Racial, ethnic, and socioeconomic disparities in COVID-19 and influenza vaccination in pediatric food allergy

Abstract

Background: Current coronavirus disease 2019 (COVID-19) and influenza vaccination‐related knowledge, attitudes, and behaviors remain poorly understood among U.S. children with food allergy, and, particularly, those from non-Hispanic Black, Latinx, and lower-income backgrounds who bear a disproportionate burden by allergic disease. These data are especially relevant due to historical vaccine hesitancy in children with food allergy and an initial contraindication for those with severe allergic reactions to be vaccinated against COVID-19. Objective: We sought to characterize COVID-19 and influenza vaccination‐related knowledge, attitudes, and behaviors in a racially, ethnically, and socioeconomically diverse longitudinal cohort of caregiver-child dyads with immunoglobulin E‐mediated food allergy. Methods: We leveraged the National Institutes of Health supported FORWARD cohort, which consists of non-Hispanic White, non-Hispanic Black, and Hispanic/Latinx children diagnosed with food allergy to assess COVID-19 testing, vaccination, and influenza vaccine concern and utilization through administering a one-time institutional review board approved survey. Results: Non-Hispanic Black participants were less likely than non-Hispanic White participants to be vaccinated (odds ratio [OR] 0.25 [95% confidence interval {CI}, 0.08‐0.75]) or tested (OR 0.33 [95% CI, 0.13‐0.85]) for COVID-19 and have the intention to vaccinate their children for influenza (OR 0.42 [95% CI, 0.18‐0.98]). More than one-third of the participants reported that they believed that their child was at greater risk of complications from COVID-19 vaccination due to a food allergy. There were racial and/or ethnic disparities in the belief that COVID vaccines contain allergenic ingredients; more Hispanic/Latinx (37%) and Black (37%) than White (22%) participants reported this belief (p = 0.02). Conclusion: The present findings of disparities in vaccination-related knowledge, attitudes, and behaviors across racial and/or ethnic, and household income strata suggested that initial reports of COVID-19 vaccination hesitancy within the population with food allergy may be further exacerbated by well-documented racial, ethnic, and socioeconomic differences in vaccine hesitancy, potentially leading to a greater infectious disease burden in these vulnerable populations. This highlights a need for targeted education and outreach among members of these communities who are living with food allergy.