JMIR Publications

ABSTRACT

Background:

Immunization is a highly cost-effective strategy for preventing and eliminating infectious diseases in children. However, caregivers' hesitancy toward vaccines may lead to insufficient vaccination coverage. Notably, caregivers of children with special health care needs (CSHCN) exhibit a relatively higher level of vaccine hesitancy than caregivers of healthy children. The outbreak of the COVID-19 pandemic may disturb children's immunization. Little is known about the hesitancy of caregivers of CSHCN before, during, and after the COVID-19 pandemic.

Objective:

To investigate the changes in caregivers’ vaccination hesitation of children with special health care needs (CSHCN) before, during, and after the COVID-19 pandemic in China, and to identify associated factors for caregivers’ attitudes towards National Immunization Program (NIP) and non-NIP vaccines.

Methods:

We included 7770 caregivers of CSHCN under the age of 18 years who visited the vaccination consultation clinic in the Children’s Hospital, Zhejiang University School of Medicine (Hangzhou, China) from May 2017 to May 2023. General and clinical information was extracted from the immunization evaluation system for CSHCN and medical records. We used Chi-square tests to compare the differences in caregivers’ willingness and hesitation to vaccinate their children across the three stages of the COVID-19 pandemic. Multinomial logistic regression models were employed to identify independent variables associated with caregivers’ willingness and hesitation towards NIP and non-NIP vaccines.

Results:

During the COVID-19 pandemic, the percentages of choosing NIP, alternative non-NIP, and non-NIP vaccines are higher (26.03%, 57.37%, and 62.73%, respectively) than those at the other two stages. In comparison, caregivers’ hesitation towards NIP and non-NIP vaccines is lowest (16.60% and 37.27%, respectively). Despite the stages of the COVID-19 pandemic, multiple factors, including children’s age and gender, parents’ educational level, comorbidities, and history of allergy, were significantly associated with caregivers’ attitudes towards NIP and non-NIP vaccines (p values<0.05).

Conclusions:

The present study demonstrated that caregivers’ willingness to vaccinate their CSHCN with NIP and non-NIP vaccines was highest, and their hesitancy was lowest during the COVID-19 pandemic in China. Additionally, we have identified multiple factors associated with caregivers’ willingness and hesitancy to vaccinate their children. These findings provide evidence-based support for developing personalized health education strategies.