Parent-Child Vaccination Concordance and Its Relationship to Child Age, Parent Age and Education, and Perceived Social Norms

Using Human-Centered Design to Bridge Zero-Dose Vaccine Gap: A Case Study of Ilala District in Tanzania

Background: Immunization plays a substantial role in reducing the under-five mortality rate. However, Tanzania still has a significant number of zero-dose and under-vaccinated children and was ranked among the top ten African countries with the highest numbers of zero-dose children in 2022. The human-centered design (HCD) approach is more ethical and effective at addressing public health challenges in complex sociocultural settings. This study aimed to use the HCD approach to aid in identifying, prioritizing, and implementing community-centric interventions in Tanzania, particularly in the Ilala District of Dar es Salaam, to increase vaccine demand and close the zero-dose gap by at least 50%. Methods: The study involved co-creation workshops with 483 participants to identify, design, and test solutions. The study followed the UNICEF Journey to Health and Immunization framework to identify barriers and enablers influencing stakeholders in adopting and sustaining health- and immunization-related actions. Results: The study identified the causes of under-five defaulting and the zero-dose gap, i.e., the inadequate support of local community leaders in under-five vaccination sensitization and surveillance; poor infrastructure to new settlement areas; hesitancy and unwillingness of parents/guardians; absence of house numbers; limited/time-constrained availability of resources to facilitate mobile immunization services, etc. The participants were able to come up with 309 ideas, which were refined through multiple iterations using the impact--effort matrix and skimmed down to three (3) solutions: (i) having health facilities to notify and alert local leaders about vaccination dates; (ii) using parents, kids, and grownups who got vaccinated to influence others; (iii) using local government leaders and house representatives for vaccine advocacy. Of these, the solution involving local government leaders and house representatives for vaccine advocacy was implemented. An advocacy strategy was used to enhance the collaboration of the District Commissioner, Council leaders, and community leaders. A home-to-home interpersonal sensitization approach accompanied by the household delivery of vaccination services was employed. The findings reveal that the HCD framework was impactful in increasing collaborations/cooperation with local government leaders and community ownership of the under-five vaccination initiative. As a result, 67,145 houses, equal to 104%, were reached, surpassing the initial target of 64,800 houses, and 131,088 families, equal to 83% of the targeted 156,995 households, were sensitized through a home-to-home campaign approach. This study demonstrates the effectiveness of the approach. Researchers and practitioners are encouraged to adopt the HCD approach when addressing public health challenges, especially in complex sociocultural settings.

University students' knowledge, perceptions, and sources of information on routinely recommended vaccines

Objective: To evaluate university students' perceptions of the importance of routine vaccines, knowledge of vaccines, most trusted sources of vaccine information, and interest in learning more about vaccines. Participants: 2,223 students attending four universities across Pennsylvania. Methods: A 32-question electronic survey was administered to university students between March and May 2023. Survey topics included importance of vaccines, self-rated knowledge of vaccines, sources of vaccine information, and interest in learning more about vaccines, including how they work, and safety concerns. Results: Most responding students perceived vaccination as important, but this varied by major, vaccination status, and living situation. About 30% of students did not know where to find vaccine information on campus. Over 30% of students, especially non-white and international students, were interested in learning more. Conclusions: Students need and desire more effective vaccine education. Educational interventions should provide outreach tailored to different groups of students and focus on visual instructional tools, such as videos and brochures, from trusted sources like healthcare providers.

Concordance, motivations and associated factors of COVID-19 vaccination among parent-child dyads: a cross-sectional study in Caraga Region, the Philippines

BACKGROUND

COVID-19 vaccination rates remain low for children aged 11 and below, and understanding the extent to which parental decisions impact their children's vaccination status remains a challenge. This study aimed to explore the concordance and motivations for vaccination among parent-child dyads and determine the associated factors influencing their children's vaccination status.

DESIGN

A cross-sectional study was conducted from 1 March 2023 to 30 March 2023, recruiting parents from six representative primary schools across Butuan City, the Philippines. Pilot-tested, self-administered questionnaires were used during the face-to-face surveys with parent participants. To determine the associated factors of parental decisions to vaccinate their children, mixed-effects logistic regression was used, with school districts as a random effect.

PARTICIPANTS

A total of 593 participating parents were included in the study, with the majority being females (n=484, 81.6%) and underserved, characterised by lacking a college degree (n=305, 51.4%) and having low to no income (n=511, 86.1%).

RESULTS

While 80.6% (n=478) of parents reported being vaccinated against COVID-19, only 36.2% (n=215) of them chose to vaccinate their children. A significant number of parents (n=285, 48.1%) reported psychological distress, with higher levels of distress prevalent among those who are indigenous, reside in rural areas and have lower income levels. Parental education and vaccination status emerged as influential factors. Specifically, parents with advanced degrees were 48% less likely to have unvaccinated children (adj OR (AOR)=0.52; 95% CI 0.30, 0.87), while unvaccinated parents had a sixfold increase in the likelihood of having unvaccinated children (AOR 6.1; 95% CI 3.14, 12.02) compared with their counterparts.

CONCLUSIONS

Efforts to increase paediatric vaccination rates should focus more on actively engaging parents, educating them about the vaccine's benefits and necessity, rather than solely relying on mandates to improve paediatric vaccination rates. Further research is needed to understand the reluctance of unvaccinated parents to vaccinate themselves and their children against COVID-19, identifying specific facilitators and barriers to develop more effective communication strategies and bolster vaccine acceptance.

Factors Associated with Parents' COVID-19 Vaccination Decisions for Their Children in an Economically Marginalized, Diverse Community

COVID-19 vaccine hesitancy is a significant public health concern, particularly among parents who serve as gatekeepers for their child(ren)'s vaccination status. This study adds to the literature by examining COVID-19 vaccine decisions among parents living in a mid-size, lower-income, racially/ethnically diverse, community. Parents of children, < 18 years and enrolled in the public schools system, were invited to complete a questionnaire offered in English, Spanish, and Portuguese. The questionnaire included questions about their child(ren)'s vaccination status, as well as factors which, based on the literature, might impact parents' vaccination decisions. Parents (n = 277) were mostly Hispanic/Latinx, females, with a high school degree/GED as their highest level of education achieved, a mean age of 40 years, and an average of two children < 18 years. Four-fifths (78.6%) of parents reported being vaccinated against COVID-19, but only 40.8% reported having all of their children vaccinated; 14.8% had some of their children get the COVID-19 vaccine, and 44.4% had none of their children get the COVID-19 vaccine. In bivariate associations, parents' vaccination status, parents age, the CDC website as a COVID-19 information source, awareness of age eligibility for the COVID-19 vaccine, parents reporting knowing someone who does not want to vaccinate their child, and parents' perceived social norm score were associated with children's vaccination status. However, when multivariate analyses were conducted, only parents' age and perceived social norms increased parents' odds of choosing to vaccinate their child. These findings have implications for those promoting COVID-19 vaccination among parents in lower-income, diverse communities.

COVID-19 immunization status in children compared to their parents: a retrospective review at an upstate NY medicine/pediatrics practice

BACKGROUND

This study aimed to investigate the relationship between parent and child COVID-19 immunization series completion using vaccine records.

METHODS

A cross-sectional chart review was performed on parent and child patients at the Albany Medical Center Internal Medicine and Pediatrics practice. Patient and parent demographic data, COVID-19 immunization status, and health care worker status was collected. Patient data was further separated into 2 cohorts to account for vaccine eligibility among child age groups, with 5-11 years and 6 months-4 years cohorts. Chi square or Fisher's exact test was used where appropriate.

RESULTS

Across both cohorts, 371 child patients were identified and cross-matched with corresponding parents. Neither cohort offered evidence linking child immunization series completion with the child's race, ethnicity, or county of residence. However, rates of series completion were higher for children with private insurance versus public options in both the 5-11 years and 6 months-4 years cohorts (both p < 0.001). Children were more likely to be immunized against COVID-19 if their parents were fully immunized against COVID-19 (both p < 0.05). Children aged 6 months-4 years were more likely to be immunized against COVID-19 if their parent was a health care worker (p = 0.038).

CONCLUSIONS

This study demonstrates a significance between child insurance status, as well as between parental vaccination status and child vaccination status. Only children under 5 years were more likely to be vaccinated against COVID-19 if their parent was a health care worker.

Parental Hesitancy toward Seasonal Influenza Vaccination for Children under the Age of 18 Years and Its Determinants in the Post-Pandemic Era: A Cross-Sectional Survey among 1175 Parents in China

Children's susceptibility to influenza increased after COVID-19 control measures were lifted. This study investigated parental hesitancy toward seasonal influenza vaccination (SIV) for children and its determinants in the post-pandemic era. An online survey of full-time adult factory workers was conducted in Shenzhen, China in December 2023. This analysis was based on 1175 parents who had at least one child under the age of 18 years. Among all parents, 37.1% were hesitant to have their index child receive SIV. Mothers exhibited lower parental hesitancy toward SIV compared to fathers (31.9% versus 41.3%, p < 0.001). After adjusting for significant background characteristics, mothers and fathers who were more satisfied with the SIV health promotion materials, perceived more severe consequences of seasonal influenza for their children, and perceived more benefits, cues to action, and self-efficacy related to their children's SIV were less likely to exhibit hesitancy toward SIV. Higher frequency of exposure to information about the increasing number of patients or severe cases due to seasonal influenza and other upper respiratory infections on social media was associated with lower parental hesitancy toward SIV among fathers but not mothers. There is a strong need to address parental hesitancy toward SIV for children in the post-pandemic era.

Rates and determinants of Rotavirus vaccine uptake among children in Italy: a cross-sectional study within the 2022 OBVIOUS* project

INTRODUCTION

The World Health Organization defines rotavirus as among the most severe causes of viral gastroenteritis affecting children under 5 year old. Italy and other European countries do not release disaggregated data on rotavirus vaccination coverage. This study aimed to assess the uptake and drivers of rotavirus vaccination in Italy.

METHODS

We administered a survey to 10,000 Italian citizens recruited via an online panel and proportionate to key demographic strata. We examined rotavirus vaccine uptake among parents whose youngest child was aged 6 weeks to 4 years, their sociodemographic characteristics, their beliefs about vaccine administration, and who recommended the rotavirus vaccination.

RESULTS

A total of 711 respondents met the inclusion criteria for the rotavirus vaccine questionnaire. The uptake was estimated at 60.3% nationwide (66.4% among mothers and 50.2% among fathers). Being a mother and living in cities/suburbs was significantly associated with a higher likelihood of vaccine uptake, while fathers were more likely to be uncertain of their children's vaccine status. Living in Central Italy and having friends/relatives opposed to vaccination were found to be significantly associated with a lower likelihood of vaccine uptake, while parents' education level and children's demographics were not found to correlate with any outcomes. In 90.3% of cases, the rotavirus vaccination was recalled as being recommended by a paediatrician.

CONCLUSIONS

Consistent collection of behavioural preferences and socioeconomic characteristics of recipients of rotavirus vaccine campaigns, their epidemiological information, cost-benefit, and national policy data are crucial for designing effective vaccination strategies in Italy and other European countries with similar social profiles to reach the target uptake.

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.