Parental vaccine hesitancy and pediatric vaccination coverage: real-world data from central Italy

Background

Vaccine hesitancy among minors reflects parental decisions. This study aimed to assess the association between parental COVID-19 vaccine hesitancy and children’s vaccination uptake, and to identify sociodemographic determinants.

Methods

Retrospective cohort study including households of residents in Local Health Authority Roma 2 (1.3 million residents) with children eligible for mandatory pediatric or recommended adolescent vaccinations. Data from routinely collected administrative data (Vaccine Registry, Municipal Registry, General Practitioner Registry) were linked using a pseudonymized identifier. The vaccination adherence was assessed pre- and post-pandemic (2019 and 2024) and by type: mandatory (≥1 dose of Measles-Mumps-Rubella and ≥3 doses of Diphtheria-Tetanus within 2 years) and recommended (≥1 dose of Human Papillomavirus vaccine within 15 years). Logistic models estimated odds ratios (ORs) of adherence by period and vaccination type, adjusting for the head of the household characteristics (age, gender, citizenship, area deprivation), and COVID-19 vaccination status when it was mandatory for adults (march 2021–june 2022).

Results

A total of 25,873 family units were included (27,500 children). Parental COVID-19 vaccination was strongly associated with children’s adherence to mandatory vaccinations, with similar effects before and after the pandemic (OR = 3.31, 95% CI 2.76–3.98; OR = 3.17, 95% CI 2.39–4.22). A positive association was also observed for pre-pandemic HPV uptake (boys: OR = 2.12, 95% CI 1.54–2.93; girls: OR = 3.02, 95% CI 2.48–3.78), with stronger effects post-pandemic (boys: OR = 4.81, 95% CI 3.95–5.85; girls: OR = 5.83, 95% CI 4.84–7.03). A modest effect of parental gender was observed.

Conclusions

Parental attitudes toward COVID-19 vaccination strongly influence children’s vaccination uptake. These findings can support targeted strategies to reduce vaccine hesitancy and to improve coverage for both mandatory and recommended vaccinations.

Key messages

• Parental COVID-19 vaccine hesitancy strongly predicts children’s uptake of both mandatory and recommended vaccines.

• Understanding the determinants of vaccine hesitancy could support the implementation of targeted strategies to improve vaccination coverage.