Original Article

Influenza Vaccine: Awareness and Barriers to Immunization in Families of Children with Chronic Medical Conditions Other than Asthma

Authors: Ayesha Mirza, MD, Asad Subedar, BA, Sandra L. Fowler, MD, Dennis L. Murray, MD, Sandra Arnold, MD, Debra Tristram, MD, Motasem Abuelreish, MD, Peter Wludyka, PhD, Thomas T. Chiu, MD, Mobeen H. Rathore, MD


Objectives: Children with chronic medical conditions (CMCs) are considered to be at increased risk for influenza and its related complications. Despite this, influenza immunization rates in the United States for children with CMCs in the primary care setting remain between 7–10%. This was a survey study looking at the barriers to influenza immunization among children with CMCs other than asthma. We examined caregiver knowledge and perceptions regarding influenza vaccine in addition to assessing other barriers, such as availability and perceived safety of the vaccine.

Methods: The study was conducted during the fall-winter influenza seasons of 2002–2003 and 2003–2004 at five academic institutions across the southeastern US. Convenience samples of 100–150 families attending pediatric subspecialty clinics were surveyed.

Results: A total of 794 surveys were completed. Controlling for disease, failure to recommend vaccination was significantly associated with failure to get the vaccine (P < 0.0001). Of the children who did not receive the vaccine, 61% of their parents believed that the vaccine itself could give influenza, 54% cited other safety concerns, and 30% thought it did not work. Among vaccine recipients, 163 (43%) reported that the primary care provider had given the vaccine, whereas 171 (45%) reported that the vaccine had been given at the subspecialty clinic.

Conclusion: This study highlights the importance of physician recommendation, as well as parental education, as some of the key elements crucial to the receipt of influenza vaccination in children with CMCs.

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1.Barker WH, Mullooly JP. Impact of epidemic type A influenza in a defined adult population. Am J Epidemiol 1980;112:798–811.
2.Mullooly JP, Barker WH. Impact of type A influenza on children: a retrospective study. Am J Public Health 1982;72:1008–1016.
3.Neuzil KM, Mellen BG, Wright PF, et al. The effect of influenza on hospitalizations, outpatient visits, and courses of antibiotics in children. N Engl JMed 2000;342:225–231.
4.Neuzil KM, Wright PF, Mitchel EF Jr, et al. The burden of influenza illness in children with asthma and other chronic medical conditions. J Pediatr 2000;137:856–864.
5.Izurieta HS, Thompson WW, Kramarz P, et al. Influenza and the rates of hospitalization for respiratory disease among infants and young children. N Engl J Med 2000;342:232–239.
6.Poehling KA, Edwards KM, Weinberg GA, et al. The underrecognized burden of influenza in young children. N Engl J Med 2006;355:31–40.
7.American Academy of Pediatrics. Influenza, in Pickering LR, Baker CJ, Long SS, et al (eds): Red Book 2006: Report of the Committee on Infectious Diseases. Elk Grove Village, IL, American Academy of Pediatrics, 2006, ed 27, pp 401–411.
8.Reichert TA, Sugaya N, Fedson DS, et al. The Japanese experience with vaccinating school children against influenza. N Engl J Med 2001;344:889–896.
9.Neuzil KM. Influenza vaccine in children with asthma: why no progress? J Pediatr 2001;138:301–303.
10.Kramarz P, DeStefano F, Gargiullo PM, et al. Influenza vaccination in children with asthma in health maintenance organizations. Vaccine Safety Datalink Team. Vaccine 2000;18:2288–2294.
11.Esposito S, Marchisio P, Droghetti R, et al. Influenza vaccination coverage among children with high-risk medical conditions. Vaccine 2006;24:5251–5255.
12.Gagliani M, Riggs MM, Kamenicky M, et al. A computerized reminder strategy is effective for annual influenza immunization of children with asthma or reactive airways disease. Pediatr Infect Dis J 2001;20:1155–1160.
13.Daley MF, Barrow J, Pearson K, et al. Identification and recall of children with chronic medical conditions for influenza vaccination. Pediatrics 2004;113:e26–e33.
14.Daley MF, Beaty BL, Barrow J, et al. Missed opportunities for influenza vaccination in children with chronic medical conditions. Arch Pediatr Adolesc Med 2005;159:986–991.
15.Marshall BC, Henshaw C, Evans DA, et al. Influenza vaccination coverage level at a cystic fibrosis center. Pediatrics 2002;109:E80.
16.Ma KK, Schaffner W, Colmenares C, et al. Influenza vaccinations of young children increased with media coverage in 2003. Pediatrics 2006;117:e157–e163.
17.Humiston SG, Lerner EB, Hepworth E, et al. Parent opinions about universal influenza vaccination for infants and toddlers. Arch Pediatr Adolesc Med 2005;159:108–112.
18.Tacken M, Braspenning J, Spreeuwenberg P, et al. Patient characteristics determine differences in the influenza vaccination rate more so than practice features. Prev Med 2002;35:401–406.
19.Daley MF, Crane LA, Chandramouli V, et al. Influenza among healthy young children: changes in parental attitudes and predictors of immunization during the 2003 to 2004 influenza season. Pediatrics 2006;117:e268–e277.