Universal flu immunization of young children: Feasible?

March 1, 2005
Michael G. Burke, MD

DR. BURKE, section editor for Journal Club, is chairman of the department of pediatrics at Saint Agnes Hospital, Baltimore. He is a contributing editor for <italic>Contemporary Pediatrics</italic>. He has nothing to disclose in regard to affiliations with

Investigators set out to determine how practical it is for a private pediatric practice to administer influenza vaccine to all healthy children 6 to 23 months of age. The study was conducted in five private pediatric practices in Colorado during the 2003-2004 influenza season-before vaccination among this age group became universal under the Recommended Childhood Immunization Schedule. The study population included children 6 to 21 months of age who had visited one of the offices in the previous 18 months and had a record in the immunization registry. (Children who would become more than 23 months of age during the influenza season were not included because of insurance considerations.) The practices' patient populations were from largely well-educated and middle class families.

To evaluate the effectiveness of immunization registry-based reminders/recall on immunization rates, the practices sent the intervention group as many as three reminder/recall letters. The control group received no reminders. More children in the intervention groups than in the control groups received one or more influenza shots, with the range among the five practices from 1.0% at the low end to 9.1% at the high end; overall, 4.4% more children in the intervention groups were immunized than in the control groups. Practices used a variety of methods to encourage immunization in both intervention and control groups. In two practices, 75% of eligible patients overall received at least one dose of vaccine. Only one practice had a vaccination rate less than 50%.

An early severe influenza epidemic in Colorado that triggered extensive media coverage during November and December 2003 seemed to blunt the effect of the registry recall, however-especially in children 6 to 11 months of age. By the end of the flu season, recall had a significant effect only on children 12 to 21 months of age, who had a 6.2% higher immunization rate than controls.

Commentary: Recognizing that recommendations for expanded influenza immunizations will put a strain on practices, the authors offer strategies to accommodate the additional load. High-volume immunization sessions, with or without an appointment, appeared to be the most successful system. Four of five practices offered vaccine to adults who accompanied a child.

You can use this article to plan for the 2005-2006 influenza vaccination program-at the same time you're hoping that manufacturers come through with a healthy supply of vaccine.