Kamila Sikora

Date of Award

8-24-2010

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Karen Jubanyik

Abstract

Emergency departments (EDs) are the only source of medical care for many adults and have been found to be feasible venues for vaccinating high-risk patients against seasonal influenza. Since the CDC guidelines expanded in 2008 to include any adults wishing to protect themselves and those around them from the flu, the vaccination of low-risk patients in the ED has not been evaluated. This study sought to assess the acceptability among adult patients of all ages for vaccinating against seasonal influenza in the Urgent Care area of an urban ED, which treats primarily healthy adults. A convenience sample of adult patients in the Urgent Care area was surveyed in November 2009. Subjects were asked about their vaccination history, as well as their perceived need and potential acceptance of a vaccine in the ED. Demographic data obtained included age, race, education, insurance status, medical history, access to primary care and contact with high-risk individuals. 381 patients were approached, of whom 352 completed the survey (92.4%; 56% male, 44% female; mean age 36 years, Standard Deviation 12.4), and 349 were vaccine-eligible. 250 (72%) denied any significant medical history. While 169 patients (48.4%) had an influenza vaccination history, only 69 (20%) were vaccinated in 2009. Of the 280 not vaccinated this year, 179 (64%) would have accepted the vaccine in the ED. Factors associated with increased odds of vaccine acceptance in the ED included: age younger than 50 years (Odds Ratio [OR] 3.28, 95% Confidence Interval [CI] = 1.74 to 6.21, p<0.01), Latino/Hispanic ethnicity (OR 2.89, 95% CI = 1.52 to 5.51, p<0.01), and close contact with high-risk individuals (OR 2.28, 95% CI = 1.33 to 3.92, p<0.01). These results suggest that the majority of relatively healthy adult patients would accept the seasonal influenza vaccine in the ED. Although a shortage of vaccines and increased vigilance during a concurrent H1N1 outbreak may have influenced overall acceptability, we conclude that influenza vaccinations during the ED patient encounter would generally be acceptable to patients as a means to improve their overall health, and indirectly the health of their high-risk close contacts.

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This is an Open Access Thesis.

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