Pediatric and Parents' Attitudes Towards COVID-19 Vaccines and Intention to Vaccinate for Children

Parents' acceptance attitudes towards the vaccination of children based on M-LSGDM approach in China: a cross-sectional study

OBJECTIVES

Ensuring that children receive timely vaccinations is paramount for preventing infectious diseases, and parental attitude plays a pivotal role in this process. This study addresses this gap in the existing literature by examining parental attitudes towards vaccinating their children.

DESIGN

A cross-sectional study.

METHODS

An online survey including parents' sociodemographic characteristics, risk perception and attitudes towards child vaccination towards COVID-19 was conducted. The modified large-scale group decision-making approach for practicality and binary logistic regression was used to identify the predictors influencing parents' decision-making.

RESULTS

Of the 1292 parents participated, 957 (74.1%) were willing to vaccinate their children, while 335 (25.9%) refused the vaccination. The study indicated that age, parental anxiety regarding child vaccination, concerns about the child's susceptibility to the disease, opinions towards vaccination benefits versus disadvantages, place of residence, average family income and children's health were significant predictors (p<0.05).

CONCLUSIONS

While most parents supported childhood vaccination, some opposed it. Addressing persistent barriers is crucial to ensure widespread vaccination and child well-being.

Parental Vaccine Literacy: Attitudes towards the COVID-19 Vaccines and Intention to Vaccinate Their Children Aged 5-11 Years against COVID-19 in Thailand

BACKGROUND

High rates of population immunity are needed to control the COVID-19 pandemic. This study aimed to assess parents' intention to have their children, aged 5-11 years, vaccinated against COVID-19 and its influencing factors in Thailand.

METHODS

A cross-sectional online survey was conducted before the nationwide COVID-19 vaccine rollout for children aged 5-11 years in Thailand. A sample of 542 parents with children in this age group was recruited online.

RESULTS

In total, 58.8% of parents intended to vaccinate their child against COVID-19. Logistic regression analysis revealed that influencing factors include child age, parents' education, interactive/critical vaccine literacy, attitudes that the COVID-19 vaccine is safe and effective for children, that the vaccine can reduce the severity of COVID-19 in children, that there were other ways to prevent children from contracting COVID-19 superior to vaccination, and that COVID-19 vaccination in children can be fatal. The main reasons for having an intention to vaccinate their children included to reduce the severity of symptoms if infected with COVID-19 and to protect them from contracting COVID-19 when they go to school.

CONCLUSIONS

Our study provides evidence regarding factors influencing parents' intention to vaccinate their children. The findings can be used to design future interventions to promote COVID-19 vaccine uptake in children.

Effective Vaccination and Education Strategies for Emerging Infectious Diseases Such as COVID-19

Social isolation and control owing to coronavirus disease 2019 (COVID-19) are easing; however, concerns regarding new infectious diseases have not disappeared. Given epidemic experiences such as severe acute respiratory syndrome (SARS), the influenza pandemic, Middle East respiratory syndrome (MERS), and COVID-19, it is necessary to prepare for the outbreak of new infectious diseases and situations in which large-scale vaccinations are required. Although the development of vaccines against COVID-19 has contributed greatly to overcoming the pandemic, concerning vaccine side effects from the general public, including medical personnel, and decreased confidence in vaccine efficacy and side effects, present many challenges in promoting and educating vaccinations for new infectious diseases in the future. In addition to plans to develop vaccines for the outbreak of new infectious diseases, education and promotion plans are necessary to administer the latest developments of vaccines to the general public. Moreover, efforts are needed to secure the necessity, legitimacy, and evidence for rapid vaccination on a large scale at the national level. It is also necessary to carefully prepare scientific bases and explanatory statements so that the general public can easily understand them. This study aimed to establish vaccine strategies and vaccination education plans for new infectious diseases that may occur in the future. Many ways to promote vaccination to the general public and healthcare workers should be prepared to ensure that the latest vaccines against new infectious diseases are administered safely. Thus, education and promotion of vaccine efficacy and safety based on specific data from clinical studies are necessary.

Parental Hesitancy and Attitude Concerning COVID-19 Vaccine and Its Side Effects in Saudi Arabia, Eastern Region

Background Vaccine hesitancy poses a substantial challenge to the field of public health. There are various factors that influence the willingness of parents to vaccinate their children. Addressing the factors contributing to vaccine hesitancy within the community has the potential to facilitate the development of more effective approaches for global vaccination initiatives. This study aims to assess parents' perspectives regarding the immunization of children aged five to 12 against COVID-19, including their experiences with adverse effects, as well as the factors that influence their hesitancy or acceptance of the vaccine in the Eastern Province of Saudi Arabia. Methods A web-based, cross-sectional study utilized an independently administered online questionnaire. The validated questionnaire was distributed to study participants through social networking platforms in order to recruit individuals from various locations in the eastern region of Saudi Arabia, such as Dammam, Al-Hassa, Al-Jubail, Ras Tanura, Dhahran, Al-Khobar, and Al-Qatif. Results The study encompassed a total of 399 participants. The most commonly reported adverse effects among the first and second children were pain at the injection site (1st child: 267 (66.70%), second child: 263 (66.20%)) and fever (1st child: 171 (43.10%), second child: 187 (47.50%)). A significant proportion of the participants, specifically 139 individuals (35%), expressed apprehension regarding immunization. This concern stemmed from various factors, including the fear of experiencing adverse effects, skepticism regarding the vaccine's efficacy, and exposure to potentially harmful information about the vaccine. Ninety-nine participants, accounting for 25% of the sample, indicated their agreement with the safety of COVID-19. Additionally, 104 participants, constituting 26% of the sample, held the belief that receiving vaccination aids in the prevention of severe illnesses caused by COVID-19. Notably, the most prevalent reason for vaccine hesitancy among participants was the fear of experiencing adverse effects. A total of 132 individuals, accounting for 33% of the participants, identified healthcare providers, including physicians and scientists, as reliable and trustworthy sources of vaccine information. A statistically significant correlation was observed between the demographic variables of the participants and their acceptance of the vaccine. Conclusion The study observed an acceptable vaccination rate among children aged five to 12 for the COVID-19 vaccine. Based on the investigation results, the primary apprehension expressed by parents regarding the immunization of their offspring pertained to the potential negative consequences associated with the vaccine. Nonetheless, it was observed that adverse effects were reported in less than fifty percent of vaccinated children. Addressing the concerns pertaining to the COVID-19 vaccination can enhance global participation in the immunization program aimed at mitigating future pandemics.

Review: Factors influencing parents' decisions to vaccinate children against COVID-19

INTRODUCTION

Vaccination is a cornerstone of public health, significantly safeguarding children's health. Despite the imperative of achieving extensive COVID-19 vaccine coverage, vaccine hesitancy poses a major challenge.

OBJECTIVE

This review's aim is to analyze parental COVID-19 vaccine acceptance and hesitancy during the COVID-19 pandemic and elucidate the factors that influenced their decisions.

METHODS

A search of Medline (PubMed), Embase, and Psycinfo was conducted on February 1, 2022. The inclusion criteria were limited to observational studies that specifically evaluated parental COVID-19 vaccine acceptance or hesitancy for children, published in English. Studies that did not focus on this specific assessment, interventional studies, clinical trials, and secondary literature were excluded.

RESULTS

In reviewing 27 articles, parental vaccination acceptance rates were found to be different worldwide. Despite this, most of the articles found the same set of factors impacting parental COVID-19 vaccine acceptance and hesitancy. Parents' age, education, race, children's age, and annual household income were the main sociodemographic factors in vaccination decisions. Other common factors were the perceived risk and benefits of the COVID-19 vaccine, the source of information, parents' acceptance of receiving vaccinations themselves, and previous acceptance of the influenza vaccine. By reviewing parents' willingness to accept the COVID-19 vaccine for their children, it became clear that a lack of information about vaccine safety and efficacy was the most common factor affecting their decision.

CONCLUSION

This review identified critical factors affecting parents' vaccination behavior for their children. Awareness of these factors may reduce parents' COVID-19 vaccine refusal for their children and guide future planning and development of public health studies.

COVID-19 Vaccination Status Among Korean Pediatric Population With Comorbidities

The pediatric population with comorbidities is a high-risk group for severe coronavirus disease 2019 (COVID-19). As of January 2023, the COVID-19 vaccination rate for at least two doses among Korean children 5-11 years is low at 1.1%. We summarized the COVID-19 vaccination status for the pediatric population (5-17 years) with comorbidities through July 2022 using the National Health Insurance Service database. Pediatric patients with comorbidities had higher vaccination rates than the general pediatric population (2.4% vs. 1.1% in 5-11-year-olds [P < 0.001], 76.5% vs. 66.1% in 12-17-year-olds [P < 0.001]). However, there were substantial differences according to comorbidity category, and the 2-dose vaccination rate was lowest among children with immunodeficiency in all age groups (1.1% in 5-11-year-olds, 51.2% in 12-17-year-olds). The COVID-19 vaccination rate among Korean children has remained stagnant at a low proportion despite ongoing outreach. Thus, more proactive strategies are needed alongside continuous surveillance.

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.

[Factors Influencing the COVID-19 Vaccination Intentions in Parents for Their Children Aged 5~11: Korea, April 2022]

PURPOSE

This study aimed to investigate COVID-19 vaccination intentions in Korean parents for their children aged 5 to 11 years and the factors influencing them.

METHODS

A cross-sectional online survey of 363 parents of children aged 5 to 11 years was conducted in Korea in April 2022. Data were analyzed using independent t-test, χ²-test, Fisher's exact test, and hierarchical logistic regression analysis using SPSS/WIN 26.0 and MedCalc software version 20.113.

RESULTS

Of 363 Korean parents with children aged 5 to 11, 42.4% intended to vaccinate their children. Significant factors influencing vaccination intention were the second or third birth order of children (OR = 3.45, 95% CI = 1.45~8.21), vaccine hesitancy-confidence (OR = 2.00, 95% CI = 1.51~2.65), vaccine hesitancy-collective responsibility (OR = 1.57, 95% CI: 1.10~2.25), and COVID-19 anxiety-avoidance (OR = 1.55, 95% CI = 1.13~2.11).

CONCLUSION

Findings suggest that COVID-19 vaccine campaigns based on reliable information and evidence from health authorities are needed to increase COVID-19 vaccination. Well-designed health communications for the target population may help to increase parental vaccine acceptance.

Willingness and attitudes of parents towards COVID-19 vaccines for children in Vietnam

BACKGROUND

With an increasing need for COVID-19 vaccination around the globe, we aim to investigate willingness and attitudes of parents regarding COVID-19 vaccines for children in Vietnam.

METHOD

A 24-item online survey was conducted among 602 parents and legal guardians of children under 18 years of age.

RESULTS

There were 82.6% of parents willing to vaccinate their children. The principal reasons for willingness were: the need for vaccination to control the COVID-19 pandemic and to reduce the risk of SARS-CoV-2 transmission when children return to school. The most common reason for refusing COVID-19 vaccine was the concern about vaccine side effects in children (73.3%), followed by perceived lack of scientific research on COVID-19 vaccines in children (31.4%). The main associated factors with increased willingness of parents towards childhood COVID-19 vaccine were: willingness to allow children to participate in a clinical vaccine trial (aOR = 3.58); possible increase in COVID-19-related mortality (aOR = 3.69); and positive media information regarding COVID-19 vaccine (aOR = 2.04). Noteworthy, higher educational status of parents was associated with decreased willingness for childhood COVID-19 vaccine (aOR = 0.26).

CONCLUSION

Understanding reasons of parents to accept childhood COVID-19 vaccines will help future plans in COVID-19 vaccination program. A larger sample size study at a national level is needed to verify the results.

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.

Parents' perception of COVID-19 risk of infection and intention to vaccinate their children

Background

Parent's perception of the COVID-19 vaccines is very important to protect themselves and their children and achieve maximum effect of vaccination programs.

Objective

Evaluate the perception and attitude of parents towards COVID-19 risk of infection and intentions to vaccinate their children.

Method

Cross-sectional study including 1032 participants who have children aged from 5 to 18 years using a structured questionnaire.

Results

Overall, 65.0% of participants or their family members suffered from comorbidities that poses them at risk for COVID-19 infection such as hypertension (25.1%) and diabetes mellitus (16.1%). The prevalence of tobacco smoking in the studied families was 36.9%. Among participants, 40.6% had a family member with history of confirmed COVID-19 infection. Nearly one-half of studied parents (48.2%) reported COVID-19 as a serious infection and the majority were worried about getting a family member infected (86.8%). Among participants 62.0% of male parents and 57.8% of female parents agreed that vaccine information is reliable. Participants reporting safety of COVID-19 vaccination represented 45.3%. If vaccine is available, 40.1% of parents intended to vaccinate their children. The main factors associated with the willingness to vaccinate children were vaccine is not suitable for children under 18 years (OR = 11.508), concern about vaccination safety (OR = 8.678), doubts about reliability of vaccine information (OR = 7.811) and ability of vaccine to prevent infection (OR = 5.766).

Conclusion

Our study provides a brief insight about how parents think about COVID-19 vaccines and acceptance to vaccinate their children.

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.

Predictors of Parents' Willingness to Vaccinate Their Children Against COVID-19 in India: A Web-Based Cross-Sectional Survey

Background

Parents are more concerned about the available evidence of the safety, efficacy, and tolerability of the pediatric COVID-19 vaccine.

Aim

To assess the parents' willingness to vaccinate their children against COVID-19 and associate it with health belief model constructs.

Materials and Methods

A countrywide, online, self-administered, cross-sectional survey was conducted from December 15, 2021 to March 8, 2022. The HBM approach was used as a theoretical context to assess the predictors of parents' willingness to vaccinate their children against COVID-19.

Results

The majority (1,563; 95.4%) of parents are intended to immunize their children against COVID-19. Parent education, financial status, job, number of children, age-related vaccination status of the child, and household suffering from chronic disorders were significantly associated with a parent's willingness to recommend the COVID-19 vaccine for their children. The findings of HBM constructs indicated that perceived benefits (OR 14.222; 95% CI 7.192-28.124) of the COVID-19 vaccine in children, susceptibility (OR 7.758; 95% CI 3.508-17.155) of children toward COVID-19, and severity (OR 3.820; 95% CI 2.092-6.977) of COVID-19 infection in children were significantly associated with parent acceptance to vaccinate their children. Parents' higher perception of barriers (OR 0.609; 95% CI 0.372-0.999) to vaccination reduces the intention to vaccinate children against COVID-19.

Conclusion

The findings of our study reveal that the value of HBM constructs in the identification of predictors associated with the parents' willingness to encourage COVID-19 vaccine for their children. It is important to improve health and reduce the barriers to COVID-19 vaccination among Indian parents having children less than 18 years.

Herd Immunity to Fight Against COVID-19: A Narrative Review

The advent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its consequent illness, coronavirus disease 2019 (COVID-19), has revealed the severe impact of new, contagious pathogens on the population throughout the globe. Here, we describe the fundamental notions of herd immunity and discuss their consequences from the perspective of COVID-19, along with the obstacles to acquiring herd immunity. SARS-CoV-2 causes COVID-19, a contagious respiratory infection. It is a major global health issue, with more than 179 million positive cases and 3.8 million deaths globally. It has impacted more than 159 countries; hence, the World Health Organization designated it a pandemic. Different vaccines have been developed against coronavirus to slow the spread of this deadly virus. Immunizing people against coronavirus is the key to getting through this infectious virus. The central concept of this review article is the effect of vaccinating a large population to achieve herd immunity and the reasons for the delay in developing herd immunity. Herd immunity can prove highly beneficial for dealing with reinfection. Moreover, it can reduce the severity of the reinfection in many people who are twice infected with COVID-19. Herd immunity can prevent people in the high-risk group such as immunocompromised individuals; those on immunosuppressants; organ transplant recipients; particular age groups such as neonates, infants, toddlers, and elderly; those with impaired immunity; those with anaphylaxis reactions; and people with chronic diseases. However, due to repeated mutations of the virus, it is evolving into new strains with more severity. Its consequences on the immune system and response to a vaccine are still a big challenge to overcome. How new variants of COVID-19 impacted herd immunity needs to be investigated. The duration required for the development of herd immunity and how long it would last is still under research, along with the number of doses needed, booster doses, and the proportion of the population to be vaccinated.

Parents' perception of COVID-19 risk of infection and intention to vaccinate their children

Background

Parent's perception of the COVID-19 vaccines is very important to protect themselves and their children and achieve maximum effect of vaccination programs.

Objective

Evaluate the perception and attitude of parents towards COVID-19 risk of infection and intentions to vaccinate their children.

Method

Cross-sectional study including 1032 participants who have children aged from 5 to 18 years using a structured questionnaire.

Results

Overall, 65.0% of participants or their family members suffered from comorbidities that poses them at risk for COVID-19 infection such as hypertension (25.1%) and diabetes mellitus (16.1%). The prevalence of tobacco smoking in the studied families was 36.9%. Among participants, 40.6% had a family member with history of confirmed COVID-19 infection. Nearly one-half of studied parents (48.2%) reported COVID-19 as a serious infection and the majority were worried about getting a family member infected (86.8%). Among participants 62.0% of male parents and 57.8% of female parents agreed that vaccine information is reliable. Participants reporting safety of COVID-19 vaccination represented 45.3%. If vaccine is available, 40.1% of parents intended to vaccinate their children. The main factors associated with the willingness to vaccinate children were vaccine is not suitable for children under 18 years (OR = 11.508), concern about vaccination safety (OR = 8.678), doubts about reliability of vaccine information (OR = 7.811) and ability of vaccine to prevent infection (OR = 5.766).

Conclusion

Our study provides a brief insight about how parents think about COVID-19 vaccines and acceptance to vaccinate their children.

COVID-19 vaccination acceptance among community members and health workers in Ebonyi state, Nigeria: study protocol for a concurrent-independent mixed method analyses of intention to receive, timeliness of the intention to receive, uptake and hesitancy to COVID-19 vaccination and the determinants

INTRODUCTION

The COVID-19 pandemic has gravely affected the lives and economies of the global population including Nigeria. The attainment of herd immunity through mass COVID-19 vaccination is the foremost control strategy, however, the deployments of COVID-19 vaccinations are facing challenges of non-acceptance. Despite the efforts of the Nigerian government and COVAX facility in making COVID-19 vaccination more available/accessible, the vaccination rate remains unexpectedly very low in Nigeria/Ebonyi state. Therefore, it is important to investigate the acceptability of COVID-19 vaccination to elucidate the explanations for the very low coverage rate. This study aims to evaluate/explore COVID-19 vaccination acceptance and the determinants among community members and health workers in Ebonyi state, Nigeria.

METHODS AND ANALYSES

The study is an analytical cross-sectional survey with a concurrent-independent mixed method design. Quantitative data will be collected from all consenting/assenting community members aged 15 years and above, in 28 randomly selected geographical clusters, through structured interviewer-administered questionnaire household survey using KoBoCollect installed in android devices. Quantitative data will be collected from all consenting health workers, selected via convenience and snowball techniques, through structured self-administered questionnaire survey distributed via WhatsApp and interviewer-administered survey using KoBoCollect installed in android devices. Qualitative data will be collected from purposively selected community members and health workers through focus group discussions. Quantitative analyses will involve descriptive statistics, generalised estimating equations (for community members data) and generalised linear model (for health workers data). Qualitative analyses will employ the thematic approach.

ETHICS AND DISSEMINATION

Ethical approval for this study was obtained from the Ebonyi State Health Research and Ethics Committee (EBSHREC/15/01/2022-02/01/2023) and Research and Ethics Committee of Alex Ekwueme Federal University Teaching Hospital Abakaliki (14/12/2021-17/02/2022), and verbal consent will be obtained from participants. Study findings will be reported at local, national and international levels as appropriate.

TRIAL REGISTRATION NUMBER

ISRCTN16735844.

Knowledge, Attitudes, and Acceptance of COVID-19 Vaccines among Secondary School Pupils in Zambia: Implications for Future Educational and Sensitisation Programmes

The coronavirus disease 2019 (COVID-19) pandemic resulted in the closure of schools to slow the spread of the virus across populations, and the administration of vaccines to protect people from severe disease, including school children and adolescents. In Zambia, there is currently little information on the acceptance of COVID-19 vaccines among school-going children and adolescents despite their inclusion in the vaccination programme. This study assessed the knowledge, attitudes, and acceptance of COVID-19 vaccines among secondary school pupils in Lusaka, Zambia. A cross-sectional study was conducted from August 2022 to October 2022. Of the 998 participants, 646 (64.7%) were female, and 127 (12.7%) would accept to be vaccinated. Those who were willing to be vaccinated had better knowledge (68.5% vs. 56.3%) and a positive attitude (79.1% vs. 33.7%) compared to those who were hesitant. Overall, the odds of vaccine acceptance were higher among pupils who had higher knowledge scores (AOR = 11.75, 95% CI: 6.51-21.2), positive attitude scores (AOR = 9.85, 95% CI: 4.35-22.2), and those who knew a friend or relative who had died from COVID-19 (AOR = 3.27, 95% CI: 2.14-5.09). The low vaccine acceptance among pupils is of public health concern, emphasising the need for heightened sensitisation programmes that promote vaccine acceptance among pupils in Zambia.

Parents' Level of COVID-19 Fear, Anxiety and Their Attitudes and Behaviors Toward Vaccination of Their Children

The aims of this study were to investigate parents' COVID-19 fear and anxiety levels and determine the relationship between parents' COVID-19 fear and anxiety levels and their attitudes and behaviors toward having themselves and their children vaccinated. This descriptive and cross-sectional type of research was conducted with 950 parents with 12-18 years old children. Having a chronic disease, being vaccinated, intention to vaccinate their children, and the children's age and school year were found to increase parents' COVID-19 fear and anxiety (p < 0.005). A statistically significant correlation was found between the parents' perceived levels of COVID-19 fear and anxiety and their intentions to vaccinate their children (p < 0.005). According to the study's findings, the age of the child, the parents' vaccination, and the parents' intentions to vaccinate their children were predictors of COVID-19 fear and anxiety.

Prevalence of parents' non-intention to vaccinate their children and adolescents against COVID-19: A comparative analysis in Colombia and Peru

•

About 9 out of 10 parents in Colombia and Peru intend to vaccinate their children and adolescents against COVID-19.

•

Colombia: being vaccinated, 35 to 54 years old, maintaining physical distance, using masks, having economic insecurity, anxiety, and comorbidities increased the intention of vaccinating children and adolescents.

•

Peru: being vaccinated, female, maintaining physical distancing, using a mask, having economic insecurity, comorbidities, and have had COVID-19 increased the intention to vaccinate children and adolescents.

•

Peru: living in a town, village or rural area was associated with reducing the intention to vaccinate children and adolescents.

We aimed to estimate the prevalence and factors associated with parents’ non-intention to vaccinate their children and adolescents against COVID-19 in Colombia and Peru. We performed a secondary analysis using a database generated by the University of Maryland and Facebook (Facebook, Inc). We Included adult (18 and over) Facebook users residing in LAC who responded to the survey between May 20, and November 5, 2021. We Included sociodemographic characteristics, comorbidities, mental health, economic and food insecurity, compliance with mitigation strategies against COVID-19, and practices related to vaccination against this disease. We estimated crude (cPR) and adjusted (aPR) prevalence ratios with their respective 95 %CI. We analyzed a sample of 44,678 adults from Colombia and 24,302 from Peru. The prevalence of parents' non-intention to vaccinate their children and adolescents against COVID-19 was 7.41 % (n = 3,274) for Colombia and 6.64 % (n = 1,464) for Peru. In Colombia, age above 35 years old, compliance with physical distancing, use of masks, having economic insecurity, anxiety symptoms, having a chronic condition or more comorbidities, and being vaccinated were associated with a higher probability of vaccinating children and adolescents against COVID-19. In Peru, female gender, compliance with physical distancing, use of masks, having economic insecurity, anxiety symptoms, having a chronic condition or more comorbidities, having had COVID-19, and being vaccinated were associated with a higher probability of vaccinating children against COVID-19. Living in a town, a village, or a rural area was associated with a higher prevalence of non-intention to vaccinate children and adolescents against COVID-19. About 9 out of 10 parents in Colombia and Peru intend to vaccinate their children and adolescents against COVID-19. This intention is associated with some factors which are similar between the two countries, as well as other factors and variations among the different regions of each country.

Parents' knowledge, attitude, and practices towards COVID-19 in children: A Lebanese cross-sectional study

Introduction

The Coronavirus disease 2019 (COVID-19) pandemic, a serious public health crisis, can affect all ages, even children. This study aimed to investigate the knowledge, attitude, and practices of parents living in Lebanon towards the COVID-19 in children.

Methods

A cross-sectional online survey was conducted between June and July 2021, targeting parents living in Lebanon. The questionnaire was divided into 4 parts: socio-demographic, knowledge, attitude, and practices. A score was calculated to evaluate parents' knowledge towards COVID-19 in children. Descriptive and bivariate analyses were conducted. Then, determinants of COVID-19 knowledge were assessed using multivariable linear regression. P < 0.05 was considered statistically significant.

Results

A total of 429 parents were included. The mean knowledge score was 11.28 ± 2.19 out of 15. Knowledge was significantly lower among older (p = 0.022), and single parents (p = 0.035), who don't know if COVID-19 is a serious disease (p < 0.001) and if it will be successfully controlled (p = 0.007), and higher among female parents (p = 0.006). The majority of parents had a positive attitude and good practices towards COVID-19 in children, but 76.7% of them were worried about their child getting coronavirus. About 66.9% of parents expressed their willingness to vaccinate their kids when a vaccine would be available for them, and 66.2% answered that they are sending or willing to send their children to the school or the nursery.

Conclusions

Parents' knowledge about COVID-19 in children was good, but remains lower among older and single parents. Health authorities should conduct awareness campaigns to target specific groups of parents who lacked critical knowledge about COVID-19 in children.

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.

Parental Attitudes Towards Vaccination Against COVID-19 in China During Pandemic

Purpose

The Chinese government has authorized the emergency use of an inactivated vaccine for COVID-19 in children and adolescents aged 3 to 17 years. This study aimed to investigate parents' attitudes towards vaccinating their children against COVID-19 and influencing factors.

Patients and Methods

Through an online questionnaire survey, we collected self-reported children's demographic characteristics, physical conditions and parents' attitudes towards COVID-19 vaccination for children. The parents in the unwilling group received online consultation about the benefits and risks of COVID-19 vaccine and were asked to complete the questionnaire again.

Results

A total of 868 participants were recruited from July 2021 to August 2021 in Nanjing, China. Overall, 76.0% of parents were willing to accept vaccination for children. Parents' willingness increased with children's age (P=0.018) and height (P=0.034), but decreased if the children fell sick within previous one month (P=0.030). Most of the unwilling parents gave a higher score to the risk of vaccination (53.76 VS 40.18). Unsafety (63.8%) and unfamiliarity (24.0%) were their major concerns. After consultation with a health worker, 24% of the unwilling parents turned willing.

Conclusion

Children's age and recent physical condition are related to parents' attitudes towards vaccination for children against COVID-19. The major concerns of parents are unsafety and unfamiliarity. Parents view health workers as a reliable source of vaccine information. A successful consultation with health workers to understand the benefits and risks of vaccination can increase parents' willingness. This study provides insight into parents' attitudes towards vaccination for children against COVID-19 in China and related influencing factors. Our findings could be referenced in establishing policies for vaccinating children against COVID-19 in China.

Attitudes and Factors Associated With Intention to the Third Dose of COVID-19 Vaccine Among Adolescents: A Cross-Sectional Survey in 3 Provinces of China

OBJECTIVE

The COVID-19 caused a world pandemic, posing a huge threat to global health. Widespread vaccination is the most effective way to control the pandemic. Vaccination with the third dose of the COVID-19 vaccine is currently underway. We aimed to determine the attitude of adolescents toward the third dose of COVID-19 vaccine.

METHODS

A structured questionnaire was administered between 16 August and 28 October 2021 among adolescents aged 12-17 years in three provinces of eastern region of China based on convenience sampling. The questionnaire was specifically developed to assess the adolescents' attitude toward and willingness to accept a third dose of the COVID-19 vaccine.

RESULTS

In total, 94.3% (1742/1847) of the adolescents intended to accept the third dose of the COVID-19 vaccine. Age between 15-17 years, no worry about vaccine safety, confidence for vaccine effectiveness, and supporting opinion from parents were independently associated with acceptance of the third dose (p < 0.05).

CONCLUSIONS

It is necessary for governments and school administrators to raise adolescents' and parents' awareness of the benefits and safety of the third dose of vaccination, which should be effective to increase the vaccination coverage among adolescents.

Immunogenicity of BNT162b2 Vaccination against SARS-CoV-2 Omicron Variant and Attitudes toward a COVID-19 Booster Dose among Healthy Thai Adolescents

Despite the BNT162b2 vaccination coverage, rapid transmission of Omicron SARS-CoV-2 has occurred, which is suspected to be due to the immune escape of the variant or waning vaccine efficacy of multiple BNT162b2 vaccination doses. Our study aims to compare immunogenicity against Omicron prior to and post a booster dose of BNT162b2 in healthy adolescents, and to evaluate their attitudes toward booster dose vaccination. A cross sectional study was conducted among healthy adolescents aged 12–17 who received two doses of BNT162b2 more than 5 months ago. Participants and their guardians performed self-reported questionnaires regarding reasons for receiving the booster. A 30 ug booster dose of BNT162b2 was offered. Immunogenicity was evaluated by a surrogate virus neutralization test (sVNT) against the Omicron variant, and anti-spike-receptor-binding-domain IgG (anti-S-RBD IgG) taken pre-booster and 14-days post-booster. From March to April 2022, 120 healthy Thai adolescents with a median age of 15 years (IQR 14–16) were enrolled. sVNT against Omicron pre- and post-booster had 11.9 (95%CI 0–23.9) and 94.3 (90.6–97.4) % inhibition. Geometric means (GMs) of anti-S-RBD IgG increased from 837 (728, 953) to 3041 (2893, 3229) BAU/mL. Major reasons to receive the booster vaccination were perceived as vaccine efficacy, reduced risk of spreading infection to family, and safe resumption of social activities. A booster dose of BNT162b2 elicits high immunogenicity against the Omicron variant. Motivation for receiving booster doses is to reduce risk of infection.

SARS-CoV-2 variants and the global pandemic challenged by vaccine uptake during the emergence of the Delta variant: A national survey seeking vaccine hesitancy causes

BACKGROUND

Herd immunity for COVID-19 is the ultimate goal to end the pandemic. Emergence of SARS-CoV-2 variants has been a subject of considerable debate regarding vaccines effectiveness. This ongoing discussion and other evolving variables contribute to the hesitancy toward vaccines and levels of vaccination acceptance among both the healthcare workers and the public. This study was conducted to assess COVID-19 vaccine uptake and hesitancy among the Saudi Arabian population during the emergence of SARS-CoV-2 Delta variant.

METHODS

A national cross-sectional survey conducted between June 28 and July 5, 2021. The survey collected sociodemographic information, personal and family history of previous COVID-19 infection, adherence to precautionary measures, COVID-19 vaccination status, parental willingness to vaccinate their teenage children, and address variable associated with hesitancy to receive vaccination.

RESULTS

Among the 4071 participants, 67 % were women, 86 % of the participants received COVID-19 vaccine, 70 % had very high or high commitment with COVID-19 precautionary measures. On multivariate analysis, vaccine hesitancy was less likely in men (OR 0.652, p-value < 0.001), those who had direct family members infected with COVID-19 (OR 0.455, p-value < 0.001), and those who reported using the Ministry of Health official channels as information sources (OR 0.522, p-value < 0.001), while those younger than 44 years had higher hesitancy to receive the vaccine (1.5-2.1 times). Of the participants, only 42 % showed willingness to vaccinate their teenage (12-18 years old) children.

CONCLUSIONS

The participants in this study had high COVID-19 vaccination rate; however, hesitancy was reported more commonly among women. Their willingness to vaccinate their teenage children was much lower. Participants relying on social media platforms were highly hesitant to receive vaccination. Public health officials should scale up their efforts targeting females, young population, and parents by vaccination awareness campaigns, and refute misinformation spread on social media, especially with the emergence of variants and the news burst that coincide with them.

The willingness of parents to vaccinate their children younger than 12 years against COVID-19: a cross-sectional study in Malaysia

Background

The initiation of a new drug, for instance, the coronavirus disease 2019 (COVID-19) vaccine in children could be a source of major concern for parents. This study aims to determine the willingness of parents in Malaysia to vaccinate their children younger than 12 years against COVID-19.

Methods

An online cross-sectional survey was conducted nationwide in Malaysia from August 29, 2021, to October 17, 2021. Parents with children younger than 12 years were enrolled via the snowball sampling method.

Results

The analysis included data from 3,528 parents (79.5%) of the 4,438 survey responses received. Of these parents, 2,598 (73.6%) were willing, 486 (13.8%) were not willing, and 444 (12.6%) were still hesitant to vaccinate their children against COVID-19. Single parents (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.32–3.04; P = 0.001), parents with secondary or lower education (OR, 1.5; 95% CI, 1.21–1.96; P < 0.001), healthcare workers (OR, 1.7; 95% CI, 1.34–2.26; P < 0.001), parents who had significant contact with COVID-19 (OR, 1.3; 95% CI, 1.09–1.63; P = 0.006), and parents who had been vaccinated against COVID-19 (OR, 15.4; 95% CI, 9.76–24.33; P < 0.001) were found more willing to immunize their children. The common reasons for vaccination given by parents who were willing to immunize their children include protection of children (99.4%), protection of other family members (99.3%), and effectiveness (98.2%). The common reasons against vaccination given by parents who were not willing to immunize their children were uncertainty about the new vaccine (96.1%), concerns about vaccine contents (93.2%), limited vaccine information from physicians (82.3%), and the belief of vaccine was unsafe (79.8%).

Conclusions

In this study, nearly three-quarters of parents were willing to vaccinate their children younger than 12 years against COVID-19. The parents’ history of COVID-19 vaccination was the strongest independent predictor of their willingness to vaccinate their children. Therefore, future health education for the COVID-19 vaccine should focus on parents who are prone to vaccine refusal or hesitation, address the common reasons for vaccine refusal, and highlight the vaccine’s benefits.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13682-z.

The Mediating Role of the Perceived COVID-19 Vaccine Benefits: Examining Israeli Parents' Perceptions Regarding Their Adolescents' Vaccination

Israel was among the first countries to initiate adolescent COVID-19 vaccination. As adolescent vaccination requires parental consent, we evaluated the factors associated with parents’ willingness to vaccinate their adolescents and their point of view regarding adolescents’ involvement in this decision. An online survey was completed by 581 parents of adolescents aged 16–18. The main independent variables included trust in the healthcare system, components of the Health Belief Model (HBM) and adolescents’ involvement in the decision, as well as background data, including demographics. Analysis included a multiple logistic regression and mediation examination. Parents reported that 446 adolescents (76.8%) have been or will soon be vaccinated against COVID-19, 12.2% chose not to vaccinate their child and 11% have not yet decided. Vaccination was significantly associated with HBM components and with adolescents’ involvement in the decision. The perceived vaccination benefits acted as a mediator in the association between parents’ COVID-19 perceived threat and adolescent vaccination, as well as between parents’ trust in the healthcare system and adolescent vaccination. Addressing vaccination benefits and barriers is pivotal in the attempt to enhance adolescents’ vaccination adherence. Considering the importance of adolescents’ involvement in the decision, addressing them directly may also be beneficial in improving vaccination rates.

Parents' Intentions and Associated Factors to Vaccinating Their Children Aged 12-17 Years with COVID-19 Vaccines: A Cross Sectional Study

No available vaccine against COVID-19 had yet been proven for 12-17-year-olds in Egypt during the study period. This is the first study to assess Egyptian parents' intentions and associated factors in relation to vaccinating their children with COVID-19 vaccines. A cross-sectional study using a questionnaire was conducted between 17 October and 17 November 2021, via social media platforms. The target group was parents with children aged 12-17 years. Parents' intention to vaccinate their children and factors associated with vaccinating their children, reasons for not intending to vaccinate their children, and circumstances whereby the parents would change their mind were recorded. Among the 1458 parents recruited, 65.6% were planning to vaccinate their children. The main concerns were fear of the vaccine's side-effects (68.3%) and conspiracy theories (18%). The factors associated with parents' intention to vaccinate their children were mother's older age (40-49 years: aOR = 1.45, 95% CI = 1.05-1.99; ≥50 years: aOR = 2.09, 95% CI = 1.16-3.75), high family income (aOR = 1.99, 95% CI = 1.41-2.79), and children with a history of chronic conditions (aOR = 2.02, 95% CI = 1.25-3.25), while higher mother's education level was negatively associated (aOR = 0.41, 95% CI = 0.27, 0.64). A comprehensive health education program regarding vaccinating children with COVID-19 vaccines is highly recommended for parents, particularly for young and highly educated mothers, to enhance children vaccination rate when the vaccine becomes available.

Global Health Strategies in the Face of the COVID-19 Pandemic and Other Unprecedented Threats

Global health is evolving as a discipline aiming at exploring needs and offering equitable health services for all people. Over the past four decades, several global initiatives have been introduced to improve the accessibility of primary health care (PHC) and solve most health issues at this level. Historically, the 1978 Alma-Ata and 2018 Astana Declarations were perhaps the most important documents for a comprehensive approach to PHC services across the world. With the introduction of the United Nations Sustainable Development Goals in 2015, developments in all spheres of human life and multi-sectoral cooperation became the essential action targets that could contribute to improved health, well-being, and safety of all people. Other global initiatives such as the Riyadh Declaration on Digital Health and São Paulo Declaration on Planetary Health called to urgent action to employ advanced digital technologies, improve health data processing, and invest more in research management. All these initiatives are put to the test in the face of the coronavirus disease 2019 (COVID-19) pandemic and other unprecedented threats to humanity.

Demographic Predictors of Mothers' Willingness to Vaccinate Young Children Against COVID-19, Get Tested and Isolate: A Cross-Sectional Survey Before and During the Greater Sydney Lockdown 2021, Australia

Background and Objectives

Having a COVID-19 vaccination, getting tested, and self-isolating if symptomatic are some of the most important mitigation strategies for preventing the spread of COVID-19. This study aimed to investigate whether demographic factors are associated with mothers' willingness to vaccinate their 4-year-old children against COVID-19 if a suitable vaccine becomes available or to get tested and self-isolate if they themselves have COVID-19 symptoms and whether the willingness could be influenced by the Greater Sydney lockdown 2021.

Methods

A cross-sectional telephone survey was conducted between 24th February and 26th October 2021. Questions from the NSW Adult Population Health Survey and from previously published studies were used to assess family demographics, mothers' willingness to vaccinate their young children, and willingness to get tested and self-isolate if symptomatic. The survey involved 604 mothers of children aged 4 years who participated in an existing trial in Sydney, Australia.

Results

Mothers were more willing to vaccinate their children when the child's father had a tertiary education or higher, with an adjusted odds ratio (AOR) of 2.60 (95% CI 1.67–4.04). Mothers who were older than 30 years or who completed the survey during the lockdown were more willing to get tested if symptomatic, with AOR 2.50 (95% CI 1.17–5.36) and AOR 3.36 (95% CI 1.41–8.02), respectively. Mothers who were married or had de-facto partners were more willing to self-isolate if symptomatic [AOR 17.15 (95% CI 3.56–82.65)].

Conclusion

Fathers' educational level, mothers' age, and marital status were associated with mothers' willingness to vaccinate their young children if a suitable vaccine were available, to get tested, and self-isolate if symptomatic respectively. The promotion of mitigation strategies for tackling the COVID-19 pandemic needs to take into account specific family demographics.

Iraqi Parents' Knowledge, Attitudes, and Practices towards Vaccinating Their Children: A Cross-Sectional Study

The focus of coronavirus disease 2019 (COVID-19) vaccination campaigns has been the adult population, particularly the elderly and those with chronic diseases. However, COVID-19 can also affect children and adolescents. Furthermore, targeting this population can accelerate the attainment of herd immunity. The aim of the current study was to evaluate parental intentions to vaccinate their children and the variables associated with them. An online questionnaire was circulated via generic Iraqi Facebook groups to explore parental intentions regarding the vaccination of their children. Multinomial regression analysis was conducted to evaluate variables associated with parental vaccination acceptance. A total of 491 participants completed the study questionnaire. Only 38.3% of the participants were willing to vaccinate their children against COVID-19, while the rest either refused to vaccinate their children (35.6%) or were unsure whether they would (26.1%). Participants’ perceptions about the effectiveness (OR = 0.726, 95% CI = 0.541−0.975, p = 0.033) and safety (OR = 0.435, 95% CI = 0.330−0.574, p < 0.0001) of COVID-19 vaccines were significantly associated with parental acceptance of having children vaccinated. Participants who had received or who were planning to receive the COVID-19 vaccine were significantly less likely to reject vaccinating their children (OR = 0.156, 95% CI = 0.063−0.387, p < 0.0001). There is high refusal/hesitancy among Iraqi parents to vaccinate their children, which is associated with concerns related to the safety and efficacy of COVID-19 vaccines. More efforts, including educational and awareness campaigns to promote the safety and efficacy of COVID-19 vaccines, should be made to increase parental acceptance of childhood COVID-19 vaccinations in Iraq.

Parental Willingness to Vaccinate Their Children Against SARS-CoV-2 in Jordan: An Explanatory Cross-Sectional Study

Background

Successful control of the COVID-19 pandemic is largely dependent on vaccine administration to epidemiologically influential groups, including children. Considering that pediatric population comprises a significant portion on the population in developing countries, and their risk of infection and spreading the disease has been underestimated, it is crucial to investigate parental willingness to administer SARS-CoV-2 vaccine to their children between 5 and 11 years old. This study investigates the prevalence and determinants of parental willingness towards vaccinating their children (5–12 years old) against COVID-19 in a developing country setting, Jordan.

Methods

A cross-sectional study, conducted between October and November 2021, utilized online Google Forms to collect data on parents’ background characteristics, willingness to vaccinate their children, SARS-CoV-2, infection and vaccine, risk perception, and factors affecting decision to vaccinate.

Results

A total of 564 parents completed the questionnaire; 82.8% were mothers, 85.3% were 30 years of age or older, and 75.9% had bachelor’s degrees or higher. Only 25.4% of parents reported willingness to vaccinate their 5–12 years old children against SARS-CoV-2. Lower parental age, higher income, and having health insurance coverage increased parental willingness. Among participants vaccinated against COVID-19, only 29.0% were willing to vaccinate their children. Healthcare providers’ trust and vaccine recommendations by pediatricians increased parental willingness. COVID-19 risk perception seems to have negative effects on parental willingness.

Conclusion

A significant proportion of parents in Jordan indicated hesitancy towards administering COVID-19 vaccine for their children. Concerns about vaccine safety and trust in the healthcare system appear to be the most important predictors of parents’ hesitancy. Effective vaccine campaigns should focus on risk perception and communication and should consider parental socio-demographic characteristics.

Public attitudes and influencing factors toward COVID-19 vaccination for adolescents/children: a scoping review

OBJECTIVE

This study aimed to systematically clarify attitudes and influencing factors of the public toward COVID-19 vaccination for children or adolescents.

STUDY DESIGN

This was a scoping review.

METHODS

This scoping review screened, included, sorted, and analyzed relevant studies on COVID-19 vaccination for children or adolescents before December 31, 2021, in databases, including PubMed, Elsevier, Web of Science, Cochrane Library, and Wiley.

RESULTS

A total of 34 studies were included. The results showed that the public's acceptance rate toward COVID-19 vaccination for children or adolescents ranged from 4.9% (southeast Nigerian mothers) to 91% (Brazilian parents). Parents' or adolescents' age, gender, education level, and cognition and behavior characteristics for the vaccines were the central factors affecting vaccination. The vaccine's safety, effectiveness, and potential side-effects were the main reasons affecting vaccination.

CONCLUSIONS

Realizing current public attitudes of COVID-19 vaccination for adolescents or children can effectively develop intervention measures and control the pandemic as soon as possible through herd immunity.

Willingness, refusal and influential factors of parents to vaccinate their children against the COVID-19: A systematic review and meta-analysis

We aimed to estimate parents' willingness and refusal to vaccinate their children against the COVID-19, and to investigate the predictors for their decision. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We searched Scopus, Web of Science, Medline, PubMed, CINAHL and medrxiv from inception to December 12, 2021. We applied a random effect model to estimate pooled effects since the heterogeneity was very high. We used subgroup analysis and metaregression analysis to explore sources of heterogeneity. We found 44 studies including 317,055 parents. The overall proportion of parents that intend to vaccinate their children against the COVID-19 was 60.1%, while the proportion of parents that refuse to vaccinate their children was 22.9% and the proportion of unsure parents was 25.8%. The main predictors of parents' intention to vaccinate their children were fathers, older age of parents, higher income, higher levels of perceived threat from the COVID-19, and positive attitudes towards vaccination (e.g. children's complete vaccination history, history of children's and parents' vaccination against influenza, confidence in vaccines and COVID-19 vaccines, and COVID-19 vaccine uptake among parents). Parents' willingness to vaccinate their children against the COVID-19 is moderate and several factors affect this decision. Understanding parental COVID-19 vaccine hesitancy does help policy makers to change the stereotypes and establish broad community COVID-19 vaccination. Identification of the factors that affect parents' willingness to vaccinate their children against COVID-19 will provide opportunities to enhance parents' trust in the COVID-19 vaccines and optimize children's uptake of a COVID-19 vaccine.

Effectiveness and Safety of SARS-CoV-2 Vaccines among Children and Adolescents: A Systematic Review and Meta-Analysis

Background: The proportion of children and adolescents with COVID-19 had gradually increased according to data reported by WHO. However, there was no meta-analysis of effectiveness and safety of SARS-CoV-2 vaccines in children and adolescents. We aimed to provide investigation-based medical evidence and reference recommendations for children and adolescents in regard to SARS-CoV-2 vaccines. Methods: We systematically searched PubMed, Embase, and Web of Science from inception to 5 January 2022. RCTs and observational studies that examined the effectiveness and safety were included. Results: A total of 13 eligible studies were included for analysis. For the first dose, the effectiveness of SARS-CoV-2 vaccines against SARS-CoV-2 infection and COVID-19 was 88.5% (95% CI:15.7−98.4%, p = 0.033) and 84.3% (95% CI: 66.6−92.6%, p < 0.001) separately. For the second dose, the effectiveness against SARS-CoV-2 infection and COVID-19 was 91.6% (95% CI: 37.8−99.5%, p = 0.083) and 92.7 (95% CI: 82.2−97.0, p < 0.001) separately. Injection-site pain, fatigue, headache, anorexia, and axillary swelling were the top five adverse events after the first dose of SARS-CoV-2 vaccines. Fatigue, injection-site pain, headache, chills, and myalgia/muscle pain were the top five adverse events after the second dose of SARS-CoV-2 vaccines. Conclusions: SARS-CoV-2 vaccines had good effectiveness and safety in children and adolescents. We suggest that children and adolescents should get vaccinated as soon as possible to protect themselves and slow the spread of the pandemic.

Expert Consensus on COVID-19 Vaccination in Korean Adolescents: A Modified Delphi Survey

The effectiveness of coronavirus disease 2019 (COVID-19) vaccines had been shown in many studies in adult population, however, the real-world evidence in the childhood population was scarce. We aimed to organize the collective expert's opinions on adolescent vaccination against COVID-19 in Korea, therefore to guide the vaccination policy in the setting of available evidence. The Delphi panels responded that adolescents were greatly impacted by the quarantine measures, and COVID-19 is an important health problem for adolescents. Panels responded that in general, the benefits of the COVID-19 vaccine overweigh the potential risks in Korean adolescents. Continuing monitoring of available data is needed to provide the best vaccination practices in adolescents guided by the updated evidence.

Factors Associated with Parental Acceptance of COVID-19 Vaccination: A Multicenter Pediatric Emergency Department Cross-sectional Analysis

Study objective

During the delta surge of the COVID-19 pandemic in 2021, we sought to identify characteristics and beliefs associated with COVID-19 vaccination acceptance in parents of pediatric emergency department (ED) patients.

Methods

We conducted a cross-sectional survey-based study of the parents of children aged 3 to 16 years presenting to 1 of 9 pediatric EDs from June to August 2021 to assess the parental acceptance of COVID-19 vaccines. Using multiple variable regression, we ascertained which factors were associated with parental and pediatric COVID-19 vaccination acceptance.

Results

Of 1,491 parents approached, 1,298 (87%) participated, of whom 50% of the parents and 27% of their children aged 12 years or older and older were vaccinated. Characteristics associated with parental COVID-19 vaccination were trust in scientists (adjusted odds ratio [aOR] 5.11, 95% confidence interval [CI] 3.65 to 7.15), recent influenza vaccination (aOR 2.66, 95% CI 1.98 to 3.58), college degree (aOR 1.97, 95% CI 1.36 to 2.85), increasing parental age (aOR 1.80, 95% CI 1.45 to 2.22), a friend or family member hospitalized because of COVID-19 (aOR 1.34, 95% CI 1.05 to 1.72), and higher income (aOR 1.60, 95% CI 1.27 to 2.00). Characteristics associated with pediatric COVID-19 vaccination (children aged ≥12 years) or intended COVID-19 pediatric vaccination, once approved for use, (children aged <12 years) were parental trust in scientists (aOR 5.37, 95% CI 3.65 to 7.88), recent influenza vaccination (aOR 1.89, 95% CI 1.29 to 2.77), trust in the media (aOR 1.68, 95% CI 1.19 to 2.37), parental college degree (aOR 1.49, 95% CI 1.01 to 2.20), and increasing parental age (aOR 1.26, 95% CI 1.01 to 1.57).

Conclusion

Overall COVID-19 vaccination acceptance was low. Trust in scientists had the strongest association with parental COVID-19 vaccine acceptance for both themselves and their children.

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

COVID-19 vaccination for children is crucial to achieve herd immunity. This is the first systematic review and meta-analysis to estimate parents’ and guardians’ willingness to vaccinate their children against COVID-19 and identify the determinants of vaccination intention. Systematic research was performed on the two databases (PubMed and EMBASE) from inception to 6 November 2021. Acceptance rates were pooled by use of a random-effects model and all predictors of vaccine acceptance were identified according to the health belief model (HBM) framework. This analysis was registered with PROSPERO (CRD42021292326) and reported in compliance with the PRISMA guidelines. Of 452 identified records, 29 eligible studies were included (N = 68,327 participants). The estimated worldwide vaccination acceptance rate was 61.40% (95% CI: 53.56–68.69%, I² = 99.3%), ranging from 21.6% to 91.4% across countries and regions. In the determinant assessment, the age of parents and guardians, access to scientific information and recommendations, routine and influenza vaccination behavior, and the willingness of parents and guardians to vaccinate themselves were potentially significant predictors of the vaccination willingness. Given the limited quality and quantity of included articles, future studies with a rigorous design will be necessary for the confirmation of our findings.

A Global Map of COVID-19 Vaccine Acceptance Rates per Country: An Updated Concise Narrative Review

The delay or refusal of vaccination, which defines vaccine hesitancy, is a major challenge to successful control of COVID-19 epidemic. The huge number of publications addressing COVID-19 vaccine hesitancy necessitates periodic review to provide a concise summary of COVID-19 vaccine acceptance rates worldwide. In the current narrative review, data on COVID-19 vaccine acceptance rates were retrieved from surveys in 114 countries/territories. In East and Southern Africa (n = 9), the highest COVID-19 vaccine acceptance rate was reported in Ethiopia (92%), while the lowest rate was reported in Zimbabwe (50%). In West/Central Africa (n = 13), the highest rate was reported in Niger (93%), while the lowest rate was reported in Cameroon (15%). In Asia and the Pacific (n = 16), the highest rates were reported in Nepal and Vietnam (97%), while the lowest rate was reported in Hong Kong (42%). In Eastern Europe/Central Asia (n = 7), the highest rates were reported in Montenegro (69%) and Kazakhstan (64%), while the lowest rate was reported in Russia (30%). In Latin America and the Caribbean (n = 20), the highest rate was reported in Mexico (88%), while the lowest rate was reported in Haiti (43%). In the Middle East/North Africa (MENA, n = 22), the highest rate was reported in Tunisia (92%), while the lowest rate was reported in Iraq (13%). In Western/Central Europe and North America (n = 27), the highest rates were reported in Canada (91%) and Norway (89%), while the lowest rates were reported in Cyprus and Portugal (35%). COVID-19 vaccine acceptance rates ≥60% were seen in 72/114 countries/territories, compared to 42 countries/territories with rates between 13% and 59%. The phenomenon of COVID-19 vaccine hesitancy appeared more pronounced in the MENA, Europe and Central Asia, and Western/Central Africa. More studies are recommended in Africa, Eastern Europe and Central Asia to address intentions of the general public to get COVID-19 vaccination.

Letramento em saúde de adolescentes na pandemia de COVID-19: revisão integrativa

RESUMO Objetivo: analisar a produção científica sobre o letramento em saúde (LS) de adolescentes durante a pandemia de COVID-19. Método: revisão integrativa, nas bases de dados MEDLINE, LILACS, CINAHL e Web of Science, entre março de 2020 e agosto de 2021. Foram incluídos artigos originais nos idiomas inglês, espanhol e português. Resultados: dos 65 estudos encontrados na busca, oito foram incluídos para análise, não havendo nenhuma publicação no Brasil, com cinco publicações no ano de 2021, predominância na língua inglesa (n=7) e todos classificados com nível de evidência VI. Dos instrumentos utilizados, eHealth literacy foi a ferramenta mais aplicada (n=2). Televisão, família e internet foram apontadas como as principais fontes de informações de saúde durante a pandemia. Considerações finais: a literatura sinalizou que o LS pode interferir na tomada de decisão dos adolescentes e que um baixo LS pode levar a decisões e ações de exposição física e mental dos adolescentes.

Health literacy of adolescents in the COVID-19 pandemic: an integrative review

ABSTRACT Objective: to analyze the scientific production on health literacy (HL) of adolescents during the COVID-19 pandemic. Method: an integrative review, in the MEDLINE, LILACS, CINAHL and Web of Science databases, between March 2020 and August 2021. Original articles in English, Spanish and Portuguese were included. Results: of the 65 studies found in the search, eight were included for analysis, with no publication in Brazil, with five publications in 2021, predominantly in English (n=7) and all classified with level of evidence VI. Of the instruments used, eHealth literacy was the most applied instrument (n=2). Television, family and the internet were identified as the main sources of health information during the pandemic. Final considerations: the literature has indicated that HL can interfere with adolescents’ decision making and that a low HL can lead to decisions and physical and mental exposure actions of adolescents.

Parents' intention for their children to receive COVID-19 vaccine: Implications for vaccination program in Macao

INTRODUCTION

The decision about vaccinating children is subject to their parents' decision. To inform strategies that support full vaccination coverage, it is important to understand the parents' vaccination attitude and tendency to act. This study aims to investigate the intention and the factors affecting parents' decision-making about vaccinating their children.

METHODS

A cross-sectional, self-administered online questionnaire was completed by parents of children aged 3-12 yeas in Macao between 7 March and 17 April 2022. The survey tool was informed by the Theory of Planned Behavior (TPB) which composes of the variable "intention" and three TPB constructs (Attitude, Subjective Norm, and Perceived Behavioral Control). Respondents rated their level of agreement on the construct statements using a 5-point Likert scale. Multiple linear regression analysis was used to determine if the TPB constructs were predictors of parents' intention.

RESULTS

A total of 1,217 parents completed the questionnaire. The majority of participants were mothers (83.2%), aged 31-40 years (62.7%), having two or more children (74.1%), had at least one dose of COVID-19 vaccine (84.4%) and considered themselves knowledgeable about the vaccine (62.1%), all of which were significantly associated with the intention to vaccinate their children (all p < 0.05). Their intention varied from negative (19.1%), neutral (38.4%) to positive (42.5%). Respondents were mostly concerned about the serious side effects that the COVID-19 vaccine (mean = 3.96 ± 1.23), highly acknowledged the expectation by the school (mean = 3.94 ± 1.15) and the community (mean = 3.90 ± 1.19) of children vaccination, and rated highly the ease of making necessary arrangement (mean = 3.93 ± 1.25). In the multiple linear regression model which explained 63.5% of the variance in the intention-to-vaccinate their children, only Attitude (B = 0.52, p < 0.001) and Subjective Norm (B = 0.39, p < 0.001) were identified as strong predictors. The major reasons for not having intention were safety concerns (n = 646/699, 92.4%). Participants' most trusted local information sources were doctors (n = 682), government (n = 426) and healthcare professional organizations (n = 416).

CONCLUSIONS

Vaccinating children with COVID-19 vaccine is a complex decision-making for parents. A key to a successful COVID-19 vaccination program is effective communication about the safety profile and the usage experiences warranting the integration of reliable information sources across different healthcare sectors.

COVID-19 Pediatric Vaccine Hesitancy among Racially Diverse Parents in the United States

On 29 October 2021, the U.S. FDA authorized the Pfizer-BioNTech COVID-19 (SARS-CoV-2) vaccine for emergency use in children ages 5–11 years. Racial/ethnic minorities have born the greatest burden of pediatric COVID-19 infection and hospitalization. Research indicates high prevalence of parental vaccine hesitancy among the general population, underscoring the urgency of understanding how race/ethnicity may influence parents’ decision to vaccinate their children. Two weeks prior to FDA approval, 400 Hispanic and non-Hispanic Asian, Black, and White parents of children 5–10 years participated in an online survey assessing determinants of COVID-19 pediatric vaccine hesitancy. Compared to 31% Black, 45% Hispanic, and 25% White parents, 62% of Asian parents planned to vaccinate their child. Bivariate and multivariate ordinal logistic regression demonstrated race/ethnicity, parental vaccine status, education, financial security, perceived childhood COVID-19 susceptibility and severity, vaccine safety and efficacy concerns, community support, and FDA and physician recommendations accounted for 70.3% of variance for vaccine hesitancy. Findings underscore the importance of multipronged population targeted approaches to increase pediatric COVID-19 vaccine uptake including integrating health science literacy with safety and efficacy messaging, communication efforts tailored to parents who express unwillingness to vaccinate, and interventions developed in partnership with and delivered through existing trusted community coalitions.

Acceptance of childhood and adolescent vaccination against COVID-19 in France: a national cross-sectional study in May 2021

The French health authorities extended vaccination against COVID-19 to adolescents in June 2021, during the epidemic resurgence linked to the delta variant and because of insufficient vaccination coverage to ensure collective protection. In May 2021, we conducted a national online cross-sectional survey of 2533 adults in France to study their attitudes toward COVID-19 vaccines and their acceptance of child/adolescent vaccination according to targeted age groups (<6 years; 6-11; 12-17) and its determinants. We applied a multi-model averaged logistic regression for each of these age groups to study the determinants of favorability to vaccination. Among the respondents, 62.7% (1597) accepted COVID-19 vaccination for adolescents, 48.3% (1223) for children aged 6-11 years, and only 31% (783) for children under 6 years. Acceptance increased with fear of contracting COVID-19 and trust in institutions and decreased as the COVID-19 vaccine risk perception score increased. People favorable to vaccination in general and those sensitive to social pressure were also more often favorable to vaccinating children/adolescents than those who were not. Drivers of acceptance were ranked differently for the different age groups. Understanding these differences is essential to anticipating obstacles to vaccination of these age groups and designing appropriate information and motivational strategies to support it.

Evaluating Rates and Determinants of COVID-19 Vaccine Hesitancy for Adults and Children in the Singapore Population: Strengthening Our Community's Resilience against Threats from Emerging Infections (SOCRATEs) Cohort

COVID-19 vaccines are crucial for achieving sufficient immunisation coverage to manage the pandemic, but vaccine hesitancy persists. This study aimed to investigate the prevalence and determinants of vaccine hesitancy in adults and in parents for vaccinating their children using an integrated social cognition model. A community-based cohort in Singapore [N = 1623] completed a survey (wave 25) between June and July 2021 which measured their risk perceptions, distress, trust, vaccination beliefs, and vaccine intentions/behaviours. Results indicated low rates of hesitancy (9.9%) for own vaccination, with most concerns citing side effects, safety, and hasty development. Remaining respondents were vaccinated (69%) or intended to vaccinate (21%). The multivariable model (non-vaccinated respondents) indicated that, living with people in poor health, subjective norm, moral norm, benefits, and necessity of vaccination were associated with lower vaccine hesitancy (R² Cox & Snell: 51.4%; p < 0.001). Hesitancy rates were higher for children’s vaccination (15.9%), with male gender, lower perceived vaccine benefits, high COVID-19 risk perceptions, vaccination concerns, and necessity beliefs associated with higher odds of parental vaccine hesitancy (R² Cox & Snell = 36.4%; p < 0.001). While levels of vaccine acceptance are high, more targeted messages are needed. For adults’ vaccination, more emphasis should be on benefits and social gains, while for parental hesitancy, messages related to safety should be prioritised.