Parental vaccination status and other socioeconomic determinants shaping COVID-19 vaccine uptake in children and adolescents in Singapore

OBJECTIVES: During the pandemic, achieving high and equitable COVID-19 vaccination coverage in children and adolescents was essential for reducing transmission, protecting vulnerable household members, and limiting disruption to schools. We examined real-world uptake of COVID-19 vaccine doses among children and adolescents in Singapore, where vaccinations for those aged 12-17 years and 5-11 years were introduced during the Delta and Omicron waves, respectively. METHODS: We conducted a retrospective cohort study using national-level data for all children and adolescents aged 5-17 years eligible for vaccination between June 1, 2021, and April 30, 2022. Time-to-vaccination for each dose was analyzed, stratified by age group. RESULTS: Among 442,399 children and adolescents, uptake declined progressively with each additional vaccination dose. Among adolescents aged 12-17 years, 95.8% completed primary vaccination, 92.5% received a first booster, and 18.6% received a second booster. Corresponding uptake among children aged 5-11 years was 75.8%, 46.1%, and 20.2%, respectively. Parental COVID-19 vaccination status was the strongest predictor of uptake. Regular influenza re-vaccination was consistently associated with shorter time-to-vaccination and showed stronger association with booster vaccination. CONCLUSION: Vaccination uptake was shaped by socioeconomic status, household structure, and parental vaccination. Tailored, family-centered strategies may help support rollout of vaccination programs.