Newborn screening programs promote vaccine acceptance among parents in Turkey: a cross-sectional study.

Abstract

Objectives: Newborn screening and childhood immunization are among the most successful public health initiatives. Turkey has a high vaccination coverage (95-99%), but a recent decline is concerning. Vaccine hesitancy (VH) is a growing global issue, identified by the WHO as a major public health threat. Given that VH may correlate with attitudes toward other health practices, we explored whether early engagement with the health system via newborn screening influences childhood vaccine acceptance. Although these programs are implemented separately but concurrently as part of the national healthcare system in Turkey, integrating newborn screening and immunization initiatives may increase vaccine uptake through early engagement and trust building. This study aims to evaluate the relationship between newborn screening and parental vaccine hesitancy.

Methods: This study was conducted at a tertiary care center in Turkey from July 2023 to April 2024. Parental VH was assessed using the PACV scale, along with questions on demographics and parental vaccination status. Participants with PACV score ≥ 50 were classified as VH+, others as VH-. Groups were compared using t-tests, Mann - Whitney U, chi-squared, or Fisher's exact tests. Multiple logistic regression was used to analyze related factors.

Results: This analytic descriptive study included 481 parents (125 with children diagnosed with biotinidase deficiency or PKU via newborn screening, and 356 with healthy children aged 2-6). The mean age of respondents was 35 years, and the majority were mothers with a college education. The main sources of vaccine information were health professionals, followed by social media and family. Overall, 19.8% of parents were vaccine-hesitant, with a lower rate in the patient group (12% vs. 22.5%). VH was higher in fathers with chronic diseases (35.1% vs 18.1%, p = .012) and was lower in mothers received tetanus vaccine during pregnancy (16.1% vs. 30.6%, p = .001) or parents who received COVID-19 vaccine (mothers: 13.9% vs. 50.6%, fathers: 14.8% vs. 49.2%, both p < .001). VH was lower in those consulting healthcare professionals and higher in those relying on social media or non-medical sources. Diagnosis and treatment through newborn screening had an effect of 0.47 odds on VH in the overall group (95% CI = 0.24-0.92, p = .028).

Conclusion: This study found lower vaccine hesitancy among participants in newborn screening programs and those whose parents received adult vaccinations, potentially due to increased contact with health professionals and greater health-seeking behavior. The influence of social media on vaccine hesitancy, evident in the general population, was not observed among cases, suggesting that systematic follow-up may buffer against external risk factors. Studies with matched cohorts, real-time data collection, and anonymous surveys are needed to improve generalizability, support causal inference, and reduce biases.