Does influenza vaccination exacerbate asthma in children?

Background:The risks of influenza vaccination in asthmatic children are still being discussed. Especially, the risk that influenza vaccination may exacerbate asthma is an issue in this debate.Methods:We conducted a randomised double-blind placebo-controlled trial in 696 children 6–18 years of age with asthma recruited in general practice during two influenza seasons, 1999–2000 and 2000–2001. Children participated for only one season. During the first week after vaccination, participants recorded local, influenza like and asthma symptoms as well as use of medication, health care use and absenteeism.Results:Except for cough during the day in the first season, favouring placebo, there were no differences indicating that vaccination exacerbates asthma.Conclusions:Influenza vaccination does not seem to exacerbate asthma.     

Parental perspectives on influenza immunization of children aged 6 to 23 months

BACKGROUND: For the first time, in 2002, the Advisory Committee on Immunization Practices encouraged the vaccination of healthy children 6 to 23 months against influenza, whenever feasible. Participating inner-city health centers designed interventions to introduce influenza vaccination among this group of children. The study was designed to assess parents' attitudes toward the vaccine. METHODS: Following the 2002-2003 influenza vaccination season, parents were surveyed to identify barriers to and facilitators of influenza vaccination. A low-literacy level, 19-question survey was mailed to parents in three waves, 4 weeks apart. A subset of children had medical record data available to confirm vaccination status. Measures of validity were calculated. This paper focused only on the children whose parent-reported vaccination status was concordant with that reported in medical records (n = 193). Associations of responses to vaccination status were calculated in 2004, using chi-square and logistic regression procedures. RESULTS: Sensitivity was 85.7% and specificity was 66% (kappa = 0.50), assessing the ability of parents to recall receipt or nonreceipt of influenza vaccine. The most important factors related to immunization of healthy infants were perceived doctor's recommendation (odds ratio [OR] = 5.5; 95% confidence interval [CI] = 2.4-12.3; p < 0.001) and belief that getting an influenza shot is a smart idea (OR = 3.5; 95% CI = 1.3-8.9; p < 0.01) for those with medical record-confirmed vaccination status. CONCLUSIONS: A clear message that the doctor recommends influenza vaccination for a child is an important factor for ensuring vaccination, and may foster the idea that vaccination is "smart."     

Determinants of influenza vaccination among young Taiwanese children

ObjectiveAccording to the Health Belief Model (HBM), individual perceptions of susceptibility, severity, benefit, barrier, self-efficacy, and cues to action are associated with health actions. In this study, we investigated the perceptions and social factors that influence the intention to vaccinate children against influenza among parents of young Taiwanese children.MethodsA nationwide survey was performed using stratified random sampling to explore the beliefs, attitudes, and intentions of parents/main caregivers with regard to vaccinating children aged 6 months to 3 years against influenza. A questionnaire was developed based on the HBM and multivariate logistic regression analyses of 1300 eligible participants were used to identify significant predictors of the intention to vaccinate.ResultsGreater perceived benefit, cues to action, and self-efficacy of childhood vaccination against influenza were positively associated with the intention to vaccinate. Children's experience of influenza vaccinations in the past year was also a positive predictor. However, perceived susceptibility, perceived severity regarding influenza and perceived barriers to vaccination were not predictive of the intention to vaccinate.ConclusionIn addition to perceived benefits and cues to action, self-efficacy of parents/main caregivers was significantly predictive of their intention to accept influenza vaccination for their young children. These components of the HBM could be used in formulating strategies aimed at promoting the use of influenza vaccine.     

Cost-effectiveness of live-attenuated influenza vaccination among school-age children

The current pediatric vaccination program in England and Wales administers Live-Attenuated Influenza Vaccine (LAIV) to children ages 2–16 years old. Annual administration of LAIV to this age group is costly and poses substantial logistical issues. This study aims to evaluate the cost-effectiveness of prioritizing vaccination to age groups within the 2–16 year old age range to mitigate the operational and resource challenges of the current strategy. We performed economic evaluations comparing the influenza vaccination program from 1995–2013 to seven alternative strategies targeted at low risk individuals along the school age divisions Preschool (2–4 years old), Primary school (5–11 years old), and Secondary school (12–16 years old). These extensions are evaluated incrementally on the status quo scenario (vaccinating subgroups at high risk of influenza-related complications and individuals 65+ years old). Impact of vaccination was assessed using a transmission model from a previously published study and updated with new data. At all levels of coverage, all strategies had a 100% probability of being cost-effective at the current National Health Service threshold, £20,000/QALY gained. The incremental analysis demonstrated vaccinating Primary School children was the most cost-efficient strategy compared incrementally against others with an Incremental Cost-Effectiveness Ratio of £639 spent per QALY gained (Net Benefit: 404 M£ [155, 795]). When coverage was varied between 30%, 55%, and 70% strategies which included Primary school children had a higher probability of being cost-effective at lower willingness-to-pay levels. Although children were the vaccine target the majority of QALY gains occurred in the 25–44 years old and 65+ age groups. Influenza strain A/H3N2 incurred the greatest costs and QALYs lost regardless of which strategy was used. Improvement could be made to the current LAIV pediatric vaccination strategy by eliminating vaccination of 2–4 year olds and focusing on school-based delivery to Primary and Secondary school children in tandem.     

Influenza vaccination among caregivers and household contacts of children with asthma

Data on influenza vaccination status among household contacts of asthmatic children are lacking. Our aim was to assess the influenza vaccination status of parents and caregivers of asthmatic children in the 2018–2019 season as well as to identify reasons for undervaccination. We performed a questionnaire-based survey in parents, caregivers and household contacts of 178 asthmatic children. Only the 50.6% of children were vaccinated, while in 79.8% of cases both parents were unvaccinated. More than 40% of them reported that they were unaware about the necessity of vaccination; approximately 30% stated that they were not properly advised, and the rest were concerned about influenza vaccine side effects and effectiveness. Factor analysis identified three groups: (a) influenza vaccine “believers” who were unaware that vaccination was necessary; (b) “deniers” who were less educated and with older children; (c) older and more educated vaccine “deniers”. To improve influenza vaccine coverage among household contacts of asthmatic children, appropriate counseling and targeted interventions should be planned.     

Association between provider recommendation and influenza vaccination status among children

BackgroundProvider recommendation is associated with influenza vaccination receipt. The objectives of this study were to estimate the percentage of children 6 months–17 years for whom a provider recommendation for influenza vaccination was received, identify factors associated with receipt of provider recommendation, and evaluate the association between provider recommendation and influenza vaccination status among children.MethodsNational Immunization Survey-Flu (NIS-Flu) parentally reported data for the 2013–14, 2014–15, and 2015–16 seasons were analyzed. Tests of association between provider recommendation and demographic characteristics were conducted using Wald chi-square tests and pairwise comparison t-tests. Multivariable logistic regression was used to determine variables independently associated with receiving provider recommendation and the association between provider recommendation and influenza vaccination status.ResultsApproximately 70% of children had a parent report receiving a provider recommendation for influenza vaccination for their child. The strongest association between receipt of provider recommendation and demographic characteristics was with child’s age, with younger children (6–23 months, 2–4 years, and 5–12 years) being more likely to have a provider recommendation than older children (13–17 years). In addition, children living in a household above poverty with household income >$75,000 were more likely to have a parent report receipt of a provider recommendation than children living below poverty. Children with a provider recommendation were twice as likely to be vaccinated than those without.ConclusionsThis study affirms the importance of provider recommendation for influenza vaccination among children. Ensuring that parents of all children receive a provider recommendation may improve vaccination coverage.     

Association between patient reminders and influenza vaccination status among children

BackgroundPatient reminders are recommended to increase vaccination rates. The objectives of this study were to estimate the percentage of children 6 months–17 years for whom a patient reminder for influenza vaccination was received by a child’s parent or guardian, estimate influenza vaccination coverage by receipt of a patient reminder, and identify factors associated with receipt of a patient reminder.MethodsNational Immunization Survey-Flu (NIS-Flu) data for the 2013–14 influenza season were analyzed. Tests of association between patient reminders and demographic characteristics were conducted using Wald chi-square tests and pairwise comparison t-tests. Multivariable logistic regression was used to determine variables independently associated with receiving a patient reminder.ResultsApproximately 22% of children had a parent or guardian report receiving a patient reminder for influenza vaccination for their child, ranging from 12.9% in Idaho to 41.2% in Mississippi. Children with a patient reminder were more likely to be vaccinated compared with children without a patient reminder (73.7% versus 55.5%). In the multivariable model, reminder receipt was higher for children 6–23 months compared with children 13–17 years, black children compared with white children, and children whose parent completed the survey in English compared with children whose parent completed the survey in a language other than English or Spanish.ConclusionsAlthough patient reminders are associated with a higher likelihood of influenza vaccination, nationally, less than one-fourth of children had a parent report receiving one. Despite being based on parental report, with its limitations, this study suggests that increasing the number of parents who receive patient reminders for their children may improve vaccination coverage among children.     

Variability in influenza vaccination opportunities and coverage among privately insured children

BackgroundUniversal influenza vaccination has been recommended since 2010, yet influenza vaccination rates among children aged 6 months to 17 years remain low compared with other routinely recommended childhood vaccines.ObjectiveAssess in-plan vaccination coverage, opportunities, and missed opportunities during the 2016–2017 influenza season.Study Design:Retrospective analyses using 2016–2017 MarketScan® data for 2,768,799 privately insured children aged 1–17 years by the end of 2016 who were continuously enrolled in the same insurance plan during the 2016–2017 influenza season (defined as August 1, 2016 through May 31, 2017). We assessed in-plan vaccination coverage (percentage receiving ≥ 1 dose of influenza vaccine from August 2016-May 2017) and vaccination opportunities (percentage with ≥ 1 provider visit between September 2016 – May 2017). Among children who remained unvaccinated at the end of the season, those with ≥ 1 influenza vaccination opportunity between September 2016-May 2017 were determined to have a missed opportunity.ResultsIn-plan vaccination coverage during the 2016–17 season was 67.7% in infants (born 2015), 49.5% in toddlers (born 2012–2014), 35.0% in school-aged children (born 2004–2011), and 22.3% in teenagers (born 1999–2003). Like vaccination coverage, vaccination opportunities decreased with age (infants: 97.7%, toddlers: 91.9%, school-aged children: 82.6%, teenagers: 79.3%). Among unvaccinated children, 93.1%, 84.1%, 73.6% and 73.6% of each age group had a missed opportunity for influenza vaccination.ConclusionOpportunities for and coverage with influenza vaccination vary even among privately insured children. Along with continued efforts to reduce missed opportunities, effective strategies to bring children to their doctor for annual influenza vaccination are needed, particularly for older children.     

Influenza vaccination coverage among children with asthma--United States, 2004-05 influenza season

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

Parental perspectives on vaccinating children against sexually transmitted infections

Several vaccines for sexually transmitted infections (STI) are presently in development and the eventual availability of such vaccines is expected to result in the prevention of a significant number of burdensome conditions. Young adolescents are presumed to be likely targets for these vaccines since adolescents' risk for STI increases as they age and become sexually active. It is unclear, however, to what extent parents will agree to having adolescents receive STI vaccines. Inasmuch as acceptance is the foundation for effective immunization programs, an understanding of parental perspectives about this issue is required to inform future STI vaccine program strategies. This paper presents findings from a qualitative study that used in-depth interviews to elicit attitudes from 34 parents about accepting vaccines for genital herpes, human immunodeficiency virus, human papillomavirus and gonorrhea for their children (aged 8-17). Data were collected from parents bringing their children for care at an urban clinic and a suburban private office. Content analysis of the responses revealed that most parents (>70%) approved the administration of all four of the STI vaccines proposed. Parents' reasons for acceptance included wanting to protect their children, being concerned about specific disease characteristics, and previous experience with the infections. Parents who declined the vaccines did so primarily because they perceived their children to be at low risk for the infections or they had low concern about features of the diseases. Most parents thought they should be the decision-maker regarding children receiving an STI vaccine. Results from this study will be used to plan subsequent investigations of the determinants of STI vaccine acceptance by parents.     

新冠感染流行对湖南省儿童流感疫苗接种的影响分析

目的 分析2018—2021年新型冠状病毒感染(简称新冠感染)流行前后湖南省儿童流感疫苗接种情况，为提高流感疫苗接种率提供基础数据。方法 通过湖南省免疫规划信息系统收集儿童流感疫苗接种信息，采用SPSS 25.0分析不同时间、年龄、地区接种率，统计学比较采用χ²检验。结果 2018—2021年6月龄～17岁儿童流感疫苗接种数分别为387 928剂次、587 206剂次、1 512 607剂次、1 114 314剂次，其中新冠感染流行后的2020年较流行前的2019年增长幅度较大，增加了157.6%;当年10月至次年3月为流感疫苗接种高峰；接种率最高是湘东地区，湘西和湘北次之。1～10岁儿童流感疫苗第1、2剂接种率在9.14%～42.62%之间，其中，5、6岁组儿童第1剂接种率最高，接种率>40%。结论 新冠感染流行后儿童流感疫苗接种率明显增加，接种高峰持续时间增加，但仍有待进一步加强。     

Factors associated with influenza vaccination among elderly Spanish women

OBJECTIVES: Influenza vaccination is an effective intervention to diminish morbidity and mortality associated with this disease in aged populations and at-risk groups. The objective of this work was to describe population patterns of vaccination among Galician women and to identify factors associated with vaccination. STUDY DESIGN: Cross-sectional study. METHODS: Cases aged 65 years and over were selected from the Women's Social and Health Interview, Galicia 2000 (n = 1111). The association between influenza vaccination last season and several sociodemographic, lifestyle, health status and health services variables was assessed by logistic regression. RESULTS: In total, 56.3% of cases had received the influenza vaccine. The following variables were significantly associated with vaccination: age 70-74 years (odds ratios, OR=1.56; 95% CI: 1.09-2.26); age> or =75 years (OR=1.88; 95% CI: 1.31-2.71); residence in towns with 5000-20,000 inhabitants (OR=1.79; 95% CI: 1.16-2.77); annual income 6.010 (OR=1.39; 95% CI: 1.01-1.90); unfavourable self-perception of health (OR=1.46; 95% CI: 1.06-2.00); not being a caregiver (OR=1.67; 95% CI: 1.17-2.38); married (OR=1.45; 95% CI: 1.05-2.01); tetanus vaccination (OR=1.43; 95% CI: 1.07-1.93); and visiting a physician in the last 2 years (OR=4.83; 95% CI: 2.61-8.93). CONCLUSIONS: The level of vaccination among Galician women is low, although it is higher than that in Spanish women overall. This work has identified groups of women who are less likely to be vaccinated, and who should be targeted in future vaccination campaigns.     

Provider attitudes regarding use of an immunization information system to identify children with asthma for influenza vaccination.

OBJECTIVES: Despite longstanding national guidelines, many children with asthma do not receive annual influenza vaccinations. Information from Medicaid-administrative claims data was integrated into the Michigan Care Improvement Registry (MCIR) to prompt providers regarding influenza vaccination among children with high-risk conditions such as asthma. The attitudes of pediatric primary care providers regarding the implementation of this system were assessed. METHODS: A survey was sent in February 2006 to office-based general pediatricians (n = 300) and family physicians (n = 300) in Michigan. The survey focused on influenza vaccination during the 2005-2006 influenza season and attitudes regarding a reminder system for providers using the MCIR. RESULTS: Overall response rate was 67 percent. MCIR participation was high (91%) among respondents, and most (83%) had MCIR information available to them prior to visits with pediatric patients. Most physicians (75%) considered the MCIR high-risk indicator for influenza vaccination a feature that they would find helpful. Some respondents reported concerns that the reminder system is limited to Medicaid patients only (44%) and regarding the completeness of Medicaid data to identify children with asthma (24%). CONCLUSIONS: Physicians have a positive overall view of a statewide registry-based automated reminder system to assist in identifying children with asthma for influenza vaccination, albeit with specific areas of concern.     

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

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

Variations in influenza vaccination among the elderly

OBJECTIVES: To identify unique, mutually exclusive population segments whose members share characteristics associated with likelihood of influenza vaccination. METHODS: Data from 30,668 elderly participants in the 1999 Behavioral Risk Factor Surveillance Systems was analyzed using classification and regression tree analysis. RESULTS: Eleven subgroups were identified: Non-Hispanic Blacks and Hispanics with no recent checkup had the lowest prevalence estimate (28.1%), whereas married white persons aged 75 plus with a recent checkup had the highest (80.6%). CONCLUSIONS: Influenza vaccination varies greatly according to preventive medical care use and race/ethnicity, factors that are amenable to targeted outreach efforts.     

Barriers to influenza vaccination among pregnant women

Objective

Despite pregnant women's increased morbidity and mortality from influenza, vaccination rates remain low. This study intended to evaluate barriers to pregnant women's uptake of influenza vaccine.

Study design

A survey was designed that assessed participant demographics, knowledge, beliefs, attitudes, and general experiences with seasonal and 2009 novel H1N1 influenza. Associations between patient characteristics and vaccine uptake were then assessed.

Results

88 women completed the survey. Women who correctly answered >75% of knowledge questions regarding influenza were significantly more likely to accept the influenza vaccine (seasonal: p = 0.04, H1N1: p < 0.01). Conversely, patients who declined the vaccine were more likely to hold false beliefs, such as perceiving that the vaccine was not protective (seasonal: p < 0.01, H1N1: p < .01) and that they were not at risk for influenza (seasonal: p <  0.01).

Conclusion

The reasons for influenza vaccine declination in pregnant patients include lower levels of knowledge and unfavorable attitudes regarding the safety and efficacy of the vaccine, and suggest the importance of education as a tool to improve vaccination uptake     

Nudging influenza vaccination among health care workers

Our online randomized controlled trial on 6230 healthcare workers (HCWs) tests the impact that three nudges – social norms, reminding the impact on beneficiaries, and defaults – have on the intention to vaccinate against seasonal influenza across job families. Willingness to get a flu shot was higher among subjects invited to imagine themselves working at the local health authority (LHA) with the greatest immunization coverage within their region relative to their counterparts prompted to imagine working at the LHA with the lowest coverage. Reminding the impact of flu vaccination on beneficiaries had different effects across job families, with physicians caring more benefits for themselves, nurses about patients’ benefits, and technicians about family and friends. Default responses anchoring toward a high rather than a low vaccination intention increased the willingness to immunize among all HCW except physicians. Targeted nudges can be considered in developing interventions to promote influenza vaccination among HCWs.     

The efficacy and problems with influenza vaccination among hospital workers

PURPOSE: The purposes of this study were: (1) to assess the therapeutic and side effects of influenza vaccination during a winter season by comparison of vaccinated and non-vaccinated subjects; and (2) to survey their willingness to receive vaccination in the future based on their experience with the present vaccination. METHOD: The subjects were 185 vaccinated hospital workers and 450 unvaccinated city office workers. We explained to the first group the desirability of receiving vaccination for the purpose of preventing in-hospital infections and received informed consent before administering influenza vaccinations. There were five subjects who did not receive any vaccination due to strong side effects from previous vaccinations or who did not give consent. We then examined the therapeutic and side effects of the vaccination with the vaccinated subjects. A questionnaire was also filled out by both groups of subjects regarding their physical condition and whether they wished to receive vaccination in the future. In this study, the criterion for influenza was a fever of 38.5 degrees C or higher while common cold was concluded with a fever under 38.5 degrees C. RESULTS AND DISCUSSION: The percentage of subjects who subsequently developed influenza symptoms was 13.2% for the vaccinated group whereas that for the unvaccinated group was 33.2%. The difference was significant (P < 0.01). There was no significant difference in the frequency of common cold symptoms between the two groups. According to the vaccinated group's self-report (through the questionnaire; n = 159), 16 subjects (10%) suffered some kind of side effects after the vaccination. In terms of their desire to receive vaccination the following year, in the vaccinated group, 25% of those who reported side effects wanted vaccination the following year whereas 86% of those who did not report side effects wanted vaccination. The difference was significant (P < 0.01). CONCLUSION: The significantly lower percentage of vaccinated subjects with influenza symptoms may have been due to the vaccination effect. The prevalence of side effects (10%) was rather low. Although a relatively high percentage of the vaccinated subjects wished to receive vaccination in the following year, the breakdown indicated that only a small number of those with side effects wanted furture vaccination. Even among those with no side effect, there were some (9.1%) who did not desire vaccination in the future. Thus, there seems to be a need for further education regarding the importance of preventing influenza through vaccination.     

Economic evidence of influenza vaccination in children

OBJECTIVE: We review published economic evaluations of influenza vaccination for children, including direct individual benefits and indirect societal benefits, to determine whether more studies are needed to fully understand the expected benefits of such strategies. METHODS: We searched MEDLINE and EMBASE databases to May 2006 and in-press articles to October 2006 for studies including economic analyses of influenza vaccination in children. Abstracts of all potentially relevant articles were screened. RESULTS: Fifteen relevant articles from 1983 were retained. Most were based on modelling, using previously published data and considered the societal perspective. Three were a part of prospective clinical trials. Various paediatric vaccination scenarios and parameters were considered. Vaccinating children against influenza was cost saving or cost effective in 10/15 studies, cost saving or effective only under certain conditions in three studies, and not cost saving or effective in two studies whatever the outcome or perspective considered. CONCLUSIONS: Most published evidence points to an economic interest for society of vaccinating children against influenza. However, differences in study design hinder the comparison of the various vaccination strategies considered. Comparable and complete data on the burden and cost of disease, and the cost of vaccination are needed, especially outside of North America.