613 - Vaccination of caregivers of infants and young children against influenza during pediatrician visits

Poster Number: 613
Publication Number: 613.224

Nathan L'Etoile, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Beth Rezet, Childrens Hospital of Philadelphia, Havertown, PA, United States; George Dalembert, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Noreena S. Lewis, Children's Hospital of Philadelphia, Wilmington, DE, United States

Background: The Advisory Committee on Immunization Practices (ACIP) recommends vaccinating contacts of children less than 5 years old against influenza, with special attention to caregivers of infants less than 6 months old. This recommendation underlies the concept of “cocooning” to decrease morbidity and mortality among this vulnerable population. Despite the ACIP recommendation, the American Academy of Pediatrics has not formally endorsed adult vaccination in pediatric settings, citing a need for further experience. A review of cocooning has shown low implementation and that barriers to this practice should be addressed.

Objective: We conducted a pilot implementation study to assess feasibility of providing influenza vaccines to adult caregivers during pediatric preventive care visits and acceptability among caregivers.

Design/Methods: During the 2021-2022 influenza season, we offered free influenza vaccines to caregivers of children < 5 years of age during a pediatrician’s visit at 2 urban, academic, pediatrics clinics, both of which serve predominantly Black and Medicaid-insured populations. At Site 1, one designated resident physician offered the vaccine, counseled on benefits/risks, and vaccinated amenable caregivers. At Site 2, all clinicians were encouraged to offer caregivers the vaccine; a nurse or medical assistant administered the vaccines. At both sites, we collected demographic and safety data (e.g., allergy and reaction history to vaccines) and whether the caregiver had received the vaccine previously as an adult. Clinic barriers to implementation were noted. Feedback was informally gathered during immunizations. 

Results: Staffing shortages due to COVID-19 impacted the delivery of this effort; nevertheless, 98 total caregivers were vaccinated, protecting 84 patients, a majority of which were Black. Of those vaccinated, 19% reported not previously receiving the influenza vaccine as an adult. Safety contraindications were not noted. Barriers to implementation included a lack of personnel to immunize on all clinic days at Site 1 and no reminders in the electronic health record at Site 2. Caregiver feedback at Site 1 included willingness to accept the vaccine to protect their child and convenience of vaccination during the visit.

Conclusion(s): In this pilot, caregivers accepted vaccination against influenza during preventative care visits for their child. Clinic barriers were lack of operationalized support, partially due to COVID-19. 19% of vaccinated caregivers had not received an influenza vaccine as an adult – vaccination during pediatrician visits to may help address barriers to vaccine uptake.