Parents’ and Guardians’ Willingness to Vaccinate Their Children against COVID-19: A Systematic Review and Meta-Analysis

Physicians' perspectives on COVID-19 vaccinations for children: a qualitative exploration in Ontario, Canada

OBJECTIVES

Parents' decisions to vaccinate their children against COVID-19 are complex and often informed by discussions with primary care physicians. However, little is known about physicians' perspectives on COVID-19 vaccinations for children or their experiences counselling parents in their decision-making. We explored physicians' experiences providing COVID-19 vaccination recommendations to parents and their reflections on the contextual factors that shaped these experiences.

DESIGN

We conducted an interpretive qualitative study using in-depth interviews. We analyzed the data using reflexive thematic analysis and a socioecological framework.

SETTING

This study involved primary care practices associated with The Applied Research Group for Kids (TARGet Kids!) primary care research network in the Greater Toronto Area, Ontario, Canada.

PARTICIPANTS

Participants were 10 primary care physicians, including family physicians, paediatricians and paediatric subspecialists.

RESULTS

Participants discussed elements at the individual level (their identity, role, and knowledge), the interpersonal level (their relationships with families, responsiveness to parents' concerns, and efforts to build trust) and structural level (contextual factors related to the evolving COVID-19 climate, health system pandemic response, and constraints on care delivery) that influenced their experiences providing recommendations to parents. Our findings illustrated that physicians' interactions with families were shaped by a confluence of their own perspectives, their responses to parents' perspectives, and the evolving landscape of the broader pandemic.

CONCLUSIONS

Our study underscores the social and relational nature of vaccination decision-making and highlights the multiple influences on primary care physicians' experiences providing COVID-19 vaccination recommendations to parents. Our findings offer suggestions for future COVID-19 vaccination programmes for children. Delivery of new COVID-19 vaccinations for children may be well suited within primary care offices, where trusting relationships are established, but physicians need support in staying knowledgeable about emerging information, communicating available evidence to parents to inform their decision-making and dedicating time for vaccination counselling.

Influence parental- and child-related factors on the acceptance of SARS-CoV-2 test methods in schools and daycare facilities

Introduction

Rapid testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections was an essential step in reducing the spread of the virus and monitoring pandemic development. Most mandatory standard pandemic testing in Germany has been performed in schools and daycare facilities. We investigated the influence of behavioral and attitudinal characteristics of children and caregivers on their acceptance of (i) antigen-based nasal swab rapid and (ii) oral saliva-based pooled Polymerase Chain Reaction (PCR) tests.

Methods

Conducted through a cross-sectional survey between November and December 2021, with 1962 caregivers and 581 children/adolescents participating, the study evaluated the acceptability of each testing method on a six-point scale. Participants scored one test method conducted on their child at one of six levels with 1 and 6 denoting "excellent" (1) and "inadequate" (6), respectively. We considered demographic variables, vaccination status, child mental health (measured by the SDQ-questionnaire), and facility type (kindergarten, primary school, secondary school) as covariates.

Results

Results reveal a preference for saliva-based PCR tests over nasal swabs by about one grade, particularly among parents of unvaccinated children, especially if their child expressed future vaccination reluctance. Testing acceptance was lower among children with mental health issues, primary school-aged, and those with less-educated parents. Perception of test accuracy and convenience influenced attitudes, favoring saliva-based PCR tests. Moreover, children with mental health issues felt less secure during testing.

Discussion

To our knowledge, this is the first study to investigate the influence of different testing methods on testing acceptance for SARS-CoV-2 in children and caregivers. Our study identifies predictors of lower acceptance of public health surveillance measures and enables the development of educational programs on testing and vaccination tailored to the needs of specific target groups. Moreover, we demonstrate that test acceptance in vulnerable groups can be enhanced by careful choice of an appropriate testing method.

Positive and negative factors of parents vaccinating their children against COVID-19: An umbrella review

Purpose

This umbrella review summarized the factors influencing parents' hesitancy to vaccinate their children against COVID-19 and the evidence to reduce it.

Methods

The analysis included PubMed, Embase, Cochrane Library, Web of Science, and Scopus articles published before March 22, 2024. It considered all meta-analyses that investigated parental COVID-19 vaccine hesitancy.

Results

Eight studies were included. Hesitancy rate of parents from five continents to vaccinate their children against COVID-19 was between 0.69 % and 95.0 %. The comprehensive synthesis in this review shows that the influencing factors originate from four aspects: Parents' attitudes, including their trust in the scientific community, concerns about COVID-19 complications, perceptions of children's susceptibility, and support from the social environment, including government incentives, low vaccination costs, and specific sociodemographic characteristics, were positive factors that reduced parental vaccine hesitancy in children. Conversely, negative aspects, including vaccine distrust, the spread of misinformation, poor economic status, and concern about unprecedentedly short development time, were associated with increased hesitancy.

Conclusion

Our study identified positive and negative factors for parental COVID-19 vaccine hesitancy in children and highlighted that parental attitude was the most important determinant.

COVID-19 vaccination rates and factors affecting vaccination in children with rheumatic disease

Objectives

This study aimed to investigate coronavirus disease 2019 (COVID-19) vaccination rates and factors affecting vaccination in children with rheumatic diseases.

Patients and methods

This multicenter cross-sectional survey-based study was conducted between July 2022 and September 2022. Four hundred seventy-four patients (256 females, 218 males; median age: 15 years; interquartile range, 13 to 16 years) were included in the patient group, and 211 healthy children (124 females, 87 males; median age: 15 years; interquartile range, 13 to 16 years) were included in the control group. A questionnaire was administered to the parents face-to-face during routine outpatient visits.

Results

Of the patients, 220 were followed up with the diagnosis of autoinflammatory disease, 174 with juvenile idiopathic arthritis, 48 with connective tissue disease, 23 with vasculitis, eight with uveitis, and one with sarcoidosis. In the study group, 256 (54%) patients and 115 (54.5%) healthy children received at least one dose of COVID-19 vaccine. Parents' concern regarding potential side effects of the vaccine was the most common reason for COVID-19 vaccination hesitancy in both groups. The median patient age, follow-up period, colchicine treatment rates, childhood vaccination and influenza vaccination rates, median parental age, parental vaccination rate, and parental education level were higher in vaccinated patients (p<0.001).

Conclusion

Parents' concerns about safety and side effects were found to be the most important factors affecting vaccination success. Identification of the underlying causes of parental vaccine hesitancy will facilitate the development of effective vaccination strategies for potential future outbreaks.

Parent-Child Associations in COVID-19-Related Preventive Behaviors and Efficacy Expectations: A One-Year Longitudinal Survey

PURPOSE

It is necessary to identify the variables that explain the variance in preventive behaviors against COVID-19 to increase adolescents' engagement in these behaviors. We focused on efficacy expectations of preventive behaviors and their associations within families. This study examined the associations between efficacy expectations and preventive behaviors, and between adolescents and their parents in terms of efficacy expectations and preventive behaviors.

METHODS

A cross-lagged panel model was employed to analyze 281 parent-child pairs consisting of 245 children (118 girls, mean age = 17.4 years), 277 mothers (median age = 49.3 years), and 211 fathers (median age = 51.5 years). Participants completed the Prevention of COVID-19 Infection Scale at baseline (October 2020 to April 2021) and one-year follow-up to assess efficacy expectations and preventive behaviors for sanitization, contact, and hoarding factors.

RESULTS

Efficacy expectations of preventive behaviors at baseline were positively associated with preventive behaviors at one-year follow-up regarding the sanitization and contact factors. Additionally, for parents, efficacy expectations of preventive behaviors at baseline were positively associated with subsequent preventive behaviors regarding the hoarding factor. Parental efficacy expectation scores for contact at baseline were positively associated with their children's scores at one-year follow-up.

DISCUSSION

The findings highlight the association between parental efficacy expectations at an initial time point and adolescents' efficacy expectations at one-year follow-up toward COVID-19 preventive measures, particularly contact-related behaviors. These insights can inform public health interventions targeting individual expectations and parental involvement to promote effective preventive practices during future health crises.

COVID-19 Vaccine Hesitancy among Parents of Children Younger than 12 Years: Experience from a Tertiary Outpatient Clinic

This study explored parents' attitudes towards vaccinating their children against COVID-19 and the rate of vaccine hesitancy in Oman. A cross-sectional, online, self-administered questionnaire, previously validated and administered between June 2021 and May 2022, was used. The questionnaire consisted of nine items. Parents of children younger than 12 years were eligible for participation. A total of 384 participants, including 207 males (54%), completed the questionnaire, resulting in an 86% response rate (384/447). The results showed that 69% of participants were hesitant to vaccinate their children aged 1-11 years. In parents of children aged 1-4 years, vaccination status was significantly associated with vaccine hesitancy (odds ratio [OR], 0.116; 95% confidence interval [CI], 0.044-0.306; p = 0.001). Furthermore, after multivariable analysis, compared to the fathers, mothers were significantly less likely to be associated with vaccine hesitancy (OR, 0.451; 95% CI, 0.240-0.848; p = 0.013).

Descriptive cross-sectional study to evaluate perception, attitude, and practice of parents regarding COVID-19 vaccination in children 10-12 years of age-A step toward prevention of future COVID-19 outbreaks in India

Purpose

COVID-19 was declared a global pandemic and all age groups were equally affected. Coronavirus had devastating effects worldwide due to the emergence of new variants till vaccination was adopted to eradicate the transmission of the virus and restore normalcy. However, children were not included in the initial phase of vaccination. The purpose of the study was to assess the level of perception, attitude, and practice among parents toward the COVID-19 vaccination drive in children 10-12 years of age.

Design and Study

The present research is a cross-sectional questionnaire-based survey including parents of children aged 10-12 years as participants. The survey was conducted between May 2022 and July 2022 with a sample size of 320.

Results

A high willingness (80%) among parents was found for getting their children vaccinated. COVID-19 vaccines were perceived to be safe by the parents (59%) and efficacious (75%) for their children. Parents (67%) felt that the benefits of getting their children vaccinated against COVID-19 prevail over the risks of the vaccine. Parents 214 (67%) feel the need of getting their child vaccinated for sending them to school followed by availing of daycare facilities after school 54 (17%) among working parents. A significant association (P < 0.05) was seen between the variables of practice being followed by parents and their children as per COVID-19 norms. Parent's negative attitude toward COVID-19 vaccination was associated with availability of no/unclear safety information (36%), fear of adverse effects of vaccine (3%), and false belief of having long-term immunity due to natural infection (32%). The positive attitude of parents was due to trust in positive information/news about the vaccine (42%), belief in the safety and efficacy of the vaccine (5%), acceptability for mild adverse effects (1%), and the necessity of vaccine to send children to schools (1%).

Conclusion and Recommendations

The awareness of parents regarding COVID-19 vaccination for children was limited, high level of acceptance for vaccination was seen in our study. We recommend to continuing educational programs through mass campaigns to increase increasing awareness among parents for getting COVID-19 vaccination for their children. Vaccine hesitancy including vaccine safety concerns of parents should be addressed by presenting myths and facts related to COVID-19 vaccine using television, radio, and social media platforms.

COVID-19 Vaccine Hesitancy: Umbrella Review of Systematic Reviews and Meta-Analysis

BACKGROUND

The unprecedented emergence of the COVID-19 pandemic necessitated the development and global distribution of vaccines, making the understanding of global vaccine acceptance and hesitancy crucial to overcoming barriers to vaccination and achieving widespread immunization.

OBJECTIVE

This umbrella review synthesizes findings from systematic reviews and meta-analyses to provide insights into global perceptions on COVID-19 vaccine acceptance and hesitancy across diverse populations and regions.

METHODS

We conducted a literature search across major databases to identify systematic reviews and meta-analysis that reported COVID-19 vaccine acceptance and hesitancy. The AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) criteria were used to assess the methodological quality of included systematic reviews. Meta-analysis was performed using STATA 17 with a random effect model. The data synthesis is presented in a table format and via a narrative.

RESULTS

Our inclusion criteria were met by 78 meta-analyses published between 2021 and 2023. Our analysis revealed a moderate vaccine acceptance rate of 63% (95% CI 0.60%-0.67%) in the general population, with significant heterogeneity (I2 = 97.59%). Higher acceptance rates were observed among health care workers and individuals with chronic diseases, at 64% (95% CI 0.57%-0.71%) and 69% (95% CI 0.61%-0.76%), respectively. However, lower acceptance was noted among pregnant women, at 48% (95% CI 0.42%-0.53%), and parents consenting for their children, at 61.29% (95% CI 0.56%-0.67%). The pooled vaccine hesitancy rate was 32% (95% CI 0.25%-0.39%) in the general population. The quality assessment revealed 19 high-quality, 38 moderate-quality, 15 low-quality, and 6 critically low-quality meta-analyses.

CONCLUSIONS

This review revealed the presence of vaccine hesitancy globally, emphasizing the necessity for population-specific, culturally sensitive interventions and clear, credible information dissemination to foster vaccine acceptance. The observed disparities accentuate the need for continuous research to understand evolving vaccine perceptions and to address the unique concerns and needs of diverse populations, thereby aiding in the formulation of effective and inclusive vaccination strategies.

TRIAL REGISTRATION

PROSPERO CRD42023468363; https://tinyurl.com/2p9kv9cr.

Prospective and Cross-Sectional Factors Predicting Caregiver Motivation to Vaccinate Children with Attention-Deficit/Hyperactivity Disorder against COVID-19: A Follow-Up Study

Adolescents with attention-deficit/hyperactivity disorder (ADHD) have higher risks of contracting COVID-19 and worse outcomes compared with adolescents without ADHD. The most effective method of preventing infection is vaccination. This follow-up study explored the prospective and cross-sectional factors influencing caregiver willingness to vaccinate children with ADHD against COVID-19. Baseline data on caregiver demographics, affiliate stigma, parenting stress, emotional difficulties, beliefs regarding the causes of ADHD, and ADHD symptoms were collected prior to the outbreak of the COVID-19 pandemic in Taiwan. At follow-up, the study assessed caregiver willingness to vaccinate children with ADHD, the challenges caregivers faced in parenting during the pandemic, and ADHD symptoms. The results revealed that caregiver age at baseline was positively associated with a willingness to vaccinate children against COVID-19 at follow-up. By contrast, the belief that ADHD resulted from failures in parental discipline at baseline was negatively associated with caregiver willingness to vaccinate. Parenting challenges were also negatively associated with caregiver willingness to vaccinate. Therefore, the age of caregivers, beliefs about the causes of ADHD, and parenting challenges during the pandemic should be considered when developing interventions to enhance caregiver willingness to vaccinate children with ADHD.

Unveiling parental perspectives: COVID-19 vaccination for children in India

Background

Irrespective of the availability of a safe and effective COVID-19 vaccine and its success rate in adults, administering vaccines to children remains a challenge for healthcare workers. Children's vaccine hesitancy among parents remains substantial and is exacerbated due to misleading information. In the present study, we aimed to investigate the hesitancy of parents and their concern about the vaccination and clinical characteristics of COVID-19 in their children.

Methods

A cross-sectional web-based and offline survey comprised of questions about the demographic of children, the status of COVID-19 infection, its severity, vaccination status, sources of information, willingness, concerns and attitude of parents to vaccinate their children against the COVID-19 virus, was conducted. Overall, 846 responses from parents fulfilling the inclusion criteria were analysed by GraphPad Prism 5.

Results

Out of the 846 responses, 51.2% (n = 433) of children were vaccinated against COVID-19. Out of vaccinated children (51.2%), 60.3% (n = 261) had experienced adverse events. Around 21% (n = 98) of children had a history of exposure to the SARS-CoV-2 virus. Among the infected children, 14.3% were asymptomatic and 85.7% had symptoms. Approximately 8% of children had comorbidities, with chronic lung diseases and asthma being the most common. Among the 846 participating parents, 59.5% were mothers and the remaining 40.5% were fathers. A total of 2.7% and 22.2% of parents were found hesitant to administer the COVID-19 vaccine to their children aged 15-18 years and below 15 years, respectively. Among hesitant parents, mothers were found slightly more hesitant as compared to fathers. Also, 35.5% of parents were found hesitant about their own COVID-19 vaccination. Furthermore, the concern for COVID-19 vaccine unwillingness among parents is that a child has already achieved natural immunity after COVID-19 infections (76.8%) followed by vaccine safety and its side effects. The motivating factors to convince parents for their children's COVID-19 vaccination were if their doctors recommend it, followed by detailed information on vaccine side effects and efficacy in children. The most trusted source of information for the parents was found to be the healthcare workers.

Conclusion

These results suggest that data and reviews regarding the safety and efficacy of the COVID-19 vaccine readily available in the public domain could serve as a highly effective strategy for promoting and implementing widespread vaccination among children. By providing easily accessible and comprehensive information, public health authorities can address parental concerns, dispel misconceptions and foster a greater sense of trust in the vaccination process.

The Status and Influencing Factors of COVID-19 Vaccination for 3-7-Year-Old Children Born Prematurely

Objective

To explore the status and influencing factors of COVID-19 vaccination for 3-7-year-old children born prematurely.

Methods

A questionnaire was administered to parents of preterm infants born between 1 January 2016 and 31 December 2019 in Gansu Maternal and Child Health Hospital using convenience sampling.

Results

It was found that 96.81% of 282 parents had known about COVID-19 vaccines and acquired COVID-19- and vaccine-related knowledge primarily through WeChat (104/282, 36.88%) and TikTok (91/282, 32.27%). Most parents of the group whose children were vaccinated with a COVID-19 vaccine believed that this approach was effective in preventing COVID-19 (49.75%), whereas most parents of the group whose children were not vaccinated were worried about the adverse reaction and safety of the vaccine (45.88%). According to the regression analysis, the risk factors of children born prematurely receiving a COVID-19 vaccine were no vaccination against COVID-19 in the mothers (odds ratio [OR]=48.489, 95% CI: 6.524-360.406) and in younger children (OR=12.157, 95% CI: 6.388-23.139). Previous history of referral (OR=0.229, 95% CI: 0.057-0.920), history of diseases (OR=0.130, 95% CI: 0.034-0.503) and high educational level of guardians (OR=0.142, 95% CI: 0.112-0.557) were protective factors for children born prematurely to receive COVID-19 vaccination.

Conclusion

There is a relatively high proportion of children born prematurely receiving COVID-19 vaccination, but some people still have concerns. Publicity in the later stage can be conducted through WeChat, TikTok and other social media platforms, with special attention paid to the populations with lower education levels.

Utility of the Theory of Planned Behaviour for predicting parents' intentions to vaccinate their children against COVID-19

Vaccination is a crucial form of primary prevention, and it is important to understand the factors that influence parents' decisions to vaccinate their children. The current study examines the utility of the Theory of Planned Behaviour (TPB) and anticipated affect for explaining parents' intentions to vaccinate their children against COVID-19. Parents (N = 843) living in the United States completed an online survey. The TPB variables explained 65% of the variability in parents' intentions. In addition to all three of the TPB antecedents predicting vaccine intentions, both anticipated regret of not vaccinating and anticipated positive emotions of vaccinating were associated with parent intentions. Contrary to predictions, subjective norms were a stronger predictor of intentions when perceived behavioural control was lower compared to higher. These findings help further our understanding of parent-for-child vaccine decisions in the context of novel health threats and inform intervention efforts aimed at encouraging this behaviour.

COVID-19 Vaccine Perspective From Adolescents' Lens in the US

Introduction The COVID-19 pandemic has presented an unprecedented global health issue. The World Health Organization estimates 773 million confirmed cases and 7 million deaths. Vaccination continues to be the most effective way to prevent COVID-19 and has demonstrated safety and efficacy in all age groups. Though a lot of studies have looked at COVID-19 vaccination acceptance and hesitancy in adults, there is scarce research addressing adolescent vaccination readiness. COVID-19 infection in this age group may result in lost school days, school and community transmission, and loss of productivity for parents. Aim This study aims to determine COVID-19 vaccination rates and factors influencing its acceptance and hesitancy in adolescents in a community setting. Methods A voluntary survey was conducted at a local high school in May 2023. Information was collected about the demographics of adolescents and the educational background of parents/guardians. The survey assessed the COVID vaccine rate, reasons for COVID-19 vaccine acceptance or refusal, number of doses of COVID-19 vaccine and boosters received, prior history of COVID-19 infection, source of information on COVID-19 vaccine, flu vaccine acceptance by the students, and whether they would be willing to take a COVID-19 vaccine booster. Results Four hundred participants, ranging in age from 13 to 19, were surveyed. The vaccination rate in boys was comparable to that in girls. 72% received at least one COVID-19 vaccine, and 66% were considered completely vaccinated. Of those completely vaccinated, 80% had undergone further updated COVID-19 booster vaccinations. Adolescents whose parents/guardians were college graduates had a higher vaccination rate than those whose parents/guardians were not. Caucasians and Asians had a higher vaccination rate compared to African Americans and mixed races. The vaccination rate was not statistically different in adolescents with prior COVID-19 infection versus no prior infection. Flu vaccination was associated with higher COVID-19 vaccination rates. Lack of trust was an important reason for vaccine hesitancy, along with questions about efficacy, concerns about side effects, parent/guardian decisions, and religious reasons. Protecting oneself, family/friends, and community were the major reasons to take the vaccine. Parents/guardians, physicians, peers, television, social media, flyers, and schools were the primary sources that adolescents relied on for information about the COVID-19 vaccination. Conclusion Lower education attainment among parents/guardians, African Americans, and mixed races was associated with lower vaccination rates. Lack of trust in the vaccine, questions about efficacy, and fear of side effects were the most frequently cited reasons for vaccine hesitancy. Parent/guardian influence and religious reasons were other significant reasons for vaccine hesitancy. Flu vaccination was associated with higher COVID-19 vaccination rates. Understanding factors influencing COVID-19 vaccination will allow us to address barriers to COVID-19 vaccination and other vaccinations appropriate for this age group. Educating adolescents in schools, involving local and state health departments to increase awareness about the vaccine, and educating parents and guardians along with the teenagers can help increase the acceptance of the vaccine. These interventions will also positively affect the acceptance of the booster and prepare us for any future pandemics.

Parental concerns and vaccine hesitancy against COVID-19 vaccination for children in Greece: A cross-sectional survey

INTRODUCTION

Parental hesitancy against children's COVID-19 vaccination remains a challenge globally. Although many studies have explored parental hesitancy, less is known about parental intentions towards COVID-19 vaccination of 6-month to 4-year-old children who were the last age group that became eligible for vaccination and for older children throughout the Omicron predominance period.

METHODS

We conducted a nationwide cross-sectional survey from November to December 2022 in Greece. We aimed to explore parental COVID-19 vaccination intentions for their children, reasons against vaccination, and to estimate the association between parents' intentions and child and parental characteristics and parental attitudes towards COVID-19 vaccination.

RESULTS

Of 431 parents, 243 (56.4 %) had not or did not intend to vaccinate their children against COVID-19. Most parents were vaccinated against COVID-19 (64.7 % no booster; 14.2 % at least one booster). Among parents with children under the age of 5, 13.0 % intended to vaccinate their children against COVID-19, while 47.3 % of parents with children 5 years of age or older reported intention or had already completed vaccination. The most common reasons against COVID-19 vaccination were fear of side effects (32.9 %), perceived short length of clinical trials (29.2 %), and the child having previously contracted COVID-19 (12.0 %). The strongest factors associated with intention or already completed vaccination were parental own vaccination against COVID-19, using a pediatrician or a healthcare professional as the main source of vaccine-related information for their children, agreeing with their pediatrician regarding COVID-19 vaccination, and trusting official healthcare guidelines. Stratified analyses by the two children's age groups (<5 and 5 to 17) yielded similar estimates. Among parents who had not or did not intend to vaccinate their children, 11.9 % would do so if recommended by a pediatrician.

CONCLUSIONS

Our findings highlight the need to incentivize healthcare professionals and pediatricians to inform parents about vaccines, clarify misconceptions and address concerns.

Determinants of parents' intention to vaccinate their children aged 12-17 years against COVID-19 in North Kivu (Democratic Republic of Congo)

Parents are facing tremendous stress in relation to the COVID-19 pandemic and the effectiveness of the COVID-19 vaccination program for children. We aimed to investigate parents' willingness to vaccinate their children against COVID-19 in North Kivu province, (Democratic Republic of Congo). A cross-sectional survey between 1 December 2021 to 20 January 2022 in six health zones (Goma, Karisimbi, Butembo, Beni, Kamango, and Katwa) was conducted in the province of North Kivu. In each health zone, we selected five clusters (Health area) using the method of probabilistic selection proportional to population size. In total, 522 parents participated in our study. Results: Overall, 32.8% of parents intended to vaccinate their children. In the multivariate analysis, a younger age of parents (aOR: 2.40, CI: [1.50-3.83]), a higher level of fear that "a member of my family" could contract COVID-19 (aOR: 2.35, CI: [1.38-4.02]), a higher level of perceived vulnerability to COVID-19 within the family (aOR: 1.70, CI: [1.005-2.2881]), a higher level of perceived susceptibility to COVID-19 within the family (aOR: 3.07, CI: [1.80-5.23]), and a history of vaccination against COVID-19 among parents (aOR: 16.47, CI: [8.39-32.33]), were all significantly associated with the intention of parents to have their children or adolescents vaccinated. According to the different explanatory factors of the will to have their children vaccinated, an emphasis on the health education of parents who are prone to refusal or hesitation of the vaccine, by addressing the common reasons for the refusal of the vaccine and highlight the vaccine's benefits.

COVID-19 vaccination hesitancy among Italian parents: A systematic review and meta-analysis

In May 2021, the Italian government extended the COVID-19 vaccination campaign to 12- to 18-year-old subjects and, starting December 2021, vaccines were also offered to children between 5 and 11 years-old. Despite these efforts, suboptimal vaccination coverages are reported. The purpose of this review is to estimate the proportion of parents/caregivers of children and adolescents expressing COVID-19 vaccine hesitancy in Italy. The vaccine hesitation rate among parents of minors was 55.1% (95%CI: 43.8-66.1%). A higher value was evidenced in studies focusing on children (59.9%; 95%CI = 43.7-75.1%) compared to the ones focusing on adolescents (51.3%; 95%CI = 34.5-68.0%). The main reasons for unwillingness were the belief that the vaccine was unsafe or ineffective, fear of adverse events, and considering COVID-19 a non-threatening disease. The implementation of effective communication campaigns and health educational programs on safe pediatric vaccinations is essential to support strategies to bolster vaccination confidence.

COVID-19 Vaccine for Children: Determinants and Beliefs Contributing to Vaccination Decision of Parents in Germany 2021/2022

To reduce the number of COVID-19 cases, vaccines were rapidly made available worldwide. For a strategically targeted response to the COVID-19 pandemic, population vaccination coverage was to be maximized. The target groups also included healthy children. In this context, it is important to understand the determinants and beliefs that lead parents to favor or oppose COVID-19 immunization in children. This study aimed to investigate parents' COVID-19 vaccination willingness in Germany for children aged 5-11 years in 2021/2022. For this purpose, the determinants and beliefs behind parents' vaccination decisions were examined. Descriptive analysis and bivariate correlations were performed on COVID-19 vaccination willingness and parents' mental health status, general vaccination attitudes, and SARS-CoV-2 politics perceptions. In total, 2401 participants fully participated in this cross-sectional study. The COVID-19 vaccination uptake (71.4%) outweighed the vaccination refusal (19.4%). Correlations revealed higher vaccine acceptance in parents presenting full vaccination certificates (90.9%), COVID-19 immunizations (99.9%), or increased COVID-19 fear (93.6%). Vaccination-refusal was associated with higher perceived pressure by COVID-19 vaccination campaigns (87.7%), higher experienced restrictions due to COVID-19 protective measures in parents' social environment (83.6%), and engagement against COVID-19 protective measures (51.6%). Besides general anxiety, no significant correlations were observed between parents' mental health variables and vaccination willingness. Although several factors are ultimately associated with vaccination willingness, future vaccination campaigns should prioritize reducing pressure, increasing trust, and considering parents' differentiation between familiar and unfamiliar pathogens during their vaccination decision-making process.

Potential motivators affecting parental intention in COVID-19 vaccination for children aged 6 months to 4 years: Implications for targeted vaccine interventions in Japan

Although COVID-19 vaccination was approved for younger children in Japan in October 2022, uptake rates remain critically low. This study aimed to investigate Japanese parents' intentions, hesitators' probability of positive intention change, and factors that motivate COVID-19 vaccination. Parents with a 6-month to 4-year-old child living in Japan participated in this internet-based, cross-sectional survey conducted from December 19, 2022, to January 4, 2023. The modified Poisson regression analysis was used to assess the probabilities of changing intention by each motivator when comparing the degree of hesitancy among hesitators, and the Poisson generalized estimating equations were used to compare the probabilities of changing intentions by potential motivators within hesitant individuals. Among 12,502 participants, 10,008 (80.1%) were hesitators. Parents with lower hesitancy levels were more likely to be motivated to vaccinate their children through potential motivators. Vaccine hesitators were motivated to vaccinate their children, particularly by proven vaccine effectiveness (including "protecting children from getting sick" with a probability ratio [PR] of 3.7 [95% confidence interval (CI) 3.5-3.9] and "less likely to infect adults" with a PR of 2.9 [95% CI 2.8-3.1]), as well as vaccine safety (including "safe vaccination of millions of children" with a PR of 3.1 [95% CI 3.0-3.3]) compared to injunctive norm (including "community leader recommendation"). Therefore, initially addressing parents with low hesitancy levels is an effective strategy that motivates COVID-19 vaccination. Also, providing evidence-based information about COVID-19 vaccine efficacy and safety that is consistent with parents' needs is crucial.

Potential determinants of parental hesitancy to vaccinate their children against COVID-19 infection: a cross-sectional investigation

Coronavirus disease 2019 (COVID-19) vaccination hesitancy has emerged as a substantial concern among the adult population globally. However, limited evidence is available about parental hesitancy to vaccinate their children against COVID-19 within the Pakistani context. Thus, the present investigation aimed to assess parental attitudes, perceptions, and willingness regarding vaccination hesitancy and associated predictors of getting their children vaccinated against COVID-19. We conducted a cross-sectional population-based, self-administered online questionnaire in Punjab, Pakistan, on randomly selected parents between October 2022 and February 2023. The data were collected based on socio-demographics, attitudes, perceptions, and willingness of parents regarding COVID-19 vaccine hesitancy for their children. Adjusted odds ratios with 95% confidence intervals were estimated to identify the predictors of vaccine hesitancy. The findings demonstrated that among 1,478 participants, a total of 40% believed that the COVID-19 vaccine may pose a greater risk to children than adults, while 38% exhibited no concerns. Around 13% of children were not vaccinated in our study sample. More than half expressed hesitancy toward vaccination, and only 35.25% were inclined to get their children vaccinated in our study sample. In addition, only 16% of the parents believed that the COVID-19 vaccination may cause an alteration in their children's DNA. A similar proportion of parents were aware of the significance of getting their children vaccinated and expressed their willingness to vaccinate their children to prevent the COVID-19 infection. However, a higher odds ratio was observed in females with a higher educational background and those in the healthcare profession. In conclusion, healthcare awareness-supporting programs for educating parents should be designed and implemented. These insights might aid in the development of strategies to eradicate barriers in existing coronavirus vaccination programs and may vaccinate a larger child population to reduce the adverse consequences of the pandemic.

COVID-19 vaccination in urban American Indian and Alaska Native children: Parental characteristics, beliefs and attitudes associated with vaccine acceptance

Background

Little is known about vaccination rates for American Indian and Alaska Native (AI/AN) parents and their children, or parental decisions in this regard. Improving vaccination rates is a serious concern due to the disproportionate incidence and morbidity of COVID-19 in AI/AN people.

Purpose

Our goal was to describe urban AI/AN parental attributes associated with COVID-19 vaccination of their children.

Methods

Survey participants (n = 572) were ≥18 years of age, had children ≥5 years of age, AI/AN, and seen at one of six urban health organizations serving primarily AI/AN people within the prior year. They were asked about gender, age, education, marital status, perceived stress, trauma history, whether they had received the COVID-19 vaccine, tested positive for COVID-19 in the past, and if their child was vaccinated. They were also asked about 16 vaccine hesitancy reasons.

Results

Parental vaccination rate was 82%, with 59% of their children vaccinated. Parents who vaccinated their children were older, had higher education, lower stress and trauma, and were more likely to be vaccinated compared to parents who did not vaccinate their children. Forty-two percent of parents indicated they would likely vaccinate their unvaccinated child in the future. Sixteen vaccine hesitancy reasons revealed four factors: distrust, inconvenience, lack of concern about the pandemic, and AI/AN concerns. Parents who had no plans to vaccinate their children had the highest vaccine distrust and lack of concern about the pandemic. Parents with greater vaccine distrust and AI/AN specific concern reported significantly greater trauma history and higher levels of education.

Conclusion

Even though vaccination rates for AI/AN parents and children are high, the consequences of COVID-19 for AI/AN people are more severe than for other US populations. Providers should use trauma-informed, trust-building and culturally competent communication when discussing choices about vaccination with AI/AN parents.

Trust in pharmaceuticals and vaccine hesitancy: exploring factors influencing COVID-19 immunization among Lebanese children aged 1 to 11 years

INTRODUCTION

The COVID-19 pandemic is a serious threat to everyone's health. Numerous studies have demonstrated that vaccines are very effective in preventing COVID-19-related severe illness, hospitalization, and death. Children's vaccination exerts its protecting effect by preventing the spread of the virus. The purpose of this study was to analyze the rate of COVID-19 immunization among Lebanese children aged 1 to 11 years and assess parental factors that affect immunization rates.

METHODS

An online cross-sectional study was conducted between January and March 2023. The online survey was distributed across all social media channels, including the Ministry of Public Health website.

RESULTS

A total of 390 parents filled the survey (mean age = 37.48 ± 8.39 years; 50.5% mothers; 70% with a university level of education). Mothers compared to fathers, having a history of bad reaction to a vaccine vs. not, and higher vaccine hesitancy were significantly associated with less willingness to administer the vaccine to the child. Trusting pharmaceutical companies was significantly associated with more willingness to administer the vaccine to the child.

CONCLUSION

The results of this study show that the factors associated with parents' decisions to vaccinate their children may vary. Our findings conclude that vaccine acceptance is being highly associated with parental concerns, trust, and information regarding the vaccine safety and efficacy.

Intention to Vaccinate against COVID-19 in Adolescents: A Systematic Review

BACKGROUND

Multiple COVID-19 vaccines have been approved for use in adolescents; these vaccines play a critical role in limiting the transmission and impact of COVID-19. This systematic review aims to summarize the willingness of adolescents aged 10 to 19 years to receive the COVID-19 vaccination and the factors influencing their decision.

METHODS

A search of literature published between January 2018 and August 2022 was performed in Medline©, EMBASE©. and CINAHL© electronic databases. Studies published in English that assessed adolescents' intentions to receive the COVID-19 vaccine were included. Qualitative studies and those unrelated to the COVID-19 vaccine were excluded. The study was conducted based on the PRISMA guidelines.

RESULTS

Of the 1074 articles retrieved, 13 were included in the final review. Most studies were conducted in the US (n = 3) and China (n = 3). The pooled prevalence of COVID-19 vaccine acceptance among adolescents was 63% (95% CI: 52-73%). Factors influencing intent to vaccinate were divided into five categories: "Socio-demographic determinants"; "Communication about COVID-19 pandemic and vaccination"; "COVID-19 vaccine and related issues"; "COVID-19 infection and related issues" and "Other determinants". The enablers were sociodemographic factors including older age, higher education level, good health perception, and parental norms in terms of parental vaccination acceptance; perceived vaccine effectiveness and safety; a desire to protect themselves and others; recent vaccination; and anxiety. The barriers were concerns over vaccine effectiveness, safety, and long-term side effects; low perceived necessity and risk of infection; and needle phobia.

CONCLUSIONS

This review highlighted that adolescents' intent to vaccinate is driven by a desire to protect themselves and others. However, concerns over vaccine effectiveness, safety, and long-term side effects hinder COVID-19 vaccine uptake. To improve vaccination acceptance, policymakers should address adolescents' concerns via more targeted public health messaging, while schools should leverage peer norms to positively influence vaccination intent.

A COVID-19 vaccination program for high-risk children aged 12-17 years in Curacao

Objective

This study aimed to describe and critically evaluate the COVID-19 vaccination program for high-risk children in Curacao and provide information about important factors such as parents' vaccination hesitancy and effective strategies for communicating and delivering information about vaccination.

Methods

This was a cross-sectional study. It was important to identify children aged 12-17 years who were at high risk of severe COVID-19 infection because of the limited medical facilities on the island; children considered to be at high risk were those with diseases such as obesity, hypertension or diabetes mellitus type 2. These children or their caregivers were invited by their pediatricians to be vaccinated as part of a program run by the Public Health Department of Curacao. These high-risk patients were vaccinated between 30 May 2021 and 25 February 2022 in designated child-friendly spaces, with a pediatrician present for guidance and reassurance. Children received the Pfizer-BioNTech COVID-19 vaccine at the recommended dose for their age. The primary outcome was a description and evaluation of the attendance for vaccination. The secondary outcomes were side effects after vaccination for the age groups 12-15 years and 16-17 years. Reasons for refusal or nonadherence were also registered.

Results

Altogether 51% (24/47) of those aged 16-17 years who were invited were vaccinated compared with 42% (26/69) of those aged 12-15 years who were invited. Altogether, 46% of these high-risk children were vaccinated compared with 48% of children aged 12-17 years without risk factors. In our population, most patients did not experience any side effects and if they did, the side effects were mild. No cases of myocarditis or pericarditis were observed. A lack of trust in the vaccine and a lack of prioritization of vaccination when scheduling daily activities were important factors in refusal and nonadherence.

Conclusions

To organize a successful vaccination program in a small community with limited resources for treating high-risk children it is crucial for medical professionals to provide reliable information. Public health initiatives should focus on assuaging parents' fears about vaccines. In addition, ensuring there is good cooperation between doctors and the Public Health Department can help to make implementation successful. Finally, involving pediatricians and using dedicated areas for vaccinating children can help build trust with parents and caregivers.

A Parent Version of the Motors of COVID-19 Vaccination Acceptance Scale for Assessing Parents' Motivation to Have Their Children Vaccinated

Parents' motivation to vaccinate their children against coronavirus disease 2019 (COVID-19) plays a crucial role in the uptake of COVID-19 vaccines among children. The Motors of COVID-19 Vaccination Acceptance Scale (MoVac-COVID19S) is a valuable tool for assessing individuals' vaccination-related attitudes and the factors influencing their decision to be vaccinated against COVID-19. This study adapted the MoVac-COVID19S to create a parent version (P-MoVac-COVID19S) and examined the psychometric soundness of two P-MoVac-COVID19S versions (a 9-item version (P-MoVac-COVID19S-9) and a 12-item version (P-MoVac-COVID19S-12)) for assessing parents' motivation to vaccinate their children. A total of 550 parents completed the P-MoVac-COVID19S and a questionnaire assessing the factors that impact parents' intention to allow their children to receive the COVID-19 vaccine using a vaccine acceptance scale. We enquired about the level of parental worry regarding the adverse effects of COVID-19 vaccines on children's health and the number of COVID-19 vaccine doses received by parents. The factor structures of the P-MoVac-COVID19S-9 and P-MoVac-COVID19S-12 were examined using confirmatory factor analysis. The internal consistency, test-retest reliability, and concurrent validity of the P-MoVac-COVID19S were also examined. The results revealed that the P-MoVac-COVID19S-12 has a four-factor structure, which aligns well with the theoretical framework of the cognitive model of empowerment; the P-MoVac-COVID19S-9 has a one-factor structure. Both the P-MoVac-COVID19S-9 and P-MoVac-COVID19S-12 had good internal consistency and test-retest reliability and acceptable concurrent validity. The results of this study demonstrated that the P-MoVac-COVID19S is a reliable and valid instrument for assessing parent's motivation to vaccinate their children against COVID-19.

COVID-19 Vaccine Uptake in Immigrant, Refugee, and Nonimmigrant Children and Adolescents in Ontario, Canada

Importance

COVID-19 vaccinations are recommended for minors. Surveys indicate lower vaccine acceptance by some immigrant and refugee groups.

Objective

To identify characteristics in immigrant, refugee, and nonimmigrant minors associated with vaccination.

Design, Setting, and Participants

This retrospective cohort study used linked, population-based demographic and health care data from Ontario, Canada, including all children aged 4 to 17 years registered for universal health insurance on January 1, 2021, across 2 distinct campaigns: for adolescents (ages 12-17 years), starting May 23, 2021, and for children (ages 5-11 years), starting November 25, 2021, through April 24, 2022. Data were analyzed from May 9 to August 2, 2022.

Exposures

Immigrant or refugee status and immigration characteristics (recency, category, region of origin, and generation).

Main Outcomes and Measures

Outcomes of interest were crude rates of COVID-19 vaccination (defined as ≥1 vaccination for children and ≥2 vaccinations for adolescents) and adjusted odds ratios (aORs) with 95% CIs for vaccination, adjusted for clinical, sociodemographic, and health system factors.

Results

The total cohort included 2.2 million children and adolescents, with 1 098 749 children (mean [SD] age, 7.06 [2.00] years; 563 388 [51.3%] males) and 1 142 429 adolescents (mean [SD] age, 14.00 [1.99] years; 586 617 [51.3%] males). Among children, 53 090 (4.8%) were first-generation and 256 886 (23.4%) were second-generation immigrants or refugees; among adolescents, 104 975 (9.2%) were first-generation and 221 981 (19.4%) were second-generation immigrants or refugees, most being economic or family-class immigrants. Immigrants, particularly refugees, were more likely to live in neighborhoods with highest material deprivation (first-generation immigrants: 18.6% of children and 20.2% of adolescents; first-generation refugees: 46.4% of children and 46.3% of adolescents; nonimmigrants: 18.5% of children and 17.2% of adolescents) and COVID-19 risk (first-generation immigrants; 20.0% of children and 20.5% of adolescents; first-generation refugees: 9.4% of children and 12.6% of adolescents; nonimmigrants: 6.9% of children and 6.8% of adolescents). Vaccination rates (53.1% in children and 79.2% in adolescents) were negatively associated with material deprivation. In both age groups, odds for vaccination were higher in immigrants (children: aOR, 1.30; 95% CI, 1.27-1.33; adolescents: aOR, 1.10; 95% CI, 1.08-1.12) but lower in refugees (children: aOR, 0.34; 95% CI, 0.33-0.36; adolescents: aOR, 0.88; 95% CI, 0.84-0.91) compared with nonimmigrants. In immigrant- and refugee-only models stratified by generation, region of origin was associated with uptake, compared with the overall rate, with the lowest odds observed in immigrants and refugees from Eastern Europe (children: aOR, 0.40; 95% CI, 0.35-0.46; adolescents: aOR, 0.41; 95% CI, 0.38-0.43) and Central Africa (children: aOR, 0.24; 95% CI, 0.16-0.35; adolescents: aOR, 0.51,CI: 0.45-0.59) and the highest odds observed in immigrants and refugees from Southeast Asia (children: aOR, 2.68; 95% CI, 2.47-2.92; adolescents aOR, 4.42; 95% CI, 4.10-4.77). Adjusted odds of vaccination among immigrants and refugees from regions with lowest vaccine coverage were similar across generations.

Conclusions and Relevance

In this cohort study using a population-based sample in Canada, nonrefugee immigrants had higher vaccine coverage than nonimmigrants. Substantial heterogeneity by region of origin and lower vaccination coverage in refugees persisted across generations. These findings suggest that vaccine campaigns need precision public health approaches targeting specific barriers in identified, undervaccinated subgroups.

Factors associated with parental intention to vaccinate their preschool children against COVID-19: a cross-sectional survey in urban area of Jakarta, Indonesia

Purpose

We reported a survey-based study assessing the parental intention to vaccinate children of 5 to 7 years old against coronavirus disease 2019 (COVID-19). The aim of this study is to assess factors influencing the parental intention to vaccinate their children against COVID-19.

Materials and Methods

This study adopted a cross-sectional design, held at the public health center of Senen district, Jakarta, Indonesia from November 1-30, 2022. The off-line questionnaires were distributed via the school administrator to all eligible parents. Factors associated with intention to vaccinate were analyzed with the regression logistic models.

Results

Of the 435 parents in this study, 215 had already vaccinated their children against COVID-19 (49.4%), and the overall intention of the participants to vaccinate was 69.7%. Factors associated with intention to vaccinate the children against COVID-19 were parental employment status, parental COVID-19 vaccine status and concern of contracting COVID-19. Parents who are employed, had completed vaccines with COVID-19 booster vaccine, and had concern of their children contracting COVID-19 were more likely to vaccinate their children (odds ratio [OR], 2.10; 95% confidence interval [CI], 1.22-3.69; p=0.011; OR, 2.15; 95% CI, 1.21-3.83; p=0.013; OR, 2.40; 95% CI, 1.34-4.30; p=0.004, respectively). Concern on the vaccine's side effects was negatively associated with the willingness to vaccinate.

Conclusion

This study showed that childhood COVID-19 vaccine only covered half of the population, with parental intentions for childhood COVID-19 vaccination being high, reaching almost two-thirds of the study participants. Factors influencing parental intentions were employment status, parental COVID-19 vaccine status, concerns about COVID-19 and concerns about vaccine side effects.

Determinants of Flu Vaccine Uptake Among the General Population in Saudi Arabia: A Study Based on the Health Belief Model

Background and objective Recently, influenza has emerged as a significant public health concern worldwide, including in Saudi Arabia. Vaccination against the flu is widely recognized as a crucial preventive measure to reduce morbidity and mortality associated with the virus. However, the uptake of flu vaccines among the general population in Saudi Arabia still remains low. In light of this, this study aimed to examine the determinants of influenza vaccine uptake in Saudi Arabia by using the Health Belief Model (HBM). Methods This cross-sectional study was conducted among adults living in all regions of Saudi Arabia by using an online self-administered questionnaire based on the HBM. The questionnaire inquired about demographics, knowledge about influenza, knowledge about vaccines, and beliefs/barriers. It was distributed via social media platforms, including WhatsApp, Twitter, and Instagram. IBM SPSS Statistics software version 29 (IBM Corp., Armonk, NY) was used for statistical analyses, and both the Chi-square test and logic regression analyses were applied to determine associations between explanatory and response variables, with the level of significance set at p<0.05. Results This study enrolled a total of 1040 participants, and the majority were Saudi nationals (96.9%). Of note, 66.2% of the participants were males, and the rest were females. Most of the participants were employed by governmental institutions (42.0%), had bachelor's degrees (58.4%), had never worked in the health sector (70.2%), and earned above 10,000 Saudi riyals per month (62.1%). Over half (55.7%) of participants had taken the flu vaccine at the time of this study. Working in the healthcare sector was associated with increased flu vaccine uptake [adjusted odds ratio (aOR): 3.84, p<0.001]. The likelihood of getting the flu vaccines was greater among men (aOR: 1.38, p=0.027), and obesity was associated with lower flu vaccine uptake (aOR: 0.29, p=0.034). Having contact with people with flu, having had flu in the past, and experiencing severe flu complications (aOR: 4.71, p=0.029; aOR: 0.13, p=0.006; and aOR: 0.29, p=0.033, respectively) were significantly associated with the flu vaccine uptake among our study participants. Perceived potential risks of the flu vaccine were also associated with taking the flu vaccine (aOR: 0.213, p=0.042). There was a significant association between seeing an advertisement for the flu vaccine and the likelihood of taking the vaccine (aOR: 5.488, p=0.042). Conclusion This study found that certain sociodemographic factors are associated with flu vaccine uptake. These factors included contact with flu-infected individuals, past experiences with flu, perceived risks, and exposure to flu vaccine advertisements. Improving healthcare accessibility, conducting awareness campaigns, and implementing workplace initiatives are recommended to address the issues related to flu vaccine uptake.

The determinants of COVID-19 vaccination intention: a meta-review

Background

A large number of systematic reviews have been published that synthesized various determinants of COVID-19 vaccination intention (CVI). However, they reported inconsistent evidence. Therefore, we conducted a meta-review (systematic review of systematic reviews) to provide a comprehensive synthesis of factors influencing CVI.

Methods

This meta-review was conducted in accordance with PRISMA guidelines. PubMed, Scopus, Web of Science, and CINAHL were searched for systematic reviews published from 2020 to 2022 that examined the determinants of CVI. AMSTAR-2 critical appraisal tool was used to ensure the quality of included reviews, and ROBIS tool was used to evaluate the risk of bias.

Results

Globally, the average rate of COVID-19 vaccination intention was 56.97%. We identified 21 main determinants of CVI: socio-demographic, geographical location, social, political, government role, study timeline, attitude, perceived severity, perceived susceptibility, perceived benefits, perceived barriers, self-efficacy and perceived behavioral control, norms, trust, conspiracy theory/propaganda/misinformation, knowledge, information and communication, vaccination recommendation, vaccination history, history of COVID-19 infection, and health status and well-being.

Conclusions

These results suggest that COVID-19 vaccination intention is a complex process and is affected by numerous multidimensional factors. Therefore, integrated communication strategies and multifaceted interventions may be effective for improving vaccination intention against COVID-19.

Worldwide Estimation of Parental Acceptance of COVID-19 Vaccine for Their Children: A Systematic Review and Meta-Analysis

Currently, the best method to well control the spread of COVID-19 without severe mental health problems is to reach herd immunity. Therefore, the vaccination rate of the COVID-19 vaccine is critical. Among the populations, children are the vulnerable ones to get vaccinated; therefore, it is important to assess parents’ and guardians’ willingness to have their children vaccinated. The present systematic review and meta-analysis synthesized evidence to estimate the parents’ acceptance rate of COVID-19 vaccination toward their children. Additionally, factors explaining the acceptance rate were investigated. Four academic databases (PubMed, Scopus, Web of Science, and ProQuest) together with Google Scholar were searched, and the references of the included publications were searched as well. Using the PECO-S framework (population, exposure, comparison, outcome, and study design), observational studies of cross-sectional, cohort, or case-control studies were included. The outcome was parents’ or guardians’ willingness to let their children be vaccinated. The studies included in the present review were restricted to English and peer-reviewed papers published between December 2019 and July 2022. A total of 98 papers across 69 different countries with 413,590 participants were included. The mean age of the parents was 39.10 (range: 18–70) years and that of their children was 8.45 (range: 0–18) years. The pooled estimated prevalence of parental acceptance to vaccinate their children with the COVID-19 vaccine was 57% (98 studies, 95% CI: 52–62%, I2: 99.92%, τ2: 0.06). Moreover, data collection time was a significant factor explaining parental willingness in the multivariable meta-regression, with a 13% decrease in parental willingness by each month increase in time, explaining 11.44% of variance. Qualitative synthesis results showed that parents’ COVID-19 vaccine knowledge, trust in theCOVID-19 vaccine, and facilitators in vaccination (e.g., low cost, good vaccine accessibility, and government incentive) were significant factors for higher willingness, while mental health problems (e.g., having worries and psychological distress) were significant factors for lower willingness. Given that the acceptance rate was relatively low (57%) and does not achieve the requirement of herd immunity (i.e., 70%), governments and healthcare authorities should try to elevate parents’ knowledge and trust in the COVID-19 vaccine, facilitate in vaccination, and reduce their mental difficulties to improve the overall vaccination rate among children.

Health Belief Model and parents' acceptance of the Pfizer-BioNTech and Sinopharm COVID-19 vaccine for children aged 5-18 years Old: A national survey

BACKGROUND

During the COVID-19 pandemic, several vaccines received approval for children aged 18 or younger. Parents' decisions to accept vaccines play an important role in the success of vaccination campaigns. The Health Belief Model (HBM) may explain its association with vaccine acceptance. This study examined parents' Pfizer-BioNTech and Sinopharm vaccine acceptance for their children and its association with HBM.

METHODS

A cross-sectional study was conducted in March 2022 using an online survey. Respondents were parents of children aged 5-18 in public and private schools. The multistage random sampling technique was used to choose schools and respondents. Multivariable analysis was conducted to examine the association between vaccine acceptance and HBM.

RESULTS

The response rate was 55 %. Of 1,056 respondents, 80.1 % were female, with a mean age of 41, and 95.8 % were not health professionals. Pfizer-BioNTech had a greater acceptance rate than Sinopharm (90 % v.s. 36 %). The Multivariable analysis shows that perceived benefits (aOR = 25.30, 95 %CI = 10.02-63.89 and aOR = 17.94, 95 %CI = 9.56-33.66 for Pfizer-BioNTech and Sinopharm, respectively) and perceived barriers (aOR = 0.06, 95 %CI = 0.01-0.50 and aOR = 0.20, 95 %CI = 0.11-0.40 for Pfizer-BioNTech and Sinopharm, respectively) were associated with vaccine acceptance for both vaccines. Education was associated with Pfizer-BioNTech vaccine acceptance (aOR = 0.96, 95 %CI 0.71-1.29).

CONCLUSIONS

The respondents were more confident in Pfizer-BioNTech than Sinopharm. Perceived barriers and perceived benefits were strongly associated with the respondents' vaccine acceptance for both vaccines. During epidemics and pandemics, the government needs vaccines with high efficacy and safety for a higher chance of parents' vaccine acceptance. Future research should examine vaccine costs as perceived barriers for a newly out-of-pocket developed vaccine.

A survey of COVID-19 vaccine acceptance across 23 countries in 2022

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continued to mutate and spread in 2022 despite the introduction of safe, effective vaccines and medications. Vaccine hesitancy remains substantial, fueled in part by misinformation. Our third study of Coronavirus Disease 2019 (COVID-19) vaccine hesitancy among 23,000 respondents in 23 countries (Brazil, Canada, China, Ecuador, France, Germany, Ghana, India, Italy, Kenya, Mexico, Nigeria, Peru, Poland, Russia, Singapore, South Africa, South Korea, Spain, Sweden, Turkey, the United Kingdom and the United States), surveyed from 29 June to 10 July 2022, found willingness to accept vaccination at 79.1%, up 5.2% from June 2021. Hesitancy increased in eight countries, however, ranging from 1.0% (United Kingdom) to 21.1% (South Africa). Almost one in eight (12.1%) vaccinated respondents are hesitant about booster doses. Overall support for vaccinating children under 18 years of age increased slightly but declined among parents who were personally hesitant. Almost two in five (38.6%) respondents reported paying less attention to new COVID-19 information than previously, and support for vaccination mandates decreased. Almost a quarter (24%) of those who became ill reported taking medications to combat COVID-19 symptoms. Vaccination remains a cornerstone of the COVID-19 pandemic response, but broad public support remains elusive. These data can be used by health system decisionmakers, practitioners, advocates and researchers to address COVID-19 vaccine hesitancy more effectively.

Association between caregiver opposition to topical fluoride and COVID-19 vaccines

PURPOSE

Caregivers who oppose topical fluoride in dental settings may be opposed to other preventive health treatments, including COVID-19 vaccines. The study objective was to examine the association between caregiver opposition to topical fluoride and COVID-19 vaccines.

METHODS

The study took place at the University of Washington in Seattle, WA. English-speaking caregivers of children aged < 18 years were eligible to participate. An 85-item REDCap survey was administered from February to September 2021. The predictor variable was topical fluoride opposition (no/yes). The outcome was COVID-19 vaccine opposition (no/yes). The models included the following covariates: child and caregiver age; caregiver race and ethnicity, education level, dental insurance type, parenting style, political ideology, and religiosity; and household income. Logistic regression models generated odds ratios (OR) and 95 % confidence intervals (α = 0.05).

RESULTS

Six-hundred-fifty-one caregivers participated, and 403 caregivers with complete data were included in the final regression model. Mean child age was 8.5 years (SD 4.2), mean caregiver age was 42.1 years (SD 9.1), 53.0 % of caregivers were female, 57.3 % self-reported as white, and 65.5 % were insured by Medicaid. There was a significant positive association between topical fluoride and COVID-19 vaccine opposition (OR = 3.13; 95 % CI: 1.87, 5.25; p < 0.001). Other factors associated with COVID-19 vaccine opposition included conservative political views (OR = 2.77; 95 % CI: 1.26, 6.08; p < 0.011) and lower education (OR = 3.47; 95 % CI: 1.44, 8.38; p < 0.006).

CONCLUSIONS

Caregivers opposed to topical fluoride in dental settings were significantly more likely to oppose COVID-19 vaccines for their child. Future research should identify ways to address both topical fluoride and vaccine opposition to prevent diseases in children.

COVID-19 mRNA Vaccine Tolerance and Immunogenicity in Hematopoietic Stem Cell Transplantation Recipients Aged 5-11 Years Old-Non-Randomized Clinical Trial

The SARS-CoV-2 pandemic had a devastating impact on the world’s population in the years 2020−2022. The rapid development of vaccines enabled a reduction in the mortality and morbidity of COVID-19, but there are limited data about their effects on immunocompromised children. The aim of this prospective study was to evaluate the safety and efficacy of the mRNA BNT162b2 (Pfizer/Biontech) vaccine in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Material and methods: Two cohorts of 34 children after allo-HSCT and 35 healthy children aged 5−11 years were vaccinated with two doses of the mRNA BNT162b2 (10 µg) vaccine. All children were evaluated for adverse effects with electronic surveys and the immunogenicity of the vaccine was assessed with anti-SARS-CoV-2 IgG titer measurements. Results: All reported adverse events (AEs) were classified as mild. The most common AE was pain at the injection site. All the other AEs (both local and systemic) were rarely reported (<15% patients). Both groups showed a similar response in anti-SARS-CoV-2 IgG production. Patients after allo-HSCT that were undergoing immunosuppressive treatment presented a poorer immunological response than patients off of treatment. Time since HSCT, patient age, lymphocyte count, and total IgG concentration did not correlate with initial/post-vaccination anti-SARS-CoV-2 IgG titers. Most patients who were eligible for a third dose of the vaccine had an excellent humoral response observed after two vaccine doses. Conclusions: The COVID-19 mRNA BNT162b2 vaccine is very well tolerated and highly immunogenic in 5−11-year-old children after HSCT. Children >2 years of age after HSCT who did not receive immunosuppressive treatment presented excellent antibody production after two doses of the vaccine, but children on immunosuppression may require a more intense vaccination schedule.

Parents' Readiness to Vaccinate Their Children Aged 5 to 17 Years Against Covid-19 and Its Associated Factors in Lira District, Uganda

Background

Data on parents' readiness to vaccinate their children aged 5 to 17 years against COVID-19 is still scarce. This study assessed parents' readiness to vaccinate their children aged 5 to 17 years against COVID-19 and factors associated in Lira district, Uganda.

Methods and Materials

A cross-sectional survey employing quantitative methods was conducted between October and November 2022 among 578 parents of children aged 5-17 years in 3 sub-counties in Lira district. An interviewer-administered questionnaire was used to collect data. Data was analyzed using descriptive statistics including means, percentages, frequencies, and odds ratios. Logistic regression was used to determine associations between the factors and the readiness of parents at a 95% level of significance.

Results

Out of 634 participants, 578 responded to the questionnaire, giving a response rate of 91.2%. The majority of the parents (327, 56.8%) were female, had children aged between 12 and 15 years (266, 46.4%), and had completed primary education (351, 60.9%). Most of the parents were Christian (565, 98.4%), married (499, 86.6%), and had been vaccinated against COVID-19 (535, 92.6%). Results also indicated that 75.6% (ranging from 71.9% to 78.9%) of the parents were unwilling to vaccinate their children for the COVID-19 virus. The predictors of readiness were the age of the child (AOR: 2.02; 95% CI: 0.97-4.20; p=0.05) and lack of trust in the vaccine (AOR: 3.33; 95% CI: 1.95-5.71; p0.001).

Conclusion

Our study shows that parents' readiness to vaccinate their children aged 5 to 17 years was only 24.6%, which is suboptimal. The predictors of hesitancy were the age of the child and a lack of trust in the vaccine. Based on our results, the Ugandan authorities should provide health education interventions targeting parents to combat mistrust with respect to COVID-19 and the COVID-19 vaccine and highlight the benefits of the vaccines.

Preventive Health Behaviours among Adolescents and Their Parents during the COVID-19 Outbreak in the Light of the Health Beliefs Model

This article analysed the relationship between the preventive health behaviours of parents and teenagers during the COVID-19 outbreak, taking the Health Beliefs Model (HBM) as a point of reference. We assumed that parents' behaviours may be a cue to action for adolescents, looking at their preventive health behaviours regarding vaccination against COVID-19, as well as vaccination intention (among unvaccinated people); wearing protective masks where it is compulsory and where it is not obligatory; and maintaining physical distance and disinfecting hands in public places. The collected data were statistically analysed using the Statistica version 13.3 software package for advanced statistical data analysis. Descriptive statistics and correlation for non-parametric data (Spearman's correlation) were used. Research on a sample of 201 parents and their children revealed that young people engage in preventive behaviour less frequently than parents, but that the likelihood of such behaviour increases if they have a parent's cue to action. When formulating recommendations, we considered the gender of the surveyed parents, as the questionnaire was mainly completed by women, which may be an indicator of the unequal involvement in addressing the topic of the pandemic and preventive health behaviours, including attitudes towards vaccines.

Status of COVID-19 Infection and Vaccination in People Aged 18 Years and over in a Town: A Cross-Sectional Study in Turkey

Objective. The objective of this study was to evaluate the cases of COVID-19 infection in people >18 years old and to investigate attitudes against vaccination and vaccine hesitancy and the factors affecting them. Methods. The data collection form used in the study was prepared by the researchers by screening the relevant literature. People over the age of 18 who agreed to participate in the study were invited to the family health center, and a questionnaire was applied by face-to-face interview method. The application time of a survey was 5-10 minutes. A total of 229 people were reached. Percentage of reaching was 95,4%. Results. The mean age of the participants was $44,13\pm 14,18$ years. 31,9% of the participants in the study had COVID-19 infections. 69,9% of those who had COVID-19 infection caught the disease in the last year, and 93,2% were followed at home. Among the people with whom the participants lived, 21,6% of those who had COVID-19 infection were hospitalized and 5,7% died. Of the participants who expressed their opinion, 32,1% think that COVID-19 vaccines have serious side effects. Postvaccine side effects developed in 32,9% of the participants who had the COVID-19 vaccine, and 11,0% had a postvaccine infection. Conclusion. The results of our study revealed that the COVID-19 vaccine was highly accepted among the adult population in Turkey during the pandemic period. However, through this study, we found concerns about the side effects of the vaccine, the lack of confidence in the vaccine ingredient, and the effectiveness of the vaccine.

Exploring Critical Factors Associated with Completion of Childhood Immunisation in the Eastern Province of Saudi Arabia

(1) Background: surveillance data from the Saudi Ministry of Health shows that the Kingdom’s large-scale immunisation programme has significantly reduced the mortality and morbidity of the target diseases among children. In this study, we review relevant literature and test a number of hypotheses related to the association between demographic, socio-economic, clinic-related, and parents-related variables and completion of childhood immunisation. In doing so, this study identifies critical factors associated with completion of childhood immunisation and presents important implications to healthcare practitioners, particularly in Saudi Arabia; (2) Literature review: a systematic literature review was conducted to understand what is currently published concerning parents’ immunisation compliance in Saudi Arabia and the factors associated with immunisation compliance. (3) Methods: from March to May 2022, an online survey was administered to parents attending one of the 27 primary health care (PHC) centres in Qatif. Data from parents (n = 353) were analysed using exploratory factor analysis, correlation, and a series of OLS and logistic regression models; (4) Results: parental (child) age was negatively (positively) associated with the completion status of childhood immunisation (both p < 0.05). Parents with positive attitudes, social norms, perceptions towards immunisation, and those working in private companies were more likely to immunise their children (all p < 0.05). Conversely, living in an apartment building, walking to PHCs, waiting longer at PHCs, and having higher knowledge of immunisation were negatively associated with the completion of childhood immunisation (all p < 0.05); (5) Conclusions: several factors that positively or negatively influence the completion of childhood immunisation have been identified. Future studies may investigate the causal link between these factors and parental decision-making regarding childhood immunisation.

Assessing Parents' Knowledge, Attitudes, and Practices Toward Vaccinating Children (Five to 15 Years Old) Against COVID-19 in the United Arab Emirates

Background  Since the approval of the Coronavirus disease 2019 (COVID-19) vaccine for children in 2021, there had been ongoing debates about the necessity of vaccinating children, owing to the seemingly mild nature of the infection in children, despite causing significant morbidity and mortality in the 5-11 age group in 2020-2021, and its association with complications such as Multisystem Inflammatory Syndrome in Children (MIS-C). This sparked the need to evaluate parents' perceptions, knowledge, and the effect of information sources on their decision-making. It is important to understand the various drivers and concerns expressed by parents locally, to shape vaccination campaigns to address such issues. While numerous studies across the world have extensively investigated parental willingness and intention to vaccinate children against COVID-19, it is important to acknowledge that these studies have been conducted before COVID-19 vaccines became approved for children in the respective countries. There is an obvious scarcity of data on the parental knowledge, attitudes, and acceptance of the vaccine for children after the respective countries have approved and provided the vaccine. The present study aims to provide data that could reveal possible barriers to vaccine uptake such as deficits in knowledge, negative attitudes, and poor practices towards the COVID-19 pandemic, and hence address these factors to make the ongoing COVID-19 vaccination campaign, as well as future childhood vaccination campaigns, more successful. Methods This is a cross-sectional online-based survey targeting parents living in the United Arab Emirates (UAE) with children aged 5-15 years. Data collected from June 23 to July 20, 2022 were analyzed using IBM SPSS (Statistical Package for Social Sciences) 28 software. The survey included questions concerning parental and children demographics, parents' level and sources of knowledge about COVID-19 infection and vaccine, attitudes of parents about the COVID-19 pandemic and vaccines, and finally parental practices concerning pandemic preventive measures and COVID-19 vaccine uptake. Results Out of 437 participants, 212 (48.5%) vaccinated their children against COVID-19, and of those who did not, only 22 (9.8%) intended to vaccinate. The most commonly cited reason by parents for vaccinating their children was to reduce complications. The most frequent concern was the novelty and lack of information, and consequently, getting more information was the most selected driver to vaccinate as well as being advised by a doctor. Significant predictors were acceptance of childhood and influenza vaccines, trust in vaccine safety and trust in information provided by health authority websites, and lastly, exposure to positive information on social media. Conclusion A considerable proportion of parents have vaccinated their children against COVID-19; however, concerns about novelty and lack of information persist, leading to a high level of vaccine hesitancy. It is imperative that public health efforts maintain momentum, and that pediatricians incorporate parental education on the COVID-19 vaccine for children, which could potentially play a major role in combating vaccine hesitancy.

Safety of COVID-19 Pfizer-BioNtech (BNT162b2) mRNA vaccination in adolescents aged 12-17 years: A systematic review and meta-analysis

The COVID-19 pandemic has severely affected adolescents. Safe and effective vaccines are pivotal tools in controlling this pandemic. We reviewed the safety profile of the BNT162b2 COVID-19 vaccine in adolescents using mostly real-world data to assist decision-making. We used random-effects model meta-analysis to derive pooled rates of single or grouped adverse events following immunization (AEFI) after each primary and booster dose, as well as after combining all doses. Reporting on over one million participants with safety data were included. The most-reported local and systemic AEFIs were pain/swelling/erythema/redness and fatigue/headache/myalgia, respectively. AESIs were rarely reported but were more frequent after the second dose than they were after the first and the booster doses. Health impact was less common among adolescents after receiving BNT162b2 vaccine. Rare life-threatening AEFIs were reported across all doses in real-world studies. Our findings highlight the significance of enhancing national and regional vaccination programs to ensure public confidence.

Predicting Vaccination Intention against COVID-19 Using Theory of Planned Behavior: A Systematic Review and Meta-Analysis

This study systematically analyzed the literature using the theory of planned behavior (TPB) as a theoretical framework to examine the influence of its constructs on vaccination intention against COVID-19. Quantitative studies were searched in PubMed, CINAHL, Web of Science, and Google Scholar following the PRISMA guidelines. The average rate of COVID-19 vaccination intention was 73.19%, ranging from 31% to 88.86%. Attitude had the strongest association with vaccination intention (r₊ = 0.487, 95% CI: 0.368-0.590), followed by subjective norms (r₊ = 0.409, 95% CI: 0.300-0.507), and perceived behavioral control (r₊ = 0.286, 95% CI: 0.198-0.369). Subgroup analyses showed that the pooled effect sizes of TPB constructs on vaccination intention varied across geographic regions and study populations. Attitude had large effect sizes in Asia, Europe, and Oceania, especially among the adult general population, parents, and patients. Subjective norms had large effect sizes in Asia and Oceania, especially among parents and patients. Perceived behavioral control was the most dominant predictor of vaccination acceptance in Africa among patients. These findings suggest that TPB provides a useful framework for predicting intention to receive a COVID-19 vaccine. Hence, public awareness and educational programs aimed at promoting COVID-19 vaccination intention should consider using TPB as a framework to achieve the goal.

[Parental intention to vaccinate their children against COVID-19]

Hintergrund

Mit Beginn der Impfkampagne hat eine neue Phase der Bewältigung der Coronapandemie begonnen. Zulassung und Empfehlung für die COVID-19-Impfung von Kindern folgten schrittweise; bis heute (mit Stand vom 04.10.2022) sind in Deutschland Impfungen für Kinder unter 5 Jahren nicht zugelassen.

Ziel der Arbeit

Ziel war es, zu untersuchen, wie sich die COVID-19-Impfintention von Eltern bezogen auf ihre Kinder von Mai 2020 bis Februar 2021 (von der ersten zur zweiten Coronawelle) entwickelte und welche Determinanten der Impfintention es gibt.

Methoden

612 Familien, die mit ihrem Kind im Alter zwischen 1,5 und 6 Jahren an der KUNO Kids Gesundheitsstudie teilnehmen, beantworteten im Mai 2020 Fragen eines Online-Surveys (Teilnahmerate 51 %), 507 nahmen an der Wiederholungsbefragung im Februar 2021 teil. Determinanten der Impfintention wurden für beide Zeitpunkte in uni- und multivariablen logistischen Regressionsmodellen analysiert.

Ergebnisse

Während 51 % der Eltern im Mai 2020 angaben, ihr Kind gegen COVID-19 impfen lassen zu wollen, reduzierte sich dieser Anteil bis Februar 2021 auf 41 %. Zu mindestens einem der beiden Zeitpunkte waren Gesundheitskompetenz sowie die wahrgenommene Kompetenz bzgl. Schutzmaßnahmen gegen das Virus signifikant positiv mit einer höheren Impfintention assoziiert, die Zugehörigkeit von Angehörigen zu einer Risikogruppe sowie der Eindruck, dass die politischen Maßnahmen übertrieben seien, ging mit einer niedrigeren Impfintention einher.

Diskussion

Die Intention, das Kind gegen COVID-19 impfen zu lassen, war nur mäßig ausgeprägt und nahm zur zweiten Coronawelle weiter ab. Einstellungs- und kompetenzbezogene Determinanten waren zu beiden Zeitpunkten wichtig und könnten in einer künftigen Impfkampagne, die Eltern jüngerer Kinder adressiert, gezielt berücksichtigt werden.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-022-03613-z) enthalten.

Immunogenicity of a Fractional Dose of mRNA BNT162b2 COVID-19 Vaccine for Primary Series and Booster Vaccination among Healthy Adolescents

Primary series vaccination with BNT162b2 followed by a booster 5 months later has been recommended for healthy adolescents. We aimed to describe the immunogenicity in a fractional dose of BNT162b2. Adolescents aged 12–18 years were randomized into six arms for primary series administration: 3wPZ30/30 (reference group), 3wPZ30/20, 3wPZ20/20, 6wPZ30/30, 6wPZ30/20, and 6wPZ20/20 μg. A booster was given at 5 months after the second dose using either 10 or 15 μg of BNT162b2. Immunogenicity following vaccination was determined by IgG against receptor-binding domain (anti-S-RBD IgG; BAU/mL), surrogate virus neutralization test (sVNT; %inhibition) and pseudovirus neutralization (pVNT;ID₅₀) against Omicron. Non-inferiority criteria were defined as a lower boundary of the geometric mean ratio (GMR) being greater than 0.67. From September to October 2021, 118 adolescents with a median age (IQR) of 14.9 years (13.9–16.7) were enrolled. Fourteen days after the primary series, the geometric means (GMs) of anti-S-RBD IgG (BAU/mL) were 3090 (95% CI 2761–3460) in 3wPZ30/30. The GMRs of anti-S-RBD were: 0.80 (95% CI 0.67–0.97) in 3wPZ30/20; 1.00 (95% CI 0.83–1.20) in 3wPZ20/20; 1.37 (95% CI 1.13–1.65) in 6wPZ30/30; 1.24 (95% CI 1.02–1.50) in 6wPZ30/20; and 1.36 (1.13–1.64) in 6wPZ20/20. After a booster dose with 15 μg (n = 24) of BNT162b2, sVNT and pVNT against Omicron variant were 91.6 (95% CI 88.4–94.9) and 331 (95% CI 221–495), respectively. In the group that received 10 μg of BNT162b2 (n = 25), sVNT was 85.6 (95% CI 80.0–91.6) and pVNT was 397 (95% CI 267–590). Healthy adolescents had good immune responses to the fractional dose regimen of BNT162b2 and this may be considered as an alternative option.

Causes of Vaccine Hesitancy in Adults for the Influenza and COVID-19 Vaccines: A Systematic Literature Review

Background: Vaccine hesitancy was labelled as one of the top ten threats to global health by the World Health Organization in 2019 and is associated with negative health outcomes. Previous reviews on cause of vaccines have not included vaccine hesitancy related to the COVID-19 vaccine. This review aimed to fill this gap by synthesising the findings of studies identifying causes of vaccine hesitancy to the COVID-19 and influenza vaccines. Methods: A systematic literature review was conducted. Searches were carried out in the PubMed, EMBASE and Cochrane databases. Following data extraction, a thematic analysis was conducted of the causes of vaccine hesitancy in adults for the influenza and COVID-19 vaccines. Results: Fourteen papers were included. Four themes were identified as causes of vaccine hesitancy comprising: concerns over safety, lack of trust, lack of need for vaccination and cultural reasons. While concerns over safety were found in all countries, some of these were specific to particular countries and cultures. Our findings suggest that scientific knowledge of vaccines and size of clinical trials during their development reduce vaccine hesitancy. However, pharmaceutical companies were not a trusted source of information. Conclusion: Our findings build on those of previous research to suggest specific information that may be helpful in addressing vaccine hesitancy. Targeted approaches from trusted sources are needed to address specific safety concerns.

COVID-19 vaccination in the Gaza Strip: a cross-sectional study of vaccine coverage, hesitancy, and associated risk factors among community members and healthcare workers

Background

The Gaza Strip, like other settings of complex humanitarian emergencies, faces immense challenges in vaccinating its population against COVID-19. This study was conducted in October 2021 among Gaza’s adult population and healthcare workers (HCWs). The primary aim was to estimate two indicators, coverage of COVID-19 vaccination and the prevalence of vaccine hesitancy. The secondary aim was to evaluate the two indicators’ associations with globally identified risk factors.

Methods

A cross-sectional study was conducted using a population-based survey of adults and a purposive survey of HCWs in Gaza. A multi-stage sampling design was used for the population survey component. For the HCW component, five health facilities were purposively selected as entry points; HCWs in the facilities holding clinical or other specialized positions were approached to participate in the survey. Data were summarized as univariable descriptive statistics with unweighted and weighted point estimates. Logistic regression was used to evaluate associations of risk factors with vaccination status and vaccine hesitancy.

Results

A total of 1075 individuals were surveyed, of whom 906 were community members and 169 were HCWs. Population-weighted vaccine coverage was estimated to be 49.08% (95% CI 43.10–55.08). 89.35% of HCWs were vaccinated. Population-weighted vaccine hesitancy was estimated to be 34.08% (95% CI 28.14–40.56) in the overall population and 67.24% (95% CI 49.04–81.41) among the unvaccinated sub-group. In logistic regression vaccination was independently associated with male sex (aOR 1.88, p = 0.006, 95% CI 1.20–2.95), older age (40+ vs. 18–39 age group) (aOR 1.92, p < 0.001, 95% CI 1.73–2.13), higher education (aOR 2.19, p < 0.001, 95% CI 1.51–3.17), and confidence in the safety of the vaccine (aOR 13.8, p < 0.001, 95% CI 10.1–18.8). Risk factors for hesitancy were similar to those identified for vaccination status, however hesitant individuals were somewhat more likely to obtain vaccine information from family members (aOR 1.29, p = 0.051, 95% CI 1.00–1.67) and less likely to trust healthcare providers (aOR 0.58, p < 0.001, 95% CI 0.49–0.68).

Conclusions

The continued emergence of SARS-CoV-2 variants reinforces the importance of achieving high levels of vaccination coverage globally—a difficult undertaking in Gaza. This study estimated half of Gaza’s adult population received at least one dose of any COVID-19 vaccine by October 2021, and the majority of unvaccinated individuals were hesitant. Disparities in vaccination across the territory’s demographic groups underscore the need for targeted outreach to these populations and messaging through community-based channels to permeate social networks of the unvaccinated.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13031-022-00477-7.

Validation and Cultural Adaptation of the Parent Attitudes about Childhood Vaccines (PACV) Questionnaire in Arabic Language Widely Spoken in a Region with a High Prevalence of COVID-19 Vaccine Hesitancy

The parents’ attitude toward vaccinating children and adolescents against coronavirus disease 2019 (COVID-19) remains inconsistent and needs further elucidation. The high rates of COVID-19 vaccine hesitancy in the Middle East and North Africa (MENA) region require intensive research to understand the determinants of this phenomenon. This study aimed to validate a version of the Parent Attitudes about Childhood Vaccines (PACV) tool in Arabic, the most widely spoken language in the MENA. The study objectives included the investigation of Arab-speaking parents’ views regarding COVID-19 vaccination of their children. Parents living in Egypt with at least one child aged 5−18 years were eligible to participate in the study that was conducted through an online survey with 15 PACV items. The PACV tool was translated into Arabic using forward and backward translation. To assess the psychometric properties of the Arabic version of PACV, Pearson’s correlation coefficient and exploratory and confirmatory factor analysis (EFA and CFA) were performed. A total of 223 parents participated in the study: 59.82% aged 30−39 years, 69.20% were females, 46.19% were university-educated, and 40.63% had one child. The overall Cronbach’s alpha for the Arabic version of PACV was 0.799. The EFA of the 15 items showed that three domains were most conceptually equivalent. All items had a positive significant correlation with the mean score of each subscale except for item 4 (r = 0.016, p = 0.811). Regression analyses results indicated that education, previous COVID-19 infection, vaccine status of parents, and PACV score were significantly associated with the intention of the parents to vaccinate their children against COVID-19. The CFA results showed that most of the factor loadings were statistically significant (p < 0.010) except for items 4 and 7. However, the root mean square error of approximation (RMSEA = 0.080) and the standardized root mean squared residual (SRMR = 0.080) indicated that the model had a reasonable fit, and the three factors were good in reproducing each correlation. Our study results indicated the validity and reliability of the PACV instrument in Arabic language. Consequently, the PACV can be used to assess COVID-19 vaccine hesitancy in a majority of MENA countries for better delineation of this highly prevalent phenomenon in the region.

Mapping the Prevalence of COVID-19 Vaccine Acceptance at the Global and Regional Level: A Systematic Review and Meta-Analysis

Despite the availability of effective and safe vaccines, the acceptance of COVID-19 vaccination is suboptimal. In this meta-analysis we quantified the prevalence estimates of COVID-19 vaccine acceptance with a specific focus on worldwide geographical differences. We searched PubMed, Scopus, Web of Science and PsycInfo up to April 2021 (PROSPERO ID: CRD42021235328). Generalized random-effects linear models with a logit link were used to calculate the pooled estimated rate of vaccine acceptance at both the global and regional level. A meta-regression analysis was performed to assess the association between COVID-19 vaccine acceptance and various characteristics of the studies. Overall, 71 articles yielding 128 prevalence estimates were included. The pooled prevalence of COVID-19 vaccination acceptance rate was 66% (95% CI: 61-71%). This varied by geographic area, ranging from 36% (95% CI: 18-60%) in Africa to 83% (95% CI: 82-84%) in Oceania, and there was high variability between countries (15.4% Cameroon-100% Bhutan). Meta-regression analysis showed that studies that investigated COVID-19 vaccination intentions using multiple choice/scoring gave a vaccine acceptance prevalence lower than studies with only two possible answers (yes/no) (ß: -1.02 95% CI: -1.41 to -0.63). Despite some variation in the estimates, the results showed that one in three people may refuse/delay COVID-19 vaccination.

Changes in Parents' COVID-19 Vaccine Hesitancy for Children Aged 3-17 Years before and after the Rollout of the National Childhood COVID-19 Vaccination Program in China: Repeated Cross-Sectional Surveys

China started to implement COVID-19 vaccination programs for children in July 2021. This study investigated the changes in parents’ COVID-19 vaccine hesitancy for children before and after the vaccination program rollout. Repeated cross-sectional online surveys among full-time adult factory workers were conducted in Shenzhen, China. This analysis was based on 844 (first round) and 1213 parents (second round) who had at least one child aged 3−17 years. The prevalence of vaccine hesitancy for children aged 3−11 years dropped from 25.9% (first round) to 17.4% (second round), while such a prevalence for children aged 12−17 years dropped from 26.0% (first round) to 3.5% (second round) (p < 0.001). Positive attitudes, a perceived subjective norm, and perceived behavioral control related to children’s COVID-19 vaccination were associated with lower vaccine hesitancy in both rounds. In the second round and among parents with children aged 3−11 years, negative attitudes and exposure to information on SARS-CoV-2 infection after receiving a primary vaccine series were associated with higher vaccine hesitancy, while exposure to experiences shared by vaccine recipients and infectiousness of variants of concern were associated with lower vaccine hesitancy. Regular monitoring of vaccine hesitancy and its associated factors among parents should be conducted to guide health promotion.

Intent among Parents to Vaccinate Children before Pediatric COVID-19 Vaccine Recommendations, Minnesota and Los Angeles County, California-May-September 2021

Objectives: This study assessed the associations between parent intent to have their child receive the COVID-19 vaccination, and demographic factors and various child activities, including attendance at in-person education or childcare. Methods: Persons undergoing COVID-19 testing residing in Minnesota and Los Angeles County, California with children aged <12 years completed anonymous internet-based surveys between 10 May and 6 September 2021 to assess factors associated with intention to vaccinate their child. Factors influencing the parents’ decision to have their child attend in-person school or childcare were examined. Estimated adjusted odds rations (AORs, 95% CI) were computed between parents’ intentions regarding children’s COVID-19 vaccination and participation in school and extra-curricular activities using multinomial logistic regression. Results: Compared to parents intending to vaccinate their children (n = 4686 [77.2%]), those undecided (n = 874 [14.4%]) or without intention to vaccinate (n = 508 [8.4%]) tended to be younger, non-White, less educated, and themselves not vaccinated against COVID-19. Their children more commonly participated in sports (aOR:1.51 1.17−1.95) and in-person faith or community activities (aOR:4.71 3.62−6.11). A greater proportion of parents without intention to vaccinate (52.5%) indicated that they required no more information to make their decision in comparison to undecided parents (13.2%). They further indicated that additional information regarding vaccine safety and effectiveness would influence their decision. COVID-19 mitigation measures were the most common factors influencing parents’ decision to have their child attend in-person class or childcare. Conclusions: Several demographic and socioeconomic factors are associated with parents’ decision whether to vaccinate their <12-year-old children for COVID-19. Child participation in in-person activities was associated with parents’ intentions not to vaccinate. Tailored communications may be useful to inform parents’ decisions regarding the safety and effectiveness of vaccination.

COVID-19 Vaccine Acceptance Among US Parents: A Nationally Representative Survey

BACKGROUND

Little was known about US parental attitudes, beliefs, and intentions surrounding coronavirus disease 2019 (COVID-19) vaccines for children before their introduction.

METHODS

An online cross-sectional nationally representative survey of US parents/guardians of children < 18 years old via Ipsos KnowledgePanel, fielded from October 26, 2021 to November 30, 2021.

RESULTS

Response rate was 64.2% (3230/5034). For children ages 0-4 years, 51.5% of parents were likely to have their children vaccinated, and for ages 5-11 and 12-17, 54.0% and 69.7% of parents, respectively, reported they were likely to vaccinate or had already vaccinated their children. Among respondents with unvaccinated children, 25.2% (ages 0-4) and 22.0% (ages 5-11) reported they would seek COVID-19 vaccination for their children as soon as authorization occurred. Factors associated with willingness to have children receive a COVID-19 vaccine were: belief in benefits of COVID-19 vaccination (odds ratio [OR] = 6.44, 5.68, 4.57 in ages 0-4, 5-11, and 12-17 respectively), acceptance of routine childhood vaccines (OR = 6.42, 5.48, 1.76), parental COVID-19 vaccination (OR = 1.85, 3.70, 6.16), perceptions that pediatric COVID-19 is severe (OR = 1.89, 1.72, 1.35), Hispanic ethnicity (OR = 2.07, 2.29, 2.60), influenza vaccine acceptance (OR = 1.07, 0.88, 1.62), presence of children of another age group in the household (OR = 0.71, 0.71, 0.65), and attitudinal barriers to COVID-19 vaccination (OR = 0.30, 0.26, 0.49).

CONCLUSIONS

Belief in the benefits of COVID-19 vaccination and acceptance of routine childhood vaccines are the strongest predictors of intention to vaccinate children. Further research is needed to track how parental attitudes change as more data about pediatric COVID-19 vaccines become available and how intentions translate into pediatric vaccine uptake.

Parental and Pediatricians’ Attitudes towards COVID-19 Vaccination for Children: Results from Nationwide Samples in Greece

Although many studies have examined factors associated with COVID-19 vaccination and healthcare professionals’ attitudes towards vaccines, less is known about parents’ and pediatricians’ attitudes towards COVID-19 vaccination for children. Using two cross-sectional surveys from November to December 2021 in Greece, we aimed to assess parental intention to vaccinate their 5 to 17 years old children against COVID-19 and to evaluate pediatricians’ attitudes towards children’s vaccination against COVID-19. Overall, 439 parents and 135 pediatricians participated. Of them, 240 (54.7%) intended to vaccinate their children against COVID-19. The most commonly reported reasons for non-intention were the short length of clinical trials and the fear of side effects. Only 16.6% of non-intenders would vaccinate their children if the pediatrician recommended it. The factors associated with higher intention to get vaccinated were a parent’s own vaccination against COVID-19, trust in official healthcare guidelines, increased trust in the state and the healthcare system during the pandemic, and older age. Of the pediatricians, 92.6% recommended children’s vaccination, and 75.6% agreed with mandating the vaccine. These findings suggest the need to tailor easy-to-understand messages by well-informed pediatricians to address safety concerns, educate, and clarify misconceptions through targeted interventions among those who currently do not wish to vaccinate their children.