Allison Kempe1, Matthew F. Daley
1, Jennifer Barrow
1, Nellie Hester
1, Brenda L. Beaty
1, Norma Allred
2, Kellyn Pearson
1, Lori A. Crane
3, and Stephen Berman
1. (1) Dept. of Pediatrics, Univ. of Colo. HSC, Children's Outcomes Research Program, The Children's Hospital, 1056 E. 19th Avenue, The Children's Hospital, Denver, CO, USA, (2) National Immunization Program, CDC, (3) Preventive Medicine & Biometrics, University of Colorado Health Sciences Center, 4200 E 9th Ave, Box B-119, Denver, CO, USA
BACKGROUND:
During 2003-2004, a well-publicized and severe influenza (flu) season in CO, the ACIP encouraged flu immunization (Iz) in children 6-23 months. ACIP will recommend Iz in this age group for 2004-2005.
OBJECTIVE:
1) To assess the maximum flu Iz rate that can be achieved in healthy children 6-21 months in private practice settings and 2) to evaluate the efficacy of registry-based recall for flu.
METHOD:
The study was conducted in 5 private pediatric practices in Denver, CO with a common billing system and Iz registry. Healthy children 6-21 months were selected (N=5200) and randomized to an intervention (I; n=2603) group that received up to 3 recall letters or to a control (C; n=2598) group that received usual care. The primary outcome was receipt of one or more flu Iz as noted either in the Iz registry or in billing data.
RESULT:
Iz rates in the I groups in the 5 practices were 74.6%, 74.1%, 66.5%, 51.2% and 43.6% by 12/31/03. Overall, 60.4% of I vs. 55.9% of C were immunized (4.5% absolute increase, p=0.001), with absolute % increases over C ranging by practice from 1.1% (p=NS, I vs C) to 9.8% (p<0.001, I vs C). However, before the epidemic (publicity beginning 11/15/03) absolute % increases over C ranged from 4.8% to 15.9% and were 9.3% overall (p<0.0001, I vs C). Before 11/15, significant effects of recall were seen both for children 12-21 months (10.1% increase over C, p<0.0001) and 6-11 months (7.8% increase over C, p=0.001), but by 12/31 significant effects of recall were seen only in the older age group (6.5% increase over C, p<0.001).
CONCLUSION:
These results demonstrate that in an epidemic flu year, private practices were able to immunize the majority of children 6-21 months in a timely manner. Although media coverage regarding the epidemic blunted the effect of registry-based recall, it was still effective in raising rates before the epidemic hit, especially for children between 1 and 2 years of age.
LEARNING OBJECTIVES:
1) To evaluate the efficacy of Iz registry-based recall for flu and 2) to assess the maximum flu Iz rate that can be achieved in healthy children 6-21 months in private practice settings