BACKGROUND:
For the 2003-04 influenza season, the Advisory Committee on Immunization Practices issued a statement “encouraging” vaccination of all healthy children aged 6-23 months.

OBJECTIVE:
To document adoption of, and barriers to, the “encouragement” for influenza (flu) vaccination of healthy children aged 6-23 months.

METHOD:
Mailed survey of a national random sample of 500 pediatricians and 500 family physicians, fielded June-September 2004.

RESULT:
Response rate was 55%, with 414 eligible respondents. Overall, 44% of respondents were “adopters” (“routinely/always” recommended flu vaccine for children 6-23 months); “non-adopters” were those who “sometimes” (41%) or “rarely/never” (15%) made this recommendation. More pediatricians (56%) than family physicians (25%) were adopters. Adopters were more likely than non-adopters to “strongly agree” with annual flu vaccination of healthy children (55% vs 20%). Few adopters postponed another recommended vaccine (3%) or scheduled additional physician visits (8%) for flu vaccination. Adopters identified flu vaccine shortage as a major barrier to compliance more often than non-adopters (65% vs 55%, respectively). Non-adopters were more likely to cite as major barriers: parental acceptance of flu vaccine (21% vs 11%); reimbursement (24% vs 17%); up-front costs (14% vs 9%); and a lack of a practice protocol for vaccination of children (8% vs 3%). More adopters (58%) than non-adopters (49%) reported future plans to start vaccinating earlier and extend vaccination later (35% vs 26% respectively) in the flu season, while 50% of both groups would offer expanded options for vaccination.

CONCLUSION:
Adoption of the ACIP encouragement was variable. Adopters reported vaccine shortage as a major barrier relative to non-adopters, who perceived more financial and logistical barriers than adopters.

LEARNING OBJECTIVES:
To understand physicians' perceptions and practices related to the ACIP encouragement for flu vaccination of healthy 6-23 month-old children.