Interventions to increase influenza vaccination rates in children with high-risk conditions--a systematic review

Vaccine. 2015 Feb 4;33(6):759-70. doi: 10.1016/j.vaccine.2014.12.013. Epub 2014 Dec 31.


Background: Influenza is a common cause of morbidity and mortality, especially among the elderly and those with certain chronic diseases. Annual influenza vaccination is recommended for individuals in at-risk groups, but rates of vaccination are particularly low in children with high-risk conditions (HRCs).

Objective: To conduct a systematic review of studies that have examined interventions aimed at improving influenza vaccination in children with HRCs.

Methods: Two databases - PubMed and SCOPUS - were searched (with no time or language restrictions) using a combination of keywords - Influenza AND vaccination OR immunization OR children AND asthma OR malignancy OR high-risk AND reminder. Duplicates were removed, and abstracts of relevant articles were screened using specific inclusion/exclusion criteria. Thirteen articles were selected, and five additional studies were identified following a review of the reference lists of the initial thirteen articles, bringing the total number to eighteen.

Results: Most studies were conducted in the United States. Among the 18 studies, there was one systematic review of a specific intervention in asthmatic children, seven randomized controlled trials (RCTs), six before-and-after studies, one non-randomized controlled trial, one retrospective cohort study, one quasi-experimental post-test study, and one letter to editors. Interventions reported include multi-component strategies, letter reminders, telephone recall, letters plus telephone calls, an asthma education tool and year-round scheduling for influenza vaccination, amongst others.

Conclusion: There is good evidence that reminder letters will improve influenza vaccination uptake in children with HRCs, but the evidence that telephone recall or a combination of letter reminder and telephone recall will improve uptake is weak. It is not known if multiple reminder letters are more effective than single letters or if multi-component strategies are more effective than single or dual component strategies. There is a need for further research of these interventions, possibly outside the United States.

Keywords: Asthma; Children; High-risk; Immunization; Influenza; Malignancy; Reminder; Vaccination.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Asthma / complications
  • Asthma / immunology*
  • Asthma / virology
  • Child
  • Child, Preschool
  • Disease Susceptibility
  • Epidemiologic Studies
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Influenza A virus / immunology
  • Influenza Vaccines / administration & dosage*
  • Influenza Vaccines / immunology
  • Influenza, Human / complications
  • Influenza, Human / immunology
  • Influenza, Human / prevention & control*
  • Influenza, Human / virology
  • Male
  • Neoplasms / complications
  • Neoplasms / immunology*
  • Neoplasms / virology
  • Reminder Systems / statistics & numerical data*
  • Risk Factors
  • Vaccination / psychology
  • Vaccination / statistics & numerical data*
  • Young Adult


  • Influenza Vaccines