我国两个地区儿童流感疫苗与肺炎疫苗接种现状与影响因素分析

目的 了解儿童流感疫苗和肺炎疫苗的接种行为与影响因素。方法 采用两阶段整群抽样,在北京市通州区和甘肃省白银市对适龄儿童家长开展横断面问卷调查,分析儿童流感疫苗和肺炎疫苗接种率及影响因素。结果 共纳入2 377名儿童,儿童流感疫苗接种率为35.93%,肺炎疫苗接种率为16.58%,两种疫苗均接种率为11.65%。接种两种疫苗的理由占比前三位分别为认为疾病严重（流感疫苗：36.02%;肺炎疫苗：49.61%）、学校、单位要求接种（流感疫苗：28.76%;肺炎疫苗：25.45%）和认为疾病易感（流感疫苗：26.41%;肺炎疫苗：13.88%）;未接种疫苗的理由前三位分别为个人方面、疫苗本身和疫苗供应。家庭居住地为农村是影响两类疫苗接种的重要因素。子女数量>1个的家庭、家庭居住地为农村和家庭人均年收入较低与两类疫苗的接种呈负相关。结论 调查地区儿童流感疫苗和肺炎疫苗接种率较低,农村家庭、多子女家庭是扩大疫苗接种的重点关注人群。加强疫苗相关知识宣教,引导家长正确认知疫苗安全性问题,协调疫苗供应与降低疫苗价格对提高流感疫苗和肺炎疫苗接种率具有促进作用。     

儿童家长四种非免疫规划疫苗犹豫调查

目的 了解中国儿童家长对B型流感嗜血杆菌疫苗（Haemophilus influenzae type b vaccine,Hib）、水痘疫苗、DTaP-IPV-Hib五联疫苗、流感疫苗四种非免疫规划疫苗犹豫情况。方法 2021年6月展开横断面研究，对0～6岁儿童家长的四种非免疫规划疫苗犹豫情况开展线上调查。利用logistics回归模型分析非免疫规划疫苗犹豫的影响因素。结果 本研究10 916名家长中，Hib、水痘疫苗、五联疫苗和流感疫苗的疫苗犹豫分别有3 846名（35.23%）、1 769名（16.21%）、4 349名（39.84%）和3 050名（27.94%）。多因素分析结果显示，地域、收入和同时接种多种疫苗的意愿是四种疫苗共同的影响因素。中部地区儿童家长四种疫苗犹豫发生可能性高于其他地区（OR=1.07, 95%CI:0.96～1.20, P=0.01; OR=1.15,95%CI:1.00～1.33, P<0.01; OR=1.19, 95%CI:1.07～1.34, P<0.01; OR=1.10, 95%CI:0.98～1.24, P<0.01）。家...     

家庭药物储存及儿童用药行为现况研究

目的 调查居民家庭药物储存及儿童用药行为,分析存在的问题,提出合理建议。方法 采用方便抽样的方法,随机在全国20家儿童医院门诊就诊的患儿家长进行问卷调查,并对调查结果进行描述性分析。结果 共回收13 940份完整问卷,结果显示,98.33%的中国居民有家庭药箱储备,家庭药箱中儿童药物储备种类排在前三位的分别为儿童感冒药（73.95%）、儿童内服止痛退热类药（48.01%）和儿童皮肤外用药（41.10%）;居民购买家庭儿童常备药的途径主要是根据医生的处方和指导（71.18%）;238个（1.71%）家庭曾发生过儿童药物中毒事件,过量服药为首位原因（44.96%）;22.33%的家长用药前不重视说明书;儿童用药不规范行为主要有服用成年人药物（32.70%）、不按时服药（30.90%）、孩子发热就用退热药（26.35%）。结论 中国家庭中儿童用药储备以小儿常见病的治疗药物为主,购买途径以医师处方为主,较为关注药物有效性和安全性。但儿童用药不规范行为较多,应充分发挥临床药师的咨询功能,从多个途径指导和改善儿童安全用药。     

肠道病毒71型疫苗上市后疫苗保护效果和免疫原性分析

目的 分析肠道病毒71型（EV-A71）疫苗上市接种后的疫苗保护效果和免疫原性。方法 采用队列研究于2017年10－12月在上海市静安区招募符合纳入标准的预防接种门诊受种者为研究对象,按0、30 d程序接种疫苗者纳入接种组,不接种疫苗者纳入对照组,随访观察1年,评估疫苗保护效果和接种2剂次疫苗后抗体水平及阳转率。结果 共纳入3 018名8~20月龄的儿童,接种组1 211人,对照组1 807人,经过1年随访,EV-A71疫苗对EV-A71感染引起的手足口病保护率为100.00%（95% CI：-66.99%~100.00%）。接种组中124人检测了中和抗体,接种首剂疫苗后60 d抗体几何平均滴度（GMT）为41.76（95% CI：35.60~49.34）,接种后365 d GMT为28.44（95% CI：23.59~34.54）。结论 EV-A71疫苗对于儿童有良好的免疫应答,EV-A71感染引起的手足口病病例较少,需进一步观察。     

1～6岁儿童饮食行为问题的发生情况及影响因素分析

目的 了解1～6岁儿童饮食行为问题的发生情况及相关影响因素。方法 采用分层随机整群抽样方法,于2019年6-12月从北京市顺义区抽取2个社区卫生服务中心和2个幼儿园,将其管辖的所有1～6岁儿童进行问卷调查,收集儿童及家庭基本情况、饮食行为问题的发生率及相关因素等数据,采用多因素logistic回归模型分析儿童不良饮食行为问题的相关影响因素。结果 共回收有效问卷2 391例,其中存在至少1种饮食行为问题的儿童1 432例（59.9%）。最常见的饮食行为问题为进食时注意力不集中（48.8%）,然后依次为进食位置不固定（14.0%）、挑食（13.0%）、进食时间过长（11.2%）、零食过多（9.0%）、汤泡饭（4.6%）。多因素logistic回归模型结果显示,母亲文化程度、家庭年收入、主要看护人、家长对儿童进食的态度是儿童饮食行为问题的相关影响因素。母亲文化程度高（OR=0.528,95% CI：0.431～0.647）、家庭年收入高（OR=0.656,95% CI：0.473～0.909）是儿童不良饮食行为的保护因素;祖父母/外祖父母看护（OR=1.366,95% CI：1.151～1.622）、靠哄骗/强制引导儿童进食的态度（OR=1.581,95% CI：1.284～1.947）是儿童不良饮食行为的危险因素。结论 1～6岁儿童饮食行为问题的发生率高,应重视对儿童家庭尤其是低年收入、低文化程度及祖父母/外祖父母看护家庭的干预指导,以降低儿童饮食行为问题的发生。     

儿童家长预防接种后留观时间及其相关因素分析

目的 分析儿童家长预防接种后留观时间及其相关因素。方法 2019年12月至2020年1月,选取我国6个省份（山东省、广东省、河南省、四川省、内蒙古自治区和辽宁省）12个县（区）34个预防接种门诊,采用分阶段抽样方法招募预防接种0~3岁儿童家长,开展问卷调查。采用多因素logistic回归模型分析儿童家长预防接种后留观时间的相关因素。采用SAS 9.4软件进行统计学分析。结果 共招募0~3岁儿童家长3 292名,符合标准的研究对象为3 178名。儿童家长预防接种后正确留观时间≥30 min的比例为87.85%（2 792/3 178）。多因素logistic回归分析结果显示,影响儿童家长预防接种后留观时间的主要因素分别为预防接种工作人员正确告知家长留观时间≥30 min（OR=31.622,95%CI：19.847~50.384）、家长职业为医护人员（OR=2.779,95%CI：1.505~5.133）、参加预防接种宣传教育活动（OR=1.986,95%CI：1.438~2.743）、家长年龄≥35岁（OR=1.900,95%CI：1.215~2.971）、胎次为第1胎（OR=1.663,95%CI：1.282~2.156）、家庭人均年收入为8 000~元（OR=1.646,95%CI：1.168~2.319）、儿童年龄为0~12月龄（OR=1.646,95%CI：1.203~2.252）和13~24月龄（OR=1.506,95%CI：1.064~2.133）、信任预防接种工作人员的预防接种建议（OR=1.481,95%CI：1.067~2.055）。结论 儿童家长预防接种后正确留观时间≥30 min的比例较高。预防接种工作人员正确告知家长留观时间的影响最大。     

儿童家长接受预防接种服务额外消耗时间对总体满意率的影响

目的 了解儿童家长对预防接种服务的总体满意率,以及接受预防接种服务额外消耗时间对其满意率的影响。方法 2019年12月至2020年1月,对0~3岁儿童家长基本情况、接受预防接种服务额外消耗时间以及对预防接种服务的总体满意情况进行问卷调查。共3 178名儿童家长纳入分析。采用二分类logistic回归模型和限制性立方样条模型分析儿童家长接受预防接种服务额外消耗时间对总体满意率的影响。结果 儿童家长对预防接种服务的总体满意率为92.32%。儿童家长从家到预防接种门诊时间M（P₂₅,P₇₅）为10.00（10.00,20.00）min,办理预约登记等候时间M（P₂₅,P₇₅）为10.00（5.00,15.00）min,等待进行注射疫苗时间M（P₂₅,P₇₅）为5.00（3.00,10.00）min,额外消耗总时间M（P₂₅,P₇₅）为30.00（20.00,45.00）min。二分类logistic回归分析结果显示,调整相关因素后,有利于提高儿童家长总体满意率的额外消耗时间因素依次为办理预约登记等候时间（4~min组与8~min组相比,OR=1.863,95%CI：1.307~2.657）、等待进行注射疫苗时间（<4、4~min组与8~min组相比,OR=1.529,95%CI：1.102~2.120;OR=1.534,95%CI：1.104~2.130）、额外消耗总时间（15~min组与30~min组相比：OR=1.470,95%CI：1.094~1.976）。限制性立方样条模型分析显示,儿童家长办理预约登记等候时间（非线性检验χ²=13.18,P=0.001）、等待进行注射疫苗时间（非线性检验χ²=13.50,P=0.001）以及额外消耗总时间（非线性检验χ²=9.38,P=0.009）与总体满意情况的关联强度呈非线性的倒“V”形剂量反应关系。结论 儿童家长办理预约登记等待时间、等待进行注射疫苗的时间和接受预防接种服务额外消耗总时间影响总体满意率。其中,办理预约登记等待时间的影响最大,且该环节等待时间较长,建议预防接种门诊利用信息化技术（如建立微信公众号、APP等）开展分时段预约,并控制单位时间服务人数,对预防接种人群进行有效分流。     

4~6岁儿童接种麻疹-流行性腮腺炎-风疹联合减毒活疫苗加强免疫的免疫原性与安全性研究

目的 探讨4~6岁儿童接种麻疹-流行性腮腺炎-风疹联合减毒活疫苗（MMR）后的加强免疫原性与安全性。方法 分别在山西省、内蒙古自治区以及北京市招募曾有8月龄和18月龄接种过1剂麻疹-风疹联合减毒活疫苗和MMR疫苗免疫史的4~6岁儿童作为研究对象,分为4、5、6岁组,进行MMR疫苗加强免疫研究。接种MMR疫苗前与接种后35~42 d各采集血标本3 ml。在研究期间,主动监测疫苗接种后30 min、1 d、2 d、3 d、4~12 d,以及13~42 d的不良事件。血清采用酶标法检测麻疹、流行性腮腺炎和风疹的IgG抗体。采用方差分析或非参数检验比较研究组间麻疹、腮腺炎和风疹抗体几何平均浓度（GMC）,采用χ²检验或Fisher确切概率法比较组间阳性率和不良事件发生率。结果 共500名完成免后采血儿童纳入免疫原性分析,535名儿童纳入安全性分析。总体不良事件发生率为20.37%,轻度不良事件最多。局部与全身不良事件发生率分别为0.37%和20.00%。局部不良事件的症状以接种部位发红为主,全身不良事件以发热症状为主,其次为咳嗽、皮疹、流涕等。在4~6岁进行1剂MMR疫苗加强免疫后,麻疹抗体、腮腺炎抗体与风疹抗体阳性率均在99%以上,3组间阳性率差异无统计学意义。3组间仅腮腺炎抗体GMC差异有统计学意义（P=0.042）,麻疹与风疹抗体相关结果均无差异。免前阴性者的麻疹、腮腺炎及风疹抗体GMC均低于免前阳性者。结论 在4~6岁儿童中进行MMR疫苗的加强免疫,具有良好的免疫原性与安全性,在4~6岁之间的加强免疫效果相近。     

2017年我国6个省份28个县（区）儿童道路交通伤害流行状况

目的 了解我国6个省份28个县（区）儿童道路交通伤害流行状况,并提出预防建议。方法 采用普查的方法,于2017年对6个省份28个县（区）61个乡镇/街道（社区）特定年龄段儿童的道路交通伤害发生情况进行问卷调查。结果 共调查204 628名儿童,发生908人次（0.44%）道路交通伤害,未上幼儿园儿童的道路交通伤害发生率最高,为0.94%。男童的道路交通伤害发生率（0.54%）高于女童（0.34%）。7月份是儿童道路交通伤害的高发期（12.92%）。儿童道路交通伤害发生时活动前三位依次是玩耍/娱乐（21.61%）、骑/乘电动自行车（20.40%）、步行（20.07%）。绝大多数病例的伤害性质以挫伤/擦伤为主,占病例总数的42.26%。受伤部位主要以下肢（38.85%）、上肢（23.29%）、头部（20.20%）为主。儿童道路交通伤害病例大多数治疗后痊愈,占全部病例数的85.43%。发生道路交通伤害的儿童,住院时间M为7 d,花费M为3 000元。结论 我国6个省份28个县（区）男童道路交通伤害发生率高于女童,未上幼儿园儿童的发生率高于其他学段的儿童,儿童在玩耍/娱乐、骑/乘电动自行车、步行时容易发生道路交通伤害。     

中国狂犬病疫苗不良反应发生率Meta分析

目的 对中国地区狂犬病暴露后的普通人群全程接种狂犬病疫苗后不良反应发生率进行Meta分析,为开展狂犬病疫苗接种策略改进提供数据支持。方法 计算机检索中国知网、万方数据知识服务平台、维普期刊资源整合服务平台、中国生物医学文献服务系统、PubMed英文数据库和The Cochrane Library中公开发表的有关狂犬病疫苗接种后不良反应的研究文献,检索时限为2000年1月至2016年7月,根据纳入和排除标准收集资料,采用R软件对狂犬病疫苗不良反应发生率进行Meta分析。结果 共纳入29篇文献,纳入文献无明显发表偏倚,其中总调查人数为94 222人,发生不良反应11 020例,不良反应发生率为1.04%～47.78%。狂犬病疫苗总不良反应的合并发生率为9.82%（95% CI：7.58%～12.72%）,局部不良反应的合并发生率为12.05%（95% CI：9.26%～15.69%）,全身不良反应的合并发生率为9.06%（95% CI：7.07%～11.61%）。液体疫苗接种不良反应合并率为32.39%（95% CI：21.88%～47.94%）,冻干疫苗接种不良反应合并率为8.65%（95% CI：4.54%～16.51%）,两组差异有统计学意义（P<0.05）。结论 狂犬病疫苗接种局部不良反应率高于全身不良反应率。液体狂犬病疫苗不良反应率高于冻干狂犬病疫苗,建议采用安全性较好的冻干狂犬病疫苗,逐步替代液体狂犬病疫苗。     

Evaluation of the reliability and validity of a vaccine hesitancy scale on knowledge,attitude, trust and vaccination environment (KATE-S) in Chinese parents

ObjectiveTo verify the reliability and validity of a vaccine hesitancy scale about knowledge, attitude, trust and vaccination environment (KATE-S) among the Chinese parents.MethodsA questionnaire survey was conducted by convenience sampling in China using the KATE-S to assess knowledge of vaccines, attitudes towards vaccines, trust in acquired information and vaccination environment and vaccination status of vaccine introduced in immunization program among children.ResultA total of 199 valid questionnaires were collected from the parents. Among those, 83 (41.7%) parents accepted all vaccines without hesitancy, 111 (55.8%) parents accepted all but had hesitancy intention, and 5 (2.5%) had hesitancy behaviour of refusing or delaying vaccination. The overall test–retest reliability, split-half reliability and Cronbach's coefficient values were 0.924, 0.885 and 0.823, respectively. The scale-level content validity index (S-CVI) of universal agreement was 0.867, and the average S-CVI was 0.978. Exploratory factor analysis extracted seven common factors from the scale, and the cumulative contribution rate was 56.8%. The correlation coefficients between the items and their dimensions ranged from 0.405 to 0.760, with a calibration success rate of 100% for convergent and discriminant validity. After adjusting for the basic characteristics, the knowledge level of hesitancy intention group and hesitancy behavior group were both lower than accept all group (OR = 0.78, 95% CI: 0.65–0.94; OR = 0.26, 95 %CI: 0.07–0.94).ConclusionThe KATE-S has good reliability and validity in Chinese parents and would be considered to expand the sample size and survey areas to obtain more representative results.     

Vaccine hesitancy among parents of adolescents and its association with vaccine uptake

BackgroundAddressing parental vaccine hesitancy may increase adolescent vaccination acceptance. However, no validated measure exists to identify parents hesitant toward adolescent vaccines.ObjectiveTo determine if a modified version of the Parent Attitudes about Childhood Vaccines (PACV) survey, a previously validated tool to identify parental hesitancy toward vaccines in infants, predicts adolescent vaccine uptake at office visits.MethodsWe modified the PACV for use in the adolescent setting and distributed it to a convenience sample of parents of adolescents aged 11 to 17 presenting for care at a diverse group of six pediatric practices in Oklahoma and South Carolina. We determined the vaccination status of the parents’ adolescents for 3 vaccines (Tetanus–diphtheria–acellular pertussis [Tdap], meningococcal conjugate [MCV4], and human papillomavirus [HPV] vaccines). We used Fisher's exact tests to compare vaccination status with each survey item and with an overall general hesitancy scale that we constructed.ResultsWe analyzed 363 surveys. At the time of the visit, vaccination coverage was 84% for Tdap, 73% for MCV, and 45% for any dose of HPV. Thirty-nine percent of parents expressed concern about vaccine efficacy and 41% expressed concern about side effects. Forty-five percent of parents disagreed with the statement that “teens can get all of the vaccines that are due at a single visit.” Two individual items were associated with not receiving a dose of HPV vaccine that was due. The overall modified PACV score failed to predict adolescent vaccine uptake at an office visit.ConclusionSeveral individual items were associated with vaccine uptake. The cumulative modified PACV, a general measure of vaccine hesitancy, was not associated with vaccination status despite illuminating parental hesitancy. We need to better understand vaccine-specific concerns for the adolescent population.     

“Everybody just wants to do what's best for their child”: Understanding how pro-vaccine parents can support a culture of vaccine hesitancy

BackgroundAlthough a large majority of parents vaccinate their children, vaccine hesitancy has become more widespread. It is not well understood how this culture of vaccine hesitancy has emerged and how it influences parents’ decisions about vaccine schedules.ObjectiveWe sought to examine how attitudes and beliefs of parents who self-report as pro-vaccine are developed and contribute to immunization decisions, including delaying or spacing vaccines.MethodsOpen-ended, in-depth interviews (N = 23) were conducted with upper-middle class parents with young children living in Philadelphia. Interview data were coded and key themes identified related to vaccine decision-making.ResultsParents who sought out vaccine information were often overwhelmed by the quantity and ambiguity when interpreting that information, and, consequently, had to rely on their own instinct or judgment to make vaccine decisions. In particular, while parents in this sample did not refuse vaccines, and described themselves as pro-vaccine, they did frequently delay or space vaccines. This experience also generated sympathy for and tolerance of vaccine hesitancy in other parents. Parents also perceived minimal severe consequences for deviating from the recommended immunization schedule.ConclusionThese findings suggest that the rise in and persistence of vaccine hesitancy and refusal are, in part, influenced by the conflicts in the information parents gather, making it difficult to interpret. Considerable deviations from the recommended vaccination schedule may manifest even within a pro-vaccine population due to this perceived ambiguity of available information and resulting tolerance for vaccine hesitancy.     

Forgone vaccination during childhood and adolescence: Findings of a statewide survey of parents

ObjectiveWidespread immunization confers both individual- and community-level protection against vaccine-preventable diseases. To better understand vaccine hesitancy, we assessed correlates of forgone vaccination for children and adolescents.MethodWe analyzed weighted data from the 2010 Child Health Assessment and Monitoring Program survey of North Carolina parents (n = 1,847) of children ages 1–17.ResultsOverall, 12% of parents reported having refused or delayed a vaccine for their child. Forgone vaccination was more common for young children than for teenagers (16% versus 8%) and for children born before rather than on/after their due dates (16% versus 10%). Parents with high (versus low) scores on an index of healthy feeding practices were also more likely to report forgone vaccination (17% versus 5%). The most common reason for forgoing vaccines was concern about safety (34%). Other reasons included believing the child did not need (18%) or was too young (13%) for the vaccine, or that the child was sick (10%).ConclusionForgoing vaccines is more common among parents who are socially advantaged and highly attentive to their children's health in other areas such as nutrition. Providers should reassure parents of premature or sick children that such circumstances are not typically contraindications to vaccination.     

Vaccine hesitancy in Argentina: Validation of WHO scale for parents

BackgroundThe WHO SAGE Working Group on Vaccine Hesitancy developed the Vaccine Hesitancy Scale (VHS) to identify and compare hesitancy in different global settings. The objectives of the study were to describe and analyze vaccine hesitancy and to validate the VHS in a group of parents in Buenos Aires city, Argentina.MethodsA cross-sectional survey was conducted in parents of 1–3 and 12–15 year-old children at three health centres in Buenos Aires City, between June 2018 and May 2019. Sociodemographic data were collected together with history of refusal and/or delay in children’s vaccination (defined as hesitancy). The 10-item VHS using 5-point Likert-scale (higher scores indicating lower hesitancy) was administered and children’s immunization record cards were verified. Link between hesitancy and socio-demographic variables, and hesitancy and vaccination status was analyzed for five specific vaccines. Cronbach‘s α was used to determine internal consistency reliability and factor analysis to confirm survey subdomains. Simple and multiple regression analysis was used to examine associations between VHS scores and hesitancy, and VHS scores and vaccination status.ResultsSix hundred parents were surveyed and 469 immunization cards verified; 11.5% (n = 69) parents were hesitant. High maternal educational level showed significant association with hesitancy (OR 2.66 95% CI: 1.20–5.9) in the adjusted model. Hesitancy was significantly associated with incomplete MMR vaccination in children (OR 4.43 95% CI: 1.08–8.20) and HPV vaccination in adolescents (OR 3.75 95% CI: 1.54–9.12). Cronbach‘s α was 0.66 and factor analysis identified three underlying constructs: “Benefits”, “Harms” and “Confidence in healthcare system”. High scores in VHS were associated with lack of hesitancy (OR 1.2 95% CI: 1.13–1.27) and complete vaccination status (OR 1.07 95% CI: 1.02–1.12).ConclusionsHesitancy was associated with high maternal educational level, and incomplete MMR and HPV immunization status in children and adolescents. VHS was a reliable and valid tool in this population.     

A qualitative study on COVID-19 pandemic impacts on parental attitudes and intentions for routine adolescent vaccinations: The role of trust

IntroductionThe COVID-19 pandemic has contributed to declines in routine childhood and adolescent vaccination coverage globally. While the declines in Australia have been less, they are a concern, given steady increases in coverage prior to the pandemic. Given limited evidence on how the experiences of parents during the pandemic affected their attitudes about and intentions towards adolescent vaccinations, with this study we aimed to explore these.MethodsThis was a qualitative study. We invited parents of adolescents eligible for school-based vaccinations in 2021 from metropolitan, regional and rural areas of New South Wales and Victoria (the most affected States) and South Australia (less affected) to half hour-long online semi-structured interviews. We analysed data thematically and applied a conceptual model of trust in vaccination.ResultsIn July 2022 we interviewed 15 accepting, 4 hesitant and two parents who refused adolescent vaccinations. We identified three themes: 1. Pandemic impacting on professional and personal lives and routine immunisations; 2. Pandemic strengthening preexisting vaccine hesitancy, with perceived lack of clarity in governmental information about vaccination and stigma around non-vaccinating as contributing factors; 3. Pandemic raising awareness of the benefits of COVID-19 and routine vaccinations, with communication campaigns and one’s trusted doctor’s vaccination recommendations as contributing factors.ConclusionsFor some parents, experiences of poor system readiness and growing distrust towards health and vaccination systems strengthened their pre-existing vaccine hesitancy. We offer recommendations on how trust in the health system and immunisation can be optimised post-pandemic to increase uptake of routine vaccines. These include improving access to vaccination services and clear, timely information about vaccines; supporting immunisation providers in their immunisation consultations; working alongside communities, and building capacity of vaccine champions.     

A validated modification of the vaccine hesitancy scale for childhood,influenza and HPV vaccines

IntroductionVaccine hesitancy contributes to outbreaks of preventable disease worldwide. The Vaccine Hesitancy Scale (VHS), developed by the international WHO SAGE Working Group, has been validated previously for measuring hesitancy towards childhood vaccines; some psychometric properties were suboptimal.MethodsWe collected data using large, nationally-representative samples of parents in the U.S. We adapted the VHS items, and additional hesitancy items, to assess hesitancy towards influenza and HPV vaccines in addition to routine childhood vaccines. We then used exploratory and confirmatory factor analysis to identify latent constructs and create modified scales for childhood (VHS-child), influenza (VHS-flu) and HPV (VHS-HPV) vaccines with improved psychometric properties. Finally, we compared hesitancy scores on the VHS-child, VHS-flu, and VHS-HPV, to self-reported receipt of each vaccine category, and compared subscale scores to assess whether drivers of hesitancy differed by vaccine category.Results2052 parents of children <18 years old completed the VHS-child and VHS-flu while 2020 parents of adolescents completed the VHS-HPV. A two-factor structure of ‘risks’ and a ‘lack of confidence’ was found for each vaccine category. Slight modifications to the VHS improved psychometric properties. Hesitancy was strongly associated with vaccine receipt: e.g., 76% of parents not hesitant towards influenza vaccine had vaccinated their child the past season, versus 9% of hesitant parents (p < 0.0001). Subscale scores also differed significantly between vaccines: lack of confidence was greater towards influenza (Median (IQR): 2.0 (1.2, 3.3)) and HPV (2.0 (1.3, 3.0)) vaccines than childhood (1.2 (1.0, 1.8), p < 0.0001 for both) vaccines; perceived risks of HPV vaccines (2.7 (1.7, 3.7)) were greater than for childhood vaccines (2.0 (1.3, 3.0), p < 0.0001).ConclusionsOur modified VHS scales perform well psychometrically and allow for consistent measurement of the extent and reasons for hesitancy between vaccine categories. We suggest that future work use these scales to examine hesitancy towards other vaccines and to monitor hesitancy over time.     

Vaccine hesitancy towards childhood immunisation amongst urban pregnant mothers in Malaysia

BackgroundVaccine hesitancy is a complex behaviour which involves various degrees of indecision about specific vaccines or vaccination uptake. Access to antenatal care had been associated with positive vaccine behavior.ObjectiveTo determine the prevalence of vaccine hesitancy towards childhood immunisation amongst urban pregnant mothers and the associated socio-demographic factors.MethodsA cross-sectional study was conducted among 1081 women who received antenatal care at a teaching hospital in Kuala Lumpur. Vaccine hesitancy was assessed using the Parent Attitudes about Childhood Vaccines (PACV) Survey in both English and validated Malay versions. The sociodemographic data of the mothers and their partners, source of vaccine information and reasons for hesitancy were analysed.ResultsEighty-six (8.0%) pregnant mothers were vaccine hesitant. Ethnicity, religion, number of children, educational level and employment status were significantly associated with vaccine hesitancy. Multivariable analysis showed that a low level of education was the most significant risk factor (p < 0.001), followed by religion (p = 0.03). Health professionals was the main source of information about vaccine. The non-vaccine hesitant women were more likely to seek information from health professionals, and health books and magazine. Fear of adverse side effects of vaccines was the predominant concern for all participants (58%) whilst fear of vaccination pain, preference for alternative medicine and lack of trust in the pharmaceutical industry were significant reasons given by the vaccine hesitant group. Partners’ ethnicity, a low educational level and a low income were significantly associated with vaccine hesitancy amongst pregnant mothers.ConclusionPrevalence of vaccine hesitancy amongst urban Malaysian pregnant women was relatively low. Muslim mothers are less likely to be vaccine hesitant. Educational level of mothers and their partners are the common determinant of vaccine hesitancy amongst antenatal mothers.     

Parents’ hesitancy towards vaccination in Indonesia: A cross-sectional study in Indonesia

BackgroundHesitancy towards vaccination has been studied as a barrier to vaccination among children, as well as participation in vaccine trials. This study aimed to investigate hesitancy towards vaccination among parents in Indonesia, as a part of the Indonesia Zika Vaccine Study.MethodsA cross-sectional study was conducted in eleven regencies and municipalities in Aceh and West Sumatra province, Indonesia. Parents were recruited from families at outpatient clinics of community health centers or hospitals. The survey included various questions about sociodemographic factors and the Parent Attitudes about Childhood Vaccination (PACV) scale. Linear regression was employed to assess the association between explanatory variables and vaccine hesitancy.ResultsA total of 956 parents were interviewed and 26.4% of participants had heard about Zika. Overall, 152 parents (15.9%) were vaccine hesitant, and this proportion was the highest in the safety and efficacy subdomain (61.6%). In the unadjusted analysis, having a diploma certificate, working in the health sector, and having heard about Zika were significantly associated with non-hesitancy towards children vaccination. Having heard about Zika was the only factor that was significantly associated with hesitancy towards vaccination in multivariate model (aOR: 0.43, 95% CI: 0.26–0.71). Mothers, younger parents (aged 20–29 years old), and those with only a primary school education were more concerned about vaccine safety and efficacy compared to fathers, older groups, and individuals with more education, respectively.ConclusionsHesitancy towards pediatric vaccination is observed in 15% of respondents and most of the hesitancy was expressed in terms of vaccine safety and efficacy. Therefore, continuous dissemination of vaccine information needs to be carried out to earn parents’ trust and increase vaccination coverage in Indonesia.