Clinical Scorecard: Investigating the Effects of COVID-19 and Parental Vaccine Reluctance in Children Undergoing Hematopoietic Stem Cell Transplantation

At a Glance

Key Highlights

• COVID-19 vaccines approved for adolescents (≥12 years) and emergency use recommended for children 5–11 years as of late 2021.
• ASH and ASTCT recommend COVID-19 vaccination ≥3 months post-HCT; CDC recommends boosters for HCT recipients within 2 years or on immunosuppression.
• Parental vaccine hesitancy is a significant barrier to COVID-19 vaccination in pediatric HCT recipients, with limited prior data on this population.

Guideline-Based Recommendations

Diagnosis

• Identify pediatric HCT recipients eligible for COVID-19 vaccination ≥3 months post-transplant.
• Assess parental vaccine hesitancy using validated tools to understand barriers.

Management

• Administer COVID-19 vaccines to pediatric HCT recipients following ASH and ASTCT guidelines.
• Provide booster doses to HCT recipients within 2 years post-transplant or on immunosuppressive therapy as per CDC recommendations.
• Implement targeted interventions to address parental vaccine hesitancy.

Monitoring & Follow-up

• Monitor vaccine response in HCT recipients due to potential inadequate immunogenicity.
• Evaluate impact of COVID-19 pandemic on families using standardized scales (e.g., CEFIS).
• Track vaccination uptake and hesitancy trends in this population.

Risks

• HCT recipients may have suboptimal vaccine response, necessitating booster doses.
• Vaccine hesitancy among parents can delay or prevent vaccination, increasing infection risk.
• COVID-19 pandemic causes psychosocial distress impacting care and vaccination decisions.

Patient & Prescribing Data

Children post-hematopoietic stem cell transplant aged 0 to ≤17 years

Vaccination recommended ≥3 months post-transplant; booster doses advised within 2 years or if immunosuppressed; parental hesitancy is a key factor influencing vaccine uptake.

Clinical Best Practices

• Engage parents early to assess and address vaccine hesitancy using validated questionnaires.
• Coordinate vaccination timing post-HCT to optimize immune response and safety.
• Utilize community and digital platforms for education and recruitment to improve vaccine acceptance.
• Monitor family impact of COVID-19 to tailor supportive interventions.

References

• WHO COVID-19 pandemic declaration
• FDA approval of COVID-19 vaccine for adolescents
• ASH and ASTCT COVID-19 vaccine recommendations
• CDC COVID-19 vaccine booster guidance for immunocompromised
• WHO vaccine hesitancy definition