Evaluation of self-reported and registry-based influenza vaccination status in a Wisconsin cohort

doi:10.1016/j.vaccine.2009.08.050

Vaccine

Volume 27, Issue 47, 5 November 2009, Pages 6546-6549

https://doi.org/10.1016/j.vaccine.2009.08.050 Get rights and content

Abstract

We evaluated influenza vaccination status as determined by self-report and a regional, real-time immunization registry during two influenza seasons when subjects were enrolled in a study to estimate vaccine effectiveness. We enrolled 2907 patients during the two consecutive seasons. The sensitivity and specificity of self-reported influenza vaccination when compared to immunization registry records were 95% and 90%, respectively. The positive predictive value of self-reported vaccination was 89% and negative predictive value was 96%. In our study population, self-reported influenza vaccine status was a sensitive and fairly specific indicator of actual vaccine status. Misclassification was more common among young children.

Introduction

Observational studies of influenza vaccine effectiveness and safety depend on accurate ascertainment of influenza vaccination status in the study population. Potential sources of data include self-report, immunization registries, and medical records. Self-reported influenza vaccination status is commonly used to estimate vaccine coverage and determine vaccine effectiveness [1], [2], [3], [4]. Evaluation of self-report has been limited, especially among parents asked about influenza vaccinations given to their children [5]. Sensitivity of self-report has been measured in elderly populations and found to be high, ranging from 96% to 100% [6], [7]; sensitivity was lower in an adult managed care population [8].

There is a need to evaluate the predictive value of self-reported influenza vaccination status in various age groups, particularly since influenza vaccine recommendations have expanded in recent years. During the 2008–09 season, annual influenza vaccination was recommended when feasible for all children six months through 18 years of age, for adults aged 50 and older, for persons aged 19–49 years diagnosed with medical conditions that increase the risk of serious influenza-related complications, and all household contacts and caregivers of children aged <5 years and adults aged >50 years. In addition, vaccination was recommended for household contacts and caregivers of persons with medical conditions that put them at higher risk for influenza complications [9].

Immunization registries are another potential source of influenza vaccination records for vaccine research, but their utility has not been fully assessed [10]. Mahon et al. recently described methodological advantages of registry-based studies [11], but potential limitations have not been evaluated. Many immunization registries are restricted to pediatric immunizations and adult immunizations may not be consistently entered. Even if adult records are allowed in the registry, influenza vaccinations may be administered by non-traditional providers who are not affiliated with the registry. Unlike most pediatric vaccines, influenza vaccines are frequently offered outside the traditional health care system, including retail outlets, community clinics, or places of employment. This may lead to misclassification of vaccination status when registries are used in observational studies of influenza vaccine.

The goals of this study were to examine (1) the sensitivity, specificity, and predictive value of self-reported influenza vaccination status in adults and children, and (2) the performance of a regional, real-time immunization registry in Wisconsin during two seasons when patients were enrolled and tested for influenza to estimate vaccine effectiveness [12], [13].

Section snippets

Study population

This study was performed as part of an evaluation of influenza vaccine effectiveness during two consecutive seasons, 2006–07 and 2007–08 [12], [13]. The source population for these studies included residents of the Marshfield Epidemiologic Study Area (MESA), a dynamic, population-based cohort of approximately 54,000 residents living in 14 zip-codes surrounding Marshfield, WI. In this area, nearly all residents receive their inpatient and outpatient care from Marshfield Clinic facilities, which

Results

Total enrollment in the study was 2907 persons, including 932 participants in 2006–07 and 1975 participants in 2007–08 (Table 1). The participation rate among eligible patients was 67% in 2006–07 and 70% in 2007–08. The median age was 4 years in 2006–07 (mean = 23) and 19 years in 2007–08 (mean = 26). The immunization registry had documentation of same-season influenza vaccination prior to the date of enrollment for 58% and 40% of participants in each season, respectively. The majority of

Discussion

Self-reported vaccination status can be used in studies of influenza vaccine effectiveness, but little is known regarding the accuracy of self-report in children and younger adult populations [2], [3], [5]. We found that the sensitivity of self-report, or the ability to accurately recall receiving influenza vaccine, was high among all age groups, but highest among adults aged 50 and older. The specificity of self-report, or the ability to accurately recall not receiving influenza vaccine, was

Acknowledgements

We thank Craig Becker, Lorelle Benetti and Debra Kempf for their assistance with this project. Funding for this research was provided by a cooperative agreement with the Centers for Disease Control and Prevention (1 U01 CI000192-01).

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Evaluation of self-reported and registry-based influenza vaccination status in a Wisconsin cohort

Abstract

Introduction

Section snippets

Study population

Results

Discussion

Acknowledgements

Am J Med

Am J Prev Med

Vaccine

Am J Prev Med

Am J Prev Med

J Pediatr

J Clin Epidemiol

Influenza vaccine effectiveness in preventing hospitalization for pneumonia in the elderly

Am J Epidemiol

Use of, effectiveness of, and attitudes regarding influenza vaccine among house staff

Infect Control Hosp Epidemiol