Influenza Vaccination Uptake in Pediatric Patients with Cancer and
Sickle Cell Disease
Abstract
Background: Influenza causes greater morbidity in pediatric patients
with cancer or sickle cell disease (SCD). Limited data exists on
influenza vaccination uptake for these populations in a low-vaccination
state. Outpatient interventions improve vaccine uptake but isolated
inpatient interventions remain unstudied. Procedure: We reviewed
influenza vaccination of pediatric patients with cancer or SCD treated
at Children’s Healthcare of Atlanta (CHOA) during three influenza
seasons. An opt-out inpatient admission order set was implemented prior
to the 2019-2020 influenza season. Vaccination status of patients that
were admitted during an influenza season was compared pre- and
post-intervention via Chi-squared analysis and multivariate logistic
regression. Results: 1548 and 2549 patients with cancer and SCD
(respectively) were eligible. The oncology (60%-62%) and SCD cohorts
(61%-65%) had similar-to-higher vaccination uptake to the US (58-64%,
p=0.01-0.79) and higher uptake compared to Georgia (51%-56%,
p<0.01). There was no significant improvement in uptake after
implementation of the inpatient intervention for admitted patients with
cancer (40% vs 56%, p=0.05-0.88) or SCD (44% vs 56%, p=0.01).
Multivariate logistic regression also found no significant increase in
vaccine uptake (Hematologic Malignancy: 0.8 [0.73-0.98], Solid
Tumor: 0.9 [0.80-1.90], CNS Tumor: 0.9 [0.71-1.14], SCD: 0.9
[0.85-0.99]). Conclusion: Pediatric patients with cancer and SCD
have similar-to-greater influenza vaccination uptake compared to Georgia
and the United States. An intervention focused on vaccinating
hospitalized patients did not significantly improve the proportion of
cancer or SCD patients who received influenza vaccine in each season.
Future studies are needed to identify alternative approaches to
improving vaccine uptake in these cohorts.