Pediatrics: Low Uptake Of Flu Vaccine Among Toddlers In Ontario

 

# 6324

 

 

Despite a universal vaccination program that began in the year 2000, a study published today in the journal Pediatrics indicates that flu vaccination rates among young children (aged 6 mos- 23 mos) in Ontario, Canada (analyzed between 2002 and 2008) never exceeded 10%.

 

This in spite of a SARS outbreak in 2003, and a high publicized serious flu season in 2003-04. This study did not extend into the 2009-10 pandemic flu season.

 

The authors suggest that `vaccine fatigue’ among parents may be a major factor in this low uptake, but acknowledge that several other Canadian provinces are doing a better job at getting kids vaccinated.

 

With the large number vaccines recommended for young children - and unfounded fears among some parents (popularly spread in the media and online) that too many inoculations, too soon, can cause serious health problems – some doctors are having to decide which vaccines to promote to parents as being the most important.

 

First the journal article, then a link to Helen Branswell’s coverage of this story.

 

Low Rates of Influenza Immunization in Young Children Under Ontario’s Universal Influenza Immunization Program

Michael A. Campitelli, MPH, Miho Inoue, MD, MSc, Andrew J. Calzavara, MSc, Jeffrey C. Kwong, MD, MSc, and Astrid Guttmann, MDCM, MSc

Abstract

OBJECTIVES: To determine physician-administered influenza vaccine coverage for children aged 6 to 23 months in a jurisdiction with a universal influenza immunization program during 2002–2009 and to describe predictors of vaccination.

<SNIP>

CONCLUSIONS: Influenza vaccine coverage among children aged 6 to 23 months in Ontario is low, despite a universal vaccination program and high primary care visit rates. Interventions to improve coverage should target both physicians and families.

 

 

Helen Branswell of the Canadian Press has more on all of this in her article:

 

May 14, 2012 Updated: May 14, 2012 | 6:52 am

Flu shot program misses children under two in Ontario: study

 

 

While far from perfect, flu vaccines remain our best protection against influenza, seasonal or otherwise. They have an enviable safety record, and most years they provide a moderate level of protection against currently circulating flu strains (see A Comprehensive Flu Vaccine Effectiveness Meta-Analysis).

 

Unfortunately, a combination of bad press from anti-vaccine activists, memories of the ill-fated 1976 H1N1 vaccination campaign (see Deja Flu, Once Again), and the mistaken belief that influenza is a mild illness all lead to many in the public to avoid getting the flu vaccine each year.

 

Our most recent mild flu season notwithstanding, most years influenza claims tens of thousands of lives in North America, including those of hundreds of children.

 

Convincing the public of the wisdom of getting the shot every year, however, remains a difficult task. 

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Referral: NEJM Perspective On Influenza Vaccine Uptake

 

 

# 5088

 

 

 

On what is hopefully the start of a quiet Thanksgiving morning, we’ve an interesting perspective article appearing in the NEJM on the public’s distrust of flu vaccines, and ways public health agencies might try to assuage them.

 

 

Perspective

Influenza Vaccine — Safe, Effective, and Mistrusted

Katherine M. Harris, Ph.D., Jürgen Maurer, Ph.D., and Arthur L. Kellermann, M.D., M.P.H.

November 24, 2010 (10.1056/NEJMp1012333)

 

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TFAH: Fighting Flu Fatigue

 

# 5044

 

 

 

TFAH (Trust for America’s Health) has released a new report called Fighting Flu Fatigue, that finds (among things) – that hospitalization rates were higher during the 2009 pandemic, but vaccination rates were lower – for African-Americans, Hispanics, and American Indian/Alaska Natives.

 

Jeffrey Levi, PhD, Executive Director of TFAH, urges in the press release that we not return to a national complacency about influenza, but that we build on the momentum of the pandemic response efforts.

 

This report makes a number of recommendations, including the creation of a major campaign that provides:

 

• Education about the need for flu shots, focused on why everyone should get immunized and the safety of the shots;
• Special, concerted outreach to minority groups. It is particularly important to use targeted, culturally-appropriate messages and messengers that encourage vaccinations and address negative beliefs and misinformation;
• Increased easy access to flu shots, even to people who are uninsured or do not receive regular medical care; and
• Incentives for health care workers to be vaccinated. Last season, only 62 percent of health care workers were vaccinated against the seasonal flu and only 37 percent received an H1N1 flu shot by January 2010.

 

 

There is a lot more to read here, as well, so be sure to read the full report.

 

First some excerpts from the press release for this report, followed by a link to the report itself.

 

 

Press Release

For Immediate Release: November 10, 2010

New Report Finds H1N1 Hospitalization Rates Higher But Vaccination Rates Lower for Minorities

Washington, D.C., November 10, 2010 - H1N1 flu hospitalization rates for African-Americans, Hispanics, and American Indian/Alaska Natives were nearly two to one higher than rates for Whites during the 2009-2010 flu season, according to a new report, Fighting Flu Fatigue, from the Trust for America's Health (TFAH). At the same time, both H1N1 and seasonal flu vaccination rates were lower for African Americans and Hispanics than for Whites.

During the 2009-2010 flu season:

• African American hospitalization rates were 29.7 per 100,000 people compared to White hospitalization rates of 16.3 per 100,000 people. Hispanic hospitalization rates were 30.7 percent per 100,000 people;
• H1N1 vaccination rates were 9.8 percent lower for African-American adults and 4.2 percent lower for African-American children than for Whites;
• Seasonal flu vaccination rates were 16.5 percent lower for African-American adults and 5.6 percent lower for African-American children than for Whites;
• H1N1 vaccination rates were 11.5 percent lower for Hispanic adults than for Whites, although rates were 5.5 percent higher for Hispanic children; and
• Seasonal flu vaccination rates were 21.7 percent lower for Hispanic adults and 2.6 percent lower for Hispanic children than for Whites.

The flu is preventable with a vaccine - yet, each year, between 3,000 and 49,000 Americans die from flu-related illnesses (based on a review of deaths from 1976 to 2007) and the flu contributes to more than $10 billion in lost productivity and direct medical expenses and $16 billion in lost potential earnings each year in the United States. Fighting Flu Fatigue examines lessons from the H1N1 pandemic to inform future flu policies and prevention in the United States.

(Continue . . .)

 

Click Image or this link for report

 

 

My thanks to Tetano on FluTrackers for posting this link.

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Consumer Reports Flu Vaccine Poll

 

 

# 4982

 

 

We’ve a new poll out today by Consumer Reports on the intent (or lack thereof) of Americans to get the seasonal flu vaccine this year.

 

Despite ample evidence of the safety and efficacy of the seasonal (and pandemic) flu shot, only 40% of those in the "work risk" category— health care workers (HCWs) and those caring for young children — said they would definitely get the vaccine this year.

 

Roughly 28% said they would `definitely not’ get the flu vaccine this year.

 

Among those who are considered `at health risk’ due to medical conditions like heart or lung disease, neurological disorders, or immune problems only 45% said they planned to take the vaccine.

 

And just over half (51%) of those over 65 said they planned to take the vaccine.

 

Disappointing numbers, obviously. 

 

Reasons cited for not taking the vaccine included:

 

• Belief the 2009 Pandemic was overblown (45%)
• Concern over side effects (44%)
• Concern over vaccine safety (41%)
• Belief the Vaccine doesn’t work (28%)

 

You’ll find the press release for this poll at:

 

Consumer Reports Flu Poll: Approximately Three Out of 10 Health Care Workers 'Living in a Bubble,' Not Getting Flu Vaccine

 

And the Consumer reports online article at:

 

Fears about the flu shot linger, our poll finds

 

 

Since surveillance and science has shown repeatedly that the flu shot is very safe, and most years about 70% effective in healthy adults under 65 (less so in the elderly),  I can only surmise that the constant drumbeat of anti-vaccine propaganda on the Internet is taking its toll.

 

The unconscionable `scare stories’ that play up rare (but not unexpected) vaccine side effects - and completely ignore the thousands of preventable  influenza deaths each year – have for many, instilled doubts over the wisdom of taking the flu shot.

 

Add to that a growing anti-government sentiment and a general distrust of the pharmaceutical industry, and even Health Care Workers who should know better, are avoiding the vaccine.

 

No vaccine is 100% safe.  But flu vaccines have a very good safety profile, and the benefits far outweigh the minute risks.

 

Last year, more than 12,000 Americans died from the Swine flu.   A disproportionate number of those (90%) were under the age of 65.

 

No deaths were attributed to the Swine flu vaccine (see CIDRAP VAERS study finds H1N1 vaccine safety similar to seasonal vaccines'), despite the hysterical and much-repeated warnings last year that the `vaccine was deadlier than the virus’.

 

Even during the greatly maligned 1976 Swine Flu vaccination campaign, only 25 deaths were linked to the vaccine (out of 40 million shots given).  Had the pandemic struck as expected (it didn’t), that would have been considered a reasonable trade off.

 

Since the virus failed to return that fall (see Deja Flu, All Over Again for my minor role in that story), the vaccine was considered a fiasco.

 

Sensational, and often false or misleading reporting - combined with pre-existing fears and beliefs of the public – are difficult obstacles for science and statistics to overcome.

 

Finding better, more convincing ways to reach the public on the importance of vaccination – in the face of a well entrenched Internet anti-vaccine movement – continues to be a major public health challenge.

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MMWR: 2009 Childhood Vaccine Uptake

 

 

 

# 4908

 

The CDC’s MMWR released a report today on the latest vaccine coverage estimates for children born during the period of January 2006 to July 2008 – or ages 19 to 34 months.

 

The National Immunization Survey (NIS), using a combination of telephone surveys and follow up mail questionnaires, has produced estimates for all 50 states along with stats for selected urban areas and territories.

 

The good news is that less than 1% of the children in the country appear to have skipped vaccinations altogether.

 

The overall vaccination rate across the country runs about 90% for most routine childhood vaccinations, but there are some states and regions with uptakes running closer to 80%. 

 

The link to this admittedly data-intensive MMWR report is below. I’ve followed that with excerpts from a CDC Press release which provides some of the highlights.

 

 

National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2009

Weekly

September 17, 2010 / 59(36);1171-1177

 

 

 

CDC Survey Finds Childhood Immunization Rates Remain High

Immunization of children aged 19-35 months old against most vaccine-preventable diseases remains high in the United States, with coverage for most of the routine vaccines remaining at or over 90 percent, according to a report by the Centers for Disease Control and Prevention. Less than 1 percent of young children got no vaccinations, the CDC report said.

 

"Nearly all parents are choosing to have their children protected against dangerous childhood diseases through vaccination," said Anne Schuchat, M.D., director of CDC's National Center for Immunization and Respiratory Diseases.

 

Today's report suggests the national picture is reassuring. However, in 2008, there were outbreaks of measles primarily in children whose parents had declined to have their children vaccinated. It is likely that communities with high numbers of under vaccinated or unvaccinated children remain, said Dr. Schuchat.

 

"While it's encouraging to see immunization rates remaining high, we know that parents have questions about vaccines and we must continue to educate parents about the importance of vaccination to help avoid future resurgences in serious, preventable illnesses," Dr. Schuchat said.

 

The 2009 National Immunization Survey (NIS) of more than 17,000 households looked at vaccination of children born between January 2006 and July 2008 and found that vaccine coverage against poliovirus; measles, mumps and rubella; hepatitis B and varicella (chickenpox), remained relatively stable and near or above the national Healthy People 2010 goal of 90 percent or higher.

 

At the same time, rates of vaccination for hepatitis A and the birth dose of hepatitis B increased significantly, with the number of children aged 19-35 months who were immunized rising by more than six percentage and five percentage points respectively.

Other findings included:

• 44 percent of children aged 19-35 months had received rotavirus vaccine during infancy; these vaccines were first licensed in 2006.
• 83.6 percent of children aged 19-35 months had received three doses of Haemophilus influenzae B, down by 6.4 points from the previous year, reflecting a national shortage of the vaccine in 2008 and 2009. Vaccine is now readily available.

(Continue . . . )

 

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The Uptake Down Under

 

 

#4874

 

 

A pair of vaccine-related studies appear today in the eMJA (electronic version of the Medical Journal of Australia) that document low influenza vaccine uptake in Australia’s general population, and particularly among pregnant women.

 

The first study finds that only about 19% of Western Australia’s population took the pandemic vaccine, ranging from just over 10% of pregnant women to just over 50% of Health Care Workers.

 

The 10% uptake among pregnant women – a group who are at particularly high risk of complications from influenza – compares poorly to the 38% uptake in the same demographic group in the United States.

 

The second study points out the reluctance to vaccinating pregnant women extends beyond the individual concerns of patients to many health care providers who either did not offer the vaccine or actively counseled against it. 

 

Both studies are online, and may be read in their entirety.

 

 

Pandemic (H1N1) 2009 influenza vaccination coverage in Western Australia

Donna B Mak, Alison M Daly, Paul K Armstrong and Paul V Effler

Conclusions:

Our estimate of pandemic influenza vaccination coverage in the adult population of WA is comparable to the national estimate of 19%, but it did not reach levels considered sufficient to interrupt community transmission.

Future influenza vaccination programs should target groups at increased risk of severe influenza, such as pregnant women.

Research

Pandemic (H1N1) 2009 influenza vaccine uptake in pregnant women entering the 2010 influenza season in Western Australia

Scott W White, Rodney W Petersen and Julie A Quinlivan

Abstract

Conclusions:

Uptake of H1N1-specific influenza vaccine in pregnant women was poor. Reasons for this relate both to vaccination not being offered to or actively sought by the women, as well as concerns — of both the women and their GPs — about vaccine safety in pregnancy.

Uptake in this setting may improve if vaccination is offered through public antenatal clinics with concurrent safety education for obstetricians and vaccination providers.

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CMAJ: Seasonal Flu Vax Rates Among Canadian HCWs

 

# 4738

 

 

One of  the ongoing debates among infection control professionals is how to increase the uptake of seasonal (and pandemic) influenza vaccines by Health Care Workers (HCWs).

 

For years, the percentage of HCWs who voluntarily get the seasonal flu vaccine has languished in Canada and the United States between 30% and 40%.

Attempts to mandate vaccination have elicited numerous objections from HCWs, although many infection control organizations (IDSA, APIC, SHEA) support the idea.

 

Last week, the IDSA published an open letter to Thomas Frieden, Director of the CDC, in support of such a mandate.

 

Yesterday a study appeared in the CMAJ that took a retrospective look at programs used to promote the voluntary update of seasonal flu vaccines by HCWs.

 

First the press release, then the abstract and a link to the entire study.

 

Canadian Medical Association Journal

Seasonal influenza immunization rates among health-care workers

Campaigns to increase seasonal influenza vaccination rates amongst health care workers in Canada that include a combination of interventions had the greatest effect on increasing vaccine coverage, according to a study published in CMAJ (Canadian Medical Association Journal) 

Seasonal influenza immunization rates among health care workers in Canada remain below 50%, yet it is recommended that all health care workers (at least 90%) should be immunized to protect against the flu virus.

Combined education/promotion and improved access to vaccines resulted in higher increases in vaccination rates amongst long-term care home workers. In one hospital campaign in which staff completed a mandatory electronic form to decline vaccination, immunization coverage increased to 55% compared to the previous nine years where rates ranged from 21% to 38%. When unvaccinated personnel were required to wear masks, rates increased to 52% from 33%.

"This review revealed gaps in the literature about the appropriate components to use to increase influenza immunization among health care personnel," writes Dr. Larry Chambers, Elisabeth Bruyére Research Institute, Ottawa, with coauthors.

 

The study, a systematic review of 12 studies, did not look at pandemic influenza programs.

 

The authors conclude that more studies with multiple campaign components are needed to assess the most appropriate influenza vaccination programs.

 

The abstract follows:

 

Seasonal influenza vaccination campaigns for health care personnel: systematic review

Po-Po Lam, Larry W. Chambers , Donna M. Pierrynowski MacDougall , Anne E. McCarthy 

 

Background: In Canada, vaccination coverage for seasonal influenza among health care personnel remains below 50%. The objective of this review was to determine which seasonal influenza vaccination campaign or campaign components in health care settings were significantly associated with increases in influenza vaccination among staff.

 

Methods: We identified articles in eight electronic databases and included randomized controlled trials, controlled before-and-after studies and studies with interrupted time series designs in our review. Two reviewers independently abstracted the data and assessed the risk of biases. We calculated risk ratios and 95% confidence intervals for randomized controlled trials and controlled before-and-after studies and described interrupted time series studies.

 

Results: We identified 99 studies evaluating influenza vaccination campaigns for health care workers, but only 12 of the studies were eligible for review. In nonhospital health care settings, including long-term care facilities, campaigns with a greater variety of components (including education or promotion, better access to vaccines, legislation or regulation and/or role models) were associated with higher risk ratios (i.e, favouring the intervention group). Within hospital settings, the results reported for various types of campaigns were mixed. Many of the criteria for assessing risk of bias were not reported.

 

Interpretation: Campaigns involving only education or promotion resulted in minimal changes in vaccination rates. Further studies are needed to determine the appropriate components and combinations of components in influenza vaccination campaigns for health care personnel.

 

The link to the entire study is here.

 

The bottom line is that campaigns utilizing only educational and promotional incentives resulted in minimal improvements in vaccination rates among health care workers.

 

Certainly nowhere near the compliance goal of 90%.

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UK: Low Uptake Of Vaccine Among HCWs

 

 

# 4273

 

Not that it comes as a terrible surprise, given the telegraphing by polls of HCWs (Health Care Workers) sentiment over the fall (see UK: NHS Fears Low Uptake Of Vaccine By HCWs.   But as we pass the mid-point in January, only about 1/3rd of nurses and less than 40% of GPs in the UK have taken the H1N1 jab.

 

This from the BBC.

 

 

 

 

'Two thirds' of London nurses without swine flu jab

updated at 05:52 GMT, Thursday, 21 January 2010

 

Just one in three nurses in London have been vaccinated against swine flu, the NHS has admitted.

 

A BBC London Freedom of Information request has shown the majority of medical staff remain unprotected against the virus.

 

Although swine flu rarely kills healthy adults, it is dangerous to many patients in hospitals.

 

NHS London insisted the vaccine take-up was "encouraging" and rising, with more than 60,000 staff having had the jab.

 

But figures, seen by BBC London, reveal the take-up has hit a plateau, with a limited increase in the numbers of staff to have been vaccinated over the last month.

 

In mid-December, a total of 33% of frontline staff - including dentists, paramedics and so on - had been vaccinated.

 

By 18 January that figure was 40% - a rise of 7%.

The vaccine has been available to some sections of the public, such as asthmatics, since October.

 

(Continue . . . )

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