for the International COVID-19 Parental Attitude Study (COVIPAS) Group* Objectives To determine factors associated with parents who plan to vaccinate their children against influenza next year, especially those who did not vaccinate against influenza last year using a global survey. Study design A survey of caregivers accompanying their children aged 1-19 years old in 17 pediatric emergency departments in 6 countries at the peak of the coronavirus disease 2019 (COVID-19) pandemic. Anonymous online survey included caregiver and child demographic information, vaccination history and future intentions, and concern about the child and caregiver having COVID-19 at the time of emergency department visit. Results Of 2422 surveys, 1314 (54.2%) caregivers stated they plan to vaccinate their child against influenza next year, an increase of 15.8% from the previous year. Of 1459 caregivers who did not vaccinate their children last year, 418 (28.6%) plan to do so next year. Factors predicting willingness to change and vaccinate included child's up-todate vaccination status (aOR 2.03, 95% CI 1.29-3.32, P = .003); caregivers' influenza vaccine history (aOR 3.26, 95% CI 2.41-4.40, P < .010), and level of concern their child had COVID-19 (aOR 1.09, 95% CI 1.01-1.17, P = .022). Conclusions Changes in risk perception due to COVID-19, and previous vaccination, may serve to influence decision-making among caregivers regarding influenza vaccination in the coming season. To promote influenza vaccination among children, public health programs can leverage this information.

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QuestionWe engage parents on a daily basis in the office to discuss immunization for their children, and some of them are hesitant about vaccination. Discussing the importance of vaccines for the child and the public, and reviewing the safety of vaccines has not led to substantial increases in acceptance in our office. What factors influence a parent's views of vaccines, and how can we effectively address them in practice?Answer Despite medical acceptance of vaccines and widespread accessibility, many Canadian children do not receive all their vaccines, and parental hesitancy has increased in the past 30 years. Thus, family physicians play an important role in addressing concerns that parents might have about vaccines and in increasing vaccine uptake. Determinants of vaccine hesitancy are heterogeneous and multifactorial. Factors that affect vaccine decision making include the perceived risks of vaccines, the relationship between parents and health care providers, and the social norm of vaccination. Communication strategies such as motivational interviewing and using presumptive language are valuable tools to increase vaccine uptake in children with vaccine-hesitant parents.Les déterminants de l'hésitation vaccinale des parents Résumé Question À la clinique, nous discutons au quotidien avec des parents de l'immunisation de leurs enfants, et certains sont réticents à la vaccination. La discussion concernant l'importance des vaccins pour l'enfant et la population, et l'explication de l'innocuité des vaccins n'ont pas entraîné une augmentation considérable de l'acceptation dans notre clinique. Quels sont les facteurs qui influencent l'opinion des parents concernant les vaccins, et comment pouvons-nous les aborder efficacement dans la pratique?

Background 22q11.2 Deletion Syndrome (22q11.2DS) can result in array of congenital abnormalities including immune dysfunction. International guidelines recommend immune evaluation of 22q11.2DS patients prior to live vaccine administration. A rotavirus vaccination program for infants aged 2 and 4 months was implemented in British Columbia (BC) in 2012. Adherence to immune workup recommendations prior to 2 months of age in patients with 22q11.2DS and adverse events following immunization is not known. Methods A retrospective chart review of children diagnosed with 22q11.2DS in BC from January 1, 2012 to January 1, 2019 was conducted. Demographic, clinical, laboratory, immunization data and adverse reactions to vaccines were obtained. International guidelines were used as a reference for adherence to immunologic workup recommendations. Results Forty-two children with 22q11.2DS were included. Immunization records were available for 39 children, and 22 (52.3%) received at least one dose of a live rotavirus vaccine. No adverse events following immunization were noted in clinical records. While 25 out of 27 (92.6%) of patients who received an immunological workup had a CD4 + lymphocyte count to qualify for safe administration of a live vaccination, only 12 (44%) received the Rotavirus vaccine. Of 22 infants diagnosed with 22q11.DS prior to 8 weeks of age, only ten (45.5%) received an immune workup before the rotavirus vaccine. Conclusions The majority of our infant cohort did not receive medical care consistent with international 22q11.2DS vaccination and immunological surveillance recommendations. More effective dissemination of 22q11.2DS guidelines and improved immunological assessment for infants with 22q11.2DS in BC is necessary.