Department of Ambulatory Care Services, Denver Health and Hospital Authority (JTB Williams, SG Federico, and SJ Hambidge), Denver, Colo; Department of Pediatrics, The University of Colorado Denver Anschutz Medical Campus (JTB Williams, SG Federico, SJ Hambidge, and ST O'Leary), Aurora, Colo.
Department of Biostatistics and Informatics, Colorado School of Public Health (JD Rice), Aurora, Colo; Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) (JD Rice and ST O'Leary), Aurora, Colo.
Acad Pediatr. 2021 Sep-Oct;21(7):1126-1133. doi: 10.1016/j.acap.2021.05.017. Epub 2021 May 21.
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.
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.
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).
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.
在一个流感季节，以疫苗犹豫父母的孩子为参照，衡量疫苗接种不足的流感风险，这些孩子来自一个弱势家庭样本。
这是一项针对 2 岁儿童的父母的前瞻性观察队列研究，这些父母来自英语和西班牙语家庭，他们在 2019 年 8 月 1 日至 2020 年 2 月 28 日期间随机接受常规、患病或专科就诊。父母回答了人口统计学问题和父母对儿童疫苗的态度调查。我们对儿童进行了随访，直至流感季结束，于 2020 年 4 月 30 日提取疫苗接种数据。我们将疫苗接种状况分为未接种或部分/完全接种两种，使用多变量泊松回归分析数据；在二次分析中，我们进行了调整后的生存时间分析。
共有 263 位家长同意（应答率：90%）；我们的最终样本包括 255 对父母。33 位（13%）家长对疫苗持犹豫态度。在调整后的分析中，与非犹豫父母（n=222）的孩子相比，犹豫父母（n=33）的孩子在流感季末未接种疫苗的风险增加了 195%（调整后的风险比 2.95；95%置信区间 1.91，4.56）。在生存时间分析中，疫苗犹豫父母的孩子在流感活动高峰期之前未接种疫苗的可能性也更高（P=0.02）。
在 2019 至 2020 年流感季，在一个贫困和少数族裔家庭的样本中，父母的疫苗犹豫使儿童患流感未接种疫苗的风险增加了两倍。由于父母对疫苗的犹豫似乎加剧了儿童流感疫苗接种的差异，未来的工作应该与贫困和少数族裔利益相关者探讨父母的犹豫，并针对所有实践场所接受护理的来自这些社区的儿童量身定制基于证据的干预措施。
