Objective  To explore parents′ willingness for their kindergarten/school children′s vaccination of quadrivalent influenza vaccine (QIV) and factors affecting the willingness and to provide evidences for promoting QIV vaccination and preventing influenza epidemic among the children in rural-urban fringe regions of the Pearl River Delta.

  Methods  With stratified multistage cluster random sampling, we conducted an anonymous questionnaire survey among 4 430 parents of children in 44 kindergartens and primary or junior high schools in Nanhai district of Foshan city, Guangdong province during November 2018.

  Results  Of the parents, 42.84% reported the willingness to pay for QIV vaccination of their children. Multivariate logistic analysis demonstrated that compared to the QIV vaccinated children′s parents, the parents with their children not having QIV vaccination were less likely to report the willingness to pay for the QIV vaccination (odds ratio OR = 0.523, 95% confidence interval CI: 0.422 – 0.647); in comparison with the parents paying no attention to the price of QIV, the parents considering a value of < 50 yuan RMB as the acceptable price of QIV were less likely to have their children to receive the vaccination (OR = 0.610, 95% CI: 0.484 – 0.769); the results did not indicate significant impact of manufacture (domestically made vs. imported) on the parents′ willingness for the vaccines with the same valence (P = 0.882); the results also revealed following significant facilitating factors of parental willingness to pay for the QIV vaccination: with a child attending public kindergarten/school, parental education of junior college, with a child involved a compulsory QIV vaccination in kindergarten/school, and selecting quadrivalent vaccine other than trivalent vaccine; while, with negative attitudes towards yearly QIV vaccination, promotion of QIV vaccination, and recommending QIV vaccination to relatives or friends were significant hindering factors for the parental willingness.

  Conclusion  For parents of kindergarten and primary/junior high school children in rural-urban fringe regions, the willingness to pay for QIV vaccination is mainly influenced by their chidren′s involvement of compulsory vaccination required by government or public facilities, the attitude towards yearly vaccination, promotion of the quadrivalent vaccine in the public and to their relatives or friends. The results suggest that education program on the vaccine related knowledge should be carried out among the parents for the promotion of QIV vaccination among kindergarten and school children.