418 - Pediatric Emergency Departments: A Missed Opportunity to Vaccinate?

Poster Number: 418
Publication Number: 418.3043

Background: Annual vaccination is the most effective strategy to prevent illness and death from influenza. While influenza vaccination programs have been well described in pediatric hospitals, the extent to which they include the emergency department (ED) is not well understood. Because the ED is a very common site of care, particularly for children with poor access to primary care and low vaccine uptake, EDs may be uniquely positioned to provide influenza vaccines to children.

Objective: To determine the extent to which hospitals with inpatient influenza vaccine programs provide influenza vaccines in the ED, and to compare the populations receiving vaccines in each setting.

Design/Methods: This was a retrospective cohort study examining influenza vaccine administration at 46 children’s hospitals in the Pediatric Health Information System (PHIS) database. Children >6 months and < 18 years old with an ED visit or hospitalization between September 1, 2016, and March 31, 2023, were included. We described demographic characteristics and compared differences between those vaccinated during ED encounters and during hospitalizations. We calculated the frequency of influenza vaccine administration per 1000 encounters in each setting and described institutional variation.

Results: In the 7-year study period, 46,901 children were vaccinated for influenza in EDs and 163,154 were vaccinated during a hospitalization. Demographics are shown in Table 1. Compared with those vaccinated during a hospitalization, a greater proportion of children vaccinated in the ED were Non-Hispanic Black race (33% vs. 23%), Medicaid insured (62% vs. 56%) and very low child opportunity index (38% vs 24%), while fewer (2.9% vs. 39%) had a complex chronic medical condition (p < 0.001 for all). Vaccination was more frequent across inpatient settings (median 39 vaccines per 1000 encounters, IQR: 25-59) than EDs (median 0.3, IQR 0.1-1.4, range 0-26). The majority of ED influenza vaccines were administered at only a small number of hospitals, with 8 EDs giving 85% of all ED-provided influenza vaccines during the study period (Figure).

Conclusion(s): Though influenza vaccine administration was common during hospitalizations, only a few institutions provided vaccines during ED encounters. Children vaccinated in the ED were more likely to be Hispanic or Non-Hispanic Black, have Medicaid insurance, and have low child opportunity index. These results suggest that there is potential to increase vaccination rates in many pediatric EDs, which may be an opportunity to reach a population known to have limited access to care and poor influenza vaccine uptake.