Influenza knowledge and barriers to vaccination in immunosuppressed patients in the pediatric rheumatology clinic.

Background: Most patients with a pediatric rheumatic disease are at increased risk of influenza due to immunosuppressive medication use. Despite initial quality improvement efforts, our influenza vaccination rate plateaued at 72%, which prompted a survey of patients and families to assess provider vaccine recommendations, influenza knowledge, and barriers to influenza vaccination.

Methods: Patients on immunosuppressive medication or their parent were eligible to complete a survey between July 2019 and January 2020. Survey questions assessed demographics, rheumatology diagnosis, immunosuppressive medication(s), influenza vaccination recommendation, patient/parent influenza knowledge, and barriers to influenza vaccination. Influenza vaccination rates for immunosuppressed patients were acquired each influenza season from 2015-2020 and tracked on a control chart.

Results: Of the 226 completed surveys, 145 (64.2%) were completed by parents and 81 (35.8%) by patients. The majority (85%) reported the influenza vaccine was recommended. The most common reasons for not receiving the influenza vaccine included: worry about disease flare (25.6%), concern the vaccine will cause influenza (25.6%), and lack of vaccine effectiveness (20.5%). Parents (40.9%) were more worried about disease flare compared to patients (17%; p = 0.024). Most respondents were able to correctly answer fever, cough and/or congestion as the most common symptoms of influenza; however, 23% answered gastrointestinal symptoms and 10.2% joint swelling. Most respondents (95.1%) were aware that immunosuppressive medication increases risk of infection. The average weekly influenza vaccination rate for the 2019-2020 flu season was 85.5%, which increased from 72.0% the previous year. Parents with higher education status were more likely to have their child receive the influenza vaccine compared to parents with less education.

Conclusions: This survey indicates that respondents understand the potential severity of influenza and the increased risk of infection due to immunosuppressive medication use; however, many inaccurately identified the most common symptoms of influenza and also reported misconceptions of influenza vaccine risks. The barriers identified in this survey will help drive future improvement efforts to increase influenza vaccination rates in this high-risk population.