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Reminders increase influenza vaccine uptake
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State immunization registries can act as an effective tool to encourage influenza vaccination during a pandemic, according to recent study findings published in the American Journal of Public Health.
“Immunization registries like [the Michigan Care Improvement Registry] are important public health tools,” Kevin Dombkowski, DrPH, a research associate professor with the University of Michigan’s Child Health Evaluation and Research Unit, said in a press release. “This study shows the value of using immunization registries to prompt parents of children with a chronic condition to get that child vaccinated.”
Kevin Dombkowski
Dombkowski and colleagues identified high-risk children aged 6 months to 18 years with no record of influenza A(H1N1)pdm09 (pH1N1) vaccination who were enrolled in Medicaid. Reminders to vaccinate were sent in December 2009.
They found that vaccination rates were higher among participants who received the reminder compared with children with undeliverable reminders and the control group who were not sent reminders.
Participants who received a reminder were more likely to get vaccinated with pH1N1 (OR=1.54; 95% CI, 1.49-1.59) and seasonal influenza (OR=1.79; 95% CI, 1.72-1.87) compared with participants who did not get a reminder. Of those who did not get a reminder, those with an undeliverable reminder were less likely to get vaccinated with pH1N1 (OR=0.83; 95% CI, 0.73-0.95) but more likely to get vaccinated with seasonal influenza (OR=1.21; 95% CI, 1.04-1.39) compared with controls.
“An [immunization information system]-based reminder effort conducted during the 2009 to 2010 influenza season and targeted to high-risk children was associated with increased influenza vaccination rates,” the researchers wrote. “Future initiatives should consider strategies to expand the ability to identify high-risk group for targeted immunization outreach and to improve the timeliness and completeness of influenza dose reporting during pandemic events.”
Kevin Dombkowski, DrPH, can be reached at kjd@med.umich.edu.
Disclosure: The work was funded in part by the CDC through a cooperative agreement with the Association for Prevention Teaching and Research.
Perspective
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Pedro A. Piedra, MD
In the summer of 2009 the first wave of the 2009 novel H1N1 pandemic struck the United States. An intense effort was made to have pandemic vaccines available to the public before the major fall wave of the pandemic. In preparation for the roll out of pandemic vaccines and the expected early shortages, five target groups were identified by the Advisory Committee of Immunization Practices one of which included children with at-risk medical conditions for severe influenza. Michigan implemented a statewide pandemic influenza vaccination reminder for children with chronic medical condition and on Medicaid. Dombkowski and colleagues reported in the American Journal of Public Health (published on line November 14, 2013) on the assessment of the Michigan program. The immunization information system (IIS) at the time the reminder letters were sent had 3 million children aged 6 months to 18 years in their database but only 202,133 (6.7%) met the Michigan Department of Community Health (MDCH) criteria for receiving the pandemic influenza vaccination reminder. Overall a modest 2% to 3% improvement in vaccination coverage was achieved among children receiving the reminder letter despite significant effort by the MDCH. This modest improvement highlights the importance of evaluating other vaccination reminder strategies. In Canada, improved influenza vaccination coverage of at-risk persons was best achieved with implementation of a universal vaccination program rather than an at-risk vaccination program. A vaccination reminder program needs to be aligned with our current universal influenza vaccination policy. Approaches that utilize the medical homes and schools might be more efficient and effective in reaching out to all children and their parents on the importance of influenza vaccination against seasonal and pandemic influenza.
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