Attitudes and barriers to vaccination in pediatric rheumatic disease: results of a caregiver survey

Children with rheumatic diseases are at elevated risk for vaccine-preventable diseases, yet vaccination rates in this population remain suboptimal. The specific barriers driving decreased immunization uptake in this population remain unclear. A convenience sample recruited through online caregiver support groups completed an exploratory survey assessing caregiver-reported immunization status along with vaccine hesitancy and other potential vaccine barriers among children with rheumatic disease. Univariable and multivariable logistic regression analyses evaluated factors associated with immunization uptake. Among 163 respondents, 64% reported full immunization for their child. General vaccine hesitancy was present in 47% of caregivers, while rheumatic disease-specific concerns were present in 66%. In univariable analyses, child age, general vaccine hesitancy, and rheumatic disease-specific concerns were associated with immunization status. In multivariable models, general vaccine hesitancy remained the only measured factor significantly associated with decreased odds of full immunization (Model 1: aOR 0.16, 95% CI 0.06–0.39; p < 0.001). Rheumatic disease-specific concerns lost significance after adjusting for general vaccine hesitancy. In this exploratory survey, general vaccine hesitancy in caregivers remained significantly associated with decreased odds of fully immunized status in children whereas rheumatic-disease specific concerns did not. These findings suggest that interventions to improve vaccine uptake in this population should address broader themes of vaccine hesitancy in addition to rheumatic-disease specific concerns. Other examined barriers were not significantly associated with immunization status.