Influenza Vaccination Coverage In Children Research Articles

Factors Influencing Childhood Influenza Vaccination: A Systematic Review.

Childhood influenza vaccination coverage remains low in lower/middle-income countries. This systematic review aims to identify influencing factors around childhood influenza vaccination. A systematic literature review was conducted and included empirical studies with original data that investigated factors influencing childhood influenza vaccination. We searched MEDLINE, Web of Science, EMBASE, CINAHL Plus, Global Health, PsycINFO, and two Chinese databases, China Knowledge Resource Integrated Database and Chongqing VIP, using a combination of the key terms 'childhood', 'influenza', 'vaccination', and related syntax for all peer-reviewed publications published before December 2019. Thirty studies were included in the analysis. Childhood influenza vaccination was positively associated with caregivers' knowledge of influenza vaccine, positive vaccine attitudes, self-efficacy, perceived susceptibility and severity of influenza, believing in the efficacy of influenza vaccine, the worry of getting sick, healthcare workers' recommendations, and previous influenza vaccination experiences. Barriers included the fear of safety and side effects of the vaccine, as well as poor access to vaccination service. To improve childhood influenza vaccine uptake, health education is necessary to address caregivers' lack of confidence on vaccine safety. Future studies are needed to investigate influencing factors around healthcare workers' vaccination recommendation behaviors and the impact of contextual factors on public vaccination behaviors.

Influenza vaccination in Western Australian children: Exploring the health benefits and cost savings of increased vaccine coverage in children

IntroductionTo assess potential benefits and direct healthcare cost savings with expansion of an existing childhood influenza immunisation program, we developed a dynamic transmission model for the state of Western Australia, evaluating increasing coverage in children < 5 years and routinely immunising school-aged children. MethodsA deterministic compartmental Susceptible-Exposed-Infectious-Recovered age-stratified transmission model was developed and calibrated using laboratory-notification and hospitalisation data. Base case vaccine coverage estimates were derived from 2019 data and tested under moderate, low and high vaccine effectiveness settings. The impact of increased coverage on the burden of influenza, influenza-associated presentations and net costs were assessed using the transmission model and estimated health utilisation costs. ResultsUnder base case vaccine coverage and moderate vaccine effectiveness settings, 225,460 influenza cases are expected annually across all ages. Direct healthcare costs of influenza were estimated to be A$27,608,286 per annum, dominated by hospital costs. Net cost savings of >$A1.5 million dollars were observed for every 10 % increase in vaccine coverage in children < 5 years. Additional benefits were observed by including primary school age children (5–11 years) in the funded influenza vaccination program - a reduction in cases, presentations, hospitalisations and approximately $A4 million net costs savings were observed for every 10 % increase in coverage. The further addition of older children (12–17 years) resulted in only moderate additional net cost savings figures, compared with a 5–11year-old program alone. Net costs savings were predominantly derived by a reduction in influenza-associated hospitalisation in adults. ConclusionsAny increase in influenza vaccine coverage in children < 5 years, above a base case of 50 % coverage resulted in a substantive reduction in influenza cases, presentations, hospitalisations and net costs when applied to the West Australian population. However, the most impactful pediatric program, from both a disease prevention and costs perspective, would be one that increased vaccination coverage among primary-school aged children.

Trends in vaccination coverage against influenza in the pediatric population: an Italian overview

Abstract Background Influenza is a major public health issue for its epidemiological, clinical and economic impact. Children are a relevant age group for the diffusion of the infection in the community as they shed the virus in greater amounts and for longer periods of time than adults of any age. Vaccination is the best strategy to fight the disease. In Italy, until last year, influenza vaccination for the pediatric population was offered free only to children in specific risk categories, while in the last season its was extended also to all subjects from 6 months to 6 years old. The purpose of this work is to analyze the trend of vaccination coverage among children in the last decade in Italy. Methods We retrieved vaccination coverage data by the Italian Ministry of Health relating to influenza vaccination in the age groups 0-2, 2-4, 5-8 and 9-14 in the years 2010-2020 and analysed trends in and between regions. Results A preliminary analysis shows that vaccination coverage in the age groups considered ranged from a minimum of 1.1% to a maximum of 4.5%. The highest average percentage reached was recorded in the season 2010-11 (3.8%), while the lowest in the 2015-16 (1.5%). The highest average values (12,9%; 10,5%) were found in Puglia and Toscana, while the lowest (0.3%) in Friuli Venezia Giulia. From 2010 to 2015 there was a progressive decline in vaccination coverage, while in the following years there was a slight increase, up to the year 2019-2020, in which the average percentage value was 3%. Further results are expected for next summer, when 2020-21 data will be available. Conclusions Our analysis shows that in the Italian regions influenza vaccination coverage in children is variable but still extremely low. Childhood vaccination could provide an opportunity to decrease the burden of disease in this age group but may also help to protect the population at risk of serious complications, such as the elderly, due to the social role children play in the spread of this virus. Key messages Influenza vaccination in children is a major public health issue. Additional efforts are needed to make vaccination available for children and improve the stakeholders’ awareness on this topic.

Improving Influenza Vaccination in Children With Comorbidities: A Systematic Review.

Children with medical comorbidities are at greater risk for severe influenza and poorer clinical outcomes. Despite recommendations and funding, influenza vaccine coverage remains inadequate in these children. We aimed to systematically review literature assessing interventions targeting influenza vaccine coverage in children with comorbidities and assess the impact on influenza vaccine coverage. PubMed, Scopus, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, and Web of Science databases were searched. Interventions targeting influenza vaccine coverage in children with medical comorbidities. Two reviewers independently screened articles, extracting studies' methods, interventions, settings, populations, and results. Four reviewers independently assessed risk of bias. From 961 screened articles, 35 met inclusion criteria. Published studies revealed that influenza vaccine coverage was significantly improved through vaccination reminders and education directed at either patients' parents or providers, as well as by vaccination-related clinic process changes. Interventions improved influenza vaccine coverage by an average 60%, but no significant differences between intervention types were detected. Significant bias and study heterogeneity were also identified, limiting confidence in this effect estimate. A high risk of bias and overall low quality of evidence limited our capacity to assess intervention types and methods. Interventions were shown to consistently improve influenza vaccine coverage; however, no significant differences in coverage between different intervention types were observed. Future well-designed studies evaluating the effectiveness of different intervention are required to inform future optimal interventions.

Parental Vaccine Hesitancy and Childhood Influenza Vaccination.

To quantify the prevalence of parental vaccine hesitancy (VH) in the United States and examine the association of VH with sociodemographics and childhood influenza vaccination coverage. A 6-question VH module was included in the 2018 and 2019 National Immunization Survey-Flu, a telephone survey of households with children age 6 months to 17 years. The percentage of children having a parent reporting they were "hesitant about childhood shots" was 25.8% in 2018 and 19.5% in 2019. The prevalence of concern about the number of vaccines a child gets at one time impacting the decision to get their child vaccinated was 22.8% in 2018 and 19.1% in 2019; the prevalence of concern about serious, long-term side effects impacting the parent's decision to get their child vaccinated was 27.3% in 2018 and 21.7% in 2019. Only small differences in VH by sociodemographic variables were found, except for an 11.9 percentage point higher prevalence of "hesitant about childhood shots" and 9.9 percentage point higher prevalence of concerns about serious, long-term side effects among parents of Black compared with white children. In both seasons studied, children of parents reporting they were "hesitant about childhood shots" had 26 percentage points lower influenza vaccination coverage compared with children of parents not reporting hesitancy. One in 5 children in the United States have a parent who is vaccine hesitant, and hesitancy is negatively associated with childhood influenza vaccination. Monitoring VH could help inform immunization programs as they develop and target methods to increase vaccine confidence and vaccination coverage.

Rural, urban, and suburban differences in influenza vaccination coverage among children

Influenza vaccination is the primary way to prevent influenza, yet influenza vaccination coverage remains low in the United States. Previous studies have shown that children residing in rural areas have less access to healthcare and lower vaccination coverage for some vaccines. Influenza vaccination coverage among children 6 months–17 years by rural/urban residence during the 2011–12 through 2018–19 influenza seasons was examined using National Immunization Survey-Flu data. The Council of American Survey Research Organizations response rates for National Immunization Survey-Flu ranged from 48% to 65% (2011–12 through the 2017–18 seasons) for the landline sample and 20%–39% (2011–12 through the 2018–19 seasons) for the cellular telephone sample. Children residing in rural areas had influenza vaccination coverage that ranged from 7.9 (2012–13 season) to 12.6 (2016–17 season) percentage points lower than children residing in urban areas, and ranged from 4.5 (2012–13 season) to 7.4 (2016–17 season) percentage points lower than children residing in suburban areas. The differences in influenza vaccination coverage among rural, suburban, and urban children were consistent over the eight seasons studied. Lower influenza vaccination coverage was observed among rural children regardless of child’s age, mother’s education, household income, or number of children under 18 years of age in the household. Rural versus urban and suburban differences in influenza vaccination coverage remained statistically significant while adjusting for selected sociodemographic characteristics. A better understanding of the reasons for lower childhood influenza vaccination coverage for children in rural and suburban areas is needed.

2733. Association Between Influenza Vaccination Coverage and Ambulatory Antibiotic Prescription Rates in Children in South Carolina

BackgroundPrior studies demonstrated an increase in ambulatory antibiotic prescription rates during the peak of Influenza virus activity, which often occurs during the first 4 months of the year in Southeastern United States. However, the impact of Influenza vaccination coverage on antibiotic prescription rates remains undefined. The purpose of this retrospective cohort study is to examine the association between Influenza vaccination coverage and ambulatory antibiotic prescription rates in children in South Carolina from 2012 to 2017.MethodsMedicaid and State Employee Health Plan pharmacy claims for outpatient oral antibiotics were utilized for estimation of community antibiotic prescription rates in South Carolina population 6 months to 17 years of age from January 1, 2012 to December 31, 2017, which represents approximately 60% of the South Carolina population in this age group. Linear regression was used to examine the association between antibiotic prescription rates in January to April of each year and Influenza vaccine coverage in children 6 months to 17 years old after adjustments for Influenza vaccine effectiveness in that season as obtained from Centers for Disease Control and Prevention (CDC).ResultsDuring the 6-year study period, the mean antimicrobial prescription rate in children in South Carolina declined from 103 to 79 per 1000 person-months for the months January through April indicating a 26% decline (P < 0.0001). Influenza vaccine coverage also increased from 50.6% during the first Influenza season of the study and peaked at 60.7% in 2014–2015 Influenza season (Figure 1). After adjusting for the vaccine effectiveness, the decline in antibiotic prescription rate was significantly associated with an increase in vaccine coverage in children (P-value < 0.01). Antibiotic prescription rates declined by 3 per 1,000 person-months for each 1% increase in Influenza vaccine coverage in children.ConclusionThere is a temporal association between the increase in Influenza vaccination coverage and the decline in ambulatory antibiotic prescription rates in children in South Carolina. Achieving the CDC’s set target Influenza vaccination coverage of 70% of the population may be associated with greater decline in ambulatory antibiotic prescription rates in children in the future. Disclosures All authors: No reported disclosures.

2761. Interventions to Improve Influenza Vaccination Coverage in Children with Medical Comorbidities: A Meta-Analysis

BackgroundInfluenza vaccination is the most effective influenza prevention tool for children with medical comorbidities. Despite this, coverage remains inadequate. Numerous interventions to improve vaccination coverage have been assessed, yet there remains a paucity of data comparing the relative efficacy and effectiveness of different interventions.MethodsWe searched MEDLINE, PubMed, Scopus, Embase, CINAHL, CENTRAL, and Web of Science (1980 to March 2019) for studies evaluating interventions which sought to improve influenza vaccine coverage in children with medical comorbidities. Interventions were divided into those targeting parents, targeting vaccination providers, and targeting the hospital, clinic or ward. Screening and data extraction from publications meeting inclusion criteria was performed by two reviewers. Results were pooled and meta-analyses were performed using Mantel–Haenszel random-effects models in Review Manager 5.Results35 articles met inclusion criteria; 14 cross-sectional, 12 randomized trials, and 9 cohort studies, 25 articles had sufficient data for pooled analysis. Of the included interventions, 17 were based within primary care or community-based settings, 17 were based in hospitals or tertiary clinics, and 1 intervention was conducted across both primary and tertiary settings. Interventions overall increased influenza vaccination likelihood by 33% (RR = 1.33: 95% CI 1.31, 1.35). Interventions targeting providers’ influenza vaccine knowledge increased vaccine coverage (RR = 1.42: 95% CI 1.36, 1.49) greater than those targeting parental knowledge (RR = 1.23: 95% CI 1.21, 1.26). Conversely, vaccination reminders targeting parents increased vaccine coverage (RR = 1.53: 95% CI 1.49, 1.58) greater than reminders targeting providers (RR = 1.23: 95% CI 1.20, 1.27). Interventions targeting hospitals, clinics or ward processes had the weakest impact on coverage (RR = 1.15: 95% CI 1.13, 1.17).ConclusionInterventions targeting parents, providers, and places individually have all shown to improve influenza vaccination in children with medical comorbidities. However, specifically targeting providers’ vaccine knowledge and parental reminders appear to have the greatest impact on vaccine uptake.Disclosures All authors: No reported disclosures.

Caregiver’s attitudes, beliefs, and experiences for influenza vaccination in Australian children with medical comorbidities

BackgroundInfluenza vaccination is recommended and funded for Australian children with medical comorbidities that increase their risk of severe influenza. Despite this, influenza vaccine coverage remains low within this population. We examined caregivers’ attitudes and practices for influenza vaccination in children with medical comorbidities. MethodsCross-sectional surveys were conducted with caregivers of children (6 months to <18 years old) with medical comorbidities attending sub-speciality paediatric outpatient clinics at the Royal Children’s Hospital (Melbourne), Princess Margaret Hospital (Perth), and Leading Steps private paediatric clinic (Gold Coast). Multivariate linear regression was used to identify surveys responses predictive of receipt of influenza vaccination in 2017. ResultsFrom the 611 surveys collected, 556 were suitable for analysis. Caregiver reported 2017 influenza vaccine coverage was 52.2% in children with medical comorbidities. Caregivers who believed influenza vaccines to be ≥50% effective were more likely to vaccinate their children (adjusted Odds Ratio [aOR]:3.79 (2.41; 5.96). Those who expressed concerns about vaccine side effects were less likely to vaccinate their children (aOR: 0.49 [95% CI: 0.30; 0.80]). Influenza vaccine uptake was significantly more likely for children who had been previously recommended influenza vaccination by their hospital-based physician (aOR: 4.33 [95% CI: 2.58; 7.27]) and had previously received a hospital-based vaccination (aOR: 3.11 [95% CI 1.79; 5.40]). Hospital-based physicians were also caregivers’ most commonly reported source of trusted vaccination information (63.5%). Whilst only 29.3% of caregivers reported their child had been recommended influenza vaccination during a previous admission, 80.1% of caregivers stated they were receptive to their child receiving potential future influenza vaccinations during hospitalisations. ConclusionsReported influenza vaccination coverage in children with medical comorbidities remains inadequate. An important finding of this study is that influenza vaccination recommendation by children’s hospital physicians and previous vaccine receipt in hospital was associated with vaccine uptake. Opportunities for vaccination, especially during hospitalisation, must be examined.

Influenza Vaccination Coverage in Children With Neurologic Disorders and Their Siblings, July 2006 to June 2014.

Children with neurologic disorders are at high risk for influenza-associated complications. We identified 184,460 children 1-17 years of age with neurologic disorders and 204,966 siblings in a commercial insurance claims database from July 2006 to June 2014. Among children with neurologic disorders, coverage increased from 22.4% in 2006-2007 to 42.3% in 2013-2014, but remained suboptimal. A lower proportion of siblings were vaccinated.

Reasons for non-vaccination: Parental vaccine hesitancy and the childhood influenza vaccination school pilot programme in England

IntroductionIn 2013, the annual influenza immunisation programme in England was extended to children to reduce the burden of influenza, but uptake was sub-optimal at 53.2%. AimTo explore the reasons some parents decided not to vaccinate their child against influenza as part of the pilot programme offered in schools. MethodsCross-sectional qualitative study conducted between February and July 2015. 913 parents whose children were not vaccinated against influenza in the school pilots in West Yorkshire and Greater Manchester, England, were asked to comment on their reasons for non-vaccination and invited to take part in a semi-structured interview. 138 parents returned response forms, of which 38 were eligible and interested in participating and 25 were interviewed. Interview transcripts were coded by theme in NVivo. ResultsA third of parents who returned response forms had either vaccinated their child elsewhere, intended to have them vaccinated, or had not vaccinated them due to medical reasons (valid or perceived). Most interviewees were not convinced of the need to vaccinate their child against influenza. Parents expressed concerns about influenza vaccine effectiveness and vaccine side effects. Several parents interviewed declined the vaccine for faith reasons due to the presence of porcine gelatine in the vaccine. ConclusionsTo significantly decrease the burden of influenza in England, influenza vaccination coverage in children needs to be >60%. Hence, it is important to understand the reasons why parents are not vaccinating their children, and to tailor the communication and immunisation programme accordingly. Our finding that a third of parents, who did not consent to their child being vaccinated as part of the school programme, had actually vaccinated their child elsewhere, intended to have their child vaccinated, or had not vaccinated them due to medical reasons, illustrates the importance of including additional questions or data sources when investigating under-vaccination.

Вакцинация против гриппа пациентов с сахарным диабетом 1-го типа

Исследован охват прививками против гриппа детей с сахарным диабетом (СД) 1-го типа в различные эпидемиологические сезоны. Данные были получены из прививочных карт 325 пациентов в возрасте 7–18 лет за период с 2007 по 2012 год. Дети с СД 1-го типа (125 человек — основная группа) имели более низкий процент охвата прививками против гриппа по сравнению с группой контроля (миопия, ожирение, низкорослость) во все сезоны. Однако наибольшая разница отмечалась в 2007 году (соответственно 10,3 и 22,8 %; р = 0,028) и в 2009 году. Охват прививками против гриппа трехвалентной вакциной у детей с СД был самым высоким в пандемический 2009 год (21,8 %), в то время как против гриппа А/H1N1 было привито всего 3,0 %. В постпандемический период (2011 год) в обеих сравниваемых группах охват прививками был наименьшим (7,5 и 11,3 % соответственно; р &gt; 0,05 %). Следует отметить, что охват вакцинацией с применением трехвалентной вакцины в 2009 году был значительно выше в группе пациентов с осложнениями СД по сравнению с диабетическими пациентами без осложнений (31,7 % против 7,3 %; p = 0,008). Педиатры и эндокринологи должны объединять усилия, чтобы увеличить охват прививками против гриппа.

Trends in childhood influenza vaccination coverage--U.S., 2004-2012.

We compared estimates of childhood influenza vaccination coverage by health status, age, and racial/ethnic group across eight consecutive influenza seasons (2004 through 2012) based on two survey systems to assess trends in childhood influenza vaccination coverage in the U.S. We used National Health Interview Survey (NHIS) and National Immunization Survey-Flu (NIS-Flu) data to estimate receipt of at least one dose of influenza vaccination among children aged 6 months to 17 years based on parental report. We computed estimates using Kaplan-Meier survival analysis methods. Based on the NHIS, overall influenza vaccination coverage with at least one dose of influenza vaccine among children increased from 16.2% during the 2004-2005 influenza season to 47.1% during the 2011-2012 influenza season. Children with health conditions that put them at high risk for complications from influenza had higher influenza vaccination coverage than children without these health conditions for all the seasons studied. In seven of the eight seasons studied, there were no significant differences in influenza vaccination coverage between non-Hispanic black and non-Hispanic white children. Influenza vaccination coverage estimates for children were slightly higher based on NIS-Flu data compared with NHIS data for the 2010-2011 and 2011-2012 influenza seasons (4.1 and 4.4 percentage points higher, respectively); both NIS-Flu and NHIS estimates had similar patterns of decreasing vaccination coverage with increasing age. Although influenza vaccination coverage among children continued to increase, by the 2011-2012 influenza season, only slightly less than half of U.S. children were vaccinated against influenza. Much improvement is needed to ensure all children aged ≥ 6 months are vaccinated annually against influenza.

Cobertura de vacunación antigripal en niños con condiciones de riesgo en Cataluña

IntroductionInfluenza vaccination is recommended in Catalonia in children older than 6 months with risk conditions for developing flu-related complications. The aim of this study is to determine influenza vaccine coverage in children with risk conditions and their association with socio-demographic factors and medical variables. Material and methodDescriptive cross-sectional study of children with risk conditions for developing influenza complications (aged between 6months and 15years old) assigned to Primary Health Care centers in Catalonia at the beginning of the 2011-2012 influenza vaccination campaign. The information on vaccination status and study variables were obtained from data registered on electronic health records by primary care teams. The relationship between influenza vaccination and demographic and medical variables was analyzed using bivariate analysis and a multiple logistic regression model. ResultsInfluenza vaccination coverage was 23.9%. Variables associated with influenza vaccination were: age 2years or older (aOR: 1.6 [1.4-1.7] in children 3-5years old; 1.8 [1.7-2.0] in those 6-10 years, and 2.2 [2.0 -2.4] in children ≥11years]); male sex (aOR: 1.1 [1.0-1.1]); foreign nationality (aOR: 1.2 [1.2-1.3]); age-appropriate immunization according to the systematic immunization schedule (aOR: 3.3 [2.8-3.8]); more than one visit to the primary care physician (5 or more visits) (aOR: 4.1 [3.8-4.4]), and more than one risk condition (3 or more conditions) (aOR: 2.5 [1.6-3.9]). DiscussionCompared to other countries, influenza vaccination coverage among children with risk conditions is low in our study. Strategies to improve coverage should be implemented.

Influenza vaccination coverage in children with inflammatory bowel disease

The aim of this study was to evaluate the influenza vaccination status among paediatric patients with inflammatory bowel disease (IBD) in Poland. This was a questionnaire-based study. 242 patients with IBD and 142 controls were enrolled in the study. Of patients with IBD, 7·8% received an influenza vaccine, compared to 18·3% of controls (P = 0·0013). There were no statistically significant differences in time from IBD diagnosis, disease activity and in drugs, between vaccinated and non-vaccinated IBD children. In conclusion, the data of our study demonstrate an alarmingly poor influenza vaccination status in the majority of children with IBD. Therefore, there is an unmet need to implement better influenza vaccination strategies for this group of patients.

Influenza Vaccination in Young Children Reduces Influenza-Associated Hospitalizations in Older Adults, 2002-2006

To assess how influenza vaccination coverage in children is related to pneumonia and influenza (P&I) in older adults and whether sociodemographic factors modify these associations. Approximately 5 million hospitalization records from the Centers for Medicare and Medicaid Services for four influenza years (2002-2006) were abstracted. A single-year age distribution of rates of P&I hospitalization was estimated according to state for each influenza season; an exponential acceleration in the P&I rates with age was observed for each influenza season. State- and season-specific P&I rate accelerations were regressed against the percentage of vaccinated children, older adults, or both using mixed effects models. U.S. population, 2002 to 2006. U.S. population aged 65 and older. State-level influenza annual vaccination coverage data in children and older adults were obtained from the National Immunization Survey and the Behavioral Risk Factor Surveillance System, respectively. Child influenza vaccination coverage was negatively associated with age acceleration in P&I, whereas influenza vaccination in the older adults themselves was not significantly associated with P&I in older adults. Vaccination of children against influenza may induce herd immunity against influenza for older adults and has the potential to be more beneficial to older adults than the existing policy of preventing influenza by vaccinating older adults themselves.

High Influenza Vaccination Coverage in Children With High-Risk Conditions During a Vaccine Shortage

To assess whether pediatric practices with a system to identify and recall children with high-risk conditions (HRCs) could maintain high influenza vaccination coverage levels among these children during a vaccine shortage year. Observational study using data from a computerized billing database and an electronic immunization information system. Four Denver pediatric practices during the 2003-2004 and 2004-2005 influenza seasons. Children aged 24 to 72 months with and without HRCs. Main Exposure The vaccine shortage of the 2004-2005 influenza season. Proportion of children with and without HRCs who were immunized and the timing of influenza immunization in nonshortage (2003-2004) and shortage (2004-2005) seasons. In the 2003-2004 season, 770 of 1166 children with HRCs (66.0%) were immunized and, in the 2004-2005 season, 656 of 1053 (62.3%) were immunized. Although vaccination coverage did not significantly decrease for children with HRCs during the 2004-2005 season (P = .07), coverage for healthy children decreased from 43.8% (4435/10 117) to 29.5% (3066/10 387) (P < .001). After the priority group recommendation in October 2004, the practices provided few vaccines to healthy children, whereas children with HRCs continued to receive the vaccine. Pediatric practices with a system to identify and recall children with HRCs can target these children for receipt of the influenza vaccine and maintain high vaccination coverage, despite a vaccine shortage that may result in decreased vaccine coverage in healthy children.

Influenza Vaccination Coverage Among Children With Asthma—United States, 2004-05 Influenza Season

In 2005, approximately 8.9% (6.5 million) of U.S. children aged <18 years were reported to have current asthma. Children with asthma are at high risk for complications from influenza, and influenza vaccination has been determined to safely and effectively reduce rates of influenza in these children. Since its establishment in 1964, the Advisory Committee on Immunization Practices (ACIP) has recommended that all children with asthma aged > or =6 months receive vaccination with inactivated influenza vaccine during each influenza season; however, national influenza vaccination coverage rates specifically for children with asthma have not been determined. Previous studies have assessed influenza vaccination rates in children with asthma at the local level using health maintenance organization and clinician group-practice information, with estimates ranging from 10% to 43% for various influenza seasons. Another study used Behavioral Risk Factor Surveillance System (BRFSS) data to estimate influenza vaccination coverage in children aged 2-17 years with one or more conditions putting them at high risk for complications from influenza (including asthma, although asthma was not assessed separately); in that study, the national rate was estimated at 34.8% for the 2004-05 influenza season (based on a sample size of 685, which included all states and the District of Columbia [DC]). To estimate national influenza vaccination coverage rates among children aged 2-17 years with current asthma, CDC analyzed data from the 2005 National Health Interview Survey (NHIS). This report describes the results of that analysis and provides the first national estimates of influenza vaccination coverage among children with asthma. The findings indicated that although children with current asthma were more likely to receive influenza vaccination than children without current asthma, the vaccination coverage rate among children with asthma was low, at 29.0% (95% confidence interval [CI] = 24.5-33.9). These findings underscore the need to increase influenza vaccination coverage in children with asthma aged 2-17 years by identifying and overcoming barriers to vaccination.

Childhood Influenza Vaccination Coverage—United States, 2004-05 Influenza Season

Children aged <2 years are at increased risk for influenza-related hospitalizations, and children aged 24-59 months are more likely than older children to visit a clinic, hospital, or emergency department with influenza-associated illness. In 2002, the Advisory Committee on Immunization Practices (ACIP) encouraged annual influenza vaccinations for children aged 6-23 months (and for household contacts of and out-of-home caregivers for children aged <2 years). For the 2004-05 influenza season, ACIP strengthened its encouragement to a full recommendation. For the upcoming 2006-07 influenza season, ACIP has further extended its recommendation to include all children aged 6-59 months (and their household contacts and out-of-home caregivers). Others recommended to receive influenza vaccination include children aged 6-18 years who have certain high-risk medical conditions, are on chronic aspirin therapy, or who are household contacts of persons at high risk for influenza complications. This report provides an assessment of influenza vaccination coverage among children aged 6-23 months during the 2004-05 influenza season. The findings demonstrate that vaccination coverage in that age group approximately doubled from the 2003-04 influenza season, with substantial variability among states and urban areas. However, the percentage of fully vaccinated children remained low, underscoring the need for increased measures to improve pediatric vaccination coverage and ongoing monitoring of coverage among young children and their close contacts.

Vacunación antigripal en niños ingresados en un hospital de tercer nivel. Factores asociados a las coberturas

Children aged less than 2 years old and those with chronic diseases have a high risk of complications and hospitalization due to influenza. Despite the broad consensus in the literature on the indication for annual immunization of these patients, less than 30 % of the children with high-risk underlying conditions are immunized each year. The aim of this study is to determine the influenza vaccine coverage in children with high-risk underlying conditions admitted to a university hospital.We performed a cross-sectional study of patients aged from 6 months to 18 years old with high-risk medical conditions and who had been hospitalized between January and May, 2005 in the Vall d'Hebron University Hospital (Barcelona). Influenza vaccine coverage, factors associated with immunization, and the reasons for nonvaccination were analyzed.Overall vaccine coverage was 23.5 %. The highest vaccination coverage was found in patients with congenital heart disease, chronic respiratory disease, and asthma (43.2 %, 42.9 % and 28.6 %, respectively). The factors most frequently associated with influenza vaccination were the type of underlying disease, having been immunized against influenza in the previous season, having received the pneumococcal vaccine, and age younger than 5 years. The main reason for nonvaccination was the lack of influenza vaccine recommendation by health professionals (95.3 %).Influenza vaccine coverage in children with high-risk conditions is low. Strategies to increase awareness among health professionals on the importance of recommending influenza immunization are required.