Major Article| Volume 44, ISSUE 10, P1084-1088, October 01, 2016

Reasons for influenza vaccination underutilization: A case-control study

  • Scott S. Field
    Address correspondence to Scott S. Field, MD, 1106 Gleneagles Dr, Huntsville, AL 35801-6404. (S.S. Field).
    Pediatric Department, Huntsville Hospital, Huntsville, AL

    School of Medicine, University of Alabama, Birmingham, Huntsville, AL
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      • Past influenza illness significantly increased participants' risk for influenza.
      • Forty-one percent of influenza-positive patients and 11% of negative controls had prior influenza.
      • Hepatitis A (less threat) vaccine was accepted more than influenza vaccines.
      • Perceived lack of need (most common reason for underutilization) may have validity.


      Influenza vaccines are underused.


      Most (131/140) patients from a pediatric practice who were tested for influenza in the 2012-2013 season were enrolled. Medical records plus questionnaires determined vaccine and past disease histories and influenza vaccine attitudes. Influenza-negative tested cases (n = 65) and negative controls (n = 110) closely age-matched to 55 test-positive cases were compared with influenza-positive cases (n = 66) regarding prior influenza, vaccine efficacy, and limited vaccine season conflicting with birth dates and preventative visit timing to determine possible validity of reasons given for underutilization.


      The most common parental reason for not vaccinating was lack of perceived need. History of previous influenza was significantly (P < .0001) associated with disease. Live attenuated vaccine rates were greater in controls than in influenza patients for ages 2-18 years (P < .005) and for ages 6-18 years (P < .0001), whereas injectable vaccine rates were not (P = .30 and P = .60, respectively). Most positive cases (59%) and controls (89%) had no prior influenza.


      Prior influenza disease may be a risk factor for infection that could influence vaccination benefit. Live attenuated influenza vaccine outperformed trivalent inactivated influenza vaccine. Limited disease experience in individuals with low influenza vaccination rates, along with vaccine efficacy limitations, lends validity to some underutilization.

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      Linked Article

      • Commentary on reasons for influenza vaccination underuse: A case–control study
        American Journal of Infection ControlVol. 45Issue 6
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          Influenza, which is among the most, if not the most, common respiratory disease in today's society, and it is very much an issue. When the parents of the children being observed in a recent study by Field1 were questioned as to why or why not in regard to giving the vaccine to their children, the normal response was that they believed it was not necessary. In American society, this is the common response of those who do not want the vaccination given to them or their children. There must be something to prove wrong those who feel this way.
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