Trends in County-Level Childhood Vaccination Exemptions in the US

BackgroundAnnual influenza vaccination with live attenuated influenza vaccine (LAIV) or inactivated influenza vaccine (IIV) is recommended for children in several countries; it is the most effective way to protect children from influenza and minimize the risk of spreading the virus to family members and the community. Here we present vaccine effectiveness (VE) data for LAIV and IIV in children, gathered globally for the 2024/25 influenza season.MethodsInterim VE studies of LAIV and IIV in children during the 2024/25 influenza season were sourced from published data (to March 2025). Identified studies, conducted in the United Kingdom (UK) and the United States (US), provided VE data for any influenza infection (all strains), categorized by strain type (including A/H3N2, A/H1N1pdm09, and influenza B) and by vaccination setting (primary/outpatient care and hospital). Studies conducted in regions and countries such as Denmark and the EU without universal influenza vaccination recommendations in children, were excluded.ResultsIn a UK study, one Department of Defense study and three Center for Disease Control and Prevention (CDC)–affiliated US VE networks reporting on influenza infections (all strains) in children (UK: 2–17 years; US 0–17 years), interim VE estimates for LAIV were 46% to 58% in the UK, and for IIV were 19% to 78% in the US. When analyzed by vaccination setting where available, VE against any influenza, A/H3N2, A/H1N1pdm09 and influenza B ranged from 42% to 83% for LAIV and 16% to 72% for IIV in children in primary/outpatient care (Figure 1). For hospitalized children, VE against any influenza, A/H3N2, A/H1N1pdm09 and influenza B ranged from 52% to 79% for LAIV and 55% to 78% for IIV (Figure 2). Where available, VE data against any influenza, A/H3N2, A/H1N1pdm09 and influenza B were comparable for both LAIV and IIV children in primary/outpatient care and hospitalized children.ConclusionInterim VE for the 2024/25 influenza season indicate that LAIV and IIV provided comparable and moderate protection for children against influenza. These VE data were consistent across outpatient/primary care and hospitals. Annual influenza vaccination with LAIV or IIV remains the most effective way to protect against influenza in multiple settings.DisclosuresAllyn Bandell, PharmD, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds (Public Company) Wilhelmine Meeraus, PhD, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds (Public Company) Oliver Dibben, PhD, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds (Public Company) Fungwe Jah, MD, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds (Public Company)

BackgroundRespiratory syncytial virus (RSV), COVID-19 and influenza are leading causes of acute respiratory illness in children. COVID-19 has been shown to have greater inpatient burden than influenza among children age < 5 years, however the comparative burden with RSV is unknown.MethodsWe defined a retrospective cohort of children age < 5 years hospitalized for RSV or influenza (April 2019 – March 2020, given disruptions in circulation during the COVID-19 pandemic), or COVID-19 (April 2021 – July 2023). We used PINC-AI Healthcare Database, which contains deidentified hospital records covering ∼25% of admissions in the United States. Outcomes of interest were length of stay (LOS), supplemental oxygen use, intensive care unit (ICU) admission, invasive mechanical ventilation (IMV) and in-hospital mortality. Adjusted risk ratios (aRR) with 95% confidence intervals (CI) were estimated using weighted robust Poisson regression to compare RSV to COVID-19 and RSV to influenza.ResultsWe identified 33,644 hospitalized children (19,015 RSV; 10,316 COVID-19; 4,313 influenza). In weighted models to reduce potential confounding, risk of supplemental oxygen, ICU admission and IMV remained higher with RSV than either COVID-19 or influenza in children < 5 years. As compared with COVID-19, RSV was associated with > 2-fold increased risk of supplemental oxygen use (aRR 2.34, 95% CI 2.21-2.47) and a more than 1.5-fold higher risk of IMV (aRR 1.56, 95% CI 1.40-1.73). Similarly, in comparison with influenza, patients hospitalized for RSV had a higher risk of all measures of healthcare resource utilization. In subgroup analyses (aged < 1; 1 and 2-4 years), risks remained elevated, particularly for children aged < 1 year, as compared to older age groups. In-hospital mortality with COVID-19 occurred for 0.5% of patients, compared to RSV (0.1%) or influenza (0.3%).ConclusionRisks for in-hospital resource utilization were higher with RSV than either COVID-19 or influenza in adjusted analyses. In-hospital death was greater for COVID-19 than RSV or flu. The severe outcomes observed in this study underscore the need for preventive measures such as maternal and childhood vaccination as well as monoclonal antibodies.DisclosuresKathleen M. Andersen, PhD, MSc, Pfizer Inc.: Employee of Pfizer Inc. and may hold stock or stock options Maria D. McColgan, MD, MSEd, Pfizer Inc.: All authors are employees of Pfizer Inc. and may hold stock and/or stock options of Pfizer Inc. Maya Reimbaeva, MS, Pfizer Inc.: All authors are employees of Pfizer Inc. and may hold stock and/or stock options of Pfizer Inc. Tara Ahi, MPH, Pfizer Inc.: Employee of Pfizer Inc. and may hold stock or stock options Mary M. Moran, MD, Pfizer Inc.: Employee of Pfizer Inc. and may hold stock or stock options Alejandro D. Cane, MD, PhD, Pfizer Inc.: All authors are employees of Pfizer Inc. and may hold stock and/or stock options of Pfizer Inc. Santiago M.C. Lopez, MD, Pfizer Inc.: Employee of Pfizer Inc. and may hold stock or stock options|Pfizer Inc.: Stocks/Bonds (Public Company)

To examine the American Cancer Society's HPV vaccination guidelines through a nursing policy analysis framework, assessing justice and equity outcomes in cancer prevention policy implementation. Human papillomavirus vaccination remains critical for cancer prevention, yet persistent health disparities undermine equity goals despite evidence-based policy recommendations. Limited research has systematically applied nursing conceptual frameworks to analyse vaccination policy through an explicit equity lens. Policy Analysis Using the Russell and Fawcett Conceptual Model for Nursing and Health Policy, Focusing on Level 4 Outcomes Addressing Justice, Social Changes and Market Interventions. Systematic analysis of policy sources (public, organisational, professional), components (personnel, services, expenditures) and outcomes across quality, cost and access dimensions. Data sources included primary policy documents, implementation reports and peer-reviewed literature from 2015 to 2024. Thematic analysis examined policy effectiveness through distributive and procedural justice lenses. Critical policy fragmentation creates systematic equity barriers, with only five jurisdictions (Virginia, District of Columbia, Rhode Island, Puerto Rico, Hawaii) achieving > 70% vaccination coverage through school-entry mandates and 46 states and territories demonstrating substantially lower rates. Rural adolescents experience 15%-20% lower vaccination rates, while Black adolescents show 10 percentage points lower coverage than white adolescents despite federal Vaccines for Children (VFC) program investment of $4.2 billion annually. Provider training gaps and cultural competency limitations disproportionately affect communities of colour. Healthcare system transformation remains concentrated in well-resourced organisations, creating two-tiered implementation that reinforces existing disparities. Achieving cancer prevention equity requires coordinated interventions across multiple policy levels, enhanced provider training emphasising cultural competency, community-based service expansion and equity-focused resource allocation. Federal leadership establishing minimum vaccination requirements linked to education funding, respecting state constitutional authority, sustainable funding models and nursing leadership represent essential actions for advancing health equity. Demonstrates nursing frameworks' utility for rigorous health policy analysis while providing evidence-based recommendations for strengthening vaccination policy to achieve cancer prevention equity across diverse populations. This study did not include patient or public involvement in its design, conduct or reporting.

Safety and immunogenicity of BNT162b2 vaccine in children with acute leukaemia: results and perspectives of an open-label, two-centre, phase 1/2 trial with dose finding study.

Social-scientific scholarship on vaccination has often stressed the importance of trust. Vaccine hesitancy has commonly been viewed as determined by the degree of trust that parents have in expert knowledge, health care authorities, and health care professionals (HCPs). Focusing primarily on parents as trustors, the bilateral nature of trust and HCPs' trust in parents have seldom been considered. This article systematically explores these commonly overlooked aspects of trust-building. Drawing on a team ethnography in seven European countries consisting of 466 hours of observations, 167 in-depth interviews with vaccine-hesitant parents, and 171 in-depth interviews with HCPs, this article explores the levels, expressions, and outcomes of trust in the vaccination context. We suggest that trustful relationships are influenced by interpersonal and generalized trust and expressed through both the affective and cognitive dimensions. We further explore interactions where HCPs' (dis)trust may mitigate vaccine hesitancy. We conclude by providing policy implications for education, campaigns, and interventions.

Background/Objectives: Vaccination programs are highly effective public health interventions, yet parental hesitancy toward combination vaccines has led to growing demand for alternative vaccination schedules, defined in this study as parental requests to split or replace recommended combination vaccines with single-antigen vaccines for non-clinical reasons. While parental attitudes have been widely studied, little empirical evidence exists on the real-world use of single-antigen vaccines and their public health implications in countries with otherwise high coverage. This study examined the prevalence patterns and parental motivations for requesting such alternative vaccination schedules in Israel, where national guidelines recommend specific combination vaccines, including measles-mumps-rubella-varicella (MMRV) and the pentavalent diphtheria-tetanus-pertussis–inactivated polio–Haemophilus influenzae type b (DTaP+IPV+Hib) vaccines, but informal accommodations exist. Methods: A mixed-methods design was employed: a retrospective cohort analysis of vaccination data from 2018 to 2021 (before and during the COVID-19 pandemic) focused on measles (first dose at 12 months) and pertussis (four-dose primary series), followed by semi-structured interviews with Maternal and Child Health clinic providers, policymakers, and parents. Results: Alternative vaccination schedules involving single-antigen measles or pertussis vaccines are occasionally used despite official policy, accounting for less than 1% of vaccinations overall. Outcomes include delayed administration, lower uptake of combination vaccines, and incomplete protection in certain groups. Parents cited safety concerns, fear of immune overload, and mistrust of authorities. These concerns were often amplified by misinformation, while providers described balancing parental preferences with the need for adequate coverage. Conclusions: This study provides new evidence on how vaccine hesitancy translates into service utilization, highlights the tension between individualized parental decision-making and contribution to collective health, and underscores the need for communication, policy strategies and service designs that sustain high coverage while addressing community-specific concerns.

Many medical providers in the United States have never seen a case of measles. This situation will likely change if decreases in childhood vaccination rates and increases in multi-state measles outbreaks continue. Measles can lead to hospitalization and severe disease, especially for high-risk groups including young children and people who are pregnant or immunocompromised. In-hospital transmission of measles can occur prior to diagnosis, as patients are infectious for approximately 4 days prior to the onset of rash. Review of the diagnosis and management of measles is essential for the hospitalist to ensure timely responses to this highly contagious virus.

Immunization is a procedure aimed at providing immunity or resistance to an infectious disease by administering a vaccine. Vaccines are designed to stimulate the person’s immune system to protect against future infections or diseases. Vaccine hesitancy is a growing concern globally, and Nigeria is no exception. Despite the introduction of routine immunization programs, vaccine hesitancy remains a significant barrier to achieving optimal vaccination coverage. This study aimed to determine the prevalence and factors associated with vaccine hesitancy among mothers and caregivers of under-five children in Osogbo Metropolis, Osun State, Nigeria. A cross-sectional survey was conducted among 325 mothers and caregivers of children under-five years old selected through a multi-stage sampling technique. A structured questionnaire was used to collect data on socio-demographic characteristics, vaccine hesitancy, attitudes towards vaccination, perceptions about childhood vaccination, and factors influencing vaccine hesitancy. Data were analyzed via descriptive (means and standard deviations) and inferential statistics (chi-squared test) on the IBM Statistical Package for the Social Sciences (SPSS) version 25.0 software. The results of the prevalence of vaccine hesitancy were 35.1% as high hesitancy, 56.9% as moderate hesitancy, and 8.0% as low hesitancy. Factors associated with vaccine hesitancy included not having enough information about vaccination (20.3%), bad experience with vaccine/vaccinator (20.0%), distance from facility (33.2%), and influence of family and friends (48.9%). 46.8% of the respondents have a positive attitude, while 53.2% have a negative attitude towards vaccination. There was a significant relationship between age (x2 = 122.044, df = 8, p &lt; 0.001); educational level (x2 = 88.497, df = 6, p &lt; 0.001); marital status (x2 = 76.383, df = 2, p &lt; 0.001); religion (x2 = 41.664, df = 2, p &lt; 0.001); respondents’ tribe (x2 = 81.653, df = 8, p &lt; 0.001); and the prevalence of vaccine hesitancy. Conclusively, vaccine hesitancy is a significant public health concern in Osogbo Metropolis, and addressing the factors associated with it is crucial to improving vaccination coverage. Interventions should focus on educating mothers and caregivers about the benefits and risks of vaccination, addressing concerns about vaccine safety, and promoting social support for vaccination.

A total of 1723 measles cases have been reported as of November 12, 2025, in the US, reaching their highest levels since elimination in 2000. MMR (measles, mumps, and rubella) vaccination coverage has decreased, and factors associated with delayed and missed vaccination since the COVID-19 pandemic are not well explored. To characterize coverage and trends of timely MMR vaccination and assess factors associated with late vaccination and nonvaccination by 2 years of age. In this cohort study, infants who accessed routine care within the first 2 months, first year, and second year of life were followed up for 24 months to assess vaccination outcomes between January 1, 2018, and April 30, 2025. Participants were children seeking care within Truveta Data, an electronic health record database from a collective of US health care systems. Timely receipt of routine 2- and 4-month immunizations and adherence to the American Academy of Pediatrics well child visit schedule. The primary outcome was timely, late, or no receipt of MMR by 2 years of age. Associations with primary exposures and sociodemographic factors were modeled using mixed-effect logistic regression with state-level random effects. Models were stratified by pre- vs post-COVID-19 MMR eligibility, with results after the COVID-19 pandemic reported as primary. In this study of 321 743 children (166 017 boys [51.6%]) with regular access to care, 78.4% (252 250 of 321 743) received their first MMR vaccination on time, increasing from 75.6% (12 840 of 16 978) in 2018 to 79.9% (39 739 of 49 767) in 2021, then decreasing to 76.9% (40 306 of 52 388) in 2024. The strongest factors associated with no MMR vaccination by 2 years was late administration of a child's 2-month vaccines (adjusted odds ratio [AOR], 6.96 [95% CI, 6.60-7.34]) and 4-month vaccines (AOR, 6.16 [95% CI, 5.84-6.50]). In this cohort study of children with regular access to care, most received their MMR vaccine on time, but the proportion not receiving the MMR vaccine by 2 years of age has increased since the COVID-19 pandemic. Children who did not receive their 2- and 4-month vaccines on time were significantly more likely to not receive any MMR vaccine by 2 years, highlighting opportunities for intervention.

Safety, tolerability, and protective efficacy of a radiation-attenuated, whole sporozoite malaria vaccine in children in Gabon: a randomised, double-blind, placebo-controlled, phase 2 trial.

Population effects of influenza vaccination in children and adolescents: Systematic review.

Association of access and acceptance barriers with under- and non-vaccination of children <5 years in Australia: A national cross-sectional survey of parents.

Change of pediatric quality of life following inactivated influenza vaccination using EuroQol-5 dimensions-youth.

Combating Vaccine Disinformation: The Professional Responsibilities of Pediatric Nurse Practitioners.

Pneumonia remains a leading cause of morbidity and mortality in children under five globally. At Rwamagana Level II Teaching Hospital, Health Management reports show a significant rise in pneumonia cases from 2019 to 2023. This study aimed to determine the prevalence and risk factors associated with pneumonia in children under five among parents at the Rwamagana Level Two Teaching Hospital. A cross-sectional study was conducted using a convenience sample of 230 people. Data were collected via a structured questionnaire and analyzed using the Statistical Package for the Social Sciences (SPSS) version 26. The findings showed that the prevalence of pneumonia among children under five attending the outpatient and paediatric departments was 17.8%. Multivariate analysis showed female children had nine times higher odds of pneumonia than males (adjusted odds ratio [AOR]=9.055, P=0.031). Children in urban areas had significantly lower odds (AOR=0.132, P=0.031), as did those from non-home-owning households (AOR=0.183, P=0.042), though this finding may reflect deeper socio-economic issues. Children with smoking parents were over 21 times more likely to develop pneumonia (AOR=21.502, P=0.002). In conclusion, pneumonia prevalence in children under five at Rwamagana Hospital is high, with significant biological and socio-economic risk factors. The study recommends intensified health education, increased childhood vaccination efforts, and parental support to improve socio-economic conditions.

Background: Disparities in basic childhood immunization coverage remain evident in communities with low education levels, often associated with limited health literacy, vaccine hesitancy, and barriers to accessing health services. In this context, the role of health cadres is considered crucial in supporting childhood vaccination uptake at the community level. Method: This study employed a quantitative cross-sectional design involving 210 mothers with children aged 12–24 months. Data were collected using structured questionnaires and analyzed through binary logistic regression to examine the influence of health cadres’ roles on the completeness of basic childhood vaccination. Results: The findings indicate that health cadres’ roles significantly influenced complete basic vaccination (OR = 3.08; p = 0.001) after controlling for maternal education and socioeconomic status. Schedule reminders and interpersonal communication emerged as the strongest dimensions of the cadres’ role, while assistance during vaccination visits showed the weakest contribution due to logistical constraints. Conclusion: The results demonstrate that achieving complete childhood vaccination depends not only on formal health system mechanisms but also on strengthening the role of health cadres as social and educational agents within the community. Enhancing persuasive communication skills, improving logistical support, and integrating cadres into community-based follow-up systems are essential to ensure sustainable improvements in basic childhood vaccination coverage.

Maternal postpartum vitamin A supplement is a necessary intervention for maternal and child health. It has not been properly investigated regarding its impact on the Pakistani child vaccination coverage of vitamin A. Objectives: To evaluate the maternal postpartum vitamin A supplementation and child vitamin A vaccination coverage, that is, first-dose, second-dose, and full two-dose coverage. Methods: A survey was carried out among 200 mother-child pairs. Information on the maternal postpartum vitamin A supplementation and the child's vitamin A vaccination status was available. Associations and the effect size were assessed on descriptive statistics, Spearman correlation, and ordinal and binary logistic regression. Results: There was a strong correlation between the child vaccination and the presence of maternal postpartum vitamin A supplementation. The children of supplemented mothers were much more likely to take 100% of vitamin A (100% vs. 51.3; OR = 84.39, p=0.001) and 25.9% vs. 0.8% coverage (OR = 41.30, p=0.001). The second dose effect was less but significant (odds ratio, OR = 2.64, p=0.004). In Spearman correlation, there was a strong positive correlation with the first dose (r = 0.733, p=0.001) and a weak positive correlation with the second dose (r =.204, p=0.004). Conclusions: Maternal postpartum vaccination with vitamin A is a key factor that determines child vaccination with vitamin A, especially the first dose. In Pakistan, continuity of postnatal care, the combination of supplementation with routine immunization, and better caregiver counseling are needed to realize full vaccination and the best preventive health care outcomes of children.

ABSTRACT Human papillomavirus (HPV) is a common infection linked to several cancers, yet awareness and vaccination rates remain low among many immigrant populations. Cape Verdeans in the United States (U.S.) are an understudied group with limited data on HPV-related knowledge and vaccine uptake. This community-based, cross-sectional study assessed HPV and HPV vaccine awareness, knowledge, healthcare provider communication, and vaccination behaviors among Cape Verdean immigrant parents. Statistical analyses compared mothers and fathers in terms of demographic, cultural and psychosocial factors and examined the association between parental knowledge and child vaccination status. Among the 166 participants, overall awareness of the HPV vaccine was low (approximately 40%). Most parents identified healthcare providers as their primary source of information, with limited exposure to public health campaigns. Mothers showed significantly higher knowledge of the HPV vaccine than fathers (p = .003) and were more likely to report that their children had initiated the HPV vaccine series (p = .02). Fathers more often held misconceptions about HPV transmission and symptoms and were less likely to report receiving provider recommendations for vaccination. Parental HPV vaccine knowledge was strongly associated with child vaccination (p < .001). Multivariable regression controlling for demographic and cultural factors further confirmed that mothers had higher HPV and vaccine knowledge and greater likelihood of child vaccine initiation compared to fathers, with child’s age and length of U.S. residency also significantly associated with uptake. These findings reveal significant knowledge and communication gaps, particularly among fathers. They highlight the need for culturally tailored education and provider engagement involving both parents to improve vaccine uptake in this underserved population.

ABSTRACT Background Clinical trials have compared new pneumococcal conjugative vaccines (PCVs; PCV15 and PCV20) to an established PCV (PCV13) in a routine 2 + 1 schedule. This study performed an indirect comparison of PCV15 vs. PCV20 immune responses in healthy infants and toddlers. Research design and methods Pooled, matching-adjusted PCV15 trials were indirectly compared to the analogous PCV20 trial for IgG response rate difference (RRD) and geometric mean concentration ratio (GMR) at the post-primary series (PPS) and post-toddler dose (PTD) timepoints. Results At PPS, PCV15 was non-inferior for RRD and GMR as compared to PCV20 for all PCV13 serotypes. Moreover, PCV15 was superior to PCV20 for the RRDs of serotypes 1, 3, 4, 5, 6B, 9V, and 23F and GMRs of serotypes 3, 4, 5, 6B, 9V, and 23F at PPS. At PTD, RRDs were comparable for all PCV13 serotypes, except serotype 3, for which PCV15 was superior. PCV15 was superior for the GMRs of serotypes 3, 6B, and 23F, and comparable for the remaining serotypes at PTD. RRDs for serotypes 22F and 33F were non-inferior at both PPS and PTD. Conclusion In a 2 + 1 schedule, PCV15 demonstrates immunogenicity comparable or superior to PCV20 across PCV13 serotypes, especially for serotype 3.