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Announcer:
You’re listening to Clinicians Roundtable on ReachMD, and this episode is sponsored by CSL Seqirus. Here’s your host, Dr. Doghramji.  

Dr. Doghramji:
Welcome to Clinicians Roundtable on ReachMD. I'm Dr. Paul Doghramji, and joining me to discuss how we can increase influenza vaccination rates among pediatric patients is Dr. Suchitra Rao, who is an Associate Professor of Pediatrics and Pediatric Hospital Medicine at the University of Colorado School of Medicine. Dr. Rao, thank you for being here today.

Dr. Rao:
Thanks so much. It's such a pleasure to be with you.

Dr. Doghramji:
Alright, to start us off, Dr. Rao, what are some statistics on the current influenza vaccination rates among pediatric patients?

Dr. Rao:
So just to put this answer into a little bit of context, the United States healthy target 2030 goal for the next decade is really to try and get to rates of around 70 percent for both children as well as for adults. And so if we look at what those numbers were at last season, we saw that the end-of-season flu vaccination rates were around 57 percent. And that's really 13 points lower than the targets that we really want to see. And there were certain groups that did have lower rates. And so that is also worth just looking into and thinking about. So for example, we found that those black and African American populations had to up to 10 percent percentage points lower than what we were seeing with the overall percentages.

And so just to put some of that into context for you, back in the 2019-2020 season, the influenza vaccine rates were more like around 64 percent. And so over time, we've been seeing the slow decline in influenza vaccine uptake, particularly in children, and that's a real issue.

Dr. Doghramji:
With that in mind, can you talk about the importance of influenza vaccination for our youngest patients, especially amid the COVID-19 pandemic and this season's RSV outbreak?

Dr. Rao:
Yeah, absolutely. So it’s really important to think about the context of vaccines now while we're in sort of the peak of our RSV season. So the reason why this is also important is that not only are we having to worry about RSV this season, but there's also concerns that we're going to see both an early and a potentially more severe influenza season as well. And so we had some forewarnings of this from what we saw from the southern hemisphere. So in countries like Australia, they saw an early flu season; they saw a much higher number than the 5-year average previously. And we've seen influenza already make its way here into the United States. It started with the East Coast states, then with the southern states, and we're starting to see it in other places as well.

And so I think what we need to remember is that these are all respiratory viruses, and some of these viruses have vaccines available now, and influenza is going to be one of those that we need to be thinking about. So I just want to always remind people that influenza vaccines continue to be the most effective way to prevent severe illness in children. And children represent the second highest group of individuals who end up being hospitalized from the flu.

And we know from a lot of studies that children serve as a very important source of transmission of influenza to other members of the community, including those who may have problems with their immune system or who may be elderly. So vaccines in kids and targeting that group doesn't just help the children, but it can help the households and the community members at large as well.

Dr. Doghramji:
Well now in your experience, Dr. Rao, are there any common concerns or misconceptions that parents have that may make them hesitant to get their child vaccinated?

Dr. Rao:
Yeah so I would say that, in general, the two most common concerns that arise around flu vaccines are that they get the vaccine, and then right away they just start getting sick, and they think that the vaccines are giving them the flu. And so in those situations, we let families know that that's just really signs of the vaccine that's triggering the immune system to protect that individual. And so that just means that the vaccine is working, it's doing its thing, and it's triggering that immune system.

And then I would say another common concern is that they just don't work. So they got the vaccine. And then a month or two later, they just got the flu anyway, so what's the point. So we really want to be talking about how it can prevent against the severe disease. So some of the statistics that I like to talk about with kids especially is that it can prevent a kid's risk from being hospitalized with the flu by 58 percent. It can prevent a child's risk of being in the ICU by 74 percent. And then it can decrease a child's risk of dying from the flu by around 65 percent.

Dr. Doghramji:
For those just tuning in, you're listening to Clinicians Roundtable on ReachMD. I'm Dr. Paul Doghramji, and I'm speaking with Dr. Suchitra Rao about common misconceptions parents have about the flu vaccine.

So, Dr. Rao, what counseling strategies can we use to address a parent's concerns about the flu vaccine?

Dr. Rao:
Yeah, so I really think this is such an important topic to discuss. So I think that developing effective strategies around influenza vaccines and other vaccines is really important and just kind of having a system and just being really comfortable with that dialogue is really going to be key.

So for example, at our hospital in our healthcare setting, we do a lot of training for nurses, medical providers, trainees, pharmacists, and all sorts of different healthcare professionals on how to really communicate some of those messages effectively.

So just to break it down, there are sort of five general areas that we discuss. So these incorporate motivational interviewing techniques, as well as some evidence-based strategies on things that really work and can be effective.

So first of all, we really want to normalize the process. So we'll say things like, "We routinely provide influenza vaccines to our patient in this clinic or in this particular setting." And the next is to really use presumptive language so, "We can take care of your child's vaccination during this visit. Let's just do it right now. Do you want the left arm? Or do you want the right arm?"

Next is to still be respectful for their concerns and ask permission to be able to talk about some of those concerns. For example, if you do end up having a family or a parent who's having some reticence, saying something like, "Do you mind if I ask why you're not wanting your child to be vaccinated and get the vaccine today?" And then based on what you hear, you really want to tailor your message and your discussion to address those concerns. So after you've given them the opportunity to address and voice some of your concerns, really mentioning things like, "Thank you, I really appreciate you letting me know about your concerns. This is something that I've been thinking a lot about, and something that I get a lot of education about. So would it be okay if I shared some of this information with you?" And then slowly work to dispel any of those mistruths, misinformation, or concerns that they may have.

And then at the end of the day, we really want to try and find that common ground. So I'll say things like, "I know that you're a wonderful parent, you want to do absolutely everything in your power to do what's best for your child. And we feel the same way. So we also want to do everything possible to try and keep your child as healthy as possible. And vaccination is one of those ways."

And so finally, I think it's also really important to remember that the number one factor in having a family decide around influenza vaccines is a strong healthcare provider recommendation.

Dr. Doghramji:
And in addition to those counseling strategies, are there any other real-world interventions that can help increase vaccination rates among pediatric patients?

Dr. Rao:
Yeah, this is a very growing area in research, and people are looking into finding evidence-based strategies that can be effective in increasing vaccination rates. And so in terms of a few of them, just to provide an example, in our healthcare setting, we've developed our influenza vaccine campaign around four or five different strategies. So the first is communication and education. So really empowering patients, families, and caregivers to be provided information and to have that information come from a trusted source to be able to maximize that acceptance. And so we talked about having that strong provider recommendation being really key.

And then also making sure that folks in your healthcare team are strong advocates themselves. So sometimes education needs to be delivered to those healthcare professionals as well as the parents and the families themselves.

Another example of effective communication was recently shown in a study was that saying things or sending messages like, "We have reserved the influenza vaccine in our clinic for you or for your child," can be a very powerful messaging tool as well.

The next one would be having automated tools in your electronic health record for a reminder recall. So we can leverage a lot of these features in our EHRs. So there's a lot of tools for automated screening, for clinical decision support, incorporating vaccine orders, as well as vaccine messages. So some evidence-based strategies that have been shown to be effective are those reminders through either letters, postcards, or text messages, those sorts of things about getting vaccines. And then standing orders have also been shown to be very effective.

Another big component that we are learning more about is really having good data analytics for provider feedback, so having a system where you can review your vaccination rates over a flu vaccine season and providing that feedback to providers. So tracking those rates over time, identifying those really high-risk groups or groups that you really want to be targeting, and provider feedback either on a weekly or monthly basis can be really helpful both in small practice settings as well as larger healthcare settings.

Dr. Doghramji:
Now we've certainly covered a lot of ground today, Dr. Rao. But before we close, do you have any takeaways you'd like to leave with our audience?

Dr. Rao:
Yeah. So I think the main thing that we know is that during this time of unprecedented strain from respiratory illnesses on our families as well as our healthcare systems, we really want to try and do everything we possibly can to try and minimize this burden of disease. And so providing vaccines, both for influenza and COVID-19 as well as routine vaccines, is really going to be one of those very important strategies. So we really do want to be having those invigorated conversations with our families and patients about this. And with influenza, we talked about how there's been a slow decline in those vaccine rates. And so we really want to try and message that we're in store for a really potentially severe season. And it's not too late to vaccinate. And so we can really use any healthcare opportunity to provide vaccines. So for example, at our hospital, we're giving vaccines to inpatients, to children undergoing surgeries, to folks in the emergency department, during subspecialty visits, and of course, during those primary care and well-child visits. So I think the time is right for us to be discussing these things right now.

Dr. Doghramji:
Well as those final thoughts bring us to the end of today's program, I want to thank my guest, Dr. Suchitra Rao, for joining me to share strategies for increasing influenza vaccination rates among pediatric patients. Dr. Rao, it was great having you on the program.

Dr. Rao:
Thanks so much. It was such a pleasure.

Announcer:
This episode of Clinicians Roundtable was sponsored by CSL Seqirus. To access this and other episodes in this series, visit ReachMD.com/Clinicians Roundtable, where you can Be Part of the Knowledge. Thanks for listening!