Abstract
BACKGROUND: Understanding parental reasons for not having their child receive an influenza vaccination and how reasons have changed over time can help immunization programs and providers tailor interventions to increase uptake of influenza vaccine among children. The objectives of this study were to estimate the percentage of children 6 months-17 years with a parent who reported selected reasons for non-receipt of influenza vaccination (or "non-vaccination") during 2015-2024, assess whether there has been an increase or decrease in the reporting of each reason for non-vaccination, particularly pre versus post COVID-19 pandemic, and if reasons for non-vaccination differ by sociodemographic characteristics. METHODS: National Immunization Survey-Flu (NIS-Flu) parentally reported data for the 2015-16, 2016-17, 2019-20, 2022-23, and 2023-24 seasons were analyzed. Percentages of children not vaccinated against influenza whose parent reported each reason for non-vaccination, overall, by state, and by sociodemographic characteristics were calculated. Tests of association between sociodemographic characteristics and across seasons were conducted for each reason for non-vaccination using t-tests. RESULTS: The most commonly reported reasons for non-receipt of influenza vaccination across all seasons studied were: belief their child is unlikely to get very sick from influenza, concern about side effects/safety, and belief influenza vaccines do not work very well (48.2 %, 43.3 %, and 37.0 %, respectively, in 2023-24). Parental reporting of thinking their child is unlikely to get very sick from influenza increased more than other reasons for non-vaccination since the COVID-19 pandemic. Across all seasons studied, very few reported access-related reasons. Reasons for non-vaccination varied by state and by demographic characteristics. CONCLUSIONS: This study suggests that concern about influenza has decreased since the COVID-19 pandemic. A strong provider recommendation for influenza vaccination, including information about the safety of the vaccine and seriousness of influenza, could help increase influenza vaccination coverage among children.