Routine Childhood Vaccination Research Articles

‘It's not for the children's sake’: A qualitative inquiry into the barriers and facilitators underlying parents' decision-making for vaccinating children against influenza in Denmark

Recently, the Danish Health Authority began recommending vaccinating children aged 2–6 years against seasonal influenza, underscoring the pivotal role of children in its transmission dynamics within the wider population and the need to protect vulnerable population groups after COVID-19. Under a third followed the recommendation. For the routine Danish childhood vaccine program coverage is usually well above 90%.Through a qualitative in-depth study with 28 key informants during the 2022/2023 influenza season, we investigated the barriers and facilitators of parents' decision-making for vaccinating their children against influenza. We found that parents' decision-making was influenced by a range of factors that present barriers or facilitators at the individual or collective levels, depending on personal antecedents and family situations. We also gained insights on how COVID-19 mass vaccination shaped parents’ attitudes and awareness toward influenza vaccination, explaining why many parents who fully complied with the COVID-19 recommendations elected to opt out of influenza.The implications of these findings extend beyond the concrete context of parent's decision-making regarding influenza vaccination, contributing to our understanding of vaccine confidence in at least two ways. First, the limited public controversy regarding childhood influenza vaccination allows for a perspective onto low vaccine uptake that does not resort to the usual framing of a well-defined “crisis”. Second, the interaction between COVID-19 vaccination and the childhood influenza vaccination reveals how the massive pressure on parents to vaccinate themselves and their children against COVID-19 contributed to an erosion of vaccine confidence in general.

Impact of COVID-19 on essential healthcare services at the primary healthcare level in Armenia: a qualitative study

BackgroundThe COVID-19 pandemic has presented significant global healthcare challenges, particularly impacting the continuity of essential health services in low- and middle-income countries. This study investigates the impact of the COVID-19 pandemic on the utilization and provision of essential health services in Armenia.MethodsWe employed a conventional qualitative study design, conducting semi-structured in-depth interviews (n = 17) within public and private primary healthcare (PHC) facilities in Armenia in 2021. Our study participants encompassed physicians providing specialty services in PHC facilities (e.g. endocrinologists, gynecologists/obstetricians, and pediatricians), regular visitors to PHC facilities (e.g. adults with chronic diseases, parents of children), and policymakers. Thematic analysis was conducted, yielding five emergent categories: mobilization and organization of PHC services during COVID-19; PHC visits during COVID-19; worsening of chronic conditions due to the decline in PHC visits; problems with routine childhood vaccinations; and patient-provider communication challenges.ResultsThe number of in-person visits to PHC facilities declined due to adaptations in service delivery, imposed lockdown measures, and the public’s fear of visiting healthcare facilities. Maternal and child health services continued with no major disruptions. PHC providers deliberately limited the number of maternal and child visits to essential antenatal care, newborn screenings, and routine childhood immunizations. Still, children experienced some delays in vaccination administration. The pandemic resulted in a notable reduction in follow-up visits and monitoring of patients with chronic conditions, thereby exacerbating their chronic conditions. Phone calls were the primary method of patient-provider communication during the pandemic.ConclusionsThe COVID-19 pandemic has had a profound impact on the delivery and utilization of essential healthcare services at PHC facilities, especially for those with chronic conditions who needed continuous care. Unified national-level guidance and technical capacity are needed to direct the provision of essential services at the PHC level, promote effective health communication, and implement digital platforms for the uninterrupted provision of essential care during public health emergencies.

Translation and Validation of the Malay Version of Modified Vaccine Hesitancy Scale (MVHS-M) for Assessment of Parental Vaccine Hesitancy

INTRODUCTION: Parental hesitancy towards routine childhood vaccines has been recognized as one of the public health threats. Since the uptake of child vaccination remains inconsistent, there is a need for a reliable and validated tool to measure this phenomenon. MATERIALS AND METHODS: A cross-sectional study was conducted at government health clinics in Kelantan between April 2023 to July 2023. A permission to use the original version of Modified Vaccine Hesitancy Scale (MVHS) was obtained and translated into the Malay version (MVHS-M) based on established guidelines. Parents who have at least one child aged 7 years or less were recruited by using systematic random sampling to validate the MVHS-M. A confirmatory factor analysis (CFA) was used to confirm the latent domain, while reliability was measured by composite reliability and test-retest. The data were analysed using IBM SPSS Version 26 and Mplus version 8. RESULTS: A total of 270 parents who fulfilled the study criteria were selected and completed the survey. The CFA showed a good fit index: RMSEA = 0.057 (90% CI 0.031, 0.082), CFI = 0.970, TLI = 0.957, and SRMR = 0.031. The composite reliability for the domain "lack of confidence" was 0.93 (95% CI 0.91, 0.94), while the domain "risk" showed a reliability of 0.74 (95% CI 0.69, 0.79). The test-retest reliability, as measured by the Intra-class Correlation Coefficient (ICC), was 0.77 (95% CI 0.59, 0.87), indicating good stability. CONCLUSION: MVHS-M is a valid and reliable tool that will be useful in identifying parental vaccine hesitancy in Malaysia.

Indirect Effects of the COVID-19 Pandemic on Routine Childhood Vaccination in Low-Income Countries: A Systematic Review to Set the Scope for Future Pandemics.

The COVID-19 pandemic halted progress in global vaccine coverage and disrupted routine childhood vaccination practices worldwide. While there is ample evidence of the vaccination decline experienced during the pandemic, it is less clear how low-income countries were affected. We executed a systematic review to synthesize the current literature on the impacts of routine childhood vaccinations in low-income countries from 1 January 2020 to 8 February 2023. We collected data using an extraction form on Covidence and assessed the quality of studies included in the review using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool. Effect estimates for changes in vaccination during the pandemic were reported and summarized. Factors that influenced changes were grouped into descriptive themes. Thirteen studies, encompassing 18 low-income countries and evaluating 15 vaccines at varying doses, were included in the final review. We found that routine childhood vaccinations during the COVID-19 pandemic varied considerably by vaccine type, location, and phase of the pandemic. Nine different themes were identified as factors that influenced changes in vaccination. Documenting past experiences and lessons learned is crucial for informing preparedness efforts in anticipation of future public health emergencies. Failure to effectively address these things in the next public health emergency could result in a recurrence of declining routine childhood vaccinations.

Risk of serious bacterial infections in pediatric patients with hyperpyrexia.

Hyperpyrexia has been associated with a greater prevalence of bacterial infections in the pediatric population, which prior to routine childhood vaccinations, has led to invasive testing and empiric antibiotic use for urinary tract infections, bacterial pneumonia, bacteremia, and bacterial meningitis. Since the implementation of routine childhood vaccinations, the prevalence of serious bacterial infections (SBIs) has declined. This study aims to determine if there is an association between hyperpyrexia and serious bacterial infections in well-appearing febrile pediatric patients presenting to the emergency department (ED). This is a cross-sectional study conducted between January 1, 2019, and December 31, 2019, at a single urban tertiary care pediatric ED. Patients were included if they were between 61 days and ≤18 years old presenting with a chief complaint of fever. Patients were excluded if they received antibiotics within 3 days of presentation, underwent surgical procedures within 2weeks of presentation, had an ED visit for febrile illness within 2weeks of study visit, were transferred from another institution, or were ill appearing. Prevalence of SBI was described and compared by presence of hyperpyrexia, age group, chronic medical condition, gender, and vaccination status. Logistic regression was used to analyze the association between SBIs and hyperpyrexia. Of the 3862 charts reviewed, 2565 patients were included. The prevalence of SBI was 5.6%. A total of 413 patients presented with hyperpyrexia. Of the patients with hyperpyrexia, 31 (7.5%) had a serious bacterial infection. Hyperpyrexia was not significantly associated with SBIs in our logistic regression models (adjusted Odds Ratio 1.40, 95% confidence interval 0.92-2.12). Serious bacterial infections were uncommon in our population. There is no statistically significant association between hyperpyrexia and SBIs in well-appearing pediatric patients presenting to the ED with fever. The lack of a statistically significant association between hyperpyrexia and SBIs argues that clinicians should be cautious using hyperpyrexia as an independent risk factor for SBIs. More research is needed to identify independent and grouped SBI risk factors in well-appearing pediatric patients presenting to the ED.

Vaccine hesitancy amongst the tribal population of India: a comparative scenario between COVID-19 vaccination and routine immunization

Vaccine hesitancy plays a crucial role in slowing down the efforts towards achieving an immunized and healthy society, particularly, children and women. VH is very conspicuous among the economically marginalized tribal and indigenous population. Previous research papers have not presented a comparative scenario between VH for RI and COVID-19 and have not discussed in detail different reasons behind VH from the gender perspective among tribal population. The key research question for this systematic review is whether the vaccine hesitancy for routine child vaccination among the tribal population will reduce or escalate or show no change after COVID-19 vaccination drive. This paper using Google Scholar database identified the research paper and reports, published between 2013 and 2023, and synthesized the factors contributing to vaccine hesitancy among the tribal population. While hesitancy due to reasons such as the safety and trust concerns, related to vaccines and the government; strong dependency on natural remedies; decision making dominated by social and cultural norms prevailing since ages; emerged as the key resistant in case of routine immunization among the tribal population, these were observed to be similar, to a large extent, in case of COVID-19, as well, in spite of two different age groups being the target of the vaccination drive. The paper identified key enablers and barriers of vaccine acceptance, which will be insightful for policy makers, healthcare agencies and professionals working to eliminate VH among tribal and indigenous population.

Attitudes Toward Routine Vaccines and COVID-19 Vaccines Among Parents of Infants and Toddlers in an Urban Safety-Net Setting.

This study explores attitudes toward diphtheria-tetanus-acellular pertussis (DTaP), measles-mumps-rubella (MMR), influenza, and coronavirus disease 2019 (COVID-19) vaccines among English-speaking and Spanish-speaking parents of infants in a safety-net setting. Parents aged 18 years or older were recruited from outpatient clinics between December 2020 and December 2021. The interviews were then recorded, transcribed, translated, and qualitatively analyzed using the modified grounded theory. Thirty-two individuals participated (18 English-speaking and 14 Spanish-speaking). Almost all supported receiving routine childhood vaccines, DTaP, influenza, and MMR and believed that vaccines promote health. Vaccine concerns differed by each vaccine. Few participants expressed concerns about DTaP and MMR vaccines. Concerns around influenza vaccines often stemmed from personal experience and perceived increased risk of flu-like illnesses. Participants expressed the most concerns related to COVID-19 vaccinations, including age-based immunity of their infants. Based on these findings, future interventions to improve vaccine uptake may focus on benefits common to all vaccines, while addressing vaccine-specific concerns.

Covid-19 Pandemi Sürecinde Sağlıklı Çocuk Takibi ve Kronik Hastalık Kontrollerinin Sürekliliği ve Pandeminin Poliklinik Başvurularına Erken ve Geç Dönemdeki Etkisinin Karşılaştırılması

Aim: Pandemic disrupted health care access in many centers all around the world. CDC recommended that seperating pandemic and non-pandemic hospitals, prioritizing emergency visits, postponing elective operations and, where possible, converting outpatient visits to telehealth calls. In this period, well-child checkups were cancelled and routine childhood vaccination was interrupted. We aimed to evaluate the impact of pandemic on the routine immunization schedule, neonatal screening program, chronic disease follow ups and outpatient clinic visits. 
 Material and Method: In total, 401 children and their parents were included in this study and patient population of interest was children of routine immunization age. Outpatient visit features and compliance with the childhood vaccination and neonatal screening program before and during the pandemic were asked. 
 Results: Compared to 2021, there was a significant increase in both the number of patients with upper respiratory tract infection symptoms and their hospital admissions. While the rates of hospital admissions increased in 2022 in those with diarrhea, almost all of the patients with lower respiratory tract infection symptoms stated that they applied to the hospital in both periods. It was observed that routine vaccination and newborn screening programs were carried out successfully during the pandemic process in Turkey. It was found that chronic disease follow-ups of children were interrupted in 2021. 
 Conclusion: This study has shown how the 3 major components of health system (outpatient clinic visits, well child check-ups and chronic disease follow-ups) were affected at different times of the pandemic in Turkey. Successful management in childhood vaccinations and neonatal screening program should also be ensured in chronic disease follow-up bythe separation of pandemic and non-pandemic hospitals. Showing the strengths and weaknesses of strategies implemented in health system during the pandemic guides the measures to be taken for similar situations that may occur in the future.

The Fundamentals of Inflammatory Bowel Disease Management in Pregnancy: A Practical Review for the Gastroenterologist.

This narrative review explores the management of Inflammatory Bowel Disease (IBD) during pregnancy, emphasizing its unique challenges to maternal and fetal health, particularly within the Canadian Gastroenterology setting. Seven key principles are highlighted: 1) Preconception counselling, aiming for steroid-free remission confirmed by objective markers, should be routine for female IBD patients. 2) Medication safety, with an eye to future pregnancies, should be addressed upon initiation. Methotrexate and small molecules are contraindicated during pregnancy, while most 5-ASA therapies, biologics, and thiopurines can be continued throughout pregnancy and breastfeeding. Steroids, though not without risks, can be utilized if necessary. 3) Routine monitoring during remission should include serum biomarkers and fecal calprotectin each trimester. 4) Routine endoscopy and imaging are not required, but if indicated, lower GI endoscopy, ultrasound, and unenhanced MRI can be used. Computed tomography and gadolinium enhanced MRI should be avoided. 5) Caesarean section is advised for patients with previous ileal pouch surgeries or active perianal disease, but other patients should follow obstetric indications for delivery. 6) Postpartum period may see more active disease, requiring continued monitoring. Breastfeeding is encouraged, and routine childhood vaccinations are advised, but live vaccinations in the first 6 months warrant detailed review. 7) Complex IBD patients may benefit from a multidisciplinary approach with robust communication between gastroenterologists and obstetricians.

Exploring the impact of the COVID-19 pandemic on perceptions of national scheduled childhood vaccines among Māori and Pacific caregivers, whānau, and healthcare professionals in Aotearoa New Zealand

ABSTRACT In Aotearoa New Zealand, there has been a marked decrease in the uptake of routine childhood vaccinations since the onset of the COVID-19 pandemic, particularly among Māori and Pacific children. This Māori and Pacific-centered research used an interpretive description methodology. We undertook culturally informed interviews and discussions with Māori and Pacific caregivers (n = 24) and healthcare professionals (n = 13) to understand their perceptions of routine childhood vaccines. Data were analyzed using reflexive thematic analysis and privileged respective Māori and Pacific worldviews. Four themes were constructed. “We go with the norm” reflected how social norms, health personnel and institutions promoted (and sometimes coerced) participants’ acceptance of routine vaccines before the pandemic. “Everything became difficult” explains how the pandemic added challenges to the daily struggles of whānau (extended family networks) and healthcare professionals. Participants noted how information sources influenced disease and vaccine perceptions and health behaviors. “It needed to have an ethnic-specific approach” highlighted the inappropriateness of Western-centric strategies that dominated during the initial pandemic response that did not meet the needs of Māori and Pacific communities. Participants advocated for whānau-centric vaccination efforts. “People are now finding their voice” expressed renewed agency among whānau about vaccination following the immense pressure to receive COVID-19 vaccines. The pandemic created an opportune time to support informed parental vaccine decision-making in a manner that enhances the mana (authority, control) of whānau. Māori and Pacific-led vaccination strategies should be embedded in immunization service delivery to improve uptake and immunization experiences for whānau.

Caregivers’ perceptions on routine childhood vaccination: A qualitative study on vaccine hesitancy in a South Brazil state capital

ABSTRACT Immunization programs worldwide have been facing challenges in keeping vaccination coverage high. Even though universally known for its robust National Immunization Program, Brazil has also faced significant challenges regarding vaccination coverage. One of the reasons for this is vaccine hesitancy, a complex, multi-causal, and context-specific phenomenon. This qualitative study aims to understand the factors associated with decision-making and the drivers of vaccine hesitancy in Florianopolis, Santa Catarina state capital, regarding caregivers’ perceptions of routine childhood vaccination. In-depth interviews were conducted in the Capital city of Santa Catarina State. Families with children up to 6 years old were included. Data were analyzed based on thematic content analysis. Twenty-nine caregivers in 18 families were interviewed. These caregivers were mainly mothers and fathers. Three themes emerged: 1. Access to information and the decision-making process, where we discuss the role of social circles, healthcare workers, and the internet; 2. Individual-institutions power relationships: Perceptions about the State’s role and the Health institutions: 3. Reasons and motivations: The senses and meanings behind non-vaccination, where we discuss the drivers of vaccine hesitancy related to risk perception, caregivers’ opinions on the medical-pharmaceutical industry, vaccines’ composition and their side effects, families’ lifestyles and worldviews, and the childhood routine vaccination schedule. The results of this study reaffirm the complexity of the decision-making process in childhood vaccination and further enable a better contextual understanding of the complex and challenging phenomenon of vaccine hesitancy.

Have routine childhood vaccine administration rates reached pre-COVID-19 pandemic levels? A hospital registry-based study from North India

Background: In many nations, including India, the COVID-19 outbreak hampered routine immunization (RI) services. Information about how a lockdown affects immunization rates is available; however, there is a dearth of published information about immunization rates after the lockdown. Aims and Objectives: To study the bearing of COVID‐19 pandemic on immunization and, with the pandemic under control, to access whether India is getting back on track with its nationwide RI program. Materials and Methods: A hospital registry-based retrospective observational study was performed. Data were collected from February 2019 until June 2022. The vaccine administration rates in 2019 were considered as baseline. Comparisons of changes in vaccination rates for different periods were done using the “N-1” Chi-squared test on the online statistical software MedCalc. Results: As compared to March until May 2019, there was a decline of 27% in the administration of birth doses, a 28% decline in other doses, and a 33% decline in maternal doses of tetanus in the year 2020. From March to May 2021, birth doses showed a decline of 32% as compared to 2019, whereas other doses showed an increase of 25%. In the same months of 2022, birth doses have still not reached pre-COVID-19 levels (a decline of 10%), though administration of other doses has almost doubled. Conclusion: We thus conclude that a significant drop in RI administration rates at our immunization clinic and vaccine administration rates did not achieve pre-COVID-19 levels as of 2022.

Social determinants of low uptake of childhood vaccination in high-risk squatter settlements in Karachi, Pakistan – A step towards addressing vaccine inequity in urban slums

BackgroundRoutine vaccination has remained historically low in major urban pockets of Pakistan, and now lags behind rural vaccination rates. Grossly insufficient publicly funded primary healthcare infrastructure, heterogeneous mix of providers and multi-ethnicity of populations pose challenges in the delivery of essential health services. This paper ascertains factors associated with uptake of routine childhood vaccination, using Pentavalent-3 vaccine, as a proxy indicator for completion of age-appropriate vaccines in urban slums of Karachi, at high risk of Polio and vaccine preventable disease outbreaks. MethodsData was drawn from baseline assessment of an urban immunization delivery pilot project in urban slums of Karachi, Pakistan. The study sample comprised of 2,097 households with children aged 4–12 months, sampled through a cross-sectional cluster survey, applying a structured questionnaire. Multivariable logistic regression was used to determine the association between Penta-3 vaccination, as the outcome variable, and predictor variables including socio-demographic characteristics and healthcare access factors. ResultsThe findings showed that the likelihood of being immunized with Penta-3 was higher for non-Pashtun ethnicity [adjusted odds ratio (aOR) 1.69; 95% CI 1.33–2.14], children of educated mothers, secondary or higher [aOR 2.95, 95% CI 2.34–3.71], and those whose fathers were formally employed (aOR 1.53; 95% CI 1.19–1.97). No association was seen by gender of child [aOR 0.89; 95% CI 0.73–1.08], and place of new born delivery [aOR 1.01; 95% CI 0.83–1.24]. ConclusionPockets of critically low under-vaccinations within the urban slums of Karachi are associated with Pashtun ethnicity, distance to the vaccination centre, lack of mothers’ education and lack of stable family income as in the case of unemployed and daily wage-earning fathers. Recognition of these factors is required in designing contextually appropriate strategies to address vaccine inequity in urban settings.

Mothers/caregivers’ knowledge of routine childhood immunization and vaccination status in children aged, 12-23 months in Ilorin, Nigeria

Background: Immunization has averted millions of hospitalizations and deaths from vaccine-preventable diseases. It is a strong public health tool for childhood infection control and prevention. Many mothers are aware of routine immunization but with doubtable knowledge.Objectives: This study determined the mothers/caregivers’ knowledge of routine childhood immunization and vaccination status of their children, aged 12-23 months in Ilorin East Area of Kwara State, Nigeria. It also identified some of the socio-demographic factors associated with good knowledge status of the mothers/caregivers.Methods: This was a community-based cross-sectional study, carried out between December, 2019 and January, 2020, among 456 mothers / caregivers-children’s pairs. Subjects were recruited using multistage cluster sampling technique. Data were collected using a pretested, semi-structured, interviewer-administered questionnaire.Results: Up to 98.0% of the respondents were aware of childhood immunization with healthcare providers (92.1%) being their major source of information. Majority of the respondents (85.3%) had good knowledge of immunization, defined by a score ≤6 out of the 10 questions tested. There was a significant relationship between respondents’ knowledge and full vaccination status of the children (p=0.001). The significant factors associated with good knowledge from binary logistic regression were mothers / caregivers’ age >30 years, antenatal clinic attendance and at least secondary education (OR, p value = 10.60, 0.013; 8.50, <0.001; and 3.98, <0.001 respectively).Conclusion: Mothers / caregivers’ knowledge on immunization was good and this positively affected the full vaccination status of their children. There is a need to sustain female education and encourage antenatal clinic attendance, as tools to improve childhood immunization.

Routine pediatric vaccinations during the COVID-19 pandemic: A review of the global impact.

The coronavirus disease 2019 (COVID-19) pandemic has put standard, routine childhood vaccinations at risk worldwide. The disruption in vaccine coverage has resulted in a negative impact on the health of children, with some races, ethnicities, age groups, areas of settlement, and parts of the world affected more than others. This literature review studied and examined the impact of COVID-19 on infant, child, and adolescent vaccinations. Retrospectively, the analysis showed a decline, delays, or interruptions in the coverage of vaccines during the pan-demic and a decline in some countries' pre-pandemic and post-pandemic eras. Necessary attempts and efforts should be made for these delayed and missed vaccinations, as failure to do so could put children's health at risk. Thus, priority should be directed at instituting catch-up programs to support vaccine uptake and decrease the probability of acquiring vaccine-preventable diseases.

Improved vaccine coverage for First Nations children receiving first dose on-reserve: a retrospective cohort study in western Canada

IntroductionFragmentation in immunisation reporting systems pose challenges in measuring vaccine coverage for First Nations children in Canada. Some Nations have entered into data-sharing agreements with the province of Alberta’s health...

Impact of the COVID-19 pandemic on the coverage and timeliness of routine childhood vaccinations in the Gambia, 2015–2021

IntroductionThe COVID-19 pandemic caused widespread morbidity and mortality and resulted in the biggest setback in routine vaccinations in three decades. Data on the impact of the pandemic on immunisation in...

Lessons From the COVID-19 Pandemic Response Implementation: A Case Study of South Sudan and Sierra Leone.

The COVID-19 pandemic caused havoc to health systems worldwide and in countries that already had weak health systems. There are lessons to be learned that could contribute to improved response preparedness to future public health emergencies, but there is little documentation on best practices in fragile countries. We describe lessons from South Sudan and Sierra Leone during the COVID-19 response implementation. We conducted a retrospective descriptive analysis of COVID-19 vaccination implementation at national and subnational levels between 2020 and 2022 in South Sudan and Sierra Leone to identify those practices that had a positive impact on public health. Several interventions were identified that not only improved the COVID-19 situation but also had a positive effect on routine immunizations. The development of a near-real-time vaccination dashboard gave stakeholders a quick look at vaccine implementation, allowing them to make decisions based on current data. The experience acquired from deploying the COVID-19 dashboard has since been applied to the development of a routine immunization dashboard in South Sudan. Surge vaccination was an effective approach to improving COVID-19 vaccination uptake. A measles reactive campaign was conducted during the initial stages of the pandemic when movement was restricted; experience gained from that effort was subsequently applied to COVID-19 mass vaccination initiatives and outbreak reactive campaigns. Additional vaccinators recruited for COVID-19 response also received comprehensive Immunization in Practice training, allowing them to provide routine childhood vaccinations alongside COVID-19 vaccination, contributing to the maintenance of routine vaccination services in both countries. Lessons were learned during the COVID-19 response implementation that have had a positive impact on routine health services. However, it is essential that these effects are maintained and further refined to strengthen the country's preparedness for future public health emergencies and better support the broader immunization service delivery.

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

Comparing vaccination coverage before and during COVID-19 pandemic in children under one year in the health district of commune V in Bamako, Mali

IntroductionAlthough an essential frontline service in the prevention of child morbidity and mortality, there are indications that routine vaccinations have been disrupted during the COVID-19 pandemic. The present study aimed to compare vaccination coverage before COVID-19 in Mali in 2019 and during COVID-19 in 2020.ObjectiveTo compare vaccination coverages before COVID-19 in Mali in 2019 and during COVID-19 in 2020.DesignCross-sectional study.Setting and participantsWe collected routine immunization data from 2019 to 2020 of children under one year in the health district of Commune V in Bamako which includes twelve community health centers (CSCom).ResultsConsidering all vaccines together, coverage in 2019 was higher than in 2020 (88.7% vs. 71,6%) (p < 10− 3, Fig. 1). In 2020, low proportions of children vaccinated were observed in May (51.1%) two months after the first COVID-19 case in Mali on March 25, 2020. For all vaccines, the mean number of children vaccinated was significantly higher in 2019 (before COVID-19) as compared to 2020 (during COVID-19) (p < 0.05). However, in September and October 2019 BCG vaccine coverage was lower in 2019 as compared to 2020 (p < 10− 3).ConclusionCOVID-19 pandemic has affected routine childhood vaccine coverage in Commune V of Bamako, particularly in May 2020. Therefore, new strategies are needed to improve vaccine coverage in young children below 1.