fvWillingness to Vaccinate Children against COVID-19 Declined During the Pandemic

Objectives To document the level of vaccine hesitancy in caregivers' of children younger than 12 years of age over the course of the pandemic in Pediatric Emergency Departments (ED). Study design Ongoing multicenter, cross-sectional survey of caregivers presenting to 19 pediatric EDs in the USA, Canada, Israel, and Switzerland during first months of the pandemic (phase1), when vaccines were approved for adults (phase2) and most recently when vaccines were approved for children (phase3). Results Willingness to vaccinate rate declined over the study period (59.7%, 56.1% and 52.1% in the three phases). Caregivers who are fully vaccinated, who have higher education, and those worried their child had COVID-19 upon arrival to the ED, were more likely to plan to vaccinate in all three phases. Mothers were less likely to vaccinate early in the pandemic, but this hesitancy attenuated in later phases. Older caregivers were more willing to vaccinate, and caregivers of older children were less likely to vaccinate their children in phase 3. During the last phase, willingness to vaccinate was lowest in those who had a primary care provider but did not rely on their advice for medical decisions (34%). Those with no primary care provider and those who do and rely on their medical advice, had similar rates of willingness to vaccinate (55.1% and 52.1%, respectively). Conclusions COVID-19 vaccine hesitancy is widespread and growing over time, and public health measures should further try to leverage identified factors associated with hesitancy in order to enhance vaccination rates among children.

Willingness to vaccinate children against COVID-19 declined during the pandemic.

OBJECTIVES: To document the level of vaccine hesitancy in caregivers' of children younger than 12 years of age over the course of the pandemic in Pediatric Emergency Departments (ED). Study design Ongoing multicenter, cross-sectional survey of caregivers presenting to 19 pediatric EDs in the USA, Canada, Israel, and Switzerland during first months of the pandemic (phase1), when vaccines were approved for adults (phase2) and most recently when vaccines were approved for children (phase3). RESULTS: Willingness to vaccinate rate declined over the study period (59.7%, 56.1% and 52.1% in the three phases). Caregivers who are fully vaccinated, who have higher education, and those worried their child had COVID-19 upon arrival to the ED, were more likely to plan to vaccinate in all three phases. Mothers were less likely to vaccinate early in the pandemic, but this hesitancy attenuated in later phases. Older caregivers were more willing to vaccinate, and caregivers of older children were less likely to vaccinate their children in phase 3. During the last phase, willingness to vaccinate was lowest in those who had a primary care provider but did not rely on their advice for medical decisions (34%). Those with no primary care provider and those who do and rely on their medical advice, had similar rates of willingness to vaccinate (55.1% and 52.1%, respectively). CONCLUSIONS: COVID-19 vaccine hesitancy is widespread and growing over time, and public health measures should further try to leverage identified factors associated with hesitancy in order to enhance vaccination rates among children.

Factors associated with unvaccinated caregivers who plan to vaccinate their children.

Vaccine hesitancy is complex and a threat to global public health during the ongoing COVID-19 pandemic. Our objective was to determine factors associated with caregivers' willingness to vaccinate children despite not being immunized themselves against COVID-19. The International COVID-19 Parental Attitude Study (COVIPAS), a multinational cohort study, recruited caregivers of children 0-18 years old in 21 Emergency Departments (EDs) in USA, Canada, Israel, and Switzerland during November-December 2021. Of a total of 4536 caregivers who completed the survey, 882 (19.4%) were unvaccinated, and 62 (7.0%) of the unvaccinated planned to vaccinate their children. Unvaccinated caregivers with children that had their childhood vaccines up-to-date (OR 3.03 (1.36, 8.09), p = 0.01), and those very worried their child has COVID-19 in the ED (OR 3.11 (1.44, 6.34), p < 0.01) were much more likely to plan to immunize their children. Primary care providers and public health agencies should not assume that unvaccinated parents will not vaccinate their children. Determining child's vaccination status and parental level of concern about COVID-19 may help identify caregivers who are open to give their children the vaccine.

Anthropometric measurements and laboratory investigations in children and youth with Type 1 diabetes (T1D) before and during the COVID-19 pandemic

Introduction: At the onset of the COVID-19 pandemic, the Diabetes Clinic at BC Children's Hospital (BCCH) in British Columbia (BC), Canada experienced a rapid shift from in-person to telehealth visits. Virtual diabetes care has shown to be feasible and effective and will likely continue beyond this pandemic. However, there are still many challenges. Objectives: To compare rates of measurement of height, weight, blood pressure (BP), A1c and laboratory screening for diabetes-related complications (based on clinical practice guidelines), 1 year before and after the onset of COVID-19. Methods: Retrospective review of the BC Pediatric Diabetes Registry that includes clinical data of patients seen in the BCCH Diabetes Clinic. Inclusion criteria were children and youth with T1D who had at least one visit during March 2019-2021. Logistic and Poisson mixed effect models were used. Results: Among 434 patients included, mean (SD) age and time since diagnosis were 12.2 (3.92) and 5.49 (3.72) years, respectively. Mean (SD) A1c was 8.1% (1.53). Table 1 shows the number of clinic visits, anthropometric and A1c measurements per patient during both periods. Over the pandemic year, 47% of patients had no growth data, 21% had no laboratory measured A1c, and only 1% had BP measurements. Screening for hyperthyroidism and nephropathy showed a downward trend (Figure 1) 1Estimated relative risk, after adjustment for age, sex, time since diagnosis, A1C before COVID onset, pump use and CGM use Conclusions: After the shift to telehealth diabetes clinic visits, our patients had a dramatic decrease in anthropometric, A1c and BP measurements. Laboratory screening for complications was already suboptimal and continued to decline post-pandemic onset. Our data show a hybrid model of virtual and in-person visits are needed to ensure standards of care related to anthropometric and laboratory screening for children and youth with T1D. Understanding patient and provider perspectives on barriers to completing investigations will inform future processes and recommendations. (Table Presented).