Influenza Vaccination Reminders Research Articles

Vaccine hesitancy and influenza beliefs among parents of children requiring a second dose of influenza vaccine in a season: An American Academy of Pediatrics (AAP) Pediatric Research in Office Settings (PROS) study

ABSTRACT To receive adequate protection against influenza, some children 6 months through 8 y old need two doses of influenza vaccine in a given season. Currently, only half of those receiving the first dose receive a second. Our objective was to assess vaccine hesitancy and influenza disease and vaccine knowledge, attitudes, and beliefs among caregivers of children who received the first of their two needed doses. As part of a national-randomized control trial of second dose text-message influenza vaccine reminders (2017–2018 season), a telephone survey collected caregiver and index child demographic information. Each child had received the first of two needed influenza vaccine doses. Caregivers completed a measure of general vaccine hesitancy – the five-question Parent Attitudes About Childhood Vaccines Survey Tool (PACV-5) – and questions about influenza infection and vaccine. We assessed associations between participant demographic characteristics, vaccine hesitancy, and influenza beliefs and calculated the standardized proportion of caregivers endorsing each outcome using logistic regression. Analyses included responses from 256 participants from 36 primary care practices in 24 states. Some caregivers (11.7%) reported moderate/high vaccine hesitancy and many had misperceptions about influenza disease and vaccine. In multivariable models, no single variable was consistently associated with inaccurate knowledge, attitudes, and beliefs. These results demonstrate that caregivers whose children received the first dose of influenza vaccine may still be vaccine hesitant and have inaccurate influenza beliefs. Pediatricians should consider broadly addressing inaccurate beliefs and promoting vaccination even after caregivers agree to the first dose.

Predictors of yearly influenza vaccination in hospitalized and community-based patients

Background: Understanding positive and negative influences on adult immunization status can help healthcare providers to better identify and target patients who are likely to need immunization. Our aim was to assess and compare influenza and pneumococcal (IV/PV) immunisation rates to identify vaccination predictors in Malta.
 Methods: One group consisted of all medical patients discharged from Mater Dei Hospital (MDH) over a one week period in February 2013. Patients were administered a phone questionnaire. A second group of patients receiving community-based care at local health centres over a one week period in March 2013 were interviewed, identifying vaccination eligibility as per 2010 WHO recommendations.
 Results: A total of 150 community (Mean age 61.5 SD 15.8, Male 60%) and 149 hospitalised (Mean age 66.8, SD 13. 6%, Male 48.3%) patients in whom influenza vaccine was indicated were recruited. In the current year, 44 and 48.3% received the seasonal influenza vaccine, while 32.0, and 49% vaccinated yearly respectively. Pneumococcal vaccination advice was less than 5% in both groups. On stepwise binary regression, vaccination predictors for the current year were regular yearly influenza vaccination (OR 93.62, CI: 31.8–275.5, p < 0.001) and vaccination reminders (OR 27.5, CI: 9.63–78.31, p < 0.001). Nursing home residence (OR 5.78, CI: 1.22–27.4,p = 0.011), congestive cardiac failure (OR 2.11, CI: 1.1–4.08, p = 0.02) and diabetes mellitus (OR 1.68, CI: 1.04–2.72, p = 0.034) were all predictors for vaccination on exclusion of the strongest two predictors. For successive yearly vaccination, influenza vaccine recommendation by healthcare professionals (OR 12.35, CI: 4.5–33.91, p < 0.001) and vaccination reminders (OR 5.99, CI: 3.13–11.45, p < 0.01) were main predictors. Congestive cardiac failure (OR 2.37, CI: 1.20–4.7, p = 0.13) and nursing home residence (OR 7.07, CI: 1.45–34.5, p = 0,005) were also positive predictors. Male gender was a negative predictor (OR 0.51, CI: 0.31–0.83, p = 0.006). Some of those who did not vaccinate were unaware of such need (40.5% of community and 15.6% of hospitalised patients).
 Conclusions: Just under half of the patient population received the IV during 2012–2013 period. Hospitalized patients are more likely to vaccinate regularly while a large proportion of community patients are unaware of the indication to vaccinate.

Predictors of yearly influenza vaccination in hospitalized and community based patients

BackgroundUnderstanding positive and negative influences on adult immunization status can help healthcare providers to better identify and target patients who are likely to need immunization. Our aim was to assess and compare influenza and pneumococcal (IV/PV) immunisation rates to identify vaccination predictors in Malta.MethodOne group consisted of all medical patients discharged from Mater Dei Hospital (MDH) over a one week period in February 2013. Patients were administered a phone questionnaire. A second group of patients receiving community-based care at local health centres over a one week period in March 2013 were interviewed, identifying vaccination eligibility as per 2010 WHO recommendations.ResultsA total of 150 community (Mean age 61.5 SD 15.8, Male 60%) and 149 hospitalised (Mean age 66.8, SD 13.6%, Male 48.3%) patients in whom influenza vaccine was indicated were recruited. In the current year, 44 and 48.3% received the seasonal influenza vaccine, while 32.0, and 49% vaccinated yearly respectively. Pneumococcal vaccination advice was less than 5% in both groups. On stepwise binary regression, vaccination predictors for the current year were regular yearly influenza vaccination (OR 93.62, CI: 31.8–275.5, p < 0.001) and vaccination reminders (OR 27.5, CI: 9.63–78.31, p < 0.001). Nursing home residence (OR 5.78, CI: 1.22–27.4,p = 0.011), congestive cardiac failure (OR 2.11, CI: 1.1–4.08, p = 0.02) and diabetes mellitus (OR 1.68, CI: 1.04–2.72, p = 0.034) were all predictors for vaccination on exclusion of the strongest two predictors. For successive yearly vaccination, influenza vaccine recommendation by healthcare professionals (OR 12.35, CI: 4.5–33.91, p < 0.001) and vaccination reminders (OR 5.99, CI: 3.13–11.45, p < 0.01) were main predictors. Congestive cardiac failure (OR 2.37, CI: 1.20–4.7, p = 0.13) and nursing home residence (OR 7.07, CI: 1.45–34.5, p = 0,005) were also positive predictors. Male gender was a negative predictor (OR 0.51, CI: 0.31–0.83, p = 0.006). Some of those who did not vaccinate were unaware of such need (40.5% of community and 15.6% of hospitalised patients).ConclusionsJust under half of the patient population received the IV during 2012–2013 period. Hospitalized patients are more likely to vaccinate regularly while a large proportion of community patients are unaware of the indication to vaccinate.

Receipt and effectiveness of influenza vaccination reminders for adults, 2011-2012 season, United States.

BackgroundReminders for influenza vaccination improve influenza vaccination coverage. The purpose of this study was to describe the receipt of reminders for influenza vaccination during the 2011‐12 influenza season among US adults.MethodsWe analyzed data from the March 2012 National Flu Survey (NFS), a random digit dial telephone survey of adults in the United States. Relative to July 1, 2011, respondents were asked whether they received a reminder for influenza vaccination and the source and type of reminder they received. The association between reminder receipt and demographic variables, and the association between influenza vaccination coverage and receipt of reminders were also examined.ResultsOf adults interviewed, 17.2% reported receiving a reminder since July 1, 2011. More than half (65.2%) of the reminders were sent by doctor offices. Hispanics and non‐Hispanic blacks were more likely than non‐Hispanic whites to report receiving a reminder. Adults who reported having a usual healthcare provider, health insurance, or a high‐risk condition were more likely to report receiving reminders than the respective reference group. Adults reporting receipt of reminders were 1.15 times more likely (adjusted prevalence ratio, 95% CI: 1.06‐1.25) to report being vaccinated for influenza than adults reporting not receiving reminders.ConclusionsDifferences exist in receipt of influenza vaccination reminders among adults. Reminders are important tools to improve adult influenza vaccination coverage. Greater use of reminders may lead to higher rates of adult influenza vaccination coverage and reductions in influenza‐related morbidity.

Text4baby Influenza Messaging and Influenza Vaccination Among Pregnant Women

IntroductionPregnant women are at risk for severe influenza-related complications; however, only 52% reported receiving an influenza vaccination during the 2013–2014 influenza season. Text4baby, a free national text service, provides influenza vaccination education and reminders to pregnant women. This study examined reported influenza vaccination during pregnancy among Text4baby participants who reported receiving influenza messages and women who reported never participating in Text4baby.MethodsOpt-in Internet Panel Surveys (April 2013 and 2014) of pregnant women collected demographic and other characteristics; influenza vaccination knowledge, attitudes, and behaviors; and Text4baby participation. Women aged 18–49 years, pregnant anytime from October to January (N=3,321) were included. Text4baby influenza message recallers reported receiving Text4baby influenza messages during their current/most recent pregnancy (n=377). Text4baby non-participants reported never receiving Text4baby messages (n=2,824). Multivariable logistic regression was performed (2014–2016) controlling for demographic and other characteristics, high-risk conditions, and provider recommendation and offer to vaccinate. Adjusted prevalence ratios (APRs) were calculated. Random sampling was assumed for this non-probability sample.ResultsText4baby recallers were more likely than non-participants to report influenza vaccination regardless of receipt of provider recommendation and/or offer to vaccinate (provider recommendation/ offer APR=1.29, 95% CI=1.21, 1.37, provider recommendation/no offer APR=1.52, 95% CI=1.07, 2.17). Among women receiving neither a provider recommendation nor offer to vaccinate, Text4baby recallers were more than three times as likely to report influenza vaccination compared with non-participants (APR=3.39, 95% CI=2.03, 5.67).ConclusionsText4baby status was associated with higher influenza vaccination, especially among women whose provider did not recommend or offer the vaccine. Encouraging Text4baby enrollment may help ensure influenza vaccination is given to protect mothers and infants.

The impacts of email reminder/recall on adolescent influenza vaccination

BackgroundWe sought to: (1) explore the feasibility of using email for seasonal influenza vaccination reminders to parents of adolescents and (2) assess influenza vaccination rates among adolescents whose parents were randomized to either receive or not receive email reminders. MethodsEmail addresses were obtained for parents of patients 10–18years from 4 practices in Michigan. Addresses were randomized to either receive email reminders, or not. Reminder messages were sent during October 2012-March 2013 (Season 1) and October 2013-March 2014 (Season 2). Vaccination status was determined 60days following the last email reminder for each season using the statewide Michigan Care Improvement Registry (MCIR); per protocol bivariate and multivariate logistic regression analyses were conducted to evaluate reminder notification. ResultsAfter email cleaning, testing, and matching with MCIR, approximately half of email addresses (2348 of 5312 in Season 1; 3457 of 6549 in Season 2) were randomized. Bivariate analyses found that influenza vaccination within 60days after notification date was similar among those notified (34%) versus not notified (29%) in both Season 1 (p=0.06) and Season 2 (39% vs. 37%, p=0.20). However, multivariate models adjusted for season, site, and receipt of notification in two seasons found a higher likelihood of influenza vaccination among children that received notification (aOR=1.28, 95% CI=1.09, 1.51); in addition, differences in influenza vaccination were also observed between practice sites (range: p=0.15 to p<0.001). ConclusionsWe found that practice-based email influenza vaccine reminders to parents of adolescents are feasible, but not without complications. Our study demonstrates that email reminders from practices can yield increases in influenza vaccination rates among adolescents. Practices should consider email as an option for influenza reminders and establish business practices for collecting and maintaining patient email addresses.This study is registered at www.ClinicalTrials.gov id #NCT01732315.

Text messaging reminders for influenza vaccine in primary care: a cluster randomised controlled trial (TXT4FLUJAB)

Objectives(1) To develop methods for conducting cluster randomised trials of text messaging interventions utilising routine electronic health records at low cost; (2) to assess the effectiveness of text messaging influenza...

Impacting delayed pediatric influenza vaccination: a randomized controlled trial of text message reminders.

Influenza vaccination coverage is low, especially among low-income populations. Most doses are generally administered early in the influenza season, yet sustained vaccination efforts are crucial for achieving optimal coverage. The impact of text message influenza vaccination reminders was recently demonstrated in a low-income population. Little is known about their effect on children with delayed influenza vaccination or the most effective message type. To determine the impact of educational plus interactive text message reminders on influenza vaccination of urban low-income children unvaccinated by late fall. Randomized controlled trial. Parents of 5,462 children aged 6 months-17 years from four academically affiliated pediatric clinics who were unvaccinated by mid-November 2011. Eligible parents were stratified by their child's age and pediatric clinic site and randomized using a 1:1:1 allocation to educational plus interactive text message reminders, educational-only text message reminders, or usual care. Using an immunization registry-linked text messaging system, parents of intervention children received up to seven weekly text message reminders. One of the messages sent to parents in the educational plus interactive text message arm allowed selection of more information about influenza and influenza vaccination. Influenza vaccination by March 31, 2012. Data were collected and analyzed between 2012 and 2014. Most children were publicly insured and Spanish speaking. Baseline demographics were similar between groups. More children of parents in the educational plus interactive text message arm were vaccinated (38.5%) versus those in the educational-only text message (35.3%; difference=3.3%, 95% CI=0.02%, 6.5%; relative risk ratio (RRR)=1.09, 95% CI=1.002, 1.19) and usual care (34.8%; difference=3.8%, 95% CI=0.6%, 7.0%; RRR=1.11, 95% CI=1.02-1.21) arms. Text message reminders with embedded educational information and options for interactivity have a small positive effect on influenza vaccination of urban, low-income, minority children who remain unvaccinated by late fall.

Issuance of patient reminders for influenza vaccination by US-based primary care physicians during the first year of universal influenza vaccination recommendations.

To estimate the number of physician-reported influenza vaccination reminders during the 2010-2011 influenza season, the first influenza season after universal vaccination recommendations for influenza were introduced, we interviewed 493 members of the Physicians Consulting Network. Patient vaccination reminders are a highly effective means of increasing influenza vaccination; nonetheless, only one quarter of the primary care physicians interviewed issued influenza vaccination reminders during the first year of universal vaccination recommendations, highlighting the need to improve office-based promotion of influenza vaccination.

Notes from the Field: Planting, Nurturing, and Watching Things Grow

Editors' Note: We invited a sample of AJPM's Editorial Board, supplement guest editors, and longtime colleagues and contributors to share their experiences and impressions of the impact of AJPM on their respective domains. We were particularly fond of Ken Powell's analogy to being "tenders of the planted seed"--as planters, weeders, and harvesters--watching and nurturing the growth of AJPM, and have elected to lead with his commentary.

Statewide Pandemic Influenza Vaccination Reminders for Children with Chronic Conditions

We evaluated the use of a statewide immunization information system (IIS) to target influenza vaccine reminders to high-risk children during a pandemic. We used Michigan's IIS to identify high-risk children (i.e., those with ≥ 1 chronic condition) aged 6 months to 18 years with no record of pH1N1 vaccination among children currently or previously enrolled in Medicaid (n = 202,133). Reminders were mailed on December 7, 2009. We retrospectively assessed children's eligibility for evaluation and compared influenza vaccination rates across 3 groups on the basis of their high-risk and reminder status. Of the children sent reminders, 53,516 were ineligible. Of the remaining 148,617 children, vaccination rates were higher among the 142,383 high-risk children receiving reminders than among the 6234 high-risk children with undeliverable reminders and the 142,383 control group children without chronic conditions who were not sent reminders. Midseason reminders to parents of unvaccinated high-risk children with current or past Medicaid enrollment were associated with increased pH1N1 and seasonal influenza vaccination rates. Future initiatives should consider strategies to expand targeting of high-risk groups and improve IIS reporting during pandemic events.

Using Medicaid Claims to Identify Children With Asthma

To assess the accuracy of using administrative data from state-managed programs to identify children with asthma in a statewide immunization information system. We wished to understand the degree to which alternative asthma case definitions applied to administrative data influence the accuracy of cases identified in an immunization information system. Children aged 2 to 18 years were sequentially classified into 3-case definition groups on the basis of Michigan Department of Community Health administrative data (2005-2006): (1) children with a Children's Special Health Care Services (CSHCS) Program qualifying diagnosis of asthma (CSHCS cases); (2) those having 1 or more asthma medication claims (Rx cases); or (3) those without asthma medications having 1 or more health services claim reporting an asthma diagnosis code (Dx cases). Children were randomly selected from each asthma case definition group; parents were invited to participate in a telephone interview to document physician diagnosis of asthma, symptoms, activity limitations, medications, and asthma health services use. The positive predictive value of parent report of a physician diagnosis of asthma; asthma severity, based on National Asthma Education and Prevention Program criteria. : Of 440 completed interviews, 89% of parents confirmed the child's high-risk status, reporting physician diagnosis of asthma (83%), wheezy-cough (5%), or reactive airway disease (1%). The positive predictive value varied for CSHCS cases (100%), Rx cases (91%) and Dx cases (73%, P < .0001). Although reported asthma severity levels were similar among CSHCS and Rx cases (P = .9100), asthma severity was lower among Dx cases (P = .0218). Medicaid administrative data can be used to accurately identify children with asthma and represents a feasible approach for Medicaid programs and health plans to identify priority groups for targeted influenza vaccination reminders.

Seasonal Influenza Vaccination Reminders for Children with High-Risk Conditions: A Registry-Based Randomized Trial

Children with chronic conditions have an increased risk of complications from influenza and have low influenza vaccination rates. To assess the feasibility and effectiveness of using a statewide immunization information system (IIS) for seasonal influenza vaccine reminders from local health departments (LHDs) targeting children with high-risk conditions. A randomized community intervention. The study was conducted in a population of 3618 children aged 24-60 months with a high-risk condition residing in three Michigan counties. Children were identified using a statewide IIS in October 2008. Children were randomized to intervention (reminder) or control (no reminder) groups. Reminders for seasonal influenza vaccination were mailed by LHDs in November 2008. Feasibility of notification (address validity, address deliverability) was assessed (November 2008-February 2009), and frequencies of notification feasibility measures were determined (analyses conducted in 2010). Effectiveness of notification (seasonal influenza vaccine receipt) was assessed using bivariate logistic regression. Among 3618 children with a high-risk condition, 2730 (75.5%) had not received a 2008-2009 influenza vaccination and were eligible at the time of notification. Among children assigned to the reminder group (n=1374), 42.6% had an address determined to be either invalid, undeliverable, or both. Among those with valid addresses (n=2001), a greater percentage of children with deliverable reminders received at least one influenza vaccination (30.8%) during the outcome observation period than did children assigned to no reminder (24.3%, OR=1.39, 95% CI=1.13, 1.72); children with an undeliverable reminder had an influenza vaccination rate (22.8%) similar to children assigned to no reminder. Receipt of a reminder was positively associated with seasonal influenza vaccination. However, more than 40% of children assigned to receive a reminder were determined to have an invalid or undeliverable address, emphasizing the need for increased quality of IIS contact information. This study is registered at www.ClinicalTrials.gov NCT01431183.

Late-Season Influenza Vaccination: A National Survey of Physician Practice and Barriers

Although late-season influenza vaccination has been recently promoted, existing data suggest it occurs infrequently.This study aims to describe among primary care physicians: (1) late-season vaccination practices; (2) perceived barriers; and (3) factors associated with late-season influenza vaccination in a year when vaccine supplies are inadequate or delayed.A survey administered March 2007-June 2007 to 1268 primary care providers in a national survey network. Data analysis was completed in 2009.Overall response rate was 74% (n=940). Seventy-one percent of respondents reported vaccinating until February/March when there were adequate vaccine supplies and 84% reported vaccinating until February/March when vaccine supplies were inadequate or delayed. Perceived barriers to late-season vaccination included difficulty administering a second dose in children if the first was given late in the season (91% of respondents); providers/patients forgetting about vaccination (77%); and concern about having unused vaccine left at the end of a season (74%). Physicians who reported vaccinating into February/March when vaccine supplies were inadequate or delayed more often reported believing late-season vaccination is clinically beneficial, experiencing difficulty persuading patients to accept late-season vaccination, forgetting about the need for vaccination, not being able to meet demand for influenza vaccine and experiencing high patient volumes during winter months.Most physicians appear willing to perform late-season vaccination despite existing data demonstrating that it occurs infrequently. Efforts to increase late-season vaccination should address vaccine supply issues, late-season influenza vaccine reminders, and patient and provider education on its clinical benefits.

The Scope and Targeting of Influenza Vaccination Reminders Among US Adults: Evidence From a Nationally Representative Survey

We analyzed data from a nationally representative survey of US adults 18 years and older fielded by Knowledge Networks (Menlo Park, California) between March 4 and April 7, 2009.

Improving clinical quality indicators through electronic health records: it takes more than just a reminder.

Improving clinical quality indicators through electronic health records: it takes more than just a reminder.

Compliance with influenza vaccination. Its relation with epidemiologic and sociopsychological factors.

To identify patient characteristics that are associated with compliance with influenza vaccination reminders in high-risk patients. Registration of the vaccination of high-risk patients invited by their family physicians. Factors that might be associated with compliance were evaluated, eg, sex, age, insurance, diagnosis, seriousness, and multiple indications. A questionnaire about sociopsychological factors was sent to all noncompliant patients and a random sample of 25% of compliant patients. Four single and 3 partnership practices with 2142 high-risk patients in a total of 26,000 patients in the Netherlands. (1) Compliance by at-risk group; odds ratios (ORs) for epidemiologic and diagnosis-based factors, adjusted by multiple logistic regression analysis; (2) adjusted ORs (adj ORs) for sociopsychological factors; and (3) decisive reason whether to comply. Compliance was 86% (95% confidence interval [CI], 85%-88%), with little difference between at-risk groups. The epidemiologic factors age older than 50 years (adj OR, 1.9; 95% CI, 1.5-2.5) and multiple indication (adj OR, 2.2; 95% CI, 1.3-3.6) were related to compliance, independent of at-risk group. Belief in the absence of side effects (adj OR, 10.5; 95% CI, 5.5-20.2) and in the efficacy of the vaccine (adj OR, 5.6; 95% CI, 3.0-10.2) were most positively associated with compliance. Perceived susceptibility to influenza also was associated (adj OR, 2.9; 95% CI, 1.5-5.8), but perception of one's health was not. There was a negative association of compliance in the interaction of age younger than 50 years and disbelief in the possible complications of influenza (adj OR, 0.2; 95% CI, 0.0-0.5). These factors and the family physician's invitation were decisive. Information about the protection and the side effects of vaccination and the complications of influenza should be directed to patients younger than 50 years; no specific high-risk groups require special information.