Influenza and Pneumococcal Immunization Status Screening and Missed Opportunities among Children with Chronic Medical Conditions in Mid-Missouri, 2006-07 Influenza Season

Learning Objectives for this Presentation:
By the end of this presentation, participants will be able to:
Recognize the barriers to timely influenza and pneumococcal immunization that high-risk children with chronic medical conditions are faced with.

Background:
Children identified as being at high-risk for influenza complications due to their underlying chronic medical condition (CMC) have higher influenza-related morbidity than healthy children. Screening for influenza and pneumococcal immunization status in these children is very important to protect them through timely vaccination.

Objectives:
To assess screening for influenza and pneumococcal immunization status and vaccination coverage among high-risk children aged 6 months to 18 years with CMC, and to review the prevalence of provider missed opportunities of all vaccine-eligible visits.

Methods:
Six-month retrospective cohort study of influenza and pneumococcal immunization status assessment and coverage at University of Missouri Health Care (UMHC) pediatric clinics. Study patients were identified by pediatric subspecialty provider and through the UMHC's billing database. Immunization status and vaccine coverage data were obtained from the billing database and the electronic medical record.

Results:
We identified 2,185 high-risk children. Missed opportunities for influenza and pneumococcal vaccination status screening and vaccination occurred at 3 visits for every vaccine given to children with asthma and at 5 visits for every vaccine given overall. Failure to screen for influenza and pneumococcal immunization status occurred in >1/2 and in >3/4 of clinic visits, respectively. Of the 2,013 vaccine-eligible patients, 33% received influenza vaccine, of which 71% were asthmatics and 10% were diabetics. Of the patients eligible for age-appropriate pneumococcal vaccination, 13% received PCV7 and 3% received PPV23. Two-thirds of PPV23 was given at the time of influenza vaccination.

Conclusions:
The prevalence of missed opportunities for influenza and pneumococcal immunization assessment and vaccination was high. Implementation of systematic vaccination programs and practice policy changes in pediatric primary and subspecialty clinics are needed.