PONE-D-21-11166Australian hospital paediatricians and nurses’ perspectives and practices for influenza vaccine delivery in children with medical comorbiditiesPLOS ONE

Dear Dr. Norman,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

While I think this is an important topic that warrants investigation, there were some issues that are significant enough that they undermine the contributions of the study and prevent me from supporting its publication without any revision. Together with both reviewers I have a number of reservations about this paper. They are outlined below.

1. The funding for influenza vaccination in the cocoon strategy should be clarified.
2. The study has some limitations to be taken into account and declared. Please, refer to the second reviewer’s comments point by point.

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Prof. Maria Gańczak

Section Editor

PLOS ONE

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4. Thank you for stating the following financial disclosure: "PP provided funding for DN's airline travel and accommodation during discussion groups and interviews conducted at Children’s Hospital at Westmead and Sydney Children’s Hospital, Randwick through her Clinical Research Funding from the Department of Immunology and Infectious Diseases, Sydney Children's Hospitals Network, Randwick. DN's airline travel and accommodation during discussions and interviews conducted at The Royal Children’s Hospital, Melbourne and Northern Hospital, Epping was provided through his University of Western Australia’s Medical School higher degree by research faculty funding. No other funding for this project was sought or provided.

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: N/A

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: What is not clear to the reader is the funding for influenza vaccination in the cocoon strategy. Do people in the cocoon pay for their vaccination, or does another institution cover the cost? Does vaccination coverage under the cocoon strategy depend on the diagnosed disease in the index person?

Reviewer #2: Dear Authors,

Thank you for your interesting article. It gives an interesting presentation on Australian situation on the topic. The study however has some limitations to be taken into account and declared.

Firstly, it included a small sample size which limits the transferability of results to other hospital settings. As you did not interview a clinician from all departments with HRC, you cannot rule out the possibility of missing additional themes or barriers.

It is not enough to interview only paediatricians and nurses to give vaccination recommendations against influenza for Australian children with comorbidities. While this study involved only a subset of HRC (High-risk children) and is limited by its small sample size, it suggests a strong need to engage parents in vaccine conversations. However, you were limited by only being able to engage with hospital sites and subspecialty teams willing to participate in the study; furthermore, participants in your study had generally positive attitudes towards the influenza vaccine. Health care workers who are highly disengaged with the value of influenza immunisation are unlikely to volunteer to be involved. Lastly, you did not undertake interviews with parents and so the comments around parental concerns about the influenza vaccination are based on the perceptions of the HCWs.

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Reviewer #1: No

Reviewer #2: Yes: Chiara Cadeddu

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Australian hospital paediatricians and nurses’ perspectives and practices for influenza vaccine delivery in children with medical comorbidities

PONE-D-21-11166R1

Dear Dr. Norman,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Maria Gańczak

Section Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: