Flu Vaccine Hesitancy in the Cancer & Blood Disease Institute at CCHMC

 Catherine Desmond, M.S.1 UC COM MS2 (medical student); Dr. Chris Dandoy, M.D.2

Affiliations: 1University of Cincinnati College of Medicine, 2CCHMC Division of Bone Marrow Transplantation and Immune Deficiency 

Introduction: The past ten months have contained some of the most robust discussions regarding vaccine use in modern history. In immunosuppressed pediatric patients, influenza vaccination can be especially important, as influenza can be highly deadly with up to two-thirds of pediatric oncology patients diagnosed with influenza requiring hospitalization3. CCHMC’s Cancer and Blood Diseases Institute (CBDI) has historically high rates of vaccination, averaging 95% influenza vaccine compliance. The questions that remained were if the public concerns regarding the COVID-19 vaccine project on the influenza vaccine, the most common reasons for influenza vaccine hesitancy, and if CBDI patients will be at a higher risk of infection this influenza season.

Methods: An anonymous survey was randomly distributed via iPad to families in the CBDI outpatient clinics until 200 participants were reached. A question at the beginning of the survey asked if families had previously completed the survey to avoid duplicate responses. The bulk of the survey was developed by modifying several validated vaccine hesitancy surveys—the Parent Attitudes about Childhood Vaccines Survey and the Vaccine Confidence Scale. Questions were consolidated and concepts such as distrust of the information parents hear about the vaccine was added. The primary question asking families to cite why they responded “No” or “Unsure” about getting the influenza vaccine was multiple select with a fill-in-the blank option. Data analysis compared frequency of reasons cited for vaccine hesitancy, compared vaccine concerns between different CBDI departments, and compared the mean self-reported vaccination rate for 2019-2020 and the anticipated vaccination rate for 2021.

Results: Of the 200 participants, their primary physicians were 45% Oncology (n = 90), 43% Hematology (n = 86), and 12% BMT/Immunology (n = 24). For 2021, 70% indicated that they were planning on the influenza vaccine, 17% were not, and 13% were unsure. By department, 72% of Oncology, 75% of Hematology, and 50% of Bone Marrow Transplant patients indicated they were planning on receiving the influenza vaccine (p = 0.047). Across all departments, the most frequent concerns cited were believing the vaccine is ineffective (n = 13), believing the vaccine is unsafe due to their child’s medical condition (n = 12), that influenza vaccination is not a priority (n = 11), and that they do not receive any vaccinations (n = 10).

Conclusion: The self-reported 70% of families planning on vaccinating their child for influenza is 25% lower than the typical vaccination rate among all CBDI patients, and could indicate a need for early conversations about vaccinations this influenza season. Specific areas of conversation may address flu vaccine efficacy, whether or not vaccinations are safe depending on where the child is in their care timeline, and the importance of prioritizing early flu vaccination this season.

Contact information: Catherine Desmond, desmonch@mail.uc.edu, (480) 406-8828

Key Words/Tags: vaccine hesitancy, influenza, heme/onc, immune deficiency, bone marrow transplant