We have read with interest the consensus document issued by the Spanish Society of Pediatric Infectious Diseases (SEIP), Spanish Association of Vaccinology (AEV), and Spanish Association of Pediatrics (AEP) on vaccination against influenza,1 which emphasizes the importance of protecting at-risk children. We share this priority completely, as influenza is a significant cause of pediatric morbidity and mortality, especially among vulnerable children.
Despite the introduction of routine vaccination against influenza for children aged 6 to 59 months from the 2023-2024 season, according to official data on childhood influenza vaccination coverage published by the Ministry of Health, the vaccination coverage in Spain remains well below target at 48.2% nationwide (40.8% in our autonomous community, the Basque Country).2 This situation is even more concerning when it comes to at-risk pediatric populations, for which the data are insufficient and fragmentary, with coverage rates that, according to the few published studies, do not exceed 25%.3
In this context, during the 2024-2025 season, the Pediatric Infectious Diseases Clinic at the Hospital Universitario de Cruces implemented an intervention aimed at patients in specific high-risk groups: patients with type 1 diabetes mellitus, cystic fibrosis, liver or kidney transplants, or kidney disease requiring immunosuppression. We identified patients using the caseload lists of each of the outpatient speciality clinics (pediatric endocrinology, pediatric pulmonology, pediatric nephrology, and transplantation) and searching the electronic health records of the hospital; we then verified their vaccination status by reviewing their health records as well as vaccination records halfway through the seasonal campaign.
Two types of interventions were implemented for unvaccinated patients. For the group of patients with diabetes, their endocrinologists were informed of the need to actively recommend vaccination and were offered immediate access to our clinic for same-visit vaccination. In contrast, in the other groups (the patients already known to us who were in follow-up in in our clinic), our team contacted the family by phone to provide information, offer personalized recommendations, and schedule a priority-level appointment for vaccination.
The results showed an increase in vaccination coverage across all groups, with significantly greater increases among those who were subject to direct intervention from our clinic. Thus, while coverage increased from 0% to 80% in liver transplant patients and from 40% to 72% in kidney transplant patients, it only increased from 29.3% to 42.9% in patients with diabetes. This difference demonstrates that the effectiveness of these measures depends largely on the active engagement of the health care provider in making a direct recommendation and on facilitating immediate access to vaccination.4
This experience underscores the need to involve all health care professionals, independently of their speciality or care setting, in actively recommending vaccination against influenza for at-risk children. Vaccination must be a shared responsibility, and its promotion supported by a consistent message from all scientific societies involved in the care of these patients. Only through joint and coordinated efforts will we be able to overcome the current barriers and achieve the vaccination coverage needed to adequately protect this vulnerable population against influenza.
