1522. Improving Influenza Immunization Rates in Children with Diabetes
Session: Poster Abstract Session: Influenza Vaccines
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
  • Influenza-Diabetes_IDSA_Poster_FINAL.pdf (468.0 kB)
  • Background:

    While influenza vaccine (IV) is recommended for all children annually, children with diabetes are at higher risk for complications and vaccine is underutilized in this population. This is the first study using order sets in the ambulatory setting to increase IV rates in diabetic children.


    A non-equivalent control group design was used to enroll 420 children and parents over 2 influenza seasons (2010-11, 2011-12) at 2 sites (A & B). No vaccine prompts were used for phase 1 which was considered a control season at both sites. An influenza vaccine order set was introduced in season 2 at site A and not B (phase 2), and phase 3 had the order set at both sites. Demographic data included: age, race, ethnicity, insurance, parental education, and parental IV status. Location of patient IV receipt and reason for non-receipt was recorded.


    Majority of children were white 357/423 (84%), non-Hispanic 402/423 (95%), with private insurance 277/423 (65%); median age 152 mos (IQR: 115,180). 72% (297/414) of mothers and 69% (264/382) of fathers had some college. Vaccine rates for children during the 3 phases were 104/140 (74%), 97/140 (69%), and 114/143 (80%) respectively. Maternal vaccine rates were 37/134 (28%), 19/136 (14%), 43/139 (31%); and paternal rates were 37/116 (32%), 18/119 (15%), 40/114 (35%) during the 3 phases respectively. Table 1 shows the comparison of immunization rates of vaccine eligible (i.e. no previous vaccine) patients in endocrine clinic over the 3 study phases.

    Table 1. Children receiving vaccine in Endocrine Clinic

    # received vaccine in clinic/eligible patients


    Comparison 1:                                                        



                               Phase 1 A (%)

    14/34 (41)

                               Phase 2 A (%)

    36/56 (64)

    Comparison 2:


                               Phase 1 B (%)

    14/30 (47)



                               Phase 2 B (%)

    42/65 (65)

    Comparison 3:


                               Phase 2 B (%)

    42/65 (65)



                               Phase 3 B (%)

    28/38 (74)

    Comparison 4:



                               Phase 2 A (%)

    36/56 (64)


                               Phase 3 A (%)

    15/34 (44)


    While use of the order set improved vaccine rates at site A, and was sustained over time; an increase was also seen at site B which may reflect increased provider awareness at both sites prompting an IV recommendation. We noted an IV rate above the national average for children, but remains sub-optimal. The provider’s strength of conviction to immunize may be key to improving IV rates for this population.

    Angela Myers, MD, MPH1,2, David Williams, MPH3, Joseph Cernich, MD4, Arthur Williams, PhD, MA(Econ), MPA5 and Mary Anne Jackson, MD, FIDSA1, (1)Children's Mercy Hospital, Kansas City, MO, (2)UMKC Sch of Med, Kansas City, MO, (3)Quality Improvement, Children's Mercy Hospitals & Clinics, Kansas City, MO, (4)Pediatrics, Children's Mercy Hospitals and Clinics and University of Missouri-Kansas City, Kansas City, MO, (5)Health Outcomes and Health Services Research, Children's Mercy Hospital and Clinics, Kansas City, MO


    A. Myers, None

    D. Williams, None

    J. Cernich, None

    A. Williams, None

    M. A. Jackson, None

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