Cameron Melissa A, Bigos David, Festa Christopher, Topol Howard, Rhee Kyung E
Department of Pediatrics, Division of Hospitalist Medicine, Rady Children's Hospital-San Diego, San Diego, California;
Departments of Anesthesia and Critical Care and.
Hosp Pediatr. 2016 Sep;6(9):507-12. doi: 10.1542/hpeds.2015-0219. Epub 2016 Aug 2.
Hospitals are required to screen and administer the influenza vaccine to all admitted children unless contraindicated or refused by parents, yet vaccination rates remain low. Our goal was to examine reasons for refusal among pediatric patients admitted during influenza season.
All children age 6 months to 18 years admitted to 2 network community hospitals from October 1, 2013 to March 31, 2014, without contraindications, were offered influenza vaccination prior to discharge. Parents who refused vaccination were asked their reason for refusal. Chi-square tests and logistic regression were used to determine factors associated with refusing the vaccine in the inpatient setting.
Three hundred twenty-five of 786 unique patients admitted during influenza season were eligible for vaccination. Of these, 49.8% refused. Parents of females, whites, and those with private insurance were more likely to refuse vaccination. Patients whose immunization status was otherwise up to date were more likely to accept (Odds Ratio 2.39, 95% Confidence Interval 1.05-5.41). Commonly cited reasons for refusal were: preference to have vaccination by the primary care provider (24.1%), concern for side effects (16.1%), not wanting vaccination (13%), doubt in efficacy (8%), concern that the child was already sick (6.8%), no prior influenza vaccination (6.7%) and feeling that it was not needed (5.6%).
Hospitalization during influenza season provides an opportunity for health-care providers to educate families about influenza and vaccinate patients if appropriate. However, nearly half of parents of eligible children declined vaccination. More study is required to determine strategies that can increase influenza vaccination acceptance.
医院必须对所有入院儿童进行流感疫苗筛查并接种，除非有禁忌或家长拒绝，但疫苗接种率仍然很低。我们的目标是调查流感季节入院的儿科患者拒绝接种的原因。
2013年10月1日至2014年3月31日期间，两所网络社区医院收治的所有6个月至18岁、无禁忌证的儿童在出院前均被提供流感疫苗接种。拒绝接种的家长被询问拒绝原因。采用卡方检验和逻辑回归分析来确定住院环境中与拒绝接种疫苗相关的因素。
流感季节收治的786名患儿中，325名符合疫苗接种条件。其中，49.8%的家长拒绝。女性、白人以及有私人保险的患儿家长更有可能拒绝接种。免疫状态在其他方面达标的患者更有可能接受接种（优势比2.39，95%置信区间1.05 - 5.41）。常见的拒绝原因包括：更倾向于由初级保健提供者进行接种（24.1%）、担心副作用（16.1%）、不想接种（13%）、怀疑疫苗效果（8%）、担心孩子已经生病（6.8%）、之前未接种过流感疫苗（6.7%）以及觉得不需要接种（5.6%）。
流感季节住院为医护人员提供了一个向家庭宣传流感知识并在适当情况下为患者接种疫苗的机会。然而，近一半符合条件儿童的家长拒绝接种。需要更多研究来确定能够提高流感疫苗接种接受率的策略。
