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Influenza vaccination rates remain lower than expected
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Despite recommendations that all children aged at least 6 months should be immunized against influenza, data from 2004 to 2009 indicate lower-than-expected coverage rates.
Katherine A. Poehling, MD, MPH, of the department of pediatrics, Wake Forest School of Medicine, Winston-Salem, N.C., and colleagues from the New Vaccine Surveillance Network concluded that seasonal influenza remains an important cause of hospitalizations, ED visits and outpatient visits among children. In addition, the use of vaccination and antiviral medications were substantially underused.
The researchers analyzed population-based surveillance data on laboratory-confirmed influenza among children aged younger than 5 years during those years. Data from more than 8,000 children seen in inpatient and clinic settings, as well as EDs, were included in the analysis.
During the five study seasons, fewer than 45% of influenza-negative children aged 6 months and older were fully vaccinated against influenza. The study findings also indicated that single-season influenza hospitalization rates were 0.4 to 1.0 per 1,000 children aged younger than 5 years; hospitalization rates were highest for infants aged younger than 6 months.
The proportion of outpatient children with influenza ranged from 10% to 25% annually.
The researchers said testing for influenza among outpatients was low (approximately 7%), but higher in inpatient settings (approximately 58%). Rates of antiviral use were similar for inpatients, at 1% for outpatients, and 2% for children hospitalized with influenza.
“Additional efforts are needed for greater dissemination and use of the existing recommendations for influenza vaccination of children ≥6 months and of pregnant women, which partially protects younger infants,” the study researchers concluded.
The Advisory Committee on Immunization Practices expanded influenza vaccination recommendations from children aged 6 months and older with underlying medical conditions, to all children aged 6 to 23 months in 2004. In 2006, the recommendation changed to all children aged 6 to 59 months and then to all children aged 6 months and older in 2008.
“Both this study and the current influenza season highlight the burden of influenza among children and the importance of influenza vaccination to protect children and their families,” Poehling told Infectious Diseases in Children.
Disclosure: Poehling reports receiving research support from BD Diagnostics.
Katherine A. Poehling, MD, MPH, can be reached at Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, at kpoehlin@wakehealth.edu.
Perspective
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Henry H. Bernstein, DO
This study by Poehling and colleagues highlights well that there continues to be notable room for improvement in our approaches to tackling the burden of influenza in children aged younger than 5 years. The authors document that despite expanded prevention recommendations and management guidelines, influenza continues to be an important cause of hospitalizations, ED utilization and outpatient clinic visits. This can be attributed, in part, to suboptimal influenza vaccine rates and insufficient use of antiviral treatments among this young cohort.
In order to protect our children, as the authors conclude, we must better use the tools we have to reduce influenza disease burden — vaccination and antiviral treatment. Influenza vaccine is needed every year for everyone. Health care providers can help bolster influenza vaccination rates among children (and adults, for that matter) by making sure parents and guardians are well informed about the influenza vaccine and its possible side effects.
The most common adverse reactions of the trivalent inactivated influenza vaccine (TIV) are local injection site pain and tenderness. Mild systemic symptoms may also occur, such as nausea, lethargy, headache, muscle aches and chills. Approximately 10% to 25% of children aged younger than 2 years may experience fever within 24 hours after immunization with TIV; fever is rarely seen in older children or adults.
The live attenuated influenza vaccine (LAIV) has the potential to produce only mild symptoms, including rhinitis, headache, wheezing, vomiting, muscles aches and fever.
In addition, presumptive antiviral treatment should be offered much more often than it apparently is happening in various clinical settings. Multiple factors may be considered, but clinicians must not be waiting for confirmatory influenza test results.
Antiviral treatment is critically important for: 1) any child hospitalized with presumed influenza or with severe, complicated, or progressive illness attributable to influenza, regardless of influenza immunization status; and 2) influenza infection of any severity in children at high risk of complications of influenza infection.
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