Prevalence and Predictors of Pediatric COVID-19 Vaccine Acceptance

Abstract

Objective As pediatric COVID-19 vaccine eligibility expands, understanding predictors of vaccine intent is critical to effectively address parental concerns. Objectives included: (1) Evaluate maternal COVID-19 vaccine intent for child(ren) and associated predictors of stated intent; (2) Describe attitudes related to hypothetical vaccination policies; (3) Summarize themes associated with intention to vaccinate child(ren) for COVID-19.

Study Design Mothers enrolled in Heath eMoms, a longitudinal survey project, were recruited for this electronic COVID-19 survey. Chi-square analysis was used to compare proportions of respondent characteristics based on vaccination intent. Population survey logistic regression was used for multivariable modeling to assess the independent association between vaccine intent and demographics.

Results The response rate was 65.3% (n = 1884); 44.2% would choose vaccination, 20.3% would not choose vaccination, and 35.5% are unsure whether to have their child(ren) vaccinated for COVID-19. Black mothers (AOR 0.26, 95% CI 0.13, 0.54), respondents with less than high school education (AOR 0.26, 95% 0.12, 0.56) and those in rural areas (AOR 0.28, 95% CI 0.16, 0.48) were less likely to choose vaccination. Commonly cited reasons for vaccine hesitancy include the belief that the vaccine was not tested enough, is not safe, and there are concerns regarding its side effects.

Conclusion Over 50% of respondents do not intend or are unsure about their intent to vaccinate their child(ren) for COVID-19 with variability noted by demographics. Opportunities exist for perinatal and pediatric providers to educate pregnant people, parents, and caregivers with a focus on addressing concerns regarding vaccine safety and efficacy.

Key Points

• COVID-19 vaccination rates remain suboptimal, especially in the pediatric population, with variation across states.

• We found that the prevalence of vaccine acceptance for young children is low.

• We highlight opportunities for providers to educate parents, focusing on addressing vaccine safety and efficacy.

Keywords

COVID-19 - vaccine hesitancy - vaccine acceptance

• References

• 1 Bell S, Clarke R, Mounier-Jack S, Walker JL, Paterson P. Parents' and guardians' views on the acceptability of a future COVID-19 vaccine: a multi-methods study in England. Vaccine 2020; 38 (49) 7789-7798
• 2 Glanz JM, Wagner NM, Narwaney KJ. et al. A mixed methods study of parental vaccine decision making and parent-provider trust. Acad Pediatr 2013; 13 (05) 481-488
• 3 Centers for Disease Control and Prevention. ChildVaxView: Vaccination Coverage Among Young Children. 2017 . Accessed September 12, 2021 at: https://www.cdc.gov/vaccines/imz-managers/coverage/childvaxview/index.html
• 4 Shulman HB, Gilbert BC, Msphbrenda CG, Lansky A. The Pregnancy Risk Assessment Monitoring System (PRAMS): current methods and evaluation of 2001 response rates. Public Health Rep 2006; 121 (01) 74-83
• 5 Simonson M, Chwe H, Lazer D. et al. The COVID States Project: A 50-State COVID-19 Survey Report #49: Vaccinating America's Youth. Northeastern University, Harvard University, Rutgers University, and Northwestern University; 2021
• 6 Alfieri NL, Kusma JD, Heard-Garris N. et al. Parental COVID-19 vaccine hesitancy for children: vulnerability in an urban hotspot. BMC Public Health 2021; 21 (01) 1662
• 7 Kaiser Family Foundation. KFF COVID-19 Vaccine Monitor: October 2021. Published October 28,. 2021 . Accessed January 14, 2022 at: https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-october-2021/
• 8 Kempe A, Saville AW, Albertin C. et al. Parental hesitancy about routine childhood and influenza vaccinations: a national survey. Pediatrics 2020; 146 (01) e20193852
• 9 Fadel CW, Colson ER, Corwin MJ. et al; Study of Attitudes and Factors Effecting Infant Care (SAFE) study. Maternal attitudes and other factors associated with infant vaccination status in the United States, 2011-2014. J Pediatr 2017; 185: 136-142.e1
• 10 Braun C, O'Leary ST. Recent advances in addressing vaccine hesitancy. Curr Opin Pediatr 2020; 32 (04) 601-609
• 11 Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr 2020; 109 (06) 1088-1095
• 12 Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis 2020; 20 (06) 689-696
• 13 Centers for Disease Control and Prevention. Health Department-Reported Cases of Multisystem Inflammatory Syndrome in Children (MIS-C) in the United States. Published January 3, 2022. Accessed January 14, 2022 at: https://covid.cdc.gov/covid-data-tracker/#mis-national-surveillance
• 14 American Academy of Pediatrics, Children's Hospital Association. Children and COVID-19: State Data Report. 2022
• 15 Rafferty MS, Burrows H, Joseph JP, Leveille J, Nihtianova S, Amirian ES. Multisystem inflammatory syndrome in children (MIS-C) and the coronavirus pandemic: current knowledge and implications for public health. J Infect Public Health 2021; 14 (04) 484-494
• 16 Leidman E, Duca LM, Omura JD, Proia K, Stephens JW, Sauber-Schatz EK. COVID-19 trends among persons aged 0-24 years - United States, March 1-December 12, 2020. MMWR Morb Mortal Wkly Rep 2021; 70 (03) 88-94
• 17 Dudley MZ, Limaye RJ, Omer SB. et al. Characterizing the vaccine knowledge, attitudes, beliefs, and intentions of pregnant women in Georgia and Colorado. Hum Vaccin Immunother 2020; 16 (05) 1109-1117
• 18 Betsch C, Bödeker B, Schmid P, Wichmann O. How baby's first shot determines the development of maternal attitudes towards vaccination. Vaccine 2018; 36 (21) 3018-3026
• 19 O'Leary ST, Brewer SE, Pyrzanowski J. et al. Timing of information-seeking about infant vaccines. J Pediatr 2018; 203: 125-130.e1
• 20 Danchin MH, Costa-Pinto J, Attwell K. et al. Vaccine decision-making begins in pregnancy: correlation between vaccine concerns, intentions and maternal vaccination with subsequent childhood vaccine uptake. Vaccine 2018; 36 (44) 6473-6479
• 21 Hwang SS, Rybin DV, Heeren TC, Colson ER, Corwin MJ. Trust in sources of advice about infant care practices: the SAFE study. Matern Child Health J 2016; 20 (09) 1956-1964
• 22 Weiner JL, Fisher AM, Nowak GJ, Basket MM, Gellin BG. Childhood immunizations: first-time expectant mothers' knowledge, beliefs, intentions, and behaviors. Vaccine 2015; 33 (Suppl. 04) D92-D98
• 23 Bianco A, Mascaro V, Zucco R, Pavia M. Parent perspectives on childhood vaccination: how to deal with vaccine hesitancy and refusal?. Vaccine 2019; 37 (07) 984-990
• 24 Chung Y, Schamel J, Fisher A, Frew PM. Influences on immunization decision-making among us parents of young children. Matern Child Health J 2017; 21 (12) 2178-2187
• 25 McClure CC, Cataldi JR, O'Leary ST. Vaccine hesitancy: where we are and where we are going. Clin Ther 2017; 39 (08) 1550-1562
• 26 American Academy of Pediatrics. Office Strategies for Improving Immunization Rates. Accessed January 14, 2022 at: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/immunizations/Practice-Management/Pages/office-strategies.aspx
• 27 Frew PM, Lutz CS. Interventions to increase pediatric vaccine uptake: an overview of recent findings. Hum Vaccin Immunother 2017; 13 (11) 2503-2511
• 28 Glanz JM, Wagner NM, Narwaney KJ. et al. Web-based social media intervention to increase vaccine acceptance: a randomized controlled trial. Pediatrics 2017; 140 (06) e20171117
• 29 Gagneur A, Battista MC, Boucher FD. et al. Promoting vaccination in maternity wards <glyph name="sbnd"/> motivational interview technique reduces hesitancy and enhances intention to vaccinate, results from a multicentre non-controlled pre- and post-intervention RCT-nested study, Quebec, March 2014 to February 2015. Euro Surveill 2019;24(36):
• 30 Gagneur A, Lemaître T, Gosselin V. et al. A postpartum vaccination promotion intervention using motivational interviewing techniques improves short-term vaccine coverage: PromoVac study. BMC Public Health 2018; 18 (01) 811
• 31 Largent EA, Persad G, Sangenito S, Glickman A, Boyle C, Emanuel EJ. US Public Attitudes Toward COVID-19 vaccine mandates. JAMA Netw Open 2020; 3 (12) e2033324
• 32 Colorado Department of Public Health and Environment, State of Colorado 2020/2021. School and Child Care Immunization Data. Accessed January 20, 2022 at: https://www.dcphrapps.dphe.state.co.us/Reports/ReportList/Partners