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Open AccessArticle

Knowledge, Attitude, and Practices of Paediatricians in the West Bank, Palestine, Regarding COVID-19 Vaccination Among Children Younger than 12 Years: A Cross-Sectional Study, October to November 2023

by Yousef Mosleh, Kostas Danis, Pawel Stefanoff and Diaa Hjaija

Vaccines 2025, 13(12), 1236; https://doi.org/10.3390/vaccines13121236 - 11 Dec 2025

Abstract

Background/Objectives: Paediatricians’ recommendations influence parental decisions to vaccinate their children. On 19 January 2022, the World Health Organization authorized the Pfizer-BioNTech COVID-19 vaccine (BNT162b2) under Emergency Use Listing for children under 12 years as a measure to mitigate disease spread and direct [...] Read more.

Background/Objectives: Paediatricians’ recommendations influence parental decisions to vaccinate their children. On 19 January 2022, the World Health Organization authorized the Pfizer-BioNTech COVID-19 vaccine (BNT162b2) under Emergency Use Listing for children under 12 years as a measure to mitigate disease spread and direct protection for children with underlying conditions. We assessed knowledge, attitudes, and practices (KAP) of Palestinian paediatricians regarding COVID-19 vaccination for children under 12 years and identified factors affecting support for vaccination. Methods: From 1 October to 8 November 2023, we surveyed paediatricians across the West Bank using structured telephone interviews. We collected data on sociodemographic characteristics and KAP regarding COVID-19 vaccination and calculated KAP scores from eight, nine, and nine items, respectively, with total scores categorized as poor/moderate/good. We performed bivariable and multivariable analyses to identify factors associated with paediatricians supporting COVID-19 vaccination for children under 12 years. Results: Of the 367 eligible paediatricians, 323 (88%) responded; the median age was 51 years (range: 28–70); 27% supported COVID-19 vaccination for children. Mean scores for knowledge (range 0–8), attitude (0–9), and practice (0–9) were 3.0 ± 2.1, 3.9 ± 2.4, and 4.0 ± 1.7, respectively. The mean overall KAP score (0–26) was 11 ± 4.8. Safety and efficacy concerns and lack of long-term data were the main reasons for hesitancy. Higher knowledge scores (PR = 1.8, 95% CI: 1.3–2.5, p = 0.001) and positive attitudes (PR = 1.6, 95% CI: 1.1–2.3, p = 0.01) were significantly associated with paediatricians’ support for vaccination. After adjustment for other factors, participants with regular continuing medical education attendance (aPR = 1.4, 95% CI: 1.0–2.6, p = 0.045), trusting WHO recommendations (aPR = 3.1, 95% CI: 1.4–7.8, p = 0.047), having a positive attitude score (aPR = 1.3, 95% CI: 0.4–4.4, p = 0.041), and a good total KAP score (aPR = 1.1, 95% CI: 1.0–1.2, p = 0.044) supported COVID-19 vaccination for children. Conclusions: Support for COVID-19 vaccination among Palestinian paediatricians was low, associated with their knowledge, attitudes, and trust in health authorities. The revised WHO recommendations from 10 November 2023, decreasing the priority of vaccinating healthy children, could influence the opinion of paediatricians. However, the low support for COVID-19 vaccinations could affect the performance of other vaccination programmes and should be carefully addressed through targeted education. Full article

(This article belongs to the Special Issue Acceptance and Hesitancy in Vaccine Uptake: 2nd Edition)

14 pages, 2302 KB

Open AccessArticle

Vaccine Attitudes Among Adults in a Southern European Region: Survey from Pre- to Post-COVID-19

by Myrian Pichiule-Castañeda, Alicia Serrano-de-la-Cruz, María-Felícitas Domínguez-Berjón and Ana Gandarillas-Grande

Vaccines 2025, 13(12), 1204; https://doi.org/10.3390/vaccines13121204 - 28 Nov 2025

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Abstract

Background: Vaccine hesitancy and refusal are growing public health challenges, reflecting individual decisions and social inequalities. The COVID-19 pandemic reshaped vaccine perceptions and may have amplified pre-existing differences. This study analyzed the evolution of vaccine hesitancy and refusal among adults in the Community [...] Read more.

Background: Vaccine hesitancy and refusal are growing public health challenges, reflecting individual decisions and social inequalities. The COVID-19 pandemic reshaped vaccine perceptions and may have amplified pre-existing differences. This study analyzed the evolution of vaccine hesitancy and refusal among adults in the Community of Madrid (Spain) between 2019 and 2024. We also explored the associated sociodemographic profiles. Methods: A retrospective observational study was conducted using data from the Non-communicable Disease Risk-Factor Surveillance System through a computer-assisted telephone interview (CATI) survey, targeting adults aged 18–64 years. Four waves (2019, 2020, 2021, 2024) were analyzed. Prevalence rates with 95% confidence intervals (95%CI) were calculated. The associations with sociodemographic variables (sex, age, country of birth, education, and employment status) were assessed using Poisson regression models to obtain crude and adjusted prevalence ratios (aPR). Results: A total of 7978 participants were included (49.1% men; mean age 41.97 years). Vaccine hesitancy increased from 3.8% (95% CI: 3.0–4.7) in 2019 to 18.5% (95% CI: 16.8–20.2) in 2024; vaccine refusal increased from 2.1% (95% CI: 1.6–2.8) to 8.0% (95% CI: 6.9–9.3). Vaccine hesitancy and refusal adjusted for socioeconomic variables increased in 2024 compared to 2019 (PRa: 5.04; 95% CI: 3.96–6.41 and aPR: 4.00; 95% CI: 2.86–5.59, respectively). Hesitancy was associated with female sex and middle age in 2019, to middle age in 2020, to intermediate education and migrant origin in 2021, and to education and migrant status in 2024. Vaccine refusal showed a similar pattern to that of vaccine hesitancy, highlighting the association with socioeconomic vulnerability. Conclusion: Between 2019 and 2024, vaccine hesitancy and refusal increased, and the association with socioeconomic vulnerability has also increased. Equity-based vaccination strategies are needed in order to strengthen institutional trust and reduce structural barriers to vaccine acceptance. Full article

(This article belongs to the Special Issue Acceptance and Hesitancy in Vaccine Uptake: 2nd Edition)

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19 pages, 308 KB

Open AccessArticle

HPV Vaccination in the U.S. Midwest: Barriers and Facilitators of Initiation and Completion in Adolescents and Young Adults

by Kristyne D. Mansilla Dubon, Edward S. Peters, Shinobu Watanabe-Galloway and Abraham Degarege

Vaccines 2025, 13(11), 1175; https://doi.org/10.3390/vaccines13111175 - 20 Nov 2025

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Abstract

Background/Objectives: HPV vaccination uptake among adolescents and young adults in the US remains low, and coverage in the Midwest falls short of the Healthy People 2030 goal of 80%. Methods: A cross-sectional survey of adolescents and young adults was conducted to [...] Read more.

Background/Objectives: HPV vaccination uptake among adolescents and young adults in the US remains low, and coverage in the Midwest falls short of the Healthy People 2030 goal of 80%. Methods: A cross-sectional survey of adolescents and young adults was conducted to identify facilitators and barriers to HPV vaccination uptake among adolescents and young adults in the Midwest. Results: Out of 1306 individuals aged 13–26 years, 397 (30.4%) were fully vaccinated (2–3 doses), 124 (9.5%) had received one dose, 324 (24.8%) were unvaccinated, and 461 (35.3%) were unsure of their vaccination status. Awareness of HPV vaccines (OR: 2.4, 95% CI: 1.6, 3.6), beliefs about vaccine effectiveness (OR: 1.8, 95% CI: 1.1, 2.9), family support (OR: 2.3 95% CI: 1.4, 3.8) and knowing someone with cervical cancer (OR: 1.8, 95% CI: 1.2, 2.7) were associated with increased odds of full vaccination. Beliefs in vaccine safety (OR: 2.0, 95%CI: 1.0, 3.9) and having health insurance coverage (OR: 1.9, 95% CI: 1.0, 3.5) were associated with increased odds of initiated vaccination (i.e., receiving at least one dose). Concerns about vaccine side effects (OR: 0.5, 95% CI: 0.3, 0.8) and not receiving recommendations from doctors were significantly associated with decreased odds of full vaccination (OR: 0.5, 95% CI: 0.3, 0.8) or initiated vaccination (OR: 0.5% CI: 0.2, 0.9). Clinician recommendations and awareness also reduced the likelihood of unknown vaccination status. Race-stratified analyses suggested heterogeneity in predictors across racial/ethnic groups. Conclusions: Our findings support the need for multi-level interventions aimed at increasing HPV vaccination initiation and completion in the Midwest. Full article

(This article belongs to the Special Issue Acceptance and Hesitancy in Vaccine Uptake: 2nd Edition)

17 pages, 722 KB

Open AccessArticle

Parental Vaccine Hesitancy, Trust in Physicians, and Future Vaccination Intentions: A PACV Cross-Sectional Study

by Sandra Janiak, Elwira Piszczek, Agnieszka Buczkowska and Krzysztof Buczkowski

Vaccines 2025, 13(11), 1127; https://doi.org/10.3390/vaccines13111127 - 1 Nov 2025

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Abstract

Background/Objectives: Parents’ vaccine hesitancy constitutes a global challenge, strongly associated with trust in healthcare professionals. This study aimed to identify socio-demographic predictors of parental pro- and anti-vaccination behaviors and investigate the association between these factors and intentions regarding children’s future immunizations. Methods: We [...] Read more.

Background/Objectives: Parents’ vaccine hesitancy constitutes a global challenge, strongly associated with trust in healthcare professionals. This study aimed to identify socio-demographic predictors of parental pro- and anti-vaccination behaviors and investigate the association between these factors and intentions regarding children’s future immunizations. Methods: We conducted a cross-sectional online survey using the Parent Attitudes about Childhood Vaccines (PACV) questionnaire. Participants were recruited purposively and via snowballing through parenting groups and educational institutions. Results: We surveyed 1.046 parents and provided attitudes for 1.701 children; 85.1% of child-specific responses reflected positive attitudes (PACV ≤ 50; median 16.7). In univariate regression, employment (OR = 2.172, 95% CI: 1.530–3.084; p < 0.001) and healthcare employment (OR = 2.907, 95% CI: 1.983–4.262; p < 0.001) increased the odds of positive attitudes, whereas each additional household member (OR = 0.693, 95% CI: 0.597–0.805; p < 0.001) and child (OR = 0.677, 95% CI: 0.579–0.792; p < 0.001) reduced them. Multivariable models confirmed higher odds for suburban/rural residence (OR = 1.614, 95% CI: 1.037–2.513; p = 0.034), employment (OR = 1.869, 95% CI: 1.284–2.721; p = 0.001), and healthcare employment (OR = 2.785, 95% CI: 1.872–4.144; p < 0.001). Among prior non-vaccinators (n = 114), 39.5% planned to vaccinate, 41.2% did not. Those who planned showed greater trust than non-planners in the child’s doctor (mean: 7.49 vs. 3.74) and schedule (mean: 7.89 vs. 1.40), p < 0.001, with lower trust correlating with greater hesitancy and safety concerns. Conclusions: Trust in physicians was strongly associated with both current attitudes and future intentions. Trust-focused, patient-centered communication may be related to more positive vaccination attitudes among parents. However, longitudinal research is needed to determine whether such trust could influence changes in vaccination behavior, especially since parents’ attitudes toward vaccinations can evolve with the arrival of subsequent children. Full article

(This article belongs to the Special Issue Acceptance and Hesitancy in Vaccine Uptake: 2nd Edition)

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17 pages, 1273 KB

Open AccessArticle

Vaccination Patterns and Determinants of Influenza and Pneumococcal Vaccines Among COPD Patients in Shanghai, China: A Comparative Analysis of Differing Funding Strategies

by Xiaoqing Tang, Sichun Wang, Haifeng Xu, Haiying Tang, Fei Bian, Kuan Wan, Ruijie Gong, Wanjing Lin, Jingyi Ye, Qiangsong Wu and Qichao Zhang

Vaccines 2025, 13(11), 1119; https://doi.org/10.3390/vaccines13111119 - 30 Oct 2025

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Abstract

Background: Preventing and reducing acute exacerbations is a key objective in chronic obstructive pulmonary disease (COPD) management. Therefore, vaccination against influenza and pneumococcal disease is particularly important for this population. Under self-funded vaccination policies, the coverage rates for both vaccines among COPD patients [...] Read more.

Background: Preventing and reducing acute exacerbations is a key objective in chronic obstructive pulmonary disease (COPD) management. Therefore, vaccination against influenza and pneumococcal disease is particularly important for this population. Under self-funded vaccination policies, the coverage rates for both vaccines among COPD patients in China are critically low. Since 2013, Shanghai has implemented a program providing one free dose of the 23-valent pneumococcal polysaccharide vaccine (PPV23) to residents aged 60 and above, whereas influenza vaccination remains self-funded. Few studies have compared influenza and pneumococcal vaccination coverage among COPD patients in China under these distinct funding strategies. Methods: This study used a stratified cluster sampling method to select COPD patients registered in the “Shanghai Community Chronic Disease Health Management System” from both urban (Xuhui) and suburban (Fengxian) districts of Shanghai. Data on demographic characteristics, medical history, physical examination results, behavioral risk factors, and vaccination records were extracted from the system. Vaccination records were verified using the “Shanghai Immunization Information System”. Descriptive analysis was conducted to assess influenza vaccine (self-funded, InfV) coverage during the 2023/2024 influenza season and cumulative PPV23 (government-funded) vaccination coverage among COPD patients. Logistic regression analysis was further employed to identify potential factors associated with InfV and PPV23 vaccination uptake in this population. Results: During the 2023/2024 influenza season, the influenza vaccination coverage under a self-funded policy was 5.87% among 1601 COPD patients in Shanghai, while the cumulative coverage of PPV23 under the government-funded program reached 52.15%. The willingness to receive PPV23 (60.40% vs. 27.55%; χ² = 350.73, p < 0.001) and the uptake among willing individuals (86.35% vs. 21.32%; χ² = 570.69, p < 0.001) were significantly higher under the free strategy compared to the self-funded InfV. For both vaccines, the primary reason for vaccine hesitancy was concern about adverse reactions, cited by over 50% of unwilling COPD patients. Multivariate analysis identified urban residence (aOR = 4.47, 95%CI: 2.86–6.98), prior PPV23 vaccination (aOR = 6.00, 95%CI: 3.43–10.49) and prior COVID-19 vaccination (aOR = 3.18, 95%CI: 1.79–5.66) as positive predictors of self-funded influenza vaccination. For PPV23 vaccination under the government-funded policy, significant factors included prior influenza vaccination (aOR = 6.89, 95%CI: 4.68–10.12), advanced age (aOR = 4.73, 95%CI: 3.68–6.09), and suburban residence (aOR = 0.37, 95%CI: 0.29–0.47). Conclusions: Influenza vaccination coverage among COPD patients in Shanghai remains critically low compared to the government-funded PPV23, highlighting the pivotal role of public funding. To address this disparity, urgent policy measures, including incorporating the influenza vaccine into publicly funded or health insurance reimbursement schemes, are essential. Full article

(This article belongs to the Special Issue Acceptance and Hesitancy in Vaccine Uptake: 2nd Edition)

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17 pages, 363 KB

Open AccessArticle

Assessing Vaccine Confidence Using the Vaccine Hesitancy Scale Among Adolescent Girls and Young Women at Risk of HIV Acquisition Living in Uganda, Zambia, and South Africa

by Nasimu Kyakuwa, Ali Ssetaala, Matt A. Price, Annet Nanvubya, Joel M. Abyesiza, Geofrey Basalirwa, Brenda Okech, Juliet Mpendo, Mubiana Inambao, Kawela Mumba-Mwangelwa, Chishiba Kabengele, Suzanna C. Francis, Pholo Maenetje, Ken Ondeng’e, Vinodh Edward, William Kilembe and Monica O. Kuteesa

Vaccines 2025, 13(11), 1083; https://doi.org/10.3390/vaccines13111083 - 22 Oct 2025

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Abstract

Background: Vaccine hesitancy (VH) remains a major threat to global health that can reverse the progress in tackling vaccine-preventable diseases. Vaccine uptake among adolescent Girls and young women (AGYW) is often low. We assessed VH using a validated scale among AGYW in Uganda, [...] Read more.

Background: Vaccine hesitancy (VH) remains a major threat to global health that can reverse the progress in tackling vaccine-preventable diseases. Vaccine uptake among adolescent Girls and young women (AGYW) is often low. We assessed VH using a validated scale among AGYW in Uganda, Zambia, and South Africa. Methods: From June 2023 to February 2024, we recruited AGYW from fishing communities in Uganda, urban and peri-urban locations in Lusaka and Ndola, Zambia, and mining communities in Rustenburg, South Africa. Eligible participants were aged 15–24 years, sexually active, and HIV-negative but at risk for HIV acquisition. We collected demographic, HIV-related behavioral data, and vaccine hesitancy data using a structured questionnaire. Vaccine confidence was assessed using the 10-question Vaccine Hesitancy Scale that describes two factors, i.e., “vaccine confidence” and “risk tolerance”. Exploratory and Confirmatory Factor Analyses were performed to assess scale validity and internal consistency. Logistic regression was used to determine associations between demographics and vaccine confidence. Results: A total of 1213 AGYW participated in the study, with a mean age of 19.4 (SD ± 2.6) years. More than half (54%) were aged between 15 and 19 years. The majority of AGYW (94%) strongly believed that vaccines were important for their health and the community and that vaccination is a good way to protect them from diseases. About two-thirds of the AGYW (66%) indicated that they were concerned about the adverse effects of vaccines, while 30% responded that they did not need vaccines for diseases that were not common. We observed that 951 (78%) of the AGYW reported high vaccine confidence, while 494 (41%) reported low concerns over risks. Vaccine confidence varied across countries, with Zambia and Uganda showing lower vaccine confidence (adjusted odds ratios of 0.28 and 0.45, respectively, p < 0.005) in comparison to South Africa. Conclusions: A high level of vaccine confidence was observed among AGYW. Vaccine confidence among AGYW was driven more by the trust in vaccine safety and the need to protect communities against diseases. These findings suggest the potential for acceptance of vaccines, including future HIV vaccines, among AGYW. Despite high levels of vaccine confidence, concerns over vaccine risks remain substantial and must be addressed. Full article

(This article belongs to the Special Issue Acceptance and Hesitancy in Vaccine Uptake: 2nd Edition)

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13 pages, 2893 KB

Open AccessArticle

Vaccine Attitudes, Knowledge, and Confidence Among Nursing, Pediatric Nursing, and Midwifery Undergraduate Students in Italy

by Ersilia Buonomo, Daniele Di Giovanni, Gaia Piunno, Stefania Moramarco, Giuliana D’Elpidio, Ercole Vellone, Enkeleda Gjini, Mariachiara Carestia, Cristiana Ferrari and Luca Coppeta

Vaccines 2025, 13(8), 813; https://doi.org/10.3390/vaccines13080813 - 30 Jul 2025

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Abstract

Background: Vaccine hesitancy (VH) represents a growing concern among healthcare professionals and students, potentially undermining public health efforts. Nursing, pediatric nursing, and midwifery students are future vaccinators and educators, making it essential to understand their attitudes, knowledge, and confidence toward vaccination. This study [...] Read more.

Background: Vaccine hesitancy (VH) represents a growing concern among healthcare professionals and students, potentially undermining public health efforts. Nursing, pediatric nursing, and midwifery students are future vaccinators and educators, making it essential to understand their attitudes, knowledge, and confidence toward vaccination. This study aims to assess vaccine-related perceptions and behaviors among these student populations in an Italian university. Methods: A cross-sectional survey was conducted between November 2022 and February 2024 at the University of Rome “Tor Vergata”. A structured, anonymous questionnaire, including the Vaccination Attitudes Examination (VAX) scale, vaccine knowledge items, and sources of information, was administered to students in nursing (n = 205), pediatric nursing (n = 46), and midwifery (n = 21). Statistical analyses included descriptive statistics, ANOVA, post hoc tests, and Mann–Whitney U tests. Results: Among the 272 participants, 20.6% reported refusing at least one recommended vaccine, and 18.4% delayed vaccination for non-medical reasons. Vaccine knowledge and confidence increased significantly with academic progression (p < 0.001). Midwifery students showed both the highest concern for long-term vaccine effects and the greatest confidence in vaccine safety. Institutional and scientific sources were the most trusted, though traditional and non-institutional media also influenced perceptions, particularly among midwifery students. Conclusions: Despite high COVID-19 vaccine uptake, VH persists among health professional students. Discipline-specific patterns highlight the need for early, targeted educational strategies to enhance vaccine literacy and reduce hesitancy. Tailored training may empower future professionals to become informed and credible advocates for vaccination. Full article

(This article belongs to the Special Issue Acceptance and Hesitancy in Vaccine Uptake: 2nd Edition)

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15 pages, 236 KB

Open AccessArticle

Multifaceted Determinants of Varicella Vaccination Uptake Among Children Aged 1–10 Years in China: Findings of a Population-Based Survey Among 996 Parents

by Weijun Peng, Yuan Fang, Hongbiao Chen, Minjie Zhang, Yadi Lin and Zixin Wang

Vaccines 2025, 13(8), 810; https://doi.org/10.3390/vaccines13080810 - 30 Jul 2025

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Abstract

Background/Objectives: Chickenpox is an ongoing health threat for young children. This study aimed to investigate varicella vaccination uptake among children and its determinants at both the individual and interpersonal levels. Methods: A cross-sectional survey of parents of children aged 0–15 years and with [...] Read more.

Background/Objectives: Chickenpox is an ongoing health threat for young children. This study aimed to investigate varicella vaccination uptake among children and its determinants at both the individual and interpersonal levels. Methods: A cross-sectional survey of parents of children aged 0–15 years and with administrative health records was conducted between September and October 2024 in Shenzhen, China. Participants were recruited through multistage random sampling. This analysis was based on a subsample of 996 parents whose children were 1–10 years old and without a prior history of chickenpox. Multivariate logistic regression models were fitted. Results: Among the participants, 47.0% reported that their children had received a varicella vaccination. Parents who believed that chickenpox was highly contagious (adjusted odds ratios [AOR]: 1.62, 95% confidence interval [CI]: 1.23, 2.13), perceived more benefits (AOR: 1.22, 95% CI: 1.05, 1.41) and cues to action (AOR: 1.33, 95% CI: 1.04, 1.69), and exhibited greater self-efficacy (AOR: 1.40, 95% CI: 1.09, 1.80) related to children’s varicella vaccination reported higher varicella vaccination uptake for their children. Greater perceived barriers related to vaccination (AOR: 0.89, 95% CI: 0.83, 0.95) and dysfunctional interactions with children (AOR: 0.97, 95% CI: 0.94, 0.99) were associated with lower varicella vaccination uptake for children. In addition, higher exposure to information encouraging parents to vaccinate their children against chickenpox (AOR: 1.24, 95%CI: 1.08, 1.41) and thoughtful consideration of the veracity of the information were associated with higher varicella vaccination uptake among children (AOR: 1.19, 95% CI: 1.05, 1.36). Conclusions: There is a strong need to promote varicella vaccination for children in China. Full article

(This article belongs to the Special Issue Acceptance and Hesitancy in Vaccine Uptake: 2nd Edition)

13 pages, 252 KB

Open AccessArticle

Perspectives of Healthcare Students on Childhood Vaccines: Insights from a Cross-Sectional Study in Bulgaria

by Maria Rohova, Nikolay L. Mihaylov, Antoniya Dimova and Rouzha Pancheva

Vaccines 2025, 13(8), 804; https://doi.org/10.3390/vaccines13080804 - 29 Jul 2025

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Abstract

Background/Objectives: Medical and nursing students, as future healthcare professionals, influence public trust and vaccine acceptance. Knowledge gaps or misconceptions regarding immunization may undermine their confidence and effectiveness in addressing vaccine hesitancy. This study explores perceptions and attitudes toward childhood vaccination among Bulgarian healthcare [...] Read more.

Background/Objectives: Medical and nursing students, as future healthcare professionals, influence public trust and vaccine acceptance. Knowledge gaps or misconceptions regarding immunization may undermine their confidence and effectiveness in addressing vaccine hesitancy. This study explores perceptions and attitudes toward childhood vaccination among Bulgarian healthcare students and factors shaping these outcomes. Methods: A cross-sectional survey was conducted in 2024, using an online self-administered questionnaire completed by 374 medical and nursing students. Descriptive statistics were used to analyze vaccine-related responses, comparing attitudes between healthcare programs and education years. Binomial logistic regression was applied to identify predictors of support for mandatory vaccination, first considering demographic and academic variables, and then adding students’ beliefs and common misconceptions. Results: Medical students showed more positive attitudes toward vaccination than nursing students, with 96.8% of medical students versus 89.4% of nursing students believing vaccines are effective (p = 0.005). Students in advanced years demonstrated stronger belief in vaccine effectiveness (p = 0.038). Additionally, misbeliefs about the measles vaccine causing autism decreased significantly, with most students in higher years rejecting this misconception (p = 0.009). Logistic regression revealed that belief in following the vaccine schedule (OR = 22.71; p < 0.001) and confidence in vaccine effectiveness (OR = 10.20; p < 0.001) were the strongest predictors of support for mandatory vaccination, with attitudinal factors explaining over half of the variance. Conclusions: Healthcare students’ attitudes about vaccination influence public health outcomes, as their perspectives reflect experience and beliefs. Targeted vaccine education helps address misconceptions and improve vaccination rates. Full article

(This article belongs to the Special Issue Acceptance and Hesitancy in Vaccine Uptake: 2nd Edition)

11 pages, 585 KB

Open AccessArticle

Vaccination Status and Influencing Factors of Delayed Vaccination in Toddlers Born to Hepatitis B Surface Antigen-Positive Mothers

by Jinling Gao, Lin Luan, Yiheng Zhu, Jie Zhu, Zhiyuan Zhu, Tian Gong, Juan Xu and Na Liu

Vaccines 2025, 13(3), 286; https://doi.org/10.3390/vaccines13030286 - 7 Mar 2025

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Abstract

Background: This study aims to analyze the vaccination status and factors influencing delayed vaccination among toddlers born to hepatitis B surface antigen (HBsAg)-positive mothers. Methods: Data of HBsAg-positive mothers between 1 January 2021 and 31 December 2022 were provided by the [...] Read more.

Background: This study aims to analyze the vaccination status and factors influencing delayed vaccination among toddlers born to hepatitis B surface antigen (HBsAg)-positive mothers. Methods: Data of HBsAg-positive mothers between 1 January 2021 and 31 December 2022 were provided by the Suzhou Maternal and Child Health Care and Family Planning Service Center. The vaccination records were obtained from the Jiangsu Province Immunization Service Management Information System. Logistic regression analysis was used to analyze influencing factors of delayed vaccination. Results: A total of 4250 toddlers born to HBsAg-positive mothers were documented. The data revealed that the first dose of the hepatitis B vaccine was administered to 100% of the toddlers. In addition, the coverage of the National Immunization Program (NIP) vaccines among these toddlers ranged from 92.9% to 99.4%. The proportion of delayed NIP vaccination varied between 0% and 12.2%. The proportion of delayed Bacillus Calmette–Guérin (BCG) vaccination was 11.3%, with the delay predominantly observed between 4 and 6 months. Notably, the proportion of delayed BCG vaccination among the toddlers born to HBsAg-positive mothers was significantly higher than that in the general population. Additionally, the proportion of the first dose of non-NIP vaccines was 3.3–36.4%, and the proportion of DTaP-IPV/Hib was 27.0%. Logistic regression analysis revealed that the regional level, the mother’s human papillomavirus (HPV) vaccination status, and the infant’s birth weight were significant factors influencing the timeliness of vaccination. Conclusions: Although the vaccination status of toddlers born to HBsAg-positive mothers in Suzhou city remains stable, the issue of delayed vaccination requires attention. It is essential to continue strengthening targeted vaccine education to reduce vaccine hesitancy and improve the rate of timely vaccination. Full article

(This article belongs to the Special Issue Acceptance and Hesitancy in Vaccine Uptake: 2nd Edition)

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13 pages, 529 KB

Open AccessArticle

Vaccination Coverage and Attitudes in Children and Adults on Biologic Therapies: Cocooning Strategies, Undervaccination Factors and Predictors of Favorable Attitudes

by Charikleia Kariniotaki, George Bertsias, Emmanouil Galanakis and Chrysoula Perdikogianni

Vaccines 2025, 13(2), 152; https://doi.org/10.3390/vaccines13020152 - 1 Feb 2025

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Abstract

Background: Infections pose a significant risk of morbidity and mortality to patients on biologics, with the vaccination of both patients and their close contacts serving as a key preventive measure. Despite its importance, there are limited data on the vaccination coverage for this [...] Read more.

Background: Infections pose a significant risk of morbidity and mortality to patients on biologics, with the vaccination of both patients and their close contacts serving as a key preventive measure. Despite its importance, there are limited data on the vaccination coverage for this group, and no studies have examined the vaccination status of patients’ close contacts. Objectives: To assess vaccination rates among patients on biologics and their household contacts, identifying reasons for inadequate vaccination and examining factors influencing vaccination status and attitudes is crucial. Methods: A cross-sectional study was conducted from September 2022 to February 2023 at the two hospitals in Heraklion, Crete, including adult and pediatric patients on biologics. Data were collected through medical records and interviews and analyzed using Microsoft Excel 2016 and MedCalc2006. Results: Among the 446 adults, vaccination rates were as follows: 83% for COVID-19, 73.8% for influenza, 64.5% for the pneumococcal conjugate vaccine, 29.6% for the pneumococcal polysaccharide vaccine, and 4% for Tdap. Among the 26 children included, those with basic immunization schedule coverage exceeded 96%, but rates for the vaccines usually administered at adolescence were lower (Tdap: 47.8%, HPV: 42.1%, MenACWY: 66.7%). COVID-19 vaccination was at 38.5%. Regarding the additional vaccines recommended due to treatment-induced immunosuppression, 69.2% of pediatric patients received the annual influenza vaccine, while only 19.2% received the pneumococcal polysaccharide vaccine. Household contacts demonstrated low vaccination rates (<59%), except for COVID-19 (81%). Female gender (p < 0.007) and older age (by 1 year, p < 0.001) were associated with favorable attitudes and higher coverage in adults, while in pediatric patients, no statistically significant associations were found. A lack of physician recommendation was the primary reported reason for not being vaccinated. Conclusions: Significant vaccination gaps exist among patients on biologics and their close contacts, largely due to inadequate physician recommendations. Raising awareness and strengthening healthcare provider roles are essential to improve coverage in this high-risk group. Full article

(This article belongs to the Special Issue Acceptance and Hesitancy in Vaccine Uptake: 2nd Edition)

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14 pages, 689 KB

Open AccessSystematic Review

Adoption of Focus Groups in Designing Interventions to Address Vaccine Hesitancy Among Adolescents and Their Parents: A Systematic Review

by Patrizia Calella, Concetta Paola Pelullo, Gabriella Di Giuseppe, Francesco Napolitano, Fabrizio Liguori, Giorgio Liguori and Francesca Gallè

Vaccines 2025, 13(11), 1108; https://doi.org/10.3390/vaccines13111108 - 29 Oct 2025

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Abstract

Background/Objectives: To address vaccine hesitancy, health promotion strategies must go beyond passive information delivery and identify individuals’ beliefs about vaccination. Focus groups (FGs) have emerged as promising tools in health education and behavioral change initiatives. Methods: To assess the employ of FGs in [...] Read more.

Background/Objectives: To address vaccine hesitancy, health promotion strategies must go beyond passive information delivery and identify individuals’ beliefs about vaccination. Focus groups (FGs) have emerged as promising tools in health education and behavioral change initiatives. Methods: To assess the employ of FGs in planning immunization strategies for adolescents, a systematic review of literature was performed from inception to July 2025 following PRISMA guidelines. PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar databases were searched. Conclusions: Twenty articles met the inclusion criteria. In these studies, FGs were used to identify barriers or facilitators to vaccination, mainly to address HPV vaccine hesitancy. Across the WHO SAGE 3C framework, the outcomes of FGs clustered more in confidence and convenience/constraints than in complacency domain. These findings highlight the potential of FGs in designing programs to increase vaccine uptake. Further research on their possible role in motivating parents or adolescents towards immunization is needed. Full article

(This article belongs to the Special Issue Acceptance and Hesitancy in Vaccine Uptake: 2nd Edition)

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Open AccessSystematic Review

Addressing Vaccine Hesitancy in College Students Post COVID-19 Pandemic: A Systematic Review Using COVID-19 as a Case Study

by Wai Yan Min Htike, Muxuan Zhang, Zixuan Wu, Xinyu Zhou, Siran Lyu and Yiu-Wing Kam

Vaccines 2025, 13(5), 461; https://doi.org/10.3390/vaccines13050461 - 25 Apr 2025

Cited by 2 | Viewed by 2205

Abstract

Background: Resistance to vaccinations continues to pose a considerable challenge to attaining widespread vaccination, especially among the college student demographic, who are pivotal in championing public health initiatives. This systematic review investigates the elements that influence reluctance to receive the COVID-19 vaccine [...] Read more.

Background: Resistance to vaccinations continues to pose a considerable challenge to attaining widespread vaccination, especially among the college student demographic, who are pivotal in championing public health initiatives. This systematic review investigates the elements that influence reluctance to receive the COVID-19 vaccine among university students globally. Utilizing the WHO’s 3C model, which encompasses confidence, complacency, and convenience, this review seeks to pinpoint the main factors and suggest focused strategies to address them. Methods: Following the PRISMA guidelines, we conducted a systematic search in PubMed, Medline, Web of Science, Scopus, Embase, and Global Health. Eligible studies were cross-sectional, peer-reviewed, and examined COVID-19 vaccine hesitancy among college students. Covidence was used for screening, and data were synthesized narratively using the 3C model. Results: Sixty-seven studies (n = 88,345 participants) from 25 countries were included in this study. Confidence factors were the most influential, with fear of side effects (87.18%) and doubts about efficacy (72.4%) as primary concerns. Complacency factors included a low perceived risk of infection (34.9%) and a preference for alternative preventive measures (52.3%). Convenience barriers involved financial costs (58.1%) and difficulty accessing vaccination centers (40.3%). Subgroup analyses revealed variations by academic discipline and geographic region, with medical students showing hesitancy despite their health knowledge. Conclusions: COVID-19 vaccine hesitancy among college students is primarily driven by safety concerns, misinformation, and accessibility barriers. Addressing hesitancy requires transparent risk communication, policy-driven accessibility improvements, and tailored educational interventions. These findings can inform strategies to enhance vaccine uptake among young adults and contribute to broader efforts in pandemic preparedness. Full article

(This article belongs to the Special Issue Acceptance and Hesitancy in Vaccine Uptake: 2nd Edition)

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