
==== Front
BMC Pediatr
BMC Pediatr
BMC Pediatrics
1471-2431
BioMed Central London

5039
10.1186/s12887-024-05039-9
Research
COVID-19 immunization status in children compared to their parents: a retrospective review at an upstate NY medicine/pediatrics practice
DeSalvo Katelyn 1
Sitsabeshon Arun 1
Walden Annamaria 1
Vu Vivian 1
Ata Ashar 2
Wales Danielle P. walesd@amc.edu

34
1 https://ror.org/0307crw42 grid.413558.e 0000 0001 0427 8745 Albany Medical College, Albany, NY USA
2 https://ror.org/0307crw42 grid.413558.e 0000 0001 0427 8745 Albany Medical Center Department of Surgery, Albany, NY USA
3 grid.413558.e 0000 0001 0427 8745 Albany Medical Center Division of Internal Medicine and Pediatrics, 1019 New Loudon Road, Cohoes, NY 12047 USA
4 https://ror.org/012zs8222 grid.265850.c 0000 0001 2151 7947 University at Albany School of Public Health, Rensselaer, NY USA
6 9 2024
6 9 2024
2024
24 57020 4 2024
28 8 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Background

This study aimed to investigate the relationship between parent and child COVID-19 immunization series completion using vaccine records.

Methods

A cross-sectional chart review was performed on parent and child patients at the Albany Medical Center Internal Medicine and Pediatrics practice. Patient and parent demographic data, COVID-19 immunization status, and health care worker status was collected. Patient data was further separated into 2 cohorts to account for vaccine eligibility among child age groups, with 5–11 years and 6 months-4 years cohorts. Chi square or Fisher’s exact test was used where appropriate.

Results

Across both cohorts, 371 child patients were identified and cross-matched with corresponding parents. Neither cohort offered evidence linking child immunization series completion with the child’s race, ethnicity, or county of residence. However, rates of series completion were higher for children with private insurance versus public options in both the 5–11 years and 6 months-4 years cohorts (both p < 0.001). Children were more likely to be immunized against COVID-19 if their parents were fully immunized against COVID-19 (both p < 0.05). Children aged 6 months-4 years were more likely to be immunized against COVID-19 if their parent was a health care worker (p = 0.038).

Conclusions

This study demonstrates a significance between child insurance status, as well as between parental vaccination status and child vaccination status. Only children under 5 years were more likely to be vaccinated against COVID-19 if their parent was a health care worker.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-024-05039-9.

Keywords

COVID-19
Immunization
Vaccination
Albany Medical College Department of Pediatricsn/a issue-copyright-statement© BioMed Central Ltd., part of Springer Nature 2024
==== Body
pmcBackground

During the COVID-19 Omicron wave, children aged 0–4 years experienced the largest increase in hospitalization rates [1]. COVID-19 ranked eighth among all cases of death in U.S. persons ages 0–19 years, and first in deaths caused by infectious or respiratory diseases in 2021–2022 [2]. Despite the risk of COVID-19 to young children, as of May 2023, only about 13% of children ages 6 months through 4 years had received 1 dose of COVID-19 vaccine across the United States. Among children ages 5–11 years, 39% of US children had received at least 1 dose of COVID-19 vaccine, with 32% of children completing the 2-dose series [3]. Children ages 6 months through 4 years who receive 2 doses of mRNA COVID vaccine reduced their risk of hospitalization by 40% [4].

Our study seeks to establish a link between parental COVID-19 immunization status and the immunization status of their children, aged 6 months through 11 years. Previous studies investigating factors associated with child COVID-19 immunization uptake have relied on data from self-reported surveys. One nationwide cohort study found that when the COVID-19 vaccine was approved for children, parents who had previously been immunized against COVID-19 were more likely to already have immunized their children or to have immediately immunized them compared to unvaccinated peers. Amongst immunized parents, only 10% reported they would not immediately vaccinate their children [5]. Another survey from Nguyen, et al. found that vaccinated parents were almost 8 times more likely to report that their children (ages 5–11 years) were also vaccinated against COVID-19 [6].

There are currently no published studies reviewing the link between parent and child COVID-19 immunization status that use actual records as a data source. However, there are many studies analyzing the varied factors that contribute to immunization rates of children. In one 2015 study, it was found that one of many the determinants of childhood immunization was “personal, family and/or community members’ experience with immunization, including pain,” meaning that parents based their decision to vaccinate their children on their own experience with immunization [7]. While the current research suggests that there is a correlation between a parent’s immunization status and their willingness to vaccinate their children, there seems to also be other factors that could come into play [8]. Health care professionals are often a positive influence on childhood immunization, however studies looking at the effect of having a health care worker as a parent are in their infancy [9]. Strictly using immunization records, our study seeks to establish the role a parent’s COVID-19 immunization status for COVID-19 plays concerning the vaccination decisions of their children.

Methods

A retrospective chart review was performed on patients of the Albany Medical Center Internal Medicine and Pediatrics practice. Records of immunizations were accessed through the electronic health record, Altera Touchworks® version 22.1, which also pulls immunization data from the state immunization registry, NYSIIS (New York State Immunization Information System), for patients who received the vaccine outside of the practice. New York State Public Health Law Sect. 2168 requires that all immunizations given to patients under age 19 years in New York to be reported to NYSIIS [10]. Subjects were patients 6 months through 11 years of age and their parents. FDA approval of COVID-19 vaccination for 5–11 years was October 29, 2021, and for 6 months-4 years was June 17, 2022. Clinics for COVID vaccination at the practice started on November 12, 2021 for 5–11-year-olds, and July 1, 2022 for ages 6 months-4 years. Chart reviews were conducted from October 2022 – April 2023 for the 5–11 years cohort and from February 2023 – May 2023 for the 6 months-4 years cohort.

Children ages 5–11 years were considered fully vaccinated if they received 2 doses of the primary mRNA COVID-19 vaccine series (Pfizer BNT162b2 or Moderna mRNA-1273). Children ages 6 months through 4 years were considered fully vaccinated if they received 2 doses of mRNA-1273 vaccine or 3 doses of BNT162b2 vaccine. Parents were considered fully vaccinated if they received 2 doses of a COVID-19 mRNA vaccine (BNT162b2 or mRNA-1273) or 1 dose of a replication-incompetent recombinant adenovirus type 26 viral vector (Janssen ChAdOx1 nCoV-19 vaccine). These definitions are congruent with the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) recommendations at the time of the study. Over 90% of the patients in both cohorts received these immunizations at the Internal Medicine and Pediatrics practice.

When data for two parents was available, the parent identified as a health care worker was used for analysis. A parent was identified as a health care worker if they fit the definition as specified by the World Health Organization (WHO) definition of a health worker, which includes if they fell into the following categories: health professionals, health associate professionals, personal care workers in health services, health management and support personnel, and other health service providers not otherwise classified [11]. If two parents were identified as health care workers, the guarantor was used for analysis. Similarly, for two parent families with one parent with a completed COVID-19 immunization series, the parent with the completed immunization series was used for analysis. None of the subjects had data for two parents where both parents were health care workers with differences in immunization completion status. Charts were reviewed to determine which parents were health care workers. If the chart did not provide this information, the primary care physician of the parent was queried directly by the study team regarding parental occupation.

5–11 Years

Each child was cross matched with a corresponding parent. In this age group, there were 44 families that had more than 1 child established at our practice. When 2 children in the same family were identified, child 1 was the child earlier in alphabetical order in relation to their first (given) name. Each child was analyzed separately in order to match with the available parent in the data set. Data is presented first for the 5–11-year cohort as this data was analyzed first.

6 months-4 Years

As above, each child was cross matched with a corresponding parent. No siblings (or second children) were in this analysis.

Data Analysis

Data analysis was conducted using Stata version 17.0. Chi square or Fisher’s exact test was used where appropriate. Logistic regression was used to estimate odds ratio.

Results

5–11 Years

Of the 207 children in this cohort, 73.9% identified as non-Hispanic White, 55.5% resided in Albany County, and 72.5% had private insurance (Table 1). Immunization series completion was not found to be statistically significant when comparing ethnicity or race, and county of residence (Table 2A). Immunization series completion was found to be statistically significant when comparing insurance type. Twenty-eight percent (n = 46) of Managed Medicaid patients were found to be fully vaccinated while 60.9% (n = 115) of privately insured patients were found to be up to date (p < 0.001) (Table 3). The relationship between child 2 COVID immunization status and insurance was not found to be statistically significant (p = 0.064), but this group has a smaller sample size.

Table 1 Demographics of children

	Number (%)		
	5–11 years	6mo-4 years	
1st child	163 (78.7)	164 (100)	
2nd child	44 (21.3)	n/a	
Race/Ethnicity			
 Non Hispanic white	153 (73.9)	117 (71.3)	
 Non Hispanic black	14 (6.8)	8 (4.88)	
 Asian	7 (3.4)	0(0)	
 Hispanic or Latino	4 (1.9)	5 (3.0)	
 Other	16 (7.7)	7 (4.3)	
 Unknown	13 (6.3)	27 (16.5)	
County of Residence			
 Albany	115 (55.5)	104 (63.4)	
 Rensselaer	29 (14.0)	15 (9.1)	
 Saratoga	30 (14.5)	25 (15.2)	
 Schenectady	32 (15.5)	18 (11)	
 Other	1 (0.5)	2 (1.2)	
Insurance			
 Private	150 (72.5)	98 (59.8)	
 Managed Medicaid	55 (26.6)	64 (39.0)	
 Medicaid	2 (0.9)	2 (1.2)	
Total	207	164	

Table 2A Demographic Variables Versus COVID Immunization Status, 5–11 years

Variable	N	Unimmunized/underimmunized (%)	Fully immunized (%)	P value	
Child 1, Race/ethnicity	
Non-Hispanic white	115	51 (44.3)	64 (55.7)	0.517	
Non-Hispanic black	6	0 (0)	6 (100)	
Asian	7	4 (57.1)	3 (42.9)	
Hispanic/Latino	4	2 (50)	2 (50)	
Other	15	8 (53.3)	7 (46.7)	
Unknown	10	8 (80)	2 (20)	
Child 2, Race/ethnicity	
Non-Hispanic white	38	19 (50)	19 (50)	0.969	
Non-Hispanic black	2	1 (50)	1 (50)	
Other	1	0 (0)	1 (100)	
Unknown	3	1 (33.3)	2 (66.7)	
Child 1, County of Residence	
Albany	96	42 (43.8)	54 (56.2)	0.400	
Saratoga	22	7 (31.8)	15 (68.2)	
Schenectady	24	13 (54.2)	11 (45.8)	
Rensselaer	20	11 (55)	9 (45)	
Other	1	0 (0)	1 (100)	
Child 2, County of Residence	
Albany	19	7 (36.8)	12 (63.2)	0.213	
Saratoga	8	5 (62.5)	3 (37.5)	
Schenectady	8	2 (25)	6 (75)	
Rensselaer	9	6 (66.7)	3 (33.3)	

Table 2B Demographic Variables Versus COVID Immunization Status, Age 6 months – 4 years

Variable	N	Unimmunized/underimmunized (%)	Fully immunized (%)	P value	
Race/Ethnicity	
Non Hispanic white	117	96 (82.1)	21 (18.0)	0.266	
Non Hispanic black	8	8 (100)	0 (0)	
Other	7	7 (100)	0 (0)	
Hispanic/Latino	5	3 (60)	2 (40)	
Unknown	27	23 (85.2)	4 (14.8)	
County of Residence	
Albany	104	83 (79.8)	21 (20.2)	0.433	
Saratoga	25	21 (84)	4 (16)	
Schenectady	18	16 (88.9)	2 (11.1)	
Rensselaer	15	15 (100)	0 (0)	
Other	2	2 (100)	0 (0)	

Table 3 Insurance versus COVID immunization status

Insurance	N	Unimmunized/underimmunized (%)	Fully immunized (%)	P value	
6 months – 4 years	
 Private	98	72 (73.5)	26 (26.5)	< 0.001	
 Managed Medicaid	64	63 (98.4)	1 (1.6)		
 Medicaid	2	2 (100)	0		
5 to 11 years Child 1	
 Private	115	45 (39.1)	70 (60.9)	< 0.001	
 Managed Medicaid	46	33 (71.7)	13 (28.3)	
 Medicaid	2	1 (50)	1 (50)	
5 to 11 years Child 2	
 Private	35	14 (40)	21 (60)	0.064	
 Managed Medicaid	9	7 (77.8)	2 (22.2)	
 Medicaid	0	0	0	

Among parents who completed their primary COVID immunization series, 59% of children in the child 1 group also were fully vaccinated with the COVID-19 immunization series (p = 0.001) (Table 4). Table 5 shows the results of the analysis where parent vaccination status was compared to child vaccination status when both child 1 and child 2 were combined in the same analysis. The results were not significant, again with a smaller sample size.

Table 4 Parental vaccination status versus child vaccination status

	N	Unimmunized, underimmunized (%)	Fully immunized	P value	
Age 6 months-4 years	
Parent immunized	133	107 (80.5)	26 (19.6)	0.027	
Parent unimmunized	31	30 (96.8)	1 (3.2)	
Age 5–11 years, Child 1	
Parent immunized	124	51 (41.1)	73 (58.9)	0.001	
Parent unimmunized	39	28 (71.8)	11 (28.2)	
Age 5–11 years, Child 2	
Parent immunized	31	13 (41.9)	18 (58.06)	0.235	
Parent unimmunized	13	8 (61.5)	5 (38.5)	

Table 5 Parental vaccine status versus child 1 and child 2 age 5–11 years

Age 5–11 years, Child 1 + Child 2	
	N	Neither child fully immunized	At least 1 child fully immunized	Both children fully immunized	P value	
Parent immunized	31	7 (53.9)	1 (7.7)	5 (38.5)	0.376	
Parent unimmunized	13	12 (38.7)	1 (3.2)	18 (58.1)	

Twenty-one percent of the 163 parents were classified as health care workers. Parents identified as health care workers were more likely to be fully vaccinated with a COVID-19 primary immunization series (p = 0.004) (Table 6). Children of health care workers were not more likely to be vaccinated when compared to children of non-health care workers (p = 0.713 for child 1, p = 0.462 for child 2) (Table 7). When child 1 and child 2 were combined, there was no significant difference between child immunization status and parental health care worker status (p = 0.671) (Table 8).

Table 6 Parental health care worker status versus parent COVID vaccination status

	N	Unimmunized or underimmunized (%)	Fully immunized (%)	P value	
Age 6 mo – 4 years	
HCW	46	3 (6.5)	43 (93.5)	0.011	
Non-HCW	118	28 (23.7)	90 (76.3)	
Age 5–11 years	
HCW	35	2 (5.7)	33 (94.3)	0.004	
Non-HCW	128	37 (28.9)	91 (71.1)	

Table 7 Parental health care worker (HCW) status versus child immunization status

	N	Child unimmunized or underimmunized	Child immunized	P value	
Age 6 months – 4 years	
HCW	46	34 (73.9)	12 (26.1)	0.038	
Non-HCW	118	103 (87.3)	15 (12.7)	
Age 5–11 years, Child 1	
HCW	35	16 (45.7)	19 (54.3)	0.713	
Non-HCW	128	63 (49.2)	65 (50.8)	
Age 5–11 years, Child 2	
HCW	9	3 (33.3)	6 (66.7)	0.462	
Non-HCW	35	18 (51.4)	17 (48.6)	

Table 8 Parent health care worker (HCW) status versus child 1 and child 2, 5–11 years

Age 5–11 years, Child 1 + Child 2	
	N	Neither child fully immunized	One child fully immunized	Both children fully immunized	P value	
HCW	9	3 (33.3)	0 (0)	6 (66.7)	0.671	
Non-HCW	35	16 (45.7)	2 (5.7)	17 (48.6)	

6 mo–4 Years

Of the 164 children identified in this age group, 71% identified as Non-Hispanic White, 63.4% resided in Albany County, and 59.8% had private insurance (Table 1). Immunization series completion was not found to be statistically significant when comparing age groups, ethnicity or race, and county of residence (Table 2B). Immunization status was found to be statistically significant when comparing insurance type. Under 3% of Medicaid insured patients were found to be fully vaccinated against COVID-19 while 26.5% of privately insured patients were found to be fully vaccinated (p < 0.001) (Table 3).

Parents fully vaccinated against COVID-19 were more likely to have their children vaccinated against COVID-19 (p = 0.027) (Table 4). Additionally, amongst all parents identified in this cohort, 81% of parents were up to date with COVID-19 primary immunization series. These results also yielded a odds ratio of 7.29 (95% confidence interval 0.95 to 55.9), indicating vaccinated parents were over 7 times more likely to vaccinate their children in this sample.

The trends identified in parents listed as health care workers were much more significant in this cohort. 28% of the 164 parents identified in this sample were classified as health care workers. Parents who were health care workers were more likely to have completed the COVID-19 immunization primary series (p = 0.011) (Table 6). 14% of parents who were not identified as health care workers completed a full vaccination regimen for their children while 28% of parents who were identified as health care workers completed a full vaccination regimen for their children (p = 0.038) (Table 7). Additionally, the odds ratio for these percentages was 2.42 (95% confidence interval of 1.03 to 5.68), therefore health care workers were more than twice as likely to vaccinate their children in this sample.

Discussion

Parents are the driving force behind their children’s health care; therefore, it is important to understand their reasons for immunizing their children against COVID-19. It is estimated that the average well child visit in the US is 18 min; physicians use over half this time addressing immunization in families expressing hesitancy or refusal— detracting from other essentials of primary care [12]. One previous study evaluating parental perspectives on childhood immunization relied on a cross-sectional survey [13]. Surveys of attitudes have, however, three main limitations. First, they may be subject to participant bias. Second, factors other than parental attitudes may affect whether the child gets immunized. Third, data on actual immunization is not collected. A retrospective chart review is better reflective of actual immunization decisions.

The overall trend found in vaccine literature shows childhood immunization completion is strongly determined by their parents’ immunization status. Yet even so, parents’ readiness to immunize themselves is consistently higher than for their children [14]. This is reinforced in our study— in the 5–11 years cohort, parents who completed a full COVID-19 vaccine series had a 58.9% rate of child COVID-19 immunization whereas parents who did not complete the series had a 28.2% rate of child COVID-19 immunization (p = 0.001) (Table 4).

We found that, if parents were health care workers, their children were more likely to be immunized against COVID-19 if they were in the 6 months-4 years cohort, but not if they were in the 5–11-year cohort. Parental perception of risk of younger children from COVID-19 may play a role [13]. An online survey in 2022 suggested that the two main concerns for parents were side effects and the notion that the vaccines were “too new” [15]. One could also speculate that parental concern of myocarditis in the older cohort from the vaccine may be a reason that the older cohort was not immunized, despite the fact that COVID-19 itself is more likely to cause myocarditis than the vaccine [16]. Interestingly, in a recent survey of health care workers and COVID-19 vaccine hesitancy, Kainth et al. found that there was greater vaccine hesitancy when health care worker had children under age 5 in the home [17]. It should be noted that this study did not look at immunization records from children in this age group. Further studies should examine this discrepancy between vaccine hesitancy and COVID-19 vaccine uptake.

This study has several limitations. First, it is cross-sectional, and parents may have subsequently decided to immunize their children. Second, it takes place at one academic primary care site in Northeastern New York and may not be externally generalizable to all populations. Third, all data was collected through Altera Touchworks®, which queried NYSIIS. Altera Touchworks will only query NYSIIS for immunization records the night prior to an appointment. If the patient was immunized offsite and was not seen in the time frame of the study for a routine well-child check or follow-up visit, we may not know that they received any COVID-19 immunization, therefore underestimating the number of completed vaccination series.

This study opens future research opportunities regarding family influences on vaccination rates, such as grandparent vaccination rates, extended family vaccination rates, and other familial factors, such as a relative with a history of an adverse event to a vaccine, that may contribute to the decision for a parent to vaccinate their child. It should be noted that most, if not all, electronic health records (EHRs) do not analyze data by families, but rather at the individual level. EHRs may consider adding this functionality to better answer these research questions. Furthermore, other studies have suggested that COVID-19 vaccine hesitancy among health professionals can vary by employment type [18]. Future studies may examine vaccination records of children stratified by their parents’ employment type.

Conclusions

Our study adds to the growing body of literature showing that children are more likely to be fully immunized against COVID-19 if their parents are also fully immunized. It is also found that immunization of children was more likely in both cohorts if they had private, rather than public, insurance, and more likely in the younger cohort if one or both parents were health care workers. These findings present opportunities for the informing public health efforts to immunize children, especially in a pandemic scenario. Future studies should also analyze best practices to improve COVID-19 immunization rates in children 6 months-11 years.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Acknowledgements

The authors would like to thank Dr. Paul Sorum, MD, PhD, for his review of this manuscript prior to journal submission. We would also like to thank Liz Irish for her help in the journal selection process.

Author contributions

KD contributed to initial study planning, data entry, analysis, and manuscript production. AS contributed to data entry, analysis and manuscript production. AW contributed to data entry, analysis, and manuscript production. VV contributed to data entry, analysis, and manuscript production. AA contributed to data analysis and manuscript review. DW contributed to study conceptualization, data entry and analysis, manuscript production. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. No learned language artificial intelligence was used in the production of this manuscript.

Funding

Financial support for publication of this article was provided by a grant from the Department of Pediatrics at Albany Medical Center.

Data availability

All data analyzed during this study are included in this published article or provided to the reviewers.

Declarations

Ethical approval

This protocol was approved by the Albany Medical College Institutional Review Board.

Consent for publication

n/a.

Competing interests

DW previously received salary support from Gilead for Project FOCUS, a hepatitis C screening project. This relationship ended in 2021. All other authors declare that they have no competing interests.

Abbreviations

ACIP Advisory Committee on Immunization Practices

CDC Centers for Disease Control and Prevention

EHR Electronic Health Record

FDA Federal Drug Administration

mRNA messenger RNA

NYSIIS New York State Immunization Information System

U.S. United States

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Katelyn DeSalvo, Arun Sitsabeshon, Annamaria Walden and Vivian Vu are Co-first authors.
==== Refs
References

1. Marks KJ Whitaker M Anglin O Milucky J Patel K Pham H Hospitalizations of children and adolescents with Laboratory-confirmed COVID-19 - COVID-NET, 14 States, July 2021-January 2022 MMWR Morb Mortal Wkly Rep 2022 71 7 271 8 10.15585/mmwr.mm7107e4 35176003
Marks KJ, Whitaker M, Anglin O, Milucky J, Patel K, Pham H, et al. Hospitalizations of children and adolescents with Laboratory-confirmed COVID-19 - COVID-NET, 14 States, July 2021-January 2022. MMWR Morb Mortal Wkly Rep. 2022;71(7):271–8.35176003 10.15585/mmwr.mm7107e4
2. Flaxman S Whittaker C Semenova E Rashid T Parks RM Blenkinsop A Assessment of COVID-19 as the underlying cause of death among children and young people aged 0 to 19 years in the US JAMA Netw Open 2023 6 1 e2253590 10.1001/jamanetworkopen.2022.53590 36716029
Flaxman S, Whittaker C, Semenova E, Rashid T, Parks RM, Blenkinsop A, et al. Assessment of COVID-19 as the underlying cause of death among children and young people aged 0 to 19 years in the US. JAMA Netw Open. 2023;6(1):e2253590.36716029 10.1001/jamanetworkopen.2022.53590
3. Children. and COVID-19 Immunization Trends. www.aap.org: American Academy of Pediatrics 2023 [updated 05/11/2023. https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-vaccination-trends/
4. Liu Y, Bruine de Buin W, Kapteyn A, Szilagyi PG. Role of Parents’ Perceived Risk and Responsibility in Deciding on Children’s COVID-19 Vaccination. Pediatrics. 2023;151(5).
5. Rane MS Robertson MM Westmoreland DA Teasdale CA Grov C Nash D Intention to Vaccinate Children against COVID-19 among Vaccinated and unvaccinated US parents JAMA Pediatr 2022 176 2 201 3 10.1001/jamapediatrics.2021.5153 34870702
Rane MS, Robertson MM, Westmoreland DA, Teasdale CA, Grov C, Nash D. Intention to Vaccinate Children against COVID-19 among Vaccinated and unvaccinated US parents. JAMA Pediatr. 2022;176(2):201–3.34870702 10.1001/jamapediatrics.2021.5153
6. Nguyen KH Nguyen K Mansfield K Allen JD Corlin L Child and adolescent COVID-19 vaccination status and reasons for non-vaccination by parental vaccination status Public Health 2022 209 82 9 10.1016/j.puhe.2022.06.002 35870290
Nguyen KH, Nguyen K, Mansfield K, Allen JD, Corlin L. Child and adolescent COVID-19 vaccination status and reasons for non-vaccination by parental vaccination status. Public Health. 2022;209:82–9.35870290 10.1016/j.puhe.2022.06.002
7. MacDonald NE Vaccine hesitancy: definition, scope and determinants Vaccine 2015 33 34 4161 4 10.1016/j.vaccine.2015.04.036 25896383
MacDonald NE. Vaccine hesitancy: definition, scope and determinants. Vaccine. 2015;33(34):4161–4.25896383 10.1016/j.vaccine.2015.04.036
8. Tu P, Smith D, Parker T, Pejavara K, Michener JL, Lin C. Parent-Child Vaccination Concordance and Its Relationship to Child Age, Parent Age and Education, and Perceived Social Norms. Vaccines (Basel). 2023;11(7).
9. Smith PJ Kennedy AM Wooten K Gust DA Pickering LK Association between health care providers’ influence on parents who have concerns about vaccine safety and vaccination coverage Pediatrics 2006 118 5 e1287 92 10.1542/peds.2006-0923 17079529
Smith PJ, Kennedy AM, Wooten K, Gust DA, Pickering LK. Association between health care providers’ influence on parents who have concerns about vaccine safety and vaccination coverage. Pediatrics. 2006;118(5):e1287–92.17079529 10.1542/peds.2006-0923
10. Immunization Laws and Regulations. New York State Department of Health; [updated August 2023. https://www.health.ny.gov/prevention/immunization/laws_regs.htm#:~:text=NYS%20Public%20Health%20Law%20Section%202168%20requires%20healthcare%20providers%20to,New%20York%20City%20(NYC)%20or
11. Organization GWH. Classifying health workers: mapping occupations to the international standard classification.; 2019 2019.
12. Garcia TB O’Leary ST Dismissal policies for vaccine refusal among US physicians: a literature review Hum Vaccin Immunother 2020 16 5 1189 93 10.1080/21645515.2020.1724742 32078411
Garcia TB, O’Leary ST. Dismissal policies for vaccine refusal among US physicians: a literature review. Hum Vaccin Immunother. 2020;16(5):1189–93.32078411 10.1080/21645515.2020.1724742
13. Hammershaimb EA Cole LD Liang Y Hendrich MA Das D Petrin R COVID-19 Vaccine Acceptance among US parents: a nationally Representative Survey J Pediatr Infect Dis Soc 2022 11 8 361 70 10.1093/jpids/piac049
Hammershaimb EA, Cole LD, Liang Y, Hendrich MA, Das D, Petrin R, et al. COVID-19 Vaccine Acceptance among US parents: a nationally Representative Survey. J Pediatr Infect Dis Soc. 2022;11(8):361–70.10.1093/jpids/piac049
14. Rees F Geiger M Lilleholt L Zettler I Betsch C Böhm R Measuring parents’ readiness to vaccinate themselves and their children against COVID-19 Vaccine 2022 40 28 3825 34 10.1016/j.vaccine.2022.04.091 35623906
Rees F, Geiger M, Lilleholt L, Zettler I, Betsch C, Böhm R, et al. Measuring parents’ readiness to vaccinate themselves and their children against COVID-19. Vaccine. 2022;40(28):3825–34.35623906 10.1016/j.vaccine.2022.04.091
15. Sehgal NKR Rader B Gertz A Astley CM Brownstein JS Parental compliance and reasons for COVID-19 vaccination among American children PLOS Digit Health 2023 2 4 e0000147 10.1371/journal.pdig.0000147 37043449
Sehgal NKR, Rader B, Gertz A, Astley CM, Brownstein JS. Parental compliance and reasons for COVID-19 vaccination among American children. PLOS Digit Health. 2023;2(4):e0000147.37043449 10.1371/journal.pdig.0000147
16. Goddard K Hanson KE Lewis N Weintraub E Fireman B Klein NP Incidence of Myocarditis/Pericarditis following mRNA COVID-19 vaccination among children and younger adults in the United States Ann Intern Med 2022 175 12 1169 771 10.7326/M22-2274 36191323
Goddard K, Hanson KE, Lewis N, Weintraub E, Fireman B, Klein NP. Incidence of Myocarditis/Pericarditis following mRNA COVID-19 vaccination among children and younger adults in the United States. Ann Intern Med. 2022;175(12):1169–771.36191323 10.7326/M22-2274
17. Kainth MK Sembajwe GN Ahn H Qian M Carrington M Armellino D Despite mandated primary series, health care personnel still hesitant about COVID-19 vaccine and immunizing children Vaccine 2024 42 12 3122 33 10.1016/j.vaccine.2024.04.028 38604909
Kainth MK, Sembajwe GN, Ahn H, Qian M, Carrington M, Armellino D, et al. Despite mandated primary series, health care personnel still hesitant about COVID-19 vaccine and immunizing children. Vaccine. 2024;42(12):3122–33.38604909 10.1016/j.vaccine.2024.04.028
18. Kupferwasser D Flores EA Merino P Phan Tran D Bolaris M Gonzales M Characterization of COVID-19 vaccine hesitancy among essential workforce members of a large safety net Urban Medical Center J Prim Care Community Health 2023 14 21501319231159814 10.1177/21501319231159814 36941757
Kupferwasser D, Flores EA, Merino P, Phan Tran D, Bolaris M, Gonzales M, et al. Characterization of COVID-19 vaccine hesitancy among essential workforce members of a large safety net Urban Medical Center. J Prim Care Community Health. 2023;14:21501319231159814.36941757 10.1177/21501319231159814
