Influenza vaccination coverage and timeliness among children requiring two doses, 2004-2009

Text Message Reminders for the Second Dose of Influenza Vaccine for Children: An RCT

BACKGROUND AND OBJECTIVES

Among children requiring 2 influenza doses in a given season, second dose receipt nearly halves the odds of influenza. Nationally, many children do not receive both needed doses. This study sought to compare the effectiveness of text message reminders with embedded interactive educational information versus usual care on receipt and timeliness of the second dose of influenza vaccine.

METHODS

This trial took place over the 2017 to 2018 and 2018 to 2019 influenza seasons among 50 pediatric primary care offices across 24 states primarily from the American Academy of Pediatrics' Pediatric Research in Office Settings practice-based research network. Caregiver-child dyads of children 6 months to 8 years in need of a second influenza vaccination that season were individually randomized 1:1 into intervention versus usual care, stratified by age and language within each practice. Intervention caregivers received automated, personalized text messages, including educational information. Second dose receipt by April 30 (season end) and by day 42 (2 weeks after second dose due date) were assessed using Mantel Haenszel methods by practice and language. Analyses were intention to treat.

RESULTS

Among 2086 dyads enrolled, most children were 6 to 23 months and half publicly insured. Intervention children were more likely to receive a second dose by season end (83.8% versus 80.9%; adjusted risk difference (ARD) 3.8%; 95% confidence interval [0.1 to 7.5]) and day 42 (62.4% versus 55.7%; ARD 8.3% [3.6 to 13.0]).

CONCLUSIONS

In this large-scale trial of primary care pediatric practices across the United States, text message reminders were effective in promoting increased and timelier second dose influenza vaccine receipt.

Vaccine hesitancy and influenza beliefs among parents of children requiring a second dose of influenza vaccine in a season: An American Academy of Pediatrics (AAP) Pediatric Research in Office Settings (PROS) study

To receive adequate protection against influenza, some children 6 months through 8 y old need two doses of influenza vaccine in a given season. Currently, only half of those receiving the first dose receive a second. Our objective was to assess vaccine hesitancy and influenza disease and vaccine knowledge, attitudes, and beliefs among caregivers of children who received the first of their two needed doses. As part of a national-randomized control trial of second dose text-message influenza vaccine reminders (2017-2018 season), a telephone survey collected caregiver and index child demographic information. Each child had received the first of two needed influenza vaccine doses. Caregivers completed a measure of general vaccine hesitancy - the five-question Parent Attitudes About Childhood Vaccines Survey Tool (PACV-5) - and questions about influenza infection and vaccine. We assessed associations between participant demographic characteristics, vaccine hesitancy, and influenza beliefs and calculated the standardized proportion of caregivers endorsing each outcome using logistic regression. Analyses included responses from 256 participants from 36 primary care practices in 24 states. Some caregivers (11.7%) reported moderate/high vaccine hesitancy and many had misperceptions about influenza disease and vaccine. In multivariable models, no single variable was consistently associated with inaccurate knowledge, attitudes, and beliefs. These results demonstrate that caregivers whose children received the first dose of influenza vaccine may still be vaccine hesitant and have inaccurate influenza beliefs. Pediatricians should consider broadly addressing inaccurate beliefs and promoting vaccination even after caregivers agree to the first dose.

Countering vaccine hesitancy through immunization information systems, a narrative review

Immunization is one of the most important public health interventions to contrast infectious disease; however, many people nowadays refuse vaccination. Vaccine hesitancy (VH) is due to several factors that influence the complex decision-making process. Information technology tools might play an important role in vaccination programs. In particular, immunization information systems (IISs) have the potential to improve performance of vaccination programs and to increase vaccine uptake. This review aimed to present IIS functionalities in order to counter VH. In detail, we analyzed the automatic reminder/recall system, the interoperability of the system, the decision support system, the web page interface and the possibility to record adverse events following immunization. IIS could concretely represent a valid instrument to increase vaccine confidence, especially trust in both health-care workers and decision makers. There are not enough trials aimed to evaluate the efficacy of IIS to counter VH. Further researches might focalize on this aspect.

Low coverage of influenza vaccination among Chinese children aged 12-23 months: Prevalence and associated factors

This study aimed to investigate prevalence and associated factors of influenza vaccination (IV) among children aged 12-23 months. Our cross-sectional survey interviewed 489 parents of children aged 12-23 months anonymously at twelve maternal and child health centers in Hong Kong. Results showed that only 11.5% of the children had ever received IV (64.3% being subsidized). Adjusted for the child's age, significant factors of the children's IV included parental knowledge about governmental policy/recommendation (Adjusted odds ratio [AOR] = 2.64, 95%CI = 1.09,6.40), knowledge about annual IV requirement (AOR = 2.30, 95%CI = 1.21,4.38), perceived safety-related barrier (AOR≥0.14, 95%CI = 0.06,0.33), cue to action (AOR = 7.79, 95%CI = 3.45,17.58), and subjective norm (AOR = 4.59, 95%CI = 2.34,9.00). IV prevalence of children aged 12-23 months remained low despite a subsidization scheme. The higher IV prevalence of older children reported by other studies suggested that parents postponed action. Promotion campaigns should shift emphases from cost reduction and mass media approaches to dissemination of knowledge about IV policy and safety, enhancement of health professionals' advice, and creation of supportive subjective norm.

Gaps in Training in Interdisciplinary Social and Behavioral Sciences and Applications Among Undergraduate and Graduate Students in the 22 Top-Ranked Schools of Public Health in China

The next generation of public health professionals requires rigorous training in behavioral health, in order to design effective behavioral interventions to respond effectively to the epidemiological transition in China. This study aimed to investigate issues in training in social and behavioral sciences in public health in China. A cross-sectional survey was conducted among 1285 and 835 last-year undergraduate and graduate public health students in 2013. The results showed that (1) majority of undergraduate students but a minority of graduate students had enrolled in psychology, social medicine, and health promotion courses; (2) very few had enrolled in other social and behavioral sciences courses; (3) high percentages of students perceived significance, needs, and interests related to social sciences courses; (4) very few were familiar with commonly used behavioral health theories and constructs, or had applied such theories/constructs to their thesis. The situation deviates from international accreditation requirement. A timely review and benchmarking are warranted.

Text message reminders for vaccination of adolescents with chronic medical conditions: A randomized clinical trial

BACKGROUND

Many adolescents with chronic medical conditions (CMCs) are at risk of vaccine-preventable infection, yet are frequently under-vaccinated. Text message reminders, particularly those with embedded educational information, have been shown to increase general pediatric vaccination. Their use has not been studied specifically among adolescents with CMCs.

METHODS

Eligible parents of adolescents with CMCs receiving care at one of 4 academically-affiliated pediatric clinics and requiring human papillomavirus (first dose), influenza, and/or pneumococcal polysaccharide vaccines were randomized in 4 consecutive cohorts to receive text message vaccine reminders with or without embedded educational information ("educational" vs. "plain" arm, respectively). Educational reminders, including one interactive message, addressed infection risk, vaccine safety/efficacy, and physician recommendations. Up to 5 weekly and 2 booster reminders were sent (October 2014-January 2015). Receipt of any needed vaccine and missed vaccination opportunities by 4, 12, and 24weeks after the initial reminder were compared between arms.

RESULTS

Of randomized parents (n=295), 175 (59.3%) were Spanish-speaking; most had adolescents with CMCs who were 13-17years (n=229; 77.6%) and publically insured (n=272; 92.5%). Baseline demographics and parental vaccine beliefs were similar between arms. More adolescents in the plain vs. educational reminder arm received any needed vaccine by 4weeks (31.9% vs. 22.7%, adjusted relative risk [aRR] 1.47, 95% CI 1.01-2.14), but not by 12 or 24weeks. Plain reminders were noted in post hoc analyses to have a greater effect than educational reminders in certain sub-populations, including 11-12year-olds and those sent the initial reminder in early fall. Fewer adolescents in the plain vs. educational reminder arm had a missed vaccination opportunity by 4weeks (10.9% vs. 41.3%; aRR 0.21, 95% CI 0.07-0.60), but not by 12 or 24weeks.

CONCLUSION

Plain text message vaccine reminders appear to have a positive effect compared to educational ones in the short-term and for certain families.

TRIAL REGISTRATION

NCT02231957 (www.clinicaltrials.gov).

Parental-Reported Full Influenza Vaccination Coverage of Children in the U.S

INTRODUCTION

Depending upon influenza vaccination history, children aged 6 months-8 years need one or two doses of influenza vaccine to be considered fully vaccinated. The objectives of this study were to quantify the percentage of children aged 6 months-8 years who were fully vaccinated against influenza based on parental report, overall, by state, and by sociodemographic characteristics, and to examine sociodemographic characteristics associated with being fully vaccinated.

METHODS

Data from the National Immunization Survey-Flu for the 2012-2013 and 2013-2014 influenza seasons were analyzed in 2015 using the Kaplan-Meier method to produce vaccination coverage estimates. Wald chi-square tests were used to test for bivariate associations, and Cox proportional hazards models were used to test for demographic characteristics independently associated with the child being fully vaccinated.

RESULTS

The percentages of children aged 6 months-8 years who were fully vaccinated during the 2012-2013 and 2013-2014 influenza seasons were 41.0% and 45.2%, respectively. Full vaccination varied widely by state and was more likely for children requiring only one dose. Based on the statistical models, children likely to be fully vaccinated were older, non-black, had a mother with an education >12 years, or lived in a high-income household.

CONCLUSIONS

Most children in the U.S. are not fully vaccinated against influenza. Reminder systems and interventions that reduce or remove barriers to children receiving their second doses of influenza vaccine may improve full influenza vaccination coverage among all children.

Trends in compliance with two-dose influenza vaccine recommendations in children aged 6 months through 8 years, 2010-2015

BACKGROUND

Children aged 6 months through 8 years may require two doses of influenza vaccine for adequate immune response against the disease. However, poor two-dose compliance has been reported in the literature.

METHODS

We analyzed data for >2.6million children from six immunization information system (IIS) sentinel sites, and assessed full vaccination coverage and two-dose compliance in the 2010-2015 influenza vaccination seasons. Full vaccination was defined as having received at least the recommended number of influenza vaccine doses (one or two), based on recommendations from the Advisory Committee on Immunization Practices. Two-dose compliance was defined as the percentage of children during each season who received at least two doses of influenza vaccine among those who required two doses and initiated the series.

RESULTS

Across seasons, ⩾1-dose influenza vaccination coverage was mainly unchanged among 6-23montholds (range: 60.9-66.6%), 2-4yearolds (range: 44.8-47.4%), and 5-8yearolds (range: 34.5-38.9%). However, full vaccination coverage showed increasing trends from 2010-11 season to 2014-15 season (6-23months: 43.0-46.5%; 2-4yearolds: 26.3-39.7%; 5-8yearolds, 18.5-33.9%). Across seasons, two-dose compliance remained modest in children 6-23months (range: 63.3-67.6%) and very low in older children (range: 11.6-18.7% in children 2-4yearsand6.8-13.3% in children 5-8years). In the 2014-15 season, among children who required and received 2 doses, only half completed the two-dose series before influenza activity peaked.

CONCLUSIONS

Improved messaging of the two-dose influenza vaccine recommendations is needed for providers and parents. Providers are encouraged to determine a child's eligibility for two doses of influenza vaccine using the child's vaccination history, and to vaccinate children early in the season so that two-dose series are completed before influenza peaks.

Do Maternal Knowledge and Attitudes towards Childhood Immunizations in Rural Uganda Correlate with Complete Childhood Vaccination?

Improving childhood vaccination coverage and timeliness is a key health policy objective in many developing countries such as Uganda. Of the many factors known to influence uptake of childhood immunizations in under resourced settings, parents' understanding and perception of childhood immunizations has largely been overlooked. The aims of this study were to survey mothers' knowledge and attitudes towards childhood immunizations and then determine if these variables correlate with the timely vaccination coverage of their children. From September to December 2013, we conducted a cross-sectional survey of 1,000 parous women in rural Sheema district in southwest Uganda. The survey collected socio-demographic data and knowledge and attitudes towards childhood immunizations. For the women with at least one child between the age of one month and five years who also had a vaccination card available for the child (N = 302), the vaccination status of this child was assessed. 88% of these children received age-appropriate, on-time immunizations. 93.5% of the women were able to state that childhood immunizations protect children from diseases. The women not able to point this out were significantly more likely to have an under-vaccinated child (PR 1.354: 95% CI 1.018-1.802). When asked why vaccination rates may be low in their community, the two most common responses were "fearful of side effects" and "ignorance/disinterest/laziness" (44% each). The factors influencing caregivers' demand for childhood immunizations vary widely between, and also within, developing countries. Research that elucidates local knowledge and attitudes, like this study, allows for decisions and policy pertaining to vaccination programs to be more effective at improving child vaccination rates.

Factors impacting influenza vaccination of urban low-income Latino children under nine years requiring two doses in the 2010-2011 season

The Advisory Committee on Immunization Practices (ACIP) recommends that certain children under 9 years of age receive two influenza vaccine doses in a season for optimal protection. Recent data indicate that many of these children fail to receive one or both of these needed doses. Contributing factors to under-vaccination of this population remain unclear. Caregivers of children aged 6 months-8 years requiring two influenza vaccine doses in the 2010-2011 season were identified from households enrolled in four urban Head Start programs. Recruitment and survey administration were conducted between March and June 2011. The impact of caregiver, provider, and practice-based factors on influenza vaccine receipt was assessed using bivariate and multivariable logistic regression analyses. Caregivers (n = 128) were predominantly mothers, Latina, Spanish-speaking, and non-U.S. born. Few children received one (31 %) or both (7 %) influenza vaccine doses. Caregivers who discussed influenza vaccination with providers were more likely to know their child needed two doses (55 vs. 35 %, p < 0.05) and have a fully vaccinated child (11 vs. 0 %, p < 0.05). Among caregivers whose child received the first dose, those who reported being told when to return for the second dose were also more likely to have a fully vaccinated child (35 vs. 0 %, p = 0.05). Belief in influenza vaccine effectiveness was positively associated with vaccination (p < 0.001), while safety concerns were negatively associated (p < 0.05). This study highlights the importance of provider-family communication about the two-dose regimen as well as influenza vaccine effectiveness and safety.

Influenza vaccine: Delayed vaccination schedules and missed opportunities in children under 2 years old

INTRODUCTION

In Argentina respiratory disease is the third leading cause of death in children under 5 years. In 2011 influenza vaccination was included in the National Calendar for children between 6 and 24 months (two doses schedule). Influenza vaccine coverage for second dose was 46.1% in 2013. The aim was to determine the proportion of delayed schedules and missed opportunities, to assess the characteristics of missed opportunities for vaccination and to explore the perception of influenza disease and vaccination from the parents of children between 6 and 24 months in different regions of Argentina in 2013.

METHODS

Analytical observational multicenter cross-sectional study. Structured surveys were carried out to the children's parents who were between 6 and 24 months of age during the influenza virus vaccination season (April-October 2013). Chi-Square test was used to assess association and differences between proportions and categorical variables. A logistic regression model was built to identify delay predictor variables in the vaccination schedules. Missed opportunities for vaccination were characterized through the estimation of proportions.

RESULTS

1350 surveys were conducted in the three centers. We detected 65% (884/1340) of delayed influenza vaccination schedules, 97% of them associated with missed opportunities of vaccination. The independent protective factors associated with a decreases risk of delayed schedules were: (a) perception of the importance of influenza vaccination (OR=0.42(0.18-0.94); p=0.035), (b) having less than one year of age (OR=0.75(0.59-0.96); p=0.022), (c) to have received information in pediatric visits or in any media (OR=0.71(0.56-0.90); p=0.004). There was 38% of MOIV in 1st dose and 63.4% in 2nd dose. The main cause of MOIV in 1st dose was not detecting the need for vaccination (39%) and in 2nd dose the unknowledge of the vaccination schedule (35.3%). No cultural reasons were detected.

CONCLUSIONS

High frequency of delayed vaccination schedules and missed opportunities were detected. Parents had little concern about the safety of influenza vaccine.

Prevalence and associated factors of seasonal influenza vaccination among 24- to 59-month-old children in Hong Kong

BACKGROUND

Influenza results in severe complications among 24- to 59-month-old children, who are recommended by the WHO to take up influenza vaccination (IV) annually. Health promotion is warranted. Yet, there is a dearth of studies on IV prevalence and associated factors in this age group.

METHODS

A random population-based telephone survey interviewed 540 parents of Chinese children aged 24-59 months in Hong Kong during March through June, 2011. Constructs of the Health Belief Model (HBM) and subjective norm formed basis for assessing parental perceptions on influenza and IV. For data analysis, adjusted, and stepwise multiple logistic regression models were fit.

RESULTS

The prevalence of having taken up at least one dose and two doses of IV among children aged 24-59 months was 58.9 and 42.4%, respectively. Significant associated factors included family members' IV experience (ORu=5.37, 95% CI: 3.48, 8.29), variables related to the HBM constructs (except perceived severity) [perceived susceptibility of seasonal influenza (ORu=2.03, 95% CI: 1.39, 2.95), perceived benefits of IV (ORu=3.11, 95% CI: 2.05, 4.71), perceived barriers (ORu=0.49, 95% CI: 0.25, 0.96) of IV, and cue to action (ORu=4.79, 95% CI: 2.87, 7.99)], supportive subjective norm (ORu=4.26, 95% CI: 2.91, 6.25), and level of fear felt during the H1N1 pandemic (ORu=1.97, 95% CI: 1.01, 3.87). Adjusted for the child's age, the same significant factors were found. Exposure to related media messages was statistically non-significant.

CONCLUSION

The reported IV prevalence was higher than that of 24- to 59-month-old children reported in other studies. There is room for improvement through health promotion, which should modify parental cognitions related to HBM (except perceived severity and self-efficacy) and involve family members to create subjective norm. Media campaigns may be inadequate for promotion of IV; use of the setting approach may be considered.

Impacting delayed pediatric influenza vaccination: a randomized controlled trial of text message reminders

BACKGROUND

Influenza vaccination coverage is low, especially among low-income populations. Most doses are generally administered early in the influenza season, yet sustained vaccination efforts are crucial for achieving optimal coverage. The impact of text message influenza vaccination reminders was recently demonstrated in a low-income population. Little is known about their effect on children with delayed influenza vaccination or the most effective message type.

PURPOSE

To determine the impact of educational plus interactive text message reminders on influenza vaccination of urban low-income children unvaccinated by late fall.

DESIGN

Randomized controlled trial.

SETTING/PARTICIPANTS

Parents of 5,462 children aged 6 months-17 years from four academically affiliated pediatric clinics who were unvaccinated by mid-November 2011.

INTERVENTION

Eligible parents were stratified by their child's age and pediatric clinic site and randomized using a 1:1:1 allocation to educational plus interactive text message reminders, educational-only text message reminders, or usual care. Using an immunization registry-linked text messaging system, parents of intervention children received up to seven weekly text message reminders. One of the messages sent to parents in the educational plus interactive text message arm allowed selection of more information about influenza and influenza vaccination.

MAIN OUTCOME MEASURES

Influenza vaccination by March 31, 2012. Data were collected and analyzed between 2012 and 2014.

RESULTS

Most children were publicly insured and Spanish speaking. Baseline demographics were similar between groups. More children of parents in the educational plus interactive text message arm were vaccinated (38.5%) versus those in the educational-only text message (35.3%; difference=3.3%, 95% CI=0.02%, 6.5%; relative risk ratio (RRR)=1.09, 95% CI=1.002, 1.19) and usual care (34.8%; difference=3.8%, 95% CI=0.6%, 7.0%; RRR=1.11, 95% CI=1.02-1.21) arms.

CONCLUSIONS

Text message reminders with embedded educational information and options for interactivity have a small positive effect on influenza vaccination of urban, low-income, minority children who remain unvaccinated by late fall.

Modeling receipt of influenza A(H1N1)pdm09 vaccinations among US children during the 2009-2010 flu season: findings from the 2010 National Health Interview Survey

OBJECTIVE

Using 32 weeks of data from the 2010 National Health Interview Survey, factors associated with receipt of influenza A(H1N1)pdm09 vaccinations among US children during October 2009 through February 2010 are examined.

METHODS

Logistic models estimated receipt of first dose by January 1, 2010 for all children aged 4.5 months through 17 years and receipt of second dose by February 1, 2010 for children aged 6 months through 9 years who received a first dose, using demographic characteristics and measures of family structure, parental education, family income, access to health care, and chronic condition status. All analyses were weighted to yield nationally representative results for the US child population.

RESULTS

Receipt of a seasonal influenza vaccination in the 12 months before October 2009 as well as race/ethnicity, family structure, and various measures representing family socioeconomic status were statistically significant correlates of receipt of the first pH1N1 dose, whereas children's asthma and chronic condition status were not.

CONCLUSIONS

In the event of future pandemics, public health officials may utilize these findings to target particular segments of the US child population that may have been underserved during the 2009 influenza pandemic.

Registry-linked electronic influenza vaccine provider reminders: a cluster-crossover trial

OBJECTIVE

To determine the impact of a vaccination reminder in an electronic health record supplemented with data from an immunization information system (IIS).

METHODS

A noninterruptive influenza vaccination reminder, based on a real-time query of hospital and city IIS, was used at 4 urban, academically affiliated clinics serving a low-income population. Using a randomized cluster-crossover design, each study site had "on" and "off" period during the fall and winter of 2011-2012. Influenza vaccination during a clinic visit was assessed for 6-month to 17-year-old patients. To assess sustainability, the reminder was active at all sites during the 2012-2013 season.

RESULTS

In the 2011-2012 season, 8481 unique non-up-to-date children had visits. Slightly more non-up-to-date children seen when the reminder was 'on' were vaccinated than when 'off' (76.2% vs 73.8%; P = .027). Effects were seen in the winter (67.9% vs 62.2%; P = .005), not fall (76.8% vs 76.5%). The reminder also increased documentation of the reason for vaccine non-administration (68.1% vs 41.5%; P < .0001). During the 2011-2012 season, the reminder displayed for 8630 unique visits, and clinicians interacted with it in 83.1% of cases where patients required vaccination. During the 2012-2013 season, it displayed for 22 248 unique visits; clinicians interacted with it in 84.8% of cases.

CONCLUSIONS

An IIS-linked influenza vaccination reminder increased vaccination later in the winter when fewer vaccine doses are usually given. Although the reminder did not require clinicians to interact with it, they frequently did; utilization did not wane over time.

Text message reminders for second dose of influenza vaccine: a randomized controlled trial

OBJECTIVE

To determine whether provision of vaccine-health-literacy-promoting information in text message vaccine reminders improves receipt and timeliness of the second dose of influenza vaccine within a season for children in need of 2 doses.

METHODS

During the 2012-2013 season, families of eligible 6-month through 8-year-old children were recruited at the time of their first influenza vaccination from 3 community clinics in New York City. Children (n = 660) were randomly assigned to "educational" text message, "conventional" text message, and "written reminder-only" arms. At enrollment, all arms received a written reminder with next dose due date. Conventional messages included second dose due date and clinic walk-in hours. Educational messages added information regarding the need for a timely second dose. Receipt of second dose by April 30 was assessed by using χ(2) tests. Timeliness was assessed by receipt of second dose by 2 weeks after due date (day 42) using χ(2) and over time using a Kaplan-Meier analysis.

RESULTS

Most families were Latino and publicly insured with no significant between-arm differences between groups. Children in the educational arm were more likely to receive a second dose by April 30 (72.7%) versus conventional (66.7%) versus written reminder-only arm (57.1%; P = .003). They also had more timely receipt by day 42 (P < .001) and over time (P < .001).

CONCLUSIONS

In this low-income, urban, minority population, embedding health literacy information improved the effectiveness of text message reminders in promoting timely delivery of a second dose of influenza vaccine, compared with conventional text messages and written reminder only.

HPV vaccination: are we initiating too late?

BACKGROUND

Human papillomavirus (HPV) vaccination is recommended in early adolescence. While limited data suggest that patients frequently delay initiation of the three-dose series, age-based variability in initiation of HPV vaccination and its clinical relevance are not well described. Thus, this study aims to characterize HPV vaccination delay among adolescent and young adult females.

METHODS

This retrospective cohort study examined age at HPV vaccination initiation and missed opportunities for receipt of the first vaccine dose (HPV1) among 11-26 year-old females (n=22,900) receiving care at 16 urban academically-affiliated ambulatory care clinics between 2007 and 2011. Predictors of timely vaccination and post-licensure trends in age at HPV1 receipt were assessed using multivariable logistic regression and a generalized linear mixed model, respectively. Chlamydia trachomatis and Papanicolaou screening before HPV vaccination initiation, as markers of prior sexual experience and associated morbidity, were examined in a subcohort of subjects (n=15,049).

RESULTS

The proportion of 11-12 year-olds who initiated HPV vaccination increased over time (44.4% [2007] vs. 74.5% [2011], p<0.01). Initiation rates also improved among 13-26 year-olds. Thus, the mean age at HPV1 receipt remained unchanged between 2007 and 2011 (16.0 ± 2.7 vs. 15.9 ± 4.0 years, p=0.45). Spanish language was a positive predictor (AOR 1.62, 95% CI 1.05-2.48) of HPV vaccination initiation among 11-12 year-olds in 2011. The majority (70.8-76.4%) of unvaccinated subjects experienced missed vaccination opportunities. Of the subcohort, 36.9% underwent Chlamydia screening before HPV1 receipt (19.1% with ≥ 1 positive result). Of those with prior Papanicolaou screening (16.6%), 32.1% had ≥ 1 abnormal result.

CONCLUSIONS

These low-income, minority females frequently delayed initiation of HPV vaccination. Many had evidence of prior sexual experience and associated morbidity, placing them at risk of HPV-related complications. Promoting timely HPV vaccination and reducing missed vaccination opportunities are crucial.

Trends in compliance with two-dose influenza vaccine recommendations among children aged 6 months through 8 years

Children aged <9 years may require two doses of influenza vaccine to achieve an adequate immune response to protect against the disease. We analyzed data for >2 million children in each influenza season from 2007 to 2012 from eight Immunization Information System Sentinel Sites to assess trends in two-dose compliance. Compliance was calculated by influenza season, age group, and influenza vaccination history. Two-dose compliance increased from 49% to 60% among 6-23 month olds from 2007 to 2012; no increase was observed for 2-4 or 5-8 year olds. In each season, compliance was 3-12 times higher among 6-23 month olds compared to older children and was two times higher among influenza vaccine naïve children compared to previously vaccinated children. Improved messaging for providers and parents about the importance of the two-dose recommendation, about which children are eligible for two doses, and provider access to complete influenza vaccination histories for all children are needed.

Timeliness of pediatric influenza vaccination compared with seasonal influenza activity in an urban community, 2004-2008

OBJECTIVES

We assessed pediatric influenza vaccination in relation to community influenza activity.

METHODS

We examined seasonal influenza vaccination in 34,012 children aged 6 months through 18 years from 5 academically affiliated clinics in northern Manhattan, New York (an urban low-income community) during the 2004-2008 seasons using hospital and city immunization registries. We calculated the cumulative number of administered influenza vaccine doses and proportion of children with any (≥ 1 dose) or full (1-2 doses per age recommendations) vaccination at the onset and peak of community polymerase chain reaction-confirmed influenza activity according to state surveillance reports and by March 31 each season.

RESULTS

Influenza vaccine administration began before October 1, peaked before influenza activity onset, and declined gradually over each season. Coverage at influenza activity onset, peak, and by March 31 increased over the 5 seasons. However, most children lacked full vaccination at these time points, particularly adolescents, minorities, and those requiring 2 doses.

CONCLUSIONS

Despite early initiation of influenza vaccination, few children were fully vaccinated when influenza began circulating. Interventions should address factors negatively affecting timely influenza vaccination, especially in high-risk populations.