Tuesday, March 31, 2009
Grand Hall area
Despite expansion of pediatric influenza vaccine recommendations, only 21.3% of children aged 6-23 months were fully vaccinated during the 2006-2007 influenza season. While missed opportunities have been shown to decrease influenza vaccination coverage among high-risk children, the extent of missed opportunities for influenza coverage among the general population of young children is unknown.
To assess missed opportunities for 6-23 month old children in three geographically distinct US counties during the 2004-2005 season.
A total of 1863 randomly selected 6-23 month old children presented at 46 physician practices during the 2004-2005 influenza season. Their charts were systematically reviewed to determine medical visit type, symptoms and diagnoses related to acute respiratory infections, and all vaccinations received. Children who presented with a serious medical illness were considered ineligible for vaccination. Missed opportunities were defined as a visit to the primary care practice by a child during 2004-2005 when the child was eligible but did not receive an influenza vaccination during the time period when a practice was administering vaccine. Vaccine availability spanned the first and last dates of influenza vaccination by practice. Missed opportunities were calculated for first and second vaccine doses.
The study population was 30.5% fully vaccinated. Most children (63.8%) had one or more missed opportunities for influenza vaccination during the period of vaccine availability. Among children with missed opportunities, influenza vaccination coverage was 12.9% for full vaccination. Most missed opportunities occurred at non-well child visits and at visits when no other vaccines were given. Eliminating all missed opportunities would have increased full vaccination coverage from 30.5% to 52.7%.
Reducing missed opportunities would substantially increase vaccination coverage. Evidence-based strategies implemented in the practice setting such as flagging charts or computer notification to identify eligible children at every visit would reduce missed opportunities.