Factors associated with in-office influenza vaccination by U.S. pediatric providers

Nursing knowledge, attitude, and practice to influenza vaccination at suburban hospital in West Java, Indonesia

BACKGROUND

High epidemiology of influenza in the world and Indonesia causes some groups to have high risk for getting infected with influenza, one of which is healthcare workers. The low rates of influenza vaccination among healthcare workers, especially in nurses, raise the need for an educational strategy to prevent influenza. This study aimed to measure the level of knowledge, attitude and practice among nurses in suburban hospital in West Java.

METHOD

This was a cross-sectional study with a random sampling method which started on July-August 2018 at Annisa Medical Center General Hospital. Knowledge, attitude, and practice of research subjects were measured using questionnaire containing 37 items. The questionnaire was the result of adaptation of several questionnaires and a validity test has been was conducted. The data obtained was then analyzed descriptively by the proportion of the score of knowledge, attitude, and practice.

RESULTS

Of 104 respondents, 19% respondents had a low level, 74% respondents had a moderate level and 7% had a high level of knowledge toward influenza vaccination. For attitude, 67% of the respondents had a positive attitude and 33% respondents had a negative attitude. The study also showed that 58% of the respondents had a positive practice and 42% respondents had negative attitude.

CONCLUSIONS

Nurses possess adequate knowledge and showed a positive attitude and practice toward influenza vaccination. A continous educational strategy was needed to improve nurses' knowledge, attitude and practice about influenza vaccination.

A population-based study of maternal and infant factors influencing influenza vaccination among young children born in Colorado from 2008 to 2016

INTRODUCTION

Influenza causes significant morbidity among young children, and vaccination remains the best strategy to prevent disease. Understanding factors influencing early influenza vaccination uptake are important to identify strategies to increase vaccination rates.

OBJECTIVE

To assess maternal and neonatal factors associated with influenza vaccination among first-born children within the first two years of life.

METHODS

We conducted a retrospective population-based cohort study linking Colorado Birth Registry data and state immunization data of all live births between 2008 and 2016. The cohort was limited to singleton, first births. Multivariable logistic regression was used to assess associations between maternal and neonatal factors and influenza vaccination.

RESULTS

Among 126,763 births meeting criteria for inclusion, 50.2% were vaccinated against influenza by two years of age. Mothers of unvaccinated children were older (27 vs 26 years, p < 0.0001), married (67.8% vs 66.8%, p < 0.0001), with a college education (38.8% vs 37.2%, p < 0.0001). Influenza vaccination rates declined over time by birth year (30.5% in 2009 vs 6.8% in 2013, p < 0.0001). Children admitted to the NICU receiving oxygen with 72 h of birth were 20% less likely to be vaccinated (RR = 0.8, 95% CI: 0.67-0.96) after adjusting for maternal age, race/ethnicity, education and preterm birth. Conversely, premature births were associated with an increase in influenza vaccination by age two years (RR = 1.1, 95%CI: 1.05, 1.15).

CONCLUSIONS

Among a large population-based cohort of mother-infant pairs in Colorado using birth and immunization registry data, there were statistically significant differences in maternal factors between unvaccinated and vaccinated children with influenza in the first 2 years of life, but the differences were too small to be clinically significant. Children admitted to the NICU were 20% less likely to be vaccinated, highlighting the need to target influenza vaccination in this population once eligible. Ongoing studies are needed to explore factors associated with early influenza vaccination.

Using the 4 Pillars™ Practice Transformation Program to increase adolescent human papillomavirus, meningococcal, tetanus-diphtheria-pertussis and influenza vaccination

OBJECTIVES

To report the results of an intervention using the 4 Pillars™ Practice Transformation Program (4 Pillars™ Program) to increase adolescent vaccinations including human papillomavirus vaccine (HPV) and influenza vaccines, which remain underutilized in this population.

STUDY DESIGN

Eleven pediatric and family medicine practices, previously control sites from a randomized controlled cluster trial, with ≥50 adolescent patients participated. The 4 Pillars™ Program was the foundation of the intervention. De-identified demographic, office visit and vaccination data were derived from electronic medical record extractions for patients whose date of birth was 4/1/1997 to 4/1/2004 (ages 11-17years at baseline). Vaccination rates for HPV, influenza, tetanus-pertussis-diphtheria (Tdap) and meningococcal (MenACWY) vaccines were determined for all eligible patients pre- and post intervention (i.e., vaccination rates on 4/1/2015 and 4/30/2016).

RESULTS

Among 9473 patients ages 11-17years at baseline (4/1/2015), mean pre-intervention vaccination rates for HPV initiation and completion, meningococcal, Tdap and influenza vaccines were below national levels. Rates increased significantly post intervention (P<0.001) for HPV initiation which increased 17.1 percentage points (PP) from 51.4%; HPV completion increased 14.8PP from 30.7%, meningococcal vaccine uptake increased 16.6PP from 79.1%, Tdap vaccine uptake increased 14.6PP from 76.9%. Influenza vaccine uptake did not increase significantly (2.3PP from 40.1%). In the regression using generalized estimating equations, odds of vaccination were higher for younger, non-white adolescents for all vaccines; being in a smaller practice decreased the odds of Tdap vaccination but increased the odds of influenza vaccination.

CONCLUSION

Clinically and statistically significant improvements in HPV series initiation and completion, and meningococcal and Tdap vaccinations were observed in primary care practices implementing the 4 Pillars™ Practice Transformation Program. Clinical Trial Registry Number: NCT02165722.

Barriers of Influenza Vaccination Intention and Behavior - A Systematic Review of Influenza Vaccine Hesitancy, 2005 - 2016

BACKGROUND

Influenza vaccine hesitancy is a significant threat to global efforts to reduce the burden of seasonal and pandemic influenza. Potential barriers of influenza vaccination need to be identified to inform interventions to raise awareness, influenza vaccine acceptance and uptake.

OBJECTIVE

This review aims to (1) identify relevant studies and extract individual barriers of seasonal and pandemic influenza vaccination for risk groups and the general public; and (2) map knowledge gaps in understanding influenza vaccine hesitancy to derive directions for further research and inform interventions in this area.

METHODS

Thirteen databases covering the areas of Medicine, Bioscience, Psychology, Sociology and Public Health were searched for peer-reviewed articles published between the years 2005 and 2016. Following the PRISMA approach, 470 articles were selected and analyzed for significant barriers to influenza vaccine uptake or intention. The barriers for different risk groups and flu types were clustered according to a conceptual framework based on the Theory of Planned Behavior and discussed using the 4C model of reasons for non-vaccination.

RESULTS

Most studies were conducted in the American and European region. Health care personnel (HCP) and the general public were the most studied populations, while parental decisions for children at high risk were under-represented. This study also identifies understudied concepts. A lack of confidence, inconvenience, calculation and complacency were identified to different extents as barriers to influenza vaccine uptake in risk groups.

CONCLUSION

Many different psychological, contextual, sociodemographic and physical barriers that are specific to certain risk groups were identified. While most sociodemographic and physical variables may be significantly related to influenza vaccine hesitancy, they cannot be used to explain its emergence or intensity. Psychological determinants were meaningfully related to uptake and should therefore be measured in a valid and comparable way. A compendium of measurements for future use is suggested as supporting information.

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.

Child and adolescent immunizations: selected review of recent US recommendations and literature

PURPOSE OF REVIEW

To provide a clinically relevant summary of the latest research and recommendations regarding childhood and adolescent immunizations.

RECENT FINDINGS

Childhood vaccination has dramatically reduced pediatric morbidity and mortality in the United States. Recent research on childhood and adolescent immunizations has focused on expanding the use of current vaccines for additional subpopulations as well as the development of new vaccines. In particular, data confirming the safety and immunogenicity of vaccines in various groups of children have shaped national guidelines. Furthermore, studies on vaccine uptake, cost-effectiveness, and impact of vaccination have reinforced the importance of adhering to these guidelines. More work needs to be done by providers and parents to increase vaccination coverage rates to better protect children and adolescents from these serious diseases. In this article, selected recent publications and recommendations on the following vaccines are reviewed: influenza, meningococcal conjugate, childhood and adolescent/adult formulations of diphtheria and tetanus toxoids and acellular pertussis, pneumococcal conjugate, and human papillomavirus.

SUMMARY

Research on childhood and adolescent vaccinations continues to shape future guidelines. Through this work, we can learn how to optimize the protection of all children and adolescents against vaccine-preventable diseases.