Original ResearchInfluenza vaccination coverage among Spanish children, 2006
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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