Parents' perspective on COVID-19 vaccine in children 6 months through 4 years: a cross-sectional study from Northwest Wisconsin

COVID-19 Vaccines in the Pediatric Population: A Focus on Cardiac Patients

Due to the deleterious global impact of the COVID-19 pandemic, tremendous effort has been invested in the development of vaccines against the virus. Vaccine candidates are first tested in adult populations, a number of which have been approved for EUL by the WHO, and are in use across the USA and MENA region. The question remains whether these (or other) vaccines should be recommended to a neonatal, pediatric, and/or adolescent cohort. Incidence and severity of COVID-19 infection are low in pediatric, neonatal, and adolescent patients. Since both overall incidence and severity are lower in children than in adults, safety is an important consideration in vaccine approval for these age groups, in addition to efficacy and a decreased risk of transmission. The following review discusses vaccine immunology in children aged 0-18 years, with emphasis on the negative impact of the COVID-19 pandemic on the lives of children, considerations for pediatric vaccine approval, and available vaccines for pediatric cohorts along with a breakdown of the efficacy, advantages, and disadvantages for each. This review also contains current and future perspectives, as well as a section on the cardiovascular implications and related dynamics of pediatric COVID-19 vaccination.

"It's not that I don't trust vaccines, I just don't think I need them": Perspectives on COVID-19 vaccination

In Quebec (Canada), the roll-out of the vaccination started slowly in December 2020 due to limited vaccine supply. While the first and second doses were well-accepted among adults and vaccine uptake was above 90%, in late 2021 and 2022, vaccine acceptance decreased for children vaccination and receipt of a 3rd or a 4th dose. In the autumn of 2022, four focus groups were conducted with vaccine-hesitant parents of children aged 0-4 and adults who expressed little intention to receive a booster dose. The objective of this study was to gather participants' perspectives on vaccination in general, on the COVID-19 vaccination campaign and the information available, and to gain insights into the underlying reasons for their low intention of either having their child(ren) vaccinated, or receiving an additional dose of vaccine. A total of 35 participants took part in the focus groups. While participants expressed a certain level of trust and confidence in public health and government authorities regarding pandemic management and the vaccination campaign, they were also concerned that transparent information was lacking to support an informed decision on booster doses and children's vaccination. Many participants felt adequately protected against the infection during the focus groups, citing a lack of perceived benefits as the primary reason for refusing a booster dose. Parents who refused to administer the COVID-19 vaccine to their young children felt that the vaccine was not useful for children and were concerned about potential side effects. The majority reported that their opinions regarding other recommended vaccines had not changed since the beginning of the pandemic. While these results are reassuring, our findings highlight the importance of transparency in public health communications about vaccines to increase confidence and to develop strategies to address vaccine fatigue and complacency toward COVID-19 vaccines.

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.

Analysis of the COVID-19 vaccine willingness and hesitancy among parents of healthy children aged 6 months-4 years: a cross-sectional survey in Italy

Introduction

In Italy, since December 2022, the COVID-19 vaccination has been extended to children aged 6 months-4 years with conditions of fragility and to those healthy at the request of the parent. The purposes of the cross-sectional survey were to determine the willingness and hesitancy of the parents/guardians to have their healthy children vaccinated against COVID-19.

Methods

The survey was performed among 389 parents/guardians with a child aged 6 months-4 years randomly selected from seven kindergartens and eight nursery schools in the geographic area of Naples, Italy.

Results

Only 10.5% were very concerned about the risk of infection, and the mean values regarding the perceived utility and safety of the COVID-19 vaccine were 3.3 and 3.2, respectively. Only 13.7% of participants were willing to consent to vaccinate the selected child against COVID-19, while 20.1% were uncertain and 66.2% did not intend. Parents/guardians of older children, those who received information about the COVID-19 vaccine from physicians or pediatricians, those who believed that the COVID-19 vaccine was useful, and those with lower hesitancy regarding the COVID-19 vaccine were more willing to vaccinate their child. The mean Parent Attitudes About Childhood Vaccines (PACV-5) score was 5.6, with 33.1% of respondents who were identified as highly hesitant toward COVID-19 vaccination (score ≥ 7). Parents/guardians with a lower perceived safety of the COVID-19 vaccine were more likely to be highly hesitant.

Discussion

The findings reveal the need to improve community-based education campaigns and effective promotion of the COVID-19 vaccination to increase willingness and address parental safety concerns.

Dilemmas and options for COVID-19 vaccination in children

Over 16 million children have been detected positive for the coronavirus disease 2019 (COVID-19) in the United States since the outbreak of the pandemic. In general, children infected with severe acute respiratory syndrome coronavirus type 2 tend to have lighter symptoms than adults. However, in some cases, the infection can develop into severe forms, such as multisystem inflammatory syndrome in children. Moreover, long-term public health preventive interventions have had some negative effects on the physical and mental health of children. Given the important role that vaccination plays in reducing severe illness and mortality, it is essential for the efficient implementation of vaccination in the pediatric population. Nevertheless, parental distrust of vaccination, especially with regard to its safety and efficacy, hinders this process. Herein, we comprehensively summarize the available data on the safety and effectiveness of COVID-19 vaccine in children. The results show that the currently approved COVID-19 vaccine is safe and effective for children. Although two doses of vaccine in children seem insufficient to prevent Omicron infection, the booster dose provides enhanced protection against infection and severe illness. Most importantly, the bivalent vaccine has been approved for use in the pediatric population to extend the immune response to currently circulating Omicron variant. And the immune protection afforded to newborns after maternal vaccination appears to last only 6 months. Therefore, in the current situation where the rate of virus mutation is accelerating and the COVID-19 pandemic is still severe, it is crucial to extend vaccine protection to children over 6 months of age to weave a tighter safety net.

Willingness and hesitancy of parents to vaccinate against COVID-19 their children ages 6 months to 4 years with frail conditions in Italy

Background

In Italy, on December 2022, COVID-19 vaccination was recommended for children aged 6 months-4 years with frail conditions and for those healthy. The purposes of the survey were to understand parental willingness and hesitancy toward COVID-19 vaccination of children with frail conditions in Italy and related influencing factors.

Methods

A cross-sectional survey was performed among 445 parents with a child aged 6 months-4 years with frail conditions who attended a teaching hospital and a public hospital randomly selected in the city of Naples, Italy.

Results

Almost one third (29.9%) were willing to vaccinate their frail children against COVID-19, whereas 21.3% were uncertain, and 48.8% did not intend to vaccinate. Parents with a higher level of perception that the vaccine is useful and safe and those who had received information by pediatrician were more likely to be willing to vaccinate their child. The mean Parent Attitudes About Childhood Vaccines (PACV-5) score was 3.4, with 13.5% of parents high-hesitant for the COVID-19 vaccination for their child. Parents with a higher COVID-19 vaccine-related safety concerns, those who have delayed at least one shot of a recommended vaccine for their child, and those who did not have received at least three doses of the vaccine against SARS-CoV-2 were more likely to be high-hesitant.

Conclusion

The survey findings have important implications for designing interventions to increase willingness and to reduce hesitancy for COVID-19 vaccine among parents of frail children aged 6 months-4 years in Italy.

Changes in COVID-19 Vaccine Acceptability among Parents with Children Aged 6-35 Months in China-Repeated Cross-Sectional Surveys in 2020 and 2021

China is considering to offer COVID-19 vaccination for children aged 6−35 months. This study investigated the changes in COVID-19 vaccine acceptability and associated factors among parents with children aged 6−35 months in 2020 and 2021. Two rounds of cross-sectional online surveys were conducted among adult factory workers in Shenzhen, China. A subset of 208 (first round) and 229 (second round) parents with at least one child aged 6−35 months was included in the study. Parental acceptability of COVID-19 vaccination increased significantly from 66.8% in the first round to 79.5% in the second round (p = 0.01). Positive attitudes, perceived subjective norm, and perceived behavioral control were associated with higher parental acceptability in both rounds of surveys (p values ranged from <0.001 to 0.003). A negative association of negative attitudes with parental acceptability was observed in the second round (p = 0.02). No significant associations of exposure to information related to COVID-19 vaccination on social media with parental acceptability was found in either round of survey. Expanding the existing COVID-19 vaccination programs to cover children aged 6−35 months is necessary in China. Future programs should focus on modifying perceptions among parents to promote COVID-19 vaccination for children in this age group.

Parental Hesitancy on COVID-19 Vaccination for Children Under Five Years in Thailand: Role of Attitudes and Vaccine Literacy

INTRODUCTION

Global vaccination efforts to control the COVID-19 pandemic may be impeded by vaccine hesitancy. Attitudes and vaccine literacy are important factors that reduce vaccine hesitancy. The role of attitudes and vaccine literacy of parents on COVID-19 vaccine intention for their children under five years was unknown.

OBJECTIVE

This study aimed to assess parents' characteristics, vaccine literacy, attitudes toward the COVID-19 vaccine, and vaccine intention/hesitancy and to determine factors influencing parents' vaccine intention for their children under five years of age.

METHODS

A cross-sectional study was conducted using an online self-administered questionnaire before the authorization of the COVID-19 vaccine for very young children in Thailand. The sample consisted of 455 parents with children under five years old. The online questionnaire included parents' sociodemographic data, vaccine literacy, attitudes toward COVID-19 vaccine, and vaccine intention to get their children vaccinated.

RESULTS

About 98% of the parents received their COVID-19 vaccination, whereas only 45.1% reported they would have their children under five years old get vaccinated. About 54.9% were either not sure or refused their child's COVID-19 vaccination. A multiple logistic regression model identified factors that increased the odds of parents' vaccine intention: parents aged > 35 years, attitudes on safety and efficacy of COVID-19 vaccine for children, advice about the COVID-19 vaccines from healthcare personnel, and the belief that COVID-19 vaccine is helpful for their children. Attitudes that COVID-19 vaccination in children could be fatal decreased parents' vaccine intention. Need for more information about the COVID-19 vaccine for children and concern about the vaccine's side effects were the most frequent reasons for vaccine hesitancy and refusal.

CONCLUSION

Parents should be provided with accurate information from healthcare personnel and media sources about the safety and effectiveness of the COVID-19 vaccine for young children under five years of age to overcome their hesitancy.

Vaccine hesitancy and the willingness to recommend the COVID-19 vaccine to children in a rural country on the United States-Mexico border

Introduction

As of October 26, 2022, only 9% of children in the United States aged 6 months to 4 years have received at least one dose of COVID-19 vaccine despite FDA approval since June 17, 2022. Rates are better yet still low for children aged 5 to 11 years as nearly 30% were fully vaccinated as of August 23, 2022. Vaccine hesitancy among adults is one of the major factors affecting low vaccine uptake rates in children against COVID-19, yet most studies examining vaccine hesitancy have targeted school-age and adolescent children.

Methods

With the aim of assessing the willingness to recommend the COVID-19 vaccination to children under 5 years compared to children 5 to 12 years of age, a county-wide survey was conducted between January 11 and March 7, 2022, among adults on the United States-Mexico border.

Results

Among the 765 responses, 72.5% were female and 42.3% were Latinx. The most significant factor associated with likelihood to recommend the COVID-19 vaccine to children less than 5 years and 5-12 years of age was adult vaccination status. Ordinal logistic regression also indicated that ethnicity, primary language, being a parent, previous COVID-19 infection, and concern about getting COVID-19 in the future were significantly associated with likelihood of COVID-19 vaccine recommendation to children < 5 years and 5-12 years old.

Discussion

This study found high consistency among respondents in their willingness to vaccinate children aged < 5 years compared with children aged 5-12 years. Our findings support public health strategies that target adult vaccinations as an avenue to improve childhood vaccinations for young children.

Parental Perceptions and Barriers towards Childhood COVID-19 Vaccination in Saudi Arabia: A Cross-Sectional Analysis

Introduction: The vaccination of children against Coronavirus disease (COVID-19) is a prime area of focus around the globe and is considered a pivotal challenge during the ongoing pandemic. This study aimed to assess parents′ intentions to vaccinate their children and the barriers related to pediatric COVID-19 vaccination. Methodology: An online web-based survey was conducted to recruit parents with at least one child under the age of 12 years from Saudi Arabia’s Al-Jouf region. The parental intentions to vaccinate children were assessed via six items, while barriers against vaccination were assessed through seven items in validated study instrument. A 5-point Likert scale was used to record the responses of parents regarding both their intentions and barriers. Results: In total, 444 parents (28.41 ± 7.4 years, 65% females) participated in this study. Almost 90% of parents were vaccinated against COVID-19 but only 42% of parents intended to vaccinate their children. The mean intention score was 2.9 ± 1.36. More than one-third of study participants had no plan to vaccinate their children against COVID-19. The majority of the respondents agreed to vaccinate their children if vaccination was made compulsory by the government (relative index: 0.76, 73%). Out of seven potential barriers analyzed, concerns over vaccine safety and side effects were ranked highest (RII: 0.754), reported by 290 (65%) participants. In multivariate logistic regression, significant predictors of parental intention to vaccinate children were the increased education level of the parents (secondary education: OR = 3.617, p = 0.010; tertiary education: OR = 2.775, p = 0.042), COVID-19 vaccination status (vaccinated: OR = 7.062, p = 0.003), mother’s involvement in decisions regarding the child’s healthcare (mother: OR 4.353, p < 0.001; both father and mother: OR 3.195, p < 0.001) and parents’ trust in the vaccine’s safety (OR = 2.483, p = 0.022). Conclusions: This study underscored the low intention among parents to vaccinate their children against COVID-19. Vaccination intention was found to be associated with education, parents’ vaccination status, the mother’s involvement in healthcare decisions, and parents’ trust in the vaccine’s safety. On the other hand, parents’ concerns over the safety and efficacy of the COVID-19 vaccine were widely reported as barriers to childhood vaccination. The health authorities should focus on addressing parental concerns about vaccines to improve their COVID-19 vaccination coverage.