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Updated 10:00 AM Sept. 18, 2006




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A missed opportunity:
Few Medicaid kids with asthma get recommended flu shot

Researchers at the University's C.S. Mott Children's Hospital say many children with asthma—who are at increased risk for influenza-related complications—aren't getting immunized against the flu, even when they visit their doctors during flu season.

In this month's issue of the Archives of Pediatric and Adolescent Medicine, the researchers report that among unvaccinated children with asthma enrolled in Michigan Medicaid, 73 percent had at least one office visit during flu season. During the course of two flu seasons, 40 percent of these children had the opportunity to become vaccinated but were not.

"Our findings confirm concerns about low influenza immunization rates among children with asthma," says study lead author Kevin Dombkowski, member of the Child Health Evaluation Research (CHEAR) Unit in the Division of General Pediatrics and research assistant professor in the Department of Pediatrics and Communicable Diseases at the Medical School.

"After studying this group of children over the course of two flu seasons, we found that only 17 percent were vaccinated during the first season and 22 percent were vaccinated the following flu season. In all, fewer than 10 percent of these children were vaccinated both seasons. The national goal is for 60 percent or more of them to receive the flu vaccine every season."

Despite vaccination recommendations, many high-risk children, including those with asthma, do not receive an annual flu shot. Even during seasons with vaccine shortages, high-risk individuals are prioritized to receive the available doses.

Prior studies have found that missed opportunities—medical visits where a vaccine-eligible child is seen by a health care professional, but not immunized—occur frequently and, if eliminated, could greatly improve vaccination rates.

The CHEAR study analyzed 4,358 children with asthma, ages 5 to 15, who were enrolled in the Michigan Medicaid program.

For the 2001-02 and 2002-03 flu seasons, researchers measured the children's outpatient office visits, rate of flu vaccinations and missed opportunities for immunization.

About 77 percent of the children had at least one office visit, and nearly 65 percent went twice during the 2001-02 flu season.

During that time period, only 17 percent received a flu shot. Among the unvaccinated children in the group, about 70 percent missed at least one opportunity to be vaccinated.

Likewise, 22 percent were vaccinated for the 2002-03 season, while about 70 percent who had the opportunity to be vaccinated were not. Overall, the majority of children in the study—71 percent—were not vaccinated for either flu season.

"If we were able to prevent even a small percentage of these missed opportunities, we could substantially increase the overall influenza vaccination rate among these children," Dombkowski says. "And if we were able to completely eliminate these missed opportunities, we would see a 77 percent influenza vaccination rate for this group."

Studies have shown that two of the greatest barriers to vaccinating high-risk children are physician failure to recommend the vaccine and a lack of parental knowledge about the risks for serious complications.

In order to boost vaccination rates, Dombkowski stresses the need for intervention aimed at improving physician and parent awareness about the importance of annual vaccinations for children with asthma. Such interventions could include physician-focused reminder systems that prompt health care professionals to recommend influenza vaccination at a medical visit, he says.

"Reminder systems are among the most effective mechanisms to improve vaccination rates and can be built into immunization registries," says Dombkowski, who pointed to his current work with the Michigan Department of Community Health—which helped support the study—to a pilot physician-reminder system for influenza vaccination this fall in Michigan's statewide immunization registry.

Along with Dombkowski, co-authors from the CHEAR Unit in the Division of General Pediatrics were Dr. Matthew M. Davis, Lisa M. Cohn and Sarah J. Clark.

The study also was supported by the Blue Cross Blue Shield of Michigan Foundation.

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