Elsevier

Academic Pediatrics

Volume 21, Issue 7, September–October 2021, Pages 1126-1133
Academic Pediatrics

Parental Vaccine Hesitancy and Risk of Pediatric Influenza Under-Vaccination in a Safety-Net Health Care System

https://doi.org/10.1016/j.acap.2021.05.017Get rights and content

Abstract

Objective

To measure the risk of influenza under-vaccination in children of vaccine-hesitant parents, referent to children of nonhesitant parents, in a sample of disadvantaged families in one influenza season.

Study Design

A prospective observational cohort study of English- and Spanish-speaking parents of 2-year-olds presenting at random for well, sick, or specialty visit care from August 1, 2019 to February 28, 2020. Parents answered demographic questions and the Parent Attitudes about Childhood Vaccines survey. We followed children until season's end, extracting vaccination data on April 30, 2020. We dichotomized vaccination status as unvaccinated or partially/fully vaccinated, analyzing data with multivariable Poisson regression; in secondary analyses, we conducted adjusted time-to-event analyses.

Results

Overall, 263 parents consented (response rate: 90%); our final sample included 255 dyads. Thirty-three (13%) parents were vaccine hesitant. In adjusted analyses, children of hesitant parents (n = 33) had a 195% increased risk (adjusted Risk Ratio 2.95; 95% confidence interval 1.91, 4.56) of being unvaccinated at season's end, referent to children of nonhesitant parents (n = 222). In time-to-event analyses, children of vaccine-hesitant parents were also more likely to be unvaccinated before influenza activity peaked (P = .02).

Conclusions

Parental vaccine hesitancy tripled the risk of pediatric influenza nonvaccination in a sample of poor and minority families during the 2019 to 2020 influenza season. As parental vaccine hesitancy appears to exacerbate pediatric influenza vaccination disparities, future work should explore parental hesitancy with poor and minority stakeholders and tailor evidence-based interventions to benefit children from these communities who receive care at all practice sites.

Section snippets

Design, Setting, and Population

We performed a prospective observational cohort study of English- and Spanish-speaking parents bringing their 2-year-old children to 3 pediatric, urban, safety-net clinics within the Denver Health system (Denver, Colo) for well or sick care during the 2019 to 2020 influenza season. We chose 2-year-old children because they are at high risk of influenza complications21 and should have completed the routine primary series of vaccines, leaving parents to decide only about the yearly influenza

Results

During the recruitment period, 2850 2-year-olds had recorded visits at the 3 recruiting clinics. We approached 293 parents for participation in the study; 263 parents consented (response rate of 90%). Two parent surveys were incomplete, and 6 children were recruited twice on separate occasions. Our final sample included 255 dyads, representing ~9% of all 2-year-olds visiting the 3 clinics during the recruitment period. Table 1 demonstrates similar demographic characteristics for participating

Discussion

This study documents how parental vaccine hesitancy impacted pediatric influenza vaccination for children of English and Spanish-speaking parents in a safety-net system. Overall, in adjusted analyses, we found that poor and minority children of hesitant parents were significantly less likely to be vaccinated by both peak influenza activity and season's end, compared to children of nonhesitant parents.

We found that poor and minority children of vaccine hesitant parents were 3 times more likely

Conclusions

Caregiver vaccine hesitancy tripled the risk of nonvaccination for 2-year-olds in a safety-net system during the 2019 to 2020 influenza season. Additionally, many children of nonhesitant parents were still unvaccinated before peak influenza activity. In a SARS-CoV-2 pandemic disproportionately affecting minority communities, seasonal pediatric influenza vaccination in safety-net systems is imperative to avert further inequities. Future work should explore influenza vaccine hesitancy in poor and

Acknowledgments

Financial statement: This work was supported by a Denver Health Junior Investigator Research Award, sponsored by the Denver Health Foundation.

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    Conflict of Interest: All authors report no conflict of interest, real or perceived, relevant to: 1) study design; 2) the collection, analysis, and interpretation of data; 3) the writing of the report; and 4) the decision to submit the paper for publication.

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