Nearly 1 in 5 children in US have a parent hesitant about vaccines, will it impact Covid-19 and flu season?
Almost 20% of US children have a parent who is hesitant about childhood vaccines and these children are significantly less likely to receive a flu vaccine, according to researchers. The findings come as health officials warn about both flu and Covid-19 circulating in the fall and winter, and follow a flu season that set records for pediatric deaths and hospitalizations.
According to the team -- which includes experts from the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), and National Center for Health Statistics -- vaccine hesitancy has contributed to large outbreaks of vaccine-preventable diseases in several countries, including the US.
While there is a lack of consensus on the definition of vaccine hesitancy, it can be defined as the “mental state of holding back in doubt or indecision regarding vaccination.” Such hesitancy may or may not lead a person to refuse or delay vaccinations for themselves or their children. “Understanding the contributions of vaccine hesitancy among other vaccination barriers is needed to inform improvements to the vaccination program,” explain authors.
What did the researchers find?
For the current analysis, the investigators examined data from the 2018 and 2019 National Immunization Survey-Flu, which included questions about parents’ vaccine hesitancy. “This is the first report on the prevalence of vaccine hesitancy among parents of children 6 months through 17 years in the US using a survey module developed by CDC and examining the association with childhood influenza vaccination coverage,” write authors in the study published in the journal Pediatrics.
The results reveal that nearly one in five children in the US had a “vaccine-hesitant” parent in 2019, and hesitancy was negatively associated with childhood influenza vaccination. About 26% of parents in 2018 reported they were “hesitant about childhood shots.” In both survey years, 6% of children had a parent reporting using a nonstandard vaccine schedule.
The influenza vaccination coverage was 26 percentage points lower in the 2017-2018 as well as the 2018-2019 season among children of parents who self-reported being somewhat or very hesitant about childhood shots compared with children of parents who were not at all or not that hesitant. “During the 2018-19 season, about 41% of children with vaccine-hesitant parents received a flu vaccine compared to 67% of children whose parents were not vaccine-hesitant. The difference was nearly the same the year before,” the findings state.
An estimated 23% in 2018 and 19% in 2019 explained that concern about the number of vaccines a child gets at one time impacted their decision to vaccinate. A child’s age was associated with parental self-report of being hesitant about childhood shots: 18% of parents of children aged 13 to 17 years compared with 20% of parents of children aged 6 to 23 months reported being hesitant. The child’s age was also associated with parental concern about the number of vaccines a child gets at one time affecting their decision to vaccinate, with a lower prevalence of concern among parents of children aged 5 to 17 years compared with children aged 6 to 23 months.
According to the analysis, 27% in 2018 and 22% in 2019 said that concerns about serious, long-term side effects impacted their decision to vaccinate. About 15% in 2018 and 14% in 2019 said they know someone with a serious long-term side effect from vaccination. Another 17% in 2018 and 14% in 2019 stated their doctor or healthcare provider was not their most trusted source of information about childhood vaccines.
Black parents were significantly more likely than White parents to be hesitant about childhood vaccination and side effects, according to the study. “Parents of non-Hispanic Black children, compared with parents of non-Hispanic White children, had a higher prevalence of self-reported hesitancy about childhood shots (29% versus 18%), concerns about the number of shots (22% versus 18%), and concerns about side effects (29.8% versus 19.9%). Parents of non-Hispanic
other or multiple race children also had a higher prevalence of concerns about side effects compared with parents of non-Hispanic White children (24% versus 20%),” write investigators.
Parents in the highest income group had lower prevalence of self-reported hesitancy about childhood shots than all other income groups (16% versus 21%-25%), and likewise, they had lower prevalence of concern about side effects than all other income groups (19% versus 23%-26%). Parents who did not report income on the survey had a higher prevalence of not following the standard schedule compared with the highest income group (9% versus 6%).
Responses in vaccine concerns varied widely by state. For example, only 13% of parents in Vermont were “somewhat to very hesitant,” compared to 25% in Mississippi. “The association of state-level parental hesitancy variables with vaccination coverage could be an avenue for future study, taking into account possible confounding and state-level vaccination program variables,” recommend authors.
Concerns remain
On a larger level, health experts are concerned that vaccine hesitancy may also impact the ability of the US and other nations to control the coronavirus pandemic. Over 927,500 total child Covid-19 cases have been reported in the US, and children represent 11.3% of all cases, reveal numbers tracked by the American Academy of Pediatrics (AAP) as of November 5. Over two weeks, between October 22 and November 5, there was a 17% increase in child coronavirus.
Moreover, according to the CDC, nearly 80% of flu-related pediatric deaths reported to it happen in children who have not been fully vaccinated against the flu. Children younger than five years old and those younger than two, in particular, are at high risk of developing serious flu-related complications. Children with certain long-term health problems, including asthma, diabetes, and disorders of the brain or nervous system, are also at high risk of serious flu complications
During the 2019-20 season, 195 children died of flu, a new record for a regular flu season. Hospitalization rates for children aged 4 years and under were at a record high, even surpassing the 2009 H1N1 pandemic, and rates for children ages 5-17 were higher than any recent regular season.
Based on their findings, the team recommends that consistently monitoring changes in vaccine hesitancy, including socioeconomic differences, could inform immunization programs in targeting interventions and provide resources to facilitate provider-patient vaccine conversations. Such measures could “ultimately increase confidence in vaccinations and improve vaccination coverage to protect children from disease,” they suggest.