Offered Influenza Vaccination Research Articles

Impact of Actively Offering Influenza Vaccination to Frail People during Hospitalisation: A Pilot Study in Italy.

Despite the worldwide recommendations for influenza immunisation, vaccination coverage for patients exposed to the highest risk of severe complications is still far from the optimal target. The need to take advantage of alternative methods to provide vaccination is essential. This study presents a hospital-based strategy which offers influenza vaccination to inpatients at discharge. This study was conducted during the 2022-2023 influenza season at the University Hospital of Palermo. A questionnaire was administered to identify the determinants for the acceptance of influenza vaccination in the frail population. Overall, 248 hospitalised patients were enrolled, of which 56.1% were female and 52.0% were over 65 years of age. The proportion of patients vaccinated against influenza during hospitalisation was 62.5%, an increase of 16% in influenza vaccination uptake among frail people in comparison with the previous influenza season (46.8% vaccinated during the 2021-22 influenza season). Factors significantly associated with vaccination acceptance were the following: to have received influenza vaccine advice from hospital healthcare workers (OR = 3.57, p = 0.001), to have been previously vaccinated for influenza (OR = 3.16 p = 0.005), and to have had a low level of education (OR = 3.56, p = 0.014). This study showed that offering influenza vaccination to hospitalised patients could be an effective strategy to increase vaccination coverage in the most vulnerable population, and these findings could be useful for planning and improving future influenza vaccination campaigns.

Receipt of COVID-19 and seasonal influenza vaccines in California (USA) during the 2021-2022 influenza season.

Despite lower circulation of influenza virus throughout 2020-2022 during the COVID-19 pandemic, seasonal influenza vaccination has remained a primary tool to reduce influenza-associated illness and death. The relationship between the decision to receive a COVID-19 vaccine and/or an influenza vaccine is not well understood. We assessed predictors of receipt of 2021-2022 influenza vaccine in a secondary analysis of data from a case-control study enrolling individuals who received SARS-CoV-2 testing. We used mixed effects logistic regression to estimate factors associated with receipt of seasonal influenza vaccine. We also constructed multinomial adjusted marginal probability models of being vaccinated for COVID-19 only, seasonal influenza only, or both as compared with receipt of neither vaccination. Among 1261 eligible participants recruited between 22 October 2021-22 June 2022, 43% (545) were vaccinated with both seasonal influenza vaccine and >1 dose of a COVID-19 vaccine, 34% (426) received >1 dose of a COVID-19 vaccine only, 4% (49) received seasonal influenza vaccine only, and 19% (241) received neither vaccine. Receipt of >1 COVID-19 vaccine dose was associated with seasonal influenza vaccination (adjusted odds ratio [aOR]: 3.72; 95% confidence interval [CI]: 2.15-6.43); this association was stronger among participants receiving >1 COVID-19 booster dose (aOR = 16.50 [10.10-26.97]). Compared with participants testing negative for SARS- CoV-2 infection, participants testing positive had lower odds of receipt of 2021-2022 seasonal influenza vaccine (aOR = 0.64 [0.50-0.82]). Recipients of a COVID-19 vaccine were more likely to receive seasonal influenza vaccine during the 2021-2022 season. Factors associated with individuals' likelihood of receiving COVID-19 and seasonal influenza vaccines will be important to account for in future studies of vaccine effectiveness against both conditions. Participants who tested positive for SARS-CoV-2 in our sample were less likely to have received seasonal influenza vaccine, suggesting an opportunity to offer influenza vaccination before or after a COVID-19 diagnosis.

“Every interaction you have …should be an opportunity to discuss and offer influenza vaccination”. Health service perspectives on influenza vaccination promotion and delivery to Aboriginal families living in New South Wales, Australia

IntroductionThere is little research to understand reasons for suboptimal influenza vaccination uptake among Aboriginal people of different ages in Australia. This study aimed to better understand the communication needs and preferences of Aboriginal families (Phase 2) in New South Wales, Australia, and their health service providers (Phase 1), to inform future interventions to improve influenza immunisation coverage in Aboriginal communities. This paper reports from Phase 1 of the study. Material and methodsAboriginal and non-Aboriginal researchers designed and conducted the study, with cultural governance provided by Aboriginal health care professionals and other community members working within health departments or community healthcare settings across Australia. In Phase 1 we conducted interviews and focus groups with 18 Aboriginal immunisation providers and mainstream immunisation co-ordinators from three geographic areas in New South Wales. We used group-based thematic analysis with a cultural lens and sought participants’ feedback prior to finalising results. ResultsWe identified four themes, framed as opportunities for improvement: better supporting Aboriginal Medical Services as providers of influenza vaccinations; improving the accessibility and appropriateness of mainstream services for Aboriginal families; improving health providers’ knowledge of Aboriginal people’ influenza risk and their willingness to recommend vaccination; and engaging communities to design influenza vaccination resources. ConclusionsTo achieve optimal influenza vaccination coverage, all health services must take responsibility for providing culturally responsive clinical care to Aboriginal families. We suggest that, where possible, mainstream services incorporate elements of the family-centred and broader model of health used by Aboriginal Medical Services. This includes creating a welcoming environment, appropriately identifying and getting to know Aboriginal patients, taking a preventative approach, and opportunistically offering and strongly encouraging influenza vaccination to the individual and their family.

Effectiveness of an intervention to overcome influenza vaccine hesitancy in specialty clinic patients.

Background:Individuals on immunosuppressive therapies experience greater morbidity and mortality due to vaccine-preventable illnesses, but there are low rates of adherence to immunization guidelines within this population.Objective:To determine the effectiveness of clinician-led education, patient-centered dialogue, and immediately available immunization on influenza vaccination uptake in patients taking immunosuppressive therapies.Method:We used a controlled before-and-after quasi-experimental design to evaluate our quality improvement intervention occurring from September 2019 to March 2020, with follow-up through July 2020. The study included 2 dermatology practices wherein nursing staff offered influenza vaccination during patient rooming (standard care). Within each practice, clinicians either implemented the intervention or provided only standard care. Patients received the intervention or standard care depending on the clinician they visited. Patients seen at the 2 clinics during the intervention period were included in analyses if they were taking or newly prescribed immunosuppressant medication at the time of their visit. We examined influenza immunization status for 3 flu seasons: 2017–2018 (preintervention), 2018–2019 (preintervention), and 2019–2020 (intervention).Intervention:Immunosuppressed patients initially declining an influenza vaccine were provided dermatologist-led education on the benefits of immunization. Dermatologists explored and addressed individual patients’ immunization concerns. Influenza vaccination was then offered immediately postdialogue.Results:Analyses included 201 dermatology patients who were prescribed or currently taking immunosuppressive medication (intervention group [72.6%], comparison group [27.4%]). During the intervention period, 91.1% of the intervention group received influenza vaccination compared to 56.4% of the comparison group. Vaccination trends from 2018–2019 (preintervention) to 2019–2020 (intervention) differed significantly between groups (χ2 = 22.92, P < .001), with greater improvement in the intervention group. In 2019–2020, influenza vaccination was more likely in the intervention group relative to the comparison group (odds ratio: 16.22, 95% confidence interval: 5.55–47.38). In the subset of patients that had never received an influenza vaccine, influenza immunization in 2019–2020 was more common in the intervention group (75.8%, 25/33) relative to the comparison group (13.3%, 2/15, P < .001).Conclusion:The intervention successfully addressed vaccine hesitancy and improved influenza immunization rates in an immunosuppressed population receiving care from a specialty clinic. Implementing a similar model across specialty clinics may improve vaccination rates for influenza, coronavirus disease 2019, and other vaccine-preventable illnesses in other populations.

Health Literacy, Socioeconomic Status and Vaccination Uptake: A Study on Influenza Vaccination in a Population-Based Sample.

Background: Health Literacy (HL) has been recently hypothesized to affect the relationship between socio-economic status (SES) and health conditions. However, to date no study has yet assessed the potential contribution of HL in the pathway through which SES affects influenza vaccination status. We aim to examine the relationships among HL, SES factors, and influenza vaccination uptake in Tuscan (Italy) residents belonging to different high-risk groups (HRGs) for influenza. Methods: The study was performed within the Tuscan population sample selected in the Italian Behavioral Risk Factor Surveillance System in 2017–2018. HL was assessed using the Italian version of the 6-items European Health Literacy Survey Questionnaire (HLS-EU-Q6). Mediation analyses were conducted using SES variables as independent variables, influenza vaccination status as dependent variable and HL as mediator variable. Results: A total of 3278 people belonged to HRGs for influenza. In the whole sample, 19.4% of the participants were vaccinated against influenza. Participants who were not employed or had a poor financial status were more likely to be vaccinated against influenza (OR 1.56, 95%CI 1.26–1.94, p < 0.001, and OR 1.21, 95%CI 1.00–1.48, p = 0.047 respectively). HL did not mediate the relationship of any of the independent variables with influenza vaccination status. Conclusions: Some SES determinants resulted to influence influenza vaccination uptake, while HL did not affect the likelihood of influenza vaccination uptake among HRGs. Universal health care systems, as in the case of Italy, offering influenza vaccination free of charge to HRGs help in reducing inequalities and mitigating HL demands.

1384. Practice Variations in Pre-Hematopoietic Stem Cell Transplantation Infectious Disease Evaluation

BackgroundHematopoietic stem cell transplantation (HCT), and other forms of cellular therapies such as chimeric antigen receptor T cell therapy (CAR-T), while of critical therapeutic value, confers significant, long-term risk of infectious complications. Recipients would benefit from evaluation by infectious disease (ID) specialists. However, amidst many existing guidelines from ID and oncology societies, pre-transplant ID evaluation and management practices vary across US institutions. To better understand these variations and identify targets for standardization, we conducted a survey of ID and oncology providers at transplant centers in the US.MethodsA 38-question, anonymous, voluntary, online survey was distributed via Google Forms to a professional organization e-mail list of ID providers as well as to followers of relevant Twitter accounts. Responses were collected and analyzed.ResultsA total of 51 responses were received, the majority of which (68.6%) came from ID providers. 60.8% of respondents worked at healthcare facilities with over 500 beds. 43 respondents (84.3%) reported that their center performed autologous and allogeneic HCT as well as CAR-T. 56.8% of CAR-T centers use a standardized template, compared to 70.8% of those providing HCT. For allogeneic HCT centers, 8% reported that no ID evaluation is offered; 34% reported that it is offered “sometimes.” Practices varied for treatment of latent tuberculosis infection prior to HCT: 26.5% treat “All the time;” 10.2% treat “Very rarely.” In assessing risk factors, only 63% and 54% identified HIV infection and healthcare occupation, respectively, as epidemiologic risk factors for tuberculosis infection. 59.2% answered that < 10% of patients are screened for Strongyloides. Only 5 respondents reported universal Strongyloides screening prior to transplant. COVID-19 vaccination for family is recommended “Always” by 95.5% of respondents. 25% have offered influenza vaccination to family through the transplant clinic.Table 1 Differences in ID evaluation practices by type of cellular therapy candidate.Table 2 Characteristics of survey respondents.ConclusionPractices around pre-HCT infectious disease evaluation and management are heterogenous among the centers surveyed. The adoption of standardized screening for and management of infectious diseases in this patient population would likely be beneficial.Disclosures All Authors: No reported disclosures

Population Mortality and Laws Encouraging Influenza Vaccination for Hospital Workers.

Since 1995, 14 states have passed laws encouraging or mandating influenza vaccination for hospital workers. Although the Centers for Disease Control and Prevention recommends vaccinating health care workers to reduce disease transmission and patient risk, the effect of these laws on pneumonia and influenza mortality is unknown. To measure the effect of state-level hospital worker influenza vaccination laws on pneumonia and influenza mortality. Quasi-experimental observational study. United States. Population of all states from 1995 to 2017. State adoption of a law promoting influenza vaccination for hospital workers. Pneumonia and influenza mortality per 100 000 persons by state and by month, both population-wide and separately by age group, obtained from restricted-access National Vital Statistics System files. Linear and log-linear models were used to compare changes in mortality rates for adopting versus nonadopting states. Implementation of state laws requiring hospitals to offer influenza vaccination to their employees was associated with a 2.5% reduction in the monthly pneumonia and influenza mortality rate (-0.16 deaths per 100 000 persons [95% CI, -0.29 to -0.02]; P = 0.022) during the years when the vaccine was well matched to the circulating strains. The largest effects occurred among elderly persons and during peak influenza months. Utilization of large-scale national data precluded analysis of more specific outcomes, such as laboratory-confirmed or hospital-acquired influenza. State laws promoting hospital worker vaccination against influenza may be effective in preventing pneumonia- and influenza-related deaths, particularly among elderly persons. Vaccinating hospital workers may substantially reduce the spread of influenza and protect the most vulnerable populations. None.

1403. The Pediatric Emergency Room as a Promising Setting for Receiving the Flu Shot

BackgroundChildren are the most likely population to get influenza, and are two times more likely compared to adults aged 65 and greater (attack rate by age group: 0-17 yo 9.3%, 18-74 yo 8.8%, 65 + 3.9%). Additionally, children are at high risk of suffering complications from influenza. According to the CDC, the overall effectiveness of the 2018-2019 flu vaccine for both strains A and B was 48% in children aged 6m-8 years and 7% in children aged 9- 17 years. Currently our Pediatric Emergency Department (PED) does not routinely offer influenza vaccine to unvaccinated patients. Our project goals are to identify barriers to the administration of influenza vaccine in the PED and to offer and administer influenza vaccine to eligible patients.MethodsAfter performing root cause analysis with key stakeholders, the first countermeasure implemented in a Plan-Do-Study Act (PDSA) cycle was the development of a screening form including eligibility criteria, history of influenza vaccine, consent for vaccine or reason for declining vaccine. The screening form was administered by resident physicians in our PED from October to November who then went on to order the vaccine for eligible patients who consented. Primary outcome measures included number of patients screened per month, percent of patients who desired the vaccine, and the percent of patients who received the vaccine in the ED during their visit. Secondary outcome measures included length of PED stay.ResultsPreliminary results show that 75% (42/56,CI: 62%-86%) of children screened in the PED between October and November were eligible for the influenza vaccine. Of those eligible, 59% (29/42, CI: 43%-74%) received the vaccine. The average length of stay was comparable between those that received influenza vaccine and those that did not (p value 0.4756).ConclusionA subset of eligible patients are now being offered and receiving the flu shot in our PED. Over half of eligible patients received the influenza vaccine, demonstrating that a resident administered screening form has been a successful countermeasure for increasing vaccine rates. Future PDSA cycles will focus on further increasing the number of patients screened and capturing patients who consented but did not receive vaccine.Disclosures All Authors: No reported disclosures

Maternal influenza vaccination: Making it a priority

Background: Due to physiological and immunological changes, pregnant women are particularly susceptible to some infections (e.g. influenza). Infants (<6 months) can’t be vaccinated against influenza and their underdeveloped immune systems confer vulnerability to infection, they are therefore reliant on maternal antibodies (passed from the mother) for protection. Vaccination against influenza during pregnancy is recommended by national and international regulatory bodies worldwide, including the World Health Organization. Despite the known potential adverse outcomes of influenza during pregnancy, the rate of influenza vaccination uptake is suboptimal. Methods and materials: We reviewed available literature to understand the benefits and risks of vaccinating pregnant women against influenza. We examined the barriers to influenza vaccination uptake during pregnancy and propose solutions to overcome these. Results: It is estimated that influenza affects 11% of women during pregnancy and the risk of severe outcomes requiring hospitalisation are higher compared with non-pregnant women. Influenza during pregnancy may also have negative consequences for the foetus, including pre-term birth and, in the worst cases, mortality. Influenza can be severe in infants (<6 months) and may also result in hospitalisation and death. There is a large body of evidence supporting the effectiveness and safety of influenza immunisation of pregnant women and their foetuses, however national and international recommendations alone aren’t enough to achieve optimal rates of vaccination in this group. Several barriers to vaccination of pregnant women against influenza exist, originating from vaccine manufacturers, healthcare professionals (HCPs), pregnant women or the wider society. HCPs may not be offering influenza vaccination and pregnant women themselves may be unaware of the benefits it can bring. Solutions to these issues include improved regulatory processes, sensitisation of HCPs to the benefits of influenza vaccination in pregnant women and implementation of multichannel campaigns encompassing community and pharmacy awareness, education, social media and more. Conclusion: Influenza infection can be severe in pregnant women and infants. Vaccination of pregnant women has been shown to be effective and well-tolerated but is under prescribed due to a number of factors, including lack of awareness about its benefits. A concerted effort involving multiple stakeholders is needed to increase uptake of influenza vaccine during pregnancy.

Protective effect of influenza vaccination on cardiovascular diseases: a systematic review and meta-analysis

Cardiovascular diseases (CVDs) are among the leading causes of mortality and morbidity worldwide. There are many contrasting ideas on the effectiveness of influenza vaccination on CVDs. This study aimed to investigate the association between influenza vaccination and the risk of CVDs. We systematically searched all PubMed/Medline, EMBASE, and the Cochrane library entries up to November 2019 for studies of influenza vs. the CVDs outcomes. We conducted a random-effects meta‐analysis using the inverse variance method for pooled risk ratios (RR) or odds ratios (OR) and evaluated statistical heterogeneity using the I2 statistic. We identified 17 studies (6 randomized controlled trial [RCT], 5 cohorts, and 6 case–control) with a total of 180,043 cases and 276,898 control participants. The pooled RR of developing CVDs after influenza vaccination in RCT studies was 0.55 (95% CI 0.41–0.73), which was significant (P-value = 0.00). The pooled OR of decreasing CVDs after influenza vaccination in cohort studies was 0.89 (95% CI 0.77–1.04). The pooled OR of developing CVDs after influenza vaccination by pooling case–control studies was 0.70 (95% CI 0.57–0.86, (P-value = 0.00). All of these studies suggest decreased risks of CVDs with influenza vaccination. The current study does support the protective role of influenza vaccination on CVDs events. Health authorities may develop evidence-based preventive strategies to offer influenza vaccination in patients with CVDs.

Influenza vaccination in breast cancer patients during subcutaneous trastuzumab in adjuvant setting

BackgroundDespite the current recommendation for influenza vaccination in cancer patients with active oncological therapy, limited data are available on the efficacy of vaccination in cancer patients receiving targeted therapies. We aimed to investigate the immunogenicity and tolerability of influenza vaccination in breast cancer patients treated with trastuzumab in adjuvant setting.MethodsA prospective open-label multicenter study was performed including patients with breast cancer during trastuzumab treatment in adjuvant setting and healthy controls. Blood samples were taken before, 4 weeks after, and 12 weeks after a single dose of trivalent influenza vaccine containing inactivated A/California/7/2009 (H1N1) pdm09, A/Hongkong4801/2014 (H3N2), and B/Brisbane/60/2008. Levels of serum antibody titers to hemagglutinin for H1N1 and influenza B strains were measured.ResultsTwenty breast cancer patients and 37 controls were included in the study. No difference in seroprotection rate between trastuzumab-treated patients and controls was observed for either H1N1 (100% in both groups) or B strain (78.9% vs. 89.2%, p value = 0.423). A statistically significant increase in geometric mean titers from baseline was seen in both groups and was evident both 4 weeks and 12 weeks after vaccination. Adverse events in the trastuzumab-treated group were uncommon and mild with only one serious adverse event not related to vaccination.ConclusionBreast cancer patients treated with trastuzumab in adjuvant setting seem to benefit from influenza vaccination in terms of immunogenicity without increasing the risk for adverse events. The current data support the recommendation to offer influenza vaccination in breast cancer patients treated with this type of targeted therapy.

Association of State Laws With Influenza Vaccination of Hospital Personnel

Healthcare personnel influenza vaccination can reduce influenza illness and patient mortality. State laws are one tool promoting healthcare personnel influenza vaccination. A 2016 legal assessment in 50 states and Washington DC identified (1) assessment laws: mandating hospitals assess healthcare personnel influenza vaccination status; (2) offer laws: mandating hospitals offer influenza vaccination to healthcare personnel; (3) ensure laws: mandating hospitals require healthcare personnel to demonstrate proof of influenza vaccination; and (4) surgical masking laws: mandating unvaccinated healthcare personnel to wear surgical masks during influenza season. Influenza vaccination was calculated using data reported in 2016 by short-stay acute care hospitals (n=4,370) to the National Healthcare Safety Network. Hierarchical linear modeling in 2018 examined associations between reported vaccination and assessment, offer, or ensure laws at the level of facilities nested within states, among employee and non-employee healthcare personnel and among employees only. Eighteen states had one or more healthcare personnel influenza vaccination-related laws. In the absence of any state laws, facility vaccination mandates were associated with an 11-12 percentage point increase in mean vaccination coverage (p<0.0001). Facility-level mandates were estimated to increase mean influenza vaccination coverage among all healthcare personnel by 4.2 percentage points in states with assessment laws, 6.6 percentage points in states with offer laws, and 3.1 percentage points in states with ensure laws. Results were similar in analyses restricted only to employees although percentage point increases were slightly larger. State laws moderate the effect of facility-level vaccination mandates and may help increase healthcare personnel influenza vaccination coverage in facilities with or without vaccination requirements.

Results from a mobile outreach influenza vaccination program for vulnerable and high‐risk populations in a high‐income setting: lessons learned

ObjectiveThe aim of this pilot project was to assess the feasibility of an outreach mobile influenza vaccination program led by a large hospital network targeting high‐risk and vulnerable populations in a high‐income setting. MethodsKey populations were identified and stakeholders with established access to these populations were engaged. A mobile, nurse‐led immunisation service attended sites where these populations attend and offered influenza vaccine. Data was collected on risk factors for severe disease and past vaccination history. Vaccine type and date of administration were entered onto the Australian Immunisation Registry. ResultsSixteen sites were visited, and 520 influenza vaccines were administered. Of those receiving the vaccine, 61% had received it previously, but only 39% in the past 12 months. A total of 232/520 participants (45%) self‐reported a risk factor for severe disease. ConclusionsAppropriate identification of vulnerable populations, with good engagement of key stakeholders, can successfully deliver vaccines to sections of the population who may struggle to engage with healthcare services even when they are freely available. Implications for public healthTaking vaccines to vulnerable populations is well received and remains an important strategy to maximise uptake, even within high‐income settings with universal access to healthcare.

Intraseason Waning of Influenza Vaccine Effectiveness.

In the United States, it is recommended that healthcare providers offer influenza vaccination by October, if possible. However, if the vaccine's effectiveness soon begins to wane, the optimal time for vaccination may be somewhat later. We examined whether the effectiveness of influenza vaccine wanes during the influenza season with increasing time since vaccination. We identified persons who were vaccinated with inactivated influenza vaccine from 1 September 2010 to 31 March 2017 and who were subsequently tested for influenza and respiratory syncytial virus (RSV) by a polymerase chain reaction test. Test-confirmed influenza was the primary outcome and days-since-vaccination was the predictor of interest in conditional logistic regression. Models were adjusted for age and conditioned on calendar day and geographic area. RSV was used as a negative-control outcome. Compared with persons vaccinated 14 to 41 days prior to being tested, persons vaccinated 42 to 69 days prior to being tested had 1.32 (95% confidence interval [CI], 1.11 to 1.55) times the odds of testing positive for any influenza. The odds ratio (OR) increased linearly by approximately 16% for each additional 28 days since vaccination. The OR was 2.06 (95% CI, 1.69 to 2.51) for persons vaccinated 154 or more days prior to being tested. No evidence of waning was found for RSV. Our results suggest that effectiveness of inactivated influenza vaccine wanes during the course of a single season. These results may lead to reconsideration of the optimal timing of seasonal influenza vaccination.

Cost-effectiveness of Strategies for Offering Influenza Vaccine in the Pediatric Emergency Department: Hart RJ, Stevenson MD, Smith MJ, et al. JAMA Pediatr. 2018;172

Cost-effectiveness of Strategies for Offering Influenza Vaccine in the Pediatric Emergency Department: Hart RJ, Stevenson MD, Smith MJ, et al. JAMA Pediatr. 2018;172

Influenza vaccine availability at urgent care centers in the state of Arizona

We surveyed urgent care centers (UCCs) in the state of Arizona to determine whether they offered the influenza vaccine during the 2016-2017 influenza season. Overall vaccine availability was 80.3% at these facilities. During this season, one-third of the UCCs offered influenza vaccination to children 6 months or older; approximately two-thirds offered influenza vaccination to children and young adults 16 years or older. This is the first study of influenza vaccine availability at UCCs.

Association of provider recommendation and offer and influenza vaccination among adults aged ≥18 years – United States

BackgroundInfluenza vaccination has been recommended for all persons aged ≥6 months since 2010. MethodsData from the 2016 National Internet Flu Survey were analyzed to assess provider vaccination recommendations and early influenza vaccination during the 2016–17 season among adults aged ≥18 years. Predictive marginals from a multivariable logistic regression model were used to identify factors independently associated with early vaccine uptake by provider vaccination recommendation status. ResultsOverall, 24.0% visited a provider who both recommended and offered influenza vaccination, 9.0% visited a provider who only recommended but did not offer, 25.1% visited a provider who neither recommended nor offered, and 41.9% did not visit a doctor from July 1 through date of interview. Adults who reported that a provider both recommended and offered vaccine had significantly higher vaccination coverage (66.6%) compared with those who reported that a provider only recommended but did not offer (48.4%), those who neither received recommendation nor offer (32.0%), and those who did not visit a doctor during the vaccination period (28.8%). Results of multivariable logistic regression indicated that having received a provider recommendation, with or without an offer for vaccination, was significantly associated with higher vaccination coverage after controlling for demographic and access-to-care factors. ConclusionsProvider recommendation was significantly associated with influenza vaccination. However, overall, 67.0% of adults did not visit a doctor during the vaccination period or did visit a doctor but did not receive a provider recommendation. Evidence-based strategies such as client reminder/recall, standing orders, provider reminders, or health systems interventions in combination should be undertaken to improve provider recommendation and influenza vaccination coverage. Other factors significantly associated with a higher level of influenza vaccination included age ≥50 years, being Hispanic, having a college or higher education, having a usual place for medical care, and having public health insurance.

Cost-effectiveness of Different Strategies for Offering Influenza Vaccination in the Pediatric Emergency Department

Cost-effectiveness of Different Strategies for Offering Influenza Vaccination in the Pediatric Emergency Department

Cost-effectiveness of Strategies for Offering Influenza Vaccine in the Pediatric Emergency Department

ImportanceInfluenza is a significant public health burden, causing morbidity and mortality in children, yet vaccination rates remain low. Vaccination in the pediatric emergency department (PED) setting may be beneficial but, to date, has not been proven to be cost-effective.ObjectiveTo compare the cost-effectiveness of 4 strategies for PED-based influenza vaccine: offering vaccine to all patients, only to patients younger than 5 years, only to high-risk patients (all ages), or to no patients.Design, Setting, and ParticipantsUsing commercial decision analysis software, a cost-effectiveness analysis was performed from January 1, 2016, to June 1, 2017, to compare influenza vaccine strategies at a tertiary, urban, freestanding PED with an estimated 60 000 visits per year among a hypothetical cohort of children visiting the above PED during influenza season. Sensitivity analyses estimated the effect of uncertainties across a variety of input variables (eg, influenza prevalence, vaccine price and effectiveness, and costs of complications).Main Outcomes and MeasuresThe primary outcomes were cost and incremental cost-effectiveness ratio in dollars per influenza case averted. Secondary outcomes included total societal costs, hospitalizations and deaths averted, and quality-adjusted life-years gained.ResultsOffering influenza vaccine to all eligible patients has the lowest cost, at $114.45 (95% CI, $55.48-$245.45) per case of influenza averted. This strategy saves $33.51 (95% CI, $18-$62) per case averted compared with no vaccination, and averages 27 fewer cases of influenza per 1000 patients. Offering vaccine to all patients resulted in 0.72 days (95% CI, 0.18-1.78 days) of quality-adjusted life-years lost, whereas offering to none resulted in 0.91 days (95% CI, 0.25-2.2 days) of quality-adjusted life-years lost. In sensitivity analyses, this strategy remains robustly cost-effective across a wide range of assumptions. In addition to being the most cost-effective strategy regardless of age or risk status, routine vaccination in the PED results in a net societal monetary benefit under many circumstances. In Monte Carlo analysis, offering vaccine to all patients was superior to other strategies in at least 99.8% of cases.Conclusions and RelevanceAlthough few PEDs routinely offer influenza vaccination, doing so appears to be cost-effective, with the potential to significantly reduce the economic (and patient) burden of pediatric influenza.

Missed Opportunity: Why Parents Refuse Influenza Vaccination for Their Hospitalized Children.

Hospitals are required to screen and administer the influenza vaccine to all admitted children unless contraindicated or refused by parents, yet vaccination rates remain low. Our goal was to examine reasons for refusal among pediatric patients admitted during influenza season. All children age 6 months to 18 years admitted to 2 network community hospitals from October 1, 2013 to March 31, 2014, without contraindications, were offered influenza vaccination prior to discharge. Parents who refused vaccination were asked their reason for refusal. Chi-square tests and logistic regression were used to determine factors associated with refusing the vaccine in the inpatient setting. Three hundred twenty-five of 786 unique patients admitted during influenza season were eligible for vaccination. Of these, 49.8% refused. Parents of females, whites, and those with private insurance were more likely to refuse vaccination. Patients whose immunization status was otherwise up to date were more likely to accept (Odds Ratio 2.39, 95% Confidence Interval 1.05-5.41). Commonly cited reasons for refusal were: preference to have vaccination by the primary care provider (24.1%), concern for side effects (16.1%), not wanting vaccination (13%), doubt in efficacy (8%), concern that the child was already sick (6.8%), no prior influenza vaccination (6.7%) and feeling that it was not needed (5.6%). Hospitalization during influenza season provides an opportunity for health-care providers to educate families about influenza and vaccinate patients if appropriate. However, nearly half of parents of eligible children declined vaccination. More study is required to determine strategies that can increase influenza vaccination acceptance.