title: Improving influenza vaccination in chronically ill children using a tertiary-care based vaccination clinic: Is there a role for the live-attenuated influenza vaccine (LAIV)?
abstract: BACKGROUND
  Children with underlying medical conditions should receive influenza vaccine (IV) yearly; yet this remains sub-optimal. We aimed to describe our experience with a tertiary-care hospital-based influenza vaccination clinic for this at-risk population.
  
  
  METHODS
  From October to December 2012, 2013, and 2014, we ran an influenza vaccination clinic at the Montreal Children's Hospital, where children with high-risk conditions come for their follow-up. Both injectable IV (IIV) and live-attenuated IV (LAIV) were offered free of charge to patients and their household contacts. Upon vaccination, parents were asked to fill a pre-piloted questionnaire.
  
  
  RESULTS
  We vaccinated a total of 2640 high-risk children and 1912 household members during the three influenza vaccination seasons. In 2012 and 2013, 631 and 630 patients with chronic illnesses were vaccinated, compared to 1379 in 2014. Caregivers preferred LAIV primarily because no needle was involved (49.0%) and because it was perceived as less painful (46.9%). LAIV was administered to 69% (2012), 55% (2013) and 47% (2014) of high-risk children. The main reason for not receiving LAIV was because it was contra-indicated. A small fraction of children previously vaccinated with LAIV who did not present any contraindication to LAIV opted for IIV: 12/101 (11.8%) in 2013 and 16/272 (5.9%) in 2014. In 2014, this was mainly due to a previous negative experience with LAIV (11/16).
  
  
  CONCLUSIONS
  Having an influenza vaccination clinic on site at a tertiary care hospital, where children come for their scheduled visits, facilitates yearly influenza vaccination in children with chronic illnesses. LAIV is preferred by caregivers and patients, when not contraindicated.
authors.affiliation: McGill University Department of Epidemiology, Statistics and Occupational Health, Montreal, QC, Canada; Division of Infectious Diseases, Department of Pediatrics, The Montreal Children's Hospital, Montreal, QC, Canada.
authors.forename: Joanna
authors.initials: J
authors.lastname: Merckx
authors.affiliation: Vaccine Study Centre, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Deirdre
authors.initials: D
authors.lastname: McCormack
authors.affiliation: McGill University Department of Epidemiology, Statistics and Occupational Health, Montreal, QC, Canada; Division of Infectious Diseases, Department of Pediatrics, The Montreal Children's Hospital, Montreal, QC, Canada; Vaccine Study Centre, Research Institute of the McGill University Health Centre, Montreal, QC, Canada. Electronic address: caroline.quach@mcgill.ca.
authors.forename: Caroline
authors.initials: C
authors.lastname: Quach
mesh_terms: D000293:Adolescent; D002170:Canada; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D000075202:Contraindications; D003430:Cross-Sectional Studies; D006801:Humans; D007223:Infant; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control*; D062606:Tertiary Care Centers; D014611:Vaccination / Q000706:statistics & numerical data*; D014613:Vaccines, Attenuated / Q000627:therapeutic use
chemical_list: D007252:Influenza Vaccines; D014613:Vaccines, Attenuated
keywords: Chronically ill children; LAIV vs TIV; Questionnaire; Seasonal influenza vaccination; Vaccination strategy