According to the results of our study the involvement of PCP alone in performing PVF was not enough to maximize the adherence of patients to the vaccination program. The best coverage rate of vaccination for patients considered at risk for pandemic flu was achieved when PCP opted for option B, vaccinating patients in his office, with the assistance of a nurse, after children’s parents had booked an appointment calling a free of charge phone number (44.2%). Results achieved for patient vaccinated with option A (PCP performing vaccination alone) and C (public HD doctors performing vaccination) were similar, being 22.8% and 24.9% respectively. Authors suspect that the difference noted for vaccination coverage rates among the groups was mainly due ti two factors.
First we suggest that the availability of a dedicated free of charge phone number may have encouraged parents to book a vaccination appointment for their children because easy and quick. Second the availability of a nurse on premises likely allowed PCPs to save time and increase the number of patients immunized: nurses was actively involved in performing medical procedures and vaccinations making more efficient the activity of the pediatrician.
In our HD the vaccination coverage rate against pandemic flu (27.7%) was far lower from the years before regarding seasonal flu: in 2008 immunization coverage against seasonal flu in children at risk was 74.7% (1688/2258)(database of Piacenza HD, not published data).
PFV coverage rate was similar in France in the same target population [4
]. We suggest that the early presentation of pandemic flu and the lack of an adequate amount of vaccine doses before the beginning of the vaccination campaign, had a negative effect on the adherence of patients to the vaccination program.
In Piacenza HD vaccination program started on the 9th of November 2009 because the PFV became available only from the end of October 2009 .The highest incidence of influenza A/H1N1 was reached between the 26th of October 2009 and the 23rd of November 2009. The peak consisted of
50 new cases/1000 persons/ week in the range 0–14
years), with a peak at 46th week of the year [1
We hypothesize that some emotional factors (e.g. newspapers headlines, inaccurate or confusing informations reported by mass media, different opinions and behaviors among healthcare workers, presence of adjuvant in PFV) played a negative effect on performances of vaccination program .It was not possible to assess properly this issue because no specific questionnaire in order to investigate the reasons of their choice was proposed to parents who decided to refuse the vaccination of their children.
Some Authors in countries other than Italy reported the low acceptability of A/H1N1 vaccination due to different reasons including fear of side-effects, vaccine safety, not believing in vaccinations or specifically in flu vaccination [5
Our study suggests that coverage levels of vaccination against pandemic flu in children at risk in Piacenza HD could be considered satisfactory (27.7%) when compared to results obtained in other groups of patients in Italy. The vaccination coverage rate achieved in Italy for severely preterm infants younger than 2
years was 7.7% and for people at risk between the ages of 6
months to 65
years was 12.7% [1
]. Another question arises about why PCPs who opted for option B enrolled a significantly higher number of patients at risk (13.6%, see Table
). One possible explanation could be that the criteria used in selecting children at risk were not uniform among group A, B and C especially concerning asthma, the most frequent chronic disease of pediatric patients in Italy.
Being the prevalence of lifetime asthma 9.3% in italian children and 10.3% in adolescents [9
] and considering that in Piacenza HD the prevalence of asthma is similar (9.5%) [10
] we hypothesize that PCPs of group A enrolled less patiets for PFV (8.9%) because they chose strict selection criteria at the time of enrolling patients,especially with regards to asthma. This may have happened because, arranging appointments and performing vaccinations on their own, these PCPs were concerned about having an excessive work load and being unable to manage it successfully. It is possible that also PCPs who decided to not vaccinate personally their patients (option C) have used stricter selection criteria to include in the vaccination program patients with asthma and they were more reluctant to book their patients for PFV performed by a public HD doctor (only 5.4% of patients at risk).
We were unable to fully answer these questions because of the lack of data. Studies on this topics would be needed.