COVID-19 Vaccination Hesitancy Among 5-11-year-old Iranian Children's Parents: What Are Underlying Beliefs?

Background: Of all teenage deaths caused by coronavirus disease 2019 (COVID-19), 47% occurred in children aged 0-9. Like many other infectious diseases, reducing mortality in children requires widespread vaccination. Despite the availability of the COVID-19 vaccine, a large percentage of children have not received the vaccine. Objective(s): This survey aimed to study parents' reluctance to receive the COVID-19 vaccine for their children in Shiraz, Iran. Method(s): An online questionnaire was sent to parents whose 5 to 11-year-old children had received no COVID-9 vaccine through the health educators of primary schools in Shiraz, Iran. The questionnaire contained demographic questions and 16 beliefs about COVID-19 vaccination that were answered as yes/no. Result(s): We assessed 1093 respondents, including 49.5% (n = 542) male and 50.5% female students' parents. The mean number of wrong beliefs was 7.21 +/- 2.80 in parents who had boys and 7.78 +/- 2.95 in girls' parents. Also, 78.6% of participants had at least five wrong beliefs or excuses for not vaccinating their children. Notably, 82.8% of mothers and 84.3% of fathers were vaccinated with 2-3 doses against COVID-19. The most common wrong beliefs were probable vaccines' side effects in the future, the undesirable effect of vaccination on children's growth, and the awful effect of the vaccine on fertility, with a prevalence of 82.7%, 81.2%, and 76.7%, respectively. Conclusion(s): This study identified that most participants believed that COVID-19 vaccines have side effects for their children and unfavorable effects on children's growth and infertility.Copyright © 2023, Author(s).

External validation of the parental attitude about childhood vaccination scale.

Introduction: Internal validation techniques alone do not guarantee the value of a model. This study aims to investigate the external validity of the Parental Attitude toward Childhood Vaccination (PACV) scale for assessing parents' attitude toward seasonal influenza vaccination. Methods: Using a snowball sampling approach, an anonymous online questionnaire was distributed in two languages (English and Arabic) across seven countries. To assess the internal validity of the model, the machine learning technique of "resampling methods" was used to repeatedly select various samples collected from Egypt and refit the model for each sample. The binary logistic regression model was used to identify the main determinants of parental intention to vaccinate their children against seasonal influenza. We adopted the original model developed and used its predictors to determine parents' intention to vaccinate their children in Libya, Lebanon, Syria, Iraq, Palestine, and Sudan. The area under the curve (AUC) indicated the model's ability to distinguish events from non-events. We visually compared the observed and predicted probabilities of parents' intention to vaccinate their children using a calibration plot. Results: A total of 430 parents were recruited from Egypt to internally validate the model, and responses from 2095 parents in the other six countries were used to externally validate the model. Multivariate regression analysis showed that the PACV score, child age (adolescence), and Coronavirus disease 2019 (COVID-19) vaccination in children were significantly associated with the intention to receive the vaccination. The AUC of the developed model was 0.845. Most of the predicted points were close to the diagonal line, demonstrating better calibration (the prediction error was 16.82%). The sensitivity and specificity of the externally validated model were 89.64 and 37.89%, respectively (AUC = 0.769). Conclusion: The PACV showed similar calibration and discrimination across the six countries. It is transportable and can be used to assess attitudes towards influenza vaccination among parents in different countries using either the Arabic or English version of the scale.

Determinants of parental seasonal influenza vaccine hesitancy in the Eastern Mediterranean region: A cross-sectional study.

Background: Seasonal influenza vaccine can reduce the risk of influenza-associated hospitalizations and deaths among children. Given that parents are the primary decision makers, this study examined the parental attitude toward childhood influenza vaccine and identified determinants of vaccine hesitancy (VH) in the Eastern Mediterranean region (EMR). Methods: A cross-sectional study was conducted using an anonymous online survey in 14 EMR countries. Parents of children aged 6 months to 18 years were included. The Parent Attitude about Childhood Vaccines (PACV) was used to assess VH. Chi square test and independent t-test were used to test for association of qualitative and quantitative variables, respectively. A structural equations model (SEM) was used to identify direct and indirect determinants of parental VH. Results: Almost half of the parents were hesitant about vaccinating their children against influenza (50.8%). Parental VH was significantly higher among older mothers (37.06 ± 8.8 years, p = 0.006), rural residents (53.6%, p < 0.001), high-income countries residents (50.6%, p < 0.001), and mothers with higher educational levels (52.1%, p < 0.001). Parents of school-aged children (5-9 years) (55.6%, p < 0.001), children free from any comorbidities (52.5%, p < 0.001), children who did not receive routine vaccination at all (51.5%, p = 0.03), children who were not vaccinated against COVID-19 (54.3%, p < 0.001), in addition to parents who were not vaccinated against influenza (57.1%, p < 0.001) were significantly associated with increased likelihood of VH. Parents who were depending on healthcare provider as a source of information regarding vaccines were less likely to report VH (47.9%, p < 0.001), meanwhile those who used social media as their source of health information showed a significantly higher VH (57.2%, p < 0.001). The SEM suggested that mother's age, residence, country income level, child gender, total number of children and source of information regarding vaccines had a direct effect on VH. Meanwhile, parents vaccinated against influenza, children completely or partially vaccinated with routine vaccines and children vaccinated against Coronavirus disease 2019 (COVID-19) had an indirect effect on VH. Conclusion: A high proportion of included parents were hesitant to vaccinate their children against seasonal influenza. This attitude is due to many modifiable and non-modifiable factors that can be targeted to improve vaccination coverage.

Parent resolution of diagnosis and intervention fidelity in a parent-delivered intervention for pre-school children with autism: A mixed methods study

Background: There is growing interest in parent-delivered interventions (PDI) for children with autism. Treatment fidelity has been associated with child outcomes in PDI but little is known about what impacts fidelity. One factor not previously examined is parents' resolution to the autism diagnosis which involves adjusting expectations about the child and sensitively responding to their cues, strengths and needs. Relatively little is known about resolution in the context of autism but there is evidence of an association between resolution and parent wellbeing. Method: The study adopted a mixed methods approach to examine whether there is an association between PDI fidelity and parent resolution to diagnosis, and whether resolution is associated with parent wellbeing. Parents of 31 preschool children diagnosed with autism who attended up to 12 Parent-delivered Early Start Denver Model (P-ESDM) coaching sessions participated in the study. A thematic analysis of parent interviews was also undertaken to identify themes raised by resolved and unresolved parents in interviews. Results: There was no difference in overall mean fidelity scores between resolved and unresolved parents. Those classified as resolved had lower depression scores and parenting stress scores than parents classified as unresolved. The qualitative analysis revealed that parents' perceptions of their child's progress and their hopes for the future appeared to distinguish resolved and unresolved parents. Conclusions: Findings suggest that parent wellbeing and child progress may predict resolution which was not related to parent treatment fidelity in this study. Parent wellbeing and resolution status should be assessed at entry to PDI.

Change in screen time of preschool children according to parental attitudes during the COVID-19 pandemic with an online survey.

The relationship between the change in the screen time of preschool children according to both parent-child characteristics and parental attitudes was investigated in an online study involving 403 mothers. Mothers completed a questionnaire on baseline characteristics and Parent Attitude Scale. Multiple logistic regression and generalized linear models revealed the associations. Change in screen time was grouped as "increase" and "no increase". 70% stated an increase in the screen time during the pandemic period. The overprotective score was low in the group with increased screen time after adjusting parental age, education, and working status, family type, number of the children, the enrolled child's age, gender, daily screen time before the pandemic, and caregiver of the child. The child having longer screen time also had higher risk for the history of an increase in screen time in the lockdown period. This situation shows a need for parental guidance for healthy screen use.

Attitude of Parents of Children with Cerebral Palsy Towards COVID-19 Vaccination.

Children with cerebral palsy (CP) are at a greater risk of respiratory complications from coronavirus disease 2019 (COVID-19). Therefore, this study aimed to assess COVID-19 vaccine hesitancy (VH) among parents of CP children in Egypt, using the Arabic version of the Parental Attitude about Childhood Vaccination (PACV) questionnaire. This cross-sectional survey study was conducted at the outpatient clinics of two hospitals in Cairo, Egypt. Parents of children with CP were recruited using a simple random sampling technique. A total of 321 parents were enrolled; more than half of them were mothers of the children (61.37%); and the majority were Egyptians (87.23%) and living in urban areas (84.42%). Nearly 70% of the parents were hesitant to administer the COVID-19 vaccine to their children. A multiple linear regression model revealed that the PACV mean scores were lower among the following categories: (1) parents who could pay back loans, compared to those who could not pay back loans and who reported insufficient income (ß = -2.39, p = 0.030); (2) non-Egyptian parents (ß = -1.54, p = 0.002); (3) those who were fully vaccinated against COVID-19 themselves or had the intention to receive the complete COVID-19 vaccination (ß = -6.28, p < 0.001); (4) those who had the intention to give the COVID-19 vaccination to their children (ß = -3.04, p < 0.001); and (5) parents whose children received routine vaccines (ß = -2.86, p < 0.045). After adjusting for other covariates, the parental COVID-19 vaccine status (ß = -6.28, p < 0.001) and parents who experienced a COVID-19-related death in the family (ß = -1.75, p < 0.001) showed significantly lower mean PACV scores. However, higher mean PACV scores were reported among parents who had a COVID-19 infection (ß = 2.77, p < 0.001) or who were not sure (ß = 2.94, p < 0.001). Our findings suggest the need to increase COVID-19 vaccine acceptance among parents of vulnerable children to reduce the negative consequences of COVID-19.

Determining Screen Time of Children Between 3-9 Years During COVID-19 Pandemic And Investigation of Factors Related To Screen Time

Objective: The first COVID-19 case in Turkey was detected on March 11, 2020, and measures were taken to prevent the epidemic's progression. As the schools were closed and curfew was imposed on children with periodically updated bans, children had to spend more time at home during the day. In the study, we aimed to determine how the COVID-19 pandemic has influenced the screen time of children aged 3-9 in Turkey and examine the factors affecting screen time. Material(s) and Method(s): This descriptive cross-sectional study was conducted between May 3, 2020, and May 30, 2020. Throughout Turkey, mothers or fathers with at least one child between the ages of 3 and 9 were invited to the online survey via social media, telephone message groups, or e-mail. The parents who voluntarily answered the online questionnaire constituted the study participants. Result(s): A total of 9483 parents with children between the ages of 3 and 9 participated in the study. It was determined that 82.9% of the children participating in the study had increased screen time compared to the pre-pandemic period. The mean increase in screen time was 151+/-96 minutes/day. The increase was more than one hour per day in 74.9% of the participants (n=5122). The average daily screen time of the children participating in the study on the dates specified during the pandemic period was 193+/-124, the average time spent for online education was 67+/-62 minutes/day, and for leisure activities with the screen was 133+/-121 minutes/day. Screen time was significantly higher in children whose parent did not have a plan for child's screen use (OR: 3.085, 95% CI, 2.723 to 3.494, p<.001) or children who did not use the screen under parental control (OR: 1.533, 95% CI, 1.352 to 1.73, p<.001). Conclusion(s): During the pandemic, daily screen time increased in a significant number of children, and the time they spent in front of the screen was relatively high. The purpose and duration of screen use varied between preschoolers and school children. Parental attitudes and behaviors were related to children's screen time during the pandemic period. Copyright © 2022 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.

Elementary school children's learning motivation and parental attitude to a child in blended learning conditions

Introduction. The changed living and learning conditions caused by quarantine and social restrictions in connection with the COVID-19 pandemic have radically transformed the interaction and communication between people. Genuine scientific interest is aroused by the problem of learning motivation and parental attitude toward the child in the context of a pandemic and the transition of the entire education system to a distance or blended learning format. The article presents a theoretical analysis of the motivation to learn of an elementary school child and the peculiarities of the parental attitude toward a child of elementary school age. Methods. The empirical research was carried out using several techniques: the method of "Learning motives questionary” by M.R. Ginzburg;the questionnaire "Parent-child interaction" by I.M. Markovskaya. The study was carried out in two stages during the 2019-2020 learning year based on the MAEI "School No. 96 Eureka-Development named after Nagibin M.V.” Rostov-on-Don. The study involved 107 schoolchildren aged 8-9 years and 107 parents of elementary school children (aged 30 to 39 years). Results. The results revealed the presence of some changes in the severity of the learning motives of younger schoolchildren: the degree of significance of cognitive motivation of younger schoolchildren from families inclined to cooperate during blended learning became significantly lower than during contact learning;in younger schoolchildren from families inclined to control, the importance of external and game motives increased, while the severity of learning and grading motives has significantly decreased. © 2022, Russian Psychological Society. All rights reserved.

Parents' and Health Professionals' Attitudes to Advancing Primary MMR Vaccine Administration from Fifteen to Six Months of Age-A Qualitative Thematic Analysis Embedded in a Randomized Trial.

Declining levels and duration of passively acquired maternal antibodies prompted a Danish trial to test the feasibility of advancing administration of the first measles, mumps, and rubella vaccine (MMR1) from 15 to 6 months of age. A trial-embedded qualitative study aimed to understand parents' (N = 24) and health professionals' (N = 11) attitudes about the measles, mumps, and rubella vaccine (MMR) in general and about advancing MMR1 administration. Overly positive parent attitudes were contrasted by members of a vaccine-skeptical organization including parents considering that their child was seriously vaccine-injured long ago. Parents' attitudes to advancing MMR1 mirrored their attitudes about the MMR vaccine in general, with four positions along a continuum of trust in the healthcare system: unquestioning trust, acceptance after careful consideration, challenging indecisiveness, and defensive rejection. Low tolerance was identified between vaccine supporters and vaccine opponents. Parents of children with perceived serious vaccine-related injuries described lifelong unresolved feelings of guilt. Supporters of advanced MMR1 saw it as a timely and convenient administration of a well-known vaccine, whereas opponents feared it would disturb the children's immature immune systems and emphasized difficulties in recognizing side effects so early in life. Health professionals were supportive of advancing the MMR1 vaccine and they carefully challenged the parents. Current MMR vaccine supporters show readiness to advance MMR1 administration.

Influenza, SARS-CoV-2, and routine childhood vaccines - trends in vaccine hesitancy in hospitalized children before and during the COVID-19 pandemic

Background. Vaccine hesitancy (VH) is adversely affecting the public health response to the COVID-19 pandemic. Similarly, influenza vaccine uptake is suboptimal. We aimed to monitor trends in VH with respect to influenza, SARS-CoV-2, and routine childhood vaccines. Methods. We conducted a repeated cross-sectional survey in English and Spanish of caregiver influenza and SARS-CoV-2 knowledge, attitudes, behaviors, and associated VH among hospitalized children 6 mo-18 yrs at a large pediatric medical institution. Caregivers were enrolled over 3 influenza seasons (S);2019-2020 (S1), 2020-2021 (S2), and 2021-2022 (S3). VH was assessed using the Parent Attitudes about Childhood Vaccines (PACV) survey;PACV score >= 50 denoted VH. Descriptive statistics were used. Results. During 3 influenza seasons, 269/282 (95%), 295/307 (96%), and 384/418 (92%) of approached caregivers were enrolled in S1, S2, and S3 respectively. Most parents (45%) identified as Hispanic/Latino, 35% as White, and 20% as Black/African American. By report, 94% of children in S1, 91% in S2, and 91% in S3 were up-to-date with routine childhood vaccines. Based on PACV score, 13% of parents were VH in 19-20 compared to 17% in 20-21 and 19% in 21-22. Approximately 70% of caregivers gave or planned to give their child the influenza vaccine across seasons. Following the COVID-19 pandemic, caregivers were less likely to believe that the 'flu can be a dangerous infection in children,' and to agree that 'all children over 6 months of age should receive the flu shot every year'. Decreased concern persisted or did not recover during the pandemic (Table 1). Parents were consistently scared of their child getting COVID-19 but fewer (49% versus 38%) were scared of their child getting the SARS-CoV-2 vaccine in S3. More (50% versus 71%) caregivers in S3 were willing to receive the SARS-CoV-2 vaccine themselves and 46% in S2 and 54% of caregivers in S3 had or planned to vaccinate their child against COVID-19 (Table 2). Conclusion. Our results suggest a trend that VH may be increasing. During the COVID-19 pandemic, caregivers of hospitalized children were less concerned about influenza than pre-pandemic. Intention to vaccinate children against COVID-19 remains suboptimal.

COVID-19 Vaccine Hesitancy among Parents of Children with Chronic Liver Diseases.

Children with chronic medical conditions are more susceptible to developing a serious negative outcome from corona virus disease 2019 (COVID-19) than healthy children. This study investigated the extent of COVID-19 vaccine hesitancy (VH) and its predictors in parents of children with chronic liver disease (CLD) in Egypt. Methods: A cross-sectional study was conducted at the National Liver Institute from September to October 2022, using a random sampling method. Data were collected using the validated Arabic version of parents' attitudes about childhood vaccines (PACV) scale. Structural equation modeling (SEM) and discriminant analysis were used to identify direct and indirect determinants of VH. Results: Of the 173 participating parents, 81.5% hesitated to vaccinate their child. Relevant characteristics for hesitancy included being the mother of the child (88.2%), younger than 40 years (92.9%), illiterate (92%), unemployed (88.8%), without health insurance (87.8%), unvaccinated against COVID-19 (97.2%), refused to complete vaccinations (85.7%), and not having chronic disease (85.7%) (p < 0.05). Previous COVID-19 infection of children motivated vaccination (p < 0.0001). Median total PACV, attitude, and trust scores were significantly higher in the hesitant group than the vaccinated group (p = 0.023). SEM suggests that child age and family size have a direct effect, while education level, and income have indirect effects on parents' hesitancy. The model showed acceptable goodness of fit (GFI = 0.994, CFI = 1, RMSEA < 0.0001). A 92.9% corrected classification of the discriminator VH variables was determined using the discriminant analysis model (safety and efficacy, attitude and trust, child age, and family size). Conclusions: Many socioeconomic factors significantly affect parents' attitudes toward their child's vaccination. Thus, increasing parents' awareness of the importance of childhood vaccination, especially among this risky group, may enhance their decision-making ability regarding vaccinating their children.

Parental Willingness for COVID-19 Vaccination among Children Aged 5 to 11 Years in Riyadh City, Saudi Arabia: A Cross-Sectional Study.

To manage the COVID-19 outbreak, the WHO recommends adult and child vaccination. Vaccine skepticism has been a major worldwide health concern for decades, and the situation is worsening. The primary purpose of this study was to investigate parental willingness to vaccinate their children (aged 5 to 11 years) against COVID-19 and to describe its relationship with attitude, barriers, facilitators, and sources of knowledge regarding the vaccine. Methods: From February to March 2022, a community-based cross-sectional survey was undertaken among the parents of Riyadh city, Saudi Arabia. We employed a convenient sampling procedure to gather the required sample. Using the Raosoft sample size calculator, a minimum sample size of 385 was determined based on a 95% confidence level, a 5% margin of error, and a 5% precision level. The data were analyzed using version 26 of SPSS. A p-value less than 0.05 was judged statistically significant. The Chi-square test and likelihood ratio were utilized to describe the relationship between socio-demographic characteristics, driving factors, and COVID-19 vaccine hesitancy. Vaccine hesitancy associated factors were identified using multivariate binary logistic regression. A total of 528 replies were received. The majority of respondents were mothers (77.7%), aged 26 to 40 years (67.8%), married (91.5%), Saudi nationals (96.2%), college graduates (70.6%), with a monthly family income of more than SAR 10,000 (46.4%), non-healthcare professionals (84.7%), employed in the government sector (33.7%), with three children (23.3%), and children aged 5 to 11 years (88.7%). A little more than half of the parents (55.7%) exhibited considerable vaccination hesitancy. About 16.28% of parents were willing to vaccinate their children as soon as possible, compared to 38.44% who had no interest whatsoever in vaccination. A greater proportion of mothers and unemployed parents were unwilling to vaccinate their children. Parents with a higher monthly income (above SAR 10,000), who worked as healthcare professionals, and whose children suffered from chronic conditions were significantly more ready to vaccinate their children against COVID-19. Parents who were aware of anti-vaccination campaigns and who vaccinated their children with required childhood vaccines were also much more likely to vaccinate their children against COVID-19. Most parents (66.9%) obtained information on COVID-19 via the Saudi Ministry of Health website, followed by social media (48.1%). The vaccine's novelty and the dearth of reliable information about its safety (65%) and insufficient information about its effectiveness (36.2%) were the primary reasons for not vaccinating children against COVID-19, whereas preventing children from contracting COVID-19 (55.9%) and government mandate (38.8%) were the primary reasons for vaccinating children against COVID-19. Conclusions: There was significant parental hesitancy to immunize their children against COVID-19. To involve and educate parents, multi-component interventions must be developed and implemented.

Abstracts of the RCPCH Conference

The proceedings contain 839 papers. The topics discussed include: parental attitudes regarding safe handling of hand sanitizers and management of children with sanitizer poisoning amongst a cohort of children admitted to a tertiary care center in Sri Lanka;pediatric major incident triage and the use of machine learning techniques to develop an alternative triage tool with improved performance characteristics;unfair and unequal: comparing the experiences and outcomes of children with acute mental health and acute physical health presentations to the pediatric emergency department;tackling child inequality in a UK emergency department: a pilot early intervention service on the shop floor;introducing a new pediatric clerking proforma in a tertiary pediatric emergency department - a quality improvement project;changing patterns of bronchiolitis attendances to the emergency department in the COVID-19 pandemic;investigating prescribing errors in salbutamol nebulizers for acute asthma patients aged 5 and above in a district general hospital;assessment for testicular torsion in a DGH hospital- a service review;and changing spectrum of children presenting with asthma and viral induced wheeze in the COVID -19 pandemic.

Black-and-white thinking and conspiracy beliefs prevent parents from vaccinating their children against COVID-19.

Understanding predictors of parents' willingness to vaccinate their children appears fundamental to promote vaccine acceptability, especially in a pandemic scenario. The present study aimed to investigate the role of conspiracy beliefs and absolutist thinking in parental attitude toward COVID-19 vaccine, and the predictive role of parents' individual differences on decisions against children's vaccination. An online survey was administered to 415 parents of children aged 5-11, at the very beginning of the vaccination targeting this population in Italy. Results showed that absolutism predicted the tendency to believe in conspiracies, associated with a negative attitude toward the COVID-19 vaccine administration to children. Moreover, mothers were less willing to vaccinate children and parents of children aged 5-7 were more hesitant, or even against vaccination, than parents of older children. Finally, the worry about consequences of COVID-19 infection on children's health facilitated vaccine adherence. These findings contribute to deepening mechanisms regarding the vaccine acceptability.

Prior home learning environment is associated with adaptation to homeschooling during COVID lockdown.

The COVID-19 crisis in 2020 led to exceptional measures to contain the spread of the virus. In France as in many countries around the world, the government ordered a lockdown with school closure for several weeks. A growing number of studies suggest that family socio-economic status might be an important predictor of how families adapted to homeschooling during lockdown. However, socio-economic status is a distal factor that does not necessarily inform on the specific characteristics of the home learning environment that may more directly influence parental adaptation to homeschooling during lockdown. Here we aimed to examine how parental adaptation to homeschooling during lockdown was influenced by prior parental attitudes and expectations towards academic learning, as well as prior familiarity with literacy and numeracy activities at home. The present study involves 52 families who participated in a study about the home learning environment in 2018. At that time, parents completed an extensive questionnaire assessing their beliefs and attitudes towards academic learning and the frequency of literacy and numeracy activities are home. At the end of the first 2020 French lockdown, we again asked the same parents to complete a questionnaire, this time assessing homeschooling conditions during lockdown as well as parental confidence towards academic domains. Over and above a range of background variables, correlation analyses revealed that parental expectations towards academic learning as well as frequency of prior shared activities were related to daily homeschooling time during lockdown. Both parental attitudes and expectations towards numeracy and literacy were also related to parental confidence in homeschooling. Our results suggest that several aspects of the home learning environment may have influenced how families adapted to homeschooling during the 2020 COVID lockdown.

Offline Learning Readiness during COVID-19 Pandemic: Indonesian’ Parent Knowledge, Belief, and Attitude

BACKGROUND: Indonesian Government advised to begin to open the school for offline learning with strict COVID-19 prevention protocol in early September 2021. However, this policy may cause parents to feel anxious and concerned about their children’s health during face-to-face learning. The previous research has focused on parents’ perspectives and readiness toward their children’s digital use in general, leaving their beliefs, attitudes, and readiness concerning offline learning in the COVID-19 pandemic unexplored. AIM: This study aimed to identify knowledge, beliefs, and attitudes toward children’s offline learning among parents during the COVID-19 pandemic in Indonesia. METHODS: A cross-sectional survey was used to collect data using Survey Monkey. The sample in this study was parents who had children aged 6–12-years-old and willing to participate in this study. A linear regression model was employed to find readiness-related factors. RESULTS: A total of 800 (response rate was 80%) participants participated in the study. The average age was 34 (SD = 12.3), 60% were female and 54% worked in the public sector. Participants had an average knowledge score of 10.3 (SD = 3.27, with a range of 0–13), parental attitudes concerning the advantages and disadvantages of offline schooling versus online learning were 3.88 (SD = 0.12), the belief was 3.78 (SD = 0.89), and the readiness score was 3.45 (SD = 0.89). Attitude (β = 3.04 and p = 0.001) and belief (β = 2.89 and p = 0.001) were the factors associated with readiness to offline learning outbreak COVID-19 pandemic. CONCLUSIONS: The results suggested that the implementation of offline learning during the pandemic has been a positive response by families. Individuals may also benefit from targeted health education programs to strengthen COVID-19 knowledge, belief, and preparation for offline learning during pandemic COVID-19.

SARS-CoV-2 Vaccine Hesitancy in Caregivers of Hospitalized Children

Background. SARS-CoV-2 vaccine hesitancy (VH) is hindering nationwide vaccination efforts;little is known about caregiver SARS-CoV-2 vaccine acceptance for children. We aimed to identify associations with SARS-CoV-2 VH in caregivers of hospitalized children. Methods. We conducted a prospective cross-sectional survey in English and Spanish of caregiver COVID-19 knowledge, attitudes, behaviors, and associated VH among hospitalized children 6 months - 18 years at a large pediatric medical institution. Parents were approached daily, averaging 4-5 days/week, from 12/8/2020--4/5/2021. VH was assessed using the Parent Attitudes about Childhood Vaccines (PACV) survey;PACV score ≥50 denoted VH. Descriptive statistics and multivariable logistic regression were used. Responses were categorized. Results. 295/307 (96%) of approached caregivers enrolled;79% were ≥ 30 years, 68% were married/ living with a partner, and 57% had at least some college. 36% identified as white, 19% Black, and 46% Hispanic/ Latino. 53% of caregiver children had public insurance. 91% of caregivers self-reported their children were up to date with routine vaccines. 17% of caregivers were vaccine-hesitant overall. 50% of caregivers were willing to receive COVID-19 vaccine themselves. Figure 1 shows intention to vaccinate their child by PACV score. 65% knew someone who was hospitalized for COVID-19. 67% were scared of their child getting COVID-19. However, 49% were scared of their child getting the vaccine, 28% did not want to vaccinate their child and 27% were neutral in the intention to vaccinate their child. Caregivers who did not intend to vaccinate their child were more likely to be Black (27% vs. 16%, p=0.04) and less likely to be Hispanic/ Latino (33% vs. 49%, p=0.02). Table 1 shows attitudes, beliefs, and behaviors surrounding the COVID-19 pandemic and vaccine in caregivers who did or did not intend to vaccinate their child. Figure 1 COVID-19 vaccine uptake by PACV score Table 1 Caregiver attitudes, beliefs, and behaviors surrounding the COVID-19 pandemic and the COVID-19 vaccine Conclusion. The majority of caregivers believe that SARS-CoV-2 vaccine will help control the pandemic, but less than half plan to vaccinate their children. A quarter of caregivers expressed uncertainty regarding the vaccine and therefore may be amenable to education and discussion. COVID-19 VH is different from VH towards routine vaccinations. More research is needed to address COVID-19 specific VH.

Influenza Vaccine Hesitancy in Hospitalized Children, before and during the COVID-19 Pandemic

Background. Influenza vaccine is recommended for all children ≥6 months, yet uptake is suboptimal. We aimed to quantify child influenza vaccine coverage and identify factors associated with influenza vaccine hesitancy (VH) before and during the COVID-19 pandemic. Methods. We conducted a prospective, repeated cross-sectional assessment in English and Spanish of caregiver influenza knowledge, attitudes, behaviors, and associated VH among hospitalized children 6 months through 18 years at a large pediatric medical institution. Caregivers were enrolled 4-5 days per week, between 12/11/2019--1/31/2020 and 12/8/2020--4/5/2021. VH was assessed using the Parent Attitudes about Childhood Vaccines (PACV) survey;PACV score ≥50 denoted VH. Descriptive statistics and multivariable logistic regression were used. Results. During 2019-2020 and 2020-2021 influenza seasons, 269/282 (95%) and 295/307 (96%) of approached caregivers enrolled, respectively. By caregiver report, 94% of children in 2019-2020 and 91% in 2020-2021 were up-to-date with routine childhood vaccines (p=0.13). Specific to influenza vaccine, 73% and 68% of children received or planned to receive influenza vaccine in 2019-2020 and 2020-2021, respectively (p=0.13). Based on PACV score, 13% of parents were VH in 2019-2020 compared with 17% in 2020-2021 (p=0.24;Figure 1). Caregivers who had not/did not intend to vaccinate their children had a higher family income (71% vs. 57% >$30,000, p< 0.01) and were less likely to be Hispanic/ Latino (35% vs. 47%, p=0.02). 77% of caregivers were satisfied with information about influenza vaccine received from healthcare providers. Overall, 36% believed "you can get the flu from the flu shot." In 2020-2021, caregivers were less likely to believe that "flu can be a dangerous infection in children," to be "scared of my child getting the flu" and to agree that "all children over 6 months of age should receive the flu shot every year" (Table 1). Conclusion. During the COVID-19 pandemic, caregivers of hospitalized children were less concerned about influenza than pre-pandemic and misinformation about influenza and influenza vaccine persisted. Increased efforts may be needed to educate caregivers about the importance of influenza immunization during the 2021-22 season.