Understanding the Impact of Approved but Unfunded Vaccine Status on Parental Acceptance of an Adjuvanted Seasonal Influenza Vaccine for Infants: Results from the Pediatric Influenza Vaccination Optimization Trial (PIVOT)-III.

The adjuvanted trivalent influenza vaccine (aTIV) provides enhanced protection against influenza for infants but is not publicly funded (NPF). The objective of this prospective cohort study of parents with children 6 through 23 months of age was to understand how NPF status influences parental perceptions of approved but unfunded vaccines and their intentions to vaccinate. At healthy baby visits, clinicians provided parents with information about influenza and vaccination. Before and after these interactions, a research nurse assessed parents' intentions to vaccinate their children and their beliefs about the safety, efficacy, and necessity of vaccinating their children with aTIV in both publicly funded (PF) and NPF settings. Overall, 15 community practice clinics (n = 15 physicians) and nine public health clinics (n = 9 nurses) recruited 207 parents. The percentage of parents intending to immunize their children with aTIV decreased from 72% (vaccine PF, free of charge), to 42% (NPF, $25 per dose), to 27% (NPF, $50 per dose). Funding status strongly influenced whether parents perceived immunization with aTIV to be necessary, safe, and effective. Information on influenza and influenza vaccines should be provided to parents routinely to allow for well-informed decisions on the suitability of specific influenza vaccines for their child.

Clinicians Are Not Able to Infer Parental Intentions to Vaccinate Infants with a Seasonal Influenza Vaccine, and Perhaps They Should Not Try: Findings from the Pediatric Influenza Vaccination Optimization Trial (PIVOT)-IV.

This prospective cohort survey evaluated the concordance of clinicians' perceptions of parental intentions and parents' actual intentions to vaccinate their infants against influenza. During a routine healthy baby visit, clinicians provided parents with information about influenza, children's vulnerability to influenza, and nonadjuvanted and adjuvanted trivalent influenza vaccines (TIV and aTIV, respectively). Before and after the clinician−parent interaction, parents were surveyed about their attitudes, their perceptions of support from significant others, and the intention to vaccinate their infant with aTIV. Clinicians were asked about their perception of parents' intentions to choose aTIV for their children. These assessments included 24 clinicians at 15 community practices and nine public health clinics, and 207 parents. The correlation coefficients of the clinicians' assessment of parents' intention to vaccinate were 0.483 (p < 0.001) if the vaccine was presented as free of cost, 0.266 (p < 0.001) if the cost was $25, and 0.146 (p = 0.036) if the cost was $50, accounting for 23%, 7%, and 2% of the variance in parental intentions, respectively. The clinicians were poor at predicting parental intentions to immunize, particularly when cost was involved. Information on vaccine options and influenza infection should be provided for every eligible patient to allow parents to determine if the vaccine is appropriate for their child.

Parental Attitudes and Perceptions of Support after Brief Clinician Intervention Predict Intentions to Accept the Adjuvanted Seasonal Influenza Vaccination: Findings from the Pediatric Influenza Vaccination Optimization Trial (PIVOT)-I.

Adjuvanted trivalent influenza vaccine (aTIV) provides enhanced protection against seasonal influenza in children compared with nonadjuvanted trivalent influenza vaccine (TIV). This prospective cohort study assessed parental attitudes, beliefs, and intentions to vaccinate their infants aged 6-23 months with aTIV. Parents were surveyed before and after routine healthy baby visits, and post clinician interaction results were analyzed using multivariable logistic regression. Physicians at 15 community practice clinics and nurses at 3 public health clinics participated; 207 parents were surveyed. After clinician consultation, most parents considered immunization with aTIV to be safe (72.9%), effective (69.6%), and important (69.0%); most perceived support for vaccination from significant others (62.8%) and clinicians (81.6%); and 66.6% intended to vaccinate their infant with aTIV. Parental attitudes toward vaccinating their infant with aTIV were strongly correlated with perceptions of vaccine safety, efficacy, and importance, and these represented the strongest influence on intentions to vaccinate (odds ratio (OR) 79.25; 95% confidence interval (CI) 6.05-1037.50). Parental intentions were further influenced by perceived strength of clinician recommendation (OR 4.55, 95% CI 1.38-15.06) and social support for vaccination (OR 3.46, 95% CI 0.50-24.13). These findings may inform clinician approaches to parental education to ensure optimal seasonal pediatric influenza vaccination.

Continuing Medical Education Improves Physician Communication Skills and Increases Likelihood of Pediatric Vaccination: Findings from the Pediatric Influenza Vaccination Optimization Trial (PIVOT)-II.

This study evaluated the impact of a continuing medical education (CME) program that emphasized actionable information, motivation to act, and skills to strengthen physician recommendations for seasonal influenza vaccination in children 6 through 23 months of age for whom influenza immunization rates are suboptimal. Physicians were randomly assigned to an accredited CME program or to no CME. Participants completed pre- and post-study questionnaires. Influenza immunization rates were compared between groups. A total of 33 physicians in the CME group and 35 in the control group documented 292 and 322 healthy baby visits, respectively. Significantly more parents immunized their children against influenza after interacting with CME-trained physicians than those with no CME training (52.9% vs. 40.7%; p = 0.007). The odds ratio for vaccination after visits with CME-trained physicians was 1.52 (95% confidence interval 1.09 to 2.12; p = 0.014), which was unaffected by the socioeconomic status of parents. Parents who discussed influenza vaccination with CME-trained physicians were 20% more likely to choose an approved but publicly unfunded adjuvanted pediatric influenza vaccine. The percentages of physicians reporting the highest levels of knowledge, ability, and confidence doubled or tripled after the CME intervention. Significantly more parents immunized very young children after interacting with physicians who had undergone CME training.

Survey of Awareness and Perceptions of Canadians on the Benefits and Risks of Clinical Trials.

BACKGROUND: Little is known about the Canadian public's perspective regarding clinical trials. METHODS: We surveyed 1602 Ontario and British Columbia residents to ascertain their understanding of and willingness to participate in clinical trials. RESULTS: Clinical trials are regarded positively with overall perceptions that they provide societal and personal benefits. Most respondents were somewhat (49%) or very willing (19%) to participate in a clinical trial. This increased with age and level of education. It was also greater among those with poor or very poor health, those with multiple chronic conditions, and those who had previously been invited into a clinical trial, all of which were correlated with age. Still, there was room for improvement in awareness and understanding of clinical trials. Forty-three percent of those surveyed felt not very informed or not at all informed and 37% had no opinion regarding clinical trials. Respondents would most often turn to their treating physician if considering participating in a clinical trial and least often to social media. CONCLUSION: While Canadians' views about clinical trials are generally positive, they are somewhat muted and a significant minority feels poorly or not at all informed. They are less willing to participate in clinical research than Americans and are roughly equivalent to Europeans. While clinicians are the top choice for learning about clinical trials, they have little or no training and little time for this role. As we move toward integrating clinical trials into the practice setting, these issues of time, training, and resources must be addressed.

Measuring the impact of influenza vaccination on healthcare worker absenteeism in the context of a province-wide mandatory vaccinate-or-mask policy.

OBJECTIVES: In 2012, British Columbia (BC) implemented a province-wide vaccinate-or-mask influenza prevention policy for healthcare workers (HCWs) with the aim of improving HCW coverage, and reducing illness in patients and staff. We assess post-policy impacts of HCW vaccination status on their absenteeism. METHODS: We matched individual HCW payroll data from December 1, 2012 to March 31, 2017 with annually self-reported vaccination status for BC health authority employees to assess sick rates (sick time as a proportion of sick time and productive time). We modelled adjusted odds ratios (OR) of taking any sick time, relative rates (RR) of sick time taken, and predicted mean sick rates by vaccination status in influenza (December 1-March 31) and non-influenza seasons (April 1 to November 30). We used two methods to assess changes in influenza season sick rates for HCWs who had a change in their vaccination status over the five years. RESULTS: HCWs who reported 'early' vaccination (before December 1 when the policy is in effect) were less likely to take sick time (OR 0.874, 95%CI: 0.866-0.881) and took less sick time (RR 0.907, 95%CI: 0.901-0.912) in influenza season compared to HCWs who did not report vaccination; whereas HCWs who reported 'late' (between December 1 and March 31, and subject to masking until vaccinated) had similar sick rates to HCWs who did not report vaccination. These trends were also observed in non-influenza season. Influenza season sick rates were similar for HCWs that had at least one year of 'early' vaccination and one year where vaccination was not reported over the five year period. CONCLUSIONS: Overall absenteeism is lower among HCWs who report vaccination versus those who do not report. However, absenteeism behaviours appear to be influenced by individual level factors other than vaccination status.

Measuring the impact of a mandatory province-wide vaccinate-or-mask policy on healthcare worker absenteeism in British Columbia, Canada.

OBJECTIVES: Vaccinate-or-mask (VOM) policies aim to improve influenza vaccine coverage among healthcare workers (HCW) and reduce influenza-related illness among patients and staff. In 2012, British Columbia (BC) implemented a province-wide VOM influenza prevention policy. This study describes an evaluation of policy impacts on HCW absenteeism rates from before to after policy implementation. METHODS: Using payroll data from regional and provincial Health Authorities (HA), we assessed all-cause sick rates (sick time as a proportion of sick time and productive time) before (2007-2011, excluding 2009-2010) and after (2012-2017) policy implementation, and during influenza season (December 1-March 31) and non-influenza season (April 1-November 30). We used a two-part negative binomial hurdle model to calculate odds ratios (OR) of taking any sick time, relative rates (RR) of sick time taken, and predicted mean sick rates, adjusting for age group, sex, job type, job classification, HA, year and vaccine effectiveness. RESULTS: During influenza season, HCWs in the post-policy period were less likely to take any sick time (OR 0.989, 95%CI: 0.979-0.999) but had higher rates of sick time (RR 1.038, 95%CI: 1.030-1.045). However, during non-influenza season, HCWs in the post-policy period were more likely to take any sick time (OR 1.015, 95%CI: 1.008-1.022) but had lower rates of sick time (RR 0.971, 95%CI: 0.966-0.976). There was an overall increase in predicted mean sick rate from pre to post-policy in influenza season (4.392% to 4.508%) and non-influenza season (3.815% to 3.901%). CONCLUSIONS: The observed year-round increase in sick rates from pre-to-post policy was likely influenced by other factors; however, opposite trends in how HCWs took sick time in the influenza and non-influenza seasons may reflect policy influences and need further research to explore reasons for these differences.