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Parental vaccine refusal, non-vaccinated children, and outbreaks of Vaccine-Preventable Diseases (VPDs) in Europe: a systematic review of aetiology and risk.

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Title: Parental vaccine refusal, non-vaccinated children, and outbreaks of Vaccine-Preventable Diseases (VPDs) in Europe: a systematic review of aetiology and risk.
Authors: Baiocchi C; College of Nursing, Midwifery and Healthcare, University of West London, Paragon House, Boston Manor Road, Brentford, London, TW89GA, UK. chiara.baiocchi@uwl.ac.uk., Bhardwaj M; College of Nursing, Midwifery and Healthcare, University of West London, Paragon House, Boston Manor Road, Brentford, London, TW89GA, UK.
Source: BMC public health [BMC Public Health] 2025 Nov 19; Vol. 25 (1), pp. 4042. Date of Electronic Publication: 2025 Nov 19.
Publication Type: Journal Article; Systematic Review
Language: English
Journal Info: Publisher: BioMed Central Country of Publication: England NLM ID: 100968562 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2458 (Electronic) Linking ISSN: 14712458 NLM ISO Abbreviation: BMC Public Health Subsets: MEDLINE
Imprint Name(s): Original Publication: London : BioMed Central, [2001-
MeSH Terms: Vaccine-Preventable Diseases*/epidemiology , Disease Outbreaks*/statistics & numerical data , Parents*/psychology , Vaccination Refusal*/statistics & numerical data , Vaccination Refusal*/psychology , Vaccination Hesitancy*, Europe/epidemiology ; Humans ; Child
Abstract: Background: Parental vaccine hesitancy is a growing concern, and Europe has witnessed significant outbreaks of Vaccine-Preventable Diseases (VPDs) over the past two decades. Unvaccinated children are at increased risk of contracting VPDs, and the incidence of several VPDs has been on the rise. Vaccine hesitancy is a serious global health challenge. Nevertheless, the specific association between intentionally unvaccinated children and VPD outbreaks in Europe remains inadequately explored. This rapid systematic review aims to identify and examine studies focused on VPD outbreaks in Europe that involve intentionally non-vaccinated children and the factors associated with vaccine hesitancy.
Methods: A rapid systematic review was conducted with a comprehensive search of electronic databases, including Medline, Embase, and Academic Search Elite. The population, exposure and outcome (PEO) framework was used to formulate the research question, inclusion and exclusion criteria. Publications from 2010 to and including August 2023 were included.
Results: Of the 330 studies initially identified, a total of nine were included in the final review. The included studies indicated that unvaccinated children due to parental refusal are contributing to outbreaks of measles, diphtheria and tetanus in the European region.
Conclusion: This systematic review provides compelling evidence of an association between intentionally unvaccinated children-those unvaccinated due to parental refusal-and outbreaks of vaccine-preventable diseases (VPDs). The findings strongly suggest that this group contributes significantly to VPD outbreaks within the European region. To deepen our understanding, further research is needed to compare the role of intentionally unvaccinated children with that of other unvaccinated groups (e.g., those unvaccinated due to medical contraindications, immunosuppression, or limited access to healthcare) in the emergence and spread of VPDs.
(© 2025. The Author(s).)
Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
References: Hum Vaccin Immunother. 2014;10(6):1755-61. (PMID: 24637343)
Vaccines (Basel). 2023 Dec 27;12(1):. (PMID: 38250844)
Psychol Health. 2020 May;35(5):538-554. (PMID: 31588791)
Euro Surveill. 2017 Jan 19;22(3):. (PMID: 28128092)
BMC Public Health. 2018 Jan 30;18(1):196. (PMID: 29378545)
BMC Public Health. 2022 Jan 14;22(1):96. (PMID: 35031053)
Cent Eur J Public Health. 2021 Dec;29(4):322-324. (PMID: 35026073)
Saudi Med J. 2019 Dec;40(12):1242-1250. (PMID: 31828276)
Epidemiol Infect. 2016 Mar;144(4):870-5. (PMID: 26265115)
BMJ. 2018 Sep 18;362:k3967. (PMID: 30228149)
Euro Surveill. 2010 Dec 16;15(50):. (PMID: 21172172)
Lancet. 2019 May 18;393(10185):2033. (PMID: 31106742)
Eur J Public Health. 2020 Oct 1;30(5):986-992. (PMID: 32460309)
Lancet Infect Dis. 2018 Oct;18(10):1070-1071. (PMID: 30303103)
Vaccine. 2019 Oct 16;37(44):6581-6583. (PMID: 31558327)
BMJ Glob Health. 2022 May;7(5):. (PMID: 35618306)
Eur J Paediatr Neurol. 2021 Sep;34:43-49. (PMID: 34388650)
Nurs Child Young People. 2020 Jul 14;32(4):20-25. (PMID: 32478497)
Lancet Infect Dis. 2021 Dec;21(12):e387-e398. (PMID: 34626552)
J Law Med Ethics. 2015 Fall;43(3):633-47. (PMID: 26479572)
Viruses. 2019 Nov 02;11(11):. (PMID: 31684034)
Adv Prev Med. 2012;2012:175694. (PMID: 23209917)
Prev Med. 2000 Feb;30(2):146-54. (PMID: 10656842)
Vaccine. 2018 Mar 14;36(12):1621-1626. (PMID: 29449097)
Int J Environ Res Public Health. 2020 Dec 15;17(24):. (PMID: 33333819)
Can Fam Physician. 2021 May;67(5):339-341. (PMID: 33980625)
Vaccine. 2016 Dec 20;34(52):6707-6714. (PMID: 27773475)
Public Health Pract (Oxf). 2021 Nov;2:100142. (PMID: 34027509)
PLoS Med. 2019 Feb 21;16(2):e1002742. (PMID: 30789892)
Vaccine. 2017 Sep 5;35(37):4840-4850. (PMID: 28760616)
BMC Public Health. 2012 Jun 06;12:408. (PMID: 22672710)
Euro Surveill. 2022 Feb;27(8):. (PMID: 35209973)
Lancet. 2018 Sep 1;392(10149):724. (PMID: 30191821)
Vaccine. 2018 Feb 1;36(6):779-787. (PMID: 29325822)
Epidemiol Infect. 2000 Oct;125(2):377-83. (PMID: 11117961)
Scand J Infect Dis. 2011 Dec;43(11-12):986-9. (PMID: 21867473)
Euro Surveill. 2013 Sep 05;18(36):pii=20580. (PMID: 24079377)
J Epidemiol Community Health. 2001 Sep;55(9):685-6. (PMID: 11511651)
Emerg Infect Dis. 2015 Nov;21(11):2067-9. (PMID: 26488199)
BMC Public Health. 2018 Dec 10;18(1):1360. (PMID: 30526589)
BMC Pediatr. 2012 Sep 21;12:154. (PMID: 22998654)
Contributed Indexing: Keywords: Children; Europe; Outbreaks; Systematic review; Vaccine hesitancy; Vaccine-preventable diseases
Entry Date(s): Date Created: 20251119 Date Completed: 20251119 Latest Revision: 20251123
Update Code: 20260130
PubMed Central ID: PMC12628525
DOI: 10.1186/s12889-025-23865-z
PMID: 41257782
Database: MEDLINE
Description
ISSN:1471-2458
DOI:10.1186/s12889-025-23865-z