An Assessment of Parents’ Childhood Immunization Beliefs, Intentions, and Behaviors Using a Smartphone Panel

Boyle J., Berman L, Glen J. Nowak, Iachan R, Middleton D and Deng Y. “An Assessment of Parents’ Childhood Immunization Beliefs, Intentions, and Behaviors Using a Smartphone Panel,” Vaccine, 2020;38(10):2416-2423.

Abstract: It is important to quickly identify parent beliefs, intentions, and behaviors toward childhood vaccination, especially parents of children 19 to 35 months. A sample of parents, ages 18 and older, from a mobile panel with people residing in the U.S. were invited to answer immunization behavior, intention, and belief questions using a smartphone app that was not vaccine specific. This survey provided insights into beliefs and behaviors of parents regarding childhood vaccination. It found evidence of differences in beliefs, particularly related to delaying or declining recommended childhood vaccinations. The survey was conducted in a few days and at lower cost than traditional methods.

Adherence to Timely Vaccinations in the United States.

Abstract: To estimate 1) the proportion of children not adhering to the Advisory Committee on Immunization Practices (ACIP) recommended early childhood immunization schedule and 2) associations between schedule adherence, sociodemographic characteristics and up-to-date immunization status by 19-35 months of age. Methods: We used 2014 National Immunization Survey (NIS) provider-verified vaccination data to classify vaccination patterns as “recommended” (i.e., in line with ACIP dose- and agespecific recommendations), “alternate” (i.e., in line with either limiting the number of shots per visit or skipping at least one vaccine series) or “unknown/unclassifiable” (i.e., not in-line with ACIP recommendations nor clearly limiting shots per visit or vaccine series). We evaluated predictors of immunization schedule adherence patterns and estimated the association between vaccination patterns and up-to-date status for all ACIP-recommended vaccinations (including rotavirus and hepatitis A vaccines) using Poisson regression. Results: The majority of children’s patterns were classified as “recommended” (63%), with 23% and 14% following alternate or unknown/unclassifiable patterns, respectively; 58% of children were up-to-date with all ACIP-recommended immunizations by 19-35 months. Not being up-to-date was associated with alternate (prevalence ratio [PR] = 4.2, 95% confidence interval [CI] 3.9, 4.5) and unknown/unclassifiable (PR = 2.4, 95% CI 2.2, 2.7) vaccination patterns. Conclusion: Overall high vaccine coverage by 19-35 months of age may miss non-adherence to the recommended immunization schedule in the first 18 months of life, leaving children vulnerable to preventable diseases. With more than one-third of US children not following the ACIP schedule, targeted interventions are needed to minimize vaccine delays and disease susceptibility.

The Global Vaccine Action Plan – insights into its utility, application, and ways to strengthen future plans.

Abstract: The pace of global progress must increase if the Global Vaccine Action Plan (GVAP) goals are to be achieved by 2020. We administered a two-phase survey to key immunization stakeholders to assess the utility and application of GVAP, including how it has impacted country immunization programs, and to find ways to strengthen the next 10-year plan.

Results: Global immunization stakeholders (n = 38) cite global progress in improving vaccine delivery (88%) and engaging civil society organizations as advocates for vaccines (83%). Among regional and national immunization stakeholders (n = 58), 70% indicated reaching mobile and underserved populations with vaccination activities as a major challenge. The top ranked activities for helping country programs achieve progress toward GVAP goals include improved monitoring of vaccination coverage and upgrading disease surveillance systems. Most respondents (96%) indicated GVAP as useful for determining immunization priorities and 95% were supportive of a post-2020 GVAP strategy. Conclusions: Immunization stakeholders see GVAP as a useful tool, and there is cause for excitement as the global immunization community looks toward the next decade of vaccines. The next 10-year plan should attempt to increase political will, align immunization activities with other health system agendas, and address important issues like reaching mobile/migrant populations and improving data reporting systems.


Development of a measure to assess vaccine confidence among men who have sex with men.

Abstract: Recent serogroup C meningococcal disease outbreaks led to meningococcal vaccine recommendations for Southern California men who have sex with men (MSM). Assessment of vaccine confidence is critical to improving vaccine coverage in the context of disease outbreaks wherein immunization(s) are recommended. Methods: We surveyed MSM using venue-based sampling and began development of the vaccine confidence index (VCI) with 30 survey items corresponding to trust- and safety-related perceptions. We performed exploratory factor analyses and computed the Cronbach’s alpha coefficient to assess internal consistency of the VCI. We created a categorical confidence variable (low, medium, and high confidence) and conducted bivariate and multivariate analyses to evaluate associations with reported confidence and immunization uptake. Results: Ten survey items were included in the final VCI and formed the confidence measure. Participants with low confidence had the lowest levels of reported uptake for both meningococcal vaccines. Confidence differed significantly (p <= 0.05) between MSM who indicated they received vaccines recommended within the context of the outbreak and those who did not. Conclusions: Our VCI is sensitive to a number of issues that may influence vaccine confidence. It is useful for assessing MSM trust and acceptance of recommended immunizations and may be used to inform intervention development.