Parental Vaccine Research Articles

A U.S. National Study of Family Resilience During the COVID-19 Pandemic.

The COVID-19 pandemic has significantly disrupted the lives of children and their caregivers. Recent research has examined the impact of the pandemic on child and caregiver functioning but there is a paucity of work examining the impact of the pandemic on the broader family system. The current study examined family resilience during the COVID-19 pandemic across three aims: Aim 1 tested whether meaning, control, and emotion systems form a unitary family adaption factor, Aim 2 evaluated a concurrent model of family resilience, and Aim 3 examined whether parent gender and vaccination status moderated paths in the final model. A nationally representative sample of U.S. parents (N = 796; 51.8% fathers, M age = 38.87 years, 60.3% Non-Hispanic White) completed a cross-sectional survey about themselves and one child (5-16 years old) between February-April 2021, including measures of COVID-19 family risk and protective factors, pre-existing family health vulnerabilities, race, COVID-19 stressors, and family adaptation. Confirmatory Factor Analysis demonstrated that the meaning (i.e., family making meaning of COVID-19), control (i.e., stability in routines), and emotional (i.e., family support) facets of family adaptation are unique but related. A path model revealed that there were concurrent effects from COVID-19 exposure, pre-existing vulnerabilities, and racial diversity status to the family protective, vulnerability, and adaptation variables. Additionally, parent COVID-19 vaccination status altered the association between pre-existing family health vulnerabilities and the family protective factor. Overall, results underscore the importance of examining pre-existing and concurrent risk and protective factors for family resilience during a stressful, global, and far-reaching event.

Frequency of parental COVID-19 vaccine hesitation and attitudes and behaviors towards protection of for their children aged 5-12 from COVID-19

Amaç: Türkiye’de bir üniversite hastanesine başvuran ebeveynlerin çocukları için; COVID-19 aşısı tereddüdü yaşama sıklığını ve COVID-19 halk sağlığı önlemlerini(HSÖ) almaya yönelik davranışlarını belirlemektir. 
 
 Yöntem: Bu çalışma Türkiye’deki bir üniversite hastanesine Ocak-Şubat 2022’de başvuran 5-12 yaş çocuğu olan ebeveynlerdeki, ebeveyn COVID-19 aşı tereddüdü ve HSÖ tanımlayıcı çalışmasıdır. Katılımcıların sosyodemografik, COVID-19 enfeksiyonu ve aşılarıyla ilgili ve anne-babanın HSÖ alma durumlarına ait özellikleri ile COVID-19 Korkusu Ölçeği çalışmanın bağımsız değişkenleridir. Tek değişkenli analizlerde Student’s t testi, varyans analizi, ki-kare testi; çok değişkenli analizlerde lojistik, doğrusal regresyon modelleri kullanılmış tip-1 hata değeri 0.05 kabul edilmiştir. Analizler SPSS23.0 programı kullanılarak yapılmıştır.
 
 Bulgular: Çalışmaya katılan ebeveynlerin yaş ortalamaları 37.17±6.49 ve %68.7’si kadın, çocuklarının yaş ortalamaları 8.57±2.32 ve %53.8’i erkektir. Ebeveynlerin %17.9’u COVID-19’dan korunma ve aşılar hakkındaki bilgilerini az yeterli/yetersiz görmekte ve %28.7’si COVID-19’a karşı çocukları için HSÖ alma tutumu açısından olumsuz tutum içindedir. Ebeveynlerin %48.8’i ebeveyn aşı tereddüdüne sahiptir. Çoklu analiz sonucunda; babaların hiç COVID-19 aşısı yaptırmaması ebeveyn aşı tereddüdü riskini 6.21kat (OR:6.21;%95GA=2.16-17.82) artırmakta; ebeveynin HSÖ bakımından olumsuz tutuma sahip olması ebeveyn aşı tereddüdü riskini 2.69kat (OR:2.69;%95GA=1.35-5.35) artırmakta; annenin HSÖ davranış puanındaki her bir birimlik artış ebeveyn aşı tereddüdünü 0.89kat (OR:0.89;%95GA=0.84-0.95)etkilemektedir. Ebeveyn HSÖ davranışları puanı üzerinde, baba HSÖ davranışları puanı en çok etkiye sahip olduğu bulunmuşken en az etkiye COVID-19 Korkusu Ölçeği puanının sahip olduğu belirlenmiştir. 
 
 Sonuç: Yaklaşık her iki ebeveynden birisi çocuklarına COVID-19 aşısı yaptırmada tereddüt yaşamaktadır. Toplumumuzda çocukların sağlık hizmetlerini kullanmasındaki genel belirleyici aktör olan babanın COVID-19 önlemleri konusunda da birincil önemde olduğu anlaşılmaktadır. Çocuk sağlığında annenin yanında babanın da eğitimi üzerinde önemle durulması gereken bir konudur.

Role of Parents’ Perceived Risk and Responsibility in Deciding on Children’s COVID-19 Vaccination

We examined associations between parents' reports for whether their children had been vaccinated against coronavirus disease 2019 (COVID-19) and parents' perceptions of the vaccine's long-term risk, as well as their own sense of responsibility on deciding to vaccinate or not vaccinate their children. During the period when the Omicron variant was dominant (February-March 2022), we surveyed parents from a nationally representative, probability-based Internet panel about vaccination of their school-aged children, perceptions that the vaccine's long-term risk exceeds risks without vaccination (henceforth: comparative long-term risk), their tendency to feel more responsible if their child became sick from vaccination than when unvaccinated (henceforth: anticipated responsibility), and their own vaccination status. We used multivariate analyses to assess associations of children's COVID-19 vaccination with parental comparative long-term risk perceptions, anticipated responsibility, parents' vaccination status, and demographics. Among 1715 parent respondents (71% of eligible), 45% perceived vaccine-related comparative long-term risk and 18% perceived greater anticipated responsibility from vaccination than no vaccination. After accounting for parental vaccination, parents who were more concerned about comparative long-term risk and who reported greater anticipated responsibility were 6% (95% confidence interval, -0.09 to -0.03; P < .001) and 15% (95% confidence interval, -0.19 to -0.11; P < .001) less likely to have vaccinated their children, respectively. Findings were driven by vaccinated parents. Parents' perceptions of the COVID-19 vaccine's long-term comparative risk and their greater anticipated responsibility for children getting sick if vaccinated (versus not) were associated with lower vaccine uptake among children of vaccinated parents.

Parental compliance and reasons for COVID-19 Vaccination among American children.

COVID-19 vaccination rates among children have stalled, while new coronavirus strains continue to emerge. To improve child vaccination rates, policymakers must better understand parental preferences and reasons for COVID-19 vaccination among their children. Cross-sectional surveys were administered online to 30,174 US parents with at least one child of COVID-19 vaccine eligible age (5-17 years) between January 1 and May 9, 2022. Participants self-reported willingness to vaccinate their child and reasons for refusal, and answered additional questions about demographics, pandemic related behavior, and vaccination status. Willingness to vaccinate a child for COVID-19 was strongly associated with parental vaccination status (multivariate odds ratio 97.9, 95% confidence interval 86.9-111.0). The majority of fully vaccinated (86%) and unvaccinated (84%) parents reported concordant vaccination preferences for their eligible child. Age and education had differing relationships by vaccination status, with higher age and education positively associated with willingness among vaccinated parents. Among all parents unwilling to vaccinate their children, the two most frequently reported reasons were possible side effects (47%) and that vaccines are too new (44%). Unvaccinated parents were much more likely to list a lack of trust in government (41% to 21%, p < .001) and a lack of trust in scientists (34% to 19%, p < .001) as reasons for refusal. Cluster analysis identified three groups of unwilling parents based on their reasons for refusal to vaccinate, with distinct concerns that may be obscured when analyzed in aggregate. Factors associated with willingness to vaccinate children and reasons for refusal may inform targeted approaches to increase vaccination.

The relationship between having a usual source of primary care and COVID-19 parental vaccine hesitancy: A nationwide survey among Japanese mothers.

Studies have shown that a usual source of care increases the receipt of child preventive care; however, the relationship between having a usual source of primary care and COVID-19 parental vaccine hesitancy has not been fully investigated. The aims of this study were to elucidate the characteristics of mothers with a primary care physician, and to explore the relationship between having a usual source of primary care and COVID-19 parental vaccine hesitancy among mothers in Japan. This cross-sectional survey-based study included 4516 mothers. Using a chi-square test, the characteristics of mothers with and without a primary care physician were compared. Poisson regression was applied to evaluate the relationship between having a usual source of primary care and parental COVID-19 vaccine hesitancy. Mothers with a usual source of primary care had higher education, lower mental distress, had younger children, and were less hesitant toward the child's COVID-19 vaccination. Vaccine hesitancy was observed in 39.8% of mothers with a usual source of primary care and 45.5% of those without. Poisson regression analysis showed that mothers with a primary care physician were less vaccine-hesitant (IRR = 0.90, 95% CI = 0.84-0.96) after adjusting for potential confounders. This study suggested that having a usual source of primary care may contribute to lower parental COVID-19 vaccine hesitancy. However, the high vaccine hesitancy rate, even among mothers with a usual source of primary care, warrants healthcare providers to be equipped to help parents make informed decisions about vaccination through the continuity of care.

Critical Dynamics in Black and Latino Parents’ Perceptions of Childhood COVID-19 Vaccination: How the “Middle” Moves

National and state data show low adoption of childhood COVID-19 vaccinations, despite emergency use authorizations and availability. We conducted 24 in-depth, semi-structured interviews with Black and Latino parents in New York City (15 in English, 9 in Spanish), who were undecided or somewhat likely to vaccinate their 5 to 11-year-old children in early 2022. The interviews explored the evolution of parental perceptions on childhood COVID-19 vaccines, and were analyzed using a matrix-driven rapid approach to thematic analysis. We present our findings as themes oriented around trust at three levels of the social ecological model. In summary, we found that structural positionality and historical traumas of participants seeded mistrust in institutions and government. This led to parental reliance on personal observations, conversations, and norms within social groups for vaccine decision-making. Our findings also describe key features of trust-building, supportive conversations that shaped the thinking of undecided parents. This study demonstrates how relational trust becomes a key factor in parental vaccine decision-making, and suggests the potential power of community ambassador models of vaccination promotion for increasing success and rebuilding trust with members of the “movable middle.”

Awareness of HPV and HPV vaccines, acceptance to vaccination and its influence factors among parents of adolescents 9 to 18 years of age in China: A cross-sectional study

BackgroundVaccination uptake rates for adolescents are still low in China despite safe and effective human papillomavirus vaccines being available. The awareness and attitudes of parents to HPV vaccines play a decisive role in adolescents' HPV vaccination uptake. MethodsA cross-sectional study was conducted from March, 2022 to May, 2022 using an anonymous questionnaire among parents of 9 to 18 years of age from 73 cities in 23 provinces in mainland China. Demographic characteristics of parents, their knowledge and attitudes about HPV and HPV vaccination, as well as factors influencing HPV vaccination in adolescents were assessed. ResultsMore than two-thirds of parents heard of HPV (75.5%) and HPV vaccines (84.7%). Of these participants, mothers (83.8%) were in the majority. Parents willing to vaccinate themselves and their children against HPV were 84.9% and 87.6%, respectively. Parents were more likely to vaccinate their daughters against HPV than their sons (P < 0.001). Parents who had heard of the HPV vaccines (P = 0.028) or had vaccinated themselves (P < 0.001) were more likely to have HPV vaccination for their children. Parents who accepted the price of the HPV vaccines (P = 0.005) were more likely to have their children vaccinated against HPV. ConclusionsChildren's gender, awareness of the HPV vaccines, parental HPV vaccination, and the price of the HPV vaccines are likely to be the reason for parents' vaccine hesitancy for adolescents. Practice implicationsNurses have a critical role in identifying parental hesitancy and providing individualized education to expand the parental awareness and knowledge and encourage on-time adolescents vaccination.

Development of a Tailored Mobile Phone-Based Intervention to Facilitate Parent-Child Communication and Build Human Papillomavirus Vaccine Confidence: Formative Qualitative Study.

Human papillomavirus (HPV) vaccine hesitancy is on the rise, and provider communication is a first-line strategy to address parental concerns. The use of the presumptive approach and motivational interviewing by providers may not be enough to influence parental decision-making owing to the providers' limited time, self-efficacy, and skills to implement these strategies. Interventions to enhance provider communication and build parental HPV vaccine confidence have been undertested. Delivering tailored patient education to parents via mobile phones before they visit the health care provider may address time constraints during clinic visits and positively affect vaccine uptake. This study aimed to describe the development and evaluate the acceptability of a mobile phone-based, family-focused intervention guided by theory to address concerns of HPV vaccine-hesitant parents before the clinic visit, as well as explore intervention use to facilitate parent-child communication. The health belief model and theory of reasoned action guided intervention content development. A multilevel stakeholder engagement process was used to iteratively develop the HPVVaxFacts intervention, including a community advisory board review, a review by an advisory panel comprising HPV vaccine-hesitant parents, a health communications expert review, semistructured qualitative interviews with HPV vaccine-hesitant parents (n=31) and providers (n=15), and a content expert review. Inductive thematic analysis was used to identify themes in the interview data. The qualitative interviews yielded 4 themes: overall views toward mobile device use for health information, acceptability of HPVVaxFacts, facilitators of HPVVaxFacts use, and barriers to HPVVaxFacts use. In parent interviews after reviewing HPVVaxFacts prototypes, almost all parents (29/31, 94%) stated they intended to have their child vaccinated. Most of the parents stated that they liked the added adolescents' corner to engage in optional parent-child communication (ie, choice to share and discuss information with their child; 27/31, 87%) and shared decision-making in some cases (8/31, 26%). After incorporating all input, the final intervention consisted of a 10-item survey to identify the top 3 concerns of parents, followed by tailored education that was mapped to each of the following concerns: evidential messages, images or graphics to enhance comprehension and address low literacy, links to credible websites, a provider video, suggested questions to ask their child's physician, and an optional adolescents' corner to educate the patient and support parent-child communication. The multilevel stakeholder-engaged process used to iteratively develop this novel intervention for HPV vaccine-hesitant families can be used as a model to develop future mobile health interventions. This intervention is currently being pilot-tested in preparation for a randomized controlled trial aiming to increase HPV vaccination among adolescent children of vaccine-hesitant parents in a clinic setting. Future research can adapt HPVVaxFacts for other vaccines and use in other settings (eg, health departments and pharmacies).

Geographic proximity to immunization providers and vaccine series completion among children ages 0-24months.

In the U.S., vaccination coverage is lower in rural versus urban areas. Spatial accessibility to immunization services has been a suspected risk factor for undervaccination in rural children. Our objective was to identify whether geographic factors, including driving distance to immunization providers, were associated with completion of recommended childhood vaccinations. We analyzed records from Montana's immunization information system for children born 2015-2017. Using geolocated address data, we calculated distance in road miles from children's residences to the nearest immunization provider. A multivariable log-linked binomial mixed model was used to identify factors associated with completion of the combined 7-vaccine series by age 24months. Among 26,085 children, 16,503 (63.3%) completed the combined 7-vaccine series by age 24months. Distance to the nearest immunization provider ranged from 0 to 81.0 miles (median=1.7; IQR=3.2), with the majority (92.1%) of children living within 10 miles of a provider. Long distances (>10 miles) to providers had modest associations with not completing the combined 7-vaccine series (adjusted prevalence ratio [aPR]: 0.97, 95% confidence interval [CI]: 0.96-0.99). After adjustment for other factors, children living in rural areas (measured by rural-urban commuting area) were significantly less likely to have completed the combined 7-vaccine series than children in metropolitan areas (aPR: 0.88, 95% CI: 0.85-0.92). Long travel distances do not appear to be a major barrier to childhood vaccination in Montana. Other challenges, including limited resources for clinic-based strategies to promote timely vaccination and parental vaccine hesitancy, may have greater influence on rural childhood vaccination.

Assessing the longitudinal effects of the continuation and discontinuation of the school-located influenza vaccination programme on parental vaccine hesitancy in Hong Kong.

School-located influenza vaccination programme (SIVP) can effectively promote childhood seasonal influenza vaccination (SIV). However, the longitudinal effects of continuation and discontinuation of the SIVP on parents' vaccine hesitancy remained unknown. A two-wave longitudinal study recruited adult parents who had at least one child attending a kindergarten or primary school using random-digital-dialled telephone interviews. Generalized estimating equation and structural equation modelling were used to examine the impact of changes in schools' SIVP participation status on parents' vaccine-related attitudes, and childhood SIV acceptance over 2years in Hong Kong. Children's SIV uptake varied by the schools' SIVP participation status. The highest SIV uptake was found in schools that consistently participated in SIVP (Consistent participation group) (2018/2019: 85.0%; 2019/2020: 83.0%) but lowest in the Consistent non-Participation group (2018/2019: 45.0%; 2019/2020: 39.0%). SIV uptake increased in the Late Initiation group but declined in the Discontinuation group. An increasing trend of parental vaccine-hesitant attitudes was observed in the Consistent non-Participation group. Initiation and continuation of the SIVP can reduce parental vaccine hesitancy to achieve a high childhood SIV uptake. Conversely, discontinuation of the SIVP or persistent resistance to the implementation of SIVP can increase parental vaccine hesitancy and reduce childhood SIV uptake.

Determinants of parental seasonal influenza vaccine hesitancy in the Eastern Mediterranean region: A cross-sectional study.

Seasonal influenza vaccine can reduce the risk of influenza-associated hospitalizations and deaths among children. Given that parents are the primary decision makers, this study examined the parental attitude toward childhood influenza vaccine and identified determinants of vaccine hesitancy (VH) in the Eastern Mediterranean region (EMR). A cross-sectional study was conducted using an anonymous online survey in 14 EMR countries. Parents of children aged 6 months to 18 years were included. The Parent Attitude about Childhood Vaccines (PACV) was used to assess VH. Chi square test and independent t-test were used to test for association of qualitative and quantitative variables, respectively. A structural equations model (SEM) was used to identify direct and indirect determinants of parental VH. Almost half of the parents were hesitant about vaccinating their children against influenza (50.8%). Parental VH was significantly higher among older mothers (37.06 ± 8.8 years, p = 0.006), rural residents (53.6%, p < 0.001), high-income countries residents (50.6%, p < 0.001), and mothers with higher educational levels (52.1%, p < 0.001). Parents of school-aged children (5-9 years) (55.6%, p < 0.001), children free from any comorbidities (52.5%, p < 0.001), children who did not receive routine vaccination at all (51.5%, p = 0.03), children who were not vaccinated against COVID-19 (54.3%, p < 0.001), in addition to parents who were not vaccinated against influenza (57.1%, p < 0.001) were significantly associated with increased likelihood of VH. Parents who were depending on healthcare provider as a source of information regarding vaccines were less likely to report VH (47.9%, p < 0.001), meanwhile those who used social media as their source of health information showed a significantly higher VH (57.2%, p < 0.001). The SEM suggested that mother's age, residence, country income level, child gender, total number of children and source of information regarding vaccines had a direct effect on VH. Meanwhile, parents vaccinated against influenza, children completely or partially vaccinated with routine vaccines and children vaccinated against Coronavirus disease 2019 (COVID-19) had an indirect effect on VH. A high proportion of included parents were hesitant to vaccinate their children against seasonal influenza. This attitude is due to many modifiable and non-modifiable factors that can be targeted to improve vaccination coverage.

Parental hesitancy against COVID-19 vaccination for children and associated factors in Taiwan

BackgroundSince July 2021, some countries and regions have initiated the vaccination of minors against coronavirus disease (COVID-19), and parental COVID-19 vaccine hesitancy will affect the vaccination of minors. We aimed to identify the level of parental hesitancy to vaccinate their children against COVID-19 in Taiwan and the factors associated with vaccine hesitancy.MethodsWe conducted a population-based, self-administered online questionnaire in Taiwan to assess parental hesitancy and the factors influencing their children’s vaccination against COVID-19.ResultsAmong 384 respondents, 64.1% were hesitant to have their children vaccinated against COVID-19. Mothers were more likely to hesitate to vaccinate their teens than their fathers (67.5% vs. 50%, P < 0.005). Multiple regression results showed that parents who were hesitant to vaccinate themselves (OR = 3.81, 95% CI:2.07–7.02) and those who scored lower on their perception of their children’s vaccination (OR = 9.73, 95% CI:5.62–16.84) were more hesitant to vaccinate their children with COVID-19 vaccine.ConclusionsAccording to the study findings, 64.1% of Taiwanese parents were hesitant to vaccinate their children against COVID-19. Parents who were hesitant to receive the COVID-19 vaccine for themselves and had negative views of the vaccine for their children were more likely to be hesitant to vaccinate their children. An in-depth discussion of the factors affecting vaccine hesitancy and targeted health education is conducive to promoting vaccination in children with COVID-19.

Examining multilevel influences on parental HPV vaccine hesitancy among multiethnic communities in Los Angeles: a qualitative analysis

BackgroundHuman papillomavirus (HPV) vaccine hesitancy is a growing concern in the United States, yet understudied among racial/ethnic minority parents. We conducted qualitative research to understand parental HPV vaccine hesitancy and inform community-specific, multilevel approaches to improve HPV vaccination among diverse populations in Los Angeles.MethodsWe recruited American Indian/Alaska Native (AI/AN), Hispanic/Latino/a (HL) and Chinese parents of unvaccinated children (9–17 years) from low-HPV vaccine uptake regions in Los Angeles for virtual focus groups (FGs). FGs were conducted in English (2), Mandarin (1), and Spanish (1) between June-August 2021. One English FG was with AI/AN-identifying parents. FGs prompted discussions about vaccine knowledge, sources of information/hesitancy, logistical barriers and interpersonal, healthcare and community interactions regarding HPV vaccination. Guided by the social-ecological model, we identified multilevel emergent themes related to HPV vaccination.ResultsParents (n = 20) in all FGs reported exposure to HPV vaccine information from the internet and other sources, including in-language media (Mandarin) and health care providers (Spanish). All FGs expressed confusion around the vaccine and had encountered HPV vaccine misinformation. FGs experienced challenges navigating relationships with children, providers, and friends/family for HPV vaccine decision-making. At the community-level, historical events contributed to mistrust (e.g., forced community displacement [AI/AN]). At the societal-level, transportation, and work schedules (Spanish, AI/AN) were barriers to vaccination. Medical mistrust contributed to HPV vaccine hesitancy across the analysis levels.ConclusionOur findings highlight the importance of multilevel influences on parental HPV vaccine hesitancy and decision-making and the need for community-specific messaging to combat medical mistrust and other barriers to HPV vaccination among racial/ethnic minority communities.

A Webinar to Improve Parental COVID-19 Vaccine Hesitancy

COVID-19 is a deadly worldwide pandemic and has led to rapid vaccine development. Vaccinating children is a key step to ending the pandemic. This project used a pretest-posttest design to determine if a 1-hr webinar improved parental COVID-19 vaccine hesitancy. The webinar was streamed live and later posted to YouTube. Parental vaccine hesitancy was measured by an adapted version of the Parental Attitudes about Childhood Vaccine survey for COVID-19 vaccines. Parental Attitudes about Childhood Vaccine data were collected during the live session and from YouTube for 4 weeks after the original webinar air date. After calculating a Wilcoxon signed rank test to measure the change of vaccine hesitancy before (median, 40.00) and after (median, 28.50) the webinar, there was a statistically significant difference (z=0.003, p=.05). The webinar demonstrated improved vaccine hesitancy and provided scientifically based vaccine information to parents.

Knowledge on Parental Hesitancy toward COVID-19 Vaccination of Children 5-11 Years Old.

Although vaccines are the safest and the most effective measure to prevent disease, disability, and death from various pediatric infectious diseases, parental vaccine hesitancy is a common and increasing phenomenon worldwide. To contribute to improving our knowledge on parental willingness and hesitancy toward COVID-19 vaccine administration in children aged 5-11 years, an anonymous online questionnaire was disseminated in Italy after the COVID-19 vaccine's authorization for this age group. An online survey was conducted using the Crowd Signal platform from 15 December 2021 to 15 January 2022 in Italy among parents of children 5-11 years old. A total of 3433 questionnaires were analyzed. Overall, a "Favorable" position was observed in 1459 (42.5%) parents, a "Doubtful" one in 1223 (35.6%) and a "Hesitant/Reluctant" one in 751 (21.9%). The univariate multinomial logistic regression analysis and the multivariate multinomial logistic regression analysis showed that the Hesitant/Reluctant parents were younger than 40 years of age, mostly female, with a secondary or middle school degree, an annual income below EUR 28,000, more than one child in the age range from 5 to 11 years, an underestimated consideration of the severity of COVID-19's effects, and concern regarding the COVID-19 vaccines in general. These results show that in Italy, most parents of children aged 5 to 11 were doubtful or hesitant/reluctant to vaccinate their children against the COVID-19 virus. Poor trust in health institutions as well as poor consideration of the epidemiological and clinical relevance of COVID-19 in children seem to have played the biggest roles in forming these attitudes. Moreover, the negative attitude of several parents who previously agreed to immunize their children against other childhood illnesses according to the official national pediatric immunization schedule clearly indicates that only the COVID-19 vaccine was put in doubt or rejected. All these findings lead us to conclude that to improve COVID-19 vaccination coverage in children aged 5 to 11, health authorities should increase parental education on the true clinical relevance of COVID-19 and on the importance of its prevention to hinder the evolution of the pandemic in pediatric subjects and the emergence of new variants, and its relative weight in influencing the efficacy of vaccines.

A Review of Parental Vaccine Hesitancy for Human Papillomavirus in Japan.

Globally, Japan has the lowest rate of vaccine confidence. The persistent parental vaccine hesitancy has been attributed to safety and efficacy concerns and is primarily driven by the negative experience with human papillomavirus (HPV) vaccines. This literature review aimed to identify factors associated with HPV vaccine uptake and potential strategies to reduce vaccine hesitancy among Japanese parents. Articles published in English or Japanese between January 1998 and October 2022 that examined Japanese parental factors for HPV vaccine uptake were identified from PubMed, Web of Science, and Ichushi-Web. In total, 17 articles met the inclusion criteria. Four key themes which affected HPV vaccine hesitancy and acceptance were identified: perceptions of risk and benefits, trust and recommendation, information and knowledge, and sociodemographic characteristics. While governmental and healthcare provider recommendations are important factors, efforts to improve parental confidence in the HPV vaccine are required. Future interventions to counteract HPV vaccine hesitancy should actively disseminate information on vaccine safety and effectiveness, along with information on the severity and susceptibility of HPV infection.

The effects of parent's health literacy and health beliefs on vaccine hesitancy.

Parental vaccine hesitancy is a key factor influencing children's vaccination against infectious diseases such as the COVID-19. The current study aims to investigate how parent's health literacy and health belief affect parental hesitancy toward the COVID-19 vaccination, and navigate effective measures to help parents make vaccination decision for children. A mixed-mode web survey was conducted among parents of children aged 3-11years. Parental vaccine hesitancy, health literacy, and health beliefs were assessed. Parallel mediation model examined whether the association between parent's health literacy and vaccine hesitancy was mediated by health beliefs. In total, 11.3% of the 346 participants reported vaccine hesitancy. Hesitant parents were more likely to be he mother (Father: 4.5%; Mother: 12.9%) and with children having allergic issues (Allergic: 18.3%; Non-allergic: 9.8%). Meanwhile, parents with lower health literacy were more likely to show hesitancy towards vaccinating their children (β=-6.87, 95% CI=[-10.50, -3.11]). This relationship was partially mediated by more perceived barriers in vaccination (β=-2.53, 95%CI=[-4.09, -1.02]), but not other health beliefs. In other words, parents with better health literacy may perceive fewer barriers in making vaccination decision for their children, thus being less hesitant. Accordingly, healthcare professionals and policy makers could design education service to promote parents' health literacy, and remove the perceived barriers as well as increase their confidence in following the COVID-19 vaccine guidance for children.

Adaptation of the infectious bronchitis virus H120 vaccine strain to Vero cell lines

Infectious bronchitis virus (IBV) has restricted cell and tissue tropism. IBVs, except the Beaudette strain, can infect and replicate in chicken embryos, primary chicken embryo kidneys, and primary chicken kidney cells, only. The limited viral cell tropism of IBV substantially hinders in vitro cell-based research on pathogenic mechanisms and vaccine development. Herein, the parental H120 vaccine strain was serially passaged for five generations in chicken embryos, 20 passages in CK cells and 80 passages in Vero cells. This passaging yielded a Vero cell-adapted strain designated HV80. To further understand viral evolution, serial assessments of infection, replication, and transmission in Vero cells were performed for the viruses obtained every tenth passage. The ability to form syncytia and the replication efficiency significantly after the 50th passage (strain HV50). HV80 also displayed tropism extension to DF-1, BHK-21, HEK-293 T, and HeLa cells. Whole genome sequencing of viruses from every tenth generation revealed a total of 19 amino acid point mutations in the viral genome by passage 80, nine of which occurred in the S gene. The second furin cleavage site appeared in viral evolution and may be associated with cell tropism extension of HV80.

Parental COVID-19 Vaccine Hesitancy for Children and Its Influencing Factors: A Riyadh-Based Cross-Sectional Study

It is well known that vaccination is the best clinical approach for successfully controlling COVID-19 infection. Understanding the disparities in COVID-19 vaccination apprehension among parents in different societies is crucial for effectively implementing COVID-19 vaccination programs. This observational cross-sectional study was carried out in the Riyadh region of Saudi Arabia between February and April 2022. The validated questionnaire was shared with parents who had children between the ages of five and eleven years. The collected data were analyzed using descriptive and inferential statistical methods. Multinomial regression analysis was conducted to determine the factors significantly affecting vaccine-use decisions. Of the 699 participants, 83% of the mothers were between the ages of 35 and 44 years, 67% were university educated, and only 14% were healthcare workers. A large proportion of parents, with an age range of 18-34 years (p = 0.001), and those with a higher income group (p = 0.014), demonstrated significant vaccine hesitancy. Further, parents who received one or two vaccination doses were significantly (p = 0.02) more hesitant than those who received more than two doses of the vaccine. Furthermore, a significantly (p = 0.002) high percentage of parents who follow the Ministry of Health (MOH) guidelines for personal preventive measures were hesitant about their children's vaccination. Concerns about side effects (31.4%) and a lack of safety data (31.2%) on the COVID-19 vaccines were the two most significant reasons for parents to develop vaccine hesitancy. Social media (24.3%), poor perceived immunity (16.3 %), and news articles (15.5%) were the top three contributors to this hesitancy. Vaccinated parents were 8.21 times more likely to be vaccination-hesitant than non-vaccinated parents. Additionally, parents with less education and a COVID-19-positive child at home increased the odds of vaccine hesitancy by 1.66 and 1.48 times, respectively. Overall, one-third of the parents were not prepared to vaccinate their children, and one-quarter of the respondents had not decided about vaccination. This study shows that parents in Riyadh are generally reluctant to vaccinate their children against COVID-19. As social media is a primary source of information for parents, public health professionals should utilize the platform to encourage parents to support vaccine acceptance.

Vaccine hesitancy, parental concerns, and COVID-19 in a digital leisure context: Implications for out-of-school time

Due to the increasing prevalence of parental vaccine hesitancy or refusal, it is important to understand parental motives for vaccine hesitancy. This study examines social media conversations and commentaries regarding concerns about parenting, vaccine hesitancy, and the COVID-19 pandemic within an in-person leisure and recreation context: out-of-school time (OST) programs. A generative, probabilistic Bayesian machine learning model was used to analyze 31,925 tweets and group them into seven categories: Government, Feelings, School, Public Health, Christmas, Risk and Safety, and Families. As a result, recommendations for research and practice are discussed in connection to both OST programs and digital leisure, including a diverse range of vaccine hesitancy motivations related to children and parents, communication management strategies for OST professionals, and the impact of the politization of leisure in a digital leisure context.