Background/Purpose: Vaccine-preventable diseases pose greater risk to children with rheumatic diseases treated with immunosuppressive therapies and to those with underlying immune dysregulation. Despite the importance of vaccine protection, children with rheumatic disease often have lower vaccination rates compared to healthy populations. The drivers of decreased vaccine uptake in pediatric rheumatic disease (PRD) are poorly understood. This study examines the caregiver attitudes and barriers surrounding immunization in PRD patients.

Methods: This study included a voluntary online survey of caregivers of PRD patients recruited through online parent support groups for PRD patients from June – July 2024. General vaccine hesitancy was assessed via a modified Parental Attitudes about Childhood Vaccines – Short Form (PACV-SF), a 4-question scale designed to screen for vaccine hesitant caregivers.1 Additional questions on barriers to vaccination were developed by the CARRA Vaccination Work Group. The primary outcome was caregiver report of immunization status. Associations with explanatory variables were assessed using chi-squared tests and Fisher’s exact test for categorical variables and Wilcoxon rank-sum tests for continuous variables. Univariable and multivariable logistic regression analyses were used to examine the association between vaccination status and explanatory variables. Multivariable Model 1 includes all explanatory variables while multivariable Model 2 includes only those found to be significant in the univariable analysis.

Results: Of the 163 respondents, 104 (64%) reported that their child had received all recommended immunizations and 59 (36%) reported partial immunization, no immunization, or uncertain immunization status (Table 1). General vaccine hesitancy, as indicated by a score >2 on the PACV-SF (Figure 1), was strongly associated with a lower odds of immunization uptake (OR 0.16, 95% CI 0.08-0.32, p< 0.001) in all models (Figure 2). Age was associated with increased odds of immunization uptake in the univariable model and multivariable Model 1. Vaccine hesitancy related to rheumatic disease was associated with decreased odds of immunization uptake in the univariable model but this association became non-significant in the multivariable models.

Conclusion: General vaccine hesitancy in caregivers strongly predicted decreased odds of fully immunized status in children. While not surprising, this was the only factor undiminished in all multivariable models, suggesting a strong independent relationship. In contrast, vaccine hesitancy related to the child’s rheumatic disease diagnosis was not significant in the multivariable models. The study’s limitations include unknown generalizability due to convenience sampling and relatively small sample size. Nevertheless, this study suggests that general vaccine hesitancy may play a stronger role in caregiver immunization decisions than other types of barriers.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessing-attitudes-and-barriers-to-vaccination-in-pediatric-rheumatic/