Flu Vaccination Rates Low Among Children

Laird Harrison

October 16, 2013

SAN FRANCISCO — Children are more likely to be vaccinated against influenza if they have recently visited their doctor, a new study shows.

The US Advisory Committee on Immunization Practices recommends that all children be vaccinated against influenza, but the rate of pediatric vaccination remains low, researchers say.

"Public health officials may want to focus on alternative routes of vaccination administration," lead author Evgeniya Antonova, PhD, senior manager at vaccine-maker MedImmune, told Medscape Medical News.

To better understand who is getting vaccinated, Dr. Antonova and her team analyzed vaccinations in patients insured by Blue Cross Blue Shield from the 2007/08 to the 2011/12 flu seasons.

Dr. Antonova presented the study here at IDWeek 2013.

The number of children in the database who were eligible for vaccination fluctuated from one season to the next, but ranged from 1,277,502 to 2,363,087.

Over the 5 influenza seasons, vaccination rates declined as the age of the children increased.

Public health officials may want to focus on alternative routes of vaccination administration.

In the 2011/12 season, the vaccination rate ranged from 52.2% in children 6 to 24 months of age to 18.0% for children 9 to 17 years of age. Proportions were similar in all 5 seasons.

The researchers found an association between influenza vaccinations and visits to doctors' offices. In 2011/12, only 5.8% of those with no office visits in the previous year were vaccinated, whereas 35.6% of those with 6 or more visits were vaccinated. That difference between the age groups stayed nearly constant during the 5 seasons.

The difference is probably not because of access to healthcare, because all of the children had health insurance, said Dr. Antonova.

The researchers also looked at differences by region, and found that children in the Northeast had the highest vaccination rate in the 2011/12 season (29.5%), followed by children in the South (26.3%), in the Midwest (23.9%), and in the West (23.6%).

They also noted a trend in the types of vaccine being administered. For children 2 to 17 years of age, the use of live attenuated influenza vaccine rose from 11.8% of children vaccinated in 2007/08 to 40.4% in 2011/12. The live attenuated influenza vaccine is taken nasally. MedImmune makes this form of influenza vaccine.

During that period, the use of preservative-free prefilled syringes rose from 19.2% to 24.8%, whereas the use of preservative-containing multidose vials declined from 69.0% to 34.9%.

Because children who don't see their doctors have low vaccination rates, Dr. Antonova suggested that pharmacies, clinics, and schools would be good alternative sites.

Vaccines Outside of Clinics

"The bottom line is that a lot of children in a lot of categories have low vaccination rates," Dr. Antonova said. "Perhaps clinicians could think about reaching out to schools and have a vaccination day."

Andrew Pavia, MD, chief of pediatric infectious diseases at the University of Utah in Salt Lake City, noted that the vaccination rates in this study are similar to those reported by the US Centers for Disease Control and Prevention.

The recommendation to offer vaccinations outside doctors' clinics has merit, he told Medscape Medical News.

It is a good idea, "but we need to understand the barriers to getting vaccinated," he said. For example, various states have restrictions dictating the age of children who can receive injections in pharmacies.

This study was funded by MedImmune. Dr. Antonova is an employee of the company. Dr. Pavia has disclosed no relevant financial relationships.

IDWeek 2013: Abstract 340. Presented on October 3, 2013.

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