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Background: Children with chronic conditions have increased risk of complications from influenza and historically have had low seasonal flu vaccination rates; prior studies have reported vaccination rates of 21% among children with asthma in the Michigan Medicaid program. The state of Michigan has utilized its statewide immunization information system to enhance flu vaccination through the 2006 implementation of a pop-up indicator to identify children with high-risk conditions (HRCs), and by facilitating registry-based reminder notification to this population.
Objectives: To assess the success of these strategies to improve flu vaccination for children with HRCs.
Methods: We identified all children age 24-59 months residing in three counties and who were labeled with the high-risk indicator on the Michigan Care Improvement Registry (MCIR). Eligible children were randomized into two groups (mailed reminder, no reminder); children without a flu vaccination dose were eligible for a reminder notice which were generated by MCIR and mailed the first week of November 2008. Date of flu vaccination through
Results: Of 3,618 children who met study criteria, 21% received flu vaccine in October. Among the remaining 2,653 children with HRCs, 1,330 were mailed reminders and 1,323 received no reminder; 29% of mailed reminders were returned as undeliverable. Overall flu vaccination rate for the season was 41% for all children with HRCs, 45% for children who received a mailed reminder notification, and 40% for children with no reminder.
Conclusions: The flu vaccination rate for children with HRCs was substantially higher than earlier rates in Michigan, suggesting that efforts to emphasize the importance of flu vaccination among this population have been successful. Flu vaccination reminders were associated with a modest increase in flu vaccination among children with HRCs.