Factors associated with caregivers’ hesitancy to vaccinate children against influenza: A cross-sectional survey in China

Seasonal influenza can cause serious harm to children under five years of age, while caregivers are still hesitant to vaccinate children against influenza. This study aimed to investigate caregivers' hesitancy regarding influenza vaccination and assess the associated factors.From August to October 2019, a cross-sectional survey was conducted in ten provinces in China. The questionnaire collected information about sociodemographic characteristics and caregivers' knowledge, perceptions and attitudes toward influenza vaccination. Caregivers were identified as not hesitating, hesitating or refusing to vaccinate children. Multinomial logistic regression was adopted to determine factors related to vaccine hesitancy based on the 3C model with three dimensions namely complacency, convenience and confidence.A total of 6668 valid questionnaires were collected, among which 38.57% did not hesitate to vaccinate children against influenza, 56.03% were hesitant, and 5.40% refused. Multinomial logistic regression showed that caregivers perceiving high importance (AOR = 0.68 for hesitancy; 0.15 for refusal), safety (AOR = 0.42; 0.46) or efficacy (AOR = 0.73; 0.65) of influenza vaccination, knowing children as a priority group (AOR = 0.80; 0.48), and trusting vaccination advice from medical staff (AOR = 0.65; 0.51) had lower odds of hesitancy or refusal. Those considering price as a hindering factor had higher odds of hesitancy (AOR = 1.66) or refusal (AOR = 1.47), and those viewing time or distance as a hindering factor (AOR = 1.45) or having heard of vaccine-related negative information (AOR = 1.78) had higher odds of hesitancy. Sociodemographic characteristics were associated with vaccine hesitancy or refusal, and the associations varied for hesitators and refusers.A large proportion of caregivers in China reported their hesitancy for influenza vaccination, and the associated factors of such hesitancy were complicated. Health professionals are recommended to spread relevant scientific knowledge and give vaccine-related suggestions to caregivers in doctor visits to promote caregivers' trust in influenza vaccination and therefore expand childhood vaccine coverage.