The influenza vaccine is underused in children with heart disease; approximately one-third were vaccinated in a prospective study of 186 children in September and October 2012.

“Annual influenza vaccination is the most effective and safe means of preventing the disease,” and children with chronic diseases including heart conditions are at increased risk for complications that would require hospitalization, wrote Gilat Livni, MD, of Tel Aviv University and colleagues.

Parents completed questionnaires on flu vaccination. Overall, 68 children (37%) had been vaccinated the previous year, 3% of these received the nasal vaccine. The average age of the children was 8 years, and there were no significant demographic differences between vaccinated and unvaccinated children.

Overall, 59% of parents reported that their primary pediatrician recommended flu vaccination, and 53% of these parents complied. By contrast, only 13% of children whose pediatricians had not recommended vaccination received it.

“The failure of parents to receive information or advice from a physician regarding vaccination was strongly inversely related to vaccination of the child,” the researchers wrote. Parents’ misconceptions included the belief that the vaccine would cause flu (66%, of whom 30% had their child vaccinated); the belief that the vaccine would cause severe side effects (55%, of whom 26% had their child vaccinated), and the belief that the vaccine was unsafe (47%, 21% of whom had their child vaccinated).

“Our results emphasize the need to raise awareness among physicians and other medical health care personnel dealing with children with heart disease of the importance of properly counseling parents regarding influenza vaccination,” the researchers said. “Recommending the vaccine should be made part of routine patient visits in fall and winter.”

The researchers had no financial conflicts to disclose. The findings were published online ahead of print in the Pediatric Infectious Disease Journal (Ped Infect Dis J. 2017. doi: 10.1097/INF.0000000000001579 ).