Is There a Secondary Vaccine Hesitancy? Parental Attitudes Toward
Revaccination of Childhood Cancer Survivors
Abstract
Introduction: Many children and adolescents who were vaccinated prior to
cancer treatment lose humoral immunity after completion of therapy.
Pediatricians and pediatric oncologists often recommend re-immunization,
although there is little consensus on timing and approach to serologic
testing. However, vaccine hesitancy in the U.S. is a growing problem. It
is not known whether parents who initially permitted vaccination might
demonstrate secondary hesitancy regarding re-immunization. Methods: We
conducted a qualitative study to explore parental attitudes toward
re-immunization after completion of cancer therapy. Twenty primary
caregivers of current pediatric cancer patients participated in
structured interviews exploring knowledge and understanding of immunity
and vaccination; previous experiences with vaccines; and attitudes
toward vaccines and revaccination. Results: Of those interviewed, 80%
were female and 90% were White Non-Hispanic. Of interviewees’ children
with cancer, 60% were male, 75% had been diagnosed within the past 6
months, and 45% had leukemia or lymphoma. All caregivers demonstrated a
basic understanding of vaccination, but only 65% understood that it was
possible to lose immunity even with previous vaccination. All caregivers
were willing to have their children immunized if tests showed lack of
humoral immunity, with 85% expressing a preference for testing prior to
revaccination. Conclusions: Primary caregivers of children with cancer
are willing to consider re-immunization interest but do express some
secondary hesitancy and strongly prefer that the need for
re-immunization be established via serologic testing, rather than
performed empirically. Caregivers’ beliefs and preferences regarding
re-immunization in pediatric oncology should be considered in the
development of post-treatment guidelines.