Uptake of funded influenza vaccines in young Australian children in 2018; parental characteristics,information seeking and attitudes

ObjectiveInfants and children under 5-years are at an increased risk of complications from influenza. We aimed to evaluate characteristics associated with uptake of Australian state and territory funded influenza vaccine programs in 2018 for children aged 6-months to 5-years.Materials and methodsA national online survey of 1002 Australian parents with at least one child aged between 6-months and 5-years (response rate 29.9%). A 23-item online questionnaire asked parents about health service use, 2017 and 2018 influenza vaccine uptake, and routine childhood vaccine status for their youngest child. Parents were also asked a range of questions about their demographics, sources of vaccine information, and beliefs and attitudes towards immunisation.ResultsA total of 1002 parents completed the questionnaire and 52.9% of children aged 6-months to 5-years in our sample were immunised against influenza in 2018; representing a significant increase from 2017. Knowing the vaccine was free for their child, and being influenced by a pharmacist increased the likelihood that their child received the influenza vaccine. Not receiving an influenza vaccine recommendation from a health care provider significantly reduced the likelihood of immunisation. Some parents were worried about the safety of the influenza vaccine for their child (36.4%), while 26.5% of parents agreed that you can catch influenza from the vaccine.ConclusionsUptake of influenza vaccine for Australian children aged 6-months to 5-years increased significantly in 2018. Continuing efforts to build parents’ trust in childhood influenza vaccination are still required. Increasing opportunities for health care providers to recommend vaccination will lead to further improvements in uptake for young children.     

Factors associated with uptake of seasonal and pandemic influenza vaccine among clinical risk groups in the UK: an analysis using the General Practice Research Database

Background

Influenza vaccine uptake rates are low compared with uptake rates of many other vaccines. It is unclear how this differs between risk groups in the population and between pandemic and non-pandemic influenza vaccines.

Aim

This study sought to estimate uptake rates of pandemic and seasonal influenza vaccines among clinical risk groups in the UK during the 2009/2010 influenza season and to identify predictors of vaccine uptake in this cohort.

Methods

Uptake rates were calculated using data from the UK General Practice Research Database (GPRD). Predictors of vaccination were identified using a modified Poisson regression with robust standard error estimates.

Results

Uptake of pandemic influenza vaccine in clinical risk groups was 40.3% and uptake of seasonal influenza vaccine was 61.3%. Factors found to be predictive of seasonal and pandemic influenza vaccination included age and the total number of underlying health conditions an individual had. At risk individuals in those age groups in which universal vaccination of the general population was recommended were more likely to have been vaccinated than individuals in age groups in which only clinical risk groups were recommended for vaccination; hence children in clinical risk groups were more likely to receive pandemic than seasonal influenza vaccine. In older people, having a history of Guillain Barré syndrome was associated with a reduced likelihood of receipt of both seasonal (IRR_adj 0.83, CI₉₅ 0.77–0.90) and pandemic influenza vaccines (IRR_adj 0.82, CI₉₅ 0.73–0.92).

Discussion

Uptake of pandemic influenza vaccine was lower than that of seasonal influenza vaccine among those at a clinically high risk of influenza related morbidity. This suggests that vaccination strategies may need to be altered during future pandemics. Recommending universal vaccination within age categories in which there is a large proportion of high risk individuals could be considered as this may result in higher uptake among clinical risk groups.     

Attitudes towards influenza and uptake of the flu vaccine: A survey of pharmacy staff working in English hospitals

ObjectivesPharmacy staff working in hospitals are at risk of contracting and disseminating influenza. Previous research focuses on community pharmacists’ attitudes towards influenza and vaccination. This survey investigates the beliefs and attitudes of pharmacists and other pharmacy staff working in English Hospitals regarding influenza and the vaccine and how this relates to vaccine uptake.MethodsA self-administered survey was provided to pharmacy staff at three hospitals in the East Midlands of England. Job role, age and vaccination status (vaccinated, intended to be vaccinated, and not vaccinated) were collected alongside ratings of agreement with 20 statements regarding influenza and vaccination using a Likert scale.Results170 pharmacy staff responded; 50.6% had been vaccinated, 17.1% intended to be vaccinated and 32.4% were not vaccinated. Increasing age showed a significant (p = 0.017) positive correlation with increased vaccine uptake as did the beliefs that vaccination protects the individual from influenza (p = 0.049) and that vaccination should be mandatory for NHS staff (p = 0.006). Fear of needles and believing their immune system is strong enough to protect against influenza were negatively correlated with vaccine uptake (p = 0.016 and p = 0.010, respectively). Job role was also strongly correlated with vaccine uptake (p = 0.001), with those holding a pharmacy degree more likely to report being vaccinated or intending to be vaccinated compared to all other pharmacy staff groups.ConclusionsThis is the first survey to focus on vaccine behaviours of all pharmacy staff groups working in hospitals. Current uptake of the influenza vaccine may be increased through engagement of senior pharmacy colleagues and providing education on influenza, vaccines, and vaccination. Similar studies should be undertaken on a larger scale to fully interrogate the differences between pharmacy staff groups.     

Understanding Knowledge, Attitudes, and Behaviors Related to Influenza and the Influenza Vaccine in US–Mexico Border Communities

Hispanics are less likely to receive the influenza vaccine compared to other racial and ethnic groups in the US. Hispanic residents of the US–Mexico border region may have differing health beliefs and behaviors, and their cross-border mobility impacts disease control. To assess beliefs and behaviors regarding influenza prevention and control among border populations, surveys were conducted at border clinics. Of 197 respondents, 34 % reported conditions for which vaccination is indicated, and travel to Mexico was common. Few (35 %) believed influenza could make them ‘very sick’, and 76 % believed they should take antibiotics to treat influenza. Influenza vaccine awareness was high, and considered important, but only 36 % reported recent vaccination. The belief that influenza vaccination is ‘very important’ was strongly associated with recent vaccination; “Didn’t think about it” was the most common reason for being un-vaccinated. Misconceptions about influenza risk, prevention and treatment were common in this Hispanic border population; improved educational efforts and reminder systems could impact vaccination behaviors.     

Influenza vaccination: Uptake and associations in a cross-sectional study of children with special risk medical conditions

ObjectiveTo determine uptake of influenza vaccination in children with special risk medical conditions (SRMC) and to explore associations with vaccination.DesignCross-sectional study.Setting/participantsParents of children with a SRMC attending either outpatient department clinics or being an inpatient at the Women’s and Children’s Hospital (WCH), Adelaide, Australia from September 2015 to February 2016 were recruited using convenience sampling.MethodsData were collected using a face-to-face survey. Influenza vaccination was verified with providers. Characteristics associated with uptake were explored using univariable and multivariable analyses.ResultsThere were 410 participants with complete data. Confirmed influenza vaccination at least once in the last two years was 50%, annual uptake was 32.8%. 63.9% of parents were aware of the vaccination recommendation and 57.9% had been recommended by a specialist or general practitioner (GP). Characteristics strongly associated with uptake included: receiving a recommendation from a specialist or GP and having a parent receive the influenza vaccine annually.ConclusionsDespite a long standing funded program, influenza vaccination uptake in children with SRMC is suboptimal. Parental vaccination behaviour, along with medical practitioner recommendation, particularly specialist recommendation, appear to be key influences in facilitating vaccination. Potential interventions could target the family rather than just the individual child. Understanding the barriers to recommendation from the perspective of general medical practitioners and specialists who treat these children is needed.     

Predictors of pneumococcal vaccination among Australian adults at high risk of pneumococcal disease

BackgroundAlthough nearly all Australian children are vaccinated against pneumococcal disease, pneumococcal vaccine uptake is low among high-risk adults. This study aimed to identify perceived barriers to pneumococcal vaccination among high-risk adults.MethodsThis paper reports combined data on pneumococcal vaccination collected from three different online, cross-sectional surveys that were administered in Australia between August 2019 and September 2020. Using Poisson regression, we identified characteristics and beliefs associated with self-reported pneumococcal vaccination among adults aged 65 and over or with chronic health conditions.ResultsThe weighted estimate for pneumococcal vaccine coverage was 24% for high-risk adults under 65 and 53% for adults aged 65 and over. Nearly half of those under 65 reported they had never heard of the pneumococcal vaccine, while 26% of those aged 65 and over had never heard of the vaccine. Among those under 65, pneumococcal vaccination was associated with high perceived disease susceptibility (PR = 1.97, 95% CI: 1.23, 3.18), not having heard of the pneumococcal vaccine (PR = 0.44, 95% CI: 0.28–0.69), awareness that their chronic health condition puts them at increased risk of pneumonia (PR = 2.44, 95% CI: 1.51–3.98), and having a doctor recommend the vaccine (PR = 3.02, 95% CI: 2.05–4.44). Among adults aged 65 and over, self-reported pneumococcal vaccination was associated with influenza vaccination in the previous 12 months (PR = 4.28, 95% CI: 2.85–6.44) and awareness that they are eligible for free pneumococcal vaccination (PR = 5.02, 95% CI: 2.34–10.77).ConclusionAwareness of pneumococcal vaccines was low among adults at high risk of pneumococcal disease, which appears to be contributing to low vaccine uptake. A doctor’s recommendation was associated with increased uptake of pneumococcal vaccine, so interventions should be developed to promote pneumococcal vaccine uptake in GP practices.     

Health benefits, risks, and cost-effectiveness of influenza vaccination of children

We estimated cost-effectiveness of annually vaccinating children not at high risk with inactivated influenza vaccine (IIV) to range from US $12,000 per quality-adjusted life year (QALY) saved for children ages 6-23 months to $119,000 per QALY saved for children ages 12-17 years. For children at high risk (preexisting medical conditions) ages 6-35 months, vaccination with IIV was cost saving. For children at high risk ages 3-17 years, vaccination cost $1,000-$10,000 per QALY. Among children notat high risk ages 5-17 years, live, attenuated influenza vaccine had a similar cost-effectiveness as IIV. Risk status was more important than age in determining the economic effects of annual vaccination, and vaccination was less cost-effective as the child's age increased. Thus, routine vaccination of all children is likely less cost-effective than vaccination of all children ages 6-23 months plus all other children at high risk.     

Prevalence of influenza-specific vaccination hesitancy among adults in the United States, 2018

BackgroundThe role of vaccine hesitancy on influenza vaccination is not clearly understood. Low influenza vaccination coverage in U.S. adults suggests that a multitude of factors may be responsible for under-vaccination or non-vaccination including vaccine hesitancy. Understanding the role of influenza vaccination hesitancy is important for targeted messaging and intervention to increase influenza vaccine confidence and uptake. The objective of this study was to quantify the prevalence of adult influenza vaccination hesitancy (IVH) and examine association of IVH beliefs with sociodemographic factors and early-season influenza vaccination.MethodsA four-question validated IVH module was included in the 2018 National Internet Flu Survey. Weighted proportions and multivariable logistic regression models were used to identify correlates of IVH beliefs.ResultsOverall, 36.9% of adults were hesitant to receive an influenza vaccination; 18.6% expressed concerns about vaccination side effects; 14.8% personally knew someone with serious side effects; and 35.6% reported that their healthcare provider was not the most trusted source of information about influenza vaccinations. Influenza vaccination ranged from 15.3 to 45.2 percentage points lower among adults self-reporting any of the four IVH beliefs. Being female, age 18–49 years, non-Hispanic Black, having high school or lower education, being employed, and not having primary care medical home were associated with hesitancy.ConclusionsAmong the four IVH beliefs studied, being hesitant to receiving influenza vaccination followed by mistrust of healthcare providers were identified as the most influential hesitancy beliefs. Two in five adults in the United States were hesitant to receive an influenza vaccination, and hesitancy was negatively associated with vaccination. This information may assist with targeted interventions, personalized to the individual, to reduce hesitancy and thus improve influenza vaccination acceptance.     

Prevalence and determinants of influenza vaccination in Australians aged 40 years and over--a national survey

OBJECTIVES: To determine influenza vaccination coverage in 2001 in Australian adults aged > or = 40 years, assess awareness of and attitudes to influenza vaccine, factors associated with vaccination, and estimate uptake of free vaccine provided to those aged > or = 65 years. METHODS: National computer-assisted telephone interview (CATI) survey in October/November 2001. RESULTS: Interviews were completed with 5,266 people aged > or = 65 and 2,415 aged 40-64 years. Thirty per cent of selected households participated. Overall, 67% of respondents believed that the vaccine was somewhat to very effective in preventing influenza. Seventy-eight per cent of those aged > or = 65 years reported influenza vaccination; 89% had received it free. Independent predictors of vaccination were: belief that influenza vaccine is effective in preventing influenza (OR=13.5, 95% CI 10.6-17.2); and the presence of chronic disease (OR=1.6, 95% CI 1.3-2.0). Overall, 24% of those aged 40-64 years were vaccinated; only 34% of those who met any of the criteria for vaccination (medical risk factor, at-risk occupation, or being Aboriginal or Torres Strait Islander) reported vaccination. CONCLUSIONS: Influenza vaccine coverage was high in those aged > or = 65 years, but coverage of those at-risk aged 40-64 years remained suboptimal. Immunisation against influenza was influenced more by beliefs about the vaccine's effectiveness and existing medical risk factors, rather than socio-demographic factors such as gender and income.     

Using classification and regression tree analysis to explore parental influenza vaccine decisions

Background and objectivesInfluenza poses a public health threat for children and adults. The CDC recommends annual influenza vaccination for children <18 years, yet vaccine uptake remains low for children (57.9%) and adults (37.1%). Given that parental decision-making is key in childhood vaccine uptake, there is a critical need to understand vaccine hesitancy among parents who decide not to vaccinate their children. This study aims to explore predictors of children’s influenza vaccine status given parental vaccination status and examine the factors that contribute to concordance or discordance between parental and children’s vaccine uptake.MethodsClassification and regression tree (CART) analyses were used to identify drivers of parental decisions to vaccinate their children against influenza. Hierarchy and interactions of these variables in predicting children’s vaccination status were explored.ResultsFrom a nationally representative sample of non-Hispanic Black and White parents who completed an online survey (n = 328), the main factors influencing parents’ decisions to vaccinate their children were vaccine behavior following physician recommendation, knowledge of influenza recommendations for children, influenza vaccine confidence and disease risk. Among unvaccinated parents, the greatest concordance was observed among parents who usually do not get vaccinated following physician recommendation and had lower knowledge of recommendations for influenza vaccination for children. The greatest discordance was observed among unvaccinated parents who had lower hesitancy about recommended vaccines.ConclusionsUnderstanding drivers of parental decisions to vaccinate themselves and their children can provide insights on health communication and provider approaches to increase influenza vaccine coverage and prevent influenza related mortality.     

Knowledge,attitudes and practices of Australian medical students towards influenza vaccination

BackgroundAnnual influenza vaccination is recommended but not compulsory for healthcare workers in Australia, including medical students. A quarter of healthcare workers are estimated to have an influenza infection in any given year, with a subsequent transmission risk to colleagues and patients. During clinical placements, medical students are also at risk of influenza. While compliance with other vaccination requirements are high, influenza vaccine uptake of healthcare workers and medical students remain low globally. We aimed to explore medical students’ influenza vaccination rates, attitudes, knowledge and intended practices at a large Australian university.MethodA 35 item self-administered online survey was distributed to medical students enrolled at a large Australian university (UNSW Australia) in April/May 2014. The survey examined the knowledge, attitudes and practices of medical students towards influenza vaccination and identified factors associated with vaccine uptake.ResultsOf the 606 students, 53.8% (95%CI 49.8–57.8%) receiving their most recent influenza vaccine in 2014. Self-protection was the most common motivator (83%) and inconvenience (64%) the most common barrier to vaccination, despite access to on campus clinics. Students generally held positive attitudes to the influenza vaccine and vaccination recommendations, though some misconceptions existed. The majority (61%) were in support of mandatory influenza vaccination policies for medical students. Significant predictors of influenza vaccination included living on campus, clinical experience, awareness of vaccination recommendations and agreeing that vaccination was important for medical students, while those with perceived time constraints were less likely to be vaccinated.ConclusionMisconceptions and access to influenza vaccine were barriers to uptake of influenza vaccine by medical students. Medical programs need to emphasise the benefits of influenza vaccination in the protection of healthcare workers and patient safety across the medical education program. Our results suggesting majority support for mandatory influenza vaccination may represent a shifting perspective in the medical community.     

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.     

Determinants of uptake of influenza vaccination among pregnant women – A systematic review

Background

Pregnant women have the highest priority for seasonal influenza vaccine. However, suboptimal coverage has been repeatedly noted in this population. To improve vaccine uptake, reviewing the determinants of vaccination is of increasing importance.

Methods

A detailed literature search was performed up to November 30, 2013 to retrieve articles related to uptake of influenza vaccination during pregnancy.

Results

Forty-five research papers were included in the review. Twenty-one studies assessed the coverage of seasonal influenza vaccination, 13 studies assessed coverage of A/H1N1 pandemic vaccination and 11 studies assessed both. Vaccination uptake ranged from 1.7% to 88.4% for seasonal influenza, and from 6.2% to 85.7% for A/H1N1 pandemic influenza. Many pregnant women were unaware that they were at high risk for influenza and its complications during pregnancy. They were also more likely to underestimate the threat of influenza to themselves and their fetus. Moreover, they had substantial concerns about the safety and efficacy of the influenza vaccine during pregnancy. Negative media reports contributed to the perception that influenza vaccination during pregnancy was risky and could result in adverse pregnancy outcomes. Although health care providers’ (HCPs) recommendations were consistently associated with vaccine uptake, most did not recommend the vaccine to their pregnant clients.

Conclusions

Influenza vaccination uptake among pregnant women is suboptimal and HCPs rarely recommend it. Positive vaccination recommendations from HCPs as well as direct access to the vaccine would likely substantially improve vaccination acceptance.     

School life and influenza immunization: A cross-sectional study on vaccination coverage and influencing determinants among Polish teachers

ObjectiveThe general public influenza vaccination coverage in Poland is one of the lowest in the EU (3.7% in 2017/2018). Teachers have the potential to be a target group for immunization programs against influenza infection, however, there is yet to be a study in Poland, or even in the EU that has assessed influenza vaccine uptake among this group. The study objective was to evaluate influenza vaccination coverage and to assess influencing determinants amongst Polish teachers.MethodA cross-sectional questionnaire-based study was conducted among 277 teachers from 9 primary schools of two regional capitals of two Polish regions: Szczecin and Lublin.ResultsA quarter of teachers have ever received influenza vaccine; 4.5% reported receiving vaccination in the 2018/2019 season. The main reasons for not being vaccinated were a lack of confidence in its effectiveness (56.9%) and concerns related to adverse effects (30.6%). Forty four percent (43.8%) of teachers believed that they are at risk of influenza infection, only 62.5% indicated vaccination as an effective method of preventing influenza. Previous information about influenza (OR = 15.70), high knowledge level about influenza (OR = 2.56), family physician recommendation (OR = 2.39), belief that influenza vaccination should be mandatory for teachers (OR = 3.29), and having a vaccinated family member (OR = 2.68) were each associated with higher odds of immunization. Willingness to be vaccinated against influenza in the next season was strongly associated with current vaccination status (OR = 7.16).ConclusionsInfluenza vaccination coverage among Polish teachers is alarmingly low; vaccine receipt was associated with teacher attitudes and beliefs. Future interventions related to maximizing vaccination coverage in this group should take advantage of the involvement of family physicians and specifically focus on teachers who have never been vaccinated before. As knowledge about influenza positively influences vaccination decisions, education strategies should focus on reducing knowledge gaps to alter attitudes and increase uptake.     

Cross-sectional study on factors associated with influenza vaccine uptake and pertussis vaccination status among pregnant women in Germany

Pregnant women and their newborns are at increased risk for influenza-related complications; the latter also have an increased risk for pertussis-related complications. In Germany, seasonal influenza vaccination is recommended for pregnant women since 2010. A dose of pertussis-containing vaccine has been recommended since 2004 for women of childbearing age if they have not been vaccinated within the past 10 years. We conducted a nationwide cross-sectional survey among pregnant women in February/March 2013 to assess knowledge, attitudes, and practices related to influenza vaccination during pregnancy and to identify factors associated with their pertussis vaccination status. In total, 1025 pregnant women participated and provided information through a self-administered questionnaire. Of these, 23.2% were vaccinated against seasonal influenza during the 2012/13 season; 15.9% during their pregnancy. Major reasons for being unvaccinated (n = 686 respondents) were lack of confidence in the vaccine (60.4%) and the perception that vaccination was not necessary (40.3%). Influenza vaccination during pregnancy was independently associated with having received influenza vaccine in the previous season, having received a recommendation from a physician, a high level of vaccine-related knowledge and of perceived disease severity. In contrast, knowledge of the recommendation for regular hand-washing to prevent influenza and the perception that vaccine-related side effects were likely to occur or likely to be severe were negatively associated with vaccine uptake. Receipt of a pertussis vaccine in the past 10 years was reported by 22.5% of participants. Pertussis vaccine uptake was independently associated with living in the Eastern federal states and receiving seasonal influenza vaccination annually, while a migration background was associated with a lower uptake. To enhance vaccine uptake in pregnant women and women of childbearing age, special efforts must be undertaken to improve knowledge of both recommendations and the benefits of vaccination. Gynecologists could serve as important facilitators.     

Influenza vaccination in pregnancy: practices among obstetrician-gynecologists--United States, 2003-04 influenza season

Women infected with influenza virus during pregnancy are at increased risk for serious complications and hospitalization. During 1997-2003, the Advisory Committee on Immunization Practices (ACIP) included healthy pregnant women who would be in their second or third trimester of pregnancy during the influenza season among those persons at high risk for whom influenza vaccination was indicated. Also included were women at any stage of pregnancy with certain chronic medical conditions, such as asthma, diabetes mellitus, or heart disease. ACIP emphasized that the influenza vaccine was safe for breastfeeding mothers and their infants and that household contacts of children aged <2 years also should be vaccinated. However, despite these recommendations, only 13% of pregnant women received influenza vaccination in 2003. To assess understanding of the ACIP recommendations among obstetrician-gynecologists (OB/GYNs), the American College of Obstetricians and Gynecologists (ACOG), with support from CDC, surveyed a national sample of OB/GYNs in May 2004. This report describes the results of that survey, which indicated that 52% of OB/GYNs surveyed would recommend influenza vaccination for a healthy woman in the first trimester of pregnancy, 95% would recommend the vaccine for a healthy pregnant woman beyond the first trimester, and 63% would recommend vaccination for a woman with a medical condition in the first trimester. However, of the physicians who would recommend vaccination, 36%-38% reported that influenza vaccination was not offered in their practices. Increased efforts are needed to improve vaccine availability and to educate OB/GYNs regarding the updated ACIP recommendations on the use of influenza vaccine in the first trimester for both healthy pregnant women and pregnant women at high risk.     

Influenza vaccination coverage among children aged 6-59 months--eight immunization information system sentinel sites, United States, 2007-08 influenza season

Vaccination is the most effective way to prevent influenza-associated morbidity and mortality. However, influenza vaccination coverage among children historically has been low. The Advisory Committee on Immunization Practices (ACIP) recommends annual vaccination with influenza vaccine for all children aged 6-59 months. Previously unvaccinated children and children who received only 1 vaccine dose for the first time in the previous influenza season are recommended to receive 2 influenza vaccine doses. To assess vaccination coverage among children aged 6-59 months during the 2007-08 influenza season, CDC analyzed data from the eight immunization information system (IIS) sentinel sites. For the eight sites, an average (unweighted) of 40.8% of children aged 6-23 months received 1 or more influenza vaccine doses, and an average of 22.1% were fully vaccinated. Among children aged 24-59 months, an average of 22.2% received 1 or more doses, and an average of 16.5% were fully vaccinated. These results indicate that influenza vaccination coverage among children remains low and highlight the need to identify additional barriers to influenza vaccination and to develop more effective interventions to promote vaccination of children aged 6--59 months who are at high risk for influenza-related morbidity and mortality.     

Parental perspectives on influenza vaccination among children with asthma

OBJECTIVES: The objectives of this study were to: (1) identify modifiable factors influencing receipt of influenza vaccination among children with asthma, and (2) to evaluate the effect of heightened media attention on vaccination rates. METHODS: During November and December 2003, we interviewed parents of children with asthma about their experiences with and beliefs about influenza vaccination. We randomly selected 500 children from a study population of 2,140 children identified with asthma in a managed care organization in Massachusetts. We obtained data on influenza vaccination status from computerized medical records and determined significant factors influencing receipt of influenza vaccination. RESULTS: Children were more likely to be vaccinated if their parent recalled a physician recommendation (odds ratio [OR] 2.6; 95% confidence interval [CI] 1.5, 4.5), believed the vaccine worked well (OR 2.0; 95% CI 1.4, 2.8), or expressed little worry about vaccine adverse effects (OR 1.3; 95% CI 1.0, 1.6), or if the child was younger (OR 1.1 per year of age; 95% CI 1.0, 1.2). During the study period, there was heightened media attention about influenza illness and the vaccine. The influenza vaccination rate for children with asthma was 43% in 2003-04 compared with 27% in 2002-03. Comparison of weekly influenza vaccination rates in 2003-04 and 2002-03 suggested that the media attention was associated with the increase in vaccination rates. CONCLUSIONS: Physician recommendations and parental education about influenza vaccine availability, effectiveness, and adverse effects are potentially important influences on influenza vaccination. Our findings suggest that media coverage of the risks of influenza was associated with a significant increase in vaccination rates.     

Increasing influenza vaccine uptake in children: A randomised controlled trial

BackgroundInfluenza vaccine is not included in the Hong Kong Government’s universal Childhood Immunisation Programme but eligible children can receive subsidised vaccine through the private sector using the Vaccination Subsidy Scheme (VSS). This study examined whether a simple intervention package can increase influenza vaccine uptake in Hong Kong children.MethodsTwo study samples were enrolled: families of children who had participated in a previous knowledge, attitudes and practices study; and mother-infant pairs recruited from postnatal wards. Control groups received publicly available leaflets about VSS. Intervention groups additionally received: (1) a concise information sheet about influenza and its vaccine; (2) semi-completed forms to utilise the subsidy; (3) contacts of VSS clinics that did not charge above the subsidy; and (4) text message reminders for vaccination. Enrolled mothers were contacted when children were approximately 1 and 2 years old to determine influenza vaccination status of the families and their plan to vaccinate their children. Mothers’ attitudes towards influenza vaccine were assessed at enrolment and at the end of the study.ResultsA total of 833 eligible mother-infant pairs were enrolled from the two samples. The intervention package improved influenza vaccine uptake by 22% at one year and 25% at two years of age. Maternal influenza vaccine uptake in intervention group was higher during this two-year period in those who had never been previously vaccinated. Mothers’ self-efficacy regarding the use of influenza vaccine in her child i.e. belief and confidence in her own ability to make a good decision, was also improved with the intervention.ConclusionsA four-component intervention package could improve influenza vaccine uptake in Hong Kong children and their mothers during the first two years of life and depending on vaccine effectiveness could potentially reduce influenza-associated hospital admissions in children below 2 years old by 13–24%.     

Self-reported prenatal influenza vaccination and early childhood vaccine series completion

BackgroundNo studies have examined associations between prenatal vaccination and childhood vaccination. Mothers who refuse influenza vaccinations during pregnancy report similar attitudes and beliefs to those who refuse vaccinations for their children. The objective of this study was to examine the association between self-reported prenatal influenza vaccination and early childhood vaccination.MethodsA retrospective cohort study was conducted with existing surveillance data from 4022 mothers who responded to the 2009–2011 Minnesota Pregnancy Risk Assessment Monitoring System survey and child vaccination records from the Minnesota Immunization Information Connection database. The childhood vaccine series outcome included the following vaccines: diphtheria, tetanus, and pertussis; poliovirus; measles, mumps, and rubella; Haemophilus influenzae type b (Hib); hepatitis B; varicella; and pneumococcal conjugate. To evaluate the association between self-reported prenatal influenza vaccination and early childhood vaccination, unadjusted and adjusted logistic regression was used to estimate log odds for childhood vaccination status, while margins post-estimation commands were used to obtain predicted probabilities and risk differences.ResultsVaccine series completion was 10.86% higher (95% confidence interval (CI) 7.33%–14.40%, adjusted and weighted model) in children of mothers who had a prenatal influenza vaccine compared to those who did not. For individual vaccines in the recommended series, risk differences ranged from 7.83% (95% CI 5.37%, 10.30%) for the Hib vaccine to 10.06% (95% CI 7.29%, 12.83%) for the hepatitis B vaccine.ConclusionSelf-reported prenatal influenza vaccination was associated with increased early childhood vaccination. More research is needed to confirm these results and identify potential intervention strategies.