Parental Willingness and Associated Factors of Pediatric Vaccination in the Era of COVID-19 Pandemic: A Systematic Review and Meta-Analysis

A significant decline in pediatric vaccination uptake due to the COVID-19 pandemic has been documented. Little is known about the parental willingness and associated factors of pediatric vaccination during the COVID-19 pandemic. An extensive literature search in the databases of PubMed, Scopus, Web of Science, and EBSCOhost were conducted. A total of 20 eligible studies published from 2020–2022 were included for systematic summary by a thematic analysis, among which 12 studies were included in a meta-analysis conducted with R-4.2.1. The prevalence of parental willingness to childhood/routine vaccination and seasonal influenza vaccination was 58.6% (95%CI 2.8–98.6%) and 47.3% (95%CI 25.3–70.5%). Moreover, there is no sufficient evidence of significant change in parental willingness to childhood/routine vaccination, human papillomavirus vaccination, or pneumococcal conjugate vaccination during the pandemic. However, a significant increase in parental willingness to vaccinate their children against seasonal influenza was found. In addition to the factors of parental vaccination willingness/hesitancy that are well-studied in literature, children/parents’ history of COVID-19 and children’s perceived vulnerability to COVID-19 were associated with parental willingness. Developing synergetic strategies to promote COVID-19 vaccination together with other pediatric vaccination is warranted during the pandemic. This may help to improve and/or catch up the vaccine uptake of children during and/or after the COVID-19 pandemic.

[1]  M. Carestia,et al.  Parents' and caregivers' role toward childhood vaccination in Albania: assessment of predictors of vaccine hesitancy. , 2022, Annali di igiene : medicina preventiva e di comunita.

[2]  Y. Ng,et al.  Effect of COVID-19 Pandemic on Influenza Vaccination Intention: A Meta-Analysis and Systematic Review , 2022, Vaccines.

[3]  Paul A Gilbert,et al.  Challenges to Adolescent HPV Vaccination and Implementation of Evidence-Based Interventions to Promote Vaccine Uptake During the COVID-19 Pandemic: “HPV Is Probably Not at the Top of Our List” , 2022, Preventing chronic disease.

[4]  M. Alimelu,et al.  Supporting Immunization Uptake during a Pandemic, Using Remote Phone Call Intervention among Babies Discharged from a Special Neonatal Care Unit (SNCU) in South India , 2022, Vaccines.

[5]  B. Chilundo,et al.  Determinants of immunisation dropout among children under the age of 2 in Zambézia province, Mozambique: a community-based participatory research study using Photovoice , 2022, BMJ Open.

[6]  Jue Liu,et al.  Association between risk perception and influenza vaccine hesitancy for children among reproductive women in China during the COVID-19 pandemic: a national online survey , 2022, BMC Public Health.

[7]  A. Banke-Thomas,et al.  Actions and Adaptations Implemented for Maternal, Newborn and Child Health Service Provision During the Early Phase of the COVID-19 Pandemic in Lagos, Nigeria: Qualitative Study of Health Facility Leaders , 2022, Annals of global health.

[8]  J. Sabatier,et al.  Impact of COVID‐19 pandemic on routine vaccination coverage of children and adolescents: A systematic review , 2022, Health science reports.

[9]  P. Galanis,et al.  Willingness, refusal and influential factors of parents to vaccinate their children against the COVID-19: A systematic review and meta-analysis , 2022, Preventive Medicine.

[10]  I. Bostanci,et al.  Attitudes towards influenza and pneumococcal vaccines in parents of asthmatic children during the COVID‐19 pandemic , 2022, Pediatric pulmonology.

[11]  Z. El-Khatib,et al.  Scaling the Children Immunization App (CIMA) to Support Child Refugees and Parents in the Time of the COVID-19 Pandemic: A Social Capital Approach to Scale a Smartphone Application in Zaatari Camp, Jordan , 2022, Journal of Epidemiology and Global Health.

[12]  Marten Postma,et al.  Parents’ Knowledge, Attitude, and Practice on Childhood Vaccination During the COVID-19 Pandemic in Indonesia , 2022, Patient preference and adherence.

[13]  M. Drainoni,et al.  Long-Term Multilevel Intervention Impact on Human Papillomavirus Vaccination Rates Spanning the COVID-19 Pandemic , 2022, Journal of lower genital tract disease.

[14]  Leesa Lin,et al.  Changes in the public attitude toward childhood vaccine and the COVID-19 vaccine during different periods: A repeated cross-section study in Wuxi city, China. , 2021, JMIR public health and surveillance.

[15]  Jeongeun Kim,et al.  Development and Evaluation of a Child Vaccination Chatbot Real-Time Consultation Messenger Service during the COVID-19 Pandemic , 2021, Applied Sciences.

[16]  H. Alwafi,et al.  Parents’ Willingness to Vaccinate Their Children Against Seasonal Influenza After the COVID-19 Pandemic in Saudi Arabia: A Retrospective Cross-Sectional Survey , 2021, Patient preference and adherence.

[17]  A. Lindstrand,et al.  Impact of the SARS-CoV-2 pandemic on routine immunisation services: evidence of disruption and recovery from 170 countries and territories , 2021, The Lancet Global Health.

[18]  Amy Ramick,et al.  “Is that for here or to go?” Drive-Through Pediatric Vaccine Clinic as a Novel Approach during a Global Pandemic , 2021, Disaster Medicine and Public Health Preparedness.

[19]  Y. Çağ,et al.  Parents’ Attitudes Toward COVID-19 Vaccination and Childhood Vaccines During the COVID-19 Pandemic , 2021, Asia-Pacific journal of public health.

[20]  Y. Molina,et al.  Shared Determinants for Human Papillomavirus and COVID-19 Vaccination Intention: An Opportunity for Resource Consolidation , 2021, American Journal of Health Promotion.

[21]  G. Cortassa,et al.  Effectiveness of Mandatory and Incentive-Based Routine Childhood Immunization Programs in Europe: A Systematic Review of the Literature , 2021, Vaccines.

[22]  Daniel R. Lavage,et al.  Parent-Reported Intention to Vaccinate Children Against COVID-19: Influences of COVID-19 and Seasonal Influenza Vaccination , 2021, Clinical pediatrics.

[23]  L. Stergioulas,et al.  Usability and Acceptability of a Mobile App for Behavior Change and to Improve Immunization Coverage among Children in Pakistan: A Mixed-Methods Study , 2021, International journal of environmental research and public health.

[24]  Osama Al-Wutayd,et al.  The impact of the COVID-19 pandemic on parents' behavior toward scheduled pediatric vaccinations in Saudi Arabia. , 2021, Journal of infection in developing countries.

[25]  H. Abusalih,et al.  Vaccine hesitancy towards childhood immunizations as a predictor of mothers’ intention to vaccinate their children against COVID-19 in Saudi Arabia , 2021, Journal of Infection and Public Health.

[26]  L. Baghdadi,et al.  Caregivers’ Sources of Information About Immunization as Predictors of Delayed Childhood Vaccinations in Saudi Arabia During the COVID-19 Pandemic: A Cross-Sectional Questionnaire Study , 2021, Risk management and healthcare policy.

[27]  M. Neely,et al.  Parental Perspectives on Immunizations: Impact of the COVID-19 Pandemic on Childhood Vaccine Hesitancy , 2021, Journal of Community Health.

[28]  A. Licari,et al.  Impact that the COVID‐19 pandemic on routine childhood vaccinations and challenges ahead: A narrative review , 2021, Acta paediatrica.

[29]  Jennifer A. Villwock,et al.  Attitudes of Suburban Kansan Parents Regarding School-Required Immunizations and the Influences of the Coronavirus Pandemic , 2021, Kansas journal of medicine.

[30]  S. Manzano,et al.  Parents' intent to vaccinate against influenza during the COVID-19 pandemic in two regions in Switzerland. , 2021, Swiss medical weekly.

[31]  Cheryl L Kovar,et al.  HPV vaccine promotion: Snapshot of two health departments during the COVID‐19 pandemic , 2021, Public health nursing.

[32]  Hongjie Yu,et al.  The Influence of the COVID-19 Epidemic on Prevention and Vaccination Behaviors Among Chinese Children and Adolescents: Cross-sectional Online Survey Study , 2021, JMIR public health and surveillance.

[33]  Junjie Zhang,et al.  Impact of the coronavirus disease 2019 epidemic and a free influenza vaccine strategy on the willingness of residents to receive influenza vaccines in Shanghai, China , 2021, Human vaccines & immunotherapeutics.

[34]  Jai K Das,et al.  The Impact of the COVID-19 Pandemic on Immunization Campaigns and Programs: A Systematic Review , 2021, International journal of environmental research and public health.

[35]  H. Bernstein,et al.  The Effect of the COVID-19 Pandemic on Childhood Immunizations: Ways to Strengthen Routine Vaccination. , 2020, Pediatric annals.

[36]  Sanjoy Roy,et al.  Childhood Immunization and COVID-19: An Early Narrative Review , 2020, Frontiers in Public Health.

[37]  Anna H. Grummon,et al.  COVID-19 and Parent Intention to Vaccinate Their Children Against Influenza , 2020, Pediatrics.

[38]  Zixin Wang,et al.  Associations of Mental Health and Personal Preventive Measure Compliance With Exposure to COVID-19 Information During Work Resumption Following the COVID-19 Outbreak in China: Cross-Sectional Survey Study , 2020, Journal of medical Internet research.

[39]  G. Thompson,et al.  Willingness to Vaccinate Children against Influenza after the Coronavirus Disease 2019 Pandemic , 2020, The Journal of Pediatrics.

[40]  J. Comeau,et al.  COVID-19 and missed routine immunizations: designing for effective catch-up in Canada , 2020, Canadian Journal of Public Health.

[41]  C. Logie,et al.  Parents’ uptake of human papillomavirus vaccines for their children: a systematic review and meta-analysis of observational studies , 2018, BMJ Open.

[42]  A. Loke,et al.  The Uptake of Human Papillomavirus Vaccination and Its Associated Factors Among Adolescents: A Systematic Review , 2017, Journal of primary care & community health.

[43]  Cornelia Betsch,et al.  Barriers of Influenza Vaccination Intention and Behavior – A Systematic Review of Influenza Vaccine Hesitancy, 2005 – 2016 , 2017, PloS one.

[44]  R. Jakes,et al.  Parental knowledge, attitudes and perception of pneumococcal disease and pneumococcal conjugate vaccines in Singapore: a questionnaire-based assessment , 2016, BMC Public Health.

[45]  J. Leask,et al.  To close the childhood immunization gap, we need a richer understanding of parents' decision-making , 2016, Human vaccines & immunotherapeutics.

[46]  N. MacDonald Vaccine hesitancy: Definition, scope and determinants. , 2015, Vaccine.

[47]  T. Ojo,et al.  Parents' Acceptability and Health Workers' Perspectives of Pneumococcal Conjugate Vaccination for Under-Fives in Ile-Ife, Nigeria , 2014 .

[48]  Heidi J Larson,et al.  Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007-2012. , 2014, Vaccine.

[49]  S. Hawker,et al.  Appraising the Evidence: Reviewing Disparate Data Systematically , 2002, Qualitative health research.