Learning Objectives for this Presentation:
By the end of the presentation participants will be able to identify barriers to late-season influenza vaccination (LSV).

Background:
Although LSV becomes particularly important when vaccine is not received early in the season, existing national data suggest that little influenza vaccination is actually occurring after December.

Objectives:
To describe among primary care physicians nationally: 1) LSV practices; 2) barriers to LSV; and 3) factors associated with LSV.

Methods:
Survey administered 3/2007-6/2007 to 1,269 primary care physicians participating in a national network representative of the memberships of the American Academy of Pediatrics, College of Physicians, and Academy of Family Physicians.

Results:
Response rate was 74% (n=940). When asked about vaccination practices, if supplies are inadequate/delayed, 3% stop vaccinating in November/December, 13% in January, 36% in February, and 48% in March. Seventy percent feel LSV is clinically beneficial but 90% feel LSV compromises patient care. Major identified barriers to LSV include: difficulty administering a second dose in children if the first is given late in the season (91%); providers/patients forgetting about the need for vaccination later in the season (77%); and difficulty persuading patients to accept later vaccination (65%). In multivariate analyses, the following were associated with vaccinating into Feb/Mar during a shortage/delay year: believing that LSV is clinically beneficial (OR 3.12, 95% CI 2.11-4.61); having ≥10% unused vaccine left at the end of the season (OR 1.90, 95% CI 1.18-3.06); and referring <10% of patients elsewhere for vaccination (OR 1.83, 95% CI 1.23-2.72).

Conclusions:
Most providers report willingness to perform late-season influenza vaccination despite existing data demonstrating that little late-season vaccination currently occurs. If providers are accurately reporting willingness, other identified barriers to late-season vaccination need to be more effectively addressed. Our data also highlight the need for education about the continued benefit of vaccination late in the season.