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Bianchi FP, Stefanizzi P, Cuscianna E, Riformato G, Di Lorenzo A, Giordano P, Germinario CA, Tafuri S. COVID-19 vaccination hesitancy among Italian parents: A systematic review and meta-analysis. Hum Vaccin Immunother 2023; 19:2171185. [PMID: 36698309 PMCID: PMC10012888 DOI: 10.1080/21645515.2023.2171185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
In May 2021, the Italian government extended the COVID-19 vaccination campaign to 12- to 18-year-old subjects and, starting December 2021, vaccines were also offered to children between 5 and 11 years-old. Despite these efforts, suboptimal vaccination coverages are reported. The purpose of this review is to estimate the proportion of parents/caregivers of children and adolescents expressing COVID-19 vaccine hesitancy in Italy. The vaccine hesitation rate among parents of minors was 55.1% (95%CI: 43.8-66.1%). A higher value was evidenced in studies focusing on children (59.9%; 95%CI = 43.7-75.1%) compared to the ones focusing on adolescents (51.3%; 95%CI = 34.5-68.0%). The main reasons for unwillingness were the belief that the vaccine was unsafe or ineffective, fear of adverse events, and considering COVID-19 a non-threatening disease. The implementation of effective communication campaigns and health educational programs on safe pediatric vaccinations is essential to support strategies to bolster vaccination confidence.
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Affiliation(s)
| | - Pasquale Stefanizzi
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Eustachio Cuscianna
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Giacomo Riformato
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Antonio Di Lorenzo
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Paola Giordano
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, Bari, Italy
| | | | - Silvio Tafuri
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, Bari, Italy
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Ferrara M, Bertozzi G, Volonnino G, Di Fazio A, Di Fazio N, Arcangeli M, La Russa R, Frati P. Learning from the Past to Improve the Future—Vaccine Hesitancy Determinants in the Italian Population: A Systematic Review. Vaccines (Basel) 2023; 11:vaccines11030630. [PMID: 36992216 DOI: 10.3390/vaccines11030630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/27/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023] Open
Abstract
WHO identifies vaccine hesitancy (VH) as one of the ten threats to global health. The authors bring to the international scientific community an Italian episode that offers the opportunity to renew the discussion on the extent of the VH matter. The purpose of this systematic review is to analyze the factors determining vaccine hesitancy in the Italian population, to understand its roots, and suggest potential strategies to mitigate it. A systematic review of the literature according to the PRISMA guidelines was carried out using the SCOPUS and Medline (via PubMed) databases, using the following strategy: (COVID-19 vaccines) AND (vaccination hesitancy) AND (Italy). After the selection process, 36 articles were included in this systematic review. The most frequently detected factors associated with VH in the Italian population can be grouped as vaccine-related factors, socio-cultural factors, and demographic factors. Currently, we are facing a gap between the population and science, governments, and institutions. To heal this breach, it is necessary to strengthen the trust of the population through the implementation of health communication and public education strategies, while scientific literacy must continue to support families and individuals in discerning evidence from opinions to recognize the real risks and balance them with the benefits.
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Affiliation(s)
- Michela Ferrara
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Giuseppe Bertozzi
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, University of Foggia, 71122 Foggia, Italy
| | - Gianpietro Volonnino
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Aldo Di Fazio
- Regional Complex Intercompany Institute of Legal Medicine, 85100 Potenza, Italy
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Mauro Arcangeli
- Department of Clinical Medicine, Public Health, Life and Environment Science, University of L'Aquila, 67100 L'Aquila, Italy
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, University of Foggia, 71122 Foggia, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
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Sahoo SS, Parida SP, Singh AK, Palepu S, Sahoo DP, Bhatia V. Decision-making in childhood vaccination: vaccine hesitancy among caregivers of under-5 children from a tertiary care institution in Eastern India. Ther Adv Vaccines Immunother 2023; 11:25151355231152650. [PMID: 36756042 PMCID: PMC9900653 DOI: 10.1177/25151355231152650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 01/05/2023] [Indexed: 02/07/2023] Open
Abstract
Background Acceptance of vaccines has been on a decline in recent times, with vaccine hesitancy being listed as one of the top 10 global health threats. This study analysed vaccine hesitancy and belief towards vaccination among caregivers of children aged below 5 years. Methods In this cross-sectional study, 196 caregivers of children aged 6 months to below 5 years who had attended an immunization clinic at a tertiary care institute of Eastern India from March to May 2019 were surveyed. Consecutive sampling was used to recruit eligible study participants. The survey assessed the attitudes of parents towards childhood vaccination by using the Vaccine Hesitancy Scale and their beliefs towards vaccination. Univariate analysis was performed to assess the association of various sociodemographic factors with vaccine hesitancy. Results Among the caregivers, most (48%) mothers were aged 26-35 years, literate and homemakers. Vaccine hesitancy was observed in 9.18% of the participants. Only the age of the child was significantly associated with vaccine hesitancy. Nearly half (48.5%) of the participants were concerned about the serious adverse effects of vaccines, and a third (30.6%) agreed that newer vaccines are associated with higher risks than the older ones. Caregivers felt that vaccines are no longer required for uncommon diseases. Conclusion Concerns regarding vaccine hesitancy are prevalent even among caregivers attending a tertiary care institute. Thus, additional studies are required to assess hesitancy in urban, rural, remote and inaccessible areas. Policymakers ought to conduct periodic assessments and implement necessary remedial measures for the long-term sustenance of the benefits of the national immunization programme.
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Affiliation(s)
| | - Swayam Pragyan Parida
- Department of Community & Family Medicine,
All India Institute of Medical Sciences, Odisha, Bhubaneswar, India
| | - Arvind Kumar Singh
- Department of Community & Family Medicine,
All India Institute of Medical Sciences, Odisha, Bhubaneswar, India
| | - Sarika Palepu
- Department of Community & Family Medicine,
All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Durgesh Prasad Sahoo
- Department of Community & Family Medicine,
All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Vikas Bhatia
- All India Institute of Medical Sciences,
Bibinagar, Telangana, India
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Zhou X, Wang S, Zhang K, Chen S, Chan PS, Fang Y, Cao H, Chen H, Hu T, Chen Y, Wang Z. Changes in Parents' COVID-19 Vaccine Hesitancy for Children Aged 3-17 Years before and after the Rollout of the National Childhood COVID-19 Vaccination Program in China: Repeated Cross-Sectional Surveys. Vaccines (Basel) 2022; 10. [PMID: 36146556 DOI: 10.3390/vaccines10091478] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022] Open
Abstract
China started to implement COVID-19 vaccination programs for children in July 2021. This study investigated the changes in parents’ COVID-19 vaccine hesitancy for children before and after the vaccination program rollout. Repeated cross-sectional online surveys among full-time adult factory workers were conducted in Shenzhen, China. This analysis was based on 844 (first round) and 1213 parents (second round) who had at least one child aged 3−17 years. The prevalence of vaccine hesitancy for children aged 3−11 years dropped from 25.9% (first round) to 17.4% (second round), while such a prevalence for children aged 12−17 years dropped from 26.0% (first round) to 3.5% (second round) (p < 0.001). Positive attitudes, a perceived subjective norm, and perceived behavioral control related to children’s COVID-19 vaccination were associated with lower vaccine hesitancy in both rounds. In the second round and among parents with children aged 3−11 years, negative attitudes and exposure to information on SARS-CoV-2 infection after receiving a primary vaccine series were associated with higher vaccine hesitancy, while exposure to experiences shared by vaccine recipients and infectiousness of variants of concern were associated with lower vaccine hesitancy. Regular monitoring of vaccine hesitancy and its associated factors among parents should be conducted to guide health promotion.
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Yang L, Yang G, Wang Q, Cui T, Shi N, Xiu S, Zhu L, Xu X, Jin H, Ji L. Understanding drivers of influenza vaccine hesitancy among pregnant women in China: evidence from an extended theory of planned behavior. Expert Rev Vaccines 2022; 21:1655-1665. [PMID: 36017619 DOI: 10.1080/14760584.2022.2117695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pregnant women have a low uptake of influenza vaccination, although being recommended as a priority. RESEARCH DESIGN AND METHODS We conducted a cross-sectional questionnaire survey in China from June to July 2021. Hierarchical regression analysis and structural equation modeling were performed based on the extended theory of planned behavior, in which attitudes, subjective norms, perceived behavioral control, and intention each affect the vaccine hesitancy; four variables of response efficacy, knowledge, vulnerability, and severity were added as extended dimensions; vaccination history played a moderator role in this model-to test the validity of the framework. RESULTS Totally, 1283 pregnant women participated in this study. The intention existed as a mediator between attitude [βindirect=0.142 (95% confidence interval (CI): 0.084, 0.206), P<0.001], subjective norms [βindirect=0.568 (95%CI: 0.424, 0.754), P<0.001], perceived behavioral control [βindirect=0.070 (95%CI: 0.025, 0.118), P=0.004] and vaccine hesitancy. Further, the differences in indirect effect between the two dimensions of attitude (P<0.001), perceived behavioral control (P<0.001), and subjective norms were each statistically significant. Vaccination history did not moderate the association between attitude (P=0.679), subjective norms (P=0.645), and hesitancy. CONCLUSIONS The subjective norms dimension has a strong association with influenza vaccine hesitancy. Vaccination history had limited ability to reduce hesitancy during pregnancy.
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Affiliation(s)
- Liuqing Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, PR China
| | - Guoping Yang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Qiang Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, PR China
| | - Tingting Cui
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, PR China
| | - Naiyang Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, PR China
| | - Shixin Xiu
- Department of Immunization Planning, Wuxi Center for Disease Control and Prevention, Wuxi, PR China
| | - Lin Zhu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Xuepeng Xu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Hui Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, PR China
| | - Lili Ji
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
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Di Giuseppe G, Paduano G, Vaienna S, Maisto G, Pelullo CP, Pavia M. Surveying Parents’ Awareness and Adherence to Influenza Vaccination Recommendations in Children in Southern Italy. Vaccines (Basel) 2022; 10:vaccines10081298. [PMID: 36016186 PMCID: PMC9412990 DOI: 10.3390/vaccines10081298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 02/02/2023] Open
Abstract
Background: This study explored awareness and adhesion of parents to the recommendations for influenza vaccination for their children. Methods: This cross-sectional study was conducted from March to June 2022 among parents of 6 months–6 years-old children in Southern Italy. Results: Only 22.1% of parents were aware that influenza vaccination was recommended for healthy children, and 31.8% reported at least one influenza vaccination in the four influenza seasons from 2018/2019 to 2021/2022. Adherence was higher among parents who had received influenza vaccination at least once, who knew the main childhood vaccinations, who knew that influenza can be prevented, that influenza vaccination is recommended for healthy children, who believe that it is useful, and who have been informed about it by physicians. Willingness to vaccinate their children in the upcoming season was 48.6% and was higher among parents who had vaccinated their children at least once, believed that influenza vaccination protects against severe complications, believed that it is useful, and that it is not better for children to acquire immunization through illness than through vaccination. Conclusions: These findings suggest that efforts should be devoted to educating parents on the risks associated with the disease and the benefits of the vaccine.
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Affiliation(s)
- Gabriella Di Giuseppe
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni 5, 80138 Naples, Italy
| | - Giovanna Paduano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni 5, 80138 Naples, Italy
| | - Sara Vaienna
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni 5, 80138 Naples, Italy
| | - Giuseppe Maisto
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni 5, 80138 Naples, Italy
| | - Concetta Paola Pelullo
- Department of Movement Sciences and Wellbeing, University of Naples “Parthenope”, Via Medina 40, 80133 Naples, Italy
| | - Maria Pavia
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni 5, 80138 Naples, Italy
- Correspondence: ; Tel.: +39-081-5667716
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