Influenza In Children Research Articles

900. Effect of Influenza Vaccine Priming on Current Season Vaccine Effectiveness among Children and Adolescents, US Flu VE Network 2014–2015 Through 2017–2018

BackgroundStudies have demonstrated that optimal protection against childhood influenza requires two “priming” doses of influenza vaccine in the first season of vaccination. Two doses of influenza vaccine are recommended for US children aged 6 months-8 years who received ≤1 dose in prior seasons. We examined risk of influenza among children fully or partially vaccinated during study seasons and vaccine effectiveness (VE) by the number of priming doses.MethodsAnalyses included children aged 6 months-17 years enrolled during outpatient visits for acute illness for ≤7 days with cough in the US Influenza Vaccine Effectiveness Network during 2014–2015 through 2017–2018. Participants’ respiratory specimens were tested for influenza by rRT-PCR. Vaccination histories back to birth year were obtained from electronic immunization records. VE was calculated by comparing vaccination odds among influenza-positive cases to test-negative controls, as 100 × (1 − odds ratio) adjusted for season, site, age, high-risk status, and calendar time.ResultsOf 7,583 children, 6,362 (84%) had received ≥1 dose in their lifetime. Among vaccinated children, 90% were primed prior to the enrollment season, and 80% were primed prior to age 2 years. Most (55%) received two priming doses in their first season. Among children recommended to receive two priming doses in the enrollment season, receipt of two doses vs. one was associated with a lower risk of influenza illness (aOR: 0.60; 95% CL: 0.36, 1.00). VE of ≥1 dose in the enrollment season against any influenza among unprimed children was 53% (95% CL: 36, 66). VE of ≥1 dose in the enrollment season was similar among children primed with one dose in their first season (46%; 95% CL: 34, 55) and among those primed with two doses (46%; 95% CL: 35, 55). Overall results were similar when stratified by age and for A/H3N2 viruses, which predominated during study years.ConclusionAmong the US children recommended to receive two priming doses of vaccine in the enrollment season, receipt of two doses provided optimal protection. VE in seasons after the priming did not differ by the number of priming doses. Results were driven by predominance of A/H3N2 viruses and may not be similar for A/H1N1pdm09 or B viruses. Current US influenza vaccine recommendations for children are effective and appropriate.Disclosures All Authors: No reported Disclosures.

Recommendations for Prevention and Control of Influenza in Children, 2019-2020.

This statement updates the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccines and antiviral medications in the prevention and treatment of influenza in children during the 2019-2020 season. The American Academy of Pediatrics continues to recommend routine influenza immunization of all children without medical contraindications, starting at 6 months of age. Any licensed, recommended, age-appropriate vaccine available can be administered, without preference of one product or formulation over another. Antiviral treatment of influenza with any licensed, recommended, age-appropriate influenza antiviral medication continues to be recommended for children with suspected or confirmed influenza, particularly those who are hospitalized, have severe or progressive disease, or have underlying conditions that increase their risk of complications of influenza.

Influenza in Children With Special Risk Medical Conditions: A Systematic Review and Meta-analysis.

Children with special risk medical conditions (SRMC) are over-represented in influenza hospitalizations. A systematic review was undertaken to determine whether children with SRMCs experience greater complications or severity following influenza infection. Bibliographies of pertinent articles were searched in MEDLINE and EMBASE (1990 to March 2018) and contact made with the investigators of unpublished studies containing relevant data. Studies of children (aged ≤18 years) with a SRMC hospitalized with influenza were included. Outcomes were pneumonia, intensive care unit (ICU) admission, mechanical ventilation, neurologic outcomes (seizures, encephalopathy), death and length of stay in hospital or ICU. Twenty-two studies met inclusion criteria. Compared with healthy peers, children with SRMC had higher odds of ICU admission [pooled odds ratio (OR) 1.66 (95% confidence interval (CI): 1.25-2.21)], for mechanical ventilation [pooled OR 1.53 (95% CI: 0.93-2.52)] and death [pooled OR 1.34 (95% CI: 0.74-2.41)]. Additionally, children with SRMC were more likely to develop bacterial pneumonia (crude OR 1.7; 95% CI: 1.1-2.6) or experience prolonged hospital length of stay [adjusted rate ratio 1.75 (95% CI: 1.44-2.11)]. The level of GRADE evidence was low for all outcomes considered in this review. While there was evidence that ICU management and bacterial pneumonia increases in children with SRMC, evidence showing an increase in the probability of death or need for mechanical ventilation was inconsistent. Further research using large datasets should evaluate the impact of complications and associated morbidity from influenza in SRMC children.

Influence of commissioned provider type and deprivation score on uptake of the childhood flu immunization.

Since 2015/16 the UK seasonal influenza immunization programme has included children aged 5 and 6 years. In the South West of England school-based providers, GPs or community pharmacies were commissioned to deliver the vaccine depending on the locality. We aimed to assess variation in vaccine uptake in relation to the type of commissioned provider, and levels of socioeconomic deprivation. Data from the South West of England (2015-16 season) were analysed using multilevel logistic regression to assess variation in vaccine uptake by type of commissioned provider, allowing for clustering of children within delivery sites. Overall uptake in 5 and 6 year olds was 34.3% (37 555/109 404). Vaccine uptake was highest when commissioned through school-based programmes 50.2% (9983/19 867) and lowest when commissioned through pharmacies, 23.1% (4269/18 479). Delivery through schools resulted in less variation by site and equal uptake across age groups, in contrast to GP and pharmacy delivery for which uptake was lower among 6 year olds. Vaccine uptake decreased with increasing levels of deprivation across all types of commissioned provider. School-based programmes achieve the highest and most consistent rates of childhood influenza vaccination. Interventions are still needed to promote more equitable uptake of the childhood influenza vaccine.

A paediatric influenza update 100 years after the Skyros island Spanish flu outbreak.

This year marks the 100th anniversary of the 1918 Spanish flu outbreak on the Greek Aegean Sea island of Skyros, which devastated its population in less than 30 days. According to Constantinos Faltaits's annals published in 1919, the influenza attack on the island of Skyros commenced acutely ‘like a thunderbolt’ on the 27th of October, 1918 and was exceptionally severe and fatal. At that time, the viral cause of the influenza had not been detected, while the total number of victims of the Spanish flu outbreak has been estimated to have surpassed 50 million, worldwide. Almost one century after this Aegean Sea island's tragedy, the ‘4th Workshop on Paediatric Virology’, organised on the 22nd of September, 2018 in Athens, Greece, was dedicated to the 100 years of the ‘Spanish’ flu pandemic. This review article highlights the plenary and key lectures presented at the workshop on the recent advances on the epidemiology, clinical management and prevention of influenza in childhood.

Acute Respiratory Illness in Rural Haiti

ObjectivesAcute Respiratory Infection (ARI) is the most common cause of childhood morbidity and mortality in developing countries, including Haiti. Our objective was to detect pathogens found in children with ARI in rural Haiti to help develop evidence-based guidelines for treatment and prevention. MethodsRetrospective study of students with ARI at four schools in rural Haiti. Viral and/or bacterial pathogens were identified by qPCR in 177 nasal swabs collected from April 2013 through November 2015. ResultsMost common viruses detected were Rhinovirus (36%), Influenza A (16%) and Adenovirus (7%), and bacteria were Streptococcus pneumoniae (58%) and Staphylococcus aureus (28%). Compared to older children, children aged 3–5 years had more Influenza A (28% vs. 9%, p=0.002) and Adenovirus detected (14% vs. 3%, p=0.01). Similarly, S. pneumoniae was greatest in children 3–5 years old (71% 3–5yrs; 58% 6–15 years; 25% 16–20 years; p=0.008). Children 3–10 years old presented with fever more than children 11–20 years old (22% vs 7%; p=0.02) and were more often diagnosed with pneumonia (28% vs 4%, p<0.001). ConclusionsYounger children had increased fever, pneumonia, and detection of Influenza A and S. pneumoniae. These data support the need for influenza and pneumococcus vaccination in early childhood in Haiti.

Influenza!! A hidden burden of disease in Malaysia

Influenza, a contagious respiratory illness presented with sudden onset of fever, sore throat, cough – usually unproductive, runny nose, headache, aching muscles and severe malaise, caused by influenza viruses that infect the nose, throat, and lungs. Yearly, influenza infection leads to an estimated 3 to 5 million cases of severe illness and 250,000 – 500,000 deaths1. In children under 5 years, an estimated 28,000 – 111,500 deaths accountable to influenza occur annually, with 99% of the number occur in developing countries2. Information on childhood influenza is scarce in Malaysia.Vaccination is the most potent measure to inhibit influenza infection and its complications3. In Malaysia, the H1N1 pandemic in 2009 has increased consciousness of the general people and medical personnel about influenza4. Most of the information were obtained from Kuala Lumpur with no information obtained from Sabah. In 2009, Seroprevalence rate of seasonal H1N1 was 14.7% and of H3N2 was 21%. Among the Malaysian population, influenza A Infection was common5.

Differences in the influenza-specific CD4 T cell immunodominance hierarchy and functional potential between children and young adults

Studies of the B cell repertoire suggest that early childhood influenza infections profoundly shape later reactivity by creating an “imprint” that impacts subsequent vaccine responses and may provide lasting protection against influenza strains within the same viral group. However, there is little known about how these early childhood influenza exposures shape CD4 T cell reactivity later in life. To investigate the effect of age on influenza-specific CD4 T cell specificity and functionality, reactivity in cohorts of 2 year old children and young adult subjects was compared. Intracellular cytokine staining was used to determine the viral antigen specificity and expression levels of various cytokines following stimulation of peripheral blood mononuclear cells with complete peptide pools representing the entire translated sequences of the pH1, H3, HA-B, NP, and M1 proteins. We found that the influenza protein-specific immunodominance pattern in children differs from that in young adults, with much lower reactivity to the NP internal virion protein in young children. Alterations in CD4 T cell functionality were also noted, as responding CD4 T cells from children produced less IFNγ and were less likely to express multiple cytokines. These differences in the repertoire of influenza-specific CD4 T cells available for recall on influenza challenge in early childhood could possibly contribute to early imprinting of influenza-specific immunity as well as the increased susceptibility of children to this viral infection.

Pediatric Resident Attitudes Toward Inpatient Immunization of Children and Adolescents: Highlighting Differences in Human Papillomavirus Vaccination.

Over a decade after its debut, human papillomavirus (HPV) vaccine coverage remains suboptimal. The inpatient setting presents a largely unexplored opportunity to increase vaccination rates. This study aims to describe pediatric resident attitudes toward inpatient immunization and compare differences by vaccine, in particular HPV. An anonymous survey of beliefs and practices regarding inpatient vaccines was distributed to pediatric resident physicians at a single freestanding urban children’s hospital in September 2017. A total of 58 surveys were collected (64% response rate). We found that pediatric residents were more likely to report that they never or rarely discuss the HPV vaccine during hospitalization compared with the primary childhood series (P = .001), Tdap (P = .02), and the influenza vaccine (P < .001), and rarely offer the HPV vaccine during hospitalization compared with childhood vaccines (P = .003) and influenza (P = .001). This suggests that provider hesitancy still exists for the HPV vaccine, presenting opportunities for further education and inpatient interventions.

Child hospital admissions associated with influenza virus infection in 6 Spanish cities (2014–2016)

IntroductionThere are only a limited number of studies on the impact of influenza in the Spanish child population. The present work intends to increase this knowledge by studying some key aspects, such as the incidence of hospital admissions, clinic variables, comorbidities, and the vaccination status in the hospitalised children. MethodsA retrospective, observational study was conducted by reviewing the medical records of children under 15 years and hospitalised due to community acquired influenza confirmed microbiologically, during 2́flu seasons (2014–2015 and 2015–2016). The study was carried out in 10 hospitals of 6 cities, which represent approximately 12% of the Spanish child population. ResultsA total of 907 children were admitted to hospital with main diagnosis of influenza infection (447 <2 years), estimating an average annual rate of hospitalization incidence of 0.51 cases/1000 children (95% CI, 0.48–0.55). Just under half (45%) of the cases had an underlying disease considered a risk factor for severe influenza, and most (74%) had not been vaccinated. The percentage of children with underlying diseases increased with age, from 26% in children <6 months to 74% in children >10 years. Admission to the PICU was required in 10% (92) of the cases, mainly due to acute respiratory failure. ConclusionInfluenza continues to be an important cause of hospitalization in the Spanish child population. Children <6 months of age and children with underlying diseases make up the majority (>50%) of the cases. Many of the severe forms of childhood influenza that occur today could be avoided if current vaccination guidelines were met.

Effectiveness of influenza vaccination on influenza-associated hospitalisations over time among children in Hong Kong: a test-negative case-control study

The protection conferred by influenza vaccination is generally thought to last less than a year, necessitating annual revaccination. However, the speed with which influenza vaccine effectiveness might decline during a year is unknown, which is of particular importance for locations with year-round influenza activity. We aimed to assess how influenza vaccine effectiveness changes by time intervals between vaccination and admission to hospital, taking advantage of almost year-round circulation of influenza in Hong Kong. In this test-negative case-control study, we analysed vaccine effectiveness in children (aged 6 months to 17 years) who were admitted to hospital in Hong Kong over 5 consecutive years (2012-17). We included those who were admitted to general wards in four public hospitals in Hong Kong with a fever (≥38°C) and any respiratory symptom, such as runny nose, cough, or sore throat. We used direct immunofluorescence assay and reverse transcription PCR to detect influenza virus infection, and recorded children's influenza immunisation history. We compared characteristics of positive cases and negative controls and examined how vaccine effectiveness changed by time between vaccination and admission to hospital with regression analyses. Between Sept 1, 2012, and Aug 31, 2017, we enrolled 15 695 children hospitalised for respiratory infections, including 2500 (15·9%) who tested positive for influenza A or B and 13 195 (84·1%) who tested negative. 159 (6·4%) influenza-positive cases and 1445 (11·0%) influenza-negative cases had been vaccinated. Most vaccinations were done by December of each influenza vaccination season. Influenza-related admissions to hospital occurred year-round, with peaks in January through March in most years and a large summer peak in 2016; pooled vaccine effectiveness for children of all ages was 79% (95% CI 42-92) for September to December, 67% (57-74) for January to April, and 43% (25-57) for May to August. Vaccine effectiveness against influenza A or B was estimated as 79% (95% CI 64-88) within 0·5-2 months of vaccination, 60% (46-71) within >2-4 months, 57% (39-70) within >4-6 months, and 45% (22-61) within >6-9 months. In separate analyses by type and subtype, we estimated that vaccine effectiveness declined by 2-5 percentage points per month. Influenza vaccine effectiveness decreased during the 9 months after vaccination in children in Hong Kong. Our findings confirm the importance of annual vaccination in children. Influenza vaccines that provide broader and longer-lasting protection are needed to provide year-round protection in regions with irregular influenza seasonality or lengthy periods of influenza activity. Health and Medical Research Fund, Hong Kong and the Research Grants Council, Hong Kong.

Community-acquired acute meningitis and encephalitis: a narrative review.

Meningitis and encephalitis are medical emergencies. Patients need prompt evaluation and immediate empiric therapy to reduce the likelihood of fatal outcomes and chronic neurological sequelae. Conjugate bacterial vaccines have significantly reduced the incidence of bacterial meningitis, especially in children. As the results of changes in patterns of bacterial drug sensitivity, ceftriaxone is now part of the recommended empiric treatment for bacterial meningitis and should be administered as early as possible. Neuroimaging delays the treatment of meningitis and is not needed in most cases. Adjunctive corticosteroid therapy is of benefit for many patients with meningitis and should be initiated in most adults before antibiotic therapy. Molecular testing can assist the specific diagnosis of encephalitis and should be based on the exposure history and geographic risk factors relevant to the patient, but non-infectious causes of encephalitis are also common. Empiric therapy for encephalitis should be directed at the most frequently identified infectious pathogen, herpes simplex virus type 1 (ie, intravenous aciclovir). Vaccines can protect against the major pathogens of childhood infections (measles, mumps, rubella, polio, varicella viruses), influenza viruses, and exotic pathogens that cause meningitis and encephalitis (rabies, Japanese encephalitis, dengue, yellow fever, tick-borne encephalitis viruses, Mycobacterium tuberculosis).

Clinical management and viral genomic diversity analysis of a child's influenza A(H1N1)pdm09 infection in the context of a severe combined immunodeficiency

IntroductionA child with severe combined immunodeficiency (SCID) had an influenza A(H1N1)pdm09 infection with viral excretion longer than 6 months, during 2013–2014 influenza season, despite cord blood transplantation and antiviral treatments. MethodsConventional real-time RT-PCR methods were used to estimate viral load and to detect the presence of the common N1 neuraminidase (NA) H275Y substitution responsible for oseltamivir resistance. Next-generation sequencing (NGS) of influenza viruses was performed retrospectively to characterize viral quasispecies in specimens. ResultsThe patient was first treated with oral oseltamivir, leading to detection of low-levels of NA-H275Y substitution. Concomitant cord blood cell transplantation, intravenous administration of zanamivir and immunoglobulins led to an increase in white blood cells and influenza viral load decrease. A viral rebound occurred as soon as the antiviral treatment was discontinued. Eventually, influenza viral load was negated with immune reconstitution. NGS found influenza quasispecies harboring NA-E119A substitution (10.3%). Moreover, NGS showed that viral genomic diversity evolved under antiviral treatment and immune status. ConclusionsConventional virological techniques were sufficient for influenza infection follow-up but NGS performances allowed characterization of viral variants evolution in this specific case of prolonged influenza virus infection. New and efficient treatments against influenza in immunocompromised patients are needed.

Recommendations for Prevention and Control of Influenza in Children, 2018-2019.

The authors of this statement update the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccine and antiviral medications in the prevention and treatment of influenza in children. Highlights for the upcoming 2018-2019 season include the following:1. Annual influenza immunization is recommended for everyone 6 months and older, including children and adolescents.2. The American Academy of Pediatrics recommends an inactivated influenza vaccine (IIV), trivalent or quadrivalent, as the primary choice for influenza vaccination in children because the effectiveness of a live attenuated influenza vaccine against influenza A(H1N1) was inferior during past influenza seasons and is unknown for this upcoming season.3. A live attenuated influenza vaccine may be used for children who would not otherwise receive an influenza vaccine (eg, refusal of an IIV) and for whom it is appropriate because of age (2 years of age and older) and health status (ie, healthy and without any underlying chronic medical condition).4. All 2018-2019 seasonal influenza vaccines contain an influenza A(H1N1) vaccine strain similar to that included in the 2017-2018 seasonal vaccines. In contrast, the influenza A(H3N2) and influenza B (Victoria lineage) vaccine strains included in the 2018-2019 trivalent and quadrivalent vaccines differ from those in the 2017-2018 seasonal vaccines.a. Trivalent vaccines contain an influenza A(Michigan/45/2015[H1N1])pdm09-like virus, an influenza A(Singapore/INFIMH-16-0019/2016[H3N2])-like virus (updated), and an influenza B (Colorado/60/2017)-like virus (B/Victoria lineage; updated).b. Quadrivalent vaccines contain an additional B virus (Phuket/3073/2013-like virus; B/Yamagata lineage).5. All children with egg allergy of any severity can receive an influenza vaccine without any additional precautions beyond those recommended for all vaccines.6. Pregnant women may receive an influenza vaccine (IIV only) at any time during pregnancy to protect themselves as well as their infants, who benefit from the transplacental transfer of antibodies. Postpartum women who did not receive vaccination during pregnancy should be encouraged to receive an influenza vaccine before discharge from the hospital. Influenza vaccination during breastfeeding is safe for mothers and their infants.7. The vaccination of health care workers is a crucial step in preventing influenza and reducing health care-associated influenza infections because health care personnel often care for individuals at high risk for influenza-related complications.8. Pediatricians should attempt to promptly identify their patients who are suspected of having an influenza infection for timely initiation of antiviral treatment when indicated and on the basis of shared decision-making between each pediatrician and child caregiver to reduce morbidity and mortality. Although best results are seen when a child is treated within 48 hours of symptom onset, antiviral therapy should still be considered beyond 48 hours of symptom onset in children with severe disease or those at high risk of complications (see Table 2 in the full policy statement).

Subtype-specific Clinical Presentation, Medical Treatment and Family Impact of Influenza in Children 1–5 Years of Age Treated in Outpatient Practices in Germany During Three Postpandemic Years, 2013–2015

Limited data on the influenza burden in pediatric outpatients are available, especially regarding direct comparison of the cocirculating (sub)types A(H1N1)pdm09, A(H3N2) and B. Children 1-5 years of age, unvaccinated against influenza and presenting with febrile acute respiratory infections (ARIs), were enrolled in 33 pediatric practices in Germany from 2013 to 2015 (January-May). Influenza was confirmed by multiplex polymerase chain reaction from pharyngeal swabs and (sub)typed. In 805 children with ARI, influenza was the most frequently detected respiratory virus (n = 305; 37.9%). Of 217 influenza patients included, 122 (56.2%) were infected with A(H3N2), 56 (25.8%) with A(H1N1)pdm09 and 39 (18.0%) with B. Median age was 3.7 years [interquartile range (IQR), 2.1-4.8]; 11% had underlying conditions. Median fever duration was 4 days (IQR, 3-5), and the disease duration was 9 days (IQR, 7-12). Most frequent diagnoses were pharyngitis (26%), bronchitis (18%) and acute otitis media (10%). Children received mainly antipyretics (86%) and adrenergic nasal drops/spray (53%); 9% received antibiotics and 3% oseltamivir. Thirty-six percent required at least 1 additional practice visit; 1% was hospitalized. Median absences from childcare were 5 days (IQR, 3-7); parents lost 4 workdays (IQR, 2-6). Symptoms, severity and impact on the family were largely unrelated to (sub)type. However, patients with A(H1N1)pdm09 had fewer underlying conditions (P = 0.017), whereas patients with B more often had pharyngitis (P = 0.022), acute otitis media (P = 0.012) and stenosing laryngotracheitis (P = 0.007). Influenza was the most frequently detected viral pathogen in outpatient children with febrile, mostly uncomplicated ARI. In this setting, clinical manifestations and severity were similar across the (sub)types prevalent during the postpandemic seasons.

Impact of the introduction of a universal childhood influenza vaccination programme on influenza-related admissions to paediatric intensive care units in England

IntroductionA universal childhood influenza vaccination programme was introduced in the UK in September 2013. We examine the impact of the gradual introduction of this programme on influenza-related paediatric intensive care...

Antiviral treatment of childhood influenza: an update.

Influenza virus can cause severe or life-threatening infection in children. This review provides an update on antiviral medications available to treat and prevent influenza in both healthy children and children with underlying medical conditions, and recommendations on their appropriate use in the outpatient and inpatient settings. Despite the significant morbidity and mortality associated with influenza infection, a large number of children hospitalized with influenza do not receive specific antiviral treatment with a neuraminidase inhibitor. Although the effectiveness of this intervention has been debated, several recent observational studies have shown the potential benefits conferred by early antiviral treatment. Oral oseltamivir and inhaled zanamivir remain the best studied antiviral agents for influenza treatment and prevention. In addition, the US Food and Drug Administration recently approved peramivir, a novel neuraminidase inhibitor available for intravenous administration. Children with suspected or documented influenza infection benefit from early antiviral treatment with neuraminidase inhibitors that can shorten illness duration, decrease symptom severity, and lower the risk of complications leading to hospitalization and death. Unless contraindicated, all hospitalized children, children with underlying medical conditions, and those with severe or progressive symptoms of influenza should receive specific antiviral treatment for influenza with a neuraminidase inhibitor. Additionally, antiviral treatment of influenza-infected children in the outpatient setting should be strongly considered.

Parents' Experience and Views of Vaccinating Their Child against Influenza at Primary School and at the General Practice.

The purpose of this study was to gain an in-depth understanding of parents’ experience and views of vaccinating their four to six-year-old child against influenza at school and at the general practice (GP). A cross-sectional qualitative study was conducted between March–June 2016 with parents of children in Reception and Year 1 in four randomly selected schools in Bury, Leicestershire, and Surrey, England. Twenty-five outreach forms were completed and returned, and seven interviews were conducted. Interview transcripts were coded by theme in NVivo (version 11, QSR International Pty Ltd., Melbourne, Australia). The primary reason parents gave for vaccinating their child was to prevent their child from contracting influenza. Parents’ perceived benefits of vaccinating in schools were to avoid the inconvenience of having to take their child to the GP, and that their child would behave better at school. Parents viewed that accompanying their child for the vaccination at school would undermine the convenience and peer-pressure advantages of the school as a venue. No parents expressed concern about their child being too young to be vaccinated in school. This research suggests that the school is a desirable venue for childhood influenza vaccination, both from the parents’ view and given that influenza vaccination coverage is higher when delivered through schools than GPs.

Racial disparities in vaccination for seasonal influenza in early childhood

ObjectivesInfluenza vaccination is the best protection against infection and severe complications of disease, such as hospitalization and death. Therefore, it is important to accurately estimate vaccination coverage and to evaluate the role of race/ethnicity. This study examines racial disparities in influenza vaccination among children using a nationally representative sample. Study designThis study used cross-sectional data from the 2009–2014 National Immunization Survey for children aged 19–35 months (n = 98,186) in the United States. MethodsThe outcome variable was receipt of influenza vaccination (yes/no) and exposure variable was race/ethnicity. Weighted multivariate logistic regression was used to estimate the odds ratio and 95% confidence intervals (CIs) for the effect of race/ethnicity on receipt of the influenza vaccine. ResultsThe overall vaccination rates were 81.6% for non-Hispanic whites, 79.2% for Hispanics, 80.5% for non-Hispanic blacks, and 80.7% for non-Hispanic mixed/other. In the adjusted model, compared with non-Hispanic white children, Hispanic children were 13% less likely to receive influenza vaccination within the last 12 months (adjusted odds ratio [aOR] = 0.87; 95% CI: 0.80–0.94). In addition, children aged 24–29 months (aOR = 0.48; 95% CI: 0.44–0.52) and 30–35 months (aOR = 0.33; 95% CI: 0.30–0.36) were significantly less likely to receive influenza vaccination within the last 12 months compared with those who were 19–23 months old. ConclusionsThere were differences in influenza vaccination rates among different racial groups. Hispanic children had the lowest vaccination rates. Findings from our study have significant implications for targeted interventions to increase the overall vaccination rate for children in the United States.

Increasing Childhood Influenza Vaccinations at the Community Pharmacy in Pennsylvania: Important Factors to Parents and Their Peers—A Pilot Study

Objective: The primary objective was to identify factors that would motivate an adult to bring a child into the community pharmacy for an influenza vaccination via a pilot study conducted in Pennsylvania.&#x0D; Design: This was a multi-site, cross-sectional, exploratory, survey-based pilot study.&#x0D; Setting: Participants were identified at three grocery store community pharmacies in southeastern Pennsylvania.&#x0D; Results: A total of 349 surveys were collected over the study period and 325 participant surveys were included in the analysis. Receiving a vaccine in fifteen minutes or less (140; 74%) and not needing an appointment (142; 75%) were the top motivating factors for parents. Privacy, increased knowledge, and pharmacist counseling were identified as motivating factors for ninety-five (51%), eighty-nine (48%), and eighty-four (45%) parents, respectively. Cost was a barrier for eighty-eight parents (47%).The motivators and barriers for peers, those without children who might influence a parental decision, were similar to those of parents, however, more peers identified a child friendly environment (45% vs. 32%; p=0.02) and pharmacist counseling (57% vs. 45%; p=0.03) as motivators.&#x0D; Conclusion: The opportunity to receive an influenza vaccination quickly, without an appointment, are the most important factors to parents and peers. Factors of cost, counseling, and increased access to educational materials are of moderate importance.&#x0D; &#x0D; Conflict of Interest: None&#x0D; Treatment of Human Subjects: IRB exemption granted&#x0D; &#x0D; Type: Original Research