Parental vaccine hesitancy and concerns regarding the COVID-19 virus

Newborn screening programs promote vaccine acceptance among parents in Turkey: a cross-sectional study

OBJECTIVES

Newborn screening and childhood immunization are among the most successful public health initiatives. Turkey has a high vaccination coverage (95-99%), but a recent decline is concerning. Vaccine hesitancy (VH) is a growing global issue, identified by the WHO as a major public health threat. Given that VH may correlate with attitudes toward other health practices, we explored whether early engagement with the health system via newborn screening influences childhood vaccine acceptance. Although these programs are implemented separately but concurrently as part of the national healthcare system in Turkey, integrating newborn screening and immunization initiatives may increase vaccine uptake through early engagement and trust building. This study aims to evaluate the relationship between newborn screening and parental vaccine hesitancy.

METHODS

This study was conducted at a tertiary care center in Turkey from July 2023 to April 2024. Parental VH was assessed using the PACV scale, along with questions on demographics and parental vaccination status. Participants with PACV score ≥ 50 were classified as VH+, others as VH-. Groups were compared using t-tests, Mann - Whitney U, chi-squared, or Fisher's exact tests. Multiple logistic regression was used to analyze related factors.

RESULTS

This analytic descriptive study included 481 parents (125 with children diagnosed with biotinidase deficiency or PKU via newborn screening, and 356 with healthy children aged 2-6). The mean age of respondents was 35 years, and the majority were mothers with a college education. The main sources of vaccine information were health professionals, followed by social media and family. Overall, 19.8% of parents were vaccine-hesitant, with a lower rate in the patient group (12% vs. 22.5%). VH was higher in fathers with chronic diseases (35.1% vs 18.1%, p = .012) and was lower in mothers received tetanus vaccine during pregnancy (16.1% vs. 30.6%, p = .001) or parents who received COVID-19 vaccine (mothers: 13.9% vs. 50.6%, fathers: 14.8% vs. 49.2%, both p < .001). VH was lower in those consulting healthcare professionals and higher in those relying on social media or non-medical sources. Diagnosis and treatment through newborn screening had an effect of 0.47 odds on VH in the overall group (95% CI = 0.24-0.92, p = .028).

CONCLUSION

This study found lower vaccine hesitancy among participants in newborn screening programs and those whose parents received adult vaccinations, potentially due to increased contact with health professionals and greater health-seeking behavior. The influence of social media on vaccine hesitancy, evident in the general population, was not observed among cases, suggesting that systematic follow-up may buffer against external risk factors. Studies with matched cohorts, real-time data collection, and anonymous surveys are needed to improve generalizability, support causal inference, and reduce biases.

The attitude of the unvaccinated children's parents toward pediatric COVID-19 vaccination in Tabriz, Iran

BACKGROUND

The COVID-19 vaccination has played a crucial role in combating the pandemic, yet vaccine hesitancy remains a significant barrier to achieving herd immunity. This challenge is particularly pronounced in specific cultural and geographic contexts. Understanding the reasons for parental reluctance to vaccinate their children is essential for developing effective public health strategies. This study aimed to assess the attitudes of parents with unvaccinated children aged 5-12 years toward COVID-19 vaccination and to explore their reasons for not vaccinating their children, despite having access to vaccination programs, in Tabriz, Iran.

METHOD

This cross-sectional study, conducted between March and August 2022 in Tabriz. A random sample of 400 parents was selected from five healthcare centers using a cluster sampling method in conjunction with the Iranian SIB system. To gather data, a questionnaire was developed based on a comprehensive literature review and interviews with local parents. The questionnaire's content validity was established through expert review, and its internal consistency reliability was assessed, yielding a Cronbach's alpha of 0.85, indicating good reliability. Statistical analysis was performed using one-way ANOVA, chi-square, and Fisher's exact tests to explore associations between demographic factors and vaccine hesitancy. Multiple logistic regression was employed to identify significant predictors of parents' reluctance to vaccinate their children. Additionally, the reasons for unwillingness were reported for hesitant and unwilling parents and compared using the chi-square test.

RESULT

Out of 400 parents of unvaccinated children, 263 parents (65.8%) were definitely unwilling, 21 (5.3%) were hesitant, and 116 (29.0%) were accepting to vaccinate their children against COVID-19. The analysis revealed that parents of children with underlying diseases were more hesitant or unwilling to vaccinate (OR = 1.77, (95% CI: (0.93, 3.42), P-value = 0.07). Additionally, mothers were more hesitant or unwilling than fathers (OR = 2.24, 95% CI: (1.42, 3.53), P-value = 0.001). The top three concerns among the unwilling and hesitant parents were the side effects of COVID-19 vaccination for children (reported by over 81.0%), the perception that vaccination could decrease the disease process (over 46.0%), and the lack of valid information about the side effects (above 42.9%). Furthermore, an important reason for unwillingness among unwilling parents was a lack of trust in the available vaccines (40.5%).

CONCLUSION

Parents' willingness to vaccinate their children against COVID-19 in Tabriz was low, primarily due to concerns about the potential side effects of the vaccine. To address this issue, culturally sensitive public health campaigns should be designed that specifically target these concerns and involve trusted community figures. These initiatives could help reduce vaccine hesitancy, particularly among mothers and parents of children with underlying health conditions.

U.S. Parental Vaccine Hesitancy and the COVID-19 Vaccine: A Scoping Review

Parental vaccine hesitancy has been a hotly debated issue long before the COVID-19 pandemic. Still, the emergence of a new vaccine during this public health crisis made even pro-vaccine individuals reconsider vaccines for their children. This scoping review was conducted to understand why parents expressed hesitancy towards the COVID-19 vaccine for children under 12 years old. The search included primary sources of evidence published in English from 2020-2022. A final 41 articles met the criteria. Overall, more vaccine-hesitant characteristics were non-white, female, lower education level, lower income, on public insurance, conservative political affiliation, younger age, and rural residence. Concerns affecting confidence in the vaccine were the risk of possible side effects and lack of trust in the development of the emergency approval of the vaccine. School nurses can acknowledge parental fears and provide parents with evidence-based information when communicating with them about vaccinations.

Navigating the shots: Parental willingness to immunize their children with COVID-19 vaccines in Saudi Arabia explored through a systematic review and meta-analysis

INTRODUCTION

Although COVID-19 vaccines have been recommended for children and adolescents since 2021, suboptimal vaccination uptake has been documented. No previous systematic review/meta-analysis (SRMA) investigated parents' willingness to administer COVID-19 vaccines for their children in Saudi Arabia. Accordingly, this SRMA aimed to estimate parents' willingness to immunize their children with COVID-19 vaccines in Saudi Arabia and to identify reasons and determinants influencing parents' decisions.

METHODS

This SRMA adhered to the PRISMA guidelines and the protocol was registered on PROSPERO (ID: CRD42023492760). An extensive systematic search was performed across electronic databases including Pub Med, Pub Med Central, ISI Web of science, Web of Science Core Collection, Medline, KCI-Korean Journal Database, ProQuest, and SciELO, to identify relevant studies published from January 1, 2020 to October 30, 2023. A random-effects model was utilized to estimate the pooled effects considering the expected variability across studies. Heterogeneity, risk of bias, publication bias and quality of studies were considered and evaluated by relevant appropriate tests to ensure robust results.

RESULTS

Twenty-five studies with 30,844 parents were included. The overall pooled rate of parents who intended to immunize their children with COVID-19 vaccines was 48.0% (95% CI: 41.0-54.0%) with high heterogeneity (I2 = 99.42%). The main reason for parents to vaccinate children was to protect child, family and community from COVID-19. Perceived efficacy/safety of vaccines were the most significant determinants associated with parents' willingness to vaccinate children.

CONCLUSION

This was the first SRMA from Saudi Arabia which emphasized the priority to focus on vaccine-related factors as main/key strategy of COVID-19 vaccines' drivers to convince parents in a logical way based on accurate cumulative and emerging scientific data about efficacy and safety of COVID-19 vaccines to optimize their uptake by children/adolescents. This SRMA can provide valuable insights for development of evidence-based policies to improve parental willingness to vaccinate children, which is crucial for controlling SARS-CoV-2 spread and promoting herd immunity in the community particularly if the virus continues to pose a major threat.

Health, beliefs, and faith: HPV vaccine uptake intent among Catholic, Evangelical, and mainline protestant parents

The HPV vaccine has the potential to prevent nearly 92% of HPV-related cancer cases, yet its uptake remains suboptimal. While well-documented barriers to HPV vaccine uptake include inadequate knowledge and lack of provider recommendation, religious preferences have emerged as another crucial factor influencing vaccination decisions. This study examined the interrelatedness of religion, beliefs, and HPV vaccination uptake among children among Catholic, Evangelical, and Mainline Protestant parents. A nationally representative survey was conducted among 1,068 U.S. parents from one of three major Christian denominations: Catholic, Evangelical, or Mainline Protestant. We examined the extent to which demographic factors, constructs from the Health Belief Model (perceived severity, susceptibility, benefits, barriers, self-efficacy, and cues to action), and faith-based support variables contributed to HPV vaccination decisions among parents from the specified religious denominations. Among the surveyed parents, 72.3% indicated that their child had received the HPV vaccine, revealing a substantial but incomplete uptake rate. Notably, no statistically significant differences were observed in vaccination rates across the three denominational groups. Perceived HPV vaccine benefits (p < .001), perceived barriers (p < .001) and perceived self-efficacy (p = .013) were strongly associated. Parents reporting that their child's healthcare provider asked them about the vaccine (p < .001) and those more receptive to faith-based support for HPV vaccination (p = .049) were more likely to report child HPV vaccine uptake. To enhance HPV vaccine uptake among the examined religious denominations, strengthening provider-parent communication regarding the HPV vaccine and fostering partnerships between healthcare providers and supportive religious congregations can serve as powerful levers for promoting vaccination acceptance and compliance.

Hesitation towards COVID-19 booster vaccination among dialysis patients: a cross-sectional study in Taizhou, China

PURPOSE

This research aimed to explore hesitation towards the COVID-19 booster vaccine among dialysis patients and study the association between COVID-19 pandemic-induced health behavior and vaccination hesitancy.

METHODS

A self-administered online questionnaire evaluating dialysis patients' hesitation to take COVID-19 booster vaccination was conducted between March 24 and 22 April 2022 in Taizhou, China. The logistic regression method was applied to identify factors associated with vaccination hesitancy, and all data were analyzed using R software.

RESULTS

Of the 365 study participants, 272 (74.5%) individuals hesitated to take the booster dose. Health behavior was found to be a significant factor for hesitation to take COVID-19 vaccines, with OR (95% CI) of 1.09 (1.02-1.17). Influenza vaccination history was also significantly associated with the hesitation (OR (95% CI) = 0.39 (0.21-0.74)). In addition, participants with higher education levels exhibited lower vaccine hesitancy compared to those with junior secondary or below, with ORs (95% CIs) of 0.49 (0.27-0.91) for senior secondary and 0.35 (0.14-0.89) for junior college or above, respectively.

CONCLUSION

The proportion of hesitancy for taking the booster vaccination of the COVID-19 vaccine was high among dialysis patients. Health behaviors, influenza vaccination history, and education levels were risk factors in their vaccination hesitancy. These findings may aid efforts to help vaccinate people with underlying diseases against future pandemics.

Investigating the influencing factors of vaccination decisions for newly developed and established vaccines: a comparative study based on latent class logit models in China

Background

The factors influencing vaccination decision-making for newly developed vaccines may be similar to and different from those for established vaccines. Understanding these underlying differences and similarities is crucial for designing targeted measures to promote new vaccines against potential novel viruses.

Objective

This study aims to compare public vaccination decisions for newly developed and established vaccines and to identify the differences and similarities in the influencing factors.

Method

A discrete choice experiment (DCE) was conducted on 1,509 representatives of the general population in China to collect data on preferences for the coronavirus disease 2019 (COVID-19) and influenza vaccines, representing the newly developed and established vaccines, respectively. The latent class logit model was used to identify latent classes within the sample, allowing for an analysis of the factors distinctly influencing choices for both types of vaccines.

Result

Participants valued similar attributes for both vaccines. However, concerns about sequelae were more significant for the newly developed vaccine, while effectiveness was prioritized for the established vaccine. Class membership analysis revealed these differences and similarities were significantly correlated with age, health, yearly household income, acquaintances' vaccination status, and risk perception.

Conclusion

The study highlights the need for tailored communication strategies and targeted vaccination interventions. For the newly developed vaccines, addressing concerns about side effects is more crucial. For long-standing vaccines, emphasizing their effectiveness can enhance uptake more significantly. Engaging healthcare providers and community influencers is essential for both vaccines to increase public confidence and vaccination rates. Clear communication and community engagement are critical strategies for addressing public concerns and misinformation, particularly during periods of heightened concern.

Esoteric beliefs and CAM impact SARS-CoV-2 immunization drivers, uptake and pediatric immunization views in Germany

Recent studies demonstrate that sociopolitical attitudes partially explain variance in (SARS-CoV-2) vaccine hesitancy and uptake. Other attitudes, such as those towards esoteric beliefs, complementary and alternative medicine (CAM), and religion, have also been proposed. However, pertinent studies provide limited direction for public health efforts, as the impact of such attitudes has been tested in isolation or on different outcomes. Moreover, related associations between SARS-CoV-2 immunization drivers as well as views towards other modes of immunization (e.g., routine pediatric immunization), remain unclear. Based on a sample of ~7400 survey participants (Germany), where esoteric belief systems and CAM (Waldorf, homeopathy) are rather prevalent, and controlling for other sociological factors, we found that (i) individuals with positive attitudes towards Waldorf education and homeopathy are significantly less likely to have received a (further) dose of SARS-CoV-2 vaccine compared to those with positive views of mainstream medicine; (ii) for the former, immunization decisions are primarily driven by external pressures, and for the latter overwhelmingly by voluntary considerations; (iii) attitudes influencing adult SARS-CoV-2 vaccine uptake similarly influence views towards routine pediatric immunization. Our findings provide significant evidence informing a more nuanced design of public health and communication campaigns, and pertinent policies.

Factors influencing Jordanian parents' COVID-19 vaccination decision for children: A cross-sectional study

BACKGROUND

Vaccine hesitancy is a major public health problem that emerged post-COVID-19 pandemic, especially for children. Different factors influence parents' perspectives about vaccinating their children and can vary across different populations and contexts.

PURPOSE

This study aimed to explore the vaccine hesitancy among parents in Jordan to vaccinate their children between the ages of 5 and 18.

DESIGN AND METHODS

A descriptive cross-sectional design was used. A convenient sample was used to recruit Jordanian parents. Data was collected via an online questionnaire including demographic data, the Vaccine Hesitancy Questionnaire, the Questionnaire of Vaccine Hesitancy Reasons, and the Vaccine Conspiracy Beliefs Scale.

RESULTS

Over 177 parents, the mean age was 37.74 years (SD = 8.39); the majority of them were females (74%). 51.4% of the participants refused to give the COVID-19 vaccine to their children. Concerns about the safety and efficacy of the vaccine and lack of information about disease and vaccine were the common reasons for the parents' hesitancy. In addition, 54.2% of participants agreement was with the conspiracy theory that pharmaceutical companies cover up the dangers of vaccines. Parents' younger age and fewer children were associated with hesitancy to vaccinate their children with COVID-19.

CONCLUSIONS

Many parents are hesitant to vaccinate their children against COVID-19. Concerns about the vaccine's efficacy and safety as well as potential long-term negative effects were the main reasons for vaccine hesitancy.

PRACTICE IMPLICATIONS

Nurses play a critical role in determining parental hesitancy. Providing detailed, accurate, evidence-based vaccine information is essential to reduce this hesitancy.

COVID-19 Vaccine Knowledge, Attitude, Acceptance and Hesitancy among Pregnancy and Breastfeeding: Systematic Review of Hospital-Based Studies

The risk of unfavourable outcomes for SARS-CoV-2 infection is significant during pregnancy and breastfeeding. Vaccination is a safe and effective measure to lower this risk. This study aims at reviewing the literature concerning the anti-SARS-CoV-2 vaccine's acceptance/hesitancy among pregnant and breastfeeding women attending hospital facilities. A systematic review of literature was carried out. Hospital-based observational studies related to vaccination acceptance, hesitancy, knowledge and attitude among pregnant and breastfeeding women were included. Determinants of acceptance and hesitancy were investigated in detail. Quality assessment was done via the Johann Briggs Institute quality assessment tools. After literature search, 43 studies were included, 30 of which only focused on pregnant women (total sample 25,862 subjects). Sample size ranged from 109 to 7017 people. Acceptance of the SARS-CoV-2 vaccine ranged from 16% to 78.52%; vaccine hesitancy ranged between 91.4% and 24.5%. Fear of adverse events for either the woman, the child, or both, was the main driver for hesitancy. Other determinants of hesitancy included religious concerns, socioeconomic factors, inadequate information regarding the vaccine and lack of trust towards institutions. SARS-CoV-2 vaccine hesitancy in hospitalized pregnant women appears to be significant, and efforts for a more effective communication to these subjects are required.

Changes in parents' attitudes towards childhood vaccines during COVID-19 pandemic

BACKGROUND

Concerns about the safety and adverse reactions of rapidly-developed vaccines against COVID-19 contributed to parents' vaccine hesitancy and this situation created an opportunity for anti-vaccine campaigners. The aim of this study was to examine the changes in parents' attitudes towards childhood vaccines during COVID-19 pandemic.

METHODS

In this cross-sectional study, parents of children who applied to the outpatient clinic of pediatric department of Trakya University Hospital, Edirne, Türkiye, between August 2020 and February 2021 were recruited into two study groups according to COVID-19 peak time in Türkiye. Group 1 included parents of children who applied after first peak of the COVID-19 pandemic and Group 2 included parents of children who applied after second peak. The World Health Organization 10-item Vaccine Hesitancy Scale (WHO-VHS) was applied to each group.

RESULTS

A total of 610 parents agreed to participate in the study. Group 1 and 2 consisted of 160 and 450 parents, respectively. While the number of parents who were hesitant about childhood vaccines was 17 (10.6%) in Group 1, it was 90 (20%) in Group 2. A statistically significant difference was found between the two groups (p = 0.008). The (WHO-VHS) mean ± SD score was found to be higher in Group 2 (23.7 ± 6.9) than Group 1 (21.3 ± 7.3) (p < 0.001). The WHO-VHS- mean ± SD scores of parents who experienced COVID-19 infection themselves or their family or acquaintances were significantly lower than those who did not (20.0 ± 6.5 vs. 24.7 ± 6.9) (p < 0.001).

CONCLUSIONS

The hesitant attitudes towards childhood and COVID-19 vaccines were low in parents who directly or indirectly experienced COVID-19 or were worried about the devastating effects of this disease. However, it was shown that as the COVID-19 pandemic progressed, parents' hesitations towards childhood vaccines increased.

Pilot study to determine effect of an altruism intervention focusing on herd immunity to enhance influenza vaccination rates

OBJECTIVE

A prospective, single-arm clinical trial was conducted to evaluate an altruism-tailored educational intervention to improve parental attitudes and vaccine uptake in vaccine-hesitant parents.

METHODS

Vaccine-hesitant parents at two primary care sites, spanning two influenza seasons from 2020 to 2021 were provided an intervention (spoken and written communication) which highlighted altruistic benefits of accepting the seasonal influenza vaccine to optimize herd immunity to help protect pediatric cancer patients. Eligible parents included those with children eligible for the seasonal influenza vaccine, those who were proficient in English, and those with scores on the adjusted Vaccine Hesitancy Scale (aVHS) suggesting vaccine hesitancy (score ≥ 3). Enrollees completed a demographic questionnaire, underwent the educational intervention, and repeated the aVHS. Vaccination status at that visit was assessed. The primary outcome was change in aVHS scores obtained pre- and post-intervention. Influenza vaccine acceptance, along with demographic information, were also analyzed.

RESULTS

We enrolled 510 parents of influenza vaccine eligible children and identified 73 vaccine-hesitant parents. There was an overall trend toward lower aVHS score, with a mean change in hesitancy score of -0.4 (P < 0.01). 43/73 (58.9 %) of the cohort experienced a positive effect toward a lower aVHS score, and 27/73 (37.0 %) of vaccine hesitant subjects became non-hesitant on the aVHS. Several demographic characteristics were associated with vaccine hesitancy in the screening population: educational level lower than bachelor's degree (p = 0.03), household income < 400 % of federal poverty level (p < 0.01), unmarried (p = 0.02), and identifying with a political affiliation other than Democrat (p < 0.01). However, no demographic characteristics were significantly associated with an individual becoming non-hesitant. Our altruism-tailored communication approach carried the largest positive impact on the altruism-specific question on the aVHS, decreasing the post-intervention response value by nearly 25 % (P < 0.01).

CONCLUSIONS

Our altruism-tailored communication approach significantly improved attitudes regarding childhood influenza vaccine among vaccine-hesitant parents.

CLINICALTRIALS

gov Identifier: NCT04568590.

Malaysian Parents' Willingness to Vaccinate Their Children against COVID-19 Infection and Their Perception of mRNA COVID-19 Vaccines

Little was known about Malaysian parental attitudes, beliefs, and intentions surrounding coronavirus disease 2019 (COVID-19) vaccines for children when the National COVID-19 Immunization Program for Children (PICKids) was launched in February 2021. A cross-sectional online survey-based study was carried out from 15 March 2022 to 23 July 2022 on Malaysian parents/guardians of children between ages 5 and below 12 years old. A total of 15.7% reported being extremely willing, and 38.9% were somewhat willing to vaccinate children with a COVID-19 vaccine. Perceived low susceptibility to COVID-19 infection showed the greatest significant impact on vaccine acceptance (OR 35.46, 95% CI 15.26-82.40). Parents with a lower level of concern have a higher willingness for vaccination (OR 1.25, 95% CI 0.90-1.75). Of the parents that knew of the mRNA vaccine, 46.6% reported that they prefer their children to be vaccinated with conventional vaccines over mRNA vaccines. Poor knowledge about mRNA vaccines, lack of confidence in the mRNA technology, fear of unknown side effects, and perception that the mRNA vaccines contain microchips were significantly associated with a higher level of concern about their children receiving an mRNA vaccine. Public education campaigns to promote COVID-19 vaccination for children warrant addressing the concerns and knowledge deficits among vaccine-hesitant parents.

Parental COVID-19 vaccination hesitancy among parents of children aged 5-18 years in Thailand: a cross-sectional survey study

BACKGROUND

To promote an acceptance rate of COVID-19 immunization among Thai children, concerns about parental vaccination hesitancy should be urgently studied. This study aimed to examine the parental COVID-19 vaccination hesitancy (PVh) level and influencing factors among Thai parents of children 5-18 years of age.

METHODS

This cross-sectional survey was conducted in Thailand during May and June of 2022. The Google forms for data collection were distributed to parents (a father, a mother, or one who nurtures and raises a child) via various online social media. Data regarding PVh level, relevant attitudes, experiences of COVID-19 and COVID-19 vaccination (EC&V), and family contexts (FC) were collected and analyzed using descriptive statistics. Mann-Whitney U test was used to compare the differences among groups of parents based on EC&V and FC. The factors influencing PVh were assessed by multiple regression analysis.

RESULTS

Four hundred and eighty-eight parents completed the online questionnaire. Their median (IQR) age was 41 (35-47) years. They lived in different provinces from all regions across Thailand. Ninety percent of them were authorized persons to make decision about children vaccination. Fifty-eight percent of the respondents had vaccine hesitancy, defined as PVh level at moderate or above. Parents who had ever refused COVID-19 vaccination for themselves or refused to vaccinate their children against any other diseases had statistically significant higher levels of PVh (p value < 0.001). Conversely, the parents who had finished the initial COVID-19 vaccine had lower PVh levels with statistical significance (p value = 0.001). Attitude towards COVID-19 (AC), attitude towards COVID-19 vaccine (AV), and perceived behavioral control (PC) of the parents negatively influenced PVh with statistical significance, according to the results of the multiple regression analysis (Betas = - 0.307, - 0.123, and - 0.232, respectively).

CONCLUSIONS

COVID-19 vaccination hesitancy was commonly found among Thai parents. The factors of the hesitancy were multifaceted. Different experiences regarding COVID-19 vaccination for themselves and any vaccinations for their children were associated with different PVhs. The attitudes especially AC, AV, and PC statistically influenced PVh. These findings should be exploited for national and local policy planning as well as public campaigns.