COVID-19 and Influenza Vaccine Acceptance and Hesitancy Among Caregivers of Children with Cancer

Abstract

Introduction:Children with cancer are immunocompromised and at increased risk for complications from infections including COVID-19 and influenza. Vaccination is recommended, but caregiver perceptions in this high-risk group are not well understood. Methods: We conducted a cross-sectional survey of English- and Spanish-speaking caregivers of pediatric oncology patients at a large urban pediatric hospital from March to June 2022. The survey addressed COVID-19 and influenza vaccine knowledge, attitudes, and experiences and included validated questions to identify vaccine hesitancy. Caregiver survey responses were linked to their child’s electronic health record data. COVID-19 vaccine acceptance, defined as documented or caregiver-reported vaccine receipt or intention to vaccinate if age-ineligible at survey administration, was the primary outcome. Influenza vaccine acceptance was a secondary outcome. Associations between survey responses and COVID-19 or influenza vaccine acceptance were assessed using multivariable logistic regression. Results: Of 441 eligible caregivers, 100 (23%) responded. COVID-19 vaccine acceptance was 71%, influenza vaccine acceptance was 82%, and 57% of caregivers were identified as vaccine hesitant. Vaccine hesitancy was significantly negatively associated with COVID-19 vaccine acceptance. Perceived vaccine safety, efficacy, prior influenza vaccination, and pandemic-related concern about cancer were positively associated with COVID-19 vaccine acceptance. Conclusion: Caregiver perceptions strongly influenced COVID-19 and influenza vaccine acceptance. Specific and provider-driven communication strategies are needed to address ongoing vaccine hesitancy in this uniquely at-risk population.