title: Influenza vaccine: Delayed vaccination schedules and missed opportunities in children under 2 years old.
abstract: BACKGROUND
  In Argentina respiratory disease is the third leading cause of death in children under 5 years. In 2011 influenza vaccination was included in the National Calendar for children between 6 and 24 months (two doses schedule). Influenza vaccine coverage for second dose was 46.1% in 2013. The aim was to determine the proportion of delayed schedules and missed opportunities, to assess the characteristics of missed opportunities for vaccination and to explore the perception of influenza disease and vaccination from the parents of children between 6 and 24 months in different regions of Argentina in 2013.
  
  
  METHODS
  Analytical observational multicenter cross-sectional study. Structured surveys were carried out to the children's parents who were between 6 and 24 months of age during the influenza virus vaccination season (April-October 2013). Chi-Square test was used to assess association and differences between proportions and categorical variables. A logistic regression model was built to identify delay predictor variables in the vaccination schedules. Missed opportunities for vaccination were characterized through the estimation of proportions.
  
  
  RESULTS
  1350 surveys were conducted in the three centers. We detected 65% (884/1340) of delayed influenza vaccination schedules, 97% of them associated with missed opportunities of vaccination. The independent protective factors associated with a decreases risk of delayed schedules were: (a) perception of the importance of influenza vaccination (OR=0.42(0.18-0.94); p=0.035), (b) having less than one year of age (OR=0.75(0.59-0.96); p=0.022), (c) to have received information in pediatric visits or in any media (OR=0.71(0.56-0.90); p=0.004). There was 38% of MOIV in 1st dose and 63.4% in 2nd dose. The main cause of MOIV in 1st dose was not detecting the need for vaccination (39%) and in 2nd dose the unknowledge of the vaccination schedule (35.3%). No cultural reasons were detected.
  
  
  CONCLUSIONS
  High frequency of delayed vaccination schedules and missed opportunities were detected. Parents had little concern about the safety of influenza vaccine.
authors.affiliation: Epidemiology, R. Gutiérrez Children's Hospital, Buenos Aires, Argentina. Electronic address: angelagentile@fibertel.com.ar.
authors.forename: A
authors.initials: A
authors.lastname: Gentile
authors.affiliation: Epidemiology, R. Gutiérrez Children's Hospital, Buenos Aires, Argentina.
authors.forename: M
authors.initials: M
authors.lastname: Juárez
authors.affiliation: Infectology, "Prof. A. Posadas" National Hospital, Buenos Aires, Argentina.
authors.forename: S
authors.initials: S
authors.lastname: Hernandez
authors.affiliation: Infectology, Misericordia Nuevo Siglo Hospital, Córdoba, Argentina.
authors.forename: A
authors.initials: A
authors.lastname: Moya
authors.affiliation: Epidemiology, R. Gutiérrez Children's Hospital, Buenos Aires, Argentina.
authors.forename: J
authors.initials: J
authors.lastname: Bakir
authors.affiliation: Epidemiology, R. Gutiérrez Children's Hospital, Buenos Aires, Argentina.
authors.forename: M
authors.initials: M
authors.lastname: Lucion
mesh_terms: D001118:Argentina; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000523:psychology*
chemical_list: D007252:Influenza Vaccines
keywords: Immunization programs/organization and administration; Immunization/utilization; Infants; Influenza vaccines