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2004-2005 Influenza Season

Mandy A Allison; Matthew F Daley; Jennifer Barrow; Norma Allred*; Lori A Crane; Brenda L Beaty; Stephen Berman; and Allison Kempe * Centers for Disease Control and Prevention, Atlanta, GA.

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2004-2005 Influenza Season

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  1. Mandy A Allison; Matthew F Daley; Jennifer Barrow; Norma Allred*; Lori A Crane; Brenda L Beaty; Stephen Berman; and Allison Kempe *Centers for Disease Control and Prevention, Atlanta, GA Identifying and Prioritizing High-Risk Patients for Influenza Vaccine During a Season of Vaccine Shortage

  2. 2004-2005 Influenza Season Early October 2004 • Chiron notifies CDC that it will be unable to supply inactivated vaccine • ACIP names priority groups October-December • CDC and departments of health make efforts to redistribute vaccine January 2005 • ACIP expands priority group definitions • Many states broaden coverage

  3. 2004-2005 Influenza Season

  4. Immunization Rates in 2004-2005 • Among adults and children with High Risk Conditions (HRCs)—BRFSS data: • 26% of 18 to 64 year olds immunized by 1/31/05 • 35% of 2 to 17 year olds immunized by 1/31/05 • Despite the vaccine shortage, rates in adults with HRCs were similar to previous years • No national comparison data available for children

  5. Role of Registries and Reminder/Recall • Registries with Reminder/Recall systems increase immunization rates in adults and children • Adults and Children—Cochrane Review • Adult influenza vaccination OR 1.66 (1.39-2.01) • Childhood influenza vaccination OR 2.87 (1.65-4.98) • Children with HRCs—Daley and colleagues • RCT in children aged 6 to 72 months with HRCs • 42% of those identified and recalled received influenza vaccine • 25% of controls received influenza vaccine

  6. Study Objectives To assess whether practices using an immunization registry and recall system were able to: • Target children with HRCs • Maintain immunization rates for children with HRCs during the vaccine shortage • Vaccinate children with HRCs earlier in the season compared to healthy children

  7. Methods: Study Setting • 4 pediatric practices in metropolitan Denver, CO • Practices participated in a regional immunization registry and shared a common billing system • During BOTH the 2003-2004 and 2004-2005 seasons, the practices identified children with HRCs and sent recall letters but did not send recall letters to healthy children

  8. Data Sources • Billing database • Demographic data • Visit and diagnosis information • CPT codes of all immunizations given • Accuracy of billing data • Compared to medical record review, 90% of children with HRCs identified • At least 96% of immunizations captured

  9. Population • Children 24 to 72 months old during 2003-2004 and/or 2004-2005 seasons • Any office visit in prior 18 months • Record in billing database and immunization registry • Children with high risk conditions (HRCs) • 2003-2004, N = 1,166 • 2004-2005, N = 1,053 • Healthy children • 2003-2004, N = 10, 117 • 2004-2005, N = 10,387

  10. High Risk Condition Definition • Chronic pulmonary disease • Chronic heart disease • Chronic renal disease • Hematologic disease • Immune suppression • Metabolic • Kawasaki disease/Rheumatoid arthritis (aspirin therapy) • Others: • Down syndrome • Muscular dystrophy • Cerebral palsy

  11. ID and Recall of Children with HRCs • Search of billing database using ICD-9-CM codes • Identified all eligible 24 to 72 month old children with an encounter for a HRC in the previous 2 years as of 10/1/03 or 10/1/04 • All identified children received 1-3 recall letters • Strongly encouraged influenza vaccination • Provided telephone number to schedule appointment

  12. Were practices able to target children with HRC’s?

  13. Results: Immunization Rates

  14. Were practices able to maintain immunization rates for children with HRCs during a shortage?

  15. Results: Immunization Rates

  16. Were practices able to immunize children with HRCs earlier in the season?

  17. Results: Timing of Immunizations Time to immunization from September 1

  18. Results: Immunization Rates and Timing

  19. Strengths and Limitations • Limitations • Other factors may have affected immunization behavior and immunization rates: • Media coverage • Parents’ attitudes regarding vaccine • Timing and severity of influenza season • Strengths • Objectively assessed immunization rates • Used same pediatric practices using same methods to identify and recall high risk children to compare between seasons

  20. Conclusions Pediatric practices with a system to identify and recall children with HRCs were able to: • Target children with HRCs for influenza vaccine • Maintain high immunization rates in children with HRCs despite vaccine shortage • Vaccinate children with HRCs earlier in the year than healthy children

  21. Implications • A registry and recall system aided pediatric practices in following ACIP recommendations during a vaccine shortage. • Practices should be encouraged to use electronic databases to identify children with HRCs and link this information to immunization registries in order to help prioritize those most in need of vaccine when there is a shortage.

  22. Acknowledgements This investigation was supported by: • Centers for Disease Control and Prevention • Association of American Medical Colleges Technical support also provided by the Colorado Immunization Information System

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