TY - JOUR
T1 - A hidden vulnerable population
T2 - Young children up-to-date on vaccine series recommendations except influenza vaccines
AU - Bleser, William K.
AU - Salmon, Daniel A.
AU - Miranda, Patricia Y.
N1 - Funding Information:
There was no external funding received for this study. We acknowledge indirect support provided by Pennsylvania State University's Department of Health Policy and Administration, Demography program, and Population Research Institute. The Population Research Institute is supported by an infrastructure grant from NIH (2R24HD041025-11). This publication was also supported, in part, by Grant UL1 TR000127 and KL2 TR000126 from the National Center for Advancing Translational Sciences (NCATS). The funders provided support in the form of salaries or infrastructure for authors WKB and PYM, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the 'author contributions' section. First, we acknowledge Rhonda BeLue, Steven A. Haas, and Marianne H. Hillemeier from Pennsylvania State University for helping to progress earlier versions of this work. The authors would also like to thank Sarah E. Patterson for bringing to our attention the “Opening Influenza Research Project” opportunity, of which this article is a part; the opportunity helped us bring this article out of our “file drawers” and to see it to publication. Second, we acknowledge Patricia Barnes of the National Center for Health Statistics (NCHS), and Emily Greenman, and Mark Roberts of the Penn State Federal Statistical Research Data Center (RDC) for helping to review proposals and access restricted data from a related project used to inform this work. Third, data collection for National Health Interview Survey and the National Immunization Survey, analyzed in this work, was approved by the NCHS Research Ethics Review Board (ERB). Analysis of de-identified data from the survey is exempt from the federal regulations for the protection of human research participants. Analysis of restricted data through the NCHS Research Data Center is also approved by the NCHS ERB. The findings and conclusions in this work are those of the authors and do not necessarily represent the views of the Research Data Center, the National Center for Health Statistics, or the Centers for Disease Control and Prevention. Fourth, this work was completed while William K. Bleser was at the Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania.
Publisher Copyright:
Copyright: © 2020 Bleser et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2020/6
Y1 - 2020/6
N2 - Very young children (under 2 years old) have high risk for influenza-related complications. Children 6 months or older in the US are recommended to receive influenza vaccination annually, yet uptake is substantially lower than other routinely-recommended vaccines. Existing nationally-representative studies on very young child influenza vaccine uptake has several limitations: few examine provider-verified influenza vaccination (relying on parental report), few contain parental vaccine attitudes variables (known to be crucial to vaccine uptake), and none to our knowledge consider intersectionality of social disadvantage nor how influenza vaccine determinants differ from those of other recommended vaccines. This nationally-representative study examines provider-verified data on 7,246 children aged 6-23 months from the most recent (2011) National Immunization Survey to include the restricted Parental Concerns module, focusing on children up-to-date on a series of vaccines (the 4:3:1:3:3:1:4 series) but not influenza vaccines (“hidden vulnerability to influenza”). About 71% of children were up-to-date on the series yet only 33% on influenza vaccine recommendations by their second birthday; 44% had hidden vulnerability to influenza. Independent of parental history of vaccine refusal and a myriad of health services use factors, no parental history of delaying vaccination was associated with 7.5% (2.6-12.5) higher probability of hidden vulnerability to influenza despite being associated with 15.5% (10.8-20.2) lower probability of being up-to-date on neither the series nor influenza vaccines. Thus, parental compliance with broad child vaccine recommendations and lack of vaccine hesitancy may not indicate choice to vaccinate children against influenza. Examination of intersectionality suggests that maternal college education may not confer improved vaccination among non-Hispanic Black and Hispanic children despite that it does for non-Hispanic White children. Policymakers and researchers from public health, sociology, and other sectors need to collaborate to further examine how vaccine hesitancy and intersectional social disadvantage interact to affect influenza vaccine uptake in young US children.
AB - Very young children (under 2 years old) have high risk for influenza-related complications. Children 6 months or older in the US are recommended to receive influenza vaccination annually, yet uptake is substantially lower than other routinely-recommended vaccines. Existing nationally-representative studies on very young child influenza vaccine uptake has several limitations: few examine provider-verified influenza vaccination (relying on parental report), few contain parental vaccine attitudes variables (known to be crucial to vaccine uptake), and none to our knowledge consider intersectionality of social disadvantage nor how influenza vaccine determinants differ from those of other recommended vaccines. This nationally-representative study examines provider-verified data on 7,246 children aged 6-23 months from the most recent (2011) National Immunization Survey to include the restricted Parental Concerns module, focusing on children up-to-date on a series of vaccines (the 4:3:1:3:3:1:4 series) but not influenza vaccines (“hidden vulnerability to influenza”). About 71% of children were up-to-date on the series yet only 33% on influenza vaccine recommendations by their second birthday; 44% had hidden vulnerability to influenza. Independent of parental history of vaccine refusal and a myriad of health services use factors, no parental history of delaying vaccination was associated with 7.5% (2.6-12.5) higher probability of hidden vulnerability to influenza despite being associated with 15.5% (10.8-20.2) lower probability of being up-to-date on neither the series nor influenza vaccines. Thus, parental compliance with broad child vaccine recommendations and lack of vaccine hesitancy may not indicate choice to vaccinate children against influenza. Examination of intersectionality suggests that maternal college education may not confer improved vaccination among non-Hispanic Black and Hispanic children despite that it does for non-Hispanic White children. Policymakers and researchers from public health, sociology, and other sectors need to collaborate to further examine how vaccine hesitancy and intersectional social disadvantage interact to affect influenza vaccine uptake in young US children.
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U2 - 10.1371/journal.pone.0234466
DO - 10.1371/journal.pone.0234466
M3 - Article
C2 - 32555653
AN - SCOPUS:85086692258
SN - 1932-6203
VL - 15
JO - PLoS One
JF - PLoS One
IS - 6
M1 - e0234466
ER -