Childhood Influenza Vaccination and Its Determinants during 2020–2021 Flu Seasons in China: A Cross-Sectional Survey

Abstract

Young children aged 6–59 months are recommended as one of the priority groups for seasonal influenza vaccination in China. This study assessed influenza vaccination coverage and the factors associated with vaccination uptake among children in three Chinese provinces. In September 2021, 2081 caregivers with children <5 years completed self-administered questionnaires as part of a cross-sectional survey. Logistic regression was used to assess determinants of childhood influenza vaccination. A total of 43.63% of respondents reported vaccinating their children against influenza during the 2020–2021 flu season. Caregivers who lived in Anhui province, had a bachelor degree or above, and an annual household income <20,000 RMB were more likely to vaccinate their children against influenza. Confidence in the importance (OR: 2.50; 95%CI: 1.77–3.54), safety (OR: 1.60; 95%CI: 1.29–1.99), and effectiveness (OR: 1.54; 95%CI: 1.23–1.93) of influenza vaccine was significantly associated with childhood vaccine acceptance. Respondents who saw that other caregivers were vaccinating their children had significantly higher odds of vaccinating their own children. Caregivers’ receiving positive influence from healthcare workers (OR: 1.33; 95%CI: 1.00–1.77), family members, or friends (OR: 1.30; 95%CI: 1.14–1.49) were also significantly associated with childhood influenza vaccination. Poor access, including conflicts between caregivers’ availability and vaccination service schedules and inconvenient transportation to the vaccination site were negatively associated with childhood flu vaccination. To promote childhood influenza vaccination, public health information campaigns need to target wealthier and less educated caregivers to enhance caregivers’ confidence in influenza vaccination. Targeted interventions are also needed to optimize access to vaccination services, including extending vaccination service hours and increasing the number of vaccination sites close to residential areas. Interventions are also needed to encourage primary care providers to play a greater role in promoting vaccination. Finally, the dissemination of related information and the public response need to be monitored for the timely understanding of public perceptions.

Parental Acceptance, Parental Hesitancy, and Uptake of Seasonal Influenza Vaccination among Children Aged 6–59 Months: A Systematic Review and Meta-Analysis

“…A total of 36 studies published from 2004 to 2023 were finally analysed and summarised [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 23 , 24 , 25 , 26 , 27 , 28 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ] ( Table 1 ). Most of the studies were performed in Asia ( n = 15, 42%) and the Americas ( n = 14, 39%), followed by Europe ( n = 5, 14%) and Oceania ( n = 2, 6%).…”

“…Thirty-one studies reported on the factors associated with SIV (uptake in the last flu season, uptake in lifetime, acceptance/hesitancy), as shown in Table 2 . Parental education level was a strong predictor reported in nine studies, with one study reporting a negative association [ 44 ] and some reporting a positive association with acceptance and uptake [ 19 , 20 , 37 , 38 , 40 , 45 , 50 ]. Household income [ 14 , 36 , 37 , 38 , 40 , 41 , 44 , 50 ] and having chronic diseases/comorbidities [ 35 , 36 , 41 , 47 , 48 , 51 , 52 ] were also important predictors of vaccine acceptance and uptake.…”

“…Parental education level was a strong predictor reported in nine studies, with one study reporting a negative association [ 44 ] and some reporting a positive association with acceptance and uptake [ 19 , 20 , 37 , 38 , 40 , 45 , 50 ]. Household income [ 14 , 36 , 37 , 38 , 40 , 41 , 44 , 50 ] and having chronic diseases/comorbidities [ 35 , 36 , 41 , 47 , 48 , 51 , 52 ] were also important predictors of vaccine acceptance and uptake. The age of children had a positive association with vaccine acceptance/uptake [ 41 , 50 ] but a negative association in others [ 44 , 45 , 51 , 52 ].…”

Changes of influenza vaccination rate and associated influencing factors after the COVID-19 pandemic in Shanghai, China

“… 13 Our study revealed that the vaccination rate among children (35.68%)was significantly higher than that among the other groups. 14 Although children aged 6–59 months are recommended as one of the key groups for seasonal influenza vaccination in China, 15 the vaccination rate of children in China is much lower than that of children in other regions in the world. For example, the VCR of children aged 5–12 years and under 5 years in the U.S. was approximately 52.6% in 2017, 16 and that in Japan was 50.6% in 2012–2013.…”

Attitudes, motivators, and barriers toward influenza vaccination for children: a study from a conflict-ridden country

“…The seasonal influenza vaccine serves as a key preventive measure against influenza and its associated complications, offering numerous benefits, such as protection against influenza infection, hospitalization, and disease severity [ 10 – 18 ]. The Centers for Disease Control and Prevention recommends that all individuals aged 6 months or older receive the vaccine annually, with a higher priority assigned to high-risk groups and healthcare workers [ 19 – 23 ].…”