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Academic Pediatrics

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COVID-19 (Disease ), Communication in medicine, Immunization of children, Preventive health services



To understand the influence of a novel infectious disease epidemic on parent general attitudes about childhood vaccines.


We conducted a natural experiment utilizing cross-sectional survey data from parents of infants in Washington and Colorado participating in a larger trial that began on September 27, 2019. At enrollment, parents completed the short version of the Parental Attitudes about Childhood Vaccines (PACV-SF), a validated survey scored from 0-4, with higher scores representing more negative attitudes. The exposure variable was onset of the SARS-CoV-2 pandemic in the US, with the before-period defined as September 27, 2019 –– February 28, 2020 and the after-period defined as April 1, 2020 ––December 10, 2020, with the after-period further separated into proximate (April 1, 2020-July 31, 2020) and distant periods (August 1, 2020-December 10, 2020). The outcome variable was parent negative attitudes about childhood vaccines, defined as a score of ≥2 on the PACV-SF. We estimated the probability of the outcome after (vs. before) the exposure using log-binomial regression with generalized estimating equations adjusted for demographic confounding variables.


Among 4,562 parents, the risk of negative attitudes was lower immediately after (vs. before) SARS-CoV-2 onset (adjusted risk ratio [aRR]: 0.58; 95% confidence interval [CI]: 0.36, 0.94; P=0.027), but by August–December 2020, the average rate of negative attitudes was 35% higher than during April–July 2020 (aRR: 1.35; 95% CI: 1.13, 1.61; P=0.0009).


A reduced risk of negative general vaccine attitudes observed immediately after SARS-CoV-2 onset was quickly attenuated.


This is the author’s version of a work. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Academic Pediatrics and is located here:



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