[Human Vaccines 1:2, 74-79; March/April 2005]; ©2005 Landes Bioscience
Physician Knowledge and Perspectives Regarding Influenza and Influenza Vaccination Research Paper
ABSTRACT
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*Correspondence to: Robert S. Daum; Section of Pediatric Infectious Diseases; University of Chicago Hospitals; 5841 S. Maryland Ave., MC 6054; Chicago, Illinois 60637 USA; Email:
[email protected] Received 12/27/05; Accepted 02/12/05
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Previously published online as a Human Vaccines E-publication: http://www.landesbioscience.com/journals/vaccines/abstract.php?id=1604
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†Present address: Children’s Hospital; Department of Pediatric Infectious Diseases;
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Pediatric Immunization Program; Department of Pediatrics; University of Chicago; Chicago, Illinois USA
Background: Recent studies have demonstrated that healthy children younger than 24 months of age are at risk for influenza-associated hospitalization and influenza related complications. In light of this, the American Academy of Pediatrics (AAP) and the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention changed their recommendation for influenza vaccination for the 2004–05 season to include universal vaccination for all healthy children 6–23 months of age. Methods: A self-administered survey was distributed to a random sampling of family practitioners and pediatricians in Chicago, IL. Questions were asked regarding demographics, current use of influenza vaccines, and knowledge regarding influenza vaccines and influenza infection in children. Answers were scored as correct based on published literature and AAP/ACIP recommendations. Results: During the 2002–2003 influenza season, recommendation for influenza vaccination and perceived use for both healthy children and children with a high-risk medical condition were both low. The majority of physicians were not aware of the severity of influenza infection in young children, could not correctly identify all contraindications to receiving vaccination, did not know which children require two vaccinations, and were not aware of the complications of influenza in children. Conclusions: To achieve the goal of universal influenza vaccination coverage for the 2004–05 season for healthy children 6–23 months of age, physicians will need a greater understanding of the severity of influenza illness in this age group coupled with an increased knowledge of indications for vaccine administration.
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Samuel R. Dominguez† Robert S. Daum*
ACKNOWLEDGEMENTS
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We thank Janet Englund, John Modlin, Georges Peter, and Margaret Rennels for their thoughtful review of our survey instrument. We also thank Dezheng Huo and J. Scott Parrot for help in data analysis. The Pediatric Immunization Program receives financial support from Aventis, the Chicago Department of Public Health, GlaxoSmith-Kline, Margaret and George Siber, Wyeth Pharmaceuticals, and the University of Chicago Hospitals.
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influenza, vaccine, children, survey
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INTRODUCTION
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Influenza poses increased risk for severe disease and complications in adults older than 50 years. Recognition that children with certain underlying chronic medical conditions have similar high risk has resulted in a longstanding recommendation for universal vaccination of this group. Recently a similar or even greater risk was documented in healthy children younger than 24 months of age.1-4 In light of this, the American Academy of Pediatrics (AAP) and the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) changed their recommendation for influenza vaccination for the 2002–2003 season to state that immunization of healthy children 6–23 month of age should be “encouraged to the extent feasible”.5,6 ACIP subsequently changed this statement again to recommend routine immunization of these young children during the upcoming 2004–2005 influenza season.7 A potential obstacle to implementing this new recommendation is health care providers’ understanding of the seriousness of influenza infection and its complications and willingness to recommend vaccination to their patients. Few data are available documenting provider attitude toward influenza vaccination for children and toward the recent changes in recommendations for vaccination. This study was designed to assess provider perceived practices regarding influenza vaccination in children, and provider knowledge regarding influenza vaccines and infections in children.
74
Human Vaccines
2005; Vol. 1 Issue 2
Physician Knowledge of Influenza in Children
Table 1
Demographic characteristics of responding physicians
Category
Percent
Pediatrician Family Practice Other
50.3% 46.0% 3.8%
Range Mean + SD
1–38 years 13.8 + 9.2 years
Range Mean + SD
27–65 years 45.1 + 9.4 years
Male Female
47.2% 52.8%
Yes No
55.8% 44.2%
Private Practice Community Health Center HMO Hospital Based Clinic Other
60.1% 14.4% 1.1% 15.5% 8.9%
0–25% 26–50% 51–75% >75%
26.5% 20.7% 6.0% 46.7%
0–10% 11–25% 26–50% >50%
29.8% 20.5% 25.0% 24.7%
90%
30.4% 14.9% 20.3% 34.4%
Specialty
Years since completion of residency Age Sex
Academic affiliation Practice setting
Table 2 Question
As of Sept 1, 2003 there was a new licensed nasal spray influenza vaccine available.
96.3%
The rate of influenza-related hospitalization for adults >50 years of age is greater than the rates for healthy children younger than 24 months of age.
49.5%
Answer: false
The fatality rate for influenza in adults >50 years of age is 66.5% greater than in healthy children younger than 24 months of age.
Answer: true
The rate of hospitalization for healthy children younger than 24 months of age with influenza is higher than the rate in older children with a high-risk condition.
60.4%
Which age groups of children require two infuenza shots?
Answer: First time recipients under the age of 9
58.5%
What is the minimum recommended interval between two influenza shots?
84.0%
Answer: true
Answer: 4 weeks
Percent of patients in practice younger than 5 years of age
MATERIALS AND METHODS We obtained a list of all pediatricians and family/general practitioners, including MDs and DOs practicing in Cook County, Illinois, from Medical Marketing Services Incorporated in August 2003. From the 1981 names provided, a random sample was drawn (n = 999) to receive our self-administered survey. A first mailing was sent in early November 2003 and a second mailing was sent six weeks later to nonrespondents. Surveys were coded to allow respondent anonymity. The survey protocol was approved by the Institutional Review Board of the University of Chicago, which indicated that neither written nor oral consent was required for this study. The survey instrument was a 30-item questionnaire. Three categories of questions were presented. The first concerned demographics of the physician and his/her practice. Included were questions regarding specialty, age, years since completion of residency, affiliation with an academic institution, size and type of practice, insurance coverage of patients, and percent of patients seen that were children. The second category of questions concerned current use of influenza vaccines. For 6–23 month old and 2–18 year old children, physicians were asked for what percent of their patients they had recommended receipt of influenza vaccination during the 2002–2003 season. They were also asked
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% Correct
Answer: true
Percent of patients in practice younger than 18 years of age
Percent of patients with private insurance
Questions regarding influenza and influenza vaccine in children
what percent of patients they thought had actually received an influenza vaccination. Responses for children in both age groups were stratified into those that were healthy and those that had a high-risk medical condition. Physicians were given six percent ranges (none, 1–10%, 11–25%, 26–50%, 51–75%, >75%) to choose as possible answers and were also asked which age groups they thought universal influenza vaccination should be recommended for healthy children, if any. The third category of questions related to knowledge of influenza vaccines and influenza infection in children. The style of questions in this section varied. Respondents were asked to choose from a list of possible contraindications to influenza vaccination, what constituted high risk medical conditions, and what the known complications of influenza in children were. True/false questions were devised to ascertain physician understanding of the seriousness of influenza in children younger than two years of age and their awareness of the newly licensed nasal spray vaccine (Table 2), FluMist™. Physicians were also asked an open-ended question regarding the age groups of healthy and high-risk children, if any, that ACIP recommended influenza vaccination during the 2002-2003 influenza season. Answers to survey questions were deemed correct based on published literature,1,6 the Advisory Committee of Immunization Practices (ACIP) recommendations,8 and the 2000 Red Book: Report of the Committee on Infectious Diseases, 25th edition.9 For the 11 questions dealing with knowledge of influenza and influenza vaccines in children, an overall score was calculated. Each question was given equal weight and partial credit was given for questions with multiple responses. Scores were generated for all respondents who answered at least six of the 11 questions (99% of respondents). For those respondents who answered six but 75%” of the time these Figure 1. Percent of physicians whose healthy patients 6 to 23 months of age were rec- young, high-risk children actually received influenza vaccination ommended to receive/believed to have received influenza vaccination during the (Fig. 2). Almost 20% of respondents recommended influenza vaccination “
