Elsevier

Public Health

Volume 123, Issue 7, July 2009, Pages 465-469
Public Health

Original Research
Influenza vaccination coverage among Spanish children, 2006

https://doi.org/10.1016/j.puhe.2009.05.002Get rights and content

Summary

Objectives

Traditionally, influenza is not considered to be a serious disease in healthy children. However, for vulnerable populations, such as young children and those with chronic medical conditions, influenza can lead to serious complications and even death. This study aimed to assess vaccination coverage among Spanish children under 16 years of age in 2006, and to describe the factors associated with vaccination.

Study design

Cross-sectional survey.

Methods

In total, 8851 records of children included in the Spanish National Health Survey for 2006 were analysed. The reply (‘yes’ or ‘no’) to the question: ‘Did you have a flu shot in the latest campaign?’ was used as a dependent variable. Influenza vaccine coverage was calculated as the percentage of individuals aged 6 months to 16 years whose parents reported that they had been vaccinated against influenza in the most recent campaign. The influence of sociodemographic variables on vaccination and the presence of associated chronic diseases (asthma and/or diabetes) were also analysed.

Results

Vaccination coverage among Spanish children in 2006 was 6.82%: 19.43% in children with associated conditions (asthma and/or diabetes), and 5.81% in healthy children. The only factor significantly associated with influenza vaccination in children with associated conditions was household income; children with a lower household monthly income were more likely to have been vaccinated against influenza than children with a higher household monthly income (odds ratio 1.96). In children for whom vaccination is not indicated, the probability of being vaccinated against influenza was greater in those whose parents were not university graduates.

Conclusion

Influenza vaccination coverage in Spanish children is low. Socio-economic inequalities continue to be a factor at the time of vaccination.

Introduction

Annual influenza epidemics continue to place a significant burden on society in terms of morbidity, mortality and lost productivity.1, 2 Traditionally, influenza is not considered to be a serious disease in healthy children, but for vulnerable populations such as young children and those with chronic medical conditions, influenza can lead to serious complications and even death.3, 4, 5, 6, 7

A recent study has shown that influenza is a common cause of hospitalization among both healthy and chronically ill children.5 The risk of influenza-associated hospitalization in healthy children under 24 months of age has been shown to be equal to or greater than the risk in previously recognized high-risk groups.8

Annual vaccination is the cornerstone of prevention. In 2006, the US Advisory Committee on Immunization Practices expanded its 2004 recommendation for routine influenza vaccination of children aged 6–23 months to include children aged 24–59 months.9 The continued expansion of the recommendations is based on the consideration that children aged 24–59 months experience increased morbidity attributable to influenza, with increased rates of outpatient visits and use of antibiotics.3, 10, 11, 12, 13, 14

In Spain, the responsibility for laying down guidelines for use of the influenza vaccine lies with the Ministry for Health and Consumer Affairs (MHCA) working in liaison with the autonomous regions.15 The Spanish Advisory Committee of the Spanish Association of Paediatrics indicates that additional epidemiological studios are necessary before changing the recommendations in Spain.16 Recommendations for the paediatric population include all children over 6 months of age with pulmonary, metabolic or cardiovascular diseases, and those suffering from immunosuppression. The vaccine is administered free of charge in these specific high-risk groups.15

Despite the availability of the influenza vaccine, influenza and its associated diseases continue to be an important public health issue in Spain. In 2004–2005, the highest rate of influenza was observed in patients under 15 years of age (49.4 cases per 1000 inhabitants).17

Different studies have indicated that demographic variables, racial disparities, level of education, size of household and household income are important predictors for influenza vaccination.18, 19, 20 Data from the 2003 Spanish National Health Survey (NHS) indicated that are socio-economic inequalities for receiving influenza vaccination in Spanish children.21

Kamal et al. showed that comorbidities influence the vaccination rate.22 This variable has also been described in the trend in influenza coverage for the Spanish population as a whole,23 and in Spanish children in particular.21

The present study examined the coverage of influenza vaccination in Spanish children aged 6 months to 15 years in 2006. The data were described by age, gender, nationality (immigrant/indigenous), household monthly income, parents' educational level and co-existence of concomitant chronic illness contained in the Spanish NHS that could constitute an indication for influenza vaccination (asthma and/or diabetes).

Section snippets

Methods

A cross-sectional study was conducted for influenza vaccination coverage in Spanish children aged less than 16 years using the 2006 Spanish NHS. The NHS was conducted by the National Statistics Institute under the sponsorship of the Spanish MHCA. This survey targeted a representative sample of Spanish children residing in main family dwellings. Study subjects were selected by means of probabilistic multistage sampling, with the first-stage units being census sections, and the second-stage units

Results

The initial household response rate for the 2006 NHS was 65%. Subsequently, 31% of the non-responding households were replaced, so that 96% of the estimated sample size was finally reached. In total, 9122 children under 16 years of age were interviewed. Details on the evaluation of non-respondents can be found elsewhere.25

Table 1 shows the characteristics of the study population and coverage of influenza vaccination. In total, 8851 individuals, aged 6 months to 15 years, were analysed, and

Discussion

These findings indicate that during 2006, influenza vaccine coverage was low in children and there was variability according to demographic characteristics. In addition, 6.82% of children stated that they had received the vaccine; this coverage is appreciably lower than that reported for children in the USA.26 Data from the 2006 US National Immunization Survey indicated that 20.6% of children aged 6–23 months were fully vaccinated and 31.9% had received at least one dose of influenza vaccine.27

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