Date of Award

Spring 2020

Degree Type



College of Pharmacy

Director of Thesis

Bryan Love, PharmD, MPH, FCCP, BCPS, (AQ ID)

Second Reader

Brandon Bookstaver, PharmD, FCCP, FIDSA, BCPS


Background: Children with chronic health conditions, including inflammatory bowel disease (IBD), are at especially high risk for influenza infection and complications. The Crohn’s & Colitis Foundation and American College of Gastroenterology recommend that IBD patients should receive annual influenza vaccination. The aims of this study were to evaluate influenza vaccination coverage over time and identify predictors of flu vaccination in pediatric IBD and non-IBD patients.

Methods: We utilized longitudinal data (2000 to 2016) from South Carolina Medicaid to conduct a matched cohort study. The primary exposure of interest was IBD diagnosis based upon ICD-9/10 diagnosis codes. Children with IBD were matched 1:4 to children without IBD on birth year and sex. Vaccination coverage for IBD and non-IBD groups for each season were calculated as [# receiving vaccine] / [# eligible]. We calculated 95% confidence intervals using nonparametric bootstrap replications adjusted for clustering. A multivariable random effects logistic regression model was used to identify predictors of vaccination.

Results: 1,184 IBD subjects and 4,736 matched non-IBD subjects were identified during the study period. The average age was 9.5 years and 52.7% of patients were male. Among IBD patients, vaccine coverage increased from 2% in 2001 to 40% in 2016. Disparities exist among black patients and patients living in rural zip codes.

Conclusion: Flu vaccination for all children significantly increased from 2001 to 2016. IBD patients were more likely to get vaccinated, although vaccination coverage in SC remains below target levels. Efforts to increase influenza vaccination in pediatric IBD patients are needed.

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