December 2003
An important drawback of the recent decision by the Advisory Committee on Immunization Practices (ACIP) to move to a full universal influenza recommendation for healthy young infants in the fall of 2004 is the possibility that the requirement will prompt the need for additional medical visits.
According to a study, a routine influenza vaccine recommendation for healthy young children 6 to 23 months of age and their household contacts could mean that up to 74% of children would require an extra office visit during the winter months.
Since influenza season typically peaks between January and March, many recommending bodies suggest offering the vaccine to patients in October through December. Children younger than 9 years receiving the vaccine for the first time need two shots during the first season they are vaccinated.
Given a three-month window of opportunity to vaccinate and assuming that only well-child care visits were used to vaccinate (and also assuming no missed opportunities for vaccination) roughly 39% of children could require an additional visit and 35% could require two additional visits, the study said.
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Visits used as a factor
The researchers analyzed insurance claims for more than 8,000 children 6 to 23 months of age in the Rochester, N.Y., area to determine the proportion of children making one or two visits to their primary medical home during three consecutive influenza seasons from 1998 to 2001.
During that time, 60% of
children had at least one well-child care visit between October and December of
each year, and 32% had additional visits during those months.
According to the study, the number of additional visits required could change depending on which and how many visits are used for vaccination. If existing vaccination visits already recommended by the ACIP and AAP that coincide with the new influenza recommendations — the 6, 12 and 15 to 18 month vaccination visits — plus regular visits (well-child care and other visits) were used for influenza vaccination during a three-month period, then as many as 46% of patients could require an additional visit – 34% requiring one extra visit and 12% requiring two visits.
Because younger infants, particularly infants 6 to 11 months of age, already make more scheduled visits during the winter, they could potentially require fewer additional visits than older children 12 to 23 months of age.
About 66% of infants 6 to 11 months of age could require an additional influenza vaccination visit while 78% of children 12 to 23 months of age could require an additional visit if only well-child care visits were used for vaccination, the study said.
Expand season and other
strategies
Another strategy to ease the burden on vaccine providers would be to expand the vaccination season to four months, according to the study. In that scenario, about 54% of children could require an additional visit for influenza vaccination, the study said.
If the vaccination period were extended to a five-month period, the study said, vaccinating young children could require proportionately fewer visits. With a five-month window for vaccination, approximately 20% to 33% of children could require at least one additional visit, according to the study.
“Recommendations that encourage continued vaccination during the influenza season (ie, continuing to vaccinate into January) should be emphasized to reduce the number of extra visits required,” the study said.
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| Source: Pediatrics. 2003;112(4):821-828. |
For more information:
- Szilagyi P, Iwane M, Schaffer S, et al. Potential burden of universal influenza vaccination of young children on visits to primary care practices. Pediatrics. 2003;112(4):821-828.