Feasibility of Influenza Immunization for Children 6-23 Months in the Inner City
Chyongchiou J. Lin1, Mary Patricia Nowalk2, Richard K. Zimmerman2, Alejandro Hoberman3, David P. Greenberg3, and Stuart T. Weinberg4. (1) Department of Health Policy and Management, University of Pittsburgh, Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA, USA, (2) Family Medicine & Clinical Epidemiology, University of Pittsburgh, 3518 Fifth Avenue, Pittsburgh, PA, USA, (3) Department of Pediatrics, Children's Hospital of Pittsburgh, 3705 5th Avenue, Pittsburgh, PA, USA, (4) PA Chapter - American Academy of Pediatrics (Consultant), 2221 Windsong Dr, Findlay, OH, USA
BACKGROUND: Children <2 years comprise the second largest number of influenza-related hospitalizations annually in the U.S. Yet until recently, no recommendations existed for vaccinating healthy children 6-23 months old. In 2002, the Advisory Committee on Immunization Practices encouraged influenza vaccination of these children.
OBJECTIVE: Determine the feasibility of vaccinating typically hard-to-reach, low-income children against influenza and assess the vaccine's effect on timely receipt of other vaccines.
METHOD: A before/after trial was conducted in a pediatric residency, 2 family practice residencies and 2 faith-based practices, at ten offices in low-income urban locations. Sites selected and implemented interventions from a menu of strategies proven to increase vaccination rates for other vaccines. Current patients who were 6-23 months old by October 1, 2002 (n=1534) were compared with children 6-23 months old by October 1, 2001 (n=1210) in the same practices.
RESULT: Influenza vaccination rates improved significantly at all three types of health centers (7.6% to 42.3% at pediatric residencies; 4.3% to 15.6% at family practice residencies; and 4.3% to 47% at faith-based sites; P<.001 for all). Rates for second doses were significantly improved over preintervention (P<.01), but were lower than first dose rates. Mean ages at vaccination for other recommended childhood vaccines did not differ or were significantly younger (MMR and varicella) for children who received influenza vaccine vs. those who did not. Moreover, a higher percentage of influenza-vaccinated than unvaccinated children received their MMR, DTaP 3, IPV 2 and Hib 2 vaccines within a two-month grace period of the recommended age (P<.039), with no change in the timing of receipt of varicella, DTaP 1, IPV 1 and Hib 1.
CONCLUSION: It is possible to increase influenza vaccination at health centers serving low-income children without delaying receipt of other vaccines.
LEARNING OBJECTIVES: Participants will understand the feasibility and impact of adding influenza vaccine to the Recommended Childhood Immunization Schedule.