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BackgroundSince 2010, the Advisory Committee on Immunization Practices (ACIP) has recommended that all persons aged ≥6months receive annual influenza vaccination.MethodsWe analyzed data from the 2015 National Internet Flu Survey (NIFS), to assess knowledge and awareness of the influenza vaccination recommendation and early influenza vaccination coverage during the 2015–16 season among adults. Predictive marginals from a multivariable logistic regression model were used to identify factors independently associated with adults’ knowledge and awareness of the vaccination recommendation and early vaccine uptake during the 2015–16 influenza season.ResultsAmong the 3301 respondents aged ≥18years, 19.6% indicated knowing that influenza vaccination is recommended for all persons aged ≥6months. Of respondents, 62.3% indicated awareness that there was a recommendation for influenza vaccination, but did not indicate correct knowledge of the recommended age group. Overall, 39.9% of adults aged ≥18years reported having an influenza vaccination. Age 65years and older, being female, having a college or higher education, not being in work force, having annual household income ≥$75,000, reporting having received an influenza vaccination early in the 2015–16 season, having children aged ≤17years in the household, and having high-risk conditions were independently associated with a higher correct knowledge of the influenza vaccination recommendation.ConclusionsApproximately 1 in 5 had correct knowledge of the recommendation that all persons aged ≥6months should receive an influenza vaccination annually, with some socio-economic groups being even less aware. Clinic based education in combination with strategies known to increase uptake of recommended vaccines, such as patient reminder/recall systems and other healthcare system-based interventions are needed to improve vaccination, which could also improve awareness.

•Approximately 18% of parents reported hesitancy toward vaccines for their adolescents.•Hesitancy is associated with 18% to 23% lower coverage for adolescent HPV vaccination.•The difference in vaccination coverage due to hesitancy is larger for males than for females.•Over 10% of non-vaccination could be attributed to parental vaccine hesitancy.•Strengthening provider recommendation can increase HPV vaccination coverage among adolescents.

Some public health professionals have expressed concern that the COVID-19 pandemic has increased vaccine hesitancy about routine childhood vaccines; however, the differential prevalence of vaccine hesitancy about specific vaccines has not been measured. Data from the National Immunization Survey-Child COVID-19 Module (NIS-CCM) were analyzed to assess the proportion of children ages 6 months–17 years who have a parent with hesitancy about: COVID-19, influenza, human papillomavirus (HPV) (for children ≥ 9 years) vaccines, and “all other childhood shots.” Interviews from October 2022 through April 2023 were analyzed. The percentage of children with a vaccine-hesitant parent varied by vaccine. 55.9% of children had a parent hesitant about COVID-19 vaccine, 30.9% hesitant about influenza vaccine, 30.1% hesitant about HPV vaccine, and 12.2% had a parent hesitant about other vaccines such as measles, polio, and tetanus. The study findings suggest that differential interventions and communications to parents be used to educate about COVID-19, influenza, HPV, and routine childhood vaccinations because the hesitancy levels differ widely.

Understanding parental reasons for not having their child receive an influenza vaccination and how reasons have changed over time can help immunization programs and providers tailor interventions to increase uptake of influenza vaccine among children. The objectives of this study were to estimate the percentage of children 6 months–17 years with a parent who reported selected reasons for non-receipt of influenza vaccination (or “non-vaccination”) during 2015–2024, assess whether there has been an increase or decrease in the reporting of each reason for non-vaccination, particularly pre versus post COVID-19 pandemic, and if reasons for non-vaccination differ by sociodemographic characteristics. National Immunization Survey-Flu (NIS-Flu) parentally reported data for the 2015–16, 2016–17, 2019–20, 2022–23, and 2023–24 seasons were analyzed. Percentages of children not vaccinated against influenza whose parent reported each reason for non-vaccination, overall, by state, and by sociodemographic characteristics were calculated. Tests of association between sociodemographic characteristics and across seasons were conducted for each reason for non-vaccination using t-tests. The most commonly reported reasons for non-receipt of influenza vaccination across all seasons studied were: belief their child is unlikely to get very sick from influenza, concern about side effects/safety, and belief influenza vaccines do not work very well (48.2 %, 43.3 %, and 37.0 %, respectively, in 2023–24). Parental reporting of thinking their child is unlikely to get very sick from influenza increased more than other reasons for non-vaccination since the COVID-19 pandemic. Across all seasons studied, very few reported access-related reasons. Reasons for non-vaccination varied by state and by demographic characteristics. This study suggests that concern about influenza has decreased since the COVID-19 pandemic. A strong provider recommendation for influenza vaccination, including information about the safety of the vaccine and seriousness of influenza, could help increase influenza vaccination coverage among children.

Vaccine hesitancy (VH) has been a major contributor to large outbreaks of vaccine-preventable diseases globally, including in the United States. Data from the 2019–2022 National Immunization Surveys were analyzed to assess parental hesitancy toward routine vaccination of their children aged 6 months −17 years. Joinpoint regression was employed to investigate trends in VH from 2019 to 2022 nationally overall and among socio-demographic subgroups. Using logistic regression, the difference between the prevalence of VH before and after the authorization of the COVID-19 vaccine for children aged 6 months-4 years, 5–11 years, and 12–17 years was computed. Both unadjusted and adjusted estimates were reported. VH was also compared within each socio-demographic subgroup with a reference level, at two-time points— before and after the authorization of the COVID-19 vaccine for each age group. Overall, VH remained around 19.0 % from Q2 2019 to Q3 2022. Parents of non-Hispanic Black children had the largest average quarterly decrease in VH (β = -0.55; p < 0.05 by test for trend). After the authorization of the COVID-19 vaccine for children aged 6 months to 4 years, the adjusted percentage of children having parents that reported VH decreased by 2.2 (95 % CI: −3.9, −0.6) percentage points (pp) from 21.6 % to 19.4 %. Conversely, for children aged 5–11 years, VH increased by 1.2 (95 % CI: 0.2, 2.3) pp, from 19.8 % to 21.0 %. VH among parents of non-Hispanic Black children decreased after the authorization of the COVID-19 vaccine for adolescents aged 12–17 years but remained significantly higher compared to parents of non-Hispanic White children before and after authorization of the COVID-19 vaccine for all age groups. About 1 in 5 children had parents reporting VH from 2019 to 2022. Parental VH increased after the authorization of the COVID-19 vaccine for children aged 5–11 years and declined for children aged 6 months-4 years.

► A shortage of Haemophilus influenzae type b (Hib) vaccine occurred in the United States during December 2007 to September 2009. ► Data from the 2009 National Immunization Survey (NIS) were analyzed to examine effects on Hib vaccination coverage. ► As expected booster dose coverage was reduced, but primary series coverage was also reduced in some states. A shortage of Haemophilus influenzae type b (Hib) vaccine that occurred in the United States during December 2007 to September 2009 resulted in an interim recommendation to defer the booster dose, but to continue to vaccinate as recommended with the primary series during the first year of life. To quantify effects of the Hib shortage on vaccination coverage and to determine if any demographic subgroups were disproportionately affected. Data from the 2009 National Immunization Survey (NIS) were divided based on child's age at the onset of the shortage. Comparisons were made in primary series coverage by 9 months between children <7 months versus ≥7 months at the start of the shortage. Comparisons in primary series plus booster dose completion by 19 months were made between children who were <12 months versus ≥12 months at the start of the shortage. Nationally, there was a difference in Hib primary series completion by 9 months among children age <7 months versus ≥7 months at the start of the shortage (73.9% versus 81.2%, P<0.001). There was a large difference in the percentage of children fully vaccinated with the primary series plus booster dose by 19 months among children age <12 months versus ≥12 months at the start of the shortage (39.5% versus 66.0%, P<0.001). There were differential effects of the shortage on primary series coverage among states and for some demographic characteristics. As expected booster dose coverage was reduced consistent with interim recommendations, but primary series coverage was also reduced by 7 percentage points nationally.

•Rural children had lower influenza vaccination coverage.•Rural disparities in child influenza vaccination coverage were consistent over time.•Rural children had lower influenza vaccination coverage across demographics.•Interaction between rural status and race was significant in adjusted analysis. Influenza vaccination is the primary way to prevent influenza, yet influenza vaccination coverage remains low in the United States. Previous studies have shown that children residing in rural areas have less access to healthcare and lower vaccination coverage for some vaccines. Influenza vaccination coverage among children 6 months–17 years by rural/urban residence during the 2011–12 through 2018–19 influenza seasons was examined using National Immunization Survey-Flu data. The Council of American Survey Research Organizations response rates for National Immunization Survey-Flu ranged from 48% to 65% (2011–12 through the 2017–18 seasons) for the landline sample and 20%–39% (2011–12 through the 2018–19 seasons) for the cellular telephone sample. Children residing in rural areas had influenza vaccination coverage that ranged from 7.9 (2012–13 season) to 12.6 (2016–17 season) percentage points lower than children residing in urban areas, and ranged from 4.5 (2012–13 season) to 7.4 (2016–17 season) percentage points lower than children residing in suburban areas. The differences in influenza vaccination coverage among rural, suburban, and urban children were consistent over the eight seasons studied. Lower influenza vaccination coverage was observed among rural children regardless of child’s age, mother’s education, household income, or number of children under 18 years of age in the household. Rural versus urban and suburban differences in influenza vaccination coverage remained statistically significant while adjusting for selected sociodemographic characteristics. A better understanding of the reasons for lower childhood influenza vaccination coverage for children in rural and suburban areas is needed.

Objective The objective was to compare estimates of childhood influenza vaccination across 7 consecutive influenza seasons based on 2 survey systems. Methods We analyzed data from the National Health Interview Survey (NHIS) and the National Immunization Survey–Flu (NIS-Flu) using Kaplan-Meier survival analysis to estimate receipt, based on parental report, of at least 1 dose of influenza vaccine among children aged 6 months to 17 years. Results We found no significant increasing trend in influenza vaccination coverage among children overall from 2012 to 2018 based on the NHIS or from 2012 to 2019 based on the NIS-Flu. We found 4 seasons with a significant increase in influenza vaccination coverage compared with the previous season (2012-2013 [NHIS, NIS-Flu], 2013-2014 [NIS-Flu], 2017-2018 [NHIS], and 2018-2019 [NIS-Flu]). As of the 2018-2019 season, based on NIS-Flu, influenza vaccination coverage was only 62.6%. Children with health conditions that put them at increased risk for complications from influenza had higher influenza vaccination coverage than children without these health conditions for all the seasons studied except 2014-2015. For all seasons studied, influenza vaccination coverage estimates for children were higher based on NIS-Flu data compared with NHIS data. Trends across seasons and differences in vaccination coverage between age groups were similar between the 2 surveys. Conclusions Influenza vaccination coverage among children appears to have plateaued. Only about half of the children in the United States were vaccinated against influenza. Improvements in measurement of influenza vaccination and development and review of strategies to increase childhood influenza vaccination coverage are needed.

Staying home when sick can reduce the spread of influenza. The objectives of this study were to quantify the percentage of workers who had paid sick leave (PSL) benefits, examine sociodemographic characteristics that may be associated with having these benefits, and examine the association between having PSL benefits and use of sick days and influenza vaccination status. The public-use dataset from the 2009 National H1N1 Flu Survey (NHFS) were analyzed in 2017. Wald chi-square tests and t-tests were used to test for associations between having PSL benefits and sociodemographic characteristics and industry and occupation groups, the associations between having PSL benefits and seeking treatment when sick with influenza-like illness (ILI), and taking days off work when sick with ILI. Logistic regression was used to determine variables associated with having PSL benefits and the association between having PSL benefits and influenza vaccination status. Sixty-one percent of employed adults reported having PSL benefits during the 2009–10 influenza season. Being younger, female, Hispanic, less educated, or a farm/blue collar worker were associated with reduced likelihood of having PSL benefits. Not having PSL benefits was associated with a lower likelihood of receiving an influenza vaccination and visiting a health professional when sick with ILI. The percentage of workers who have PSL benefits differs by sociodemographic characteristics and industry/occupation groups. Offering PSL benefits along with promoting influenza vaccination and encouraging employees with ILI to stay home can increase influenza vaccination coverage and help control the spread of influenza.

Provider recommendation is associated with influenza vaccination receipt. The objectives of this study were to estimate the percentage of children 6 months–17 years for whom a provider recommendation for influenza vaccination was received, identify factors associated with receipt of provider recommendation, and evaluate the association between provider recommendation and influenza vaccination status among children. National Immunization Survey-Flu (NIS-Flu) parentally reported data for the 2013–14, 2014–15, and 2015–16 seasons were analyzed. Tests of association between provider recommendation and demographic characteristics were conducted using Wald chi-square tests and pairwise comparison t-tests. Multivariable logistic regression was used to determine variables independently associated with receiving provider recommendation and the association between provider recommendation and influenza vaccination status. Approximately 70% of children had a parent report receiving a provider recommendation for influenza vaccination for their child. The strongest association between receipt of provider recommendation and demographic characteristics was with child’s age, with younger children (6–23 months, 2–4 years, and 5–12 years) being more likely to have a provider recommendation than older children (13–17 years). In addition, children living in a household above poverty with household income >$75,000 were more likely to have a parent report receipt of a provider recommendation than children living below poverty. Children with a provider recommendation were twice as likely to be vaccinated than those without. This study affirms the importance of provider recommendation for influenza vaccination among children. Ensuring that parents of all children receive a provider recommendation may improve vaccination coverage.