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Vaccine hesitancy and reported non-vaccination in an Irish pediatric outpatient population

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Abstract

Vaccine hesitancy is defined as a delay in acceptance, or refusal, of vaccines, despite availability. It is a complex and context specific phenomenon and identified as a global health priority. The “Parent Attitudes about Childhood Vaccines” (PACV) questionnaire is a validated tool for identifying vaccine hesitancy. Our aim was to use the PACV to assess vaccine hesitancy and its relationship with reported non-vaccination in an Irish population, for the first time. Our participants were parents or caregivers of children attending general pediatric clinics in a tertiary pediatric hospital in Dublin, Ireland, between September and December 2018. In total, 436 participants completed the questionnaire. 5.5% of our population reported non-vaccination. Human papilloma virus and measles, mumps, rubella vaccines were the most commonly cited vaccines of concern (11.5% and 6.7%, respectively), and autism spectrum disorder was the most commonly side effect of concern (4.3%). Mean PACV score was 26.9 (SD 19.1), with a significant difference between non-vaccinators and vaccinators (53.2 vs 25.3, p<0.001). Safety and efficacy concerns were the major contributor to non-vaccination. 14.4% of our population were vaccine-hesitant using the conventional cut-off score, which increased to 22% when using an optimal cut-off which maximized sensitivity and specificity. The accuracy of the PACV score to identify non-vaccination was good (area under the ROC curve = 0.827), and the optimal cut-off had a high negative predictive value (98.5%).

Conclusion: PACV identified reported non-vaccination with high accuracy in our population. It may be useful to screen vaccine-hesitant parents who could benefit from interventions to improve uptake.

What is Known:

• Vaccine hesitancy is a leading threat to global health, with falls in vaccine uptake associated with disease outbreaks worldwide.

• The Parent Attitudes about Childhood Vaccines (PACV) questionnaire is a validated measure of vaccine hesitancy and correlates with non-vaccination in many populations.

What is New:

• This large study in a pediatric outpatient clinic setting represents the first use of the PACV in a Western European population to assess vaccination hesitancy.

• The PACV may be an effective way of screening a pediatric clinic population to identify vaccine-hesitant parents or caregivers for targeted vaccine promotion.

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Availability of data and material

All relevant data is published in the manuscript and supplementary materials.

Code availability

Not applicable.

Abbreviations

ASD:

Autism spectrum disorder

CI:

Confidence interval

HPV:

Human papillomavirus

MMR:

Measles, mumps, rubella

PACV:

Parent attitudes about childhood vaccines

ROC:

Receiver operating characteristic

SD:

Standard deviation

STROBE:

Strengthening the Reporting of Observational Studies in Epidemiology

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Author information

Author notes

  1. Sean Olann Whelan

    Present address: Department of Pediatrics, Cork University Hospital, Cork, Ireland

Authors and Affiliations

  1. Department of General Pediatrics, CHI at Temple Street, Dublin, Ireland

    Sean Olann Whelan, Lisa Lawlor & Joanne Beamish

  2. School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland

    Frank Moriarty

  3. Department of Neurology and Clinical Neurophysiology, CHI at Temple Street, Dublin, Ireland

    Kathleen Mary Gorman

  4. School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland

    Kathleen Mary Gorman

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  1. Sean Olann Whelan
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  2. Frank Moriarty
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  3. Lisa Lawlor
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  4. Kathleen Mary Gorman
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  5. Joanne Beamish
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Contributions

SOW conceived the study. SOW and JB designed the study. SOW and LL collected the data. SOW and FM conducted the analysis. All authors interpreted the findings. SOW, FM, and KG drafted the manuscript. All authors critically revised and approved the final manuscript. JB oversaw the study process.

Corresponding author

Correspondence to Sean Olann Whelan.

Ethics declarations

Ethical approval

Approval was obtained from Children’s Health Ireland at Temple Street Ethics Research Committee (Reference 18.071). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Consent to participate

All participants consented to participation at recruitment without prejudice.

Consent for publication

All participants consented to publication at recruitment.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Gregorio Paolo Milani

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Whelan, S.O., Moriarty, F., Lawlor, L. et al. Vaccine hesitancy and reported non-vaccination in an Irish pediatric outpatient population. Eur J Pediatr 180, 2839–2847 (2021). https://doi.org/10.1007/s00431-021-04039-6

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  • DOI: https://doi.org/10.1007/s00431-021-04039-6

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