impracticable concept. We propose that VH should be defined as a state of indecisiveness regarding a vaccination decision.

Text Message Reminders for the Second Dose of Influenza Vaccine for Children: An RCT

BACKGROUND AND OBJECTIVES

Among children requiring 2 influenza doses in a given season, second dose receipt nearly halves the odds of influenza. Nationally, many children do not receive both needed doses. This study sought to compare the effectiveness of text message reminders with embedded interactive educational information versus usual care on receipt and timeliness of the second dose of influenza vaccine.

METHODS

This trial took place over the 2017 to 2018 and 2018 to 2019 influenza seasons among 50 pediatric primary care offices across 24 states primarily from the American Academy of Pediatrics' Pediatric Research in Office Settings practice-based research network. Caregiver-child dyads of children 6 months to 8 years in need of a second influenza vaccination that season were individually randomized 1:1 into intervention versus usual care, stratified by age and language within each practice. Intervention caregivers received automated, personalized text messages, including educational information. Second dose receipt by April 30 (season end) and by day 42 (2 weeks after second dose due date) were assessed using Mantel Haenszel methods by practice and language. Analyses were intention to treat.

RESULTS

Among 2086 dyads enrolled, most children were 6 to 23 months and half publicly insured. Intervention children were more likely to receive a second dose by season end (83.8% versus 80.9%; adjusted risk difference (ARD) 3.8%; 95% confidence interval [0.1 to 7.5]) and day 42 (62.4% versus 55.7%; ARD 8.3% [3.6 to 13.0]).

CONCLUSIONS

In this large-scale trial of primary care pediatric practices across the United States, text message reminders were effective in promoting increased and timelier second dose influenza vaccine receipt.

Factors associated with caregivers' hesitancy to vaccinate children against influenza: A cross-sectional survey in China

BACKGROUND

Seasonal influenza can cause serious harm to children under five years of age, while caregivers are still hesitant to vaccinate children against influenza. This study aimed to investigate caregivers' hesitancy regarding influenza vaccination and assess the associated factors.

METHODS

From August to October 2019, a cross-sectional survey was conducted in ten provinces in China. The questionnaire collected information about sociodemographic characteristics and caregivers' knowledge, perceptions and attitudes toward influenza vaccination. Caregivers were identified as not hesitating, hesitating or refusing to vaccinate children. Multinomial logistic regression was adopted to determine factors related to vaccine hesitancy based on the 3C model with three dimensions namely complacency, convenience and confidence.

RESULTS

A total of 6668 valid questionnaires were collected, among which 38.57% did not hesitate to vaccinate children against influenza, 56.03% were hesitant, and 5.40% refused. Multinomial logistic regression showed that caregivers perceiving high importance (AOR = 0.68 for hesitancy; 0.15 for refusal), safety (AOR = 0.42; 0.46) or efficacy (AOR = 0.73; 0.65) of influenza vaccination, knowing children as a priority group (AOR = 0.80; 0.48), and trusting vaccination advice from medical staff (AOR = 0.65; 0.51) had lower odds of hesitancy or refusal. Those considering price as a hindering factor had higher odds of hesitancy (AOR = 1.66) or refusal (AOR = 1.47), and those viewing time or distance as a hindering factor (AOR = 1.45) or having heard of vaccine-related negative information (AOR = 1.78) had higher odds of hesitancy. Sociodemographic characteristics were associated with vaccine hesitancy or refusal, and the associations varied for hesitators and refusers.

CONCLUSION

A large proportion of caregivers in China reported their hesitancy for influenza vaccination, and the associated factors of such hesitancy were complicated. Health professionals are recommended to spread relevant scientific knowledge and give vaccine-related suggestions to caregivers in doctor visits to promote caregivers' trust in influenza vaccination and therefore expand childhood vaccine coverage.

Evaluating COVID-19 Vaccine Willingness and Hesitancy among Parents of Children Aged 5–11 Years with Chronic Conditions in Italy

COVID-19 vaccination has been extended to include children aged 5–11 years. This cross-sectional survey evaluated parental COVID-19 vaccine willingness and hesitancy, and associated factors, for their children aged 5–11 years with chronic conditions. A telephone survey was conducted from 14 December 2021 to 4 January 2022. The questionnaire assessed participants’ socio-demographic and health-related information, attitudes towards COVID-19 infection, hesitancy, by using the PACV-5 (Parent Attitudes About Childhood Vaccines Survey Tool), and sources of information. A total of 430 answers were collected anonymously. Respondents with no cohabitant who had been infected by SARS-CoV-2 and having been vaccinated against COVID-19 had a higher concern about the severity of COVID-19. The parents’ perceived risk that the child could be infected by SARS-CoV-2 was higher in those more concerned about the severity of COVID-19, with an older child, and who had at least one cohabitant positive for COVID-19. Only 38.8% parents were willing to vaccinate their children against COVID-19. Parents who did not need additional information, those with higher education, those who have been vaccinated against COVID-19, those whose child was older, who had received information on this vaccination from physicians, with higher self-reported concern about the severity of COVID-19, and who had a higher perceived risk that their child could be infected by SARS-CoV-2, expressed a greater willingness to vaccinate their child. Overall, 26.3% were high-hesitant, with a PACV-5 score ≥ 7. Respondents who did not get the COVID-19 vaccine, were less educated, with a lower concern about severity of COVID-19, and with a lower perceived risk that their child could be infected by SARS-CoV-2, were more likely to be high-hesitant. New policies and educational programs regarding COVID-19 vaccination for children with chronic conditions are needed to reduce hesitancy and increase vaccination uptake.

Influenza-Related Knowledge, Beliefs, and Experiences Among Caregivers of Hospitalized Children

OBJECTIVE

Caregivers frequently decline influenza vaccine for their hospitalized child. In this study, we aimed to examine factors impacting their influenza vaccine decision-making.

METHODS

We conducted a cross-sectional survey study of English- and Spanish-speaking caregivers of children hospitalized at a tertiary care pediatric hospital between November 2017 and April 2018. The survey assessed influenza-related knowledge, beliefs, experiences, and vaccine hesitancy. Multivariable logistic regression examined associations between survey responses and child influenza vaccination status at admission (already vaccinated versus not yet vaccinated this season) and, among caregivers with vaccine-eligible children, influenza vaccine acceptance (versus declination) for their child during hospitalization.

RESULTS

Caregivers (N =522; 88.9% response rate) were mostly non-Hispanic white (66.9%) and English-speaking (97.7%). At admission, 63.2% of children were already vaccinated this season. The caregiver view that influenza vaccination is important for their child's health was the strongest positive predictor of having an already vaccinated child (adjusted odds ratio [aOR]: 3.16; 95% confidence interval [CI]: 2.46-4.05); vaccine hesitancy was the strongest negative predictor (aOR: 0.61; 95% CI: 0.50-0.75). Among caregivers with vaccine-eligible children, 30.3% accepted influenza vaccine for their hospitalized child. Their belief regarding the child health benefits of influenza vaccination was associated with vaccine acceptance during hospitalization (aOR: 6.87; 95% CI: 3.38-13.96). Caregiver vaccine hesitancy and agreement that children with mild illness should delay vaccination negatively impacted vaccine acceptance (aOR: 0.39; 95% CI: 0.25-0.62; aOR: 0.33; 95% CI: 0.20-0.56, respectively).

CONCLUSIONS

We identified key factors impacting influenza vaccine decision-making among caregivers of hospitalized children, a critical step to improving uptake in this population.

What Is the State-of-the-Art in Clinical Trials on Vaccine Hesitancy 2015-2020?

BACKGROUND

Vaccine hesitancy is related to a delay in acceptance or refusal of vaccination.

AIM

to perform a systematic review of clinical trials on vaccine hesitancy (2015-2020).

METHODS

a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria (PRISMA). Five databases were screened-PubMed, Cochrane Library, DOAJ, SciELO and b-on-which comprise multiple resources.

KEYWORDS

"Vaccine hesitancy" and ("randomized controlled trial" or "clinical trial").

INCLUSION CRITERIA

trials about "vaccine hesitancy" enrolling patients and/or health professionals (2015-2020).

EXCLUSION CRITERIA

studies about other topics, repeated and qualitative studies, reviews and papers written in languages other than English, Portuguese, French or Spanish.

RESULTS

a total of 35 trials out of 90 were selected (19 PubMed, 14 Cochrane Library, 0 DOAJ, 0 SciELO and 2 b-on). Selected trials were classified into five topics: children/pediatric (n = 5); online or electronic information (n = 5); vaccination against a specific disease (n = 15) (e.g., influenza or COVID-2019); miscellaneous (n = 4); and educational strategies (n = 6).

CONCLUSION

the provision of online or electronic information (e.g., through virtual reality, social websites of experts, or apps), communication-based interventions and training of health professionals, residents or subjects seemed to improve vaccine hesitancy.

Influenza vaccination among U.S. pediatric patients receiving care from federally funded health centers

INTRODUCTION

During the 2018-2019 influenza season, vaccination coverage among U.S. children was 62.6%. The purpose of this study was to estimate the prevalence of influenza vaccinations among pediatric patients seen in U.S. health centers, and to explore potential disparities in vaccination coverage among subpopulations. Funded by the Health Resources and Services Administration (HRSA) within the U.S. Department of Health and Human Services, these health centers provide primary and preventive care to underserved and vulnerable individuals and families in order to reduce health disparities based on economic, geographic, or cultural barriers.

METHODS

Cross-sectional data, analyzed in 2019, came from the most recent waves of the Health Center Patient Survey (2009, 2014). The sample consisted of children ages 2-17 years receiving care from HRSA-funded health centers. The outcome of interest was self- or parent-reported receipt of influenza vaccine in the past year. Multivariable logistic regression was used to estimate the adjusted prevalence rate ratios for the association between demographic characteristics (age, sex, race/ethnicity, poverty level, urban/rural residence, geographic region), health-related variables (receipt of well-child check-up, asthma diagnosis), and influenza vaccination.

RESULTS

Influenza vaccination coverage among pediatric health center patients increased from 46.6% in 2009 to 67.8% in 2014. In the adjusted model for 2014, there were few statistically significant differences in vaccination coverage among subpopulation groups, however American Indian/Alaska Native children had 31% increased vaccination coverage compared with non-Hispanic White children (aPRR: 1.31, 95% CI: 1.02-1.60) and children living in the South had 26% decreased vaccination coverage compared with those living in the Northeast (aPRR: 0.74, 95% CI: 0.54-0.93).

CONCLUSIONS

Influenza vaccination coverage among pediatric health center patients in 2014 exceeded the national average (as of 2018-2019), and few differences were found among at-risk subpopulations. HRSA-funded health centers are well-positioned to further increase the vaccination rate among children living in underserved communities.