The feasibility of universal influenza vaccination for infants and toddlers

Background: Physicians' opinions on the feasibility of routine influenza vaccination of infants and toddlers are unknown. Objective: To assess the opinions of primary care providers regarding (1) the feasibility of an expanded influenza vaccination recommendation, (2) potential barriers, and (3) current and projected use of immunization reminder systems for influenza vaccination. Methods: In February 2001, we mailed a 20-item, selfadministered survey to a national random sample of pediatricians and family physicians (FPs). The survey primarily focused on a scenario of routine influenza vaccination for children aged 12 through 35 months using either injected or intranasal spray vaccine. Results: Four hundred fifty-eight eligible physicians completed the survey (eligible response rate: pediatricians, 72%; FPS, 52%). Regarding the scenario mentioned above, most physicians agreed that implementation would be feasible (pediatricians, 80%; FPS, 69%); would significantly decrease illness visits during influenza season (pediatricians, 67%; FPS, 57%); and was justified by influenza's severity and complications (pediatricians, 61%; FPs, 41%). When considering a scenario that extended down to 6 months of age and only allowed use of injectable vaccine for infants, fewer physicians (pediatricians, 50%; FPS, 40%) considered implementation feasible. The issues most frequently cited as important potential barriers for practices were costs (77%), vaccine safety issues (52%), and the inability to identify eligible children (46%). Conclusion: To make widespread implementation feasible, the following are needed: minimizing costs for families and physician practices, educational campaigns on key issues, and primary care system changes (eg, tracking of eligible children, reminder and/or recall systems, and immunization clinics).