The effect of physician’s recommendation on seasonal influenza immunization in children with chronic diseases

Abstract

BackgroundDespite recommendations by Health Authorities, influenza immunization coverage remains low in children with chronic diseases. Different medical providers involved in the management of children with chronic conditions may affect the pattern of influenza vaccine recommendations and coverage. The likelihood of vaccination by type of provider in children with chronic conditions is poorly understood. Therefore, the objectives of this study were to analyze the pattern and the effect of recommendations for seasonal influenza immunization provided by different physician profiles to families of children with chronic diseases and to measure the frequency of immunization in the study population.MethodsWe recruited children with chronic diseases aged 6 months–18 years who subsequently presented to specialty clinics for routine follow-up visits, during spring 2009, in three Italian Regions Families of children with chronic diseases were interviewed during routine visits at reference centers through a face-to-face interview. We analyzed the following immunization predictors: having received a recommendation toward influenza immunization by a health provider; child’s sex and age; mothers and fathers’ age; parental education and employment; underlying child’s disease; number of contacts with health providers in the previous year. Influenza immunization coverage was calculated as the proportion of children who received at least one dose of seasonal influenza vaccine in the previous season. We calculated prevalence ratios and we used a generalized linear model with Poisson family, log link and robust error variance to assess the effect of socio-demographic variables, underlying diseases, and recommendations provided by physicians on influenza immunization.ResultsWe enrolled 275 families of children with chronic diseases. Overall influenza coverage was 57.5%, with a low of 25% in children with neurological diseases and a high of 91.2% in those with cystic fibrosis. While 10.6% of children who did not receive any recommendation toward influenza immunization were immunized, among those who received a recommendation 87.5-94.7% did, depending on the health professional providing the recommendation. Receiving a recommendation by any provider is a strong predictor of immunization (PR = 8.5 95% CI 4.6;15.6) Most children received an immunization recommendation by a specialty (25.8%) or a family pediatrician (23.3%) and were immunized by a family pediatrician (58.7%) or a community vaccinator (55.2%).ConclusionsReceiving a specific recommendation by a physician is a strong determinant of being immunized against seasonal influenza in children with chronic diseases independently of other factors. Heterogeneity exists among children with different chronic diseases regarding influenza recommendation despite international guidelines. Increasing the frequency of appropriate recommendations toward influenza immunization by physicians is a single powerful intervention that may increase coverage in children with chronic conditions.

Prevalence and determinants of influenza vaccine coverage at tertiary pediatric hospitals

“…In corroboration with previous studies [19][20][21][22][23][24], the most important determinant of influenza vaccine coverage amongst the children in this study was a recommendation by a healthcare worker. High risk children accessed outpatient pediatric clinics at a tertiary pediatric hospital frequently and also had higher vaccine coverage.…”

Knowledge, attitudes, and practices about influenza illness and vaccination: a cross‐sectional survey in two South African communities

“…While studies of vaccine acceptability among primary caretakers in the community are limited, willingness to accept influenza vaccine in this study was similar to acceptability observed among healthcare workers in Kenya16 and Cote d'Ivoire17 and higher than acceptability observed among pregnant women in Cote d'Ivoire18 during the 2009 influenza A (H1N1) pandemic. We did not explore how clinician recommendations, which have been shown to influence vaccination attitudes and practices,19 might affect willingness to receive influenza vaccine in this population. Health messaging in South African communities should consider highlighting influenza as a disease distinct from upper respiratory infections and should clarify that influenza can cause severe outcomes that may be mitigated by vaccination and other prevention strategies.…”

Pertussis vaccine for adults: Knowledge, attitudes, and vaccine receipt among adults with children in the household

“…Understanding factors associated with and obstacles preventing Tdap receipt will aid in the development of future interventions to improve Tdap vaccine coverage in this population. It has been well described in the pediatric population that provider recommendation and source of vaccine information play an important role in parental vaccine decision making [6][7][8][9][10][11]. However few studies have described the association between these factors and adult vaccine receipt.…”