High Inter-Office Variability in Pediatric Influenza Vaccination

Background: Limited data are available on the utilization of influenza vaccines in US pediatric offices.

Objectives: To describe office-level influenza vaccination with regards to timing, uptake, and vaccination-related practices in a geographically representative sample of US pediatric practices.

Methods: An observational study was conducted in 2008–2009 in 84 US outpatient pediatric offices located in 34 states. Sites were recruited from a random sample of licensed US pediatricians. Offices prospectively tracked influenza vaccinations administered by age group and vaccination-related activities. Office-level results were summarized and the number of first vaccinations administered per 100 children and the ratio of second to first vaccinations administered to children <9 years requiring 2 doses were calculated.

Results: There was considerable variability across offices on all outcomes evaluated. Influenza vaccines were offered for a median of 199 days per office (range, 82–249), with a median first available date of August 31 (July 31–November 14), last available date of March 29 (February 14–May 18), and a median of 45 hours per week (4–72 h). Offices reported delivering an average of 51% (range, 0%–100%) of vaccinations during well visits, 16% (range, 0%–60%) during sick visits, 28% (range, 0%–100%) during normal clinic hours, and 5% (range, 0%–70%) outside normal clinic hours. The median number of first vaccinations per 100 children was 23 (range, 2–79), and the median ratio of second to first vaccinations was 0.57 (range, 0.05–1.11).

Conclusions: Among US pediatric offices, there is considerable heterogeneity in the timing and delivery of influenza vaccinations. National estimates of pediatric vaccination rates should be interpreted in this context, and educational efforts should target offices with low vaccine utilization. Sponsored by MedImmune.