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Children with sickle cell disease are at increased risk of serious infections, many of which can be prevented by receipt of recommended immunizations. Study objectives were to (1) assess the primary immunization series coverage among children with sickle cell disease and (2) compare the coverage with that of those without sickle cell disease.The Michigan Care Improvement Registry was used to obtain primary immunization series doses and sickle cell disease status for all eligible children in Michigan born in 2001-2016 (analysis was conducted in 2019). Completion of series and each individual vaccine were assessed for every child at ages 19 and 35 months. Proportions were stratified by sickle cell disease status and compared using chi-square tests. Logistic regression was used to model the odds of completing the series at each age, as predicted by sickle cell disease status and adjusting for the presence of Medicaid identification number.The proportion of children who completed the immunization series was higher for those with sickle cell disease than for those without sickle cell disease at 19 months (58.5% vs 48.0%) and 35 months (74.7% vs 59.6%) (both p0.0001). The odds of completing the series were 1.4 times higher at 19 months (95% CI=1.2, 1.6) and 1.7 times higher at 35 months (95% CI=1.5, 2.0) for children with sickle cell disease than for those without, adjusting for the presence of Medicaid identification number.Although children with sickle cell disease had higher immunization rates than those without sickle cell disease,40% of children with sickle cell disease did not receive all recommended immunizations by age 19 months. Immunization information systems should be utilized to improve routine immunization coverage of children with sickle cell disease.

Background Although previous studies have found reminder/recall to be effective in increasing immunization rates, little guidance exists regarding the specific ages at which it is optimal to send reminder/recall notices. Purpose To assess the relative effectiveness of centralized reminder/recall strategies targeting age-specific vaccination milestones among children in urban areas during June 2008–June 2009. Methods Three reminder/recall strategies used capabilities of the Michigan Care Improvement Registry (MCIR), a statewide immunization information system: a 7-month recall strategy, a 12-month reminder strategy, and a 19-month recall strategy. Eligible children were randomized to notification (intervention) or no notification groups (control). Primary study outcomes included MCIR-recorded immunization activity (administration of ≥1 new dose, entry of ≥1 historic dose, entry of immunization waiver) within 60 days following each notification cycle. Results A total of 10,175 children were included: 2,072 for the 7-month recall, 3,502 for the 12-month reminder, and 4,601 for the 19-month recall. Immunization activity was similar between notification versus no notification groups at both 7 and 12 months. Significantly more 19-month-old children in the recall group (26%) had immunization activity compared to their counterparts who did not receive a recall notification (19%). Conclusions Although recall notifications can positively affect immunization activity, the effect may vary by targeted age group. Many 7- and 12-month-olds had immunization activity following reminder/recall; however, levels of activity were similar irrespective of notification, suggesting that these groups were likely to receive medical care or immunization services without prompting.

Results: Among 3618 children with a high-risk condition, 2730 (75.5%) had not received a 2008 - 2009 influenza vaccination and were eligible at the time of notification. Among children assigned to the reminder group (n1374), 42.6% had an address determined to be either invalid, undeliverable, or both. Among those with valid addresses (n2001), a greater percentage of children with deliver- able reminders received at least one influenza vaccination (30.8%) during the outcome observation period than did children assigned to no reminder (24.3%, OR1.39, 95% CI1.13, 1.72); children with an undeliverable reminder had an influenza vaccination rate (22.8%) similar to children assigned to no reminder. Conclusions: Receipt of a reminder was positively associated with seasonal influenza vaccination. However, more than 40% of children assigned to receive a reminder were determined to have an invalid or undeliverable address, emphasizing the need for increased quality of IIS contact information.

Children with chronic conditions have an increased risk of complications from influenza and have low influenza vaccination rates.To assess the feasibility and effectiveness of using a statewide immunization information system (IIS) for seasonal influenza vaccine reminders from local health departments (LHDs) targeting children with high-risk conditions.A randomized community intervention.The study was conducted in a population of 3618 children aged 24-60 months with a high-risk condition residing in three Michigan counties. Children were identified using a statewide IIS in October 2008.Children were randomized to intervention (reminder) or control (no reminder) groups. Reminders for seasonal influenza vaccination were mailed by LHDs in November 2008.Feasibility of notification (address validity, address deliverability) was assessed (November 2008-February 2009), and frequencies of notification feasibility measures were determined (analyses conducted in 2010). Effectiveness of notification (seasonal influenza vaccine receipt) was assessed using bivariate logistic regression.Among 3618 children with a high-risk condition, 2730 (75.5%) had not received a 2008-2009 influenza vaccination and were eligible at the time of notification. Among children assigned to the reminder group (n=1374), 42.6% had an address determined to be either invalid, undeliverable, or both. Among those with valid addresses (n=2001), a greater percentage of children with deliverable reminders received at least one influenza vaccination (30.8%) during the outcome observation period than did children assigned to no reminder (24.3%, OR=1.39, 95% CI=1.13, 1.72); children with an undeliverable reminder had an influenza vaccination rate (22.8%) similar to children assigned to no reminder.Receipt of a reminder was positively associated with seasonal influenza vaccination. However, more than 40% of children assigned to receive a reminder were determined to have an invalid or undeliverable address, emphasizing the need for increased quality of IIS contact information.This study is registered at www.ClinicalTrials.gov NCT01431183.

Background Longstanding recommendations for influenza vaccines among children were augmented by the Advisory Committee on Immunization Practices (ACIP) in 2002 and again in 2008 to encourage vaccination among healthy children aged 6 months–18 years. Little is known about the hospital costs and length of stay among high-risk and otherwise healthy children for the groups affected by the 2002 and 2008 recommendations of the ACIP. The burden of influenza may vary between children with high-risk medical conditions and those who are otherwise healthy. The objective of the current study was to characterize the national burden of influenza hospitalizations and to evaluate how hospital costs and length of stay varied among children diagnosed with influenza. Methods A retrospective analysis of influenza hospitalizations was performed in 2006 using the Healthcare Cost and Utilization Project Kids' Inpatient Database, a nationally representative database of hospital discharge records for children from January to December 2003. Children aged ≤18 years with the primary or secondary diagnosis of influenza were classified into three groups based on ACIP recommendations (0–5 months, 6–23 months, 24 months–18 years) and further subdivided by diagnostic codes (asthma, other chronic diseases, without chronic conditions). The outcome measures were aggregate national and mean hospital costs and mean length of stay. Results In 2003, aggregate national costs for children with a diagnosis of influenza were $76.5 million, 55% of which was among the group for whom an influenza vaccine was recommended or encouraged in 2003. These costs corresponded to 77,264 inpatient days for 27,363 influenza hospitalizations (2.8 days average length of stay). Mean costs were higher for children with influenza and chronic diseases ($7774) compared to those for children with asthma ($3469) and children without chronic conditions ($2785). Sub-analyses regarding recently expanded national recommendations revealed that 41% of all hospitalizations with a diagnosis of influenza were among otherwise healthy children aged 24 months–18 years. Conclusions In 2003, over half of the influenza hospitalizations and costs associated with influenza occurred among children for whom an influenza vaccination was recommended. The frequency of influenza hospitalizations among children aged 24 months–18 years supports recent expansion of the ACIP influenza vaccination recommendations.

Background: Vaccination status is assessed nationally in terms of up-to-date status without regard to the age at which recommended doses were actually received. Our study was conducted in 2000–2001 using the most current National Health Interview Survey (NHIS) public use files available. Methods: Retrospective analysis to determine up-to-date and age-appropriate vaccination status for children aged 25 to 72 months. Five years of pooled data (1992–1996) were obtained from the NHIS Immunization Supplement for children aged 25 to 72 months with immunization data based on written records. The outcome measures used were months of vaccination delay relative to age-appropriate vaccination standard as well as up-to-date vaccination status for the fourth diphtheria-tetanus-pertussis (DTP 4), Polio3, the first measles-mumps-rubella (MMR1) doses, and the 4:3:1 series. Results: Of the 9223 eligible children, 80% were up-to-date for the 4:3:1 vaccination series, but 48% had experienced delays relative to age-appropriate standards. For the DTP4 dose, 85% were up-to-date, although only 46% had received this dose at the appropriate age. Similarly, 90% of children were up-to-date with their Polio3 dose, with 64% receiving this dose at the appropriate age; 96% were up-to-date for the MMR1, and 58% received this dose at the appropriate age. Age-appropriate DTP4 vaccination increased by 17 percentage points from 1992 to 1996, whereas up-to-date DTP4 status increased by only 6% during the same period. Conclusions: Children with up-to-date vaccination status often experienced considerable delay relative to age-appropriate vaccination standards. Consequently, vaccination status measures based solely on up-to-date status tend to understate the degree of underimmunization in a population. National surveillance of age-appropriate vaccination is necessary to identify subpopulations with the greatest prevalence of vaccination delay and to reveal underlying trends that may not be evident through assessments of up-to-date status.