Parental experience with childhood COVID-19 vaccines and factors associated with parental hesitancy despite being vaccinated: findings of a cross-sectional analysis from Pakistan and implications for the future.

This study examined parental experiences with COVID-19 vaccination and factors contributing to COVID-19 vaccine hesitancy (CVH) among them to help guide future policy initiatives. Cross-sectional study. Lahore, the second largest metropolis in Pakistan. This study was conducted among parents residing in Lahore from March to April 2023. Participants were recruited via convenience sampling. Data were collected using a prevalidated questionnaire that consisted of four sections: (1) informed consent, (2) demographic details, (3) COVID-19 vaccine uptake in children aged 5-17 years, parents' experience with childhood COVID-19 vaccination and their intention to vaccinate their unvaccinated children and (4) a modified 5C scale tailored to determine parents' confidence, complacency, constraints, calculation and collective responsibility with regard to COVID-19 vaccination. This study included 414 parents (median age=37 years; mothers=62%). COVID-19 vaccination rates for children in the age groups 12-17 years and 5-11 years were 72.5% and 30.1%, respectively. Transient adverse events following immunisation were reported by 32.7% of parents. Of parents with unvaccinated children aged 12-17 years, only 35% intended to vaccinate them. The majority of parents were not willing to vaccinate their children below 11 years of age. Parents with a self-reported positive history of COVID-19 disease (OR=2.531, p=0.016), and confident in the vaccine's safety and efficacy (OR=1.968, p=0.010), were more inclined to vaccinate their 5-11 years. In terms of vaccination of children below 5 years, confidence in the vaccine (OR=2.942, p=0.003) and a sense of collective responsibility were positive predictors (OR=2.260, p=0.035), while calculation was identified as a negative predictor of parents' intention to vaccinate their under 5 years (OR=0.421, p=0.018). CVH was significantly higher among parents of children aged 5-11 years and children younger than 5 years old. Priority should be given by health authorities to address parental concerns about vaccines and ensure that parents understand the significance of vaccination in protecting their children, to increase vaccination rates. This is because hesitancy towards one specific vaccine can negatively impact hesitancy rates in general.

Salman M ，Mallhi TH ，Khan YH ，Ul Mustafa Z ，Tanweer A ，Ikram M ，Hussain K ，Butt MH ，Ramdas N ，Meyer JC ，Godman B ... -  《BMJ Open》

Caregivers' hesitancy and outright refusal toward children's COVID-19 vaccination in the Democratic Republic of Congo: A community-based cross-sectional study.

Guillaume AS ，Ndwandwe D ，Nyalundja AD ，Bugeme PM ，Ntaboba AB ，Hatu'm VU ，Tamuzi JL ，Iwu-Jaja C ，Shindano TA ，Wiysonge CS ，Katoto PDMC ... -  《-》

Self-Reported COVID-19 Vaccine and Booster Acceptance and Hesitancy Among Autistic Adults in Pennsylvania: Cross-Sectional Analysis of Survey Data.

The autistic population is rapidly increasing; meanwhile, autistic adults face disproportionate risks for adverse COVID-19 outcomes. Limited research indicates that autistic individuals have been accepting of initial vaccination, but research has yet to document this population's perceptions and acceptance of COVID-19 boosters. This study aims to identify person-level and community characteristics associated with COVID-19 vaccination and booster acceptance among autistic adults, along with self-reported reasons for their stated preferences. Understanding this information is crucial in supporting this vulnerable population given evolving booster guidelines and the ending of the public health emergency for the COVID-19 pandemic. Data are from a survey conducted in Pennsylvania from April 11 to September 12, 2022. Demographic characteristics, COVID-19 experiences, and COVID-19 vaccine decisions were compared across vaccination status groups. Chi-square analyses and 1-way ANOVA were conducted to test for significant differences. Vaccination reasons were ranked by frequency; co-occurrence was identified using phi coefficient correlation plots. Most autistic adults (193/266, 72.6%) intended to receive or received the vaccine and booster, 15% (40/266) did not receive or intend to receive any vaccine, and 12.4% (33/266) received or intended to receive the initial dose but were hesitant to accept booster doses. Reasons for vaccine acceptance or hesitancy varied by demographic factors and COVID-19 experiences. The most significant were previously contracting COVID-19, desire to access information about COVID-19, and discomfort with others not wearing a mask (all P=.001). County-level factors, including population density (P=.02) and percentage of the county that voted for President Biden (P=.001) were also significantly associated with differing vaccination acceptance levels. Reasons for accepting the initial COVID-19 vaccine differed among those who were or were not hesitant to accept a booster. Those who accepted a booster were more likely to endorse protecting others and trusting the vaccine as the basis for their acceptance, whereas those who were hesitant about the booster indicated that their initial vaccine acceptance came from encouragement from someone they trusted. Among the minority of those hesitant to any vaccination, believing that the vaccine was unsafe and would make them feel unwell were the most often reported reasons. Intention to receive or receiving the COVID-19 vaccination and booster was higher among autistic adults than the population that received vaccines in Pennsylvania. Autistic individuals who accepted vaccines prioritized protecting others, while autistic individuals who were vaccine hesitant had safety concerns about vaccines. These findings inform public health opportunities and strategies to further increase vaccination and booster rates among generally accepting autistic adults, to better support the already strained autism services and support system landscape. Vaccination uptake could be improved by leveraging passive information diffusion to combat vaccination misinformation among those not actively seeking COVID-19 information to better alleviate safety concerns.

Shea L ，Cooper D ，Ventimiglia J ，Frisbie S ，Carlton C ，Song W ，Salzer M ，Lee B ，Hotez E ，Vanness DJ ... -  《JMIR Public Health and Surveillance》

Parental decisions regarding the vaccination of children and adolescents against SARS-CoV-2 from 2020 to 2023: A descriptive longitudinal study of parents and children in Montreal, Canada.

Given the growing evidence on the benefits of hybrid immunity, continued monitoring of vaccine uptake is warranted, particularly of socio-demographic subgroups with early vaccine hesitancy. Racial/ethnic and lower income groups experienced a high infection incidence, but few studies account for the child's history of SARS-CoV-2 infection on the parent's decision to vaccinate their child. EnCORE is a SARS-CoV-2 pediatric cohort study comprising five rounds of data collection from 2020 to 2023, with parental questionnaires at each round. Parent's responses on their intention to vaccinate their child and their reasons were summarized descriptively. Vaccine uptake was estimated through time and in relation to participant characteristics, using multivariable regression to adjust for covariates including a history of PCR/serology-confirmed SARS-CoV-2 infection prior to vaccine eligibility. At study end, we estimated the average time lapsed from last vaccine dose. The samples for vaccine uptake and intention to vaccinate analyses were 631 and 1137 participants, respectively. At study end, uptake was 88 % but approximately 49 % of 2-to-4-year-olds remained unvaccinated (95 % CI 39.0, 58.1) and for vaccinated participants the median time since last vaccination was 353 days. In regression analyses, after adjusting for infection prior to vaccine eligibility and other covariates, we found approximately a two-fold increase in unvaccinated status associated with the parent's identification as a racial/ethnic minority and with household income in the lowest sample tercile (minority: adjusted relative risk [aRR] 2.45, 95 % CI 1.56, 3.86; income: aRR 1.76, 95 % CI 1.17, 2.66). By mid-2023, most participants were not protected by vaccine-induced antibodies, because they were unvaccinated or several months had lapsed from their last dose. A COVID-19 infection prior to vaccine eligibility was associated with a greater risk of remaining unvaccinated but did not fully account for low uptake in ethnic/racial minorities and lower income groups.

Charland K ，Quach C ，Papenburg J ，Pierce L ，Tuong Nguyen C ，Saucier A ，Barbosa Da Torre M ，Hamelin MÈ ，Carbonneau J ，Boivin G ，Zinszer K ... -  《-》

Impact of the COVID-19 pandemic on self-paid vaccination intentions for children: a cross-sectional study in China.

While it is widely accepted that COVID-19 has disrupted routine vaccination globally, the long-term impact of COVID-19 on parental vaccination intentions is uncertain. This study aims to estimate whether COVID-19 impacted parental intentions for self-paid vaccines, and provides suggestions for local vaccination policy and intervention strategies accordingly. A questionnaire-based cross-sectional survey was conducted among 2212 caregivers in Zhejiang province between 22 March and 30 June 2023. The following information was collected: sociodemographic characteristics, self-paid vaccination related intentions and behaviours, and vaccine hesitancy measured by the Vaccine Hesitancy Scale. Multiple multinomial logistic regression models were used to analyse the factors influencing the change in vaccination intentions. In total, 19.32% (n=390) of respondents increased their intention to immunise their children with self-paid vaccines after the COVID-19 epidemic, 9.16% (n=185) decreased their intention, and 71.52% (n=1444) of respondents indicated that the COVID-19 epidemic did not affect their intention. The major reason for increased intentions was 'Vaccines are effective in preventing diseases' (83.89%) and for decreased intentions was 'Worried about the side effects of vaccines' (65.95%). A higher hesitancy degree (OR=2.208, p=0.0001), reduced trust in vaccines after COVID-19 (OR=16.650, p<0.0001), doctors' recommendation of Expanded Programme on Immunization vaccines (OR=2.180, p=0.0076), and non-perfect satisfaction with vaccine information (all OR>1, all p<0.05) were considered to be drivers of decreased intention. Although the intentions of self-paid vaccinations were not largely influenced, nearly 30% of caregivers' vaccination intentions changed after the COVID-19 pandemic and most of them increased their intentions. In addition, vaccination history of self-paid vaccines, vaccine information, vaccine trust and doctors' recommendations were the active factors for self-paid vaccination. Therefore, education on the knowledge of self-paid vaccines for caregivers should be implemented to increase their vaccination intentions and decrease the threat of infectious diseases to children's health.

Wang S ，Xu J ，Zhu J 《BMJ Open》