Do interventions improve flu vaccinations in vulnerable kids?


Improving influenza vaccination coverage is important for all children, but some are at greater risk for poorer outcomes. A review examines whether interventions can improve vaccine coverage.

Influenza can be dangerous for any child, but children who have medical comorbidities are at greater risk of poorer clinical outcomes and severe influenza than children without them. However, influenza vaccinations aren’t administered as much as they should be. A review in Pediatrics examined the impact of interventions on improving this vaccine coverage.1

The investigators used PubMed, Scopus, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine, and Web of Science to find articles that were published from January 1976 to March 2019. The studies were cohort, quasi-experimental studies, or randomized control trials, and occurred in community, primary care, and hospital setting. They were reviewed if they included children who met medical comorbidity criteria and evaluated at least 1 intervention designed to improve influenza vaccination in children with at least 1 medical comorbidity. Four reviewers also independently assessed the risk of bias.

Of the 961 articles reviewed, 35 met the inclusion criteria. A majority of the studies looked at the seasonal influenza vaccination, but 2 studied the pandemic H1N1/09 influenza vaccination. Interventions in the studies included parental reminders such as postcards or text messages, verbal reminders at appointments, provider educational sessions, patient portal reminders, and phone calls. The results from the studies indicated that vaccination reminders and education, directed at either parents or provider, was linked to significant improvement in influenza vaccine coverage. In fact, interventions helped improve influenza vaccine coverage by an average of 60%, although no significant difference was noted between intervention types.

The investigators concluded that using interventions did lead to improvements in coverage, in a population that needs significant coverage improvement. They urged further study that evaluates other intervention types to fuel future interventions that can improve outcomes.


1. Norman D, Barnes R, Pavlos R et al. Improving influenza vaccination in children with comorbidities: a systematic review. Pediatrics. February 8, 2021. Epub ahead of print. doi:10.1542/peds.2020-1433

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