Various provider groups have been surveyed regarding their knowledge of recommendations for influenza immunization [10
]. Not surprisingly, pediatricians tend to be the most knowledgeable with respect to current recommendations for children, and this is the group that was targeted in the present study.
Current recommendations state that influenza vaccination should be offered during routine healthcare visits, sick visits, and influenza vaccine clinics, among other venues [4
]. The survey results support that regular visits, sick visits, and special clinics are regularly used by pediatricians. Pediatricians noted that they administer an injectable form of influenza vaccine more frequently than the nasal spray. In Maryland, the 2 largest medical insurers did not reimburse for the nasal spray at the time of the survey and this likely influenced vaccine choice. Despite controversy over the safety of thimerosal-containing vaccines, preservative-containing and preservative-free injectable vaccines were equally used; VFC participation appeared to increase utilization of thimerosal-free formulations. Similar to previous reports [11
], the majority of practices did not have any callback system in place to notify patients about immunization opportunities. Respondents reported that they immunize children at rates in excess of those reported by the CDC from national surveys [13
], likely due to overestimation of their actual vaccination rates [11
Overall, pediatricians do not believe the practice of administering influenza vaccine to children is profitable for their practice. Increased reimbursement for influenza vaccine and its administration would likely increase vaccination coverage in the future.
Almost 90% of respondents noted they would support school-based immunization programs, the value of which has been previously demonstrated [14
]; approximately 60% stated they would participate in such programs. Given the logistical obstacles to vaccinating large numbers of school-aged children, school-based vaccination programs may be essential for achieving high rates of vaccination coverage in children 5 to 18 years of age, who are recommended to be vaccinated beginning in the 2008–2009 influenza season [4
There are several inherent limitations to the survey findings. Results of previous surveys of immunization practices among various physician groups indicate that pediatricians are fairly diligent in providing feedback, and response rates of 50% to 60% are common [10
]. It is unclear why the response rate was less than 25% in the present study. There is potential for bias given this response rate; responders may have disproportionate interest in influenza vaccination. Because only pediatricians in the state of Maryland were surveyed, extrapolations to broader populations are problematic. In particular, findings regarding school-based programs may have been influenced by past school-based influenza vaccination programs conducted in Maryland [14
]. Nevertheless, several of the findings pertaining to immunization practices are consistent with survey results from other investigators [11