Published online January 3, 2005
PEDIATRICS Vol. 115 No. 1 January 2005, pp. 146-154 (doi:10.1542/peds.2004-1804)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Web of Science (22)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kempe, A.
Right arrow Articles by Berman, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kempe, A.
Right arrow Articles by Berman, S.
Related Collections
Right arrow Infectious Disease & Immunity
Right arrowRelated AAP Red Book topics:
Influenza
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

Implementation of Universal Influenza Immunization Recommendations for Healthy Young Children: Results of a Randomized, Controlled Trial With Registry-Based Recall

Allison Kempe, MD, MPH*,{ddagger}, Matthew F. Daley, MD*,{ddagger}, Jennifer Barrow, MSPH{ddagger}, Norma Allred, PhD§, Nellie Hester, BA{ddagger}, Brenda L. Beaty, MSPH{ddagger}, Lori A. Crane, PhD, MPH{ddagger},|, Kellyn Pearson, MSN{ddagger} and Stephen Berman, MD*,{ddagger}

* Departments of Pediatrics
| Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado
{ddagger} Children’s Outcomes Research Program, Children’s Hospital, Denver, Colorado
§ National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia

Background. An Advisory Committee on Immunization Practices policy of encouraging influenza vaccination for healthy 6- to 23-month-old children was in effect during the 2003–2004 influenza season, which was unusually severe in Colorado. We collaborated with 5 pediatric practices to attempt universal influenza immunization in this age group.

Objectives. The objectives were (1) to assess the maximal influenza immunization rates that could be achieved for healthy young children in private practice settings, (2) to evaluate the efficacy of registry-based reminder/recall for influenza vaccination, and (3) to describe methods used by private practices to implement the recommendations.

Methods. The study was conducted in 5 private pediatric practices in Denver, Colorado, with a common billing system and immunization registry. Although recommendations by the Advisory Committee on Immunization Practices included children who were 6 to 23 months of age at any point during the influenza season, our practices chose not to recall children 22 to 23 months of age, because they would have become >24 months of age during the study period. Therefore, our study population consisted of all healthy children 6 to 21 months of age from the 5 practices (N = 5193), who were randomized to intervention groups (n = 2595) that received up to 3 reminder/recall letters or to control groups (n = 2598) that received usual care. The primary outcome was receipt of ≥1 influenza immunization, as noted either in the immunization registry or in billing data.

Results. Immunization rates for ≥1 dose of influenza vaccine for the intervention groups in the 5 practices were 75.9%, 75.4%, 68.1%, 55.6%, and 44.3% at the end of the season. Overall, 62.4% of children in the intervention groups and 58.0% of children in the control groups were immunized (4.4% absolute difference), with absolute differences, compared with control values, ranging from 1.0% to 9.1% according to practice. However, before intensive media coverage of the influenza outbreak began (November 15, 2003), absolute differences, compared with control values, ranged from 5.1% to 15.3% and were 9.6% overall. Before November 15, significant effects of recall were seen for children in the intervention groups, in both the 12- to 21-month age category (10.4% increase over control) and the 6- to 11-month category (8.1% increase over control); at the end of the season, however, significant effects of recall were seen only for the older age group (6.2% increase over control). The rates of receipt of 2 vaccine doses ≥1 month apart for eligible children ranged from 21% to 48% among the practices. Four of the 5 practices held influenza immunization clinics during office hours, evenings, or weekends, and these clinics achieved higher coverage rates.

Conclusions. These results demonstrated that, in an epidemic influenza year, private practices were able to immunize the majority of 6- to 21-month-old children in a timely manner. Although media coverage regarding the epidemic blunted the effect of registry-based recall, recall was effective in increasing rates early in the epidemic, especially for children between 1 and 2 years of age. The practices that achieved the highest immunization rates were proactive in planning influenza clinics to handle the extra volume of immunizations required.

Key Words: influenza • immunizations • reminder/recall • immunization registry

Abbreviations: ACIP, Advisory Committee on Immunization Practices

Accepted Oct 4, 2004.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 PediatricsHome page
A. G. Fiks, K. F. Hunter, A. R. Localio, R. W. Grundmeier, T. Bryant-Stephens, A. A. Luberti, L. M. Bell, and E. A. Alessandrini
Impact of Electronic Health Record-Based Alerts on Influenza Vaccination for Children With Asthma
Pediatrics, July 1, 2009; 124(1): 159 - 169.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
M. A. Allison, M. F. Daley, J. Barrow, L. A. Crane, B. L. Beaty, N. Allred, and A. Kempe
High Influenza Vaccination Coverage in Children With High-Risk Conditions During a Vaccine Shortage
Arch Pediatr Adolesc Med, May 1, 2009; 163(5): 426 - 431.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
C. M. Rand, P. G. Szilagyi, B.-K. Yoo, P. Auinger, C. Albertin, and M. S. Coleman
Additional Visit Burden for Universal Influenza Vaccination of US School-Aged Children and Adolescents
Arch Pediatr Adolesc Med, November 1, 2008; 162(11): 1048 - 1055.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
E. K. Miller, M. R. Griffin, K. M. Edwards, G. A. Weinberg, P. G. Szilagyi, M. A. Staat, M. K. Iwane, Y. Zhu, C. B. Hall, G. Fairbrother, et al.
Influenza Burden for Children With Asthma
Pediatrics, January 1, 2008; 121(1): 1 - 8.
[Abstract] [Full Text] [PDF]

Home page
 CLIN PEDIATRHome page
M. F. Daley, L. A. Crane, V. Chandramouli, B. L. Beaty, J. Barrow, N. Allred, S. Berman, and A. Kempe
Misperceptions About Influenza Vaccination Among Parents of Healthy Young Children
Clinical Pediatrics, June 1, 2007; 46(5): 408 - 417.
[Abstract] [PDF]

Home page
 PediatricsHome page
J. A. Boom, A. C. Dragsbaek, and C. S. Nelson
The Success of an Immunization Information System in the Wake of Hurricane Katrina
Pediatrics, June 1, 2007; 119(6): 1213 - 1217.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
J. R. Verani, M. Irigoyen, S. Chen, and F. Chimkin
Influenza Vaccine Coverage and Missed Opportunities Among Inner-city Children Aged 6 to 23 Months: 2000-2005
Pediatrics, March 1, 2007; 119(3): e580 - e586.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
T. A. Santibanez, J. M. Santoli, C. B. Bridges, and G. L. Euler
Influenza Vaccination Coverage of Children Aged 6 to 23 Months: The 2002-2003 and 2003-2004 Influenza Seasons
Pediatrics, September 1, 2006; 118(3): 1167 - 1175.
[Abstract] [Full Text] [PDF]

Home page
 Epidemiol RevHome page
D. C. Ompad, S. Galea, and D. Vlahov
Distribution of Influenza Vaccine to High-Risk Groups
Epidemiol. Rev., August 1, 2006; 28(1): 54 - 70.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
K.K. Ma, W. Schaffner, C. Colmenares, J. Howser, J. Jones, and K.A. Poehling
Influenza Vaccinations of Young Children Increased With Media Coverage in 2003
Pediatrics, February 1, 2006; 117(2): e157 - e163.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
M. F. Daley, L. A. Crane, V. Chandramouli, B. L. Beaty, J. Barrow, N. Allred, S. Berman, and A. Kempe
Influenza Among Healthy Young Children: Changes in Parental Attitudes and Predictors of Immunization During the 2003 to 2004 Influenza Season
Pediatrics, February 1, 2006; 117(2): e268 - e277.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
M. F. Daley, B. L. Beaty, J. Barrow, K. Pearson, L. A. Crane, S. Berman, and A. Kempe
Missed Opportunities for Influenza Vaccination in Children With Chronic Medical Conditions
Arch Pediatr Adolesc Med, October 1, 2005; 159(10): 986 - 991.
[Abstract] [Full Text] [PDF]