Parental Hesitancy About Routine Childhood and Influenza Vaccinations: A National Survey

Changes of influenza vaccination rate and associated influencing factors after the COVID-19 pandemic in Shanghai, China

The vaccination rate for seasonal influenza remains low in most regions of China. It is essential to understand the factors that associated with the low influenza vaccination rate in various populations after the COVID-19 pandemic. A cross-sectional survey was conducted with residents in Pudong New Area, Shanghai, China. Respondents' vaccination condition during the 2021-2022 flu season and the reasons for receiving or not receiving influenza vaccine were investigated. Binary logistic regression was conducted to explore potential factors influencing vaccination uptake. 2,476 of 14,001 respondents received an influenza vaccine, with a total coverage of 17.68% (95% CI: 17.05%, 18.32%). Children had the highest vaccination coverage (35.68%; 95% CI: 34.02, 37.33), followed by adults (12.75%; 95% CI: 11.91%, 13.58%) and elderly individuals (11.70%, 95% CI: 10.78%, 12.62%). For children, lower household income was an significant promoting factor. For adults, factors significantly associated with vaccination were household income, sex, and education level. For elderly, factors significantly associated with vaccination were household income, education level, living state, and having underlying diseases. (P < .05)The main reason for vaccine hesitancy among children was worried about side effects (21.49%), for adults and elderly was self-rated good health (adults: 37.14%, elderly people: 30.66%). The overall influenza vaccination coverage rate in Shanghai, especially among elderly individuals, is lower than many developed countries. Appropriate strategies and programs targeting different populations need to be implemented to enhance influenza vaccine coverage.

Recommendations for Prevention and Control of Influenza in Children, 2024-2025: Technical Report

This technical report accompanies the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccine and antiviral medications in the prevention and treatment of influenza in children during the 2024 to 2025 season. The rationale for the American Academy of Pediatrics recommendation for annual influenza vaccination of all children without medical contraindications starting at 6 months of age is provided. Influenza vaccination is an important strategy for protecting children and the broader community against influenza. This technical report summarizes recent influenza seasons, morbidity and mortality in children, vaccine effectiveness, and vaccination coverage and provides detailed guidance on vaccine storage, administration, and implementation. The report also provides a brief background on inactivated (nonlive) and live attenuated influenza vaccines, available vaccines for the 2024-2025 influenza season, vaccination during pregnancy and breastfeeding, diagnostic testing for influenza, and antiviral medications for treatment and chemoprophylaxis. Strategies to promote vaccine uptake are emphasized.

Determinants of undervaccination of routine childhood immunization in Argentina: A cross-sectional study

Routine childhood immunization is one of the most effective methods of preventing infectious diseases in children. In Argentina, there has been a decline in routine immunization coverage since 2015, with very little evidence to date on underlying drivers of this steady decline. We administered an online nationwide behavioral insights survey in Argentina between July 1-25, 2022, targeting parents with at least one child under the age of 12 years. Our survey included 1504 parents, 7% (n = 111) of whom did not or only partially vaccinated their children. We found that, compared to the youngest parents (aged 18-24), older parents were less likely to under-vaccinate their children (e.g., 30-34 year-old parents: adjusted Odds Ratio (aOR): 0.31, 95% Confidence Interval (CI) 0.16-0.57). Parents who undervaccinated their children were more likely to take vaccination advice from parent and wellness social media influencers (parent influencers: aOR 2.51, 95% CI 1.46-4.31), and were less likely to trust the social media accounts of official health organizations (aOR 0.82, 95% CI 0.70-0.96). Furthermore, these parents had heightened concerns about routine immunizations, including the number of vaccines given to children and potential for adverse side effects. When asked whether they knew enough to make a vaccine decision for their children, parents who undervaccinated their children were more likely to report that they did not know enough about vaccines or the vaccination schedule to make a decision. These results offer important insights into parental concerns surrounding routine childhood immunization and suggest potential drivers of - and solutions to - the decline in routine immunization seen in Argentina since 2015.

Pediatric practice experiences with second dose influenza vaccination: An AAP Pediatric Research in Office Settings (PROS) Study

OBJECTIVES

Explore pediatric staff experiences administering the second influenza vaccine dose.

STUDY DESIGN

Qualitative focus groups/interviews.

METHODS

As part of the National Institutes of Health-funded Flu2Text randomized control trial of text message reminders for second influenza vaccine dose, we conducted seven focus groups and four individual interviews (n = 39 participants total) with clinicians and staff from participating practices from the American Academy of Pediatrics' Pediatric Research in Office Settings (PROS) Network. Of 37 participating practices, 10 were selected through stratified sampling of practices with highest (n = 5) and lowest (n = 5) randomized controlled trial effect sizes. A semi-structured discussion guide included questions that addressed parental, practice, and health system barriers/facilitators to second influenza vaccine dose administration. Using the Systems Model of Clinical Preventive Care as a conceptual framework, two investigators independently coded transcripts (Κ = 0.86, high agreement) with NVivo 12 Plus. Coding inconsistencies were resolved by consensus.

RESULTS

Clinicians/staff reported that administering the second influenza vaccine dose in a season was more complex than other childhood vaccines. They highlighted parental uncertainty about the need for the second dose and the difficulty and inconvenience of bringing children back to the office as important barriers. Caregiver-staff relationships were perceived as helpful in getting children vaccinated with their second dose and vaccine reminders were seen as important cues-to-action.

CONCLUSIONS

Ensuring receipt of two doses of the influenza vaccine in a given season presents unique challenges. Themes identified provide a framework for understanding opportunities to bolster second dose receipt, including explaining why two doses are needed, offering flexible hours for vaccination, and sending vaccine reminders.

Vaccinating for My Family or for My Community? The Effect of Message Framing on Parental Intention to Vaccinate during the COVID Pandemic

BACKGROUND

Social media is one of the major platforms for disseminating essential health messages. The present study examined the effect of message framing (self-interest motive, prosocial motive) on an online platform for parental intention to vaccinate against COVID-19. It also examined how the effect may vary across participants' levels of parental identity centrality/salience and community orientation before the vaccine was officially available.

METHODS

Six hundred and sixty-three Hong Kong Chinese parents were recruited, and a total of 278 valid responses were retained in the analyses. Participants were randomly assigned to one of the three conditions: self-interest motive, prosocial motive, and control. Participants in the self-interest motive condition and the prosocial motive condition read a condition-specific message about the COVID-19 vaccine. Then, they reported their levels of intention to vaccinate against COVID-19, including parent-vaccination, child-vaccination, and medical information-seeking.

RESULTS

A significant group effect on child-vaccination was found. Participants in the self-interest motive condition reported a higher intention to vaccinate their children against COVID-19 compared with the other two conditions. Results of moderation analyses indicated that communal orientation moderated the effect of a self-interest-motive-emphasized message on parental intention to vaccinate against COVID-19. The effect of a self-interest-motive-emphasized message appeared to be stronger on parent-vaccination, child-vaccination, and medical information-seeking among parents who reported lower levels of communal orientation.

CONCLUSION

These findings provided some initial evidence of the effectiveness of message-framing in promoting parents' intention to vaccinate their children on online platforms.

Influenza vaccine uptake among youth with sickle cell disease who are seen in clinic before and after the COVID-19 pandemic

Influenza vaccination is critical for children with sickle cell disease (SCD) due to risks of severe influenza infections. Despite declining influenza vaccination among children since the COVID-19 pandemic, less is known about influenza vaccine coverage among youth with SCD during this same period. We compared influenza vaccine uptake among youth with SCD seen by a SCD provider in clinic during the 2019-2020 and 2022-2023 influenza seasons and described infection characteristics. Overall, 85% (n = 220) of children received their influenza vaccine during 2019-2020 compared to 75% (n = 245) in 2022-2023 (p = 0.059). Participants seen during both seasons were more likely to shift from vaccinated in 2019-2020 to unvaccinated in 2022-2023 than vice versa (McNemar's OR = 3.0; p = 0.008). Among 66 documented infections, 25.8% resulted in hospitalization. We found high influenza vaccine uptake but those seen during both seasons were more likely to become unvaccinated. More research is needed to understand influenza vaccine decision-making in this population.

Impact of the COVID-19 pandemic on self-paid vaccination intentions for children: a cross-sectional study in China

OBJECTIVES

While it is widely accepted that COVID-19 has disrupted routine vaccination globally, the long-term impact of COVID-19 on parental vaccination intentions is uncertain. This study aims to estimate whether COVID-19 impacted parental intentions for self-paid vaccines, and provides suggestions for local vaccination policy and intervention strategies accordingly.

METHODS

A questionnaire-based cross-sectional survey was conducted among 2212 caregivers in Zhejiang province between 22 March and 30 June 2023. The following information was collected: sociodemographic characteristics, self-paid vaccination related intentions and behaviours, and vaccine hesitancy measured by the Vaccine Hesitancy Scale. Multiple multinomial logistic regression models were used to analyse the factors influencing the change in vaccination intentions.

RESULTS

In total, 19.32% (n=390) of respondents increased their intention to immunise their children with self-paid vaccines after the COVID-19 epidemic, 9.16% (n=185) decreased their intention, and 71.52% (n=1444) of respondents indicated that the COVID-19 epidemic did not affect their intention. The major reason for increased intentions was 'Vaccines are effective in preventing diseases' (83.89%) and for decreased intentions was 'Worried about the side effects of vaccines' (65.95%). A higher hesitancy degree (OR=2.208, p=0.0001), reduced trust in vaccines after COVID-19 (OR=16.650, p<0.0001), doctors' recommendation of Expanded Programme on Immunization vaccines (OR=2.180, p=0.0076), and non-perfect satisfaction with vaccine information (all OR>1, all p<0.05) were considered to be drivers of decreased intention.

CONCLUSION

Although the intentions of self-paid vaccinations were not largely influenced, nearly 30% of caregivers' vaccination intentions changed after the COVID-19 pandemic and most of them increased their intentions. In addition, vaccination history of self-paid vaccines, vaccine information, vaccine trust and doctors' recommendations were the active factors for self-paid vaccination. Therefore, education on the knowledge of self-paid vaccines for caregivers should be implemented to increase their vaccination intentions and decrease the threat of infectious diseases to children's health.

COVID-19 Vaccine Hesitancy in Caregivers of Hospitalized Children From 2020 Through 2023

OBJECTIVES

Data on US caregiver perceptions on coronavirus disease 2019 (COVID-19) and COVID-19 vaccination are limited. We identified trends in and associations with COVID-19 vaccine hesitancy in caregivers of hospitalized children.

METHODS

Cross-sectional surveys on pediatric COVID-19 disease and vaccine attitudes, behaviors, and beliefs were administered across study years (December 8, 2020-April 5, 2021, November 30, 2021-March 15, 2022, and October 26, 2022-March 15, 2023). English and Spanish-speaking caregivers of hospitalized children ages 6 months to 11 years were included. General vaccine hesitancy was assessed using the Parent Attitudes about Childhood Vaccines survey.

RESULTS

Of 1268 caregivers from diverse backgrounds, one-third vaccinated or intended to vaccinate their child. Half endorsed fear of their child receiving the COVID-19 vaccine and were concerned the vaccine was new. Over time, more believed "the COVID-19 vaccine does not work" and fewer agreed "children who are otherwise healthy can die from COVID-19." Study season (2022-2023), older child age, higher income, child receipt of influenza vaccine, caregiver receipt of COVID-19 vaccine, and not being worried about vaccine novelty were positively associated with child vaccination. Intent to vaccinate was negatively associated with study season (2022-2023), Parent Attitudes about Childhood Vaccines score ≥50, lack of child influenza and caregiver COVID-19 vaccination, lack of fear of their child "getting COVID-19" and being "worried that the COVID-19 vaccine is new." The majority who intended to vaccinate were willing to immunize before discharge.

CONCLUSIONS

Vaccine novelty and perceived lack of need were associated with refusal. Caregiver COVID-19 and child influenza vaccine acceptance were positively associated with COVID-19 vaccine acceptance. The inpatient setting offers the opportunity to improve vaccine uptake.

Latinx youth's and parents' covid-19 beliefs, vaccine hesitancy and vaccination rates: Longitudinal associations in a community sample

INTRODUCTION

The Latinx population has the second highest COVID-19 death rate among racial/ethnic groups in the United States and less than half of Latinx youth aged 5-17 years old completed their COVID-19 primary vaccination series as of September 2022. COVID-19 vaccine misinformation detrimentally impacts vaccination rates. In this study, we examined factors that predicted Latinx youth COVID-19 vaccine hesitancy and vaccination status.

METHODS

A community-based sample of 290 Latinx parent and adolescent dyads from a Southwestern metropolitan area of the United States who were recruited to complete an online survey at baseline at T1 (August 2020 -March 2021) and one year later. We tested a longitudinal mediation model in which we examined individual and family factors that would predict youth COVID-19 vaccine hesitancy and vaccination status over time.

RESULTS

Youth's pandemic disbelief (i.e., the belief that the COVID-19 pandemic is a conspiracy or not real) predicted greater youth's COVID-19 vaccine hesitancy, and in turn, a lower likelihood of youth's COVID-19 vaccination. Youth's pandemic disbelief also predicted greater parent's vaccination hesitancy which, in turn, predicted greater youth's vaccination hesitancy and a lower likelihood of COVID-19 vaccination. Parents' pandemic disbelief predicted their own COVID-19 hesitancy, but not youth hesitancy.

DISCUSSION

Our study findings provide initial evidence that general pandemic disbelief was a significant driver of vaccine hesitancy and vaccination among Latinx families. The study contributes to the limited research investigating COVID-19 vaccination in the Latinx community and among Latinx youth, further aiding how COVID-19 vaccine disparities can be mitigated among racial/ethnic populations.

Parental hesitancy about COVID-19, influenza, HPV, and other childhood vaccines

BACKGROUND

Some public health professionals have expressed concern that the COVID-19 pandemic has increased vaccine hesitancy about routine childhood vaccines; however, the differential prevalence of vaccine hesitancy about specific vaccines has not been measured.

METHODS

Data from the National Immunization Survey-Child COVID-19 Module (NIS-CCM) were analyzed to assess the proportion of children ages 6 months-17 years who have a parent with hesitancy about: COVID-19, influenza, human papillomavirus (HPV) (for children ≥ 9 years) vaccines, and "all other childhood shots." Interviews from October 2022 through April 2023 were analyzed.

RESULTS

The percentage of children with a vaccine-hesitant parent varied by vaccine. 55.9% of children had a parent hesitant about COVID-19 vaccine, 30.9% hesitant about influenza vaccine, 30.1% hesitant about HPV vaccine, and 12.2% had a parent hesitant about other vaccines such as measles, polio, and tetanus.

CONCLUSION

The study findings suggest that differential interventions and communications to parents be used to educate about COVID-19, influenza, HPV, and routine childhood vaccinations because the hesitancy levels differ widely.

The affecting factors of COVID-19 vaccine hesitancy in parents of children with cancer: A cross-sectional Jordanian study

BACKGROUND AND OBJECTIVE

Children with cancer have higher mortality and morbidity rates than have been reported in general children patients infected by coronavirus infection 2019 (COVID-19). Thus, for children with cancer, COVID-19 vaccination is a priority. This study aims to investigate the factors influencing COVID-19 vaccine hesitancy in parents of children with cancer in Jordan.

METHODS

A cross-sectional study was conducted during the third quarter of 2022 at the King Hussein Cancer Center in Amman, Jordan. The study employed a self-administered questionnaire, incorporating COVID-specific questions. Participants included parents of children aged 18 years or younger undergoing treatment or monitoring at the center. A straightforward random sampling approach was used to recruit participants. Ethical approval and institutional permission were obtained, ensuring voluntary participation with the right to withdraw.

RESULTS

A total of 409 participants, predominantly female, were enrolled in the study. Notably, most of the enrolled parents did not intend to have their children vaccinated either for seasonal flu or for COVID-19, 76.2% and 78.7%, respectively. The bulk of the parents were encouraged to vaccinate their child by the child's pediatrician (82.9%). Parents' age and their children's age were significantly influenced their willingness to vaccinate their children with the COVID-19 vaccine (p < .001), in which parents' age group 45-54 years and children's age group above 15 years old show the highest vaccination rate. Meanwhile, there was a significant association between children's vaccination with parents suffering from chronic disease (p < .001) and parents receiving the COVID-19 vaccine (p = .014). There are still some concerns regarding the COVID-19 vaccine's effectiveness, safety, and whether it is essential for their child.

CONCLUSION

A large proportion of parents in Jordan are hesitant about the COVID-19 vaccine when considering its administration to their children with cancer. This finding emphasizes the importance of communication and education to address vaccination hesitancy.

Effects of parental childhood cultural health environment on children's influenza and COVID-19 vaccination status

Most studies examining factors associated with pediatric influenza (flu) and coronavirus disease (COVID-19) vaccination uptake focus on parental demographics. We examined whether the childhood cultural health environment (CHE) of parents (measured by self-reported regular attendance at doctor and dentist visits during childhood) was associated with flu and COVID-19 vaccination of their children. Using 2023 survey data from 397 US parents and causal inference methods, we estimated the average causal effect of parental CHE on flu vaccination rates (0.16 [95 % confidence interval: 0.06,0.27]) and COVID-19 (0.14 [95 % confidence interval: 0.04,0.24]), indicating that if all parents had attended regular doctor/dentist visits as children, flu and COVID-19 vaccination rates in children would be 16 % and 14 % higher, respectively, than if none had. Our findings suggest that early life exposure to medical and dental care has significant and lasting effects on the health of individuals and families.

Determinants of influenza non-vaccination among Canadian children: insights from a nationwide survey

Background

To identify determinants influencing Canadian parents' decision not to vaccinate their children aged 6 months to 17 years against seasonal influenza.

Methods

Data from the 2022 Childhood COVID-19 Immunization Coverage Survey, a national survey of approximately 10,500 Canadian parents/guardians and their children, was analyzed. The survey examined influenza vaccine coverage, parental perspectives on vaccines, reasons for hesitancy, and factors influencing immunization. Socio-demographic characteristics, including ethnicity, household income, working sector, educational attainment, and prevalence of chronic medical conditions among children were considered. Historical vaccine uptake and the impact of the COVID-19 pandemic on immunization decisions were also reviewed. Key determinants of non-vaccination in the 2021-2022 influenza season were analyzed using multivariable logistic regression, with a statistical significance level set at p-value <0·05.

Results

70% of children aged 6 months to 17 years did not receive the seasonal influenza vaccine. Key predictors for non-vaccination included: residing in rural settings (aOR 1·35, 95% CI 1·13-1·60), parental education attainment of less than high school (aOR 2·48, 95% CI 1·24-4·97), and the absence of chronic medical conditions in children (aOR 1.60, 95% CI 1.34-1.91)· Other strong predictors included lower household income; deterrence due to the COVID-19 pandemic; and parental hesitancy stemming from concerns about the vaccine's safety, effectiveness, and by beliefs that their child was not at risk of contracting the influenza or severe consequences from the infection.

Conclusion

This research underscores pivotal determinants of parental decisions not to vaccinate their children against seasonal influenza and sheds light on the impact of the COVID-19 pandemic. The results highlight the importance of addressing safety concerns and providing clear information to alleviate hesitancy.

Understanding Parental Intentions for COVID-19 Child Vaccination: A Cross-Sectional Study From Jordan Using Theory of Planned Behavior

Introduction

Using the Theory of Planned Behavior, this study addresses the factors that influence parental intentions to vaccinate their 12- to 17-year-old children against COVID-19. The study looked at how attitudes, subjective norms, perceived behavioral control, and fear of the COVID-19 vaccine impact these intentions.

Methods

Between November and December 2021, 396 Jordanian parents completed an anonymous online survey. A multivariate logistic regression analysis was used for analyzing the relationships.

Results

While 94.7% of children had received routine vaccinations, only 23.5% intended to vaccinate their children against COVID-19, indicating a vaccine acceptance gap. The analysis revealed that attitudes are the most significant positive predictor of vaccination intent, accounting for 75% of the variance. Subjective norms had a positive influence on parents' decisions, whereas fear of the COVID-19 vaccine was a significant barrier. Perceived behavioral control had a small but negative effect, indicating significant challenges to vaccination.

Conclusion

The Theory of Planned Behavior (TPB) clarifies numerous factors that influence parents' decisions to immunize their children against COVID-19. Understanding these factors is critical for narrowing the gap between high rates of routine vaccinations and low rates of COVID-19 vaccinations, as well as developing effective strategies to increase vaccine acceptance among parents.

Factors associated with childhood non-vaccination against COVID-19 in Canada: A national survey analysis

Background

COVID-19 vaccination efforts are critical in mitigating the impact of the virus, but despite proven safety and efficacy, vaccination rates among children in Canada are lower than in adults, prompting a need to explore determinants of childhood COVID-19 non-vaccination to improve uptake.

Method

This study analyzed data from the Canadian COVID-19 Immunization Coverage Survey 2022. Using multivariable logistic regression, it examined the association between COVID-19 non-vaccination among children aged 5-17 and factors such as parental sociodemographic characteristics, vaccine knowledge, attitudes, and beliefs (KAB), and vaccination history.

Results

The analysis revealed that negative KAB towards vaccines, reflected in higher KAB composite scores, significantly increased the likelihood of non-vaccination. Additionally, factors such as lower household incomes, rural residence, employment in sectors not at risk for vaccine-preventable diseases, and younger parental age were associated with higher non-vaccination. The study also highlighted ethnic disparities in vaccination odds and found that children with incomplete routine vaccinations or inconsistent flu vaccination histories were more likely to be unvaccinated against COVID-19. Surprisingly, children of parents who consistently received flu vaccinations were more likely to be unvaccinated against COVID-19. Furthermore, parental education levels showed a complex relationship with children's COVID-19 vaccination status, indicating nuanced influences on vaccination decisions.

Conclusion

The findings offer vital insights into the factors influencing COVID-19 vaccination uptake among children in Canada, suggesting avenues for targeted strategies to improve vaccine coverage.

Impact of the COVID-19 pandemic on routine childhood vaccination in 9 U.S. jurisdictions

IMPORTANCE

Routine vaccinations are key to prevent outbreaks of vaccine-preventable diseases. However, there have been documented declines in routine childhood vaccinations in the U.S. and worldwide during the COVID-19 pandemic.

OBJECTIVE

Assess how the COVID-19 pandemic impacted routine childhood vaccinations by evaluating vaccination coverage for routine childhood vaccinations for children born in 2016-2021.

METHODS

Data on routine childhood vaccinations reported to CDC by nine U.S. jurisdictions via the immunization information systems (IISs) by December 31, 2022, were available for analyses. Population size for each age group was obtained from the National Center for Health Statistics' Bridging Population Estimates.

MAIN OUTCOMES AND MEASURES

Vaccination coverage for routine childhood vaccinations at age three months, five months, seven months, one year, and two years was calculated by vaccine type and overall, for 4:3:1:3:3:1:4 series (≥4 doses DTaP, ≥3 doses Polio, ≥1 dose MMR, ≥3 doses Hib, ≥3 doses Hepatitis B, ≥1 dose Varicella, and ≥ 4 doses pneumococcal conjugate), for each birth cohort year and by jurisdiction.

RESULTS

Overall, there was a 10.4 percentage point decrease in the 4:3:1:3:3:1:4 series in those children born in 2020 compared to those children born in 2016. As of December 31, 2022, 71.0% and 71.3% of children born in 2016 and 2017, respectively, were up to date on their routine childhood vaccinations by two years of age compared to 69.1%, 64.7% and 60.6% for children born in 2018, 2019, and 2020, respectively.

CONCLUSIONS AND RELEVANCE

The decline in vaccination coverage for routine childhood vaccines is concerning. In order to protect population health, strategic efforts are needed by health care providers, schools, parents, as well as state, local, and federal governments to work together to address these declines in vaccination coverage during the COVID-19 pandemic to prevent outbreaks of vaccine preventable diseases by maintaining high levels of population immunity.

A Latent Profile Analysis of COVID-19 and Influenza Vaccine Hesitancy among Economically Marginalized Hispanic Mothers of Children under Five Years of Age in the US

Rates of COVID-19 and influenza vaccine coverage among Hispanic young children continue to be low in comparison to other racial and ethnic groups in the United States. This study utilized a person-centered approach to understand COVID-19 and influenza vaccination hesitancy for young children under the age of five among 309 economically marginalized Hispanic mothers. Drawing on the cultural health belief model, in 2022, following FDA approval of the COVID-19 vaccine for young children, a latent profile analysis was conducted from which three profiles emerged. The Low Acculturation group (Profile 1), was notable for lower acculturation, moderate cultural medical mistrust, lower access to vaccines, and higher financial security. Compared to Profile 1, the two remaining profiles had higher acculturation and lower levels of financial security, but differed in that the High Acculturation group (Profile 2) had higher vaccine accessibility and the Moderate Acculturation group (Profile 3) had higher cultural medical mistrust. Relative to other profiles, Low Acculturation mothers were more likely to plan to vaccinate their child against current and seasonal COVID-19 and seasonal influenza, report that their child's health provider recommended the COVID-19 shot and reported lower COVID-19 and influenza vaccine mistrust. However, they also reported lower vaccine accessibility and moderate levels of cultural medical mistrust. The study highlights the importance of developing person-centered public health strategies that draw on Hispanic cultural values and consider diversity within lower income Hispanic populations to increase future pediatric COVID-19 and flu vaccination coverage among young Hispanic children.

Diverse Parents Decision-Making to Vaccinate Their Child under Five Attending Childcare Programs

Background: On 18 June 2022, Moderna and Pfizer-BioNTech COVID-19 vaccines were authorized under an Emergency Use Authorization by the United States Food and Drug Administration to prevent severe coronavirus disease in children six months to four years of age. Despite approval of the COVID-19 vaccinations for young children, there remain ongoing challenges reaching widespread coverage due to parental decision-making. Parental decision-making plays a pivotal, yet understudied, role governing vaccine adoption among this priority demographic. Methods: This cross-sectional analysis examined COVID-19 vaccine intentions for 320 predominately Hispanic parents of two to five-year-olds attending Miami-Dade County childcare programs in Florida USA, several months following the June 2022 emergency authorization. Parent's self-reported survey data encompassed vaccine choices and rationales, social determinants of health, and parent immigrant status. Data analyses illustrate the associations between parent decision-making and these variables. Regression modeling and tests of independence identified predicting factors for parental vaccine decision-making. Results: Only 25% of parents intended to vaccinate their young child, while 34% resisted and 41% felt unsure, despite 70% personal vaccination rates. Household income under $25,000, identifying as a migrant, or testing COVID-19-positive significantly predicted unsure decision-making. The majority of hesitant groups expressed concerns around side effects (20%), safety (2.9%), and sufficiency of vaccine knowledge (3.3%). Conclusions: In this sample, the predominance of parents were unsure and resistant rather than accepting of having their child vaccinated despite emergency approval of the pediatric vaccine. Associations and predictive factors are examined.

Navigating parental attitudes on childhood vaccination in Jordan: a cross-sectional study

This study investigated parental attitudes toward childhood vaccination in Jordan, focusing on acceptance, concerns, and perceptions. A cross-sectional survey conducted from January to February 2024 included 939 parents. Findings indicated that 85.4% (n = 802) of respondents received the COVID-19 vaccine, while only 25% (n = 229) vaccinated their children. Concerns regarding vaccine safety and efficacy were prevalent, with 63.9% (n = 600) expressing worries about side effects and 46.9% (n = 440) trusting immunization programs. Post-pandemic, 34% (n = 319) reported a more negative attitude. Logistic regression showed parents not vaccinating their children against COVID-19 were significantly less likely to exhibit positive attitudes toward childhood vaccination (OR = 0.412, p < 0.001). Older participants were more inclined toward negativity post-pandemic (OR = 1.031, p = 0.007). In conclusion, parental attitudes shifted post-COVID-19, reflecting hesitancy and decreased trust. Addressing concerns and restoring confidence are crucial, especially for children's health. Education through healthcare providers and dispelling social media misinformation are essential. Implementing strategies to enhance post-pandemic vaccine acceptance is imperative for preventing outbreaks of vaccine-preventable diseases.

Family Structure Associated with Measles-Rubella and Varicella Vaccination in Children

BACKGROUND

Delayed vaccination is a well-studied and critical public health issue. However, limited studies have explored whether familial factors influence vaccination delay. This study aimed to determine whether family structure and comorbidities affect the refusal or delayed receipt of measles-rubella and varicella vaccines.

METHODS

We gathered data on all children from birth to 13 months of age between 2006 and 2020 using vaccination records linked with the administrative healthcare claims data from a Japanese city. Multivariable logistic regression analyses were conducted to examine the association of refusal or delay in receiving the first-dose measles-rubella and varicella vaccines with the following factors: the child's sex; presence of parents, siblings, and grandparents; parental and grandparental comorbidities; chronic pediatric comorbidities in the child and siblings; and year of vaccination.

RESULTS

We identified a total of 14,241 eligible children. Refusal or delayed receipt of the first-dose measles-rubella vaccine was associated with an adjusted odds ratio of 2.46 (95% confidence interval, 1.86-3.24) for maternal absence and 1.61 (1.44-1.80) for paternal absence. Similarly, the refusal or delay in receiving the first-dose varicella vaccine was associated with an adjusted odds ratio of 2.04 (95% confidence interval, 1.01-4.16) for maternal absence and 1.37 (1.12-1.69) for paternal absence. The presence of siblings and maternal comorbidities were significantly associated with vaccination delays.

CONCLUSION

The absence of a parent, the presence of siblings, and maternal comorbidities were associated with the refusal or delay in receiving measles-rubella and varicella vaccines. Strategies for vaccine recommendation should therefore consider family structure and maternal comorbidities.

Developing a novel screening tool to address pediatric COVID-19 vaccine hesitancy at point of care

Many children are still not vaccinated against COVID-19, often attributed to rising pediatric vaccine hesitancy. To address this complex public health issue, interventions that uncover parental thinking at point of care are needed to help facilitate discussions in the exam room. The cognitive science framework of Rule Developing Experimentation helps distinguish how people think about day-to-day topics by presenting respondents with a systematic combination of messages that determines the ideas primarily driving their decisions. We hypothesized that Rule Developing Experimentation can empirically assess and identify parental mind-sets in deciding to vaccinate their children to prevent COVID-19. Artificial intelligence was also incorporated to more efficiently help formulate messages. Through an iterative process, surveying a total of 600 participants, three mind-sets emerged regarding the types of messages which parents believe would convince them to vaccinate their children to prevent COVID-19. These three mind-sets are summarized by the following phrases - "Covid is Serious," "Science Says Vaccine Works," and "Vaccine Returns Kids to Normalcy". Using these mind-sets, a simple six-question instrument (i.e., Personal Viewpoint Identifier) was then created to quickly discern at point of care a parent's mind-set surrounding pediatric COVID-19 vaccination. By quickly identifying a parent's mindset at point of care, providers can then utilize the results of the assessment to deliver individualized messaging to parents about the benefits of COVID-19 vaccination. A future study is planned to evaluate the impact of incorporating the Personal Viewpoint Identifier into routine pediatric care settings on COVID-19 vaccination rates.

Factors associated with vaccine hesitancy against COVID-19 among adults in Europe: a descriptive study analysis applying socio-ecological framework

OBJECTIVE

This study aimed to explore the factors associated with COVID-19 vaccine hesitancy in Europe among adults by using the Socio-Ecological Model.

RESULTS

This cross-sectional study used secondary data collected from respondents residing in 27 EU countries at the time of May 2021. The outcome was vaccine hesitancy against COVID-19, and the total sample size of 23,606 was analysed by binary logistic regression, as well as McKelvey and Zavonoia's R2. After adding each level of variables, the model found the significant and increased association with vaccine hesitancy in younger age groups (21-39 years and 40-60 years vs. 65 years+), who left full-time education at a young age (16-19 years), those with manual jobs, those with children at home, individuals residing in small towns, and beliefs related to the vaccine. Together, the levels explained 49.5% of the variance associated with vaccine hesitancy, and the addition to each variable layer increased the variance. This highlights the need to consider broad factors at multiple levels to enhance vaccine acceptance and uptake.

Longitudinal parental perception of COVID-19 vaccines for children in a multi-site, cohort study

OBJECTIVES

Pediatric COVID-19 vaccine hesitancy and uptake is not well understood. Among parents of a prospective cohort of children aged 6 months-17 years, we assessed COVID-19 vaccine knowledge, attitudes, and practices (KAP), and uptake over 15 months.

METHODS

The PROTECT study collected sociodemographic characteristics of children at enrollment and COVID-19 vaccination data and parental KAPs quarterly. Univariable and multivariable logistic regression models were used to test the effect of KAPs on vaccine uptake; McNemar's test for paired samples was used to evaluate KAP change over time.

RESULTS

A total of 2,837 children were enrolled, with more than half (61 %) vaccinated by October 2022. Positive parental beliefs about vaccine safety and effectiveness strongly predicted vaccine uptake among children aged 5-11 years (aOR 13.1, 95 % CI 8.5-20.4 and aOR 6.4, 95 % CI 4.3-9.6, respectively) and children aged 12+ years (aOR 7.0, 95 % CI 3.8-13.0 and aOR 8.9, 95 % CI 4.4-18.0). Compared to enrollment, at follow-up parents (of vaccinated and unvaccinated children) reported higher self-assessed vaccine knowledge, but more negative beliefs towards vaccine safety, effectiveness, and trust in government. Parents unlikely to vaccinate their children at enrollment reported more positive beliefs on vaccine knowledge, safety, and effectiveness at follow-up.

CONCLUSION

The PROTECT cohort allows for an examination of factors driving vaccine uptake and how beliefs about COVID-19 and the COVID-19 vaccines change over time. Findings of the current analysis suggest that these beliefs change over time and policies aiming to increase vaccine uptake should focus on vaccine safety and effectiveness.

Predictors of seasonal influenza and COVID-19 vaccination coverage among adults in Tennessee during the COVID-19 pandemic

Background

The COVID-19 pandemic has convoluted hesitancy toward vaccines, including the seasonal influenza (flu) vaccine. Because of COVID-19, the flu season has become more complicated; therefore, it is important to understand all the factors influencing the uptake of these vaccines to inform intervention targets. This article assesses factors related to the uptake of influenza and COVID-19 vaccines among adults in Tennessee.

Methods

A cross-sectional, secondary data analysis of 1,400 adults was conducted in Tennessee. The adult sample came from two data sources: Data source 1 completed a baseline survey from January to March 2022, and data source 2 was completed from May to August 2022. Data on vaccine attitudes, facilitators and barriers, and communication needs were collected via random digit dial by Scientific Telephone Samples (STS). Two multivariable logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to predict sociodemographic and overall vaccine-related factors associated with receipt or non-receipt (referent) of COVID-19 and influenza vaccines.

Results

Approximately 78% of the adult sample had received the COVID-19 vaccination. A significant positive association for COVID-19 vaccine uptake was seen among those who were older (aged 50-65) (aOR = 1.9; 95% CI: 1.2-3.2), Black (aOR = 2.0; 95% CI:1.3-2.8), and had a college education and higher (aOR = 2.3; 95% CI: 1.5-3.6). However, there was a significant negative association for persons reporting they were extremely religious (aOR = 0.5; 95% CI:0.3-0.9). Over 56% of the adult sample had received the influenza vaccination this season. Those who had a higher annual household income ($80,000+) (aOR = 1.9; 95% CI: 1.3-2.6) and had health insurance (aOR = 2.6; 95% CI: 1.4-4.8) had a significant positive association with influenza vaccine receipt. However, those who were employed part-time or were unemployed had a significant negative association for influenza vaccine receipt (aOR = 0.7; 95% CI: 0.5-0.9). Both COVID-19 and influenza vaccine receipt had strongly significant positive trends with increasing belief in effectiveness and trust (p < 0.0001) and strongly significant negative trends with higher levels of overall vaccine hesitancy (p < 0.0001).

Conclusion

Strategies to increase COVID-19 and influenza vaccination should be age-specific, focus on increasing geographical and financial access, and offer tailored messages to address concerns about these vaccines.

Short term safety of BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 vaccine among children aged 5-11 years, a nationwide parental survey

PURPOSE

SARS-CoV-2 vaccine safety is of major interest worldwide, and transparent information about potential side effects is essential to decrease vaccine hesitancy. The aim of this study was to assess SARS-CoV-2 BNT162b2 vaccine short-term side effects among children aged 5-11 years.

METHODS

An observational, cross sectional study of vaccine side-effects using electronic surveys sent to parents one week post administration of BNT162b2 vaccine to their child in a large health maintenance organization in Israel.

RESULTS

First dose and second dose surveys were filled for 5,842 and 6,126 children, respectively, with a response rate of 32.1% and 24.8%. Local side effects were reported by 68.7% and 69.1% of the first and second survey respondents, and general side effects were reported by 20.8% and 34.5% of them. The symptoms most frequently reported were fatigue, headache and myalgia. Duration of symptoms lasted three days or less among 86.5% and 81.5% of first and second dose survey respondents. Most respondents (92%) reported that their child did not need any medical consultation following vaccination.

CONCLUSIONS

We found further support for the BNT162b2 SARS-CoV-2 vaccine short- term safety among children aged 5-11 years. With ongoing pandemic and future booster COVID-19 vaccines, these findings can encourage vaccine confidence for parents and providers.

Attitudes Toward Routine Vaccines and COVID-19 Vaccines Among Parents of Infants and Toddlers in an Urban Safety-Net Setting

This study explores attitudes toward diphtheria-tetanus-acellular pertussis (DTaP), measles-mumps-rubella (MMR), influenza, and coronavirus disease 2019 (COVID-19) vaccines among English-speaking and Spanish-speaking parents of infants in a safety-net setting. Parents aged 18 years or older were recruited from outpatient clinics between December 2020 and December 2021. The interviews were then recorded, transcribed, translated, and qualitatively analyzed using the modified grounded theory. Thirty-two individuals participated (18 English-speaking and 14 Spanish-speaking). Almost all supported receiving routine childhood vaccines, DTaP, influenza, and MMR and believed that vaccines promote health. Vaccine concerns differed by each vaccine. Few participants expressed concerns about DTaP and MMR vaccines. Concerns around influenza vaccines often stemmed from personal experience and perceived increased risk of flu-like illnesses. Participants expressed the most concerns related to COVID-19 vaccinations, including age-based immunity of their infants. Based on these findings, future interventions to improve vaccine uptake may focus on benefits common to all vaccines, while addressing vaccine-specific concerns.

Maternal worry of children contracting COVID-19 predicts vaccine uptake in young children in Vermont

Background

Young children, 6 months to 4 years of age, were the last population for whom the COVID-19 vaccines became available and remain the group with the lowest uptake. Scarce information exists on drivers of vaccine uptake in young children. The relationship between parental perceived risk of infection and child COVID-19 vaccination is unknown.

Objective

Examine the association between perceived risk of infection and early childhood vaccination.

Methods

In June 2020, perinatal women in Vermont were enrolled in a longitudinal survey study assessing life changes during the pandemic. Surveys included worry of infection, Parents Attitude about Childhood Vaccines (PACV), intention to vaccinate children with the COVID-19 vaccine, and masking behaviors. Once vaccines became available, surveys also included child vaccination status. A demographic-adjusted stepwise logistic regression was conducted to assess the relationship of worry of infection and vaccine hesitancy on child vaccination status.

Results

85 women completed baseline and follow up surveys. Participants were highly adherent to adult COVID vaccines with 93 % at least partially vaccinated and only 3 % demonstrated general childhood vaccine hesitancy on the PACV. However, in this highly adherent population, only 61 % of young children are vaccinated. In univariate [OR = 7.35 95 % CI (2.70 to 20.02)] and demographic adjusted [OR = 6.03 95 % CI (1.30 to 27.90)] models, current worry about child infection was associated with higher odds of child vaccination. Previously established predictors, vaccine hesitancy [OR = 0.91 95 % CI (0.84 to 0.99)] and younger maternal age [OR = 1.33 95 % CI (1.07 to 1.65)] were again associated lower odds of child vaccination.

Conclusion

Among vaccine adherent parents, worry of infection was a strong predictor of vaccine uptake. Continued efforts to articulate the potential morbidity of COVID in young children, along with established methods to address general vaccine hesitancy may aid in COVID vaccine uptake in this population.

Routine childhood immunization in Sub-Saharan Africa: addressing parental vaccine hesitancy

OBJECTIVES

Parental vaccine hesitancy (VH) is a major barrier to childhood vaccination. We aimed to identify the determinants of parental VH towards routine childhood immunization in 12 Sub-Saharan African countries.

STUDY DESIGN

A cross-sectional study was conducted from November 1 to December 15, 2022.

METHODS

Parents of children aged 19 months to 6 years and residing in the Sub-Saharan Africa were included. An anonymous online survey and face-to-face interviews were conducted. The Parent Attitude about Childhood Vaccine Scale was used to identify vaccine-hesitant parents. Multivariate regression and mediating analysis were performed.

RESULTS

Across the 5032 participants, 21.2% were hesitant towards routine childhood immunization. Urban residents (adjusted odds ratio [AOR] = 1.32, 95% confidence interval [CI]: 1.10-1.58), non-first-born children (AOR = 1.54, 95% CI: 1.19-1.98), and chronically ill children (AOR = 2.00, 95% CI: 1.69-2.37) increased the likelihood of parental VH. Mothers with higher education, attending at least one antenatal care (ANC) visit (AOR = 0.25, 95% CI: 0.19-0.32), and had a healthcare facility-based delivery (AOR = 0.55, 95% CI: 0.44-0.70) decreased the odds of parental VH. Parental VH mediated the effect of ANC and mothers' age on vaccination uptake. ANC increased the odds of vaccination uptake (odds ratio [OR] = 12.49, 95% CI: 9.68-16.13). Parental VH mediated the association between ANC and vaccination uptake, decreasing the likelihood of vaccination uptake (OR = 0.12, 95% CI: 0.10-0.14). Each additional year of the mother's age decreased the odds of vaccination uptake (OR = 0.95, 95% CI: 0.95-0.96). The indirect effect of mother's age on vaccination through parental VH decreased the odds of vaccination uptake (OR = 0.45, 95% CI: 0.44-0.45). Parental VH continued to be a mediator of the combined effect of mother's age and ANC on vaccination uptake, decreasing the likelihood of vaccination uptake (OR = 0.0017, 95% CI: 0.00166-0.00168).

CONCLUSIONS

Context-specific interventions are needed to address parental VH and improve vaccine acceptance and coverage.

High Caregiver Adverse Childhood Experiences Are Associated With Pediatric Influenza and COVID-19 Vaccination Uptake

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.

Influenza vaccination in children with pulmonary disease during the COVID-19 pandemic

INTRODUCTION

Influenza is associated with considerable respiratory morbidity and mortality. Healthcare authorities recommend immunization of all children as vaccinations protect vulnerable populations, minimize influenza triggered asthma attacks, and reduced the burden of respiratory illnesses during the SARS-CoV-2 pandemic. Medical professionals should counsel parents of children with chronic lung disease to receive annual influenza vaccinations as part of supportive care. We aimed to describe adherence to influenza vaccination in respiratory patients and identify potential reasons for non-vaccination.

METHODS

This study included questionnaires reviewing personal experience and beliefs regarding influenza vaccination, provided by parents of patients who visited the Pediatric Pulmonary Institute at Schneider Children's Medical Center with their children, during March-August 2021.

RESULTS

Of 198 parents who completed our questionnaire, 114 (57.3 %) vaccinated their children against influenza during that year. Average age was 6.9 ± 4.5 years. Demographic data were similar between the vaccinated and unvaccinated groups. Influenza vaccination rates differed significantly between parents who received an explanation from their primary physician and those who did not (65.4 % vs. 43.7 %, respectfully, p = 0.003), and parents who received explanations from a pulmonary specialist and those who did not (77.3 % vs. 48.8 %, respectively, p = 0.004). The combined recommendation of a primary physician and pulmonologist translated to a significantly higher vaccination rate among those who received such recommendations, as compared to those who did not (p < 0.001). Parents who believed in vaccine efficacy and safety were more likely to vaccinate their children (p < 0.001). Factors significantly affecting the decision of the parents to have their child vaccinated were their knowledge, beliefs, and conceptions about the vaccine.

CONCLUSIONS

Pediatric respiratory patients' influenza vaccination rate was 57 %. Major factors encouraging vaccination were correct parental knowledge and receiving recommendations from their primary physician\pulmonologist. This emphasizes the need for providing patients with information, by first explaining the vaccine's importance to physicians.

Family Communication Patterns and Parents' Intentions to Vaccinate Their Child Against COVID-19

This study explored how family communication patterns relate to parental knowledge about COVID-19, vaccine confidence, and intentions to vaccinate their children. Parents from 4 states (Ohio, New York, Georgia, and Texas; n = 702) completed an online survey in March 2021. Results revealed that conversation orientation was positively associated with both COVID-19 knowledge and overall vaccine confidence, which were both positively associated with intentions to vaccinate one's child. The relationships between the 4 subscales of conformity and the outcome variables were mixed. We discuss the potential benefits of applying family communication patterns theory to complicated situations where parents are making health decisions for both themselves and their children.

COVID-19 vaccine or booster hesitancy among children aged 6 month-5 years, 5-11 years, and 12-17 years in the United States: An analytic cross-sectional study

With the increased accessibility of COVID-19 vaccine, many households have had concerns when vaccinating children, leading to vaccine hesitancy. This study examined the COVID-19 vaccine and booster hesitancy among children aged 6 months-5 years, 5-11 years, and 12-17 years in the United States. We analyzed data from Phase 3.8 (March 1, 2023 to May 8, 2023) of the Household Pulse Survey (HPS) collected by the U.S. Census Bureau. We conducted survey-weighted multiple logistic regression models in vaccine hesitancy among respondents with children from those three different age groups, controlling for various demographic factors such as COVID-19 vaccination status, COVID-19 positive test results, race/ethnicity, gender at birth, age, region, marital status, educational attainment, household income, health insurance, and children's school type. The percentage of respondents indicating hesitancy towards vaccinating their children (expressing uncertainty, probably not, or definitely not) decreased as their children's age increased. Specifically, the proportion was 57.4% for children aged 6 months-5 years, 43.3% for children aged 5-11 years, and 25.9% for children aged 12-17 years. Concerns about possible side effects of the COVID-19 vaccine were the most prevalent among respondents who expressed vaccine hesitancy, regardless of the level of hesitancy, while those with strong hesitancy showed higher proportions of not believing their children need a vaccine, lack of trust in COVID-19 vaccines and the government, and parents/guardians not vaccinating their children. This study provide insight into our current situation, aiming to build assurance among households regarding the efficacy and benefits of COVID-19 vaccines for children of all ages.

Routine childhood vaccination among ethnocultural groups in Canada during the COVID-19 pandemic: A national cross-sectional study

Some ethnocultural groups in Canada experience low routine childhood vaccination, with social locations and discriminations contributing to inequities. This study aimed to characterize routine childhood vaccination in the context of the COVID-19 pandemic, including the influence of discriminatory experiences when accessing health services. We conducted a cross-sectional national survey to assess parents' acceptance of routine vaccines for their children ≤ 17 years in Oct/Nov 2021. Descriptive statistics were used to explore differences among ethnocultural groups and logistic regression to assess associations with parents' low acceptance. Of 2531 parents, 21.8 % self-identified as Racialized minorities, 7.7 % Indigenous, 23.3 % newcomers, 10.0 % spoke minority languages most often, and 69.6 % belonged to a reference group who did not report these characteristics. Statistically significant findings included 36.6 % of Indigenous parents reporting that the pandemic made them realize that routine vaccines were more important compared to 16.7 % of newcomers. Discrimination/racism when accessing health services was most often experienced by Indigenous (27.8 %) and Racialized minorities (20.2 %), compared to the reference group (4.8 %). Racialized minorities were more likely to report low acceptance of routine vaccination (aOR = 2.19, 95 % CI: 1.18-4.05), and younger parents and those with only preschool-aged children were less likely to have low acceptance (aOR = 0.59, 95 % CI: 0.37-0.94; aOR = 0.53, 95 % CI: 0.36, 0.79). Low acceptance was associated with everyday stress preventing vaccination (aOR = 2.18, 95 % CI: 1.41-3.38). Public health decision-makers should ensure equitable access to routine childhood vaccination that targets the inclusion of ethnocultural groups, who may experience disproportionate barriers and low acceptance.

Impact of household decision makers' hesitancy to vaccinate children against COVID-19 on other household members: A family-based study in Taizhou, China

Background

Vaccination is the most effective means of preventing outbreaks of infectious diseases, and family ;decision makers play an important role in decision-making regarding family matters and may influence other family members to take an active role in vaccinating children against COVID-19.

Purpose

This study examined the influence of family decision makers on the hesitation of other family members to vaccinate their children against COVID-19.

Methods

A population-based, self-administered online questionnaire was administered in Taizhou, China, from September 1, 2021, to September 15, 2021. The questionnaire included demographic information, knowledge, attitudes, and perceptions about the COVID-19 vaccine as well as hesitation regarding the use of the COVID-19 vaccination in children. In total, 490 respondents were included in this study. Logistic regression was used to assess the factors associated with vaccine hesitancy.

Results

In total, 490 respondents from 190 households were interviewed. Of the 190 family decision makers, 43.7% (83/190) were hesitant to vaccinate their children against COVID-19. When family decision makers were hesitant to vaccinate children against COVID-19, 65.1% (82/126) of the other family members expressed similar hesitancy regarding vaccination. When family decision makers were not hesitant to vaccinate children, only 21.3% (37/174) of other family members were hesitant to do so. In the regression analysis, family decision makers' hesitation to vaccinate their children was associated with other family members' hesitation (OR=6.264, 95% CI:3.132-12.526). In addition, decision makers' perceptions of the safety of the vaccine (OR=0.422, 95% CI:0.215-0.826) and hesitation to vaccinate themselves (OR=8.967, 95% CI:4.745-16.948) influenced their hesitation to vaccinate their children.

Conclusion

The present study found that family decision makers' hesitation to vaccinate children against COVID-19 influenced other family members' hesitation to vaccinate children. In addition, family decision makers' perceptions of the safety of the vaccine and their hesitation to vaccinate themselves influenced other family members' hesitation to vaccinate their children.

Factors associated with parental intention to vaccinate their child against influenza, Finland, February to March, 2022: a web-based survey

BackgroundInfluenza vaccination for children aged 6 months to 6 years is included in the national vaccination programme in Finland. Although all vaccines in the programme are free of charge, national coverage of influenza vaccination among children under 3 years and 3-6 years during 2020/21 was 43% and 35% respectively, with regional differences.AimTo assess factors underlying parental vaccination intention in order to increase influenza vaccine uptake among children.MethodsWe conducted a web-based survey among parents (n = 17,844) of randomly selected eligible children (aged 6 months-6 years) in February-March 2022 in five Finnish municipalities from regions of high and low coverage. Logistic regressions were used to determine associations between vaccination intention and e.g. sociodemographic factors, attitudes and knowledge. Linkage to the national vaccination register was used to confirm realisation of vaccination intention after the study.ResultsParticipation rate was 13% (n = 2,322 parents). Influenza knowledge, trust in official information, responding parent's education level, adherence to the vaccination programme, number of children and changes in attitudes towards vaccination since COVID-19 were all associated with intention to vaccinate. Vaccination intention for children was 64%, and realised vaccination 51%.ConclusionDespite the low participation rate, both vaccinated and unvaccinated children were represented. Influenza vaccine uptake is not dependent on a single factor. Our results identified the need for open dialogue between parents and healthcare professionals, as the lack of vaccine being offered by healthcare professionals was the most reported reason for not vaccinating.

Determinants of parental vaccine hesitancy in Canada: results from the 2017 Childhood National Immunization Coverage Survey

BACKGROUND

In 2019, the World Health Organization (WHO) designated vaccine hesitancy as one of the ten leading threats to global health. Vaccine hesitancy exists when vaccination services are available and accessible, but vaccine uptake is lower than anticipated. It is often attributed to lack of trust in vaccine safety and effectiveness, or low level of concern about the risk of many vaccine-preventable diseases. This study aimed to examine the sociodemographic factors associated with parental vaccine hesitancy and vaccine refusal in Canada using data from the 2017 Childhood National Immunization Coverage Survey (CNICS).

METHOD

The 2017 CNICS was a cross-sectional and nationally representative survey to estimate national vaccine uptake and to collect information about parents' Knowledge, Attitudes and Beliefs (KAB) regarding vaccination. Using the KAB questions, parental vaccine hesitancy (i.e., parental hesitation, delay or refusal of at least one recommended vaccination) and refusal (i.e., unvaccinated children) by sociodemographic factors was estimated using weighted prevalence proportions. A multinomial logistic regression model was fitted to examine associations between parental vaccine hesitancy or refusal and sociodemographic factors among parents of two-year-old children in Canada. Adjusted odds ratios (aOR) of being vaccine-hesitant or vaccine-refusing versus being non-vaccine-hesitant were generated.

RESULTS

Both unadjusted and adjusted logistic regressions models showed that parents with lower household income (aOR 1.7, 95% CI 1.2-2.5), and those with a higher number of children in the household (aOR 2.2, 95% CI 1.4-3.5) had higher vaccine hesitancy. Conversely, lower vaccine hesitancy was observed among non-immigrant parents (aOR 0.4, 95% CI 0.3-0.6). In addition, lower household income (aOR 4.0, 95% CI 1.3-12.9), and higher number of children in the household (aOR 6.9, 95% CI 2.1-22.9) were significantly associated with parental vaccine refusal. Regional variations were also observed.

CONCLUSION

Several sociodemographic determinants are associated with parental vaccine hesitancy and refusal. The findings of the study could help public health officials and policymakers to develop and implement targeted interventions to improve childhood vaccination programs.

U.S. public support and opposition to vaccination mandates in K-12 education in light of the COVID-19 pandemic

BACKGROUND

Vaccination mandates have long been an effective tool in increasing vaccination rates and reducing the potential for disease outbreaks. In the wake of COVID-19, opposition to mandates in the K-12 setting has garnered more attention, and policymakers opposed to them have become more active. This study sought to assess whether these efforts are supported by the U.S. public.

METHODS

We fielded a large, national survey (N = 16,461) from January to April of 2022 to assess U.S. public opinion about seven specific vaccination mandates (diphtheria, tetanus, & pertussis (DTaP); polio; chickenpox; measles, mumps, and rubella (MMR); hepatitis; human papillomavirus (HPV); and COVID-19) in K-12 educational settings.

RESULTS

We found that Americans are overwhelmingly supportive of all vaccination mandates with support ranging from a high 90 percent of respondents for DTaP, polio, chickenpox, and MMR to a low of 68 percent for COVID-19. Individuals who deemed vaccines safe and important, those with trust in the National Institutes of Health and the Food and Drug Administration, urban residents, and ethnic and racial minorities tended to be consistently more supportive. Perceptions about vaccine effectiveness were positively associated with mandate support in most cases, as was trust in medical doctors. Respondents who believed that vaccines cause autism, those with better health and more trust in religious leaders tended to be consistently more opposed. Women were generally more supportive of mandates except for HPV and COVID-19. Ideology and partisanship affected opinion for COVID-19 as did trust in the Centers for Disease Control and Prevention. We found no effects for income or education.

CONCLUSION

Vaccination mandates in K-12 have broad support among the American public, even in more controversial cases such as HPV and COVID-19. Vocal opposition and growing interest by policymakers to limit or undo vaccination mandates are not supported by the broader public.

Knowledge, Attitudes, Intentions and Vaccine Hesitancy among Postpartum Mothers in a Region from the Northwest of Romania

This study aims to identify the presence of vaccine hesitancy and the factors that could have determined it in a group of mothers in the postpartum period, with an evaluation of both the level of knowledge and information, as well as the attitudes, perceptions, intentions and sources of information about vaccination. The study was based on a survey-Vaccine Hesitancy Identification Survey-applied in two maternity wards from Bihor County and structured into six subscales (34 items). Based on the answers to the key questions ("Which of the following statements best describes your plans for vaccinating your child?"-item 1 of subscale 4; "Overall, how hesitant do you consider yourself to be about vaccinating your child?"-item 4 of subscale 4), we identified two groups: the group of mothers without hesitant behavior (non-hesitant), called the group pro vaccine (GPV), and the group of mothers with hesitant behavior, called the group non vaccine (GNV). Vaccine hesitancy was identified in our study in 47.28% of the participants (191 of the 404 mothers included). Most of them come from an urban environment (57.59%), have university and post-secondary education (58.64%) and are prim parous (58.64%). The behavior of participants from GNV is influenced by a low level of knowledge and information regarding vaccination and by concerns related to adverse reactions, new vaccines and the number of vaccines administered. Also, this group is characterized by an increased perception of the risks related to vaccination, while the perception of the risks associated with the disease is low. For all subscales, important differences were registered between the two groups in favor of GPV, a group characterized by positive attitudes and perceptions and a better level of knowledge compared to GNV. This study aims to represent a starting point for the organization and running of information campaigns regarding vaccination at the level of Bihor County, especially in areas with low vaccination coverage, where this behavior is identified.

The Patient Protection and Affordable Care Act and Pediatric Medical Clinicians' Application of Fluoride Varnish

Importance

Fluoride varnish reduces children's tooth decay, yet few clinicians provide it. Most state Medicaid programs have covered this service during medical visits for children aged 1 to 5 years, but private insurers began covering it only in 2015 due to the Patient Protection and Affordable Care Act (ACA) mandate that they cover a set of recommended preventive services without cost-sharing. Evidence on clinicians' behavior change postmandate is limited.

Objective

To examine monthly changes in fluoride varnish applications among pediatric clinicians following the ACA mandate.

Design, Setting, and Participants

Using all-payer claims data from Massachusetts, this cohort study applied an interrupted time-series approach with linear regression models comparing changes in monthly clinician-level outcomes before and after the mandate. Participants included clinicians who billed at least 5 well-child visits for patients aged 1 to 5 years and were observed at least once premandate. Adjusted for clinician fixed effects, models were assessed overall and separately for clinicians categorized by their monthly share of well-child visits paid by private insurers before the mandate: mostly private (>66% of visits paid by private insurers), mostly public (<33% of visits paid by private insurers), or mixed (33%-66% of visits paid by private insurers) insurance types. Analysis was performed from June 1, 2022, to July 31, 2023.

Exposure

Preenactment and postenactment of the ACA mandate for private insurers to cover fluoride varnish applications without cost-sharing.

Main Outcomes and Measures

Clinician-month measures of whether fluoride varnish was provided during at least 1 well-child visit and the share of such visits, analyzed separately for clinicians who did and did not apply fluoride varnish premandate.

Results

The sample included 2405 clinicians, with 107 841 clinician-months. Premandate, 10.48% of the visits included fluoride varnish applications. Two years postmandate, the likelihood of ever applying fluoride varnish was 13.64 (95% CI, 10.97-16.32) percentage points higher. For clinicians providing fluoride varnish premandate, the share of visits with fluoride varnish increased by 9.22 (95% CI, 5.41-13.02) percentage points. This increase was observed in clinicians who treated children with insurance that was mostly mixed and mostly private; no substantial change was observed among those treating children with mostly public insurance.

Conclusions and Relevance

In this cohort study of pediatric primary care clinicians, an association between the ACA mandate and an increase in fluoride varnish application was observed, especially among clinicians primarily treating privately insured patients and those applying it premandate. However, application remains infrequent, suggesting persistent barriers.

Vaccine Mandates and Influenza Vaccination During the Pandemic

OBJECTIVES

To determine whether a state influenza vaccine mandate and elevated community coronavirus disease 2019 (COVID-19) severity affected a child's probability of receiving an influenza vaccine during the 2020-2021 influenza season, given the child's previous vaccination history.

METHODS

Longitudinal cohort study using enrollment and claims data of 71 333 children aged 6 months to 18 years living in Massachusetts, New Hampshire, and Maine, from a regional insurer. Schoolchildren in Massachusetts were exposed to a new influenza vaccine mandate in the 2020-2021 season. Community COVID-19 severity was measured using county-level total cumulative confirmed case counts between March 2020 and August 2020 and linked by zip codes. The primary outcome of interest was a claim for any influenza vaccine in the 2020-2021 season.

RESULTS

Children living in a state with a vaccine mandate during the 2020-2021 influenza season had a higher predicted probability of receiving an influenza vaccine than those living in states without a mandate (47.7%, confidence interval 46.4%-49.0%, vs 21.2%, confidence interval 18.8%-23.6%, respectively, for previous nonvaccinators, and 78.2%, confidence interval 77.4%-79.0%, vs 58.2%, confidence interval 54.7%-61.7%, for previous vaccinators); the difference was 6.5 percentage points greater among previous nonvaccinators (confidence interval 1.3%-11.7%). Previously vaccinated children had a lower predicted probability of receiving an influenza vaccine if they lived in a county with the highest COVID-19 severity compared with a county with low COVID-19 severity (72.1%, confidence interval 70.5%-73.7%, vs 77.3%, confidence interval 74.7%-79.9%).

CONCLUSIONS

Strategies to improve uptake of influenza vaccination may have differential impact based on previous vaccination status and should account for community factors.

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.

Recommendations for Prevention and Control of Influenza in Children, 2023-2024

This technical report accompanies the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccine and antiviral medications in the prevention and treatment of influenza in children during the 2023-2024 season. The rationale for the American Academy of Pediatrics recommendation for annual influenza vaccination of all children without medical contraindications starting at 6 months of age is provided. Influenza vaccination is an important strategy for protecting children and the broader community against influenza. This technical report summarizes recent influenza seasons, morbidity and mortality in children, vaccine effectiveness, and vaccination coverage, and provides detailed guidance on vaccine storage, administration, and implementation. The report also provides a brief background on inactivated and live-attenuated influenza vaccines, available vaccines this season, vaccination during pregnancy and breastfeeding, diagnostic testing for influenza, and antiviral medications for treatment and chemoprophylaxis. Strategies to promote vaccine uptake are emphasized.

Influenza Vaccinations Among Privately and Publicly Insured Children With Asthma

OBJECTIVE

Annual influenza vaccination rates for children remain well below the Healthy People 2030 target of 70%. We aimed to compare influenza vaccination rates for children with asthma by insurance type and to identify associated factors.

METHODS

This cross-sectional study examined influenza vaccination rates for children with asthma by insurance type, age, year, and disease status using the Massachusetts All Payer Claims Database (2014-2018). We used multivariable logistic regression to estimate the probability of vaccination accounting for child and insurance characteristics.

RESULTS

The sample included 317,596 child-year observations for children with asthma in 2015-18. Fewer than half of children with asthma received influenza vaccinations; 51.3% among privately insured and 45.1% among Medicaid insured. Risk modeling reduced, but did not eliminate, this gap; privately insured children were 3.7 percentage points (pp) more likely to receive an influenza vaccination than Medicaid-insured children (95% confidence interval [CI]: 2.9-4.5pp). Risk modeling also found persistent asthma was associated with more vaccinations (6.7pp higher; 95% CI: 6.2-7.2pp), as was younger age. The regression-adjusted probability of influenza vaccination in a non-office setting was 3.2pp higher in 2018 than 2015 (95% CI: 2.2-4.2pp), and significantly lower for children with Medicaid.

CONCLUSIONS

Despite clear recommendations for annual influenza vaccinations for children with asthma, low rates persist, particularly for children with Medicaid. Offering vaccines in non-office settings such as retail pharmacies may reduce barriers, but we did not observe increased vaccination rates in the first years after this policy change.

Assessing the longitudinal effects of the continuation and discontinuation of the school-located influenza vaccination programme on parental vaccine hesitancy in Hong Kong

BACKGROUND

School-located influenza vaccination programme (SIVP) can effectively promote childhood seasonal influenza vaccination (SIV). However, the longitudinal effects of continuation and discontinuation of the SIVP on parents' vaccine hesitancy remained unknown.

METHODS

A two-wave longitudinal study recruited adult parents who had at least one child attending a kindergarten or primary school using random-digital-dialled telephone interviews. Generalized estimating equation and structural equation modelling were used to examine the impact of changes in schools' SIVP participation status on parents' vaccine-related attitudes, and childhood SIV acceptance over 2 years in Hong Kong.

RESULTS

Children's SIV uptake varied by the schools' SIVP participation status. The highest SIV uptake was found in schools that consistently participated in SIVP (Consistent participation group) (2018/2019: 85.0%; 2019/2020: 83.0%) but lowest in the Consistent non-Participation group (2018/2019: 45.0%; 2019/2020: 39.0%). SIV uptake increased in the Late Initiation group but declined in the Discontinuation group. An increasing trend of parental vaccine-hesitant attitudes was observed in the Consistent non-Participation group.

CONCLUSIONS

Initiation and continuation of the SIVP can reduce parental vaccine hesitancy to achieve a high childhood SIV uptake. Conversely, discontinuation of the SIVP or persistent resistance to the implementation of SIVP can increase parental vaccine hesitancy and reduce childhood SIV uptake.

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.

Parent-reported Barriers and Parental Beliefs Associated with Intentions to Obtain HPV Vaccination for Children in a Primary care Patient Population in Minnesota, USA

Human papillomavirus (HPV) vaccine uptake among adolescents remains suboptimal in the US. The COVID-19 pandemic posed new challenges to increase HPV vaccination rates. To characterize parent-reported barriers to obtain HPV vaccination for their children and to identify psychosocial factors associated with parents' intention to vaccinate their children for HPV, we administered parent surveys between April 2020 and January 2022 during a randomized pragmatic trial assessing the impact of evidence-based implementation strategies on HPV vaccination rates for adolescent patients at six Mayo Clinic primary care practices in Southeast Minnesota. A total of 342 surveys were completed (response rate 34.1%). Analyses were focused on parents of unvaccinated children (n = 133). The survey assessed the main reason the child did not receive the HPV vaccine, parental beliefs about the vaccine, and the parent's intention to vaccinate the child for HPV in the next 12 months. Frequently reported awareness and access barriers to HPV vaccination included not knowing the child was due (17.8%) and COVID-19 related delay (11.6%). Frequently reported attitudinal barriers include the belief that the child was too young for the vaccine (17.8%) and that the vaccine is not proven to be safe (16.3%). Injunctive social norm (Adjusted-OR = 3.15, 95%CI: 1.94, 5.41) and perceived harm beliefs (Adjusted-OR = 0.58, 95%CI: 0.35, 0.94) about the HPV vaccine were positively and negatively associated with HPV vaccination intention, respectively. Our findings suggest that continued efforts to overcome parental awareness, access, and attitudinal barriers to HPV vaccination are needed and underscore the importance of utilizing evidence-based health system-level interventions.

Parental intention to vaccinate children against seasonal influenza in the Eastern Mediterranean region: A cross-sectional study using the health belief model

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.

Childhood Vaccine Attitude and Refusal among Turkish Parents

We aimed to understand and resolve anti-vaccine attitudes by examining the factors associated with vaccine attitudes and exploring potential strategies to improve childhood vaccination rates. Between 2014 and 2021, a total of 628 families refused vaccination in Adiyaman. A total of 300 families accepted visits and were visited. During the visits, the families were administered a questionnaire to determine the reasons for vaccine rejection and their opinions on the matter. While providing general information about the vaccine, parents were encouraged to reconsider their decision, and at the end, parents completed the questionnaire. The questionnaire included sociodemographic questions, reasons for vaccine refusal, and a vaccine attitude scale. Among the participants in the study, 9.3% were convinced about the vaccine. The mean vaccine attitude scale score was calculated as 23.6 ± 2.5 (min = 15-max = 29). Significantly higher rates of persuasion were observed among fathers (17.3%) compared to mothers (7.7%) (p = 0.038). Participants who had received some vaccinations had a higher rate of persuasion (11.6%) compared to those who had not received any vaccinations (2.6%) (p = 0.02). Childhood vaccine refusal is a complex issue that has been the subject of numerous studies. Studies on this subject will increase awareness of vaccines.

Pertussis immunization during pregnancy: results of a cross-sectional study among Italian healthcare workers

Background

This study aimed to assess whether Italian healthcare workers (HCWs) recommend the reduced antigen content tetanus-diphtheria-acellular pertussis vaccination (Tdap) to pregnant people, as well as what variables could predict their decision to advise and recommend immunization to pregnant people.

Methods

This cross-sectional study took place between August 2021 and June 2022 in a sample of obstetricians-gynecologists, midwives, and primary-care physicians in two regions of Southern Italy. A self-administered questionnaire was used to gather the data.

Results

The results showed 91.3% (379) of participants knew that receiving the Tdap vaccine during pregnancy protects against pertussis in both the expectant person and the newborn before active immunization. Only 68.9% (286) knew that the Tdap vaccination has to be administered during the third trimester of gestation. A small but still significant proportion of participants (14.7%) (61) believed that the potential risks of vaccines administered during pregnancy outweighed the benefits. An improvable proportion of HCWs regularly provided information [71.8% (298)] and recommended [81% (336)] Tdap vaccination to pregnant people. The strongest factors that drove HCWs to inform pregnant people about the Tdap vaccination were to be aware that vaccinating those in close contact with newborns is an effective strategy to prevent pertussis (OR: 2.38; 95% CI: 1.11-5.13) and that the Tdap vaccine is provided only in the third trimester of pregnancy (OR: 1.74; 95% CI: 1.06-2.86). Informing pregnant people about the possibility of receiving the Tdap vaccine during pregnancy (OR: 60.13; 95% CI: 23.50-153.8) was the strongest predictor of having recommended the Tdap vaccination during pregnancy.

Conclusion

Educational and informative interventions to improve HCWs' knowledge about the importance of the Tdap vaccine and their communication skills to properly counsel pregnant people are needed. Beyond vaccine recommendations, how well immunization strategies are implemented in real-world situations impacts vaccination uptake. Therefore, during regular care visits, expecting people must have easy access to vaccines. Prenatal immunizations should become common practice, and there should be no conceptual doubt about vaccinations among HCWs to safeguard pregnant people and their unborn children from vaccine-preventable diseases.

Reductions in Childhood Pneumonia Mortality After Vaccination in the United States

BACKGROUND

We aim to estimate the magnitude of the reduction in pneumococcal pneumonia and meningitis mortality after the mass introduction of pneumococcal conjugate vaccine (PCV)7 and PCV13 in children in the United States.

METHODS

We assessed the trends in mortality rates from pneumococcal pneumonia and meningitis, in the United States between 1994 and 2017. We fitted an interrupted time-series negative binomial regression model (adjusted by trend, seasonality, PCV7/PCV13 coverage, and H. influenzae type b vaccine coverage) to estimate the counterfactual rates without vaccination. We reported a percent reduction in mortality estimates relative to the projected no-vaccination scenario, using the formula 1 minus the incidence risk ratio, with 95% confidence intervals (CIs).

RESULTS

Between 1994 and 1999 (the prevaccination period), the all-cause pneumonia mortality rate for 0-1-month-old children was 2.55 per 100,00 pop., whereas for 2-11 months-old children, this rate was 0.82 deaths per 100,000 pop. During the PCV7-period in 0-59-month-old children in the United States, the adjusted reduction of all-cause pneumonia was 13% (95% CI: 4-21) and 19% (95% CI: 0-33) of all-cause meningitis For PCV13, the reductions in this age group were 21% (95% CI: 4-35) for all-cause pneumonia mortality and 22% (95% CI: -19 to 48) for all-cause meningitis mortality. PCV13 had greater reductions of all-cause pneumonia than PCV13 in 6-11-month-old infants.

CONCLUSIONS

The universal introduction of PCV7, and later PCV13, for children 0-59 months old in the United States was associated with decreases in mortality due to all-cause pneumonia.