The awareness and acceptance of anti-COVID 19 vaccination in adolescence | Italian Journal of Pediatrics

COVID-19 had devastating effects on children’s and adolescents’ life, including neuropsychological impairment, discontinuation of social life and education [1]. These effects emerged in Italy during the lockdown period [2]. Safe and effective vaccines against SARS-CoV-2 for children had been available since 2021 and were included in several national immunization strategies [3].

The rationale for children immunization against SARS-CoV-2 is still debated. On one hand, not only vaccines prevent the acute illness, but also protects from long-term sequelae of COVID-19 such as inflammatory multisystem syndrome and long COVID [3]. On the other hand, the risk of severe acute disease in healthy children infected with SARS-CoV- 2 is lower than in adults [4]. Vaccinating children and adolescents against SARS-CoV2 protect from severe disease. Nevertheless, we should keep in mind that the emergence of new variants may decrease the efficacy of the actual vaccines against infection [5].

In Italy, the Ministry of Health recommended as of June 4 and December 7, 2021, extended vaccination for children 12–19 years old and for those 5–11 years of age, respectively.

Nonetheless, as of September 16, 2022, COVID-19 vaccination uptake was 83.55% in adolescents 12–19 years old and only 35,14% in the 5–11 age group [6].

The pediatric population represents a challenging target for vaccination. The extension of the anti- COVID-19 vaccination to children has introduced new and different considerations from a health, social, bio-legal point of view, especially in reference to the active involvement of adolescents.

In fact, despite the existing evidence on safety and effectiveness of COVID-19 vaccines for adolescents and children, many caregivers are still hesitant toward COVID-19 vaccination for their children [5]. Several factors have been associated with hesitancy and/or refusal of pediatric COVID-19 vaccine, including the perception of a low risk of SARS-CoV-2 infection and complications in children as well as the scarcity of studies in children [7]. Moreover, the emergence of Omicron BA.1 variants affected the efficacy of the vaccine in children and adults, rising concerns on immunization strategies, although preventing severe or potentially life-threating disease in the youngest is crucial [4, 8].

It is a common observation that adolescents are socially active, move independently, and are not always willing to follow parental rules. Moreover, it has been found that adolescents in Western Countries behave in a homogeneous manner and like expressing autonomous vaccination opinion [9].

In Italy, any decision regarding medical treatment for children must be made by those who exercise parental responsibility. Nevertheless, starting from the age of 12, children should be consulted in any case. This right also regards minors who are capable of discernment even if younger than 12 years. For these reasons, the approach to any preventive strategy in adolescents is no longer entirely determined by the judgement of parents and pediatricians as in the first few years of life, but is rather the result of a more complex process involving adolescents’ thoughts and opinions, their relationship with their parents, friends, doctors, and the information they learn from media [10].

In light of these factors, we performed a survey among adolescents aged 10 to 17 years, which in Italy account for 7,69% of the total population. The scope of the survey is to explore factors associated with COVID 19 immunization and their perceptions on COVID-19 vaccines.

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