Recommended Childhood Vaccines Research Articles

Prevalence, spatial variation and determinants of zero-dose children in Ethiopia: Spatial and multilevel analyses

ObjectivesVaccination is a crucial public health intervention protecting individuals and communities from vaccine-preventable diseases. However, unvaccinated children in low- and middle-income countries pose a significant challenge. Ethiopia, a Global Alliance for Vaccines and Immunisation (GAVI)-supported country, ranks fifth in zero-dose immunisation burden, indicating concerning vaccine coverage gaps. Despite the severity of this issue, there is a dearth of research investigating the disparities, prevalence and contributing factors associated with zero-dose children in Ethiopia. This study aimed to assess the prevalence, spatial distribution and determinants of zero-dose children in Ethiopia. Study designA community-based cross-sectional study was conducted using data from the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). Data were collected from 21 March 2019 to 28 June 2019. MethodsThe study included a total of 1334 children aged 12–35 months (weighted sample). For spatial and multilevel analyses, ArcGIS 10.8 and Stata 17 software were used, respectively. The measure of association was determined by computing the adjusted odds ratio (AOR) at a 95 % confidence interval (95 % CI), and a p-value <0.05 was considered statistically significant. ResultsThe prevalence of zero-dose children in Ethiopia was 46.5 % (95 % CI: 43.8, 49.2). Southeast Amhara, Afar, Somali, Oromia and SNNPR (Southern Nations, Nationalities and Peoples’ Region) regions had high zero-dose proportions. Maternal age 15–19 years (AOR = 1.63; 95 % CI: 1.05, 2.64), lack of antenatal care (AOR = 1.77; 95 % CI: 1.34, 2.35), rural residence (AOR = 1.94; 95 % CI: 1.17, 3.19) and region were significantly associated to zero-dose status in Ethiopia. ConclusionsThe prevalence of zero-dose children in Ethiopia was high and the distribution exhibited significant variation across the country's clusters. Individual and community factors were key contributors. It is essential that areas with a high prevalence of zero-dose children have access to recommended childhood vaccines. This proactive approach can help protect children from morbidity and mortality caused by vaccine-preventable diseases.

Mapping changes in the utilization of childhood immunization over 5 years in a south Indian tertiary care hospital

Background: Altered vaccine demands and uneven utilization patterns in childhood immunization are evident nationwide. These variabilities may stem from a range of internal and external factors influencing parental preferences. Regular checks and balances are necessary to ensure equal accessibility for all sections of society. Aim: To assess the usage trends of childhood vaccines for 5 years (2018–2022) and to monitor instances of delayed/incomplete immunization status within the community. Methodology: This study recorded the utilization trends of all recommended childhood vaccines over a 5-year period using an ambispective design. The immunization details from 3 years (2018, 2019 and 2020) were retrieved retrospectively, while those from 2 years (2021–2022) were collected prospectively through the immunization registry. Trends in childhood vaccine utilization were recorded across different years, and delays and incomplete vaccine utilization among children, along with factors resulting in deviated immunization timelines, were analysed and compared. The association of factors with deviated immunization utilization was determined using the chi-square test, and a two-way ANOVA analysed utilization variabilities over 5 years. Result: Overall, the study profiled 32,085 children’s (who utilized 87,782 vaccine doses) vaccine utilization pattern for 5 years. Optional vaccines were less utilized (18.12% doses by 25.14% children) compared to mandatory vaccines (81.88% doses utilized by 74.86%). The most utilized mandatory vaccine was oral polio (17.48%) and for optional vaccines, it was measles mumps rubella (MMR; 28.31%). Boys had the highest utilization (55.97%) with a significant male preponderance in optional vaccine utilization ( p value &lt;0.05). Overall, there was a 26.12% decline (percent change) in vaccine utilization in 2022 compared to 2018. Among children with delayed immunization timelines (6.02%), 3.38% were on catch-up, and 2.45% were not. The most commonly delayed vaccines were diphtheria + tetanus + pertussis boosters (30.90%), Tdap (26.19%) and MMR vaccines (20.65%). Influenza vaccines (28.08%) were the most partially utilized optional vaccine, followed by varicella vaccines (20.92%). Factors such as gender (female), age over 1 year, rural residence and low- to middle-income families were significant predictors of deviated immunization status in children. Conclusion: The study mapped the utilization trends of immunizations at a tertiary care hospital in south India over the past 5 years, including the COVID-19 years. Gender inequality in the utilization of optional vaccines is a concern that warrants further research and redressal. Timely administration of childhood vaccinations is crucial for reducing susceptibility to vaccine-preventable diseases and promoting overall well-being.

Maternal Perception, Hesitancy, and Satisfaction Toward Childhood Immunization in Primary Health Centers, Hafr Al-Batin: A Multicenter Cross-Sectional Study from Eastern Saudi Arabia.

Consumer perception of and satisfaction with vaccination services is a critical and commonly used indicator for evaluating the quality of services provided by concerned authorities. The present survey assessed maternal perceptions, hesitancy, satisfaction, and factors associated with childhood immunization services provided at the primary health centers (PHCs) of eastern Saudi Arabia. The current analytical cross-sectional study included mothers of childhood vaccine beneficiaries attending PHCs in Hafr Al-Batin. We collected data related to mothers' perceptions, hesitancy, and satisfaction using a validated Arabic version of the data collection tool. Factors associated with low and high satisfaction with the immunization services were evaluated using logistic regression analysis. We performed Spearman correlation test to identify the correlation between the perception and satisfaction scores. Of the 675 participants, 87.4% were satisfied with the immunization services provided at the PHCs. The participants' satisfaction was significantly associated with the immunized child's age group (adjusted odds ratio [AOR] = 1.89, 95% CI = 1.39-2.89, p = 0.037) and occupation status (AOR = 1.42, 95% CI = 1.17-1.74, p = 0.024). Vaccine hesitancy was significantly associated with the mother's age group (AOR = 1.89, 95% CI of AR = 1.35-3.39, P = 0.003) and number of children (AOR = 1.42, 95% CI of AR = 1.17-1.74, P = 0.024), Additionally, we found a significant positive correlation (Spearman's rho = 0.207, p < 0.001) between perception and satisfaction scores. We recommend targeted health education programs for mothers to improve their perceptions and the importance of all recommended childhood vaccines. Additionally, we suggest continuing maternal satisfaction assessments to enhance and maintain the quality of vaccination services.

EPH154 Assessing Impact of the Affordable Care Act on Measles-Mumps-Rubella (MMR) Vaccination Rates Using the National Ambulatory Medical Care Survey

Affordable Care Act (ACA), enacted in 2010, creates new opportunities to cover individuals with low-to- moderate income and provides access to preventive health services, such as CDC recommended childhood vaccinations. The US CDC recommends all children get two doses of Measles-Mumps-Rubella (MMR) vaccine (first dose:12-15 months; second dose 4-6 years). This study assessed the impact of the Affordable Care Act (AFC) on MMR vaccination rates among children 7 years and younger.

Addressing Vaccine Hesitancy Through a Comprehensive Resident Vaccine Curriculum.

Vaccine hesitancy can lead to incomplete vaccination, increased risk of vaccine-preventable diseases, and distrust or conflict between physicians and patients. Yet many physicians are uncomfortable navigating vaccine hesitancy and educating vaccine-hesitant patients and families. We developed a vaccine hesitancy curriculum to increase vaccine knowledge, comfort, and communication skills in pediatric residents. The curriculum consisted of four interactive 40-minute sessions delivered to pediatric residents over 10 months. The first two sessions discussed recommended childhood vaccines, the third session examined common vaccine misconceptions, and the final session reviewed vaccine hesitancy-specific communication skills, incorporating practice through role-playing. Residents completed pre- and posttests assessing knowledge and comfort as well as receiving a standardized patient (SP) assessment of vaccine-specific communication skills after the curriculum. Thirty-five residents were in the educational intervention group and 35 in a control group. Pretest scores did not differ significantly between the groups. The mean knowledge score for the intervention group increased from 47% on the pretest to 66% on the posttest. The mean self-reported comfort score (1 = low comfort, 5 = high comfort) for the intervention group increased from 2.9 on the pretest to 3.8 on the posttest. The control group showed no difference between pre- and posttest scores for knowledge or comfort. The mean postintervention SP assessment score was significantly higher for the intervention group (78%) than the control group (52%). Implementation of a comprehensive vaccine hesitancy curriculum resulted in improved vaccine knowledge, self-reported comfort, and communication skills among pediatric residents.

Invited Commentary: The Use of Population Attributable Fractions in Studies of Vaccine Hesitancy.

Vaccine hesitancy-the delay or refusal of vaccines despite their availability-has been linked to lower vaccination rates and outbreaks of vaccine-preventable diseases. Using cross-sectional surveys of 78,725 parents and other family members in the United States, Nguyen et al. (Am J Epidemiol. 2022;191(9):1626-1635) calculated the population attributable fraction (PAF) of vaccine hesitancy on nonreceipt of recommended childhood vaccines, including influenza vaccine. The PAF is readily calculated: p(rr - 1)/rr, where p is the proportion of those hesitant among nonvaccinated individuals, and rr is the risk ratio of nonvaccination between those hesitant over those nonhesitant. By vaccine, the PAF ranged from 6.5% for nonreceipt of the hepatitis B vaccine birth dose to 31.3% for nonreceipt of the diphtheria-tetanus-pertussis vaccine dose 3. For nonreceipt of influenza vaccine, the PAF varied geographically, with relatively high values in some Northeast (e.g., New York at 22.6%) and Northwest (e.g., Oregon at 23.0%) states and lower values in certain Southern (e.g., Louisiana at 7.5%) and Mountain West (e.g., Utah at 8.8%) states. The PAF can elucidate the contribution of vaccine hesitancy on nonvaccination in different circumstances. Future studies can apply this technique in different populations and incorporate different measures of vaccine hesitancy.

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.

Factors affecting recommended childhood vaccine demand

Reaching a high vaccination coverage level is of vital essence when preventing epidemic diseases. For mandatory vaccines, the demand can be forecasted using some demographics such as birth rates or populations between certain ages. However, it has been difficult to forecast non-mandatory vaccine demands because of vaccine hesitation, alongside other factors such as social norms, literacy rate, or healthcare infrastructure. Consequently, the purpose of this study is to explore the predominant factors that affect the non-mandatory vaccine demand, focusing on the recommended childhood vaccines, which are usually excluded from national immunization programs. For this study, fifty-nine factors were determined and categorized as system-oriented and human-oriented factors. After a focus group study conducted with ten experts, seven system-oriented and eight human-oriented factors were determined. To reveal the cause and effect relationship between factors, one of the multi-criteria decision-making methods called Fuzzy-DEMATEL was implemented. The results of the analysis showed that “Immunization-related beliefs”, “Media/social media contents/messaging”, and “Social, cultural, religious norms” have a strong influence on non-mandatory childhood vaccine demand. Furthermore, whereas “Availability and access to health care facilities” and “Political/ financial support to health systems” are identified as cause group factors, “Quality of vaccine and service delivery management” is considered an effect group factor. Lastly, a guide was generated for decision-makers to help their forecasting process of non-mandatory vaccine demands to avoid vaccine waste or shortage.

Attitudes of Suburban Kansan Parents Regarding School-Required Immunizations and the Influences of the Coronavirus Pandemic.

IntroductionUnderstanding suburban, Kansas parental attitudes and adherence of recommended childhood vaccination schedules adopts a new level of importance in the era of the SARS-CoV-2019 (COVID-19) pandemic. With hopes for release of a safe and effective COVID-19 vaccine underway, understanding parental perception of vaccines is important to design successful vaccination interventions.MethodsA web-based, cross-sectional survey was administered to approximately 900 parents in Johnson County, Kansas during the summer of 2020. Pearson chi square and Mann-Whitney U tests were utilized to assess the attitudes of Kansas parents towards a potential addition of the influenza vaccine to the required list for K-12 students and furthermore, their general perception of vaccinations, and the impact of COVID-19 on those beliefs.ResultsA total of 179 parents responded. Fifty-one percent (n = 92) were in favor of adding the influenza vaccine to the mandatory list (Pro-Addition). Anti-Addition parents had significantly higher levels of distrust (2.1, p < 0.001) and were significantly more concerned about vaccine adverse effects. When presented with a hypothetical situation in which a “safe and effective” COVID-19 vaccine was available, 24% of Anti-Addition parents indicated they would receive the vaccine or obtain it for their children (21 people, p < 0.001).ConclusionsKansas suburban parents were split on their attitudes towards the addition of the influenza vaccine to the required list for children and the effects of the pandemic. Follow-up qualitative studies of Anti-Addition parents are critical for successful vaccine distribution and coverage in the communities.

Detecting adherence to the recommended childhood vaccination schedule from user-generated content in a US parenting forum.

Vaccine hesitancy is considered as one of the leading causes for the resurgence of vaccine preventable diseases. A non-negligible minority of parents does not fully adhere to the recommended vaccination schedule, leading their children to be partially immunized and at higher risk of contracting vaccine preventable diseases. Here, we leverage more than one million comments of 201,986 users posted from March 2008 to April 2019 on the public online forum BabyCenter US to learn more about such parents. For 32% with geographic location, we find the number of mapped users for each US state resembling the census population distribution with good agreement. We employ Natural Language Processing to identify 6884 and 10,131 users expressing their intention of following the recommended and alternative vaccination schedule, respectively RSUs and ASUs. From the analysis of their activity on the forum we find that ASUs have distinctly different interests and previous experiences with vaccination than RSUs. In particular, ASUs are more likely to follow groups focused on alternative medicine, are two times more likely to have experienced adverse events following immunization, and to mention more serious adverse reactions such as seizure or developmental regression. Content analysis of comments shows that the resources most frequently shared by both groups point to governmental domains (.gov). Finally, network analysis shows that RSUs and ASUs communicate between each other (indicating the absence of echo chambers), however with the latter group being more endogamic and favoring interactions with other ASUs. While our findings are limited to the specific platform analyzed, our approach may provide additional insights for the development of campaigns targeting parents on digital platforms.

Cost-effectiveness of pediatric norovirus vaccination in daycare settings

ObjectiveNoroviruses are the leading cause of acute gastroenteritis in the United States and outbreaks frequently occur in daycare settings. Results of norovirus vaccine trials have been promising, however there are open questions as to whether vaccination of daycare children would be cost-effective. We investigated the incremental cost-effectiveness of a hypothetical norovirus vaccination for children in daycare settings compared to no vaccination. MethodsWe conducted a model-based cost-effectiveness analysis using a disease transmission model of children attending daycare. Vaccination with a 90% coverage rate in addition to the observed standard of care (exclusion of symptomatic children from daycare) was compared to the observed standard of care. The main outcomes measures were infections and deaths averted, quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratio (ICER). Cost-effectiveness was analyzed from a societal perspective, including medical costs to children as well as productivity losses of parents, over a two-year time horizon. Data sources included outbreak surveillance data and published literature. ResultsA 50% efficacious norovirus vaccine averts 571.83 norovirus cases and 0.003 norovirus-related deaths per 10,000 children compared to the observed standard of care. A $200 norovirus vaccine that is 50% efficacious has a net cost increase of $178.10 per child and 0.025 more QALYs, resulting in an ICER of $7,028/QALY. Based on the probabilistic sensitivity analysis, we estimated that a $200 vaccination with 50% efficacy was 94.0% likely to be cost-effective at a willingness-to-pay of $100,000/QALY threshold and 95.3% likely at a $150,000/QALY threshold. ConclusionDue to the large disease burden associated with norovirus, it is likely that vaccinating children in daycares could be cost-effective, even with modest vaccine efficacy and a high per-child cost of vaccination. Norovirus vaccination of children in daycare has a cost-effectiveness ratio similar to other commonly recommended childhood vaccines.

Drivers of hesitancy towards recommended childhood vaccines in African settings: a scoping review of literature from Kenya, Malawi and Ethiopia

ABSTRACT Introduction There is a dearth of literature on vaccine hesitancy in Africa. In this study, we aimed to explore the drivers of hesitancy toward recommended childhood vaccines in Kenya, Malawi, and Ethiopia. Methods A scoping review methodology was used as this evidence synthesis approach is suitable for mapping existing literature and identifying knowledge gaps. For this study, we systematically searched four electronic databases for published and unpublished literature from the three African countries. The methodological framework that was used is in line with Arksey and O’Malley’s recommendations as modified by Levac. Results A total of 23 publications met the inclusion criteria and were included in the study. Majority of the studies were published after 2012. In these three African countries, hesitancy toward recommended childhood vaccines is driven by a mix of caregiver-related factors, health systems-related factors as well as the influence of community context. Conclusion This study demonstrated that vaccine hesitancy in Kenya, Malawi, and Ethiopia is a complex phenomenon that is driven by multiple interrelated and interconnected factors.

Variability in influenza vaccination opportunities and coverage among privately insured children

BackgroundUniversal influenza vaccination has been recommended since 2010, yet influenza vaccination rates among children aged 6 months to 17 years remain low compared with other routinely recommended childhood vaccines. ObjectiveAssess in-plan vaccination coverage, opportunities, and missed opportunities during the 2016–2017 influenza season. Study Design:Retrospective analyses using 2016–2017 MarketScan® data for 2,768,799 privately insured children aged 1–17 years by the end of 2016 who were continuously enrolled in the same insurance plan during the 2016–2017 influenza season (defined as August 1, 2016 through May 31, 2017). We assessed in-plan vaccination coverage (percentage receiving ≥ 1 dose of influenza vaccine from August 2016-May 2017) and vaccination opportunities (percentage with ≥ 1 provider visit between September 2016 – May 2017). Among children who remained unvaccinated at the end of the season, those with ≥ 1 influenza vaccination opportunity between September 2016-May 2017 were determined to have a missed opportunity. ResultsIn-plan vaccination coverage during the 2016–17 season was 67.7% in infants (born 2015), 49.5% in toddlers (born 2012–2014), 35.0% in school-aged children (born 2004–2011), and 22.3% in teenagers (born 1999–2003). Like vaccination coverage, vaccination opportunities decreased with age (infants: 97.7%, toddlers: 91.9%, school-aged children: 82.6%, teenagers: 79.3%). Among unvaccinated children, 93.1%, 84.1%, 73.6% and 73.6% of each age group had a missed opportunity for influenza vaccination. ConclusionOpportunities for and coverage with influenza vaccination vary even among privately insured children. Along with continued efforts to reduce missed opportunities, effective strategies to bring children to their doctor for annual influenza vaccination are needed, particularly for older children.

Provision of Pediatric Immunization Services During the COVID-19 Pandemic: an Assessment of Capacity Among Pediatric Immunization Providers Participating in the Vaccines for Children Program - United States, May 2020.

Recent reports suggest that routine childhood immunization coverage might have decreased during the coronavirus disease 2019 (COVID-19) pandemic (1,2). To assess the capacity of pediatric health care practices to provide immunization services to children during the pandemic, a survey of practices participating in the Vaccines for Children (VFC) program was conducted during May 12-20, 2020. Data were weighted to account for the sampling design; thus, all percentages reported are weighted. Among 1,933 responding practices, 1,727 (89.8%) were currently open; 1,397 (81.1%) of these reported offering immunization services to all of their patients. When asked whether the practice would likely be able to accommodate new patients to assist with provision of immunization services through August, 1,135 (59.1%) respondents answered affirmatively. These results suggest that health care providers appear to have the capacity to deliver routinely recommended childhood vaccines, allowing children to catch up on vaccines that might have been delayed as a result of COVID-19-related effects on the provision of or demand for routine well child care. Health care providers and immunization programs should educate parents on the need to return for well-child and immunization visits or refer patients to other practices, if they are unable to provide services (3).

Factors associated with the access and continuum of vaccination services among children aged 12\u201323\u2009months in the emerging regions of Ethiopia: evidence from the 2016 Ethiopian demography and health survey

BackgroundChild vaccination is an instrument for saving millions of lives. Only one in twenty children has access to childhood vaccination in hard to reach areas in developing countries. Although studies have been done on childhood vaccination, factors associated with access and continuum were not considered in Ethiopia. Therefore, this study aimed to identify the factors associated with the access and continuum of childhood vaccination in the emerging regions of Ethiopia based on the 2016 EDHS datasets.MethodsThe two-stage stratified sampling technique was used for the survey carried out on 642 mothers of children aged 12–23 months. Access is the provision of services in shorter waiting times and flexibly at all times and alternative methods of communication. Accordingly, continuum of care reflects the extent to which a series of discrete health care events are being experienced by people coherently and interconnected over time. As a result, access and continuum of childhood vaccination are determined using pentavalent-1 and measles vaccination status of children, respectively. A binary logistic regression model was fitted to identify the factors associated with access and continuum of the vaccination.ResultsOverall, 25.1% of children aged 12–23 months received all of the recommended childhood vaccines. Sixty-two percent of children accessed and 46.9% had continuum of childhood vaccination in the emerging regions of Ethiopia. Pentavalent_1 to 3 and BCG to measles dropout rates were 33.42 and 17.53%, respectively. Mothers’ formal education (AOR = 1.99; 95%CI: 1.20, 3.31), ANC (AOR = 4.13; 95%CI: 2.75,6.19), health facility delivery of last birth (AOR = 1.58; 95%CI: 1.19, 2.82), rich wealth (AOR = 1.57; 95%CI: 1.19, 3.14) and average child birth weight (AOR = 1.67; 95%CI: 1.03, 2.72) were positively associated with childhood access to vaccination. On the other hand, mothers’ ANC attendance (AOR = 3.68; 95%CI: 2.48, 5.47) and rich wealth (AOR = 2.07; 95%CI: 1.15, 3.71) were positively associated with the continuum of the services. On the contrary, children with rural resident mothers (AOR = 0.33; 95%CI: 0.14, 0.76) and small birth weight (AOR = 0.51; 95%CI: 0.33, 0.81) were negatively associated to the access and continuum of childhood vaccination, respectively.ConclusionChildhood vaccination status was low in the emerging regions of Ethiopia. Variables such as maternal education, birth weight of children, ANC, health facility delivery and wealth were associated with the access and continuum of the vaccination. Therefore, empowering women with education and strengthening maternal healthcare services might enhance childhood vaccination. In addition, the government needs to design a compensation mechanism for the cost relating to childhood vaccination to improve the access and continuum of the service.

Nurses' Perspectives on the Dismissal of Vaccine-Refusing Families From Pediatric and Family Care Practices.

Dismissal of families who refuse mandated childhood vaccines from pediatric practices has become more common among US pediatricians over the past 2 decades. While nurses (registered nurses [RNs] and advanced practice registered nurses [APRNs]) often are the first health-care professional to encounter parents' vaccine hesitancy and serve as a primary source of information, there are no published data on nurses' perspectives on dismissal as a response to vaccine refusal. This study examined nurses' perspectives on dismissal of vaccine-refusing families from primary care practices. Cross-sectional survey administered electronically from February to September 2018. Data analysis was conducted from November 2018 to March 2019. Data were collected electronically from a national sample of nurses. A convenience sample of 488 primary care nurses (74% APRNs) was recruited and enrolled in the study through collaboration with 4 professional nursing associations. A cross-sectional survey was conducted from February to September 2018. We explored correlates of nurses' (n = 488) attitudes toward dismissal by modeling attitude scores as a function of practice and respondent characteristics. We also modeled odds of encountering vaccine refusal and odds of reporting dismissal of a vaccine-refusing family in the last 12 months, each as a function of respondents' practice characteristics. Eighty-four percent of respondents encountered vaccine refusal in the previous 12 months, and 22% reported that their practice had dismissed a vaccine-refusing family within the previous 12 months. Twenty-eight percent agreed/strongly agreed that they would dismiss or support a decision to dismiss families who refuse all vaccines, and 12% supported dismissal of families for refusal of some but not all vaccines. Thirty-nine percent of respondents disagreed/strongly disagreed with dismissing families who refuse all vaccines, and 50% disagreed/strongly disagreed with dismissal for refusal of some but not all. Almost all nurses working in primary care encounter vaccine refusal, and most consider all Centers for Disease Control and Prevention-recommended childhood vaccines to be important to public health. There is significant polarization of nurses' attitudes toward the appropriateness of dismissal as a response to vaccine refusal. We recommend the development of professional nursing guidelines for responding to vaccine refusal. However, because there are no data on the community health impact of dismissal policies, we recommend further research on outcomes of dismissal policies to inform such guidelines.

An assessment of parents’ childhood immunization beliefs, intentions, and behaviors using a smartphone panel

IntroductionIt is important to quickly identify parent beliefs, intentions, and behaviors toward childhood vaccination, especially parents of children 19 to 35 months. This paper describes parental immunization beliefs, intentions, and behaviors; assesses the relationships between beliefs and intentions regarding child immunization and actual behaviors; and assesses whether beliefs, intentions, and/or behaviors varied across demographic subgroups. MethodsA sample of parents, ages 18 and older, from a mobile panel with people residing in the U.S. were invited to answer immunization behavior, intention, and belief questions using a smartphone app that was not vaccine specific. 10,000 panel members with a child under 18 were sent invitations. 1029 surveys were completed by a respondent with a child 19 to 35 months. The survey instrument replicated many NIS questions and had similar sequencing. FindingsRespondents reported that most children received all recommended vaccines, except flu vaccine, suggesting some may not understand the immunization schedule. Demographics closely associated with immunization behaviors were respondents’ education and household income. There is strong agreement that vaccines are effective, important to community health, and the child’s health. There is concern about the number of shots received, disease prevention, and ingredient safety. Some belief remains about vaccines causing learning disabilities. Positive beliefs about the benefits of childhood vaccines and concomitant risks vary with demographics. ConclusionsThis survey provided insights into beliefs and behaviors of parents regarding childhood vaccination. It found evidence of differences in beliefs, particularly related to delaying or declining recommended childhood vaccinations. The survey was conducted in a few days and at lower cost than traditional methods. This serves as a model for health agencies where rapid results or inexpensive approaches are needed.

283. Potentially Achievable Hepatitis A Vaccination Coverage with Simultaneous Administration of Vaccines Among Young Children in the United States

BackgroundThe Advisory Committee on Immunization Practices recommends simultaneous administration of all age-appropriate doses of vaccines. We estimated the vaccination coverage for ≥2 doses of hepatitis A vaccine (≥2 HepA) that could have been achieved if opportunities for simultaneous administration with other recommended childhood vaccines had not been missed.MethodsWe analyzed National Immunization Survey-Child data for 2008–2017 in the United States. We defined potentially achievable ≥2 HepA coverage by age 24 months as the possible coverage if opportunities for simultaneous administration with other age-appropriate doses of vaccines for children by age 24 months had not been missed. We compared potentially achievable vaccination coverage to reported ≥2 HepA vaccination coverage by birth years 2007 to 2015. For children born in 2015, we stratified estimates by state and by selected socio-demographic factors. Both potentially achievable and reported ≥2 HepA coverage were evaluated using a Kaplan–Meier survival procedure to account for censoring of vaccination status.ResultsCompared with reported vaccination coverage, potentially achievable coverage for ≥2 HepA was at least 10 percentage points higher across birth years 2007 to 2015 and would have surpassed the 85% target of Healthy People 2020 for children born in 2015 (Figure 1). For the 2015 birth cohort, potentially achievable ≥2 HepA coverage exceeded the 85% Healthy People 2020 target in ten states (Figure 2). In addition, potentially achievable vaccination coverage was higher than reported coverage across all selected socio-demographic factors, with differences ranging from 20.1 percentage-points (private insurance only) to 31.7 percentage-points (non-Hispanic Black) (Table 1).ConclusionPotentially achievable coverage with ≥2 HepA consistently exceeded reported coverage for children from nine recent birth cohorts and across all selected socio-demographic characteristics. Coverage could increase substantially if missed opportunities were eliminated. Evidence-based interventions such as establishment of standing orders, use of provider reminders, and use of immunization information systems are recommended to increase HepA coverage among young children. Disclosures All authors: No reported disclosures.

Providing Adolescents with Independent and Confidential Access to Childhood Vaccines: A Proposal to Lower the Age of Consent

The recent rise in rates of nonvaccination and vaccine-preventable diseases and the attendant risks to the public’s health require that lawmakers consider new policy solutions. This Article proposes one such solution. We recommend creation of a limited exception to parental decisionmaking authority by permitting certain older minors to provide legally binding consent for childhood vaccinations. We analogize this proposed policy to other statutory exceptions that permit certain minors independent access to services relating to contraception, pregnancy, sexually transmitted diseases, mental health and substance abuse, and sexual assault without parental consent. In this interdisciplinary paper, we analyze the constitutional, policy, scientific, and practical issues relevant to this proposal, and provide lawmakers with a blueprint with which to enact the proposed legislative reform. We also suggest that, in the absence of legislative action, courts allow petitioning mature minors to consent independently to recommended childhood vaccinations. In addition, consistent with protections recommended for other treatment-specific exceptions to parental consent rules, we recommend protecting the confidentiality of minors who request vaccinations, both from direct disclosure of medical information without the minors’ consent and from dissemination of information by insurance companies that might cover the cost of the vaccinations.

Increasing Human Papillomavirus Vaccination Rates Among Adolescents: Overcoming Vaccine Hesitancy and Using Practice Improvements

The human papillomavirus (HPV) is responsible for thousands of cases of cancer annually, including cancers of the cervix, oropharynx, and anogenital areas. Since 2006, a vaccine for HPV has been available that offers the hope of dramatically reducing rates of HPV-related cancers. Rates of vaccination for HPV are much lower than rates of other recommended childhood vaccinations, because of difficulties reaching teenage patients and hesitancy toward the vaccine. This article provides recommendations to help pediatric and family practice providers increase rates of uptake of the HPV vaccine among adolescent patients, including communication strategies, and practice improvements that encourage vaccination.