Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Human vaccines & immunotherapeutics
Factors influencing vaccine uptake during pregnancy: A systematic literature review.
A systematic literature review was conducted to build a comprehensive evidence base of qualitative/quantitative studies to identify barriers and enablers influencing maternal immunization (MI). Searches of seven databases on 20/10/2023 and 26/10/2023 yielded 87,367 records. Two reviewers performed full-text screening of 484 records. English-language articles from countries that had national recommendations for pertussis-containing maternal vaccines and reported on maternal vaccine acceptance, trust, and hesitancy were eligible. Overall, 184 studies were included. Barriers involving individual and group influences like lack of knowledge and reduced awareness of MI, pre-existing anti-vaccination beliefs and attitudes, and perceived concerns about vaccine safety and efficacy were the most prominent. Proactive communication and recommendations from healthcare professionals and public health authorities were major enablers, alongside trusting the information provided by healthcare professionals. Our results show that vaccine hesitancy is a complex phenomenon. Addressing both practical and perceptual barriers to MI might increase vaccination coverage among pregnant individuals. What is the context? Vaccines administered during pregnancy help protect both mother and newborn from serious infections. Yet, some expectant mothers hesitate to receive such vaccines.What is new? We systematically searched the available scientific literature to identify the factors that positively and negatively influence vaccine acceptance among expectant mothers.We analyzed data from 184 studies from countries across Europe, North America, Oceania, Asia, and South America that have national recommendations for vaccines against whooping cough.We found that vaccine refusal was mainly driven by personal perceptions of the vaccine or influences of the social environment.Convincing recommendations from healthcare professionals, fair access to prenatal care, increased trust in healthcare authorities and vaccines, and clear communication with the expectant mother were identified as promoters of vaccine acceptance.What is the impact? Addressing the identified issues might increase vaccine uptake among expectant mothers, which might have a serious impact on reducing infectious disease severity in newborns.
23 July 2026
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Instruments for measuring parents' vaccine hesitancy towards their children based on the COSMIN guidelines: A systematic review
BACKGROUND: Parental vaccine hesitancy undermines immunization gains, leading to resurgent outbreaks and increased child mortality. Reliable assessment instruments are urgently needed to guide effective interventions and improve coverage. Despite multiple vaccine hesitancy assessment instruments, no systematic reviews have evaluated the measurement properties of these instruments against established methodological standards, limiting evidence-based selection. OBJECTIVE: To systematically evaluate the methodological quality and measurement properties of vaccine hesitancy assessment instruments for parents of 0-18 children, providing an evidence-based basis for selecting appropriate instruments. DESIGN: Measurement properties are systematically reviewed according to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. METHODS: Six electronic databases were systematically searched from inception until July 15, 2025. Methodological quality was assessed using the COSMIN Risk of Bias Checklist and measurement properties were synthesized according to the COSMIN criteria. A modified Grading, Recommendations, Assessment, Development, and Evaluation system was used to assess the certainty of evidence. RESULTS: Forty studies evaluating 31 vaccine hesitancy assessment instruments were included. Based on COSMIN evidence grading, the Malay version of the modified vaccine hesitancy scale (MVHS-M), the Vietnamese version of the parent attitudes about childhood vaccines survey (PACV-Viet), and the parental attitude scale towards vaccination (PASV) received Category A recommendation. The general vaccine hesitancy scale (GVHS), vaccination attitudes examination (VAX), vaccine acceptance instrument (VAI), and vaccine barriers assessment tool (VBAT) received Category C recommendation, while others were Category B recommendation. CONCLUSIONS: This systematic review identified MVHS-M, PACV-Viet, and PASV as effective tools for assessing vaccine hesitancy in parents, suitable for both research and clinical use. Future research should comprehensively assess their measurement properties, especially exploring measurement error and responsiveness. REGISTRATION: A protocol was registered on the PROSPERO (CRD420251070194).
12 July 2026
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