Reis, Christopher A.

Vaccine hesitancy refers to the delay in accepting or refusing vaccines despite the availability of vaccination services. Well-conducted studies and trials reviewed in this article support methods both to prevent and manage vaccine hesitancy. Clinicians should know which vaccines their patients are due to receive and should use every encounter to address this issue. Research shows clinicians' recommendations increase vaccine uptake. Recommendations that patients perceive as stronger have a greater effect in increasing vaccine uptake. Using presumptive language to phrase the recommendation is more effective than presenting the vaccine conversationally as an option for the patient. When the patient counters the strong recommendation with hesitancy, the clinician should engage the patient with motivational interviewing, perhaps using a four-step process called the "Four A's".

ABSTRACTIntroductionThere is a lack of data regarding SARS‐CoV‐2 vaccination rates and tixagevimab‐cilgavimab (TC) uptake among pediatric solid organ transplant recipients. The purpose of our study was to assess these rates.Materials and MethodsWe reviewed vaccination records of pediatric recipients of heart, kidney, and liver transplants at Mayo Clinic, Rochester, MN, who received a transplant between January 2011 and December 2021. All SARS‐CoV‐2 vaccines and doses of TC received on or before September 1, 2022, the date of approval of the bivalent SARS‐CoV2 vaccine, were included. We also assessed whether patients had been seen by an infectious diseases physician (ID) in the preceding 6 months.ResultsOur study included 110 patients: 47 kidney, 36 heart, and 27 liver transplant recipients. All vaccine doses recorded were monovalent SARS‐CoV‐2 vaccines. Sixty‐eight (61.8%) patients received at least one vaccine. This varied by age group, with f of ≥12 years olds, 40.9% of 5–11 year olds and 14.3% of under 5 year olds (p = 0.001). Seven patients (6.4%) were up‐to‐date (UTD) for age. There was no difference in UTD status by organ type (p = 0.335). Patients who saw ID were significantly more likely to be UTD (13.2% versus 2.8%; p = 0.047). Among those eligible, 14 (18.2%) received TC, with rates not different based on transplanted organ type (p = 0.158) or whether they saw ID (p = 0.273).ConclusionsDespite the availability of vaccines, nearly 40% of pediatric solid organ transplant recipients remained unvaccinated against SARS‐CoV‐2 at time of the bivalent vaccine release. Less than a fifth of eligible patients received TC. Strategies to increase uptake of SARS‐CoV‐2 vaccines as well as adjunctive agents among this vulnerable group should be further explored.