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The Impact of Missed Opportunities on Seasonal Influenza Vaccination Coverage for Healthy Young Children

Allred, Norma J. PhD, MSN; Poehling, Katherine A. MD, MPH; Szilagyi, Peter G. MD, MPH; Zhang, Fan PhD, MD, MPH; Edwards, Kathryn M. MD; Staat, Mary Allen MD, MPH; Donauer, Stephanie MS; Prill, Mila M. MSPH; Fairbrother, Gerry PhD

Journal of Public Health Management and Practice: November/December 2011 - Volume 17 - Issue 6 - p 560–564
doi: 10.1097/PHH.0b013e31821831c3

Objective: To estimate the impact of missed opportunities on influenza vaccination coverage among 6- through 23-month-old children who sought medical care during the 2004–2005 influenza season.

Design: Retrospective cohort study.

Setting: Fifty-two primary care practice sites located in Rochester, New York, Nashville, Tennessee, and Cincinnati, Ohio.

Participants: Children 6 through 23 months of age.

Methods/Outcome Measure: Charts were reviewed and data collected on influenza vaccinations, type of health care visit (well child or other), and presence of illness symptoms. Missed opportunity was defined as a practice visit by an eligible child during influenza season, when vaccine was available, but during which the child did not receive an influenza vaccination. Vaccine was assumed to be available between the first and last dates influenza vaccination was recorded at that practice. Each child was classified as fully vaccinated, partially vaccinated, or unvaccinated.

Results: Data were analyzed for 1724 children, 6 through 23 months of age. Most children (62.0%) had at least 1 missed opportunity during this period. Among children with any missed opportunities, 12.8% were fully and 29.8% were partially vaccinated. Overall, 33.6% of the missed opportunities occurred during well child visits and 66.4% during other types of visits; 75% occurred when no other vaccines were given. Eliminating all missed opportunities would have increased full vaccination coverage from 30.3% to 49.9%.

Conclusions: Missed opportunities for influenza vaccination are frequent. Reducing missed opportunities could significantly increase influenza vaccination rates and should be a goal in each practice.

This study measures the frequency of missed opportunities for influenza vaccination in a large cohort of healthy young children from 3 geographically distinct areas during the 2004–2005 influenza season, the first season after the universal influenza recommendation for healthy 6- through 23-month-old children.

National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Allred and Zhang and Ms Prill); Department of Pediatrics, Wake Forest University Medical Center, Winston-Salem, North Carolina (Dr Poehling); School of Medicine and Dentistry, University of Rochester, Rochester, New York (Dr Szilagyi); Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Edwards); and Division of Infectious Diseases (Dr Staat) and Center for Epidemiology and Biostatistics (Ms Donauer), Cincinnati Children's Hospital Medical Center (Dr Fairbrother), Cincinnati, Ohio.

Correspondence: Norma J Allred, PhD, MSN, 1600 Clifton Rd NE, MS A-19, Atlanta GA 30333 (

This work was funded by the Centers for Disease Control and Prevention as part of the New Vaccine Surveillance Network and the National Vaccine Program Office. Dr Poehling received support from National Institute of Allergy and Infectious Diseases (K23 AI065805) and Wachovia Research Fund. Data have previously been presented in part at the annual meeting of the Pediatric Academic Society, Baltimore, Maryland, May 1–5, 2009.

Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Disclosure: The authors declare no conflict of interest.

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.