Search Results (61)

Childhood immunization is one of the most effective public health measures, yet inequities remain in marginalized populations across Asia, where parental adherence is essential to sustaining the Expanded Program on Immunization. This narrative review examines determinants of adherence among under-five children in disadvantaged communities. Following PRISMA guidelines, searches of PubMed, Scopus, and Google Scholar identified studies published between 2015 and 2025, with earlier key works included as relevant. Twenty-one studies from South, Southeast, and East Asia were analyzed. Five domains were associated with adherence: socioeconomic and access factors, where maternal education, household income, and possession of immunization cards were positive predictors, while remote residence was a barrier; trust, cultural beliefs, and social norms, with misinformation and vaccine controversies reducing uptake, and provider trust and supportive norms improving it; migration and mobility, as migrant, stateless, and left-behind children had lower coverage due to weak registration and disrupted caregiving; household and caregiver dynamics, where decision-making by family or community members shaped uptake, while large family size and maternal employment limited adherence; and health system capacity, with inadequate infrastructure and follow-up hindering coverage and integration with maternal–child health services facilitating it. Addressing these intersecting barriers through equity-focused strategies is critical to achieving universal immunization coverage. Full article

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

Background/Objectives: The Human Papillomavirus (HPV) is one of the most common causes of STIs, posing a significant public health problem. Today, the transmission of HPV can be very effectively prevented, making it important to vaccinate the target population at a young age. The aim of this study was to examine the attitudes and beliefs of parents regarding the HPV vaccine and the HPV vaccination of their child. Methods: This cross-sectional study was conducted in Osijek, Croatia, from June 2021 to September 2022 via a self-administered questionnaire and included 215 respondents. Results: The results showed that respondents who would vaccinate their child were significantly more likely to be those who work in the healthcare field, who had heard of the term HPV, who had sought information about the HPV vaccine on their own, and who had received information about vaccination from school doctors. The attitude towards vaccination was more negative among respondents who did not intend to vaccinate their child. In predicting the decision not to vaccinate one’s child against HPV, bivariate logistic regression revealed that the probability of non-vaccination increases with working outside the field of healthcare (OR = 4.61) and a negative attitude towards vaccination (OR = 1.46), while the probability of non-vaccination decreases if information was received from a school doctor (OR = 0.46). Furthermore, multivariate logistic regression showed that there is a significant model in predicting non-vaccination against HPV, consisting of two predictors: working outside the healthcare field (OR = 8.15) and a negative attitude towards vaccination (OR = 1.49). Conclusions: Given that parents are responsible for making the decision about HPV vaccination, it is necessary to invest additional efforts in educating them about the importance of preventing HPV infections and the benefits of HPV vaccination itself. Full article

Background: Respiratory syncytial virus (RSV) is a major cause of infant respiratory illness, leading to significant hospitalizations. Two preventive strategies exist: maternal vaccination and a long-acting monoclonal antibody for neonates. In The Netherlands, neonatal immunization is planned to start from autumn 2025 onward, contingent on acceptance by parents and healthcare professionals. Maternal vaccination is already available at own costs. Understanding acceptance, perceptions, and barriers is critical for effective implementation. This study explores these factors to inform strategies for optimal uptake. Methods: This mixed-method study involved semi-structured online interviews with 21 (expectant) mothers (EMs) and 32 healthcare professionals (HCPs) involved in maternal and neonatal care (e.g., pediatricians, youth doctors/nurses, obstetricians, midwives, and general practitioners) and a quantitative descriptive analysis of factors influencing EM choices. Interviews were transcribed and thematically analyzed. Results: Both EMs and HCPs showed strong support for RSV immunization, with a preference for maternal vaccination or a combined approach. Concerns about neonatal injections during the sensitive postpartum period and unfamiliarity with newborn injections (e.g., vitamin K) influenced preferences. EMs noted hesitation about additional pregnancy/postpartum vaccinations, emphasizing the importance of well-timed interventions. HCPs highlighted logistical challenges, such as defining responsibilities, navigating National Immunization Program (NIP) changes, and ensuring readiness. All interviewed individuals value the option to choose between strategies, necessitating informed decision-making and respect for preferences. EMs make their final decision together with their partner, supported by expert information and their personal environment. Conclusions: Support for RSV immunization is high, with maternal vaccination preferred, though neonatal immunization is accepted if appropriately timed. Providing clear personalized and consistent information, heightened public awareness of RSV’s impact, respecting individual choices, and offering options are key to maximizing uptake. Full article

Vaccines are among the most effective public health interventions, significantly reducing morbidity and mortality from infectious diseases. Despite their proven efficacy, vaccine hesitancy has emerged as a pressing global challenge. This review examines the drivers, barriers, and interventions associated with vaccine hesitancy and uptake, focusing on childhood vaccinations and the role of parents as primary decision-makers. Misinformation, safety concerns, and political decisions have contributed to declining vaccination rates, posing threats to public health. The article proposes targeted programs and policies to rebuild vaccine confidence, emphasizing the role of trusted messengers, health literacy, and structural reforms to reduce barriers. Recommendations highlight the importance of accurate information, open communication, and advocacy for school vaccine mandates. The conclusion stresses the urgent need to implement robust policies and community-based initiatives to ensure widespread immunization and safeguard population health. Full article

Background/Objective: The COVID-19 pandemic profoundly transformed social life worldwide, indiscriminately affecting individuals across all age groups. Children have not been exempted from the risk of severe illness and death caused by COVID-19. Objective: This paper sought to describe the clinical findings, laboratory and imaging results, and hospital care provided for severe and critical cases of COVID-19 in unvaccinated children, with or without severe asthma, hospitalized in a public referral service for COVID-19 treatment in the Brazilian state of Pernambuco. Methods: This was a case series study of severe and critical COVID-19 in hospitalized, unvaccinated children, with or without severe asthma, conducted in a public referral hospital between March 2020 and June 2021. Results: The case series included 80 children, aged from 1 month to 11 years, with the highest frequency among those under 2 years old (58.8%) and a predominance of males (65%). Respiratory diseases, including severe asthma, were present in 73.8% of the cases. Pediatric multisystem inflammatory syndrome occurred in 15% of the children, some of whom presented with cardiac involvement. Oxygen therapy was required in 65% of the cases, mechanical ventilation in 15%, and 33.7% of the children required intensive care in a pediatric intensive care unit. Pulmonary infiltrates and ground-glass opacities were common findings on chest X-rays and CT scans; inflammatory markers were elevated, and the most commonly used medications were antibiotics, bronchodilators, and corticosteroids. Conclusions: This case series has identified key characteristics of children with severe and critical COVID-19 during a period when vaccines were not yet available in Brazil for the study age group. However, the persistence of low vaccination coverage, largely due to parental vaccine hesitancy, continues to leave children vulnerable to potentially severe illness from COVID-19. These findings may inform the development of public health emergency contingency plans, as well as clinical protocols and care pathways, which can guide decision-making in pediatric care and ensure appropriate clinical management, ultimately improving the quality of care provided. Full article

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States (U.S.) and a major contributor to several cancers, including cervical, anal, penile, and oropharyngeal cancers. Although a safe and effective vaccine is available, HPV vaccination rates remain suboptimal, particularly among racial, ethnic, and immigrant minority groups. This study explored multiple factors, such as cultural, social, and structural influences, influencing HPV vaccine decision-making among Cape Verdean immigrant parents in the U.S., a population currently underrepresented in HPV research. Methods: Qualitative study using individual, in-depth interviews with Cape Verdean immigrant parents of children aged 11 to 17 years living in the U.S. Interviews were transcribed verbatim and analyzed thematically using the social ecological model (SEM) to identify barriers and facilitators at the intrapersonal, interpersonal, organizational, community, and policy levels. Results: Forty-five Cape Verdean parents (27 mothers, 18 fathers) participated. Fathers were significantly older than mothers (50.0 vs. 41.1 years, p = 0.05). Most were married or partnered (60%), had at least a high school education (84.4%), and reported annual household incomes of US$50,000 or more (66.7%), with no significant gender differences. Nearly all spoke Creole at home (95.6%). Fathers had lower acculturation than mothers (p = 0.05), reflecting less adaptation to U.S. norms and language use. Most parents had limited knowledge of HPV and the vaccine, with gendered beliefs and misconceptions about risk. Only seven mothers (25.9%) reported receiving a provider recommendation; all indicated that their children had initiated vaccination (1 dose or more). Mothers were the primary decision-makers, though joint decision-making was common. Trust in providers was high, but poor communication and the lack of culturally and linguistically appropriate materials limited informed decision-making. Stigma, misinformation, and cultural taboos restricted open dialogue. Trusted sources of information included schools, churches, and Cape Verdean organizations. While parents valued the U.S. healthcare system, they noted gaps in public health messaging and provider engagement. Conclusions: Findings revealed that HPV vaccine uptake and hesitancy among Cape Verdean immigrant parents in the U.S. were influenced by individual beliefs, family dynamics, healthcare provider interactions, cultural norms, and structural barriers. These findings highlight the need for multilevel strategies such as culturally tailored education, community engagement, and improved provider communication to support informed vaccination decisions in this population. Full article

Background: Human papillomavirus (HPV) vaccination is crucial for preventing HPV-related cancers, yet vaccination rates remain suboptimal, particularly in Florida. Social influence, including family and peer support, may shape parental decisions to vaccinate their children. In this study, we examined the role of social networks (online and offline) in parental intention to vaccinate their 11- to 12-year-old children against HPV. Methods: We conducted a cross-sectional survey among 746 parents in Florida as part of the Text & Talk trial (2022–2023). Among other questions, parents reported on their intention to vaccinate, perceived social norms, and support received from up to three reported confidants. We performed logistic regression and multivariable analyses to assess the relationship between network support, social norms, and vaccination intent. Results: Seventy percent of parents intended to vaccinate their children. Greater support from the first reported confidant was significantly associated with higher vaccination intention (OR = 1.30, p < 0.0001). Perceived norms among friends (p = 0.01) and higher overall network support (p < 0.0001) were also predictive of intent. The higher the percentage of reported family members, the higher the support received for the vaccine (p = 0.04). Conclusions: Social support, particularly from close confidants and peers, plays a critical role in shaping parental HPV vaccination decisions while accounting for perceived social norms. Public health interventions can leverage peer networks alongside family support to enhance HPV vaccine uptake. Full article

Objectives: The aim of the present study was to provide insight into potential predictors of HPV vaccination uptake and the willingness to get vaccinated. Methods: This cross-sectional study was conducted among university students using an online, anonymous, self-administered questionnaire. Vaccine hesitancy was measured according to the adult Vaccine Hesitancy Scale (aVHS). Sociodemographic characteristics, beliefs about vaccination decision-making, vaccination behavior, and willingness to receive the HPV vaccine among unvaccinated students, and sources of information about vaccinations were investigated. Results: Among the 542 sampled students, 11.1% were classified as vaccine-hesitant. About one third (31.7%) had not received the HPV vaccination. Males, older students, those who had not received the dTap-IPV booster dose, and those being discouraged from getting vaccinated by a healthcare worker were more likely not to be vaccinated. Students having one parent holding a university degree or higher were more likely to be vaccinated compared to those having parents with a high school diploma or less. Among unvaccinated students, 65.7% were willing to get vaccinated against HPV, and it was positively associated with a low aVHS score and female gender, as well as being enrolled in medical and life sciences majors. Conclusions: Suboptimal HPV vaccination uptake was observed, especially among male and older university students. Insights from the present study highlight the need to address misconceptions about HPV infection and vaccines by providing facts that can be used in conversations with individuals who may feel insecure after having heard various myths about HPV vaccination. Full article

Research on vaccination hesitancy has been extensive, but the role of information processing in decision making still needs to be explored. The study examines the alignment between parents’ COVID-19 vaccination intentions and actual behavior, focusing on the impact of different kinds of information processing on the consistency or inconsistency of these behaviors. It analyzes parents’ reliance on health information sources, and education levels, with institutional trust, ability to critically evaluate conspiracy theories and scientific knowledge as moderators. A total of 1118 Israeli parents participated in digital surveys and were classified into the following 4 groups based on their initial vaccination intentions and actual behaviors: (1) consistent—pro-vaccine and vaccinated; (2) inconsistent—pro-vaccine but unvaccinated; (3) inconsistent—anti-vaccine but vaccinated; and (4) consistent—anti-vaccine and unvaccinated). The results show that consistent parents process information using system 1, i.e., heuristic information processing, reliance on health information sources, moderated by institutional trust and education. However, inconsistent parents used systems 1 and 2, namely heuristic–systematic information processing, influenced by knowledge of COVID-19 and the ability to assess conspiracy theories critically. Full article

Pediatricians are among the most trusted sources of vaccine information for parents. We aimed, in this study, to describe the attitudes and practices of Tunisian pediatricians regarding non-National Immunization Schedule (NIS) vaccines, specifically the COVID-19 vaccination for children, and to identify factors associated with their willingness to recommend it. We conducted a national cross-sectional study among Tunisian pediatricians between July and October 2023 using a standardized questionnaire administered face-to-face. We calculated prevalence with 95% confidence intervals (95%CIs) and adjusted odds ratios (aOR) using multivariable logistic regression. Of 330 contacted pediatricians, 192 (58.2%) responded (mean age: 50.9 ± 12.9 years). The majority (89.1%, 95% CI: [84.6–93.5]) said that they recommend other vaccines that are not part of the NIS and 40.6% [33.7–47.6] declared their willingness to recommend the COVID-19 vaccination for children. The odds of pediatricians willing to recommend the COVID-19 vaccination for children were higher among those who believed that this vaccine would reduce school absenteeism (aOR = 2.3 [1.1–5.1]) and among those who have great confidence in the Ministry of Health’s recommendations regarding COVID-19 vaccination (aOR = 6.1 [2.2–16.9]). More than half of the pediatricians in Tunisia recommend other vaccines that are not part of the NIS but show hesitancy toward the COVID-19 vaccine. Thus, involving pediatricians in the decision-making process for childhood vaccination strategies is crucial. Full article

Background: School-based immunization programs are crucial for equitable vaccine coverage, yet their success depends on parental consent processes. This study investigates patterns of vaccine decision-making within Australia’s school-based immunization program, specifically focusing on human papillomavirus (HPV) and diphtheria-tetanus-pertussis (dTpa) vaccines offered free to adolescents aged 12–13. Methods: This qualitative study was conducted in the South Eastern Sydney Local Health District (2022–2023). Semi-structured interviews were held with school staff (n = 11) across government, Catholic, and independent schools, parents whose children were not vaccinated at school (n = 11) and a focus group with public health unit staff (n = 5). Data were analyzed to identify key barriers and patterns in vaccine decision-making. Results: Analysis revealed three distinct groups of parents whose children were not vaccinated through the school program: (1) those favoring general practitioners for vaccination, driven by trust in medical providers and a preference for personalized care; (2) those intending to consent but facing logistical barriers, including communication breakdowns and online consent challenges; and (3) vaccine-hesitant parents, particularly regarding HPV vaccination, influenced by safety concerns and misinformation. These findings demonstrate that non-participation in school vaccination programs should not be automatically equated with vaccine hesitancy. Conclusions: Tailored interventions are necessary for addressing vaccine non-participation. Recommendations include strengthening collaboration with general practitioners, streamlining consent processes and providing targeted education to counter misinformation. This study provides valuable insights into social determinants of vaccine acceptance and offers actionable strategies for improving vaccine uptake in school-based programs. Full article

Background/Objectives: In Vietnam, COVID-19 vaccination campaigns for children have encountered numerous challenges due to acceptance issues among parents. This study aimed to assess parental decision-making and identify factors influencing their decision to vaccinate their children against COVID-19. Methods: This was a cross-sectional online survey conducted between April and May 2023 among parents of children aged 6–17 years enrolled in urban and rural schools in Thai Nguyen province, Vietnam. Data on parental and child demographics, vaccination decision-making, COVID-19 experiences, and health beliefs based on the Health Belief Model were collected and analyzed, using univariate and multivariable multinomial regression analyses. Results: Among 4235 respondents (median age 41 years, 80.4% female), 81.3% had accepted all vaccine doses for their children, 9.7% had accepted some doses, 4.6% had rejected all doses, and 4.5% had not vaccinated their children for reasons unrelated to vaccine acceptance. Factors influencing parental decision-making included parental age, educational status, area of residence, health beliefs, prior experience with COVID-19 vaccination, and their child’s age and health status. Conclusions: We found overall high levels of parental acceptance for COVID-19 vaccination for children in Thai Nguyen province. To enhance COVID-19 vaccination acceptance, targeted communication strategies should focus on younger parents, those living in urban areas, parents with higher educational levels, and those with children who are younger or have underlying medical conditions. Trusted sources such as healthcare workers, teachers, and official health websites are essential for disseminating accurate information and fostering trust in vaccination programs. Full article

The uptake of human papilloma virus (HPV) and other adolescent vaccinations in special schools for young people with disability is significantly lower than in mainstream settings. This study explored the factors believed to influence parental decision making regarding vaccine uptake for students with intellectual disability and/or on the autism spectrum attending special schools in New South Wales, Australia, from the perspective of all stakeholders involved in the program. Focus groups and interviews were conducted with 40 participants, including parents, school staff, and immunisation providers. The thematic analysis identified two themes: (1) appreciating diverse parental attitudes towards vaccination and (2) educating parents and managing vaccination questions and concerns. While most parents were described as pro-vaccination, others were anti-vaccination or vaccination-hesitant, articulating a marked protectiveness regarding their child’s health. Reasons for vaccine hesitancy included beliefs that vaccines cause autism, concerns that the vaccination may be traumatic for the child, vaccination fatigue following COVID-19, and assumptions that children with disability will not be sexually active. Special school staff regarded the vaccination information pack as inadequate for families, and nurses described limited educational impact resulting from minimal direct communication with parents. More effective communication strategies are needed to address vaccine hesitancy among parents with children with disability. Full article

Since 2018, Taiwan has included the human papillomavirus (HPV) vaccination into its national immunization program for junior high school girls. However, the reports of side effects following vaccination have increased parental concerns. This study investigated parental intentions regarding the HPV vaccination for their daughters and related factors in Taiwan. A total of 213 parents of girls aged between 12 and 15 years participated in an online survey. The survey collected data on various factors, including the parental intention to vaccinate their daughters against HPV; the motivation behind the vaccinations, as measured using the Motors of Human Papillomavirus Vaccination Acceptance Scale; an understanding of the reasons behind the government’s promotion of HPV vaccinations; concerns regarding the side effects of vaccinations for their daughters; an awareness of the reported side effects of HPV vaccines experienced by some individuals; the exposure to information on HPV vaccines from social media; and mental health status, measured using the Brief Symptom Rating Scale. The associations between these variables and the parental intention to vaccinate their daughters against HPV were examined using a multivariable linear regression analysis model. The findings revealed a moderate to high level of intention among participants to vaccinate their daughters against HPV. Parents who perceived a greater value in HPV vaccination for their daughters’ health (B = 0.524, standard error [se] = 0.039, p < 0.001) and had greater autonomy in decision-making regarding vaccination (B = 0.086, se = 0.038, p = 0.026) exhibited a higher intention to vaccinate their daughters against HPV. Conversely, parents who expressed greater concern regarding the side effects of HPV vaccines for their daughters had a lower intention to vaccinate (B = −0.762, se = 0.203, p < 0.001). Based on these findings, this study recommends integrating these factors into the design of intervention programs aimed at enhancing parental intentions to vaccinate their daughters against HPV. Full article