Seasonal Influenza Vaccination Reminders for Children with High-Risk Conditions A Registry-Based Randomized Trial
Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan 48109-5456, USA. American journal of preventive medicine
(Impact Factor: 4.53).
01/2012; 42(1):71-5. DOI: 10.1016/j.amepre.2011.09.028
Children with chronic conditions have an increased risk of complications from influenza and have low influenza vaccination rates.
To assess the feasibility and effectiveness of using a statewide immunization information system (IIS) for seasonal influenza vaccine reminders from local health departments (LHDs) targeting children with high-risk conditions.
A randomized community intervention.
The study was conducted in a population of 3618 children aged 24-60 months with a high-risk condition residing in three Michigan counties. Children were identified using a statewide IIS in October 2008.
Children were randomized to intervention (reminder) or control (no reminder) groups. Reminders for seasonal influenza vaccination were mailed by LHDs in November 2008.
Feasibility of notification (address validity, address deliverability) was assessed (November 2008-February 2009), and frequencies of notification feasibility measures were determined (analyses conducted in 2010). Effectiveness of notification (seasonal influenza vaccine receipt) was assessed using bivariate logistic regression.
Among 3618 children with a high-risk condition, 2730 (75.5%) had not received a 2008-2009 influenza vaccination and were eligible at the time of notification. Among children assigned to the reminder group (n=1374), 42.6% had an address determined to be either invalid, undeliverable, or both. Among those with valid addresses (n=2001), a greater percentage of children with deliverable reminders received at least one influenza vaccination (30.8%) during the outcome observation period than did children assigned to no reminder (24.3%, OR=1.39, 95% CI=1.13, 1.72); children with an undeliverable reminder had an influenza vaccination rate (22.8%) similar to children assigned to no reminder.
Receipt of a reminder was positively associated with seasonal influenza vaccination. However, more than 40% of children assigned to receive a reminder were determined to have an invalid or undeliverable address, emphasizing the need for increased quality of IIS contact information.
This study is registered at www.ClinicalTrials.gov NCT01431183.
Available from: Chyongchiou Jeng (C.J.) Lin
- "Efficient and effective methods for vaccinating large numbers of children in primary care offices are essential. Previous research in this arena has been limited geographically to one or a few offices, to offices in a localized area [5-10], or to practices in three diverse U.S. counties . The purpose of this study was to describe influenza vaccination activities in 174 pediatric offices across the U.S. in a variety of settings and examine the relationships of office characteristics and those activities to influenza vaccination coverage and two-dose compliance. "
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ABSTRACT: In the United States, influenza vaccination is recommended for all children 6 months and older; however, vaccination rates are below target levels. A broad sample of U.S. pediatric offices was assessed to determine factors that influence in-office influenza vaccination rates.
Offices (N = 174) were recruited to participate in an observational study over three influenza seasons (2008--2009, 2009--2010, 2010--2011). Only data from the first year of an office's participation in the study were used. Associations of coverage and 2-dose compliance rates with office characteristics and selected vaccination activities were examined using univariate regression analyses and linear regression analyses using office characteristics identified a priori and vaccination activities with P values <=0.10 in univariate analyses.
Influenza vaccination coverage for children 6 months to 18 years of age averaged 25.2% (range: 2.0%--69.1%) and 2-dose compliance for children <9 years of age averaged 53.4% (range: 5.4%--96.2%). Factors associated with increased coverage were non-rural site (P = 0.025), smaller office size (fewer than 5000 patients; P < 0.001), use of evening and weekend hours to offer influenza vaccine (P = 0.004), a longer vaccination period (P = 0.014), and a greater influenza vaccine coverage rate among office staff (P = 0.012). Increased 2-dose compliance was associated with smaller office size (P = 0.001) and using patient reminders (P = 0.012) and negatively related to use of electronic provider reminders to vaccinate (P = 0.003).
To maximize influenza vaccine coverage and compliance, offices could offer the vaccine during evening and weekend hours, extend the duration of vaccine availability, encourage staff vaccination, and remind patients that influenza vaccination is due. Additional efforts may be required in large offices and those in rural locations.
Available from: Elyse Olshen Kharbanda
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ABSTRACT: Influenza infection results in substantial costs, morbidity, and mortality. Vaccination against influenza is particularly important in children and adolescents who are a significant source of transmission to other high-risk populations, yet pediatric and adolescent vaccine coverage remains low. Traditional vaccine reminders have had a limited effect on low-income populations; however, text messaging is a novel, scalable approach to promote influenza vaccination.
To evaluate targeted text message reminders for low-income, urban parents to promote receipt of influenza vaccination among children and adolescents.
Randomized controlled trial of 9213 children and adolescents aged 6 months to 18 years receiving care at 4 community-based clinics in the United States during the 2010-2011 influenza season. Of the 9213 children and adolescents, 7574 had not received influenza vaccine prior to the intervention start date and were included in the primary analysis.
Parents of children assigned to the intervention received up to 5 weekly immunization registry-linked text messages providing educational information and instructions regarding Saturday clinics. Both the intervention and usual care groups received the usual care, an automated telephone reminder, and access to informational flyers posted at the study sites.
Receipt of an influenza vaccine dose recorded in the immunization registry via an electronic health record by March 31, 2011. Receipt was secondarily assessed at an earlier fall review date prior to typical widespread influenza activity.
Study children and adolescents were primarily minority, 88% were publicly insured, and 58% were from Spanish-speaking families. As of March 31, 2011, a higher proportion of children and adolescents in the intervention group (43.6%; n = 1653) compared with the usual care group (39.9%; n = 1509) had received influenza vaccine (difference, 3.7% [95% CI, 1.5%-5.9%]; relative rate ratio [RRR], 1.09 [95% CI, 1.04-1.15]; P = .001). At the fall review date, 27.1% (n = 1026) of the intervention group compared with 22.8% (n = 864) of the usual care group had received influenza vaccine (difference, 4.3% [95% CI, 2.3%-6.3%]; RRR, 1.19 [95% CI, 1.10-1.28]; P < .001).
Among children and adolescents in a low-income, urban population, a text messaging intervention compared with usual care was associated with an increased rate of influenza vaccination. However, the overall influenza vaccination rate remained low.
clinicaltrials.gov Identifier: NCT01146912.
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ABSTRACT: To provide a clinically relevant synopsis of recent research findings as well as updated guidelines from the American Academy of Pediatrics and Advisory Committee on Immunization Practices regarding child and adolescent immunizations.
Childhood vaccinations have served to dramatically reduce pediatric morbidity and mortality in the USA. Much of the recent research has focused on the improvement of current vaccines as well as on the development of new vaccines. By improving the safety, efficacy and immunogenicity of vaccinations, children can be more fully protected. Additionally, recommendations have broadened as vaccinations have been proven well tolerated and effective for a growing number of subpopulations. Although more groups of children are now included in vaccination recommendations, efforts must continue to ensure that all eligible children receive their vaccinations. This article reviews selected recent publications on influenza, human papillomavirus, the childhood and adolescent/adult formulations of diphtheria and tetanus toxoids and acellular pertussis, meningococcal conjugate and pneumococcal vaccines. The relationship between febrile seizures and childhood immunizations is explored.
The research on childhood and adolescent vaccinations is continuously growing and will serve to shape future recommendations. Through their findings, we can learn how to optimize the protection of all children and adolescents against these very serious diseases.
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