Improving Influenza Immunisation for High-Risk Children and Adolescents

Influenza vaccination rates among children remain relatively low, despite the fact that influenza is responsible for considerable morbidity in children, particularly those suffering from chronic diseases such as asthma or cardiovascular disorders. This research reports on an effort to increase vaccination rates in children, particularly high-risk children, across numerous hospitals, clinics and community-based pediatric practices.

One of the goals of the effort described in this paper was to disseminate a series of strategies used in preceding years to increase vaccination rates at clinics associated with Cincinnati Children's Hospital Medical Center (CCHMC), particularly cystic fibrosis (CF) clinics. Strategies included: reminders sent to families; enhanced access, such as shot clinics; a Web-based registry and tracking system to identify and follow at-risk patients; in-clinic reminders to patients; preplanning with suppliers to insure sufficient vaccine; a designated site leader, and others. On the basis of the past success of these strategies, the project was scaled up in 2003–2004 to target 18,866 high-risk children.

Overall, 9,374 (49.7%) children received influenza vaccinations, with the CF clinics achieving the highest rate of immunization, at 82.1 percent. Hospital clinics that had participated previously vaccinated an average of 66.6 percent of children, community-based practices achieved a 51.2 percent rate and clinics participating for the first time vaccinated 38.9 percent of targeted children. Other studies have reported low rates (9–10%) for children with asthma in primary care clinics, although there is much variation in rates among community-based pediatric practices. Additional research to determine which interventions are most effective, to assess the cost-effectiveness of such interventions, and to understand factors such as patient insurance status in regard to immunization rates, are a pressing need.