Flu vaccination rates lag for at-risk adolescents

November 03, 2008

BOSTON, Mass. (Nov. 3, 2008) --Influenza vaccination rates for adolescents who suffer from asthma and other illnesses are still far too low, according to a recent study.

The research, published in the November 2008 issue of Pediatrics, was based at the Department of Ambulatory Care and Prevention at Harvard Medical School and Harvard Pilgrim Health Care.

"Influenza vaccination has been recommended for adolescents with high-risk conditions for well over a decade," notes lead author Mari Nakamura, a clinical fellow in pediatrics at Children's Hospital Boston. "We wanted to examine how effective this risk-based policy has been in achieving vaccination coverage."

Each year, between 20 and 40 percent of children and adolescents come down with the flu. For children with certain high-risk conditions, this can lead to severe illness, hospitalizations, and in some cases, even death. Because of this, the Centers for Disease Control strongly recommends that all adolescents vulnerable to influenza complications get vaccinated.

The study charted vaccination rates from 1992 to 2002 for 18,703 adolescents with asthma, cardiac disease, immune system disorders and other high-risk conditions who received care at Harvard Vanguard Medical Associates and were insured through Harvard Pilgrim Health Care. The investigators also identified medical visits for checkups and other preventive care that these adolescents had during flu seasons to determine whether there were missed opportunities for vaccination.

Vaccination rates improved during the study period, but only from 8 percent to 15 percent. During the last four years of the study period, 1999 to 2002, only 11 percent of adolescents with high-risk conditions received vaccinations during all four seasons. Over 56 percent of adolescents received no flu vaccinations during this four-year period.

Missed opportunities were common as approximately 45 to 55 percent of high-risk adolescents had one or more health care visits during the flu season at which the vaccine was not administered. In contrast, those who had preventive care visits were more likely to receive influenza vaccine.

Grace Lee of the Department of Ambulatory Care and Prevention, and senior author on the current study, published another study in the October issue of Pediatrics. In that study she found that among adolescents who had not been vaccinated for tetanus-diphtheria (Td), 75 percent did not receive an immunization despite visiting a healthcare provider.

Since 2005, three additional vaccines to prevent meningococcal disease, pertussis, and human papillomavirus have been approved and recommended for adolescents in the US. The introduction of these new vaccines has generated interest in improving how we track adolescent vaccinations.

The study team concludes both patients and providers need to be part of any intervention strategy aimed at increasing vaccination rates among this population. Previous research has also shown that letters to parents and electronic reminders for providers can be effective at improving vaccination rates.

The new recommendation for universal influenza vaccination of children and adolescents, issued by the CDC's Advisory Committee on Immunization Practices this past spring, may help to assure that adolescents are protected against the disease.

Dr. Nakamura observes, "Our findings lend support for the simplicity of universal vaccination. More adolescents, especially those with high-risk conditions, may be vaccinated if providers and parents don't first have to identify who meets criteria for vaccination, as under a risk-based approach."
-end-
This research was supported by the Harvard Pilgrim Health Care Foundation. Full citation:

Pediatrics, October 2008, Volume 122, Issue 5
"Influenza Vaccination in Adolescents with High-Risk Conditions"
Mari M. Nakamura, MD(1) and Grace M. Lee, MD, MPH(2,3)

1-Harvard Pediatric Health Services Research Fellowship Program, Children's Hospital Boston
2-Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care
3-Division of Infectious Diseases, Departments of Medicine and Laboratory Medicine, Children's Hospital Boston

Harvard Medical School (http://hms.harvard.edu/hms/home.asp) has more than 7,500 full-time faculty working in 11 academic departments located at the School's Boston campus or in one of 47 hospital-based clinical departments at 18 Harvard-affiliated teaching hospitals and research institutes. Those affiliates include Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Cambridge Health Alliance, Children's Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Hebrew SeniorLife, Joslin Diabetes Center, Judge Baker Children's Center, Immune Disease Institute, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, and VA Boston Healthcare System.

Harvard Pilgrim Health Care (http://www.hphc.org) is a not-for-profit health care plan operating in Massachusetts, New Hampshire, and Maine with a network of more than 22,000 doctors, 135 hospitals, and more than 970,000 members. Harvard Pilgrim was the first New England health plan to establish a nonprofit foundation with the sole purpose of serving the community at large. The efforts of the foundation reflect Harvard Pilgrim's mission, which is to improve the health of its members and the health of society.

Harvard Medical School

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