No abstract

Background: Influenza causes greater morbidity in children with cancer or sickle cell disease (SCD). Literature on influenza vaccination receipt for these populations is limited in low-vaccination states. Outpatient interventions improve vaccine receipt but isolated inpatient interventions remain unstudied. Procedure: We reviewed influenza vaccine receipt of children with cancer or SCD treated at Children’s Healthcare of Atlanta during three influenza seasons. We implemented a clinical decision support intervention during an influenza season and compared influenza vaccine receipt preintervention and postintervention among admitted children. Results: The oncology cohort (N=1548, 60% to 62%) and the SCD cohort (N=2549, 61% to 65%) had similar-to-higher vaccination receipt to the United States (58% to 64%, P=0.01 to 0.79) and Georgia (51% to 56%, P<0.01). The intervention did not significantly improve vaccination receipt for admitted children with cancer (40% vs. 56%, P=0.05 to 0.88) or SCD (44% vs. 56%, P=0.01). Regression modeling also found no significant increase in vaccine receipt (hematologic malignancy: 0.8 [0.73 to 0.98], solid tumor: 0.9 [0.80 to 1.90], central nervous system tumor: 0.9 [0.71 to 1.14], SCD: 0.9 [0.85 to 0.99]). Conclusions: Children with cancer and SCD have similar-to-greater influenza vaccination receipt compared with Georgia and the United States. An inpatient intervention did not significantly improve influenza vaccine receipt in these patient cohorts. Future studies are needed to identify alternative approaches to improving vaccine receipt in these cohorts.

Objective Vaccine hesitancy and refusal and the resulting outbreaks of vaccine-preventable diseases continue to be an issue today. Most of contemporary research on these issues has focused on underlying characteristics of non-vaccinators and ambivalent parents; however, few studies have looked into how or when vaccine preferences develop. In this study, we sought to explore when parental preferences for vaccines develop in relation to a pregnancy. We also examined self-reported influences on vaccine decision making. Methods We recruited and administered a short survey to parents at the North Carolina Women's Hospital in Chapel Hill, NC, following the birth of their child from February to April 2015. Results A total of 166 parents (55%) completed the entire survey. Seventy-two percent of surveyed parents reported deciding on their vaccine preferences for their newborn before conception. Parents who were older, Caucasian, married, and had attained higher levels of education were significantly more likely to develop preconception vaccine preferences. The presence of partner conversations in the past and the desire for more information on vaccines were also significant predictors of preconception vaccine preference development. After logistic regression adjustment, only education level and past vaccine conversations remained significant. The most common influences for vaccine decision making were family, friends, and medical staff and organizations. Conclusion Our study documents that a majority of parents establish vaccine decision making and preferences before conception. Notable influences from friends, family, and medical sources are part of the process. These findings suggest that vaccine information and interventions currently are given too late in the vaccine preference decision-making process.