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OBJECTIVES: Explore pediatric staff experiences administering the second influenza vaccine dose. STUDY DESIGN: Qualitative focus groups/interviews. METHODS: As part of the National Institutes of Health-funded Flu2Text randomized control trial of text message reminders for second influenza vaccine dose, we conducted seven focus groups and four individual interviews (n = 39 participants total) with clinicians and staff from participating practices from the American Academy of Pediatrics' Pediatric Research in Office Settings (PROS) Network. Of 37 participating practices, 10 were selected through stratified sampling of practices with highest (n = 5) and lowest (n = 5) randomized controlled trial effect sizes. A semi-structured discussion guide included questions that addressed parental, practice, and health system barriers/facilitators to second influenza vaccine dose administration. Using the Systems Model of Clinical Preventive Care as a conceptual framework, two investigators independently coded transcripts (Κ = 0.86, high agreement) with NVivo 12 Plus. Coding inconsistencies were resolved by consensus. RESULTS: Clinicians/staff reported that administering the second influenza vaccine dose in a season was more complex than other childhood vaccines. They highlighted parental uncertainty about the need for the second dose and the difficulty and inconvenience of bringing children back to the office as important barriers. Caregiver-staff relationships were perceived as helpful in getting children vaccinated with their second dose and vaccine reminders were seen as important cues-to-action. CONCLUSIONS: Ensuring receipt of two doses of the influenza vaccine in a given season presents unique challenges. Themes identified provide a framework for understanding opportunities to bolster second dose receipt, including explaining why two doses are needed, offering flexible hours for vaccination, and sending vaccine reminders.
RESUMEN
BACKGROUND: There is growing evidence that there is within (intra-) season waning of influenza vaccine protection in older adults, suggesting there may be a benefit to giving influenza vaccine closer to the time of increased infection risk. We aimed to quantitatively evaluate the impact of modifying the timing of influenza vaccination in U.S. older adults. METHODS: Using historical data (2010/2011-2015/2016, inclusive) on influenza activity and vaccine uptake, we explore the optimal time to begin vaccinating older adults (≥65â¯years) in the U.S. to maximize prevention of influenza. We modelled the effect of changing the timing of vaccination by estimating the percentage change to the current disease burden and used this to calculate the estimated optimal week to begin vaccination in the U.S. RESULTS: When we assumed a relatively slower waning protection rate (over 52â¯weeks), the estimated optimal time to begin vaccinating those agedâ¯≥65â¯years varied between mid-August (week 34, 2012-2013) and mid-late October (week 43, 2011-2012) depending on the season, resulting in 0.44% and 5.11% of the current disease burden prevented respectively. Under faster waning (over 26â¯weeks), the estimated optimal week varied between early September (week 37, 2012-2013) and mid-November (week 47, 2011-2012), resulting in 3.69% and 11.97% of the current disease burden prevented respectively. CONCLUSIONS: While it is difficult to determine the ideal time to start to vaccinate due to substantial variation in timing of individual seasons, we found that there are potentially substantial benefits to minimizing the time between vaccination and influenza activity in U.S. older adults. Modest delays in immunization were beneficial in the seasons we evaluated. If further evidence suggests fast waning, longer delays may be warrant as in these scenarios the timing of the current vaccination was often very suboptimal.
