Influenza Vaccines Commonly Recommended for Children with Asthma and other Chronic Medical Conditions, but Infrequently Given

NEW YORK CITY, Oct. 24 ??? Annual influenza vaccination is strongly recommended for children over six months old who have chronic medical conditions including asthma and diabetes, but such children infrequently receive the vaccine and the reasons why have not been clear. A new study in the current issue of The New York Academy of Medicine???s Journal of Urban Health reports that parents??? belief in the vaccine plays a strong role and that a simple recommendation from the child???s doctor to get the flu vaccine could motivate parents to vaccinate their children.

Since the 2006-07 flu season is only now beginning, doctors still have time to issue recommendations to ensure that more children get the vaccine, the authors say. This year (although not at the time of the study), the flu vaccine is recommended for all children between the ages of six months and 59 months, in addition to those with high-risk medical conditions.

Researchers from the University of Pittsburgh surveyed nearly 1,000 parents of children ages 2 to 13 years whose chronic medical conditions place them at increased risk of complications from the flu. The survey was conducted following the 2002-03 and 2003-04 flu seasons at inner city health centers in Pittsburgh where flu shots were actively promoted, and the goal was to learn more about parents??? beliefs and attitudes regarding the vaccine. Results of the study show that the number of at-risk children getting flu vaccines actually declined over time, from 44 percent of parents completing the survey, to 25 percent of parents. The children were significantly more likely to be vaccinated against the flu if their parents:

-believed that their pediatrician recommended the flu vaccine, and/or received a reminder from the doctor???s office to vaccinate their child;

-could easily get to the doctor???s office for the influenza vaccine; and,

-believed that their child should be vaccinated against the flu or had relatives who thought so.

It is promising that actions as simple as a recommendation and a reminder from the pediatrician could lead to more children being vaccinated against the flu, said Mary Patricia Nowalk, PhD, of the Department of Family Medicine and Clinical Epidemiology at the University of Pittsburgh, one of seven authors of the paper. With so many immunizations required throughout childhood ??? 28 vaccines by the age of two -- many parents understandably rely on their physicians for guidance, she said.

???Given the hospitalizations of children due to flu, our findings about the importance of physician recommendation, and the complex and changing childhood immunization schedule, we believe that fresh, pointed reminders may be needed to prompt parents to have their children immunized against influenza,??? Nowalk said.

Nowalk and colleagues distributed the easy-to-understand surveys at health clinics in neighborhoods with large minority populations and serving many low-income children. In 2003, 476 parents of children who have chronic medical conditions completed the survey; in 2004, 475 parents did so. The number of parents who vaccinated their children against the flu decreased dramatically in 2004 to 25 percent, from 44 percent in 2003. Survey results show that fewer parents in 2004 reported receiving a flu shot reminder from their child???s physician. In addition, fewer parents in 2004 felt that their child???s doctor had recommended the flu shot or that getting a flu shot was easy and convenient.

Since fewer parents reported receiving reminders in 2004 and far fewer children were vaccinated against the flu, researchers say that doctors may need to continually change the format and delivery method of the flu shot reminders that they send out to patients??? families, the researchers say. Doctors who use electronic medical records could program in automatic reminders to recommend a flu vaccine when chronically ill children make an office visit, and could send electronic reminders to parents via email or text messaging on cell phones. ???For patients who are less ???wired,??? reminder phone calls that are made automatically or colorful, eye-catching mailed reminders can convey vaccination messages,??? Nowalk said.

Annual influenza vaccination has long been recommended by the Advisory Committee on Immunization Practices of the U.S. Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics, and the American Academy of Family Physicians for those older than six months of age and at increased risk for complications of the flu. These include children with cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders that can compromise respiratory function or the handling of respiratory secretions, or that can increase the risk for aspiration (the accidental sucking of fluid or food particles into the lungs).The vaccine is also recommended for those with cardiovascular disease, diabetes, chronic respiratory disease such as asthma, or for those who are immunocompromised.

Read the full study, entitled ???Beliefs and Attitudes about Influenza Immunization among Parents of Children with Chronic Medical Conditions over a Two-Year Period,??? on the Springer website at http://dx.doi.org/10.1007/s11524-006-9084-z. The study appears in the September/October 2006 issue of the Journal of Urban Health, published bi-monthly for the Academy by Springer. The Journal is edited by David Vlahov, PhD, Interim Executive Director of the Academy and Director of the Academy???s Center for Urban Epidemiologic Studies.

Founded in 1847, the Academy is an independent, non-partisan, non-profit institution whose mission is to enhance the health of people living in cities worldwide through research, education, advocacy, and prevention. Visit us online at www.nyam.org.

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The study was funded by the CDC, the Association of Teachers of Preventive Medicine, and the EXPORT Health Project at the Center for Minority Health in the University of Pittsburgh Graduate School of Public Health.

Posted on October 24, 2006

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