Parent Attitudes About Childhood Vaccines Research Articles

1734. Influenza, SARS-CoV-2, and routine childhood vaccines – trends in vaccine hesitancy in hospitalized children before and during the COVID-19 pandemic

Abstract Background Vaccine hesitancy (VH) is adversely affecting the public health response to the COVID-19 pandemic. Similarly, influenza vaccine uptake is suboptimal. We monitored trends in VH to influenza, COVID-19, and routine childhood vaccines. Methods A repeated cross-sectional survey in English and Spanish of caregiver influenza and COVID-19 knowledge, attitudes, behaviors, and associated VH among hospitalized children 6 mo-18 yrs at a pediatric hospital. We enrolled over 4 seasons (S); ‘19-20 (S1), ‘20-21 (S2), ‘21-22 (S3), ‘22-23 (S4). In S4, we targeted caregivers of children 6 mo-11 yrs. VH was assessed using the Parent Attitudes about Childhood Vaccines (PACV) survey; PACV score ≥ 50 denoted VH. In S4, a messaging intervention was piloted. Caregivers were randomized to watch 1 of 2 COVID-19 educational videos; half watched a second video featuring a family adversely impacted by COVID-19. All caregivers completed a survey to assess acceptance and efficacy of the video(s) in changing intent to vaccinate their child. Figure 1. Participant flow chart from 2019-2023 Results Across all seasons, ≥ 92% of caregivers approached were enrolled. Most (48%) identified as Hispanic/Latino, 35% as White, and 19% as Black. By parental report, 94% of children in S1, 91% in S2, 91% in S3, and 89% in S4 were up-to-date with routine vaccines. Based on PACV score, 13% were VH in S1, 17% in S2, 19% in S3, and 20% in S4 (p=0.14). During S2-3, fewer caregivers endorsed “flu can be a dangerous infection in children” and “I am scared of my child getting the flu” (p< 0.01). Decreased concern recovered in S4 but did not translate to increased vaccine uptake (Table 1). Caregivers were less scared of their child getting COVID-19 and more scared of the vaccine in S4. Fewer caregivers in S4 were willing to receive the COVID-19 vaccine; 46% in S2, 54% in S3, and 29% in S4 had/planned to vaccinate their child (Table 2). Of 800 caregivers, 74% liked the educational videos and 54% thought they were helpful when considering the COVID-19 vaccine for their child. Of 399, 73% liked the family story and 50% thought it was helpful. Table 1. Trends in caregiver attitudes regarding the influenza vaccine Table 2. Trends in caregiver attitudes and vaccine acceptance during the COVID-19 pandemic Conclusion Parental concern regarding influenza is largely back to pre-pandemic levels but vaccine acceptance has not recovered. Vaccine uptake against COVID-19 remains suboptimal. Educational videos may help caregivers when deciding about the COVID-19 vaccine for their child. Disclosures C.Mary Healy, MD, Dexcom Inc: Stocks/Bonds|Intuitive: Stocks/Bonds|Quidel Corporation: Stocks/Bonds|Up to Date: Honoraria|Vapotherm: Stocks/Bonds Claire Bocchini, MD, Pfizer: Local sub-I for pediatric SARS-CoV-2 vaccine trials

Vaccine Hesitancy Among Parents and Its Determinants During the Era of COVID-19 in Taif City, Saudi Arabia.

Background Vaccine hesitancy is a growing concern worldwide, particularly during the COVID-19 pandemic. The aim was to investigate vaccine hesitancy and its determinants among parents in Taif, Saudi Arabia. Methods A cross-sectional study was conducted among parents using a validated and reliable questionnaire, the parentattitudes about childhood vaccines (PACV). Parents of children aged (two months to seven years) attending primary health care centers (PHCC) outpatient clinics were selected using a stratified sampling technique and interviewed to fill out the pre-structured questionnaire. Result The study included 301 parents, with 41.2% between the ages of 30-39 years and 25.2%% between 40-49 years. Mothers constituted 69.1% of the respondents. The most common sources of information regarding vaccinations were the doctor (34.9%), the internet (27.9%), and social media (16.6%). COVID-19 influenced the beliefs of more than half (52.5%) of parents regarding the importance of vaccinations. The median PACV score for vaccination hesitancy was 23.3/100, interquartile range (IQR) (13.3-33.3). The highest hesitation was among the age group of 30-39 years old (21.6%) and those whose beliefs were not influenced by the COVID-19 pandemic (16.1% vs. 5.7%) (p-value=0.003). The study found a significant difference in vaccine hesitancy rates between the different sources of information (p-value <0.001); parents who got their information about vaccinations from social media were more likely to be hesitant about vaccinations (40%). Concerns about side effects (93.8%), thinking that vaccines are not safe (84.4%), and thinking that fewer vaccines are needed (78.1%) were the top three factors influencing vaccine hesitancy. Conclusion This study urges promoting vaccine uptake through healthcare providers and combating vaccine misinformation on social media. Additionally, addressing safety concerns and misconceptions about vaccine necessity, and focusing on first-time parents, younger parents, and those with lower socioeconomic status are recommended strategies to improve vaccine uptake rates.

580. Influenza, SARS-CoV-2, and routine childhood vaccines – trends in vaccine hesitancy in hospitalized children before and during the COVID-19 pandemic

Abstract Background Vaccine hesitancy (VH) is adversely affecting the public health response to the COVID-19 pandemic. Similarly, influenza vaccine uptake is suboptimal. We aimed to monitor trends in VH with respect to influenza, SARS-CoV-2, and routine childhood vaccines. Methods We conducted a repeated cross-sectional survey in English and Spanish of caregiver influenza and SARS-CoV-2 knowledge, attitudes, behaviors, and associated VH among hospitalized children 6 mo-18 yrs at a large pediatric medical institution. Caregivers were enrolled over 3 influenza seasons (S); 2019-2020 (S1), 2020-2021 (S2), and 2021-2022 (S3). VH was assessed using the Parent Attitudes about Childhood Vaccines (PACV) survey; PACV score ≥ 50 denoted VH. Descriptive statistics were used. Results During 3 influenza seasons, 269/282 (95%), 295/307 (96%), and 384/418 (92%) of approached caregivers were enrolled in S1, S2, and S3 respectively. Most parents (45%) identified as Hispanic/Latino, 35% as White, and 20% as Black/African American. By report, 94% of children in S1, 91% in S2, and 91% in S3 were up-to-date with routine childhood vaccines. Based on PACV score, 13% of parents were VH in 19-20 compared to 17% in 20-21 and 19% in 21-22. Approximately 70% of caregivers gave or planned to give their child the influenza vaccine across seasons. Following the COVID-19 pandemic, caregivers were less likely to believe that the “flu can be a dangerous infection in children,” and to agree that “all children over 6 months of age should receive the flu shot every year”. Decreased concern persisted or did not recover during the pandemic (Table 1). Parents were consistently scared of their child getting COVID-19 but fewer (49% versus 38%) were scared of their child getting the SARS-CoV-2 vaccine in S3. More (50% versus 71%) caregivers in S3 were willing to receive the SARS-CoV-2 vaccine themselves and 46% in S2 and 54% of caregivers in S3 had or planned to vaccinate their child against COVID-19 (Table 2). Table 1.Influenza comparison of study population, 2019-2020 versus 2020-2021 versus 2021-2022 Table 2. SARS-CoV-2 comparison of study population, 2020-2021 versus 2021-2022 Conclusion Our results suggest a trend that VH may be increasing. During the COVID-19 pandemic, caregivers of hospitalized children were less concerned about influenza than pre-pandemic. Intention to vaccinate children against COVID-19 remains suboptimal. Disclosures C. Mary Healy, MD, Dexcom: Stocks/Bonds|Emmes Corporation: Advisor/Consultant|Intuitive: Stocks/Bonds|Quidel Corporation: Stocks/Bonds|Up to Date: Honoraria|Vapotherm: Stocks/Bonds.

Vaccine hesitancy and its determinants among refugee parents resettled in Aotearoa New Zealand

ABSTRACT Vaccine hesitancy is an important factor underpinning suboptimal vaccine uptake and evidence on marginalized subgroups, such as refugees, is limited. This cross-sectional survey was conducted in 2020/21 with former refugee parents who resettled in Aotearoa New Zealand (NZ). The Parent Attitudes about Childhood Vaccines (PACV) was offered in Somali, Oromo, Arabic, and English languages, and the reliability of the four versions were evaluated. The prevalence of parental vaccine hesitancy was explored and the association between vaccine hesitancy and sociodemographic factors was examined using logistic regression. One hundred and seventy-eight responses were included in the analysis. The Cronbach’s alpha scores for Somali, Oromo, Arabic, and English PACV were 0.89, 0.64, 0.53, and 0.77, respectively. The rate of parental vaccine hesitancy was 16.3%, 95% CI (10.7, 21.3). Most caregivers were concerned about vaccine side effects (47%), safety (43%), and efficacy (40%). Less than a quarter (21%) of parents had delayed their child receiving a vaccine and 12% had refused to vaccinate their child for reasons other than medical exemptions. After adjusting for covariate/s, parents’ primary source of information and education status were significantly associated with vaccine hesitancy. Media as a primary source of vaccine information and low education status were associated with higher vaccine hesitancy. Vaccine hesitancy is relatively low among former refugees and is influenced by modifiable factors, including educational level and primary source of vaccine information. Vaccine information tailored to former refugee parents’ concerns are required to reduce vaccine hesitancy and improve vaccine uptake.

Parental attitudes in the pediatric emergency department about the COVID-19 vaccine

BackgroundCOVID-19 vaccinations are now recommended in the United States (U.S.) for children ≥ 6 months old. However, pediatric vaccination rates remain low, particularly in the Hispanic/Latinx population. ObjectiveUsing the 4C vaccine hesitancy framework (calculation, complacency, confidence, convenience), we examined parental attitudes in the emergency department (ED) towards COVID-19 vaccination, identified dimensions of parental vaccine hesitancy, and assessed parental willingness to have their child receive the COVID-19 vaccine. MethodsAs part of a larger multi-methods study examining influenza vaccine hesitancy, we conducted interviews that included questions about COVID-19 vaccine authorization for children. We used directed content analysis to extract qualitative themes from 3 groups of parents in the ED: Hispanic/Latinx Spanish speaking (HS), Hispanic/Latinx English speaking (HE), non-Hispanic/non-Latinx White English speaking (WE). Themes were triangulated with the Parent Attitudes about Childhood Vaccines (PACV) survey, where higher scores indicate increased vaccine hesitancy. ResultsFactors influencing vaccine hesitancy were mapped to the 4C framework from 58 sets of interviews and PACVs. HE and HS parents, compared to WE parents, had less knowledge about COVID-19 and its vaccine, and more beliefs in COVID-19 vaccine myths. However, both HS and HE parent groups were more inclined to endorse COVID-19 vaccine effectiveness as a reason to have their children vaccinated. HS parents felt that COVID-19 increased their fear of illnesses in general and were worried about confusing COVID-19 with other infections. Median PACV scores of HS (Mdn = 20) and HE (Mdn = 20) parent groups were higher than of WE parents (Mdn = 10), but parental willingness to have their child receive COVID-19 vaccination was similar across groups. ConclusionsHigher COVID-19 vaccine hesitancy among HS and HE parents compared to WE parents may be attributed to insufficient knowledge about COVID-19, its vaccine, along with COVID-19 vaccine myths. Efforts to provide targeted vaccine education to different populations is warranted.

Validation and Cultural Adaptation of the Parent Attitudes about Childhood Vaccines (PACV) Questionnaire in Arabic Language Widely Spoken in a Region with a High Prevalence of COVID-19 Vaccine Hesitancy.

The parents’ attitude toward vaccinating children and adolescents against coronavirus disease 2019 (COVID-19) remains inconsistent and needs further elucidation. The high rates of COVID-19 vaccine hesitancy in the Middle East and North Africa (MENA) region require intensive research to understand the determinants of this phenomenon. This study aimed to validate a version of the Parent Attitudes about Childhood Vaccines (PACV) tool in Arabic, the most widely spoken language in the MENA. The study objectives included the investigation of Arab-speaking parents’ views regarding COVID-19 vaccination of their children. Parents living in Egypt with at least one child aged 5–18 years were eligible to participate in the study that was conducted through an online survey with 15 PACV items. The PACV tool was translated into Arabic using forward and backward translation. To assess the psychometric properties of the Arabic version of PACV, Pearson’s correlation coefficient and exploratory and confirmatory factor analysis (EFA and CFA) were performed. A total of 223 parents participated in the study: 59.82% aged 30–39 years, 69.20% were females, 46.19% were university-educated, and 40.63% had one child. The overall Cronbach’s alpha for the Arabic version of PACV was 0.799. The EFA of the 15 items showed that three domains were most conceptually equivalent. All items had a positive significant correlation with the mean score of each subscale except for item 4 (r = 0.016, p = 0.811). Regression analyses results indicated that education, previous COVID-19 infection, vaccine status of parents, and PACV score were significantly associated with the intention of the parents to vaccinate their children against COVID-19. The CFA results showed that most of the factor loadings were statistically significant (p < 0.010) except for items 4 and 7. However, the root mean square error of approximation (RMSEA = 0.080) and the standardized root mean squared residual (SRMR = 0.080) indicated that the model had a reasonable fit, and the three factors were good in reproducing each correlation. Our study results indicated the validity and reliability of the PACV instrument in Arabic language. Consequently, the PACV can be used to assess COVID-19 vaccine hesitancy in a majority of MENA countries for better delineation of this highly prevalent phenomenon in the region.

Educational videos to address vaccine hesitancy in childhood immunization

BackgroundAs one of the essential programs that have been developed for decades, childhood immunizations are mandatory to protect children from vaccine-preventable diseases. Despite its availability and accessibility, immunization coverage has not reached the intended goals. Vaccine hesitancy and COVID-19 pandemic may threaten immunization coverage in children. This study aimed to evaluate the tailored educational videos to reduce vaccine hesitancy and analyze the changes in childhood routine immunization status. MethodsThis was an interventional quasi-experimental study in three subdistricts of North Jakarta, Indonesia. Participants were allocated into educational videos exposures (intervention group, n = 116) or to the digital version of the maternal and child health handbook (control group, n = 104). We administered a pre- and post-intervention vaccine hesitancy survey using the Parent Attitudes about Childhood Vaccines (PACV) questionnaire with cut-off scores of 50. ResultsA total of 220 parents were recruited in this study from June 18, 2021, to December 10, 2021. The pre-intervention PACV survey showed that 19 (8.6%) parents were vaccine-hesitant from both groups: 12 (10.3%) and 7 (6.7%) of parents among intervention and control groups. After the interventions, there were 8 (6.9%) and 8 (7.7%) vaccine-hesitant parents in the intervention and control groups, respectively. We found a significant difference in the post-intervention PACV median score between the intervention and control groups (17 vs 23; p = 0.035). Around 25% of parents have not completed their children’s immunization status: 22.4% and 28.8% in the intervention and control groups, respectively. There was a significant difference between the proportion of PACV hesitancy on the immunization status within intervention and control groups (p = 0.001). ConclusionThere was a reduction in vaccine hesitancy after interventions. Educational videos intervention distributed through WhatsApp group was associated with lower vaccine hesitancy and can be used as health education tools among Indonesian parents in the community.

Validity and reliability of the Turkish version of the Parent Attitudes About Childhood Vaccines (PACV) scale

AimsThis study aimed to determine the validity and reliability of the Turkish version of the “Parental Attitudes toward Childhood Vaccines” (PACV) scale. Materials and methods: A two-stage observational validation study was conducted. A back-translation technique was used and then the scale was validated with a sample of 343 parents with children aged 0–72 months. The test–retest method, Cronbach's alpha coefficient, Split-half analysis, and item analysis methods were used to determine the reliability of the scale, factor analyses were run to determine construct validity. Explanatory Factor Analysis and Confirmatory Factor Analysis were applied to assess construct validity. ResultsCronbach's alpha coefficient was measured as .84. The Spearman–Brown coefficient was .82 and the Guttman Split-half coefficient was .81. According to the item-total correlation and Cronbach's alpha values when the item was deleted, no item was deleted from the scale. The intraclass correlation coefficient between the test–retest measurements was .79. The three-factor structure consisting of 15 items explained 51.6% of the total variance. As a result of the confirmatory factor analysis, a sufficient fit of the model to the model proposed in the original version of the scale was evident (χ2/sd=2.214, RMSEA=.06). ConclusionThe Turkish version of the PACV is a valid and reliable scale and can be used to identify parental attitudes toward childhood vaccines.

Analysis on vaccine hesitation and its associated factors among parents of preschool children in Songgang Street, Shenzhen.

China has the largest number of vaccinated population around the world. However, there has been few research on the prevalence and associated factors of vaccine hesitation among parents of preschool children. Therefore, we conducted this study to evaluate the status of vaccine hesitation and its associated factors among children’s parents. A cluster random sampling method was adopted to select six community health service centers in Shenzhen, and parents of preschool children who were immunized in the vaccination outpatient department of the selected community health centers were surveyed using a structured self-administered questionnaire. Vaccine hesitation was assessed by the Parent Attitudes about Childhood Vaccines (PACV) scale. A multiple linear regression analysis was used to assess the associated factors for vaccine hesitance among children's parents. A total of 1025 parents (response rate, 93.18%) filled out the questionnaires. The average score of vaccine hesitancy was 43.37 (SD = 10.34) points. 23.61% of parents wanted children to get all the recommended shots, 53.76% of them did not believe that many of the illnesses shots prevent were severe, and 75.41% of them could not guarantee the information they receive about shots. The results of multiple linear regression showed that the number of children in the family (β = −0.93, 95% CI: −1.31 to 0.54), health status of the child (β = 0.47, 95% CI: 0.07 to 0.87), education level of the parents (Father: β = −0.84, 95%CI: −1.37 to 0.31; Mother: = −1.59, 95%CI:−2.13 to −1.05), and annual family income (β = 1.64, 95%CI: 1.13–2.16) were significantly associated with vaccine hesitation. The average score of parents' vaccine hesitation in Shenzhen was 43.37. The results showed that the number of children in the family, health status of the children, education level of the parents and annual family income were important factors associated with the parents' vaccine hesitation.

Parental Hesitancy towards the Established Childhood Vaccination Programmes in the COVID-19 Era: Assessing the Drivers of a Challenging Public Health Concern.

(1) Background: Vaccine hesitancy remains a major public health concern. The reasons behind this attitude are complex and warrant careful consideration, especially in the context of the COVID-19 era. The purpose of this study was to estimate vaccine hesitancy towards the established childhood immunization programmes in a non-random sample of Greek parents and explore possible links with important drivers of this phenomenon. (2) Methods: An online self-administered questionnaire was used from October 2020 to April 2021 to collect socio-demographic, lifestyle, and health status data and evaluate knowledge, views, and attitudes of the Greek population on COVID-19 pandemic-related issues. Parents were further asked to complete the Parent Attitudes about Childhood Vaccines (PACV) questionnaire. (3) Results: A total of 1095 parents participated in the study with a mean age of 50 years (SD 9.5 years). The hesitancy against the established childhood vaccinations was estimated at 8.9% (95% CI, 7.3–10.8%). Married status and higher education and income were negatively correlated with hesitancy, whereas positive correlations were found for stress and depressive symptoms and current smoking. Variables related to proper awareness, sound knowledge, and trust toward authorities regarding the COVID-19 pandemic were strongly associated with being less hesitant against the established childhood vaccination programmes. (4) Conclusion: The estimated parental hesitancy against the established childhood vaccination programmes is worrisome. Variables related to good awareness and knowledge of the COVID-19 pandemic were strongly associated with being less hesitant against childhood vaccinations. Since controversy surrounding COVID-19 vaccinations may decrease parents’ confidence in routine childhood vaccinations, appreciating the complex reasons behind vaccine hesitancy may inform public health policies to overcome barriers and increase vaccine acceptance.

Parental and provider vaccine hesitancy and non-timely childhood vaccination in Switzerland

ObjectiveAlthough medical providers are a trusted vaccination information source for parents, they do not universally support vaccination. Complementary medicine (CM) providers are particularly likely to hold vaccine hesitant (VH) views, and VH parents often consult with them. Little research compares VH of parents and providers, and if and how each is associated with uptake of recommended childhood vaccines. MethodsWe defined non-timely receipt as recommended vaccines given > 1 month later than officially recommended, based on vaccination records. We administered versions of the Parent Attitudes about Childhood Vaccines (PACV) 5-item survey instrument to 1256 parents and their children’s pediatricians (N = 112, 40 CM-oriented, 72 biomedical [not CM-oriented]) to identify moderately (PACV-score 5–6) and highly (PACV-score 7+) hesitant providers/parents. We obtained multivariable adjusted odds ratios to test relationships between parental VH and provider type/VH, and between non-timely receipt of selected childhood vaccines and parental VH and provider type/VH. ResultsNo biomedical providers were VH, 9 CM providers were moderately VH, and 17 were highly VH. Parents seeing moderately and highly hesitant providers had adjusted odds ratio (AOR) for being VH = 6.6 (95% confidence interval (CI), 3.1–14.0) and AOR = 31.3 (95% CI 16.8–58.3), respectively. Across all vaccine uptake endpoints, children of moderately and highly hesitant parents had 1.9–3.8 and 7.1–12.3 higher odds of non-timely vaccination, and children seeing highly hesitant CM providers had 4.9–9.4 higher odds. Children seeing moderately hesitant CM providers had 3.3 higher odds of non-timely vaccination for the 1st dose of measles and 3.5 higher odds for 1st dose of polio/pertussis/tetanus. ConclusionVH by both parents and providers each is associated with non-timely childhood vaccination. As VH parents are more likely to consult with VH providers, interventions aimed at increasing timely vaccination need to primarily target VH providers and their clients.

Vaccine Hesitancy among Parents and Its Association with the Uptake of Measles Vaccine in Urban Settings in Khartoum State, Sudan.

Vaccine uptake is one of the indicators that has been used to guide immunization programs. This study aimed to evaluate whether measles vaccine uptake is predicted by measles vaccine hesitancy. A community-based cross-sectional study was conducted in urban districts in Khartoum state in February 2019. Measles vaccine uptake among children was measured as either fully vaccinated or partially/not vaccinated. The Parent Attitudes about Childhood Vaccines (PACV) scale was used to measure measles vaccine hesitancy. Multivariate logistic regression was run to identify the predictors of measles vaccination uptake, controlling for sociodemographic variables, and the adjusted odds ratios (aORs) with 95% CI were calculated. The receiver operator characteristic (ROC) curve was created, and the area under the curve (AUC) for the PACV was computed. Data were collected from 495 participants. We found that measles vaccine hesitancy (PACV scores) predicts the uptake of measles vaccine after controlling for other potential social confounders, such as the mother’s age and the number of children (aOR 1.055; 95% CI 1.028–1.028). Additionally, the ROC for the PACV yielded an area under the curve (AUC 0.686 (95% CI 0.620–0.751; p < 0.001)). Our findings show that measles vaccine hesitancy in Sudan directly influences the uptake of the measles vaccine. Addressing the determinants of vaccine hesitancy through communication strategies will improve vaccine uptake.

1175. Influenza Vaccine Hesitancy in Hospitalized Children, Before and During the COVID-19 Pandemic

BackgroundInfluenza vaccine is recommended for all children ≥6 months, yet uptake is suboptimal. We aimed to quantify child influenza vaccine coverage and identify factors associated with influenza vaccine hesitancy (VH) before and during the COVID-19 pandemic.MethodsWe conducted a prospective, repeated cross-sectional assessment in English and Spanish of caregiver influenza knowledge, attitudes, behaviors, and associated VH among hospitalized children 6 months through 18 years at a large pediatric medical institution. Caregivers were enrolled 4-5 days per week, between 12/11/2019--1/31/2020 and 12/8/2020--4/5/2021. VH was assessed using the Parent Attitudes about Childhood Vaccines (PACV) survey; PACV score ≥50 denoted VH. Descriptive statistics and multivariable logistic regression were used.ResultsDuring 2019-2020 and 2020-2021 influenza seasons, 269/282 (95%) and 295/307 (96%) of approached caregivers enrolled, respectively. By caregiver report, 94% of children in 2019-2020 and 91% in 2020-2021 were up-to-date with routine childhood vaccines (p=0.13). Specific to influenza vaccine, 73% and 68% of children received or planned to receive influenza vaccine in 2019-2020 and 2020-2021, respectively (p=0.13). Based on PACV score, 13% of parents were VH in 2019-2020 compared with 17% in 2020-2021 (p=0.24; Figure 1). Caregivers who had not/did not intend to vaccinate their children had a higher family income (71% vs. 57% >&30,000, p< 0.01) and were less likely to be Hispanic/Latino (35% vs. 47%, p=0.02). 77% of caregivers were satisfied with information about influenza vaccine received from healthcare providers. Overall, 36% believed “you can get the flu from the flu shot.” In 2020-2021, caregivers were less likely to believe that “flu can be a dangerous infection in children,” to be “scared of my child getting the flu” and to agree that “all children over 6 months of age should receive the flu shot every year” (Table 1).Table 1. Caregiver knowledge and attitudes about seasonal influenza vaccine, 2019-20 versus 2020-21 Figure 1. Influenza vaccine uptake by PACV score during 2019-2020 (a) and 2020-2021 (b) seasons ConclusionDuring the COVID-19 pandemic, caregivers of hospitalized children were less concerned about influenza than pre-pandemic and misinformation about influenza and influenza vaccine persisted. Increased efforts may be needed to educate caregivers about the importance of influenza immunization during the 2021-22 season.Disclosures C. Mary Healy, MD, Dexcom (Shareholder)Intuitive (Shareholder)Quidel Corporation (Shareholder)Up to Date (Other Financial or Material Support, Honorarium)Vapotherm (Shareholder)

1172. SARS-CoV-2 Vaccine Hesitancy in Caregivers of Hospitalized Children

BackgroundSARS-CoV-2 vaccine hesitancy (VH) is hindering nationwide vaccination efforts; little is known about caregiver SARS-CoV-2 vaccine acceptance for children. We aimed to identify associations with SARS-CoV-2 VH in caregivers of hospitalized children. MethodsWe conducted a prospective cross-sectional survey in English and Spanish of caregiver COVID-19 knowledge, attitudes, behaviors, and associated VH among hospitalized children 6 months - 18 years at a large pediatric medical institution. Parents were approached daily, averaging 4-5 days/week, from 12/8/2020--4/5/2021. VH was assessed using the Parent Attitudes about Childhood Vaccines (PACV) survey; PACV score ≥50 denoted VH. Descriptive statistics and multivariable logistic regression were used. Responses were categorized. Results295/307 (96%) of approached caregivers enrolled; 79% were ≥ 30 years, 68% were married/ living with a partner, and 57% had at least some college. 36% identified as white, 19% Black, and 46% Hispanic/ Latino. 53% of caregiver children had public insurance. 91% of caregivers self-reported their children were up to date with routine vaccines. 17% of caregivers were vaccine-hesitant overall. 50% of caregivers were willing to receive COVID-19 vaccine themselves. Figure 1 shows intention to vaccinate their child by PACV score. 65% knew someone who was hospitalized for COVID-19. 67% were scared of their child getting COVID-19. However, 49% were scared of their child getting the vaccine, 28% did not want to vaccinate their child and 27% were neutral in the intention to vaccinate their child. Caregivers who did not intend to vaccinate their child were more likely to be Black (27% vs. 16%, p=0.04) and less likely to be Hispanic/ Latino (33% vs. 49%, p=0.02). Table 1 shows attitudes, beliefs, and behaviors surrounding the COVID-19 pandemic and vaccine in caregivers who did or did not intend to vaccinate their child.Figure 1 COVID-19 vaccine uptake by PACV scoreTable 1 Caregiver attitudes, beliefs, and behaviors surrounding the COVID-19 pandemic and the COVID-19 vaccineConclusionThe majority of caregivers believe that SARS-CoV-2 vaccine will help control the pandemic, but less than half plan to vaccinate their children. A quarter of caregivers expressed uncertainty regarding the vaccine and therefore may be amenable to education and discussion. COVID-19 VH is different from VH towards routine vaccinations. More research is needed to address COVID-19 specific VH.Disclosures C. Mary Healy, MD, Dexcom (Shareholder)Intuitive (Shareholder)Quidel Corporation (Shareholder)Up to Date (Other Financial or Material Support, Honorarium)Vapotherm (Shareholder)

Parent Attitudes about Childhood Vaccines: Point Prevalence Survey of Vaccine Hesitancy in an Irish Population.

Understanding parental attitudes to their children’s vaccination is critical to developing and implementing interventions that address parents’ hesitancy and improve vaccine uptake. The Parent Attitudes about Childhood Vaccines (PACV) survey is a validated tool for identifying vaccine hesitancy in parents. We evaluated the rate of vaccine hesitancy and areas of concern regarding childhood vaccinations using an adapted version of the PACV survey, in a convenience sample of parents attending a STEM (Science, Technology, Engineering and Mathematics) outreach event in Ireland, in 2018. A score ≥ 50 identified vaccine hesitant parents. Of 105 parents who completed the survey, the prevalence of vaccine hesitancy was 6.7%, (7/105). Parents had concerns around vaccine side effects (36.2%, n = 38), vaccine safety (20%, n = 21) and the number of vaccines administered (13.3%, n = 14). Parents trusted the vaccine information they received (85.6%, n = 90) and 81.9% (n = 86) believed that the vaccine schedule was good for their child. The findings indicate the presence of vaccine hesitancy in parents in Ireland regarding paediatric vaccines with further research necessary to address parents’ vaccine concerns. Future research should explore further, by qualitative methods, parents’ vaccine concerns. There is also potential to identify vaccine hesitant parents with the PACV survey as a surveillance method in healthcare settings; for example, in community pharmacies, family doctor clinics and out-patient clinics.

Do Chinese Parents Deny to Vaccinate Their Children? An Analysis of Vaccine Hesitation and Influencing Factors

Background: China has the largest number of vaccinated population around the world. However, there has been little research on the prevalence and associated factors of vaccine hesitation among Chinese parents of preschool child, and further research is urgently needed. Therefore, we carried out a survey to evaluate the status of vaccine hesitation and its associated factors among children’s parents and provided an reference for relevant research and policy-making. Methods: A cluster random sampling method was adopted to select 6 community health service centers of Shenzhen, and parents of preschool children who were immunized in the vaccination outpatient department in the selected community health centers were recruited and surveyed using a structured questionnaire. Vaccine hesitation was assessed by the Parent Attitudes about Childhood Vaccines (PACV) scale. A multi-variable analysis assessed the relationship between demographics characteristics and scores of hesitance scale. Results: A total of 1,025 parents filled out the questionnaires with effective recovery rate of 93.18%. The average score of vaccine hesitancy was 43.37 (43.37±10.34) points, with 58.50% of parents have delayed having their child get a shot, and 74.73% of parents concerned that their child might have a serious side effect from a shot. The results of multiple linear regression showed the number of children in the family (β=-0.93, 95%CI: -1.31 – -0.54), the health status of the child (β=0.47, 95%CI: 0.07 – 0.87), the education level of the parents (Father:β=-0.84, 95%CI: -1.37 – -0.31; Mother: = -1.59, 95%CI: -2.13 – -1.05), and the annual family income (β=1.64, 95%CI: 1.13 – 2.16) were significant associated with vaccine hesitation. Conclusions: The average score of parents' vaccine hesitation in Shenzhen was 43.37. The results showed that the number of children in the family, the health status of the children, the educational level of the parents and the annual family income were important factors influencing the parents' vaccine hesitation. Funding Information: This study was supported by the National Social Science Foundation of China (18ZDA085) and Science and Technology Innovation Commission of Shenzhen. Declaration of Interests: We declare that we have no conflict of interests. Ethics Approval Statement: This study was approved by the Research Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China and performed in accordance with the principles of the Declaration of Helsinki. Respondents were informed that their participation was voluntary, and consent was implied on the completion of the questionnaire.

Vaccine hesitancy and reported non-vaccination in an Irish pediatric outpatient population.

Vaccine hesitancy is defined as a delay in acceptance, or refusal, of vaccines, despite availability. It is a complex and context specific phenomenon and identified as a global health priority. The "Parent Attitudes about Childhood Vaccines" (PACV) questionnaire is a validated tool for identifying vaccine hesitancy. Our aim was to use the PACV to assess vaccine hesitancy and its relationship with reported non-vaccination in an Irish population, for the first time. Our participants were parents or caregivers of children attending general pediatric clinics in a tertiary pediatric hospital in Dublin, Ireland, between September and December 2018. In total, 436 participants completed the questionnaire. 5.5% of our population reported non-vaccination. Human papilloma virus and measles, mumps, rubella vaccines were the most commonly cited vaccines of concern (11.5% and 6.7%, respectively), and autism spectrum disorder was the most commonly side effect of concern (4.3%). Mean PACV score was 26.9 (SD 19.1), with a significant difference between non-vaccinators and vaccinators (53.2 vs 25.3, p<0.001). Safety and efficacy concerns were the major contributor to non-vaccination. 14.4% of our population were vaccine-hesitant using the conventional cut-off score, which increased to 22% when using an optimal cut-off which maximized sensitivity and specificity. The accuracy of the PACV score to identify non-vaccination was good (area under the ROC curve = 0.827), and the optimal cut-off had a high negative predictive value (98.5%).Conclusion: PACV identified reported non-vaccination with high accuracy in our population. It may be useful to screen vaccine-hesitant parents who could benefit from interventions to improve uptake. What is Known: • Vaccine hesitancy is a leading threat to global health, with falls in vaccine uptake associated with disease outbreaks worldwide. • The Parent Attitudes about Childhood Vaccines (PACV) questionnaire is a validated measure of vaccine hesitancy and correlates with non-vaccination in many populations. What is New: • This large study in a pediatric outpatient clinic setting represents the first use of the PACV in a Western European population to assess vaccination hesitancy. • The PACV may be an effective way of screening a pediatric clinic population to identify vaccine-hesitant parents or caregivers for targeted vaccine promotion.

Application of the Parent Attitudes about Childhood Vaccines (PACV) survey in three national languages in Switzerland: Exploratory factor analysis and Mokken scale analysis

ABSTRACT Vaccine hesitancy (VH) is a complex and context-specific phenomenon that is linked to under-immunization and poses challenges to immunization programs. The Parent Attitudes about Childhood Vaccines (PACV) is an instrument developed to measure VH. We translated the PACV into three languages (German, French and Italian) and administered it to 1388 Swiss parents. We used exploratory factor analysis (EFA) to confirm the scale sub-domains, Cronbach’s alpha to assess internal consistency reliability, and Mokken scale analysis (MSA), to explore unidimensionality of each language version. We determined to construct validity by linking parental PACV score to children’s immunization status for the first dose of measles vaccine. For the 15-item PACV, EFA extracted three sub-domains in German and French and four sub-domains in Italian. Cronbach’s alpha was >0.8 across the three languages, and MSA produced a 13-item German, 14-item French, and 11-item Italian PACV. EFA and MSA of the short version PACV extracted a single factor and scale with Cronbach’s alpha >0.7 in all three language versions. VH was significantly associated with non-timely receipt of the first dose of measles in all languages (odds ratio of 20.7, 21.3, and 8.3 for German, French, and Italian languages, respectively). The translated and revised PACV-15 versions are valid and reliable instruments for VH measurement. The structure and reliability of the short version of the PACV was as good as the long version. Our results suggest that the PACV can be used to measure parental VH outside the US in the validated languages.

Prevalence and predictors of vaccine hesitancy among expectant mothers in Enugu metropolis, South-east Nigeria.

Vaccine hesitancy, defined as delay in acceptance or refusal of vaccines despite availability of vaccinations services, constrains control of vaccine-preventable diseases. This study determined the prevalence and correlates of vaccine hesitancy among pregnant women attending a university teaching hospital in Enugu metropolis, South-east Nigeria using cross-sectional survey and parent attitudes about childhood vaccines (PACV) questionnaire. We dichotomised the 256 expectant mother participants into hesitant and non-hesitant categories using median PACV and sub-scale scores. Overall, 31.6% of participants were hesitant. About 17.6%, 14.8%, and 30.9% of mothers were hesitant due to their vaccination behaviour, beliefs about vaccine safety and efficacy, and general attitudes and trust of service providers, respectively. Mothers aged less than 30years were three times more likely to be vaccine hesitant than older ones. Public health practitioners should target young, expectant mothers by developing and conducting vaccine hesitancy screening, focused health education, and information campaigns. The prevalence of childhood vaccine hesitancy among expectant mothers is high. Younger expectant mothers are more likely to be vaccine hesitant than older ones. Involvement of maternal health service workers to provide vaccine literacy and to support expectant mothers to make informed decision about childhood vaccination might be helpful in reducing vaccine hesitancy.

Parental Vaccine Hesitancy and Vaccination Disparities in a Safety-Net System

Poor and minority children still lag behind wealthier, white children in vaccination coverage.1,2 Structural, logistic, cultural, and attitudinal barriers contribute to vaccination disparities.3,4 Vaccine hesitancy (VH) is an important attitudinal barrier and a growing challenge.5 We measured VH and its association with child average days undervaccinated (ADU) in English- and Spanish-speaking parents of children aged 2 years in 3 safety-net clinics, describing associations by language, race, and ethnicity.We surveyed English- and Spanish-speaking parents bringing children aged 2 years to 3 pediatric clinics for well or sick care from August 2019 through February 2020. Parents were eligible if (1) English or Spanish was their first language, (2) their child turned 2 years in the last 12 months, and (3) the child had 1 previous well visit in the last 18 months. We excluded parents of children with medical contraindications to vaccination. A bilingual research assistant recruited dyads in waiting rooms; parents completed the survey on an iPad and received $5. The Colorado Multiple Institutional Review Board approved this study.We measured parental VH with the Parent Attitudes about Childhood Vaccines (PACV) tool because of its previous validation studies,6–8 brevity and simplicity, and rigorous Spanish translation.9 We transformed responses into scaled (0–100) and dichotomized (<50 = not hesitant and ≥50 = hesitant) scores, as described in previous validation work.7 We collected parent demographics and extracted child vaccination data from electronic medical records. Our independent variable of interest was parental VH. Our outcome variable was child ADU at age 2 years (ie, 730 days), which calculates the difference between when vaccine doses are given and when they are due and ranges from 0 (immunized on time) to 638 (unvaccinated).10 We compared parents by VH status on independent variables and performed multivariable linear regression analyses to assess parental VH with child ADU associations. For a 2-sided α of .05, power of 0.80, population ADU mean of 36 ± 89,10 VH effect size of 55 ADU,8,9 and parental VH prevalence of 10%,8,9 we estimated needing 259 parents (24 hesitant and 235 not hesitant). Analyses were conducted by using R (R Foundation for Statistical Computing, Vienna, Austria).Of 293 parents approached, 263 (90%) participated. Two surveys were incomplete, and 6 parents responded twice. In Table 1, we describe our final sample of 255 predominantly Hispanic, English-speaking dyads, stratified by parental VH status. Thirty-three (13%) parents were hesitant; 4 (4%) Spanish-speaking parents were hesitant versus 29 (19%) English-speaking parents (P < .01). PACV item responses also differed by language (Supplemental Table 3). Among all children, the mean ADU at age 2 was 66 days (SD 151). In adjusted analyses, children of English-speaking VH parents had a 114-day greater ADU compared with children of English-speaking non-VH parents (P = .02). Parental VH did not associate with changes in child ADU for Spanish-speaking dyads (P = .61). Children of Black parents (referent to non-Hispanic white) were significantly undervaccinated, independent of parental VH (Table 2).In a safety-net system sample, we found VH in 1 in 8 parents of children aged 2 years, with differential impacts by language, race, and ethnicity. In previous studies, researchers described VH in wealthier, privately insured clinics; in our study, we found VH in clinics serving minority, publicly insured, and Spanish-speaking children, with a prevalence (13%) similar to that previously reported (8%–25%).8,9,11 Nearly 1 in 4 Black parents had VH, and Black children aged 2 years were additionally undervaccinated, independent of parental VH. Parental VH should be explored as an important vaccination barrier along with others identified for Black toddlers, such as public insurance, access, distrust of health care, and missed opportunities.12–15 Parental VH was not associated with ADU changes among Spanish-speaking families, perhaps because of respeto, the cultural value by which Spanish-speaking parents may deferentially subjugate their concerns to clinical expertise.16 This finding bolsters existing work showing how language and culture impact pediatric care.17As a single-site retrospective study of parents of children aged 2 years, our conclusions should be explored in other systems and with other age and language groups. Furthermore, trust between staff and patients may have caused a social desirability bias to participate, and we were unable to recruit dyads who failed to present for care. Still, our work highlights the need to explore VH by language and culture and pursue implementation studies to adapt evidence-based interventions for families in safety-net systems.We acknowledge Jason Glanz, PhD, and the Kaiser Permanente Institute for Health Research for providing us with the algorithm for ADU and instructing us in its use.