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Why Are Some Parents Still Hesitant To Vaccinate Their Child Against RSV?

Increasing knowledge of the vaccine-preventable disease will ultimately improve vaccine uptake among target groups, researchers suggest.

Most parents have never refused any recommended vaccines and trust their child's physician, but vaccine hesitancy still poses a challenge to immunization programs.1 While many factors influence parental decision-making when it comes to vaccinating their child against respiratory syncytial virus (RSV), research suggests that increased awareness of the diseases can reduce vaccine hesitancy and improve trust in health care providers.

The researchers believe the study found that many parents are supportive of RSV vaccination, with informed and aware parents being more likely to vaccinate their children with the new RSV vaccine.MargJohnsonVA - stock.Adobe.Com

This survey study published in Vaccine aimed to investigate vaccine hesitancy within the context of new RSV vaccines and increased virus activity in 2022 and 2023.

"Overall, parental acceptance of immunizations is related to the perceived risk and severity of the disease," wrote the researchers of the study. "This was supported by our data showing that well-informed parents tend to be more concerned about RSV infection, and consequently are more willing to vaccinate their children."

RSV is the most common viral pathogen identified in young children with acute lower respiratory infections. Moreover, a substantial proportion of RSV-associated morbidity occurs within the first year of life. A study of 1262 children hospitalized for RSV infection found that about 70% of cases were for children under 1 year of age, with the majority (69.9%) of children being under 3 months of age.2

In the present study, the researchers included parents or caregivers of infants aged 0 to 36 months using personal approach methods or flyers distributed in children's hospitals, pediatric practices, and child-care facilities in Regensburg, Germany, between February to June 2023. The survey included questions pertaining to demographics, socioeconomic status, mental well-being, knowledge of RSV and perceptions of the disease, and attitudes to general childhood and RSV vaccines.

A total of 191 parents and caregivers completed the survey, with a high proportion of participating mothers (88%). The mean (SD) age of participants was 35 (4) years, with most responses coming from families with 1 child (48%) being older than 6 months (86%).

Of the participants, 84% reported they had never refused any recommended vaccinations, and 91% reported they trusted their child's pediatrician. However, 11% of participants said they felt children should have fewer vaccinations or be able to get over the illness on their own.

Additionally, parents who were supportive or undecided about RSV vaccination were less likely to be vaccine hesitant in general (OR, 0.03; P < .001; OR, 0.13; P = .003).

Furthermore, 58% reported having good or basic knowledge of RSV, which correlated with a higher socioeconomic status index (P = .049). While 24% were undecided about RSV vaccination, all parents rated its benefit high in the first year of life.

Parents who refused the RSV vaccination were less concerned about the infection compared with those who support vaccinations (OR, 0.44; P < .001), while those previously hospitalized children (OR, 3.88; P = .017) or preterm-born children (OR, 5.12; P = .026) were generally more concerned.

However, the researchers acknowledged some limitations to the study, including potential participation bias, a small sample size, and potential overestimation of participant knowledge through self-reported answers. Additionally, the study excluded vaccine hesitancy among pregnant individuals.

Despite these limitations, the researchers believe the study found that many parents are supportive of RSV vaccination, with informed and aware parents being more likely to vaccinate their children with the new RSV vaccine.

"Now that RSV has become a vaccine-preventable disease, providing the unique opportunity to substantially reduce illness and deaths in the coming season 2023/2024, it is essential that especially the "target group" of parents who are hesitant but accessible receive all the information on the new vaccines they need to make an informed decision in due time," wrote the researchers.

References

1. Langer S, Holzapfel S, August L, et al. Parental knowledge and attitudes to infant immunization in the context of RSV: All about confidence? Vaccine. Published online June 19, 2024. Doi:10.1016/j.Vaccine.2024.06.018

2. Steinzor P. How COVID-19 has impacted RSV epidemiology among children in a hospital setting. June 7, 2024. Accessed June 26, 2024. Https://www.Ajmc.Com/view/how-covid-19-has-impacted-rsv-epidemiology-among-children-in-a-hospital-setting

What The Recent Chicago Measles Outbreak Reveals About Childhood Vaccines

As a new parent, one of the initial milestones is your baby's first series of vaccinations. While this may cause some anxiety, a Chicago doctor emphasizes that the brief discomfort for your child brings significant health benefits.

"Vaccines are the most successful public health intervention in the history of humankind," says Dr. Marielle Fricchione, a pediatrician and infectious diseases specialist at Rush Children's Hospital.  

The lifesaving power of childhood vaccinations

Dr. Fricchione wants to reassure parents that common childhood vaccines are not only a crucial protection for kids, but they have years of research to back up their safety and efficacy. 

Photo Credit: Illinois Chapter of the American Academy of Pediatrics

"Vaccines, particularly those for children, have undergone extensive testing and monitoring, making them among the safest and most effective medical interventions available," she says. "We are fortunate to live in a country with a robust safety structure around vaccines. The data supporting their safety and efficacy is overwhelming."

Protecting against measles

One compelling reason to vaccinate children is prevention of measles, a highly contagious and potentially deadly disease. Dr. Fricchione's experience in public health, including her work during a recent measles outbreak in Chicago, underscores the importance of vaccination.

"During this outbreak, we saw firsthand the severe consequences of measles. Children were hospitalized, suffering from high fevers, rashes and dehydration. Beyond the immediate symptoms, measles can lead to long-term complications like subacute sclerosing panencephalitis (SSPE), a fatal brain disorder that can develop years after the initial infection."

The recent measles outbreak in Chicago was stopped from a more significant spread due to vaccines, says Dr. Fricchione. "The quick action taken by the city to vaccinate at-risk people kept measles from spreading even further. Even one dose of a measles vaccine offers helpful protection."

Vaccination doesn't just protect the individual child. "Measles is one of the most infectious diseases we encounter," Dr. Fricchione says. "When enough people are protected or immune to a disease, it stops it from spreading, this is called herd immunity. For herd immunity to be effective, at least 94% of the population need to be immune. This high threshold is crucial to prevent outbreaks."

"Community immunity" and the consequences of declining vaccination rates

If vaccination rates continue to decline, the consequences could be dire for individual children and the community at large, says Dr. Fricchione. "We have seen vaccine hesitancy lead to outbreaks. Without sufficient immunization, diseases like measles can spread rapidly, putting vulnerable populations, such as children with cancer and others who cannot be vaccinated, at great risk."

Dr. Fricchione advises parents to consider not just their own child's health but the health of the community. "Everywhere your child goes, they interact with different large and small communities — school, their neighborhood, grandparents, even the community within your own home. Ensuring high vaccination rates means preventing outbreaks that could affect anyone."

While some may call this "herd immunity," Dr. Fricchione prefers the term "community immunity." 

"'Community immunity' emphasizes the interconnectedness and collective responsibility of individuals within various communities to protect each other. Particularly, individuals like children with cancer or those who are immunocompromised or too young to be vaccinated." 

Unfortunately, vaccination rates have declined in some areas, partly due to the disruptions caused by the COVID-19 pandemic. Dr. Fricchione stresses the urgency of catching up on missed vaccinations. "We are in a high-risk time with children's vaccinations. It's essential to get up to date before school starts and ensure our community is protected."

Addressing vaccine hesitancy

Dr. Fricchione acknowledges that every parent has unique concerns and experiences with the medical system. 

"It's important to build a trusting relationship with families and understand their worries," she says. "As a mother myself, I empathize with the parents' fears. Sharing personal stories and reassuring them about the rigorous safety standards of vaccines can help."

Dr. Fricchione's youngest child, a daughter, was born prematurely and unable to receive key vaccines for some time. "I was so worried about my daughter being vulnerable. As a doctor, I know how serious some diseases can be."

Dr. Fricchione emphasizes that making the decision to vaccinate is about choosing to protect one's child from preventable diseases. "There is so much we can't control as parents, but vaccination is something we can do to ensure our children's health. It's about peace of mind, knowing that you've done everything possible to keep them safe."

Separating misconceptions and facts

One of the most common misconceptions about vaccines is that they are riskier than the diseases they prevent. Dr. Fricchione points to the extensive research and data available. 

"We have decreased and before COVID, nearly eliminated so many childhood diseases in this country that it's hard for parents to judge the danger of diseases they haven't seen firsthand. But the data is clear: vaccines are much safer than the diseases they prevent."

She also notes that, "Vaccines save millions of children's lives globally every year. Millions! They also prevent suffering, long-term health issues, missed school and so much more. As pediatricians, we are so grateful to be able to recommend vaccines— because we know they make a difference."

Building trust and making informed choices

For parents who are still unsure, Dr. Fricchione advises having an open and honest conversation with their child's pediatrician. "Don't be afraid to ask questions and express your concerns. We understand that this is a significant decision, and we are here to support you. We share the same goal and that's to help you raise a happy, healthy, thriving child!"

By fostering trust and providing clear, evidence-based information, Dr. Fricchione hopes to help parents make informed choices about vaccinating their children. "We all want the best for our kids. Vaccinating them is one of the most important steps we can take to protect their health and ensure they have a bright future."

For more information about children's health in Illinois, visit illinoisaap.Org/

Navigating The Impact Of COVID-19 On Childhood Vaccinations

The COVID-19 pandemic profoundly affected every aspect of daily life, including routine childhood vaccinations. Immunize Canada recognizes the importance of addressing concerns and providing insights into how the pandemic has influenced childhood immunization practices, its implications on public health, strategies to tackle vaccine hesitancy among parents, and the ground-breaking advancements in vaccine development that emerged during this crisis.

The COVID-19 pandemic disrupted health systems worldwide, leading to widespread interruptions and gaps in routine immunization services for children. Lockdown measures, fear of contracting the virus, and strained health resources resulted in missed or delayed vaccinations for many children. Routine visits to health providers declined significantly, leading to a backlog of missed vaccinations. The closure of schools, which often serve as vaccination centres, further exacerbated the issue. Consequently, a substantial number of children fell behind on their vaccination schedules, leaving them vulnerable to preventable diseases.

The repercussions of missed or delayed childhood vaccinations extend beyond individual health outcomes to affect public health on a broader scale. Vaccination rates serve as a critical measure of community immunity (also known as herd immunity). When vaccination rates decline, the risk of outbreaks and resurgence of vaccine-preventable diseases rises. Diseases such as measles, pertussis, and polio, which were once under control, may resurface and spread rapidly among unvaccinated/ under-vaccinated populations. This not only poses a threat to the health of children but also places a burden on health systems already grappling with the demands of the pandemic.

Vaccine hesitancy

Vaccine hesitancy, fueled by misinformation, disinformation and distrust in vaccines, presents a significant challenge to public health efforts. To address this issue, it is essential to engage in transparent and clear communication, provide evidence-based information, encourage and develop community-led strategies and address concerns with empathy and understanding. Healthcare providers play a crucial role in building trust and providing accurate information about the safety and efficacy of vaccines. Tailored educational campaigns aimed at dispelling myths and addressing common misconceptions can help alleviate vaccine hesitancy. Fostering partnerships with community leaders and leveraging social media platforms to disseminate accurate information can further enhance vaccine acceptance and uptake. Communication and collaborations between specific communities and healthcare providers should be sought to better understand the barriers to vaccination and also optimize access.

The development of COVID-19 vaccines marked a monumental achievement in scientific innovation and collaboration. The unprecedented speed at which vaccines were developed underscores the power of investment in research, technology, and global cooperation during times of crisis. The mRNA vaccine technology demonstrated remarkable efficacy and safety profiles. This breakthrough has paved the way for potential applications in vaccine development for other infectious diseases, including influenza, HIV, and Zika virus, to name a few. The mRNA platform offers advantages such as rapid development, scalability, and versatility, making it a promising tool in the fight against emerging infectious threats.

Safeguarding public health for future generations

The COVID-19 pandemic has had far-reaching implications for childhood vaccinations, underscoring the importance of maintaining immunization services amid crises. Addressing missed or delayed immunizations, combating vaccine hesitancy, and leveraging lessons from COVID-19 vaccine development are crucial steps in safeguarding public health and ensuring a resilient health system for future generations. Immunize Canada remains committed to advocating for vaccination as a cornerstone of disease prevention and control, working towards a healthier and more resilient society.

Contributor Details

Anne

Pham-Huy MD, FRCPC

Chair

Immunize Canada

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