title: Missed Opportunity: Why Parents Refuse Influenza Vaccination for Their Hospitalized Children.
abstract: Hospitals are required to screen and administer the influenza vaccine to all admitted children unless contraindicated or refused by parents, yet vaccination rates remain low. Our goal was to examine reasons for refusal among pediatric patients admitted during influenza season.
  
  
  
  All children age 6 months to 18 years admitted to 2 network community hospitals from October 1, 2013 to March 31, 2014, without contraindications, were offered influenza vaccination prior to discharge. Parents who refused vaccination were asked their reason for refusal. Chi-square tests and logistic regression were used to determine factors associated with refusing the vaccine in the inpatient setting.
  
  
  
  Three hundred twenty-five of 786 unique patients admitted during influenza season were eligible for vaccination. Of these, 49.8% refused. Parents of females, whites, and those with private insurance were more likely to refuse vaccination. Patients whose immunization status was otherwise up to date were more likely to accept (Odds Ratio 2.39, 95% Confidence Interval 1.05-5.41). Commonly cited reasons for refusal were: preference to have vaccination by the primary care provider (24.1%), concern for side effects (16.1%), not wanting vaccination (13%), doubt in efficacy (8%), concern that the child was already sick (6.8%), no prior influenza vaccination (6.7%) and feeling that it was not needed (5.6%).
  
  
  
  Hospitalization during influenza season provides an opportunity for health-care providers to educate families about influenza and vaccinate patients if appropriate. However, nearly half of parents of eligible children declined vaccination. More study is required to determine strategies that can increase influenza vaccination acceptance.
authors.affiliation: Department of Pediatrics, Division of Hospitalist Medicine, Rady Children's Hospital-San Diego, San Diego, California; mcameron@rchsd.org.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Cameron
authors.affiliation: Departments of Anesthesia and Critical Care and.
authors.forename: David
authors.initials: D
authors.lastname: Bigos
authors.affiliation: Departments of Anesthesia and Critical Care and.
authors.forename: Christopher
authors.initials: C
authors.lastname: Festa
authors.affiliation: Departments of Anesthesia and Critical Care and Hospital Medicine, Children's Hospital of Philadelphia at Virtua, Voorhees, New Jersey; and.
authors.forename: Howard
authors.initials: H
authors.lastname: Topol
authors.affiliation: Department of Pediatrics, Division of Hospitalist Medicine, Rady Children's Hospital-San Diego, San Diego, California; Department of Pediatrics, Division of Academic General Pediatrics and Community Health, University of California, San Diego, La Jolla, California.
authors.forename: Kyung E
authors.initials: KE
authors.lastname: Rhee
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006764:Hospitals, Community; D006801:Humans; D007223:Infant; D007251:Influenza, Human; D008297:Male; D010290:Parents; D012189:Retrospective Studies; D000072758:Vaccination Refusal