Document Type


Degree Name



Oregon Health & Science University


Introduction: Asthma exacerbation during influenza infection may result in pneumonia, hospitalization and death (CDC, 2013). The ACIP (Advisory commission of immunization policy) (2014) now recommends cautious use of LAIV (live attenuated influenza vaccine) for children over 5 years, with a diagnosis of asthma, and remains a contraindication for children ages 2-4 years who have had asthma symptoms or wheeze within the last 12 months. It is critical to determine if the rate of influenza vaccination has changed since implementation of these new guidelines.

Methods: A retrospective electronic health records review of 6,730 of children was conducted to compare the September 1st 2013-January 1st 2014 influenza season to the September 1st 2014-January 1st 2015 influenza season at a rural pediatric practice. Focus groups with providers were conducted to determine if barriers or facilitators to vaccination could be identified in their practice.

Results: 6,730 children ages 2-18 years of ago were included. This rural pediatric practice was predominantly Hispanic or Latino population (73%) with the majority of patients (56%) having Medicaid insurance. Data revealed in the 2013-2014 influenza season that a total of 82.8% of children (2998 out 3620 children seen) received influenza vaccination. A total of 675 children were seen with a diagnosis of asthma and 504 children received an influenza vaccine (74.6%). Of these children 17.6% of children with asthma received the Flumist or trivalent intranasal preparation and 40.9% with Flumist and the trivalent nasal prep. Following implementation of the new guidelines in the 2014-2015 influenza season total vaccination for all children seen was 91.9% with 32.7% of children with a diagnosis of asthma received the Flumist and 52.6% of all patients seen received Flumist vaccination. Focus group data revealed that health care providers found that the practice of vaccination outreach thru flu clinics, vaccine tracking and VFC (vaccine for children) designation to be facilitators to vaccination. The use of the Flumist vaccine and the media were identified as both facilitators and barriers to vaccination. Additional limiting factors identified by the providers included: access to vaccination, time and changing vaccination policies and practices. The providers identified the need for a standardized vaccine alert system for patients, increased access to the electronic health record and increased outreach and education to high-risk populations.


Overall this rural health practice had higher rates compared to national and state averages with total children seen in consecutive influenza seasons at 82.8% and 91.9% for all children compared to all persons in Oregon at 42.2% for the 2013-2014 influenza season (CDC, 2014). Children with asthma also had higher rates of vaccination compared to national averages at 74.6% and 76.7% in 2013-2014 and 2014-2015 compared to 52.8% at the national level (CDC, 2012). Following implementation of the new guidelines for use of Flumist in children with asthma there was there was a 15% increase in children with asthma vaccinated using the Flumist preparation. There was an overall increase in vaccination rates between influenza seasons, vaccination rates increased by approximately 9% for all children seen during September 1st thru January 1st. Children in age groups 2-5 years and 14-18 years had the lowest rates of vaccination in two consecutive influenza seasons. Children with a diagnosis of asthma had lower overall rates of influenza vaccination compared to children without a diagnosis of asthma. Children under 5 years of age and children with asthma are at higher risk for morbidity and mortality associated with influenza. More research is needed to understand the gaps in practice and patient/family preference that contribute to lower levels of vaccination and reduce barriers to improve vaccination rates in these high-risk populations.




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