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Influenza
PEDIATRICS Vol. 112 No. 4 October 2003, pp. 821-828

Potential Burden of Universal Influenza Vaccination of Young Children on Visits to Primary Care Practices

Peter G. Szilagyi, MD, MPH*,{ddagger}, Marika K. Iwane, PhD, MPH*,||, Stanley Schaffer, MD*,{ddagger}, Sharon G. Humiston, MD, MPH*,§, Richard Barth, BS*,{ddagger}, Thomas McInerny, MD*,{ddagger}, Laura Shone, MSW*,{ddagger} and Benjamin Schwartz, MD*,||

* New Vaccine Surveillance Network
{ddagger} Departments of Pediatrics
§ Emergency Medicine, University of Rochester School of Medicine and Dentistry, Strong Children’s Research Center, Rochester, New York
|| National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia

Objective. To estimate the additional number of visits to primary care practices that would be required to deliver universal influenza vaccination to 6- to 23-month-old children.

Methods. Children who were covered by commercial and Medicaid managed care plans (70% of children in the region; >8000 children in each of 3 consecutive influenza seasons) in the 6-county region surrounding and including Rochester, New York, were studied. An analysis was conducted of insurance claims for visits (well-child care [WCC]; all other visits) to primary care practices during 3 consecutive influenza vaccination seasons (1998–2001). We determined the proportion of children who made 1 or 2 visits during the potential influenza vaccination period, simulating several possible lengths of time available for influenza vaccination (2, 3, 4, or 5 months). We measured the proportion of children who were vaccinated during each influenza vaccination period. The added visit burden was defined as the number of additional visits that would be required to vaccinate all children, simulating 2 scenarios: 1) administering influenza vaccination only during WCC visits and 2) considering all visits as opportunities for influenza vaccination.

Results. Results were similar for each influenza season. Considering a 3-month influenza vaccination window and assuming that no opportunities were missed, if only WCC visits were used for influenza vaccination, then 74% of 6- to 23-month-olds would require at least 1 additional visit for vaccination—39% would require 1 additional visit and 35% would require 2 additional visits. If all visits to the practice were used for influenza vaccination during the 3-month window, then 46% would require at least 1 additional visit—34% would require 1 additional visit and 12% would require 2 additional visits. Longer vaccination periods would require fewer additional visits; eg, if a 4-month period were available, then 54% of children would require 1 or 2 additional visits if only WCC visits were used and 29% would require 1 or 2 additional visits if all visits were used for influenza vaccinations. Younger children (eg, 6- to 11-month-olds) would require fewer additional visits than older children (12- to 23-month-olds) because younger children already have more visits to primary care practices.

Conclusions. Implementation of universal influenza vaccination will result in a substantial increased burden to primary care practices in terms of additional visits for influenza vaccination. Practice-level strategies to minimize the additional burden include 1) using all visits (not just WCC visits) as opportunities for vaccination, 2) providing influenza vaccination for the maximum possible time period by starting to vaccinate as early as possible and continuing to vaccinate as late as possible, and 3) implementing short and efficient vaccination-only visits to accommodate the many additional visits to the practice.

Key Words: universal child influenza vaccination • visit burden • pediatric primary care

Abbreviations: ACIP, Advisory Committee on Immunization Practices • VFC, Vaccines for Children Program • AAP, American Academy of Pediatrics • ICD-9, International Classification of Diseases, Ninth Revision • WCC, well-child care

Received for publication Mar 17, 2003; Accepted Jun 4, 2003.




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