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Seasonal influenza vaccination reminders for children with high-risk conditions: a registry-based randomized trial
Kevin J Dombkowski1, Laura B Harrington, Shiming Dong
1Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan 48109-5456, USA. kjd@med.umich.edu
Insights
Seasonal influenza vaccination reminders sent via a statewide immunization information system (IIS) increased vaccine uptake in high-risk children. However, poor address quality in the IIS limited reminder effectiveness, highlighting the need for better data accuracy.
Area of Science:
- Public Health
- Epidemiology
- Health Informatics
Background:
- Children with chronic health conditions face higher risks from influenza and exhibit low vaccination rates.
- Targeting these vulnerable children for influenza vaccination is a critical public health objective.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of using a statewide immunization information system (IIS) to send seasonal influenza vaccine reminders.
- To assess the impact of reminders from local health departments (LHDs) on influenza vaccination rates in high-risk children.
Main Methods:
- A randomized community intervention involving 3618 children (aged 24-60 months) with high-risk conditions across three Michigan counties.
- Children were identified via a statewide IIS and randomized to receive mailed vaccination reminders or no reminders.
- Feasibility (address validity/deliverability) and effectiveness (vaccine receipt) were assessed using logistic regression.
Main Results:
- Of eligible children, 75.5% had not received the 2008-2009 influenza vaccine.
- Over 40% of children in the reminder group had invalid or undeliverable addresses.
- Children receiving deliverable reminders showed higher vaccination rates (30.8%) compared to the control group (24.3%).
Conclusions:
- Reminder receipt was positively associated with increased seasonal influenza vaccination.
- The high rate of invalid/undeliverable addresses underscores the critical need for improved data quality within immunization information systems (IIS).
- Enhancing IIS data accuracy is essential for optimizing public health reminder systems.
Background:
Children with chronic conditions have an increased risk of complications from influenza and have low influenza vaccination rates.
Purpose:
To assess the feasibility and effectiveness of using a statewide immunization information system (IIS) for seasonal influenza vaccine reminders from local health departments (LHDs) targeting children with high-risk conditions.
Design:
A randomized community intervention.
Setting/Participants:
The study was conducted in a population of 3618 children aged 24-60 months with a high-risk condition residing in three Michigan counties. Children were identified using a statewide IIS in October 2008.
Intervention:
Children were randomized to intervention (reminder) or control (no reminder) groups. Reminders for seasonal influenza vaccination were mailed by LHDs in November 2008.
Main Outcome Measures:
Feasibility of notification (address validity, address deliverability) was assessed (November 2008-February 2009), and frequencies of notification feasibility measures were determined (analyses conducted in 2010). Effectiveness of notification (seasonal influenza vaccine receipt) was assessed using bivariate logistic regression.
Results:
Among 3618 children with a high-risk condition, 2730 (75.5%) had not received a 2008-2009 influenza vaccination and were eligible at the time of notification. Among children assigned to the reminder group (n=1374), 42.6% had an address determined to be either invalid, undeliverable, or both. Among those with valid addresses (n=2001), a greater percentage of children with deliverable reminders received at least one influenza vaccination (30.8%) during the outcome observation period than did children assigned to no reminder (24.3%, OR=1.39, 95% CI=1.13, 1.72); children with an undeliverable reminder had an influenza vaccination rate (22.8%) similar to children assigned to no reminder.
Conclusions:
Receipt of a reminder was positively associated with seasonal influenza vaccination. However, more than 40% of children assigned to receive a reminder were determined to have an invalid or undeliverable address, emphasizing the need for increased quality of IIS contact information.
Trial Registration:
This study is registered at www.ClinicalTrials.gov NCT01431183.
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