Background/Purpose: EULAR guidelines recommend that annual influenza immunization be considered for all children with pediatric rheumatic diseases based on the possible increased risk of flu infection and the safety and immunogenicity of the vaccine. In accordance with these guidelines our division advices influenza immmunization for children and their families that are more at risk because of their disease or treatment. Despite our yearly recommendation with a flu vaccine letter and discussion with parents, there has been no systematic evaluation of who receives this vaccine. The purpose of this survey was to better understand families’ decision making around influenza immunization and how to better promote it for at risk children and their families.

Methods: From March to May 2019 families were invited, at the time of registration for their rheumatology visit, to fill a short survey related to influenza immunization. Eligibility was screened by the nurse and communicated to the clinic receptionist. Surveys were available in French and English and took 2-5 minutes to complete. Questions offered preselected responses with tick boxes and space to write additional comments. The questions explored who received the vaccine, why/why not, whether they received a reminder, barriers to vaccination and beliefs about risk. Families returned the completed survey to the receptionist or the nurse.

Results: The survey had an 88% response rate. The majority of the children were followed for Juvenile Idiopathic Arthritis (67%). For the immunization period 2018-2019, 111 (49%) of the 228 respondents received the flu vaccine. The vaccine was done for both the child and family members 86% of the time. Most received the vaccine at their local community clinic. Out of 100 respondents reporting receiving our reminder letter, 72 had the flu vaccine. Children vaccinated were on no treament in 41%, on non-steroidal anti-inflammatory drugs in 20%, on methotrexate (MTX) alone in 52%, on MTX and a biologic in 67%, and on a biologic alone in 84%.

Some families, whose children were on immunosuppressive medications identified that they felt their child was more likely to get the flu and/or to become more ill than other children if they had the flu. Of those, 79% chose to have their child vaccinated.

Families who vaccinated their child did so for a variety of reasons, the most important being to protect their child. Families who decided not to vaccinate most commonly felt that the vaccine was not always effective. Having easier access to the flu vaccine, as well as reassurance about safety and efficacy were identified as factors that would make it easier to receive the flu vaccine.

Conclusion: While a fairly high proportion of families indicate choosing the flu vaccine for their child and family, there is still room for improvement. For the season 2019-2020 we included a letter of information, attached to our regular flu vacine reminder letter, to address concerns identified as important to families. A poster with the findings of the survey  was placed in the clinic to stimulate conversation with families. Eliciting parents’ perception of their child’s risk of influenza illness should be part of our conversation, as this seems to be an important influence on choosing to vaccinate.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/influenza-immunization-a-quality-assurance-survey-in-a-pediatric-rheumatology-clinic/