Improving Influenza Vaccination in Children With Comorbidities: A Systematic Review

Norman, Daniel; Barnes, Rosanne; Pavlos, Rebecca; Bhuiyan, Mejbah; Alene, Kefyalew Addis; Danchin, Margie; Seale, Holly; Moore, Hannah C; Blyth, Christopher C

doi:10.1542/peds.2020-1433

Cited by 15 publications

(22 citation statements)

References 50 publications

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“…Overall, recall/reminders for patients and HCP reminders had the highest level of evidence and were the most effective interventions in improving influenza vaccination rates in all high-risk groups and in all types of setting including from primary and tertiary hospitals to large-scale community interventions in the real-world settings. [5][6][7][8][9]15,18,21,[25][26][27][28][29][30][39][40][41]43,50,51 Most reminders identified in this review incorporated educational information to either patients or HCPs. Although, the evidence on whether patient focused educational interventions in improving influenza vaccination uptake is mixed and varies with different target populations, they have shown a positive impact in improving vaccination uptake when administered through different outlets.…”

Section: Discussionmentioning

confidence: 99%

“…Another systematic review of 11 studies (five RCTs and six quasi experimental) 15 (NHMRC level II) also demonstrated that implementation of reminder/recall systems improve influenza vaccination rates in children with asthma (Table 3). Normal et al 8 (2021) and Aigbogun et al 9 (2014) conducted a systematic review of 35 studies (five RCTs and 29 non-RCTs) and 18 studies (seven RCTs & 12 non-RCTs) respectively assessing interventions aimed at increasing influenza vaccination rates in children with high-risk conditions. Normal et al 8 (2021) identified a further 17 studies not captured by Aigbogun et al 9 (2014) and pooled effect estimates for each intervention type in the included RCTs and other study methods (NHMRC level I).…”

Section: (I) People With Medical Conditionsmentioning

confidence: 99%

“…Normal et al 8 (2021) identified a further 17 studies not captured by Aigbogun et al 9 (2014) and pooled effect estimates for each intervention type in the included RCTs and other study methods (NHMRC level I). Both systematic reviews 8,9 found sufficient evidence that reminder letters to parents can improve influenza vaccination uptake in children with high-risk conditions (Table 3). (ii) Elderly adults Thomas et al 5 (2018) conducted a systematic review of 61 RCTs focused on improving influenza vaccination rates in people aged 60 years and older in the community.…”

Section: (I) People With Medical Conditionsmentioning

confidence: 99%

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A rapid global review of strategies to improve influenza vaccination uptake in Australia

Mohammed

McMillan

Elliott

et al. 2021

Human Vaccines & Immunotherapeutics

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This study aimed to identify effective strategies for improving the uptake of influenza vaccination and to inform recommendations for influenza vaccination programs in Australia. A rapid systematic review was conducted to assimilate and synthesize peer-reviewed articles identified in PubMed. The National Health and Medical Research Council (NHMRC) Hierarchy of Evidence was used to appraise the quality of evidence. A systematic search identified 4373 articles and 52 that met the inclusion criteria were included. The evidence suggests influenza vaccination uptake may be improved by interventions that (1) increase community/patient demand and access to influenza vaccine and overcome practice-related barriers; (2) reinforce the critical role healthcare providers play in driving influenza vaccination uptake. Strategies such as standing orders, reminder and recall efforts were successful in improving influenza vaccination rates. Community pharmacies, particularly in regional/remote areas, are well positioned to improve influenza vaccine coverage. The findings of this rapid review can be utilized to improve the performance of influenza immunization programs in Australia and other countries with comparable programs; and recommend priorities for future evaluation of interventions to improve influenza vaccination uptake.

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Section: Discussionmentioning

confidence: 99%

Section: (I) People With Medical Conditionsmentioning

confidence: 99%

Section: (I) People With Medical Conditionsmentioning

confidence: 99%

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A rapid global review of strategies to improve influenza vaccination uptake in Australia

Mohammed

McMillan

Elliott

et al. 2021

Human Vaccines & Immunotherapeutics

View full text Add to dashboard Cite

show abstract

“…A study of children hospitalized due to influenza infection indicated that subspecialty clinics represented the visit type with the highest proportion of missed opportunities for vaccination, particularly for children with a high-risk medical condition (23). Vaccine reminderrecall is an effective strategy relevant to ambulatory settings that has been implemented using various modalities (e.g., letter, telephone, text message, email, EHR-based messages) (24)(25)(26)(27).…”

Section: Vaccination In Subspecialty Clinicsmentioning

confidence: 99%

Beyond Influenza Vaccination: Expanding Infrastructure for Hospital-based Pediatric COVID-19 Vaccine Delivery

Hofstetter

Rao

Jhaveri

2022

Clinical Therapeutics

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Controlling the spread of COVID-19 will rely on increasing vaccination rates in an equitable manner. The main reasons for under-vaccination are varied among different segments of the population and include vaccine hesitancy and lack of access. While vaccine hesitancy is a complicated problem that requires long-term solutions, enhancing access can be achieved through evidenced-based delivery strategies that augment traditional approaches. Hospital-based COVID-19 vaccination programs hold particular promise for reaching populations with decreased vaccine access and those at higher risk for adverse outcomes from COVID-19 infection. Hospitals have the necessary equipment and storage capabilities to maintain cold chain requirements, a common challenge in the primary care setting, and can serve as a central distribution point for delivering vaccines to patients in diverse hospital locations, including inpatient units, emergency departments, urgent care centers, perioperative areas, and subspecialty clinics. They also have the capacity for mass vaccination programs and other targeted outreach efforts. Hospital-based vaccination programs can leverage existing infrastructure such as electronic health record tools that have been successful approaches for influenza and other routine vaccinations. With the possibility of COVID-19 becoming endemic, much like seasonal influenza, these programs will require flexibility as well as planning for long-term sustainability. The goal of this review is to highlight existing vaccine delivery to children in hospital-based settings, including key advantages and important challenges, and outline how these systems could be expanded to include COVID-19 vaccine delivery.

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“…24 Maximizing coverage with current influenza vaccines requires interventions targeting parental attitudes, clinician behaviors, and immunization delivery practices. 25 It is anticipated that future influenza vaccines currently in development should produce greater protection in children and adults. 26 Children aged <6 months were at greater odds of being admitted to ICU and experience longer hospital stays.…”

Section: The Prevalence and Impact Of Comorbiditiesmentioning

confidence: 99%

Influenza hospitalizations in Australian children 2010–2019: The impact of medical comorbidities on outcomes, vaccine coverage, and effectiveness

Norman

Cheng

Macartney

et al. 2021

Influenza Resp Viruses

Self Cite

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Background: Children with comorbidities are at greater risk of severe influenza outcomes compared with healthy children. In Australia, influenza vaccination was funded for those with comorbidities from 2010 and all children aged <5 years from 2018. Influenza vaccine coverage remains inadequate in children with and without comorbidities.Methods: Children ≤16 years admitted with acute respiratory illness and tested for influenza at sentinel hospitals were evaluated (2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019). Multivariable regression was used to identify predictors of severe outcomes. Vaccine effectiveness was estimated using the modified incidence density test-negative design.Results: Overall, 6057 influenza-confirmed hospitalized cases and 3974 test-negative controls were included. Influenza A was the predominant type (68.7%). Comorbidities were present in 40.8% of cases. Children with comorbidities were at increased odds of ICU admission, respiratory support, longer hospitalizations, and mortality. Specific comorbidities including neurological and cardiac conditions increasingly predisposed children to severe outcomes. Influenza vaccine coverage in influenza negative children with and without comorbidities was low (33.5% and 17.9%, respectively). Coverage improved following introduction of universal influenza vaccine programs for children <5 years. Similar vaccine effectiveness was demonstrated in children with (55% [95% confidence interval (CI): 45; 63%]) and without comorbidities (57% [(95%CI: 44; 67%]). Conclusions: Comorbidities were present in 40.8% of influenza-confirmed admissions and were associated with more severe outcomes. Children with comorbidities were more likely experience severe influenza with ICU admission, mechanical ventilation, and in-hospital morality. Despite demonstrated vaccine effectiveness in those with and without comorbidities, vaccine coverage was suboptimal. Interventions to increase vaccination are expected to reduce severe influenza outcomes.

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Improving Influenza Vaccination in Children With Comorbidities: A Systematic Review

Cited by 15 publications

References 50 publications

A rapid global review of strategies to improve influenza vaccination uptake in Australia

A rapid global review of strategies to improve influenza vaccination uptake in Australia

Beyond Influenza Vaccination: Expanding Infrastructure for Hospital-based Pediatric COVID-19 Vaccine Delivery

Influenza hospitalizations in Australian children 2010–2019: The impact of medical comorbidities on outcomes, vaccine coverage, and effectiveness

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