Do parents prefer inactivated or live attenuated influenza vaccine for their children?☆
Introduction
In the United States, children aged 6 months to 18 years are recommended to receive annual influenza vaccination [1]. Two types of influenza vaccination are available for children, the inactivated influenza vaccine (IIV) administered by an injection and the live attenuated influenza vaccine (LAIV) administered by a nasal spray [2]. LAIV was first available and approved for use in children as young as 5 years old in 2003, and then in 2007 the approved use was expanded to also include children 2–4 years [3], [4]. At a meeting of the Advisory Committee on Immunization Practices (ACIP) in June 2014, the committee voted to include in their recommendation for the 2014–15 influenza season a preference for the use of LAIV for healthy children 2–8 years; this recommendation was based on studies that appeared to show higher efficacy of LAIV when compared with IIV among children [5]. Eight months later, at the February 2015 meeting of the ACIP, the committee voted to remove this preferential recommendation when other study data showed that LAIV may not have higher efficacy than IIV [6]. Then, at the June 2016 meeting of the ACIP, the committee voted in favor of an interim recommendation that LAIV not be used during the 2016–17 influenza season due to data showing poor or relatively lower than expected effectiveness of LAIV from 2013 through 2016 [7]. The interim recommendation that LAIV not be used was extended to the 2017–18 season [8]. At the February 2018 meeting, ACIP voted to recommend LAIV as an option for vaccination beginning with the 2018–19 influenza season [1]. The American Academy of Pediatrics, however, advises parents preferentially to choose IIV for the 2018–19 season [9], [10]. Changes in type recommendations could potentially affect vaccination coverage levels if parents have strong preferences for a vaccine type and are unwilling to accept another type, yet little is known about parental preferences for IIV versus LAIV for their children. A study published in 2015 showed that 32.2%, 32.1%, and 33.3% of children 2–17 years in the United States received LAIV during the 2011–12, 2012–13, and 2013–14 influenza seasons, respectively [11]. The objectives of this study were to: determine what proportion of vaccinated children had parents that prefer LAIV or IIV for their children; examine whether preferences differ by socio-demographic characteristics; examine reasons for the preferences; and determine what percentage of children are vaccinated with other than their parent’s preferred type of vaccine.
Section snippets
Methods
Data from the National Immunization Survey-Flu (NIS-Flu) for the 2014–15 and 2015–16 influenza seasons were analyzed. The NIS-Flu is a national, random-digit-dialed, dual frame (landline and cellular telephone) survey of households with children. It includes three components: the NIS-Child for children 19–35 months, the NIS-Teen for children 13–17 years, and the NIS Child Influenza Module (NIS-CIM) for children 6–18 months and 3–12 years identified during the screening of households for the
Results
In both the 2014–15 and 2015–16 seasons, more than half of vaccinated children (55.2% and 53.7%, respectively) had parents who did not have a preference as to whether their child received IIV or LAIV (Table 1). The percentage of children with parents preferring LAIV for their child was 22.7% and 21.7% for the 2014–15 and 2015–16 seasons, respectively. For IIV preference, there was a statistically significant increase from 22.1% for the 2014–15 to 24.7%, for the 2015–16 season.
The most common
Discussion
During the 2014–15 and 2015–16 influenza seasons over half of vaccinated children aged 2–17 years in the United States had parents who did not have a preference about the type of influenza vaccination their child received, and among those with a preference, they were almost evenly split between those who prefer IIV or LAIV. A lack of preference for spray over shot was found in a study conducted in Japan to evaluate parents’ preference for type of influenza vaccine if alternatives were available
Conclusions
For the upcoming 2018–19 influenza season, with the interim recommendation not to administer LAIV lifted by the ACIP but a preferential recommendation for IIV in place by the AAP, this study is helpful by showing that most parents do not have a vaccine type preference for their children [1], [9], [10]. The lack of overwhelming preference is advantageous for the maintenance of vaccination coverage levels during times when one vaccine type is not available or not recommended.
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.