As noted above, our study would not have captured individuals who are vaccinated through alternative venues such as public health programs, employer programs, or schools. Among alternative vaccination venues, pharmacies

Compound Library screening and the workplace accounted for 18% and 17% of adult vaccinations, respectively, in 2012–2013; conversely, only 3% of children received an influenza vaccination in a pharmacy and a negligible percentage were immunized in the workplace [21]. Although school-based vaccination programs continue to gain a foothold, only 6% of children and 2% of adults were reported to have been immunized in schools in 2012–2013 [21]. Therefore, expanding the availability of influenza vaccines to include other locations such as pharmacies and Stem Cell Compound Library schools should be explored to improve vaccine rates.

In some areas, school located influenza vaccination (SLIV) programs have demonstrated that seasonal influenza vaccination rates were higher (more than 4.4 times in elementary, 2 times – in middle, and 1.7 times – in high school students) than in non-SLIV locations [22]. Multiple SLIV programs have been very effective .at achieving high vaccination rates [22], [23], [24], [25], [26] and [27]. Also, SLIV programs demonstrated protection not only to the vaccinated children, but also to their parents [22] and other members in the community [28]. A key aspect of vaccination outside of the traditional medical home is that information should be transmitted back to the medical home to ensure accuracy of medical records and avoid duplicate vaccination. The results of this analysis should be viewed in the context of its limitations. This study included medical claims made for 3-mercaptopyruvate sulfurtransferase privately-insured individuals. Capitated members of health maintenance organizations, individuals without insurance coverage, cash pay at pharmacy, or children receiving Medicaid or CHIP, or vaccines through the Vaccines for Children program, were not included. We chose not investigate immunization

trends among adults ≥65 years because, for this patient population, private insurance represents a secondary source of reimbursement after Medicare. Annual influenza vaccination claims for privately-insured children and adults increased steadily from 2007–2008 to 2010–2011 and reached a plateau in 2011–2012. Children appeared to lose their in-office vaccination opportunities as they grew older and as the frequency of their outpatient office well-check and illness-related visits diminished (this fact was true for adults as well). Other vaccination venues such as pharmacies, clinics, or school programs may help increase vaccination coverage in the US in order to meet influenza vaccination targets of Healthy People 2020. EA was an employee of MedImmune at the time of analysis and manuscript development.