Caregivers' Intention to Vaccinate Their Children Under 12 Years of Age Against COVID-19: A Cross-Sectional Multi-Center Study in Milan, Italy

Abstract

The impact of Coronavirus disease 2019 (COVID-19) on the pediatric population is increasingly recognized. A widespread vaccination in childhood would provide benefits for children and might help ending the pandemic by enhancing community protection. Following recent approval by the European Medicines Agency (EMA) of Comirnaty (Pfizer-BioNTech) for children aged 5-11 years, we aimed to investigate caregivers' intention to vaccinate their children <12 years of age against COVID-19. A structured questionnaire was administered to caregivers of children aged <12 years visiting the Emergency Department or the outpatient clinics in three major hospitals of Milan, Italy, from 20 September to 17 October 2021. A total of 612 caregivers were invited to participate and 604 accepted (response rate >98%). Three questionnaires were excluded due to compiling errors and 601 were included in the analysis. A total of 311 (51.7%) caregivers stated they would have their child vaccinated, 138 (23%) would refuse to vaccinate their child and 152 (25.3%) were unsure. The intention to vaccinate the child was higher in caregivers vaccinated against COVID-19, in those with a bachelor's degree or higher level of education, and in those with friends/acquaintances who became ill or died due to COVID-19. This study shows that increasing efforts are necessary to provide evidence-based tailored information to caregivers and to promote vaccination in this pediatric age group.

Keywords: SARS-CoV-2; adolescents; caregivers; children; infants; parents; vaccination; vaccine hesitancy.

Figure 1

All levels of the categorical variables considered in the univariate analysis were projected in a new space defined by the first two dimensions (Dim1, Dim2) computed by MCA. Only variables showing a possible joint association to the caregiver's intention to vaccinate the child are displayed. The level “Vaccinate Child: Yes” (i.e., the caregiver willing to vaccinate the child), the level “Bachelor's degree or superior” (i.e., the caregiver holding a bachelor's degree or higher level of education) and the level “Caregiver Vaccinated” (i.e., the caregiver has completed/is about to complete the primary vaccination course) are close in the multivariate space, indicating a possible joint association. The categories of the variables are colored considering the parameter of cos2, which measures the degree of association between variable categories and a particular axis. If a variable category is well-represented by two dimensions, the sum of the cos2 is closed to one and tends to red color.

Figure 2

In this forest plot, the strength of association between the different conditions and the propensity to vaccinate the child are represented by means of the logarithmic form of the odds ratios computed by modeling a logistic regression model. Here, the conditions positively associated to the propensity to vaccinate the child are represented. The greater the logarithms of the odds ratios, the stronger is the association between a given condition and the propensity to vaccinate the child. Triangles indicate the point estimation while whiskers represent the 95% confidence intervals. For the caregiver having a friend or acquaintance who got ill or died due to COVID-19, the reference level is “neither of the two” conditions; for the caregiver's COVID-19 vaccination status, the reference level is “Caregiver Not Vaccinated”; for the caregiver's level of education, the reference level is “lower level of education.” Reference level means that when computing the odds ratio, the condition is put at the denominator.

Figure 3

As in Figure 2, the strength of association between the conditions and the propensity to vaccinate the child are represented here by means of the prevalence ratios (PRs) indicated as triangles and whiskers (95% confidence intervals). Only the conditions positively associated to the propensity to vaccinate the child are displayed. The blue dashed line indicates a prevalence ratio equal to one (the condition displayed in the plot has an equal effect related to the condition with which is compared). Again, the condition “Caregiver vaccinated” is compared with its reference level “Caregiver Not Vaccinated”; the conditions “Friend Sick from COVID-19” and “Friend Dead from COVID-19” are compared with the reference level “neither of the two”; the condition “Bachelor's degree or superior,” referring to the caregiver's level of education, is compared with its reference level “lower level of education”.