Vaccination hesitation in children under five years of age: a scoping review

Melo Júnior, Eugênio Barbosa de; Almeida, Priscilla Dantas; Pereira, Beatriz Mourão; Borges, Paulo de Tarso Moura; Gir, Elucir; Araújo, Telma Maria Evangelista de

doi:10.1590/0034-7167-2022-0707

Eugênio Barbosa de Melo JúniorCorresponding author: Eugênio Barbosa de Melo Júnior, E-mail: eugeniobmj@gmail.com

conception or design of the study/research

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Universidade Federal do Piauí. Teresina, Piauí, Brazil

http://orcid.org/0000-0002-0444-2960

Priscilla Dantas Almeida

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Universidade Federal do Amazonas. Manaus, Amazonas, Brazil

http://orcid.org/0000-0002-6574-6335

Beatriz Mourão Pereira

final review with critical and intellectual participation in the manuscript

Universidade Federal do Piauí. Teresina, Piauí, Brazil

http://orcid.org/0000-0001-8541-4031

Paulo de Tarso Moura Borges

final review with critical and intellectual participation in the manuscript

Universidade Federal do Piauí. Teresina, Piauí, Brazil

http://orcid.org/0000-0002-2121-6156

Elucir Gir

final review with critical and intellectual participation in the manuscript

Universidade de São Paulo. Ribeirão Preto, São Paulo, Brazil

http://orcid.org/0000-0002-3757-4900

Telma Maria Evangelista de Araújo

conception or design of the study/research

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Universidade Federal do Piauí. Teresina, Piauí, Brazil

http://orcid.org/0000-0001-5628-9577

Corresponding author: Eugênio Barbosa de Melo Júnior, E-mail: eugeniobmj@gmail.com

EDITOR IN CHIEF: Dulce Barbosa

ASSOCIATE EDITOR: Mitzy Danski

Sources	Syntax
BIREME SciELO PubMed CAPES Theses and Dissertations Catalog Google Scholar	Hesitação Vacinal OR Vaccination Hesitancy
	Hesitação Vacinal AND Fatores Associados
	Vaccination Hesitancy AND Associated factors

Id	Title	Year	Country	Design	LoE(¹⁸18 Joanna Briggs Institute. JBI levels of evidence, October 2013 [Internet]. 2014[cited 2022 May 09]. Available from: http://joannabriggs.org/assets/docs/approach/JBI-Levels-of-evidence_2014.pdf http://joannabriggs.org/assets/docs/appr... )
S1(²⁰20 Azizi FSM, Kew Y, Moy FM. Vaccine hesitancy among parents in a multi-ethnic country, Malaysia. Vaccine. 2017;35(22):2955-61. https://doi.org/10.1016/j.vaccine.2017.04.010 https://doi.org/10.1016/j.vaccine.2017.0... )	Vaccine hesitancy among parents in a multi-ethnic country, Malaysia	2017	Malaysia	Cross-sectional study	4.b
S2(²¹21 Longitudinal Trends in Vaccine Hesitancy in a Cohort of Mothers Surveyed in Washington State, 2013-2015. Public Health Rep. 2017;132(4):451-4. https://doi.org/10.1177/0033354917711175 https://doi.org/10.1177/0033354917711175... )	Longitudinal Trends in Vaccine Hesitancy in a Cohort of Mothers Surveyed in Washington State, 2013-2015	2017	USA	Randomized clinical trial	1.c
S3(²²22 Repalust A, Šević S, Rihtar S, Štulhofer A. Childhood vaccine refusal and hesitancy intentions in Croatia: insights from a population-based study. Psychol Health Med. 2017;22(9):1045-55. https://doi.org/10.1080/13548506.2016.1263756 https://doi.org/10.1080/13548506.2016.12... )	Childhood vaccine refusal and hesitancy intentions in Croatia: insights from a population-based study	2017	Croatia	Cross-sectional study	4.b
S4(²³23 Brown AL, Sperandio M, Turssi CP, Leite RMA, Berton VF, Succi RM, et al. Vaccine confidence and hesitancy in Brazil. Cad Saude Publica. 2018;34(9):e00011618. https://doi.org/10.1590/0102-311X00011618 https://doi.org/10.1590/0102-311X0001161... )	Vaccine confidence and hesitancy in Brazil	2018	Brazil	Cross-sectional study	4.b
S5(²⁴24 Hu Y, Chen Y, Wang Y, Liang H. Measuring childhood vaccination acceptance of mother in Zhejiang province, East China. Hum Vaccin Immunother. 2019;15(2):287-94. https://doi.org/10.1080/21645515.2018.1526557 https://doi.org/10.1080/21645515.2018.15... )	Measuring childhood vaccination acceptance of mother in Zhejiang province, East China	2018	China	Cross-sectional study	4.b
S6(²⁵25 Alsubaie SS, Gosadi IM, Alsaadi BM, Albacker NB, Bawazir MA, Bin-Daud N, et al. Vaccine hesitancy among Saudi parents and its determinants. Saudi Med J. 2019;40(12):1242-50. https://doi.org/10.15537/smj.2019.12.24653 https://doi.org/10.15537/smj.2019.12.246... )	Vaccine hesitancy among Saudi parents and its determinants	2019	Saudi Arabia	Cross-sectional study	4.b
S7(²⁶26 Bianco A, Mascaro V, Zucco R, Pavia M. Parent perspectives on childhood vaccination: how to deal with vaccine hesitancy and refusal?. Vaccine. 2019;37:984-90. https://doi.org/10.1016/j.vaccine.2018.12.062 https://doi.org/10.1016/j.vaccine.2018.1... )	Parent perspectives on childhood vaccination: How to deal with vaccine hesitancy and refusal?	2019	Italy	Cross-sectional study	4.b
S8(²⁷27 Chang K, Lee SY. Why do some Korean parents hesitate to vaccinate their children?. Epidemiol Health. 2019;41:e2019031. https://doi.org/10.4178/epih.e2019031 https://doi.org/10.4178/epih.e2019031... )	Why do some Korean parents hesitate to vaccinate their children?	2019	Korea	Cross-sectional study	4.b
S9(²⁸28 Díaz Crescitelli ME, Ghirotto L, Sisson H, Sarli L, Artioli G, Bassi MC, et al. A meta-synthesis study of the key elements involved in childhood vaccine hesitancy. Public Health. 2020;180:38-45. https://doi.org/10.1016/j.puhe.2019.10.027 https://doi.org/10.1016/j.puhe.2019.10.0... )	A meta-synthesis study of the key elements involved in childhood vaccine hesitancy	2019	Italy	Systematic review	1.b
S10(²⁹29 Syiroj ATR, Pardosi JF, Heywood AE. Exploring parents’ reasons for incomplete childhood immunisation in Indonesia. Vaccine. 2019;37(43):6486-93. https://doi.org/10.1016/j.vaccine.2019.08.081 https://doi.org/10.1016/j.vaccine.2019.0... )	Exploring parents’ reasons for incomplete childhood immunisation in Indonesia	2019	Indonesia	Cross-sectional study	4.b
S11(³⁰30 Migriño Junior J, Gayados B, Birol KRJ, De Jesus L, Lopez CW, Mercado WC, et al. Factors affecting vaccine hesitancy among families with children 2 years old and younger in two urban communities in Manila, Philippines. Western Pac Surveill Response J. 2020;11(2):20-6. https://doi.org/10.5365/wpsar.2019.10.2.006 https://doi.org/10.5365/wpsar.2019.10.2.... )	Factors affecting vaccine hesitancy among families with children 2 years old and younger in two urban communities in Manila, Philippines	2020	Philippines	Cross-sectional study	4.b
S12(³¹31 Olson O, Berry C, Kumar N. Addressing parental vaccine hesitancy towards childhood vaccines in the united states: a systematic literature review of communication interventions and strategies. Vaccines. 2020;8(4);1-25. https://doi.org/10.3390/vaccines8040590 https://doi.org/10.3390/vaccines8040590... )	Addressing Parental Vaccine Hesitancy towards Childhood Vaccines in the United States: A Systematic Literature Review of Communication Interventions and Strategies	2020	USA	Systematic review	1.b
S13(³²32 Alqahtani YA, Almutairi KH, Alqahtani YM, Almutlaq AH, Asiri AA. Prevalence and Determinants of Vaccine Hesitancy in Aseer Region, Saudi Arabia. Clin Basic Res. 2021;21(4):532-38. https://doi.org/10.18295/squmj.4.2021.023 https://doi.org/10.18295/squmj.4.2021.02... )	Prevalence and Determinants of Vaccine Hesitancy in Aseer Region, Saudi Arabia	2021	Saudi Arabia	Cross-sectional study	4.b
S14(³³33 Chung-Delgado K, Venero JEV, Vu TM. Vaccine Hesitancy: Characteristics of the Refusal of Childhood Vaccination in a Peruvian Population. Cureus. 2021;13(3):e14105. https://doi.org/10.7759/cureus.14105 https://doi.org/10.7759/cureus.14105... )	Vaccine Hesitancy: Characteristics of the Refusal of Childhood Vaccination in a Peruvian Population	2021	Peru	Cross-sectional study	4.b
S15(³⁴34 Thapar R, Kumar N, Surendran P, Shahdiya A, Mahendran V, Ramesh R, et al. Vaccine hesitancy among mothers of under-five children in Coastal South India: a facility-based crosssectional study. F1000Research. 2021;10:1-18. https://doi.org/10.12688/f1000research.28293.3 https://doi.org/10.12688/f1000research.2... )	Vaccine hesitancy among mothers of under-five children in Coastal South India: a facility-based cross-sectional study [version 3; peer review: 2 approved]	2021	India	Cross-sectional study	4.b
S16(³⁵35 Dasgupta P, Bhattacherjee S, Mukherjee A, Dasgupta S. Vaccine Hesitancy for Childhood Vaccinations in Slum Areas of Siliguri, India. Indian J Public Health. 2018;62:253-8. https://doi.org/10.4103/ijph.IJPH_397_17 https://doi.org/10.4103/ijph.IJPH_397_17... )	Vaccine Hesitancy for Childhood Vaccinations in Slum Areas of Siliguri, India	2022	India	Cross-sectional study	4.b
S17(³⁶36 Çelik K, Turan S, Üner S. I’m a mother, therefore I question”: Parents’ legitimation sources of and hesitancy towards early childhood vaccination. Soc Sci Med. 2021;282:114132. https://doi.org/10.1016/j.socscimed.2021.114132 https://doi.org/10.1016/j.socscimed.2021... )	I’m a mother, therefore I question”: Parents’ legitimation sources of and hesitancy towards early childhood vaccination	2021	Turkey	Cross-sectional study	4.b
S18(³⁷37 Ilter H, Demir LS. Opinions of parents concerning childhood vaccine refusal. Gulhane Med J. 2021;63:96-103. https://doi.org/10.4274/gulhane.galenos.2020.1312 https://doi.org/10.4274/gulhane.galenos.... )	Opinions of parents concerning childhood vaccine refusal	2021	Turkey	Cross-sectional study	4.b

Id	Objective(s)	Population	Sample
S1(²⁰20 Azizi FSM, Kew Y, Moy FM. Vaccine hesitancy among parents in a multi-ethnic country, Malaysia. Vaccine. 2017;35(22):2955-61. https://doi.org/10.1016/j.vaccine.2017.04.010 https://doi.org/10.1016/j.vaccine.2017.0... )	Assess the Parent Attitudes about Childhood Vaccines (PACV) questionnaire test-retest reliability in Malay and determine the prevalence of VH among parents and its associations with sociodemographic characteristics.	Parents^* * fathers and mothers. aged 18 years or older, with at least one child under the age of seven, or pregnant women who visited the pediatric and/or antenatal clinics during data collection	545 participants
S2(²¹21 Longitudinal Trends in Vaccine Hesitancy in a Cohort of Mothers Surveyed in Washington State, 2013-2015. Public Health Rep. 2017;132(4):451-4. https://doi.org/10.1177/0033354917711175 https://doi.org/10.1177/0033354917711175... )	Assess trends in parental VH during the first two years of their children’s lives in a cohort of mothers in Washington state.	Mothers of children up to two years old	237 mothers
S3(²²22 Repalust A, Šević S, Rihtar S, Štulhofer A. Childhood vaccine refusal and hesitancy intentions in Croatia: insights from a population-based study. Psychol Health Med. 2017;22(9):1045-55. https://doi.org/10.1080/13548506.2016.1263756 https://doi.org/10.1080/13548506.2016.12... )	Estimate the prevalence and sociodemographic and sociocultural determinants of refusal intentions and childhood VH among Croatian adults.	Individuals aged between 18 and 88 years	1,000 participants
S4(²³23 Brown AL, Sperandio M, Turssi CP, Leite RMA, Berton VF, Succi RM, et al. Vaccine confidence and hesitancy in Brazil. Cad Saude Publica. 2018;34(9):e00011618. https://doi.org/10.1590/0102-311X00011618 https://doi.org/10.1590/0102-311X0001161... )	Assess confidence and VH in Brazil as part of a broader project to map vaccine confidence worldwide.	Graduated dental surgeons, parents^* * fathers and mothers. /companions of children who attended oral health outpatient clinics during data collection	952 participants
S5(²⁴24 Hu Y, Chen Y, Wang Y, Liang H. Measuring childhood vaccination acceptance of mother in Zhejiang province, East China. Hum Vaccin Immunother. 2019;15(2):287-94. https://doi.org/10.1080/21645515.2018.1526557 https://doi.org/10.1080/21645515.2018.15... )	Assess VH among mothers and examine risk factors associated with maternal intention to vaccinate in Zhejiang Province.	Mothers of children aged 24 to 35 months	770 mothers
S6(²⁵25 Alsubaie SS, Gosadi IM, Alsaadi BM, Albacker NB, Bawazir MA, Bin-Daud N, et al. Vaccine hesitancy among Saudi parents and its determinants. Saudi Med J. 2019;40(12):1242-50. https://doi.org/10.15537/smj.2019.12.24653 https://doi.org/10.15537/smj.2019.12.246... )	Assess the prevalence of VH and its determinants among Saudi parents.	Parents^* * fathers and mothers. who attended an outpatient pediatric clinic during the data collection period	500 participants
S7(²⁶26 Bianco A, Mascaro V, Zucco R, Pavia M. Parent perspectives on childhood vaccination: how to deal with vaccine hesitancy and refusal?. Vaccine. 2019;37:984-90. https://doi.org/10.1016/j.vaccine.2018.12.062 https://doi.org/10.1016/j.vaccine.2018.1... )	Assess attitudes about childhood vaccines and vaccine refusal or delay among parents and assess the role played by variables mapped as potential determinants.	Parents^* * fathers and mothers. of students aged up to five who attended kindergartens during the data collection period	575 participants
S8(²⁷27 Chang K, Lee SY. Why do some Korean parents hesitate to vaccinate their children?. Epidemiol Health. 2019;41:e2019031. https://doi.org/10.4178/epih.e2019031 https://doi.org/10.4178/epih.e2019031... )	Study the reasons why some Korean parents hesitate to vaccinate their children, applying the health belief model.	Parents^* * fathers and mothers. of children attending alternative education preschools and primary schools during the data collection period	141 participants
S9(²⁸28 Díaz Crescitelli ME, Ghirotto L, Sisson H, Sarli L, Artioli G, Bassi MC, et al. A meta-synthesis study of the key elements involved in childhood vaccine hesitancy. Public Health. 2020;180:38-45. https://doi.org/10.1016/j.puhe.2019.10.027 https://doi.org/10.1016/j.puhe.2019.10.0... )	Summarize the evidence on VH in childhood from the perspective of parents.	Qualitative articles focused on vaccine refusal and VH	27 articles
S10(²⁹29 Syiroj ATR, Pardosi JF, Heywood AE. Exploring parents’ reasons for incomplete childhood immunisation in Indonesia. Vaccine. 2019;37(43):6486-93. https://doi.org/10.1016/j.vaccine.2019.08.081 https://doi.org/10.1016/j.vaccine.2019.0... )	Explore the underlying factors behind why Indonesian parents choose not to immunize or partially immunize their children.	Parents^* * fathers and mothers. or guardians of partially and intentionally unvaccinated children	16 participants
S11(³⁰30 Migriño Junior J, Gayados B, Birol KRJ, De Jesus L, Lopez CW, Mercado WC, et al. Factors affecting vaccine hesitancy among families with children 2 years old and younger in two urban communities in Manila, Philippines. Western Pac Surveill Response J. 2020;11(2):20-6. https://doi.org/10.5365/wpsar.2019.10.2.006 https://doi.org/10.5365/wpsar.2019.10.2.... )	Determine factors influencing VH among parents and caregivers of children aged two years and younger in selected urban communities in Manila.	Parents^* * fathers and mothers. and caregivers of children up to two years of age	110 participants
S12(³¹31 Olson O, Berry C, Kumar N. Addressing parental vaccine hesitancy towards childhood vaccines in the united states: a systematic literature review of communication interventions and strategies. Vaccines. 2020;8(4);1-25. https://doi.org/10.3390/vaccines8040590 https://doi.org/10.3390/vaccines8040590... )	Develop a catalog of interventions and health communication strategies to address and prevent parental VH.	Articles published from January 2008 to October 2019	75 articles
S13(³²32 Alqahtani YA, Almutairi KH, Alqahtani YM, Almutlaq AH, Asiri AA. Prevalence and Determinants of Vaccine Hesitancy in Aseer Region, Saudi Arabia. Clin Basic Res. 2021;21(4):532-38. https://doi.org/10.18295/squmj.4.2021.023 https://doi.org/10.18295/squmj.4.2021.02... )	Assess the general population’s knowledge of vaccines to determine the prevalence of VH in the Aseer region, southern Saudi Arabia.	Parents^* * fathers and mothers. from the Aseer region, Saudi Arabia	796 participants
S14(³³33 Chung-Delgado K, Venero JEV, Vu TM. Vaccine Hesitancy: Characteristics of the Refusal of Childhood Vaccination in a Peruvian Population. Cureus. 2021;13(3):e14105. https://doi.org/10.7759/cureus.14105 https://doi.org/10.7759/cureus.14105... )	Investigate the characteristics of the vaccination decision-making process that may result in the refusal of childhood immunization in parents from Lima, Peru.	Parents^* * fathers and mothers. or guardians of children treated at a private pediatric practice	552 participants
S15(³⁴34 Thapar R, Kumar N, Surendran P, Shahdiya A, Mahendran V, Ramesh R, et al. Vaccine hesitancy among mothers of under-five children in Coastal South India: a facility-based crosssectional study. F1000Research. 2021;10:1-18. https://doi.org/10.12688/f1000research.28293.3 https://doi.org/10.12688/f1000research.2... )	Identify the prevalence and reasons for VH among mothers of children under five in Mangalore.	Mothers of children under five	172 participants
S16(³⁵35 Dasgupta P, Bhattacherjee S, Mukherjee A, Dasgupta S. Vaccine Hesitancy for Childhood Vaccinations in Slum Areas of Siliguri, India. Indian J Public Health. 2018;62:253-8. https://doi.org/10.4103/ijph.IJPH_397_17 https://doi.org/10.4103/ijph.IJPH_397_17... )	Discover the proportion and factors that contribute to VH, in childhood vaccination, in slums of the city of Siliguri.	Parents^* * fathers and mothers. of children under five years of age	194 participants
S17(³⁶36 Çelik K, Turan S, Üner S. I’m a mother, therefore I question”: Parents’ legitimation sources of and hesitancy towards early childhood vaccination. Soc Sci Med. 2021;282:114132. https://doi.org/10.1016/j.socscimed.2021.114132 https://doi.org/10.1016/j.socscimed.2021... )	Understand how mothers decide about childhood immunization and the attitudes, perceptions and beliefs underlying these decisions.	Mothers of children under five years of age	23 participants
S18(³⁷37 Ilter H, Demir LS. Opinions of parents concerning childhood vaccine refusal. Gulhane Med J. 2021;63:96-103. https://doi.org/10.4274/gulhane.galenos.2020.1312 https://doi.org/10.4274/gulhane.galenos.... )	Reveal the opinions, knowledge and attitudes of parents who refuse childhood vaccination.	Parents^* * fathers and mothers. of children under four years of age	590 participants

Order	Category of results	Articles	Total
1	Misinformation and fake news	S1, S2, S5, S6, S7, S8, S9, S10, S11, S12, S14, S15, S16, S17 and S18	15 studies
2	Adverse effects	S1, S2, S4, S7, S9, S10, S11, S12, S13, S14 and S15.	11 studies
3	Vaccine safety and efficacy	S1, S2, S4, S6, S7, S9, S10, S11, S12, S14, S17 and S18.	12 studies
4	Religious beliefs	S3, S9, S10, S17 and S18.	05 studies

[1] Corresponding author: Eugênio Barbosa de Melo Júnior, E-mail: eugeniobmj@gmail.com

Brasil

Brasil

Vaccination hesitation in children under five years of age: a scoping review

Vacunación vacuna en niños menores de cinco años: una revisión del alcance

ABSTRACT

Objectives:

Methods:

Results:

Conclusions: