Vaccine-hesitant parents especially leery of flu shots, study finds

About 1 in 15 US parents (6.1%) is hesitant about routine childhood vaccines, and more than 1 in 4 (26%) are unsure about flu vaccines, according to a study published today in Pediatrics.

Researchers surveyed 2,176 parents in February 2019 using an online panel and a modified five-point Vaccine Hesitancy Scale found that 12% strongly agreed, and 27% somewhat agreed, that they worried about perceived serious side effects of childhood and flu vaccines. And while 70% strongly agreed that routine childhood vaccines are effective, only 26% said they thought the same about flu vaccines.

Thirteen percent either strongly or somewhat disagreed that all childhood vaccines offer benefit. Of hesitant parents, 67.5% reported having deferred or refused routine childhood vaccination, versus 8.7% of non-hesitant parents. Likewise, 70.1% of reluctant parents said they had deferred or refused flu vaccination for their child, versus 10.0% of non-reluctant parents.

Low flu vaccination rates

Only 10.1% of vaccine-hesitant parents reported that their child had been or would be vaccinated against the flu in the current season (8.6% had already received the vaccine), versus 84.1% of non-hesitant parents.

Factors predicting childhood and flu vaccine hesitancy included an educational level lower than a bachelor's degree, household income less than 400% of the federal poverty level, residency in the western United States, having a child in the preschool years, having a higher number of children in the household, and being unmarried.

The authors noted that the World Health Organization has deemed vaccine hesitancy 1 of the 10 biggest threats to global health. In the United States, where yearly flu vaccination is recommended for children 6 months an older, only 58% of children were vaccinated in the 2018-19 flu season.

Lower rates of childhood vaccination against whooping cough, mumps, and measles have led to outbreaks of those diseases in the United States and abroad.

The authors attribute low flu vaccination rates to yearly reports of low flu vaccine effectiveness from surveillance networks and the Centers for Disease Control and Prevention recommendation that the live attenuated vaccine (FluMist) not be used for the 2016-17 season because of low effectiveness. That recommendation was reversed for the 2018-19 season.

Communicating with parents about benefits

The researchers said that messages that build on intention to vaccinate or focus on changing behavior rather than beliefs or attitudes will help providers convince more parents to vaccinate.

Their recommendations include strong and presumptive recommendations, the use of standing orders, flu vaccination clinics or school-based vaccination, reminders, state-level school vaccination requirements, minimization of philosophic exemptions to those requirements, and motivational social media posts by trained parents.

"With respect to influenza vaccination, with our data, we underscore the importance of better communicating to providers and parents the effectiveness of influenza vaccines in reducing severity and morbidity from influenza, even in years when the vaccine has relatively low effectiveness," the authors wrote.

Lead author Allison Kemp, MD, MPH, of the University of Colorado said in a university press release that the best way to overcome vaccine hesitancy may be to prevent it by talking to expectant parents. "Ideally, we'd like to immunize parents against all the misinformation that is out there," she said.

In a commentary in the same journal, Annabelle de St. Maurice, MD, MPH, of the University of California Los Angeles and Kathryn Edwards, MD, of Vanderbilt University in Nashville, Tennessee, call for determining the correct evidence-based messaging to counter misperceptions about vaccines and rebranding flu vaccine as a "routine" childhood immunization.

"Instead of saying, 'Is it okay if your child receives the flu vaccine today?' providers could state, 'Today, your child will receive their recommended influenza vaccine'‌" they wrote. "Because families consider their child's primary care provider to be a trusted source of information, this presumptive approach is generally successful."

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