Pediatric Office Characteristics and Activities Associated with Increased Influenza Vaccine Delivery

Background: Efficient delivery of influenza vaccines is critical given the recent increase in the number of children recommended for annual influenza vaccination.

Objectives: To evaluate US pediatric office characteristics that correlate with vaccination coverage (receipt of ≥1 dose) and compliance with the recommended 2-dose regimen.

Methods: In this prospective, observational study, US outpatient pediatric offices tracked influenza vaccinations by age group as well as vaccination-related activities throughout the 2007-2008 and 2008-2009 seasons. Coverage was determined by the number of children vaccinated divided by the total number of children under the office’s care; 2-dose compliance was the rate of second dose receipt in children identified as requiring 2 vaccinations. Stepwise linear regression analyses evaluated correlations between office characteristics and vaccination coverage/compliance.

Results: Vaccination coverage for 6 months to 18 years was assessed at 36 and 77 offices in each season, respectively. For coverage, the strongest associations were with smaller practice size (0.5%-0.8% increase per 1000 fewer patients; P≤0.02), higher staff-to-patient ratio (+2.0% per additional staff member per 1000 patients; P<0.001), extended vaccine availability (+1.4% per additional 10 days; P<0.001), and staff support of CDC recommendations (+2.8% per 0.5 point increase on 5-point scale; P<0.001). Two-dose compliance was evaluated at 36 and 75 offices and was associated with extended vaccine availability (+1.2%-5.1% per additional 10 days; P≤0.002), urban location (-14.3%; P=0.022), and support for CDC recommendations (+3.6% per 0.5 point increase on 5-point scale; P<0.005).

Conclusions:  Pediatric offices may be able to increase in-office influenza vaccination coverage and compliance by offering vaccines for a longer duration of time and with clinics outside of normal hours. Larger offices and urban offices may be at a disadvantage in delivering vaccine. Providers should ensure adequate levels of staffing and staff member support for national recommendations. Sponsored by MedImmune.