Improving flu shot rates in hospitalized children


Hospitalized children are often at risk of influenza morbidity and mortality, which means that influenza vaccination before discharge can help mitigate those risks. A study discusses how a quality improvement program could make a difference.

Despite its efficacy, the flu shot rates are still relatively low in children with only 63% of US children receiving it for the 2018-2019 influenza season. Children who are hospitalized often have conditions that may predispose them to influenza morbidity and mortality, but coverage rates are frequently lower than the national average. An investigation in JAMA Network Open examined whether a clinical decision support strategy could improve influenza vaccination rates before discharge from the hospital.1

Investigators conducted this quality improvement study in children who were eligible for the season influenza vaccine and were hospitalized in a tertiary pediatric health system that provides care to more than half a million patients every year in 3 hospitals. The intervention included putting a default flu short order into admission sets for eligible patients, providing a script to offer the flu shot that uses the presumptive strategy, and just-in-time education for clinicians that addressed vaccine eligibility.

There were 17,740 hospitalizations, mostly among Black (n = 8943) and White (n = 7559) patients with many using public insurance (n = 11,724). Of those hospitalizations, 10,997 were eligible for the influenza vaccine in the 2019-2020 influenza season, which were split evenly into the intervention group and concurrent controls. A pool of 6743 hospitalizations from 2018-2019 served as historical controls. Vaccine administration rates were 31% in the intervention group, 19% in the concurrent control group, and 14% in the historical control group. Following adjustment, investigators found that the odds of being administered an influenza vaccine was 3.25 (95% CI, 2.94 – 3.59) times higher in the intervention group and 1.28 (95% CI, 1.15-1.42) times higher in the concurrent controls than in the historical controls.

The investigators concluded that the program appeared to be linked to a definite improvement in vaccination rates among children who are hospitalized. Further study should see whether the benefits are sustained across seasons and whether the model would have similar results at other institutions.


1. Orenstein E, El Sayed-Ali O, Kandaswamy S, et al. Evaluation of a clinical decision support strategy to increase influenza vaccination among hospitalized children before inpatient discharge. JAMA Netw Open. 2021;4(7):e2117809. doi: 10.1001/jamanetworkopen.2021.17809

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