Background: Pediatric influenza has significant morbidity and mortality. Effective prevention includes annual vaccination. Vaccination rates in the United States among children remain low. During the 2018‐2019 influenza season, vaccination rates were 63.8% among children 6 months to 17 years of age. Pediatric providers often face refusal by parents to administer the influenza vaccine to their children, even if they agree to have their child vaccinated for other childhood diseases. The incidence of COVID-19 disease is increasing, and adult vaccination is about to become available. It is unknown whether the COVID-19 pandemic and COVID-19 vaccination program will affect parental decision making regarding the influenza vaccine immunization for their children.
Objective: To identify reasons for refusal of influenza vaccine by parents, and to determine differences among parents who do not support influenza immunization before and during the COVID-19 pandemic.
Design/Methods: Self-administered questionnaire completed by parents of children, 6 months to 18 years old of age during well child visits, from September 2019 to October 2020 who refused influenza vaccination.
Results: 131 parents completed the questionnaire; 82 (62.6%) pre COVID-19 and 49 (37.4%) during the COVID-19 pandemic starting in March 2020. 62 children were male, with mean age 1.4±4.5 years. 71 were Hispanic, 34 Black, and 14 mixed race. 66 parents refusing influenza vaccination reported their children received the vaccine in prior seasons. 87 believed their children would contract a mild flu-like illness from influenza disease after receiving the vaccination. There was no significant difference in reasons to refuse influenza vaccination pre compared with during the COVID-19 pandemic. The most common reasons pre and during COVID-19 for refusal to vaccinate their child for influenza were: 1) child is too young for influenza vaccine (pre / during COVID-19 4.9% / 18.4%), 2) fear of child death after vaccination (pre / during COVID-19 1.2% / 10.2%), and 3) fear of needles (pre / during COVID-19 24.4% / 10.2%).
Conclusion: Influenza vaccination refusal reasons did not significantly change prior to and during the COVID-19 pandemic. Common reasons for refusal pre and during COVID-19 pandemic were, "their child too young for influenza vaccine", "fear of child death after receiving a vaccination", and "fear of needles". During a well-child care visit, it is important that healthcare workers discuss the parental perception of and provide proper counseling about influenza vaccination. Future studies should investigate whether or not addressing specific concerns with parents regarding vaccination refusal will result in a lower rate of vaccination refusal.
