2761. Interventions to Improve Influenza Vaccination Coverage in Children with Medical Comorbidities: A Meta-Analysis

BACKGROUND: Influenza vaccination is the most effective influenza prevention tool for children with medical comorbidities. Despite this, coverage remains inadequate. Numerous interventions to improve vaccination coverage have been assessed, yet there remains a paucity of data comparing the relative efficacy and effectiveness of different interventions. METHODS: We searched MEDLINE, PubMed, Scopus, Embase, CINAHL, CENTRAL, and Web of Science (1980 to March 2019) for studies evaluating interventions which sought to improve influenza vaccine coverage in children with medical comorbidities. Interventions were divided into those targeting parents, targeting vaccination providers, and targeting the hospital, clinic or ward. Screening and data extraction from publications meeting inclusion criteria was performed by two reviewers. Results were pooled and meta-analyses were performed using Mantel–Haenszel random-effects models in Review Manager 5. RESULTS: 35 articles met inclusion criteria; 14 cross-sectional, 12 randomized trials, and 9 cohort studies, 25 articles had sufficient data for pooled analysis. Of the included interventions, 17 were based within primary care or community-based settings, 17 were based in hospitals or tertiary clinics, and 1 intervention was conducted across both primary and tertiary settings. Interventions overall increased influenza vaccination likelihood by 33% (RR = 1.33: 95% CI 1.31, 1.35). Interventions targeting providers’ influenza vaccine knowledge increased vaccine coverage (RR = 1.42: 95% CI 1.36, 1.49) greater than those targeting parental knowledge (RR = 1.23: 95% CI 1.21, 1.26). Conversely, vaccination reminders targeting parents increased vaccine coverage (RR = 1.53: 95% CI 1.49, 1.58) greater than reminders targeting providers (RR = 1.23: 95% CI 1.20, 1.27). Interventions targeting hospitals, clinics or ward processes had the weakest impact on coverage (RR = 1.15: 95% CI 1.13, 1.17). CONCLUSION: Interventions targeting parents, providers, and places individually have all shown to improve influenza vaccination in children with medical comorbidities. However, specifically targeting providers’ vaccine knowledge and parental reminders appear to have the greatest impact on vaccine uptake. DISCLOSURES: All authors: No reported disclosures.