Improving Influenza Immunization Research Articles

Partnering with parents to remove barriers and improve influenza immunization rates for young children.

Despite the ongoing public health initiatives to increase pediatric influenza immunization rates to 80%, only a few US health centers have been able to meet this goal. The suboptimal immunity to influenza poses individual and societal risks for vaccine-preventable cases of influenza and its complications. At a diverse, urban, family health center, its influenza immunization rate of 44% represented the lowest uptake rate compared with all other early childhood vaccines, increasing the risk of morbidity and mortality in young children, including hospitalization and death. To identify key barriers to influenza immunization, the investigators interviewed parents of children aged 6 through 24 months at this urban family health center via randomized sampling using an open-ended telephone survey. Based on the concerns parents expressed through the survey, a program was designed and implemented that included reminder calls, parent education, proactive appointment scheduling, and social media reminders. After implementing a parent-driven quality-improvement program for 6 months during influenza season, the health center's pediatric influenza immunization rates rose to 57% compared with 44% during the year before. Childhood immunization is a critical priority to protect the health and wellness of children. Increasing parent engagement in discussions about increasing immunization rates not only promotes awareness surrounding vaccines but also allows primary care providers to learn from parents to create a patient-centered immunization program. Programs that specifically target immunization efforts toward parental concerns have the potential for increased vaccine acceptance and improved health outcomes.

Improving influenza immunization rates in the uninsured.

Infection from influenza virus causes tens of thousands of deaths annually in the United States, costing millions to manage hospital complications. Barriers exist for patients to choose the influenza vaccine, which is proven to effectively reduce incidence of infection and complications from influenza virus. A significant percent of uninsured patients are at high risk of these complications because of chronic illness. This article examines the literature for evidence of effective interventions to increase influenza uptake rate in the uninsured adult population. Literature review of data sources including the Cumulative Index to Nursing and Allied Health Literature, PubMed, Scopus, and the Cochrane Database of Systematic Reviews. Effective interventions include free vaccines, mass communication efforts, implementing an influenza questionnaire, training health care workers, using a vaccine facilitator, implementing a standing orders policy and opt-out policy, scheduling year-round appointments, clinicians recommending the vaccine, clinician audit and feedback, tracking in an electronic medical record, and narrative communication techniques. To reduce influenza-related costs, and improve health outcomes, it is imperative that nurse practitioners use evidence-based interventions in the practice setting to increase influenza uptake rates in the adult uninsured population.

Use of Seasonal Influenza Vaccination and Its Associated Factors among Elderly People with Disabilities in Taiwan: A Population-Based Study.

BackgroundInfluenza immunization among elderly people with disabilities is a critical public health concern; however, few studies have examined the factors associated with vaccination rates in non-Western societies.MethodsBy linking the National Disability Registration System and health service claims dataset from the National Health Insurance program, this population-based study investigated the seasonal influenza vaccination rate among elderly people with disabilities in Taiwan (N = 283,172) in 2008. A multivariate logistic regression analysis was conducted to adjust for covariates.ResultsNationally, only 32.7% of Taiwanese elderly people with disabilities received influenza vaccination. The strongest predictor for getting vaccinated among older Taiwanese people with disabilities was their experience of receiving an influenza vaccination in the previous year (adjusted odds ratio [AOR] = 6.80, 95% confidence interval [CI]: 6.67–6.93). Frequent OPD use (AOR = 1.85, 95% CI: 1.81–1.89) and undergoing health examinations in the previous year (AOR = 1.66, 95% CI: 1.62–1.69) also showed a moderate and significant association with receiving an influenza vaccination.ConclusionsAlthough free influenza vaccination has been provided in Taiwan since 2001, influenza immunization rates among elderly people with disabilities remain low. Policy initiatives are required to address the identified factors for improving influenza immunization rates among elderly people with disabilities.

Factors Influencing the Decision to Receive an Influenza Vaccination Among Manufacturing Plant and Day Care Center Employees.

To improve influenza immunization rates, it is essential to understand why adults are not immunized and the factors that influence their decisions. This information can be used to tailor educational materials and outreach.

An Evidence-based Project to Improve Influenza Immunization Uptake

Influenza, a severe acute respiratory illness, infects between 5% and 20% of the United States population annually. Immunization is recognized as the best protection against influenza. The US Centers for Disease Control and Prevention has recommended annual immunization (> 6 months); however, < 42% of the population and < 20% of college students receive an annual vaccination. An evidence-based awareness project was implemented in a college health setting to increase the number of influenza vaccinations administered. The number of students vaccinated at the college increased by 226%. The use of evidence-based strategies by college health practitioners can target health messages to increase student awareness.

Employing a Multifaceted Approach Aimed at Increasing Influenza Vaccination Rates

Improving influenza vaccination rates continues to be a challenge faced by healthcare providers every flu season. A great amount of time and resources are devoted each year towards advertisement and awareness campaigns aimed at improving public participation. However, despite continued efforts by providers to improve influenza immunization rates in their respective communities, it was reported by the CDC that the influenza immunization rate for all people’s ≥6 months of age during the 2013-2014 flu season was 46.2%. The results reported were obtained via an analysis of state and national telephone survey data in the United States that captured an unweighted sample size of 481,432 individuals through the use of the NIS-Flu and BRFSS telephone survey systems [1]. The 2013-2014 influenza immunization rate falls far short of influenza vaccination goals set by Healthy People 2020. This goal aims to achieve an 80% influenza vaccination rate among individuals 6 months to 64 years old including all pregnant women and a 90% rate among all high risk or institutionalized adults, adults >64 years, and healthcare personnel [2]. Pharmacists have the opportunity as one of the most trusted and accessible healthcare professionals to positively impact vaccination rates throughout their community.

Reduced incidence of pneumonia in influenza-vaccinated solid organ transplant recipients with influenza disease

Whether influenza vaccination influences the severity of illness in cases of clinical failure in solid organ transplant (SOT) recipients receiving influenza vaccine has not been extensively studied. Our goal was to evaluate the frequency of influenza vaccination among SOT recipients with influenza disease and its impact on the illness severity during the 2010–2011 season. Adult SOT recipients with confirmed influenza infection were included from December 2010 to April 2011. Follow-up data were recorded and antibody titres were determined using a microneutralization assay. Sixty-four SOT recipients were included in the study, ten (15.6%) with severe disease, requiring admission to intensive care units, of whom four (6.3%) died. In all, 34 (53.1%) received the 2010–2011 seasonal influenza vaccine and 32 (50.0%) received the 2009-H1N1 pandemic vaccine, and none had detectable antibodies against influenza at the time of diagnosis of influenza infection. Twenty-three (67.6%) of the patients that received the vaccine required hospital admission and presented less dyspnoea (10, 29.4% versus 14 (50.0%), p 0.09) and pneumonia (8, 23.8% versus 15, 50.0%, p 0.03, relative risk 0.3, 95% CI 0.1-0.9) than unvaccinated patients, with relative risk reductions of 60% and 70%, respectively. Although influenza vaccination confers protection on SOT recipients against developing influenza pneumonia, the rate of clinical failure is still high. New strategies to improve influenza immunization are needed for this group of patients.

Influenza Immunization in Older Adults with and without Cancer

To compare the likelihood of receiving an influenza immunization in older adults before and immediately after a cancer diagnosis occurring in 2001 and for the same time periods with older adults not diagnosed with cancer. Retrospective analysis comparing influenza immunization rates of Medicare beneficiaries with and without a diagnosis of cancer. Surveillance, Epidemiology, and End Results-Medicare Data. Propensity score matching matched a group of 35,229 persons without cancer with 35,257 individuals diagnosed with cancer in 2001. Receipt of influenza vaccination based upon Medicare Claims Data. A difference-of-difference analysis revealed that influenza immunization rates increased over time for persons diagnosed with cancer (46.8% before to 50.8% after cancer diagnosis), but the increase was greater in beneficiaries without a cancer diagnosis (42.6% to 79.7%) (P < .001; 95% confidence interval = 0.320-0.324). Logistic regression analysis revealed that individuals without a cancer diagnosis were 7.25 times as likely to receive an influenza immunization. Older adults who have been recently diagnosed with cancer receive influenza immunizations at much lower rates than older adults who have not been diagnosed with cancer despite interaction with healthcare providers. Opportunities exist to improve influenza immunization in this population, who are susceptible to influenza because of compromised immune systems.

Texting Parents to Improve Influenza Immunization Rates

Texting Parents to Improve Influenza Immunization Rates

Improving Influenza Immunization Rates Through a Specialized Clinic Review

Purpose: The purpose of this capstone project was to determine if alternative access by way of a focused immunization clinic rather than a regular physician office visit caused an increase from 2009 to 2010 in the number of people in a rural community who received the influenza vaccine. Reasons why the immunization clinic was chosen by the patient for immunization were identified. Methods: This project was conducted by using a descriptive survey design. A questionnaire was given to individuals who participated in an influenza immunization clinic in a rural community in a southeastern state. Data were collected using a seven-item questionnaire completed by participants. Results: Evaluation of data revealed that 40% of individuals who did not receive their vaccine in 2009 received a flu shot in 2010 through access to the immunization clinic. Conclusion: Evidence suggests that providing alternative access to immunizations in a rural community could potentially improve the rate of participation of individuals.

Pediatric influenza immunization in an integrated safety net health care system

ObjectiveIn 2008 the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) recommended that all children aged 6 months to 18 years receive annual influenza vaccine. Full pediatric influenza administration has proven difficult. We compared rates of full influenza immunization between a safety net health care system and CDC sentinel sites and evaluated sociodemographic factors associated with full influenza immunization. Patients and methodsWe matched influenza immunization data for 2008–2009 from a health care system immunization registry with patient demographic/billing data and compared rates to CDC sentinel sites using bivariate analysis. We evaluted immunization rates by patient characteristics using multivariate analysis. ResultsFull influenza immunization was achieved in 32% of Denver Health (DH) children compared to 12% at the CDC sites (p<0.001). The largest differences occurred in children aged 11–12 and 13–18 years, 47% DH vs 12% CDC sites, and 33% DH vs 9% CDC sites respectively, (p<0.001 for both). In multivariate analysis, DH children were more likely to be immunized if they were Asian, Odds Ratio (OR) 1.59 95%CI (CI) 1.32–1.91, or Hispanic OR 1.18 CI 1.07–1.30, compared to white, spoke Spanish OR 1.19 CI 1.13–1.26, or other non-English language OR 2.05 CI 1.80–2.34, and had a greater number of visits for well care OR 2.86 CI 2.74–2.98 and sick/follow-up care OR 1.59 CI 1.56–1.62, during the influenza season. They were less likely to be immunized if they had commercial insurance OR 0.68 CI 0.62–0.75 or were uninsured OR 0.77 CI 0.72–0.80, compared to Medicaid/SCHIP. ConclusionsUsing immunization registry prompts, standing orders, multiple sites and visit types for immunization, an integrated safety net health care system had higher full influenza immunization rates than the CDC sentinel sites singularly or collectively. These procedures can be applied elsewhere to improve influenza immunization rates.

Using Reminder/Recall Systems to Improve Influenza Immunization Rates in Children With Asthma

IntroductionAsthma is a major public health concern in the U.S. pediatric population. Children with asthma tend to fare worse when they acquire respiratory illnesses such as influenza, requiring more episodic office visits and hospitalizations than do healthy children with the same illnesses. Despite the American Academy of Pediatrics recommendation that children with chronic diseases be immunized for seasonal influenza annually, influenza immunization rates in this population peaks at < 30%. The purpose of this literature review was to examine the effectiveness of reminder/recall systems in improving influenza immunization rates among children with asthma. MethodThis literature review was conducted using PubMed, CINAHL, EMBASE, and Cochrane. Of the 178 articles found, 12 met criteria for inclusion. Articles were included if they addressed influenza vaccination in asthmatic children and “high-risk” children and considered asthmatics in the definition of “high risk.” Additionally, inclusion criteria required discussion of at least one mode of reminder method or recall method that was used to influence the rate of influenza vaccination in children with asthma. For the purposes of this review, “reminders” is defined as any action performed by health provider or representative of the health provider that was aimed at informing and/or reiterating to patients the importance of influenza vaccination for asthmatic children and/or the potential for increased morbidity with acquisition of the flu and/or availability of the vaccine. “Recall” methods included all efforts made by the health provider or his/her representative to encourage patients to return to clinics for vaccination during the influenza season. Articles were excluded if they focused on improving influenza vaccination rates in healthy children and if they used reminder/recall systems to influence vaccination against diseases other than influenza. No systematic review was found on this particular topic. ResultsProviders have used reminder and recall systems that alert patients of the need for vaccination and encourage compliance with this recommendation. Implemented techniques included verbal and mailed reminders, electronically generated alerts, and year-round scheduling of flu vaccination appointments. DiscussionImprovements have been seen in influenza immunization rates with the implementation of reminder/recall systems; however, most have been modest. Enhancements in patient education and access to vaccination are other areas of needed improvement.

Increasing Inner-City Adult Influenza Vaccination Rates: A Randomized Controlled Trial

In a population of seniors served by urban primary care centers, we evaluated the effect of the practice-based intervention on influenza immunization rates and disparities in vaccination rates by race/ethnicity and insurance status. A randomized controlled trial during 2003-2004 tested patient tracking/recall/outreach and provider prompts on improving influenza immunization rates. Patients aged > or = 65 years in six large inner-city primary care practices were randomly allocated to study or control group. Influenza immunization coverage was measured prior to enrollment and on the end date. At study end, immunization rates were greater for the intervention group than for the control group (64% vs. 22%, p < 0.0001). When controlling for other factors, the intervention group was more than six times as likely to receive influenza vaccine. The intervention was effective across gender, race/ ethnicity, age, and insurance subgroups. Among the intervention group, 3.5% of African Americans and 3.2% of white people refused influenza immunization. Patient tracking/recall/outreach and provider prompts were intensive but successful approaches to increasing seasonal influenza immunization rates among this group of inner-city seniors.

Recommendation for Mandatory Influenza Immunization of All Health Care Personnel

The purpose of this statement is to recommend implementation of a mandatory influenza immunization policy for all health care personnel. Immunization of health care personnel is a critically important step to substantially reduce health care-associated influenza infections. Despite the efforts of many organizations to improve influenza immunization rates with the use of voluntary campaigns, influenza coverage among health care personnel remains unacceptably low. Mandatory influenza immunization for all health care personnel is ethically justified, necessary, and long overdue to ensure patient safety.

2009 pandemic influenza: a review

A review of influenza is particularly relevant this year due to the ongoing novel H1N1 influenza pandemic. Surveillance and clinical data including risk factors for infection and complications due to the current H1N1 pandemic are reviewed. New evidence on the safety of antiviral agents in children and studies on interventions to reduce community transmission of influenza are included. Influenza vaccine efficacy and improving immunization coverage have also been addressed by recent studies. These studies from the early phase of the pandemic identify the population that are at high risk for complications, and affirm that active surveillance and prevention are important aspects of a public health response. Appropriate use of antiviral agents and improving influenza immunization coverage for all ages continue to be a challenge. Further studies are underway to improve the public health response, and the pandemic H1N1 strain is being incorporated into the 2010 seasonal influenza vaccine.

Cost-effectiveness of live-attenuated influenza vaccine, trivalent in preventing influenza in young children attending day-care centres

Vaccinating children at day-care may be a cost-effective approach for improving influenza immunization rates in this high-risk group. This study uses influenza attack-rate data from a randomized, blinded, placebo-controlled clinical trial of live-attenuated influenza vaccine, trivalent in day-care centres from two consecutive influenza seasons, one with a moderate attack rate (H1N1 dominant) and one with a high attack rate (H3N2 dominant). Costs were measured in US dollars. In the moderate attack-rate season (vaccinated, 2.2%; placebo, 13.4%), vaccination saved US$ 5.47 per child in societal costs. In the high attack-rate season (vaccinated, 4.7%; placebo, 32.1%), vaccination led to a societal costs savings of US$ 144.44 per child.

Knowledge, attitudes, and practices regarding influenza vaccination among health professional students

Influenza is a serious health problem worldwide and is associated with an average of 226,000 hospitalizations each year in the United States. 1. Harper S.A. Fukuda K. Uyeki T.M. et al. Prevention and control of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2005; 54: 1-40 PubMed Google Scholar The principal method for prevention of influenza-related deaths and complications is vaccination of persons at high risk. The Advisory Committee on Immunization Practices (ACIP) recommends vaccination of health care workers (HCWs) because they care for persons at high risk for influenza-related complications. 1. Harper S.A. Fukuda K. Uyeki T.M. et al. Prevention and control of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2005; 54: 1-40 PubMed Google Scholar Despite these recommendations, vaccination rates among HCWs are only approximately 40%. 1. Harper S.A. Fukuda K. Uyeki T.M. et al. Prevention and control of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2005; 54: 1-40 PubMed Google Scholar Fear of vaccine adverse effects and inconvenience are among the reasons HCWs choose not to be vaccinated. 2. Goldstein A.O. Kincade J.E. Gamble G. Bearman R.S. Policies and practices for improving influenza immunization rates among healthcare workers. Infect Control Hosp Epidemiol. 2004; 25: 908-911 Crossref PubMed Scopus (52) Google Scholar ,3. Lester R.T. McGeer A. Tomlinson G. Detsky A.S. Use of, effectiveness of, and attitudes regarding influenza vaccine among house staff. Infect Control Hosp Epidemiol. 2003; 24: 839-844 Crossref PubMed Scopus (134) Google Scholar

Improving Influenza Vaccination Rates of High-Risk Inner-City Children Over 2 Intervention Years

Influenza immunization rates among children with high-risk medical conditions are disappointingly low, and relatively few data are available on raising rates, particularly over 2 years. We wanted to determine whether interventions tailored to individual practice sites improve influenza immunization rates among high-risk children in inner-city health centers over 2 years. A before-after trial to improve influenza immunization of children was conducted at 5 inner-city health centers (residencies and faith-based). Sites selected interventions from a menu (eg, standing orders, patient and clinician reminders, education) proved to increase vaccination rates, which were directed at children aged 2 to 17 years with high-risk medical conditions. Intervention influenza vaccination rates and 1 and 2 years were compared with those of the preintervention year (2001-2002) and of a comparison site. Influenza vaccination rates improved modestly from baseline (10.4%) to 13.1% during intervention year 1 and to 18.7% during intervention year 2 (P <.001), with rates reaching 31% in faith-based practices. Rates increased in all racial and age-groups and in Medicaid-insured children. The increase in rates was significantly greater in intervention health centers (8.3%) than in the comparison health center (0.7%; P <.001). In regression analyses that controlled for demographic factors, vaccination status was associated with intervention year 1 (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.6-2.2) and with intervention year 2 (OR, 2.8; 95% CI, 2.3-3.4), as well as with practice type. Adolescents had lower vaccination rates than children 2 to 6 years old (OR, 0.6; 95% CI, 0.5-0.7). Tailored interventions selected from a menu of interventions modestly increased influenza vaccination rates over 2 years at health centers serving children from low-income families. We recommend this strategy for faith-based practices and residencies with 1 practice site, but further research is needed on multisite practices and to achieve higher influenza vaccination rates.

Policies and Practices for Improving Influenza Immunization Rates Among Healthcare Workers

To determine the attitudes, policies, and barriers for requiring annual versus voluntary influenza vaccinations for the staff of healthcare institutions in North Carolina. Five different types of institutions serving at-risk elderly populations throughout North Carolina were chosen for study, including hospitals, home health agencies, nursing homes, dialysis centers, and assisted living facilities. Infection control managers completed a 45-question telephone survey on policies for annual influenza vaccinations for employees, incentives to encourage immunizations, support for mandatory influenza vaccinations for workers, barriers to employee vaccinations, and support for a state law to mandate influenza immunizations for employees with patient care contact. Of 312 institutions, 268 (86%) participated in the study. Only 38% of institutions reported having formal written employee influenza vaccination policies, and only 2% actually mandated annual employee vaccinations. Reported barriers to increasing healthcare worker annual influenza vaccinations included "fear of side effects" and "perceived ineffectiveness of the flu vaccine." Almost half of the respondents would support mandating influenza vaccinations for all healthcare workers with direct patient contact. A state-wide survey of the receptivity, policies, and implications of mandated employee influenza vaccinations among healthcare institutions serving the elderly in North Carolina found written policies uncommon and most of the mechanisms used to increase vaccinations voluntary. Efforts should be tailored to individuals, institutions, and healthcare systems to dramatically increase employee immunization rates.

Improving Influenza Immunization Rates Among Healthcare Workers Caring for High-Risk Pediatric Patients

To assess influenza vaccination rates of healthcare workers (HCWs) in neonatal intensive care units (NICUs), pediatric intensive care units (PICUs), and oncology units in Pediatric Prevention Network (PPN) hospitals. Infection control practitioners and HCWs in NICUs, PICUs, and oncology units. In November 2000, posters, electronic copies of a slide presentation, and an influenza fact sheet were distributed to 32 of 76 PPN hospitals. In January 2001, a survey was distributed to PPN hospital participants to obtain information about the immunization campaigns. On February 7, 2001, a survey of influenza immunization was conducted among HCWs in NICU, PICU, and oncology units at participating hospitals. Infection control practitioners from 19 (25%) of the 76 PPN hospitals completed the surveys. The median influenza immunization rate was 43% (range, 12% to 63%), with 7 hospitals exceeding 50%. HCWs (n = 1123) at 15 PPN hospitals completed a survey; 53% of HCWs reported receiving influenza immunization. Immunization rates varied by work site: 52% in NICUs and PICUs compared with 60% in oncology units. Mobile carts and PPN educational fact cards were associated with higher rates among these subpopulations (P < .001) (361 [63%] of 575 vs 236 [44%] of 541 for mobile carts; 378 [60%] of 633 vs 219 [45%] of 483 for fact cards). Despite delayed distribution of influenza vaccine during the 2000-2001 season, immunization rates at 7 hospitals and among HCWs in high-risk units exceeded the National Association of Children's Hospitals and Related Institutions goal of 50%.