Pediatric Flu Vaccination: Understanding Low Acceptance Rates Could Help Increase Coverage

A study of H1N1 and seasonal influenza vaccination in a sample of black and Hispanic children in Atlanta found a low rate of vaccine acceptance among parents and caregivers. Only 36 percent of parents and caregivers indicated they would immunize children against H1N1, and 22 percent indicated their children received the seasonal influenza vaccine in the previous three months. The majority of children in the sample (71 percent) were from households with less than $40,000 in annual income.

Researchers say this low level of vaccine coverage and acceptance highlights the importance of understanding individual and community concerns that influence parents' decisions to have their children vaccinated. The study was published in the Vaccine Safety Supplement of the April issue of the journal Pediatrics.

Children aged six months through 18 years, and caregivers of children younger than six months, were among the stated high-priority groups for the 2009 H1N1 vaccine. More recently, the ACIP has recommended that all persons older than six months should be vaccinated annually against influenza.

The study found that parents who said they were concerned about influenza, were concerned about H1N1 disease, and had confidence in vaccines and their preventive abilities were more likely to accept vaccination.

Although income did not correlate with vaccine acceptance, parents without health insurance were more likely to say they would vaccinate their children against H1N1 than were parents with insurance. The authors speculated this is due to concern related to treatment cost among parents without insurance.

Safety issues were generally not cited as a factor influencing decisions, but perceived greater risk of exposure and illness for children from the H1N1 virus was cited as a reason for those accepting vaccination. Other factors contributing to acceptance included lack of confidence in the effectiveness of hand washing, masks, and quarantine approaches over the H1N1 vaccine as prevention methods, and having a desire to promote inuenza vaccination in the community.

"The well-publicized risks to children of contracting the H1N1 virus may have outstripped vaccine safety concerns in this case," notes lead author Paula Frew, PhD. "This shows that more comprehensive education of minority parents with regard to disease risk may provide a boost to vaccination rates." Frew is assistant professor of medicine and director of community research in Emory University School of Medicine.

"Physicians have a central community leadership role in educating parents about the importance of influenza vaccination" the authors write. "Moreover, our study results show parental confidence in the health departments to provide influenza vaccination compared with other community-based venues."

"Physician support of vaccination can help increase vaccine coverage, and community health departments are ideal locations for vaccine administration," says Frew.

Other authors of the study, all from Emory, include senior author Saad Omer, PhD, Brooke Hixson, MPH, Carlos del Rio, MD, and Alejandra Esteves Jaramillo, MD.

The study was supported in part by the Emory AIDS International Training and Research Program.