COVID-19 and Influenza Vaccine Acceptance and Hesitancy Among Caregivers of Children With Cancer.
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INTRODUCTION: Children with cancer are immunocompromised and at increased risk for severe outcomes from infections such as COVID-19 and influenza. Vaccination is recommended, but caregiver perceptions in this high-risk group are not well characterized. METHODS: We conducted a cross-sectional survey of English- and Spanish-speaking caregivers of pediatric oncology patients at a large urban pediatric hospital between March and June 2022, during evolving COVID-19 vaccine authorization and recommendations for children. The survey assessed vaccine-related knowledge, attitudes, and hesitancy regarding COVID-19 and influenza. Responses were linked to the child's electronic health record. COVID-19 vaccine acceptance, defined as documented or caregiver-reported receipt, or intention to vaccinate if age-ineligible, was the primary outcome. Influenza vaccine acceptance was a secondary outcome. Associations were analyzed using multivariable logistic regression. RESULTS: Of 442 eligible caregivers, 100 (23%) participated. COVID-19 vaccine acceptance was 71%, influenza acceptance was 82%, and 57% of caregivers were vaccine-hesitant. Vaccine hesitancy was negatively associated with COVID-19 vaccine acceptance. In contrast, perceived vaccine safety, efficacy, prior influenza vaccination, and concern about cancer during the pandemic were positively associated. CONCLUSION: Caregiver attitudes significantly influenced vaccine acceptance. Interventions that strengthen provider communication, address safety and efficacy concerns, and acknowledge caregiver perceptions may help reduce hesitancy in this vulnerable population.