Vaccine hesitancy and influenza beliefs among parents of children requiring a second dose of influenza vaccine in a season: An American Academy of Pediatrics (AAP) Pediatric Research in Office Settings (PROS) study

ABSTRACT

To receive adequate protection against influenza, some children 6 months through 8 y old need two doses of influenza vaccine in a given season. Currently, only half of those receiving the first dose receive a second. Our objective was to assess vaccine hesitancy and influenza disease and vaccine knowledge, attitudes, and beliefs among caregivers of children who received the first of their two needed doses. As part of a national-randomized control trial of second dose text-message influenza vaccine reminders (2017–2018 season), a telephone survey collected caregiver and index child demographic information. Each child had received the first of two needed influenza vaccine doses. Caregivers completed a measure of general vaccine hesitancy – the five-question Parent Attitudes About Childhood Vaccines Survey Tool (PACV-5) – and questions about influenza infection and vaccine. We assessed associations between participant demographic characteristics, vaccine hesitancy, and influenza beliefs and calculated the standardized proportion of caregivers endorsing each outcome using logistic regression. Analyses included responses from 256 participants from 36 primary care practices in 24 states. Some caregivers (11.7%) reported moderate/high vaccine hesitancy and many had misperceptions about influenza disease and vaccine. In multivariable models, no single variable was consistently associated with inaccurate knowledge, attitudes, and beliefs. These results demonstrate that caregivers whose children received the first dose of influenza vaccine may still be vaccine hesitant and have inaccurate influenza beliefs. Pediatricians should consider broadly addressing inaccurate beliefs and promoting vaccination even after caregivers agree to the first dose.

KEYWORDS:

• Influenza
• influenza vaccine
• vaccine hesitancy
• primary care
• childhood vaccination
• parent attitudes

Acknowledgments

The authors thank all Flu2Text practices (see list of below), pediatricians, nurse practitioners, other physicians, staff, parents, and families who participated in our study, and the University of South Carolina Institute for Public Service and Policy Research, Survey Research Lab. This work was supported by the National Institutes of Health (NIH) National Institute of Child Health and Health Development (NICHD) grant number R01HD086045 (PI: Stockwell, Fiks). Additional infrastructure funding was provided by the American Academy of Pediatrics and the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under UA6MC15585 – National Research Network to Improve Children’s Health. The information, content and/or conclusions are those of the author(s) and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Flu2Text practices participating in this study, who agreed to be acknowledged included ABC Pediatrics, PC; Advanced Pediatrics, PC; All Pediatrics, PC; Altru Health System; Anaconda Pediatrics; Anchorage Pediatric Group; Ashley Clinic; A to Z Pediatrics, PLLC; Bethesda Pediatrics; Building Blocks Pediatrics; Burlington Pediatrics; Cambridge Pediatrics; Child Health Partners, PC; Childhood Health Associates of Salem; Elmwood Pediatric Group, LLP; Fishing Bay Family Practice; Goshen – Columbus Pediatrics & Adolescent Care; Hirsch Pediatrics, LLC; Ivancic Pediatric Clinic, PA; Mesa Pediatrics; One Hanson Place Pediatrics, PC; OHSU Doernbecher Pediatrics – Westside Clinic; Pediatric Associates of Davidson County, PA; Pediatric Associates of Medford; Pediatrics by the Sea; Pennridge Pediatric Associates; Prattville Pediatrics; Priority Care Pediatrics; Purohit Pediatric Clinic; Quality Kids Kare, PC; Scarano & Taylor Pediatrics; Southeastern Pediatric Associates; Springfield Pediatrics; Sunset Park Family Health Center at NYU Langone; The Child & Teen Wellness Center; Zaheer Pediatrics & Associates, SC; Zimble & Reinstein Pediatrics.

Disclosure of potential conflicts of interest

Dr. Fiks reported receiving an independent research grant from Pfizer for work unrelated to this project and unrelated to vaccination. He also received grants from the National Institutes of Health; grants and personal fees from the Patient-Centered Outcomes Research Institute and the Academic Pediatric Association; personal fees from the American Academy of Pediatrics, Boston Medical Center, Children’s Specialized Hospital, Columbia University, PRIME, and Washington University; and conference travel support from Children and Screens outside the submitted work. Additionally, Dr. Stockwell was an unremunerated coinvestigator for an unrelated, investigator-initiated grant from the Pfizer Medical Education Group. No other disclosures were reported.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by the American Academy of Pediatrics and the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) [UA6MC15585]; National Institutes of Health (NIH) National Institute of Child Health and Health Development (NICHD) [R01HD086045].