HomeThe PCMC Journalvol. 20 no. 2 (2024)

Covid-19 hesitancy among adolescents: a systematic review

Mary Roseanne Munoz | Alicia Tamesis

Discipline: medicine by specialism

 

Abstract:

OBJECTIVE: Vaccine hesitancy has been a public health issue for some time now, but gained more attention during COVID-19 pandemic. This systematic review aimed to estimate the prevalence of COVID-19 vaccination hesitancy and identify factors affecting it among adolescents. MATERIALS AND METHODS: The preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P 2020) was used. A search was performed in PubMed/MEDLINE, EMBASE, Google Scholar, Herdin, and Cochrane databases on September 2023 using the key words: (COVID-19 OR SARS-COV OR corona virus) AND (Vaccination OR immunization) AND (adolescence OR teenagers OR youth) AND (hesitancy OR acceptance). Observational studies which determined the prevalence or risk factors for COVID-19 vaccine hesitancy among adolescents aged 10-19 years old were included. RESULTS: There were 5 good quality cross-sectional studies included. The prevalence of adolescents who did not want to be vaccinated ranged between 8.4% and 61.0%; while the prevalence of being unsure if they want to be vaccinated was between 31.6% and 88.0%. Factors associated with vaccine hesitancy included being economically disadvantaged, not having influenza vaccination, worrying about its effectiveness and safety, and low perceived necessity. CONCLUSION: There is good quality evidence that COVID-19 vaccine hesitancy exists among adolescents. It is recommended that health workers should conduct information and education campaigns to iterate the effectiveness, safety, and misconceptions about of COVID-19 vaccination. Vaccination programs should also reach out to economically disadvantaged adolescents, and tapping parents and social media may be an effective strategy to improve vaccination acceptance among adolescents.



References:

  1. Wiersinga, W. J., Rhodes, A., Cheng, A. C., Peacock, S. J., & Prescott, H. C. (2020). Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. JAMA, 324(8), 782–793. https://doi.org/10.1001/jama.2020.12839
  2. World Health Organization. (2023). Who coronavirus (COVID-19) dashboard. World Health Organization. https://covid19.who.int/
  3. Department of Health. (2023). Covid-19 case tracker. Department of Health.  https://doh.gov.ph/covid-19/case-tracker  
  4. Holder, J. (2023). Tracking coronavirus vaccinations around the world. The New York Times. https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html  
  5. MacDonald, N. E., & SAGE Working Group on Vaccine Hesitancy (2015). Vaccine hesitancy: Definition, scope and determinants. Vaccine, 33(34), 4161–4164.  https://doi.org/10.1016/j.vaccine.2015.04.036
  6. Leask J. (2011). Target the fence-sitters. Nature, 473(7348), 443–445. https://doi.org/10.1038/473443a
  7. World Health Organization. (2023). Ten Threats to Global Health in 2019: World Health Organization. 2019.
  8. Willis, D. E., Andersen, J. A., Bryant-Moore, K., Selig, J. P., Long, C. R., Felix, H. C., Curran, G. M., & McElfish, P. A. (2021). COVID-19 vaccine hesitancy: Race/ethnicity, trust, and fear. Clinical and translational science, 14(6), 2200–2207.   https://doi.org/10.1111/cts.13077
  9. Malik, A. A., McFadden, S. M., Elharake, J., & Omer, S. B. (2020). Determinants of COVID-19 vaccine acceptance in the US. EClinicalMedicine, 26, 100495.   https://doi.org/10.1016/j.eclinm.2020.100495
  10. Fisher, K. A., Bloomstone, S. J., Walder, J., Crawford, S., Fouayzi, H., & Mazor, K. M. (2020). Attitudes Toward a Potential SARS-CoV-2 Vaccine : A Survey of U.S. Adults. Annals of internal medicine, 173(12), 964–973. https://doi.org/10.7326/M20-3569
  11. Fridman, A., Gershon, R., & Gneezy, A. (2021). COVID-19 and vaccine hesitancy: A longitudinal study. PloS one, 16(4), e0250123.  https://doi.org/10.1371/journal.pone.0250123
  12. Philippine Statistics Authority. (2022). Age and Sex Distribution in the Philippine Population (2020 Census of Population and Housing). Philippine Statistics Authority.  https://psa.gov.ph/population-and-housing/node/167965  
  13. Cadeddu, C., Castagna, C., Sapienza, M., Lanza, T. E., Messina, R., Chiavarini, M., Ricciardi, W., & de Waure, C. (2021). Understanding the determinants of vaccine hesitancy and vaccine confidence among adolescents: a systematic review. Human vaccines & immunotherapeutics, 17(11), 4470–4486. https://doi.org/10.1080/21645515.2021.1961466
  14. Alemu, D., Diribsa, T., & Debelew, G. T. (2023). COVID-19 Vaccine Hesitancy and Its Associated Factors Among Adolescents. Patient preference and adherence, 17, 1271–1280. https://doi.org/10.2147/PPA.S400972
  15. Schaffer DeRoo, S., Pudalov, N. J., & Fu, L. Y. (2020). Planning for a COVID-19 Vaccination Program. JAMA, 323(24), 2458–2459.  https://doi.org/10.1001/jama.2020.8711
  16. Lin, Y., Hu, Z., Zhao, Q., Alias, H., Danaee, M., & Wong, L. P. (2020). Understanding COVID-19 vaccine demand and hesitancy: A nationwide online survey in China. PLoS neglected tropical diseases, 14(12), e0008961.  https://doi.org/10.1371/journal.pntd.0008961
  17. Masiero, M., Riva, S., Oliveri, S., Fioretti, C., & Pravettoni, G. (2018). Optimistic bias in young adults for cancer, cardiovascular and respiratory diseases: A pilot study on smokers and drinkers. Journal of health psychology, 23(5), 645–656.  https://doi.org/10.1177/1359105316667796
  18. Xu, Y., Yang, Y., & Ma, X. (2018). Time perspective, optimistic bias, and self-control among different statuses of university smokers in China: a cross-sectional study. Psychology, health & medicine, 23(9), 1054–1059.  https://doi.org/10.1080/13548506.2018.1425461
  19. Duan, L., Shao, X., Wang, Y., Huang, Y., Miao, J., Yang, X., & Zhu, G. (2020). An investigation of mental health status of children and adolescents in china during the outbreak of COVID-19. Journal of affective disorders, 275, 112–118.  https://doi.org/10.1016/j.jad.2020.06.029
  20. Zheng, X., Guo, Y., Yang, H., Luo, L., Ya, B., Xu, H., Xue, Z., Li, Q., Shi, J., Bi, J., Ma, W., & Wang, P. (2021). A Cross-Sectional Study on Mental Health Problems of Medical and Nonmedical Students in Shandong During the COVID-19 Epidemic Recovery Period. Frontiers in psychiatry, 12, 680202. https://doi.org/10.3389/fpsyt.2021.680202
  21. Scherer, A. M., Gedlinske, A. M., Parker, A. M., Gidengil, C. A., Askelson, N. M., Petersen, C. A., Woodworth, K. R., & Lindley, M. C. (2021). Acceptability of Adolescent COVID-19 Vaccination Among Adolescents and Parents of Adolescents - United States, April 15-23, 2021. MMWR. Morbidity and mortality weekly report, 70(28), 997–1003.  https://doi.org/10.15585/mmwr.mm7028e1
  22. Fazel, M., Puntis, S., White, S. R., Townsend, A., Mansfield, K. L., Viner, R., Herring, J., Pollard, A. J., & Freeman, D. (2021). Willingness of children and adolescents to have a COVID-19 vaccination: Results of a large whole schools survey in England. EClinicalMedicine, 40, 101144. https://doi.org/10.1016/j.eclinm.2021.101144
  23. Rehati, P., Amaerjiang, N., Yang, L., Xiao, H., Li, M., Zunong, J., Wang, L., Vermund, S. H., & Hu, Y. (2022). COVID-19 Vaccine Hesitancy among Adolescents: Cross-Sectional School Survey in Four Chinese Cities Prior to Vaccine Availability. Vaccines, 10(3), 452. https://doi.org/10.3390/vaccines10030452
  24. Wang, D., Chukwu, A., Mwanyika-Sando, M., Abubakari, S. W., Assefa, N., Madzorera, I., Hemler, E. C., Ismail, A., Lankoande, B., Mapendo, F., Millogo, O., Workneh, F., Azemraw, T., Febir, L. G., James, C., Tinkasimile, A., Asante, K. P., Baernighausen, T., Berhane, Y., Killewo, J., … Fawzi, W. W. (2022). COVID-19 vaccine hesitancy and its determinants among sub-Saharan African adolescents. PLOS global public health, 2(10), e0000611. https://doi.org/10.1371/journal.pgph.0000611
  25. Wong, W. H. S., Leung, D., Chua, G. T., Duque, J. S. R., Peare, S., So, H. K., Chan, S. M., Kwan, M. Y. W., Ip, P., & Lau, Y. L. (2022). Adolescents' attitudes to the COVID-19 vaccination. Vaccine, 40(7), 967–969. https://doi.org/10.1016/j.vaccine.2022.01.010
  26. Zhang, P., Li, Y., Wang, H., Luo, L., Wang, P., Wang, H., Li, Q., Meng, Z., Yang, H., Liu, Y., Zhou, S., Li, N., Zhang, S., Bi, J., Zhang, J., & Zheng, X. (2022). COVID-19 Vaccine Hesitancy Among Older Adolescents and Young Adults: A National Cross-Sectional Study in China. Frontiers in public health, 10, 877668. https://doi.org/10.3389/fpubh.2022.877668
  27. Black, S., & Rappuoli, R. (2010). A crisis of public confidence in vaccines. Science translational medicine, 2(61), 61mr1. https://doi.org/10.1126/scitranslmed.3001738
  28. Murphy, J., Vallières, F., Bentall, R. P., Shevlin, M., McBride, O., Hartman, T. K., McKay, R., Bennett, K., Mason, L., Gibson-Miller, J., Levita, L., Martinez, A. P., Stocks, T. V. A., Karatzias, T., & Hyland, P. (2021). Psychological characteristics associated with COVID-19 vaccine hesitancy and resistance in Ireland and the United Kingdom. Nature communications, 12(1), 29. https://doi.org/10.1038/s41467-020-20226-9
  29. Schwarzinger, M., Watson, V., Arwidson, P., Alla, F., & Luchini, S. (2021). COVID-19 vaccine hesitancy in a representative working-age population in France: a survey experiment based on vaccine characteristics. The Lancet. Public health, 6(4), e210–e221. https://doi.org/10.1016/S2468-2667(21)00012-8
  30. Nguyen, K. H., Srivastav, A., Razzaghi, H., Williams, W., Lindley, M. C., Jorgensen, C., Abad, N., & Singleton, J. A. (2021). COVID-19 Vaccination Intent, Perceptions, and Reasons for Not Vaccinating Among Groups Prioritized for Early Vaccination - United States, September and December 2020. MMWR. Morbidity and mortality weekly report, 70(6), 217–222. https://doi.org/10.15585/mmwr.mm7006e3
  31. Basch, C. H., Meleo-Erwin, Z., Fera, J., Jaime, C., & Basch, C. E. (2021). A global pandemic in the time of viral memes: COVID-19 vaccine misinformation and disinformation on TikTok. Human vaccines & immunotherapeutics, 17(8), 2373–2377. https://doi.org/10.1080/21645515.2021.1894896
  32. You, D., Beise, J., Lee, S., Requejo, J., & Strong, K. (2021). Demographic challenges and opportunities for child health programming in Africa and Asia. BMJ (Clinical research ed.), 372, n19. https://doi.org/10.1136/bmj.n19
  33. Simas, C., & Larson, H. J. (2021). Overcoming vaccine hesitancy in low-income and middle-income regions. Nature reviews. Disease primers, 7(1), 41. https://doi.org/10.1038/s41572-021-00279-w
  34.  Behrouzi, B., Araujo Campoverde, M. V., Liang, K., Talbot, H. K., Bogoch, I. I., McGeer, A., Fröbert, O., Loeb, M., Vardeny, O., Solomon, S. D., & Udell, J. A. (2020). Influenza Vaccination to Reduce Cardiovascular Morbidity and Mortality in Patients With COVID-19: JACC State-of-the-Art Review. Journal of the American College of Cardiology, 76(15), 1777–1794. https://doi.org/10.1016/j.jacc.2020.08.028
  35. Wang, J., Jing, R., Lai, X., Zhang, H., Lyu, Y., Knoll, M. D., & Fang, H. (2020). Acceptance of COVID-19 Vaccination during the COVID-19 Pandemic in China. Vaccines, 8(3), 482. https://doi.org/10.3390/vaccines8030482
  36. Dror, A. A., Eisenbach, N., Taiber, S., Morozov, N. G., Mizrachi, M., Zigron, A., Srouji, S., & Sela, E. (2020). Vaccine hesitancy: the next challenge in the fight against COVID-19. European journal of epidemiology, 35(8), 775–779. https://doi.org/10.1007/s10654-020-00671-y
  37.  Lane, S., MacDonald, N. E., Marti, M., & Dumolard, L. (2018). Vaccine hesitancy around the globe: Analysis of three years of WHO/UNICEF Joint Reporting Form data-2015-2017. Vaccine, 36(26), 3861–3867. https://doi.org/10.1016/j.vaccine.2018.03.063
  38. Pilowsky I. (1993). Abnormal illness behavior. The American journal of psychiatry, 150(3), 531. https://doi.org/10.1176/ajp.150.3.531a
  39. Guo, Y., Kuroki, T., Yamashiro, S., & Koizumi, S. (2002). Illness behaviour and patient satisfaction as correlates of self-referral in Japan. Family practice, 19(4), 326–332. https://doi.org/10.1093/fampra/19.4.326
  40. Solís Arce JS, Warren SS, Meriggi NF, Scacco A, McMurry N, Voors M, et al. COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries. Nature medicine. 2021;27(8):1385–94. pmid:34272499
  41.  Wong, L. P., Alias, H., Danaee, M., Ahmed, J., Lachyan, A., Cai, C. Z., Lin, Y., Hu, Z., Tan, S. Y., Lu, Y., Cai, G., Nguyen, D. K., Seheli, F. N., Alhammadi, F., Madhale, M. D., Atapattu, M., Quazi-Bodhanya, T., Mohajer, S., Zimet, G. D., & Zhao, Q. (2021). COVID-19 vaccination intention and vaccine characteristics influencing vaccination acceptance: a global survey of 17 countries. Infectious diseases of poverty, 10(1), 122.  https://doi.org/10.1186/s40249-021-00900-w
  42.  Bono, S. A., Faria de Moura Villela, E., Siau, C. S., Chen, W. S., Pengpid, S., Hasan, M. T., Sessou, P., Ditekemena, J. D., Amodan, B. O., Hosseinipour, M. C., Dolo, H., Siewe Fodjo, J. N., Low, W. Y., & Colebunders, R. (2021). Factors Affecting COVID-19 Vaccine Acceptance: An International Survey among Low- and Middle-Income Countries. Vaccines, 9(5), 515. https://doi.org/10.3390/vaccines9050515
  43. Lv, M., Luo, X., Shen, Q., Lei, R., Liu, X., Liu, E., Li, Q., & Chen, Y. (2021). Safety, Immunogenicity, and Efficacy of COVID-19 Vaccines in Children and Adolescents: A Systematic Review. Vaccines, 9(10), 1102. https://doi.org/10.3390/vaccines9101102
  44. Xu, Y., Xu, D., Luo, L., Ma, F., Wang, P., Li, H., Li, Q., Wei, L., Diao, J., Liu, Y., Zhang, W., & Zheng, X. (2021). A Cross-Sectional Survey on COVID-19 Vaccine Hesitancy Among Parents From Shandong vs. Zhejiang. Frontiers in public health, 9, 779720. https://doi.org/10.3389/fpubh.2021.779720
  45. Chevallier, C., Hacquin, A. S., & Mercier, H. (2021). COVID-19 Vaccine Hesitancy: Shortening the Last Mile. Trends in cognitive sciences, 25(5), 331–333. https://doi.org/10.1016/j.tics.2021.02.002
  46. Dubé, E., Gagnon, D., MacDonald, N. E., & SAGE Working Group on Vaccine Hesitancy (2015). Strategies intended to address vaccine hesitancy: Review of published reviews. Vaccine, 33(34), 4191–4203. https://doi.org/10.1016/j.vaccine.2015.04.041
  47. Ernsting, A., Knoll, N., Schneider, M., & Schwarzer, R. (2015). The enabling effect of social support on vaccination uptake via self-efficacy and planning. Psychology, health & medicine, 20(2), 239–246. https://doi.org/10.1080/13548506.2014.920957