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. 2023 Nov 1;152(5):e2023061545.
doi: 10.1542/peds.2023-061545.

Vaccine Mandates and Influenza Vaccination During the Pandemic

Claire Abraham  1   2   3 , Laura F Garabedian  3 , Robert F LeCates  3 , Alison A Galbraith  4
Affiliations

Vaccine Mandates and Influenza Vaccination During the Pandemic

Claire Abraham et al. Pediatrics. .

Abstract

Objectives: To determine whether a state influenza vaccine mandate and elevated community coronavirus disease 2019 (COVID-19) severity affected a child's probability of receiving an influenza vaccine during the 2020-2021 influenza season, given the child's previous vaccination history.

Methods: Longitudinal cohort study using enrollment and claims data of 71 333 children aged 6 months to 18 years living in Massachusetts, New Hampshire, and Maine, from a regional insurer. Schoolchildren in Massachusetts were exposed to a new influenza vaccine mandate in the 2020-2021 season. Community COVID-19 severity was measured using county-level total cumulative confirmed case counts between March 2020 and August 2020 and linked by zip codes. The primary outcome of interest was a claim for any influenza vaccine in the 2020-2021 season.

Results: Children living in a state with a vaccine mandate during the 2020-2021 influenza season had a higher predicted probability of receiving an influenza vaccine than those living in states without a mandate (47.7%, confidence interval 46.4%-49.0%, vs 21.2%, confidence interval 18.8%-23.6%, respectively, for previous nonvaccinators, and 78.2%, confidence interval 77.4%-79.0%, vs 58.2%, confidence interval 54.7%-61.7%, for previous vaccinators); the difference was 6.5 percentage points greater among previous nonvaccinators (confidence interval 1.3%-11.7%). Previously vaccinated children had a lower predicted probability of receiving an influenza vaccine if they lived in a county with the highest COVID-19 severity compared with a county with low COVID-19 severity (72.1%, confidence interval 70.5%-73.7%, vs 77.3%, confidence interval 74.7%-79.9%).

Conclusions: Strategies to improve uptake of influenza vaccination may have differential impact based on previous vaccination status and should account for community factors.

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Conflict of interest statement

Conflict of Interest Disclosures: The authors have no conflicts of interest to disclose

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