Using reminder/recall systems to improve influenza immunization rates in children with asthma

J Pediatr Health Care. Sep-Oct 2013;27(5):327-33. doi: 10.1016/j.pedhc.2011.11.005. Epub 2012 Feb 8.


Introduction: Asthma is a major public health concern in the U.S. pediatric population. Children with asthma tend to fare worse when they acquire respiratory illnesses such as influenza, requiring more episodic office visits and hospitalizations than do healthy children with the same illnesses. Despite the American Academy of Pediatrics recommendation that children with chronic diseases be immunized for seasonal influenza annually, influenza immunization rates in this population peaks at < 30%. The purpose of this literature review was to examine the effectiveness of reminder/recall systems in improving influenza immunization rates among children with asthma.

Method: This literature review was conducted using PubMed, CINAHL, EMBASE, and Cochrane. Of the 178 articles found, 12 met criteria for inclusion. Articles were included if they addressed influenza vaccination in asthmatic children and "high-risk" children and considered asthmatics in the definition of "high risk." Additionally, inclusion criteria required discussion of at least one mode of reminder method or recall method that was used to influence the rate of influenza vaccination in children with asthma. For the purposes of this review, "reminders" is defined as any action performed by health provider or representative of the health provider that was aimed at informing and/or reiterating to patients the importance of influenza vaccination for asthmatic children and/or the potential for increased morbidity with acquisition of the flu and/or availability of the vaccine. "Recall" methods included all efforts made by the health provider or his/her representative to encourage patients to return to clinics for vaccination during the influenza season. Articles were excluded if they focused on improving influenza vaccination rates in healthy children and if they used reminder/recall systems to influence vaccination against diseases other than influenza. No systematic review was found on this particular topic.

Results: Providers have used reminder and recall systems that alert patients of the need for vaccination and encourage compliance with this recommendation. Implemented techniques included verbal and mailed reminders, electronically generated alerts, and year-round scheduling of flu vaccination appointments.

Discussion: Improvements have been seen in influenza immunization rates with the implementation of reminder/recall systems; however, most have been modest. Enhancements in patient education and access to vaccination are other areas of needed improvement.

Keywords: Influenza; asthma; child; flu; immunization; recall; reminder; vaccine.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Asthma / epidemiology
  • Asthma / immunology*
  • Attitude to Health
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Immunization / statistics & numerical data
  • Immunization Programs / organization & administration*
  • Influenza Vaccines*
  • Influenza, Human / epidemiology
  • Influenza, Human / immunology
  • Influenza, Human / prevention & control*
  • Male
  • Parents
  • Patient Compliance
  • Program Evaluation
  • Public Health*
  • Reminder Systems* / statistics & numerical data
  • United States / epidemiology


  • Influenza Vaccines