Vaccine Hesitancy in Autism Spectrum Disorder: A Systematic Review With Meta-Analyses

Area of Science:

• Neuroscience
• Public Health
• Immunology

Background:

• Vaccine hesitancy is a significant public health concern.
• Autism spectrum disorder (ASD) is a complex neurodevelopmental condition.
• Understanding vaccination behaviors in ASD-related populations is crucial for public health strategies.

Purpose of the Study:

• To systematically review and meta-analyze vaccine hesitancy and vaccination behaviors in autism spectrum disorder (ASD)-related populations.
• To quantify the prevalence of vaccine hesitancy among caregivers of children with ASD.
• To synthesize evidence on vaccine refusal, delay, and under-vaccination in ASD-affected families.

Main Methods:

• Systematic review and meta-analysis following PRISMA 2020 guidelines.
• Searched multiple databases (MEDLINE/PubMed, Web of Science, EBSCO, TR Dizin) from inception to September 2025.
• Included quantitative, qualitative, and mixed-methods studies on vaccine hesitancy or vaccination behaviors in ASD-related populations.

Main Results:

• Twenty studies were included (16 quantitative, 3 qualitative, 1 mixed-methods).
• Pooled prevalence of vaccine hesitancy among caregivers of children with ASD was 23.65%.
• Caregivers of children with ASD had higher odds of vaccine hesitancy/refusal compared to caregivers of neurotypical children (OR=2.31) and children with other neurodevelopmental conditions (OR=2.23).
• Under-vaccination was higher among younger siblings in ASD-affected families (RR=3.20).
• Commonly cited reasons included the disproven MMR-autism claim, safety concerns, and distrust.

Conclusions:

• Vaccine hesitancy and under-vaccination are disproportionately prevalent in ASD-affected families.
• Autism-informed counseling and myth-correction by clinicians are recommended.
• Service adaptations may improve timely vaccine uptake in this population.