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Poscia A, Paolorossi G, Collamati A, Costantino C, Fiacchini D, Angelini C, Bernabei R, Cimini D, Icardi G, Siddu A, Silenzi A, Spadea A, Vetrano DL. Enhancing routine immunization efforts for older adults and frail individuals: Good practices during the SARS-CoV-2 pandemic in Italy. Hum Vaccin Immunother 2024; 20:2330152. [PMID: 38533904 DOI: 10.1080/21645515.2024.2330152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/10/2024] [Indexed: 03/28/2024] Open
Abstract
Infectious diseases pose a significant burden on the general population, particularly older adults who are more susceptible to severe complications. Immunization plays a crucial role in preventing infections and securing a healthier aging, but actual vaccination rates among older adults and frail individuals (OAFs) remains far from recommended targets. This study aims to collect and share good practices implemented in several Italian local health districts during the SARS-CoV-2 pandemic to ease routine immunization for OAFs. A 28-items questionnaire has been developed to collect information on organization aspect of immunization services and local good practices implemented before and during the SARS-CoV-2 pandemic. Twelve Public Health managers representative of 9 Italian Regions were further interviewed between January and March 2021. Despite literature suggests several effective interventions to increase vaccine demand, improve vaccine access, and enhance healthcare providers' performance, our survey highlighted substantial heterogeneity in their implementation at local level. Seven good local practices have been identified and described: mass vaccination centers; vaccination mobile units; drive-through vaccination; co-administration; tailored pathways; cooperation among providers involved in vaccination; digitization. Our survey pointed out valuable strategies for enhancing routine immunization for OAFs. Providers should combine effective interventions adequate to their specific context and share good practices.
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Affiliation(s)
| | - Giulia Paolorossi
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, Ancona, Italy
| | | | - Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | | | - Claudio Angelini
- Public Health Department, AST Ascoli Piceno, Ascoli Piceno, Italy
| | - Roberto Bernabei
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Andrea Siddu
- General Directorate for Health Prevention, Ministry of Health, Ministero della Salute, Rome, Italy
| | - Andrea Silenzi
- General Directorate for Health Prevention, Ministry of Health, Ministero della Salute, Rome, Italy
| | - Antonietta Spadea
- UOC Vaccinations, Department of Prevention, Local Health Authority Roma1, Rome, Italy
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Stockholm Gerontology Research Centre, Stockholm, Sweden
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Veronese N, Ragusa FS, Titone PR, Vernuccio L, Catanese G, Randazzo MA, Palermo M, Di Bella G, Mansueto P, Dominguez LJ, Barbagallo M. Management of the vaccination campaign in a population of frail older outpatients affected by cognitive or endocrinological conditions: a pilot study in Italy. Aging Clin Exp Res 2024; 36:179. [PMID: 39212773 PMCID: PMC11364585 DOI: 10.1007/s40520-024-02824-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024]
Abstract
Vaccination, particularly against pneumococcus and influenza, is a low-cost primary prevention, useful to avoid hard complications, particularly among frail older people. In this pilot study, we aimed to assess the effect of a strategy for influenza and pneumococcal vaccination for outpatients mainly affected by cognitive or endocrinological conditions, evaluating what could stimulate or demotivate vaccination among older people. This study was conducted during the 2023-2024 influenza season at the outpatient clinics in Palermo, Italy. A total 76 patients were included. More than half of the patients could be considered as pre-frail and about 20% frail, according to a comprehensive geriatric evaluation. Among patients, 46.05% received only vaccination against pneumococcus, 28.95% both vaccinations, and 25.0% only against influenza. Compared with the previous seasons, a 19.5% increase of influenza and 90.2% of pneumococcal vaccine uptake was observed. Side effects of vaccination were the main reason of the previous rejection, namely 76.9% for influenza and 53.8% for anti-pneumococcal vaccination. In conclusion, our study indicates how a new vaccination strategy in different settings could be feasible. Proposing influenza and pneumococcal vaccination for frail older outpatients could be an effective instrument to improve immunization coverage that is still low among older people.
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Affiliation(s)
- Nicola Veronese
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Geriatrics Section, University of Palermo, Palermo, Italy.
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 141, Palermo, 90127, Italy.
| | - Francesco Saverio Ragusa
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Geriatrics Section, University of Palermo, Palermo, Italy
| | - Pascal Roberto Titone
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Geriatrics Section, University of Palermo, Palermo, Italy
| | - Laura Vernuccio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Geriatrics Section, University of Palermo, Palermo, Italy
| | - Giuseppina Catanese
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Geriatrics Section, University of Palermo, Palermo, Italy
| | | | - Mario Palermo
- Sicilian Health Department, Public Health and Environmental Risks Service, Palermo, Italy
| | - Giovanna Di Bella
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Geriatrics Section, University of Palermo, Palermo, Italy
| | - Pasquale Mansueto
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Geriatrics Section, University of Palermo, Palermo, Italy
| | - Ligia J Dominguez
- Department of Medicine and Surgery, "Kore" University of Enna, Enna, Italy
| | - Mario Barbagallo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Geriatrics Section, University of Palermo, Palermo, Italy
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Domnich A, Lapi F, Orsi A, Grattagliano I, Rossi A, Cricelli C, Icardi G. Declining number of general practitioners can impair influenza vaccination uptake among Italian older adults: Results from a panel analysis. BMC Health Serv Res 2024; 24:950. [PMID: 39164724 PMCID: PMC11334494 DOI: 10.1186/s12913-024-11443-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 08/14/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Seasonal influenza vaccination coverage in Italian older adults is insufficient and well below the minimum target of 75%. In Italy, most influenza vaccine doses are administered by general practitioners (GPs), whose number has been declining. In parallel, the number of patients per GP and GP workload increased dramatically, which theoretically may impair vaccination counselling. In this ecological study, we aimed to assess whether influenza vaccination coverage in older adults is associated with the density of GPs having high number of patients. METHODS The study outcome was the influenza vaccination coverage rate in adults aged ≥ 65 years and registered in 20 Italian regions over the last 23 years. The independent variable of interest was the proportion of GPs with more than 1,500 adult patients, which is an imposed normative ceiling. This latter variable was considered as a proxy of GP overload. By adopting a panel regression approach, different specifications of fixed- and random-effects models were run to assess the association of interest, when adjusted for several social structural, economic and healthcare-related variables. RESULTS Over the last two decades, most regions showed a negative association between influenza vaccination coverage rates and the density of GPs with a high number of patients. This latter negative association was confirmed (P < 0.05) in different panel model specifications. In particular, in the fully adjusted two-way fixed-effects model, each 10% increase in the number of GPs with more than 1,500 patients was associated with a 1.7% decrease in influenza vaccination coverage. However, this association was present only in region-years where at least 18% of GPs were deemed overloaded. CONCLUSIONS In the upcoming years, the number of Italian GPs is projected to decline further. At the same time, the aging Italian population will determine an even greater workload for GPs. This study demonstrated that increased GP workload may partially explain the spatiotemporal variation in influenza vaccination uptake in the Italian elderly. With the imperative of increasing or at least maintaining influenza vaccination coverage rates, several short- and mid-term initiatives should be implemented in order to optimize GP workload during seasonal immunization campaigns.
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Affiliation(s)
- Alexander Domnich
- Hygiene Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy.
| | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Andrea Orsi
- Hygiene Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Interuniversity Research Centre On Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
| | | | - Alessandro Rossi
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Giancarlo Icardi
- Hygiene Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Interuniversity Research Centre On Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
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Xie YJ, Liao X, Lin M, Yang L, Cheung K, Zhang Q, Li Y, Hao C, Wang HH, Gao Y, Zhang D, Molassiotis A, Siu GKH, Leung AYM. Community Engagement in Vaccination Promotion: Systematic Review and Meta-Analysis. JMIR Public Health Surveill 2024; 10:e49695. [PMID: 38478914 PMCID: PMC11127135 DOI: 10.2196/49695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/27/2023] [Accepted: 02/27/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Community engagement plays a vital role in global immunization strategies, offering the potential to overcome vaccination hesitancy and enhance vaccination confidence. Although there is significant backing for community engagement in health promotion, the evidence supporting its effectiveness in vaccination promotion is fragmented and of uncertain quality. OBJECTIVE This review aims to systematically examine the effectiveness of different contents and extent of community engagement for promoting vaccination rates. METHODS This study was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive and exhaustive literature search was performed in 4 English databases (PubMed, Embase, Web of Science, and Cochrane Library) and 2 Chinese databases (CNKI and Wan Fang) to identify all possible articles. Original research articles applying an experimental study design that investigated the effectiveness of community engagement in vaccination promotion were eligible for inclusion. Two reviewers independently performed the literature search, study selection, quality assessment, and data extraction. Discrepancies were resolved through discussion, with the arbitration of a third reviewer where necessary. RESULTS A total of 20 articles out of 11,404 records from 2006 to 2021 were retrieved. The studies used various designs: 12 applied single-group pre-post study designs, 5 were cluster randomized controlled trials (RCTs), and 3 were non-RCTs. These studies targeted multiple vaccines, with 8 focusing on children's immunization, 8 on human papillomavirus vaccine, 3 on hepatitis B virus vaccine, and 1 on COVID-19 vaccine. The meta-analysis revealed significant increases in vaccination rates both in pre-post comparison (rate difference [RD] 0.34, 95% CI 0.21-0.47, I2=99.9%, P<.001) and between-group comparison (RD 0.18, 95% CI 0.07-0.29, I2=98.4%, P<.001). The meta-analysis revealed that participant recruitment had the largest effect size (RD 0.51, 95% CI 0.36-0.67, I2=99.9%, P<.001), followed by intervention development (RD 0.36, 95% CI 0.23-0.50, I2=100.0%, P<.001), intervention implementation (RD 0.35, 95% CI 0.22-0.47, I2=99.8%, P<.001), and data collection (RD 0.34, 95% CI 0.19-0.50, I2=99.8%, P<.001). The meta-analysis indicated that high community engagement extent yielded the largest effect size (RD 0.49, 95% CI 0.17-0.82, I2=100.0%, P<.001), followed by moderate community engagement extent (RD 0.45, 95% CI 0.33-0.58, I2=99.6%, P<.001) and low community engagement extent (RD 0.15, 95% CI 0.05-0.25, I2=99.2%, P<.001). The meta-analysis revealed that "health service support" demonstrated the largest effect sizes (RD 0.45, 95% CI 0.25-0.65, I2=99.9%, P<.001), followed by "health education and discussion" (RD 0.39, 95% CI 0.20-0.58, I2=99.7%, P<.001), "follow-up and reminder" (RD 0.33, 95% CI 0.23-0.42, I2=99.3%, P<.001), and "social marketing campaigns and community mobilization" (RD 0.24, 95% CI 0.06-0.41, I2=99.9%, P<.001). CONCLUSIONS The results of this meta-analysis supported the effectiveness of community engagement in vaccination promotion with variations in terms of engagement contents and extent. Community engagement required a "fit-for-purpose" approach rather than a "one-size-fits-all" approach to maximize the effectiveness of vaccine promotion. TRIAL REGISTRATION PROSPERO CRD42022339081; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339081.
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Affiliation(s)
- Yao Jie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Xiaoli Liao
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Meijuan Lin
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Lin Yang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Kin Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Qingpeng Zhang
- Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong Kong, China (Hong Kong)
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Yan Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Chun Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Harry Hx Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Usher Institute, Deanery of Molecular, Genetic & Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Yang Gao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Dexing Zhang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Alex Molassiotis
- Health and Social Care Research Centre, University of Derby, Derby, United Kingdom
| | - Gilman Kit Hang Siu
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Angela Yee Man Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
- Research Institute on Smart Aging (RISA), The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
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Szilagyi PG, Duru OK, Casillas A, Ong MK, Vangala S, Tseng CH, Albertin C, Humiston SG, Clark E, Ross MK, Evans SA, Sloyan M, Fox CR, Lerner C. Text vs Patient Portal Messaging to Improve Influenza Vaccination Coverage: A Health System-Wide Randomized Clinical Trial. JAMA Intern Med 2024; 184:519-527. [PMID: 38497955 PMCID: PMC10949147 DOI: 10.1001/jamainternmed.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/26/2023] [Indexed: 03/19/2024]
Abstract
Importance Increasing influenza vaccination rates is a public health priority. One method recommended by the US Centers for Disease Control and Prevention and others is for health systems to send reminders nudging patients to be vaccinated. Objective To evaluate and compare the effect of electronic health record (EHR)-based patient portal reminders vs text message reminders on influenza vaccination rates across a health system. Design, Setting, and Participants This 3-arm randomized clinical trial was conducted from September 7, 2022, to April 30, 2023, among primary care patients within the University of California, Los Angeles (UCLA) health system. Interventions Arm 1 received standard of care. The health system sent monthly reminder messages to patients due for an influenza vaccine by portal (arm 2) or text (arm 3). Arm 2 had a 2 × 2 nested design, with fixed vs responsive monthly reminders and preappointment vs no preappointment reminders. Arm 3 had 1 × 2 design, with preappointment vs no preappointment reminders. Preappointment reminders for eligible patients were sent 24 and 48 hours before scheduled primary care visits. Fixed reminders (in October, November, and December) involved identical messages via portal or text. Responsive portal reminders involved a September message asking patients about their plans for vaccination, with a follow-up reminder if the response was affirmative but the patient was not yet vaccinated. Main Outcomes and Measures The primary outcome was influenza vaccination by April 30, 2023, obtained from the UCLA EHR, including vaccination from pharmacies and other sources. Results A total of 262 085 patients (mean [SD] age, 45.1 [20.7] years; 237 404 [90.6%] adults; 24 681 [9.4%] children; 149 349 [57.0%] women) in 79 primary care practices were included (87 257 in arm 1, 87 478 in arm 2, and 87 350 in arm 3). At the entire primary care population level, none of the interventions improved influenza vaccination rates. All groups had rates of approximately 47%. There was no statistical or clinically significant improvement following portal vs text, preappointment reminders vs no preappointment reminders (portal and text reminders combined), or responsive vs fixed monthly portal reminders. Conclusions and Relevance At the population level, neither portal nor text reminders for influenza vaccination were effective. Given that vaccine hesitancy may be a major reason for the lack of impact of portal or text reminders, more intensive interventions by health systems are needed to raise influenza vaccination coverage levels. Trial Registration ClinicalTrials.gov Identifier: NCT05525494.
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Affiliation(s)
- Peter G. Szilagyi
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
| | - O. Kenrik Duru
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Alejandra Casillas
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Michael K. Ong
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- VA Greater Los Angeles Healthcare System, Los Angeles, California
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California at Los Angeles
| | - Chi-Hong Tseng
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California at Los Angeles
| | - Christina Albertin
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
| | | | - Emma Clark
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
| | - Mindy K. Ross
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
| | - Sharon A. Evans
- Department of Information Services and Solutions, UCLA Health System, Los Angeles, California
| | - Michael Sloyan
- Department of Information Services and Solutions, UCLA Health System, Los Angeles, California
| | - Craig R. Fox
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Anderson School of Management, University of California, Los Angeles
- Department of Psychology, University of California, Los Angeles
| | - Carlos Lerner
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
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Cheng BH, Ho PS, Hsu CC, Chen FL, Chen MA, Kabasawa Y, Huang HL. Effectiveness of the lay health advisor program on oral function and quality of life in aboriginal older adults: A randomized controlled trial. J Oral Rehabil 2024; 51:840-850. [PMID: 38186265 DOI: 10.1111/joor.13649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 07/23/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Aboriginal older adults residing in remote areas have poor oral function due to inadequate access to healthcare services. Lay health advisor (LHA) strategies can fill capacity shortages of healthcare professionals in rural communities and increase population acceptance of health care or healthy behaviours. OBJECTIVE(S) To evaluate the effectiveness the LHA program on oral function and oral health-related quality of life (OHRQoL) among older adults in aboriginal community. METHODS Participants were randomly assigned to an experimental group (EG; n = 122) and a control group (CG; n = 118). All participants performed oral exercises, and the EG received additional one-on-one 30-min lessons by an LHA over 4 weeks. Data were collected through face-to-face interview and oral examination. The generalized estimating equation model was used to analyse changes in outcomes over time. RESULTS The EG exhibited significantly greater improvement in swallowing (β = .63) at the 6-month follow-up and in masticatory performance (β = .52) and pronunciation of the syllable/pa/ (β = 2.65) at the 2-week follow-up than the CG did. The EG had a significantly lower plaque control record (β = -.14) and plaque index (β = -.30) at the 3-month follow-up than the CG did. Moreover, the OHRQoL was significantly increased at 6-months follow-up in the EG (p = .010). CONCLUSION The LHA program had positive effects on chewing, swallowing and plaque control in aboriginal older adults. LHA group also experienced positive long-term effect on OHRQoL after intervention.
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Affiliation(s)
- Bo-Han Cheng
- Department of Oral Hygiene, College of Jenteh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Shan Ho
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
- Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli County, Taiwan
| | - Fu-Li Chen
- Department of Public Health, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ming-An Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuji Kabasawa
- Oral Care for Systemic Health Support, Faculty of Dentistry, School of Oral Health Care Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hsiao-Ling Huang
- Department of Oral Hygiene, College of Jenteh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan
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Mastrovito B, Lardon A, Dubromel A, Nave V, Beny K, Dussart C. Understanding the gap between guidelines and influenza vaccination coverage in people with diabetes: a scoping review. Front Public Health 2024; 12:1360556. [PMID: 38706547 PMCID: PMC11066301 DOI: 10.3389/fpubh.2024.1360556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
Background Diabetes affects millions of people worldwide, making them more vulnerable to infections, including seasonal influenza. It is therefore particularly important for those suffering from diabetes to be vaccinated against influenza each year. However, influenza vaccination coverage remains low in this population. This review primarily aims to identify the determinants of influenza vaccination in people with diabetes (T1D or T2D). Secondly, it aims to assess main recommendations for influenza vaccination, vaccine effectiveness, vaccination coverage, and how education and pharmacists can encourage uptake of the vaccine in the diabetic population. Methods A scoping review was conducted in January 2022 to systematically review evidence on influenza vaccination in people with diabetes using data from PubMed, Science Direct, and EM Premium with terms such as "Diabetes mellitus," "Immunization Programs," "Vaccination," and "Influenza Vaccines." Quality assessment and data extraction were independently conducted by two authors. Disagreements between the authors were resolved through discussion and consensus, and if necessary, by consulting a third author. Results Of the 333 records identified, 55 studies met the eligibility criteria for inclusion in this review. Influenza vaccination was recommended for people ≥6 months. Despite effectiveness evidence showing a reduction in mortality and hospitalizations in people with diabetes vaccinated vs. non-vaccinated ones, very few studies reported a coverage rate ≥ 75%, which is WHO's target objective. Determinants such as advanced age, presence of comorbidities and healthcare givers' advice were associated with increased vaccination uptake. On the contrary, fear of adverse reactions and concerns about vaccine effectiveness were significant barriers. Finally, education and pharmacists' intervention played a key role in promoting vaccination and increasing vaccination uptake. Conclusion Influenza vaccination coverage in people with diabetes remains low despite recommendations and evidence on vaccine effectiveness. Motivators and barriers as well as several socio-demographic and clinical factors have been identified to explain this trend. Efforts are now needed to increase the number of diabetics vaccinated against influenza, mainly through education and the involvement of healthcare givers.
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Affiliation(s)
- Brice Mastrovito
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Alexia Lardon
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Amelie Dubromel
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Viviane Nave
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Karen Beny
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Claude Dussart
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
- EA 4129 P2S Parcours Santé Systémique, Claude Bernard University Lyon 1, Lyon, France
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Wennekes MD, Almási T, Eilers R, Mezei F, Petykó ZI, Timen A, Vokó Z. Effectiveness of educational interventions for healthcare workers on vaccination dialogue with older adults: a systematic review. Arch Public Health 2024; 82:34. [PMID: 38468334 PMCID: PMC10929108 DOI: 10.1186/s13690-024-01260-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/28/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Healthcare workers (HCW) significantly influence older adults' vaccine acceptance. This systematic review aimed to identify effective educational interventions for HCWs that could enhance their ability to engage in a dialogue with older adults on vaccination. METHODS Medline, Scopus, Cochrane library and grey literature were searched for comparative studies investigating educational interventions concerning older adult vaccinations. The search encompassed all languages and publication years. Analysis was performed on the outcomes 'vaccines offered or ordered' and 'vaccination rates'. Whenever feasible, a sub-analysis on publication year was conducted. Methodological limitations were assessed using the RoB 2 for RCTs and the GRADE checklist for non-randomized studies. Study outcomes were categorized according to the four-level Kirkpatrick model (1996) for effectiveness: reaction, learning, behaviour, and results. RESULTS In total, 48 studies met all inclusion criteria. Most studies included reminder systems signalling HCWs on patients due for vaccination. Other interventions included seminars, academic detailing and peer-comparison feedback. Four articles reporting on the reaction-level indicated that most HCWs had a favourable view of the intervention. Two of the six articles reporting on the learning-level observed positive changes in attitude or knowledge due to the intervention. Seventeen studies reported on the behaviour-level. An analysis on eleven out of seventeen studies focusing on vaccines 'ordered' or 'offered' outcomes suggested that tailored reminders, particularly those implemented before 2000, were the most effective. Out of 34 studies reporting on the result-level, 24 were eligible for analysis on the outcome 'vaccination rate', which showed that compared to usual care, multicomponent interventions were the most effective, followed by tailored reminders, especially those predating 2000. Nonetheless, tailored reminders often fell short compared to other interventions like standing orders or patient reminders. In both the behaviour-level and result-level 'education only' interventions frequently underperformed relative to other interventions. Seventeen out of the 27 RCTs, and seven of the 21 non-randomized studies presented a low-to-medium risk for bias in the studies' findings. CONCLUSIONS Tailored reminders and multicomponent interventions effectively assist HCWs in addressing vaccines with older adults. However, education-only interventions appear to be less effective compared to other interventions rates, attitude, knowledge.
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Affiliation(s)
- Manuela Dominique Wennekes
- Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
- Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands.
| | | | - Renske Eilers
- Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | | | - Zsuzsanna Ida Petykó
- Syreon Research Institute, Budapest, Hungary
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Aura Timen
- Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Zoltán Vokó
- Syreon Research Institute, Budapest, Hungary
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
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McLaughlin MM, Raitt MH, Tarasovsky G, Whooley MA, Dhruva SS. Informational Postcards Increase Engagement with Remote Monitoring Among Veterans with Pacemakers and Implantable Cardioverter-Defibrillators: a Stepped-Wedge Randomized Controlled Trial. J Gen Intern Med 2024; 39:87-96. [PMID: 38252247 PMCID: PMC10937872 DOI: 10.1007/s11606-023-08478-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 10/12/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Remote monitoring (RM) of pacemakers and implantable cardioverter-defibrillators (ICDs) reduces morbidity and mortality. However, many patients are not adherent to RM. OBJECTIVE To test the effect of informational postcards on RM adherence. DESIGN/PATIENTS Stepped-wedge randomized controlled trial among Veterans with pacemakers and ICDs. INTERVENTION In wave 1, Veterans who had sent at least 1 transmission within the past 2 years but had become non-adherent were randomly assigned to receive a postcard or no postcard. Those receiving postcards were randomized to 1 of 2 messages: (1) a"warning" postcard describing risks of non-adherence or (2) an "encouraging" postcard describing benefits of adherence. In wave 2, Veterans who had either not received a postcard in wave 1 or had since become non-adherent were mailed a postcard (again, randomized to 1 of 2 messages). Patients who did not send an RM transmission within 1 month were mailed a second, identical postcard. MAIN MEASURES Transmission within 70 days. KEY RESULTS Overall, 6351 Veterans were included. In waves 1 and 2, postcards were mailed to 5657 Veterans (2821 "warning" messages and 2836 "encouraging" messages). Wave 1 included 2178 Veterans as controls (i.e., not mailed a postcard), some of whom received a postcard in wave 2 if they remained non-adherent. In wave 2, 3473 postcards were sent. Of the 5657 patients mailed a postcard, 2756 (48.7%) sent an RM transmission within 70 days, compared to 530 (24.3%) of 2178 controls (absolute difference 24.4%, 95% confidence interval [CI] 22.2%, 26.6%). Of those who sent a transmission, 71.8% did so after the first postcard. Transmission rates at 70 days did not significantly differ between "warning" and "encouraging" messages (odds ratio 1.04, 95% CI 0.92, 1.18). CONCLUSIONS Informational postcards led to a 24.4% absolute increase in adherence at 70 days among Veterans with pacemakers and ICDs who were non-adherent to RM.
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Affiliation(s)
- Megan M McLaughlin
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Merritt H Raitt
- Portland Veterans Affairs Health Care System, Portland, OR, USA
| | - Gary Tarasovsky
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Mary A Whooley
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Sanket S Dhruva
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA.
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10
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Eiden AL, Barratt J, Nyaku MK. A review of factors influencing vaccination policies and programs for older adults globally. Hum Vaccin Immunother 2023; 19:2157164. [PMID: 36656057 PMCID: PMC9980618 DOI: 10.1080/21645515.2022.2157164] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Policies and programs to increase vaccine coverage rates among adults 50 years of age or older are limited and vaccine uptake is often suboptimal. Our review evaluated evidence on the effectiveness and success of adult-targeted vaccination interventions and identified literature gaps. Literature was retrieved (2021) from PubMed, Embase, and Google Scholar databases. Outcomes assessed included data on an intervention's effectiveness and impact on vaccine uptake. Interventions were characterized thematically: affordability (n = 9), awareness (n = 25), and vaccination access (n = 6); and included influenza, pneumococcal, tetanus-containing, and herpes zoster vaccines. Interactive interventions directed toward patients, including provider-led educational initiatives and provider recommendations showed more positive associations than less interactive interventions, such as posters and reminder-recall letters. Provider interventions, including awareness campaigns, incentives, affordability efforts, or vaccination site expansion generally showed positive associations. Combining interventions was found to be successful across several studies. Barriers and interventions varied for population subgroups, therefore, tailoring programs is critical.
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Affiliation(s)
- Amanda L Eiden
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, NJ, USA
| | - Jane Barratt
- International Federation on Ageing, Toronto, ON, Canada
| | - Mawuli K Nyaku
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, NJ, USA
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11
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Wang Z, Chan PSF, Fang Y, Yu FY, Ye D, Zhang Q, Wong MCS, Mo PKH. Chatbot-Delivered Online Intervention to Promote Seasonal Influenza Vaccination During the COVID-19 Pandemic: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2332568. [PMID: 37695585 PMCID: PMC10495860 DOI: 10.1001/jamanetworkopen.2023.32568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/30/2023] [Indexed: 09/12/2023] Open
Abstract
Importance Receiving seasonal influenza vaccination (SIV) is important for adults during the COVID-19 pandemic. There are few robust evaluations of tailored interventions for improving SIV uptake among adults 65 years or older. Objective To evaluate the relative efficacy of a stages of change (SOC)-tailored online intervention compared with a standard, non-SOC-tailored online intervention in increasing SIV uptake among Hong Kong residents 65 years or older. Design, Setting, and Participants This nonblinded parallel-group randomized clinical trial was conducted between December 1, 2021, and July 31, 2022, in Hong Kong, China. Eligible participants were 65 years or older, had Cantonese- and/or Mandarin-speaking skills, were community-dwelling, had Hong Kong residency, were smartphone users, and had not received SIV for the 2021 to 2022 influenza season. Participants were recruited through random telephone calls, and those who completed the baseline telephone survey were randomized to either the intervention or control group. Both complete case and intention-to-treat (ITT) analyses were performed. Intervention In the intervention group, a simplified rule-based chatbot first assessed participants' SOC related to SIV uptake and then automatically selected and sent participants SOC-tailored online health promotion messages (videos) through a messaging application (WhatsApp; Meta) once every 2 weeks for 4 sessions. In the control group, the chatbot sent a link to access through the messaging application a standard online health promotion message (video) covering general SIV information every 2 weeks for 4 sessions. Main Outcomes and Measures The primary outcome was self-reported SIV uptake at month 6, which was validated by the research team. The secondary outcome was SOC measured at both baseline and month 6 by validated questions. Results A total of 396 participants (mean [SD] age of 70.2 [4.3] years; 249 females [62.9%]) were randomized to the intervention (n = 198) or control (n = 198) group. The ITT analysis showed that the validated SIV uptake rate was higher in the intervention group than the control group at month 6 (50.5% vs 35.3%; P = .002). The mean (SD) SOC score was higher in the intervention group than the control group (2.8 [1.4] vs 2.4 [1.4]; P = .02). More participants in the intervention group completed at least 1 episode of intervention than in the control group (77.3% vs 62.6%; P < .001). Conclusions Results of this trial indicate that the SOC-tailored online intervention was more effective than the non-SOC-tailored intervention and may be a sustainable new method in increasing SIV uptake among adults 65 years or older. Trial Registration ClinicalTrials.gov Identifier: NCT05155241.
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Affiliation(s)
- Zixin Wang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Paul Shing-fong Chan
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Fuk-yuen Yu
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Danhua Ye
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Qingpeng Zhang
- Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong Kong SAR, China
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Martin C. S. Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Phoenix K. H. Mo
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
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12
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Tuckerman J, Riley K, Straube S, Mohammed H, Danchin M, Marshall HS. Interventions for increasing the uptake of immunisations in healthcare workers: A systematic review. Vaccine 2023; 41:5499-5506. [PMID: 37527954 DOI: 10.1016/j.vaccine.2023.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 07/14/2023] [Accepted: 07/26/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE This systemic review aimed to evaluate the effectiveness of interventions for increasing the uptake of immunisation in healthcare workers (HCWs) compared to no or alternative interventions. METHODS A systematic review was undertaken (until March 2022) using a search strategy established a priori to capture studies that examined the effect of interventions on vaccination levels in HCWs. We included randomised controlled trials (RCT), cluster RCTs, controlled before-after (CBA) studies and interrupted time-series (ITS) studies. We described studies descriptively and synthesized results with a fixed-effect or random-effects model meta-analysis, where appropriate. The risk of bias was assessed for each study; the quality evidence per comparison was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS We identified three RCTs, six cluster RCTs and four ITS studies. There was a diverse range of interventions; many included an educational component. Based on the evidence examined the following may be effective strategies in increasing the proportion of HCWs vaccinated: policy interventions, targeted and multicomponent strategies, tailored programs directed at management, physician delivered education with a vaccine 'champion' and individual decision analysis. Limited eligible studies restricted synthesis and interpretation of findings. No studies evaluated the effectiveness of legislation. Nor did we find studies evaluating the effectiveness of incentives on their own or studies focusing solely on improving access to vaccination. We judged all the studies as either unclear or high risk of bias. CONCLUSION Few robust studies that evaluate interventions to increase vaccination in HCWs are available. A limitation of this systematic review is that interventions are diverse, poorly reported and few were sufficiently alike to combine in an evaluation. More research on the effects of interventions to increase vaccination in HCWs is required, this should address a variety of vaccines and not just influenza vaccination.
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Affiliation(s)
- Jane Tuckerman
- Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
| | - Kathryn Riley
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, North Adelaide, Australia
| | - Sebastian Straube
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Hassen Mohammed
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, North Adelaide, Australia
| | - Margie Danchin
- Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Royal Children's Hospital, Melbourne, Australia
| | - Helen S Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, North Adelaide, Australia; Adelaide Medical School, University of Adelaide, South Australia, Australia; Robinson Research Institute, University of Adelaide, South Australia, Australia
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13
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Che X, Liu Y, Gu W, Wang F, Wang J, Jiang W, Du J, Zhang X, Xu Y, Zhang X, Wang J. Analysis on the intention and influencing factors of free influenza vaccination among the elderly people aged 70 and above in Hangzhou in 2022. Front Public Health 2023; 10:1052500. [PMID: 36684888 PMCID: PMC9853049 DOI: 10.3389/fpubh.2022.1052500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/15/2022] [Indexed: 01/09/2023] Open
Abstract
Background Although influenza vaccination is recommended for people aged 70 and above in Hangzhou, and the vaccine is provided free of charge, the elderly influenza vaccination rate is still low. The purpose of this study was to understand the barriers and motivations of older people in deciding to receive free influenza vaccine through questionnaires. Methods The method of stratified random sampling was adopted to take samples. A questionnaire survey was conducted among the elderly aged 70 years and above by face-to-face interview or telephone interview. Results A total of 11,663 elderly people aged 70-100 years were successfully and effectively interviewed. 85.98% of the respondent were willing to get the influenza shot, 8.91% were unwilling to get the influenza shot, and 5.11% were on vaccine hesitancy. The people of age of 70-79 years old (hesitancy: OR 70~79 = 0.668, 95%CI: 0.571 0.782, Unwilling: OR 70 - 79 = 0.755, 95%CI: 0.622 0.916), primary school degree or below (hesitancy: OR Secondary school degree or above = 1.467, 95%CI: 1.249 1.724, Unwilling: OR Secondary school degree or above = 1.255, 95%CI: 1.028 1.535), remote areas (hesitancy: OR near central urban area = 2.111, 95%CI: 1.604 2.778, OR central urban area = 2.957, 95%CI: 2.255 3.877, Unwilling: OR near central urban area = 1.687, 95%CI: 1.230 2.313. OR centralurbanarea = 2.218, 95%CI: 1.626 3.027), and convenient for movement (hesitancy: OR yes = 0.494, 95%CI: 0.420 0.580, Unwilling: OR yes = 0.585, 95%CI: 0.480 0.713), understanding of the free vaccine policy (hesitancy: OR understand = 0.204, 95%CI: 0.171 0.245, Unwilling: OR understand = 0.164, 95%CI: 0.128 0.210), influenza knowledge level≥ 13 points (hesitancy: OR ≥13points = 0.628, 95%CI: 0.533 0.739, Unwilling: OR ≥13points = 0.538, 95%CI: 0.437 0.662), influenza vaccine knowledge level≥ 12 points (hesitancy: OR ≥12points = 0.422, 95%CI: 0.350 0.508, Unwilling: OR ≥12points = 0.370, 95%CI: 0.290 0.472), and social trust level ≥ 12 points (hesitancy: OR ≥12points = 0.134, 95%CI: 0.112 0.160, Unwilling: OR ≥12points = 0.220, 95%CI: 0.180 0.269) are more willing to receive free influenza vaccine. Conclusion The proportion of elderly people aged 70 and above who are willing to receive free influenza vaccine is high in Hangzhou. But the level of knowledge about influenza, vaccine and trust in society is low. The government should continue to improve the elderly's awareness and trust in society through medical staff, family members, television and radio media, and guide the elderly to actively vaccinate against influenza. Effective publicity should be carried out through the above channels to guide the elderly to actively vaccinate against influenza.
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Affiliation(s)
- Xinren Che
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Yan Liu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Wenwen Gu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Fangying Wang
- School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Jun Wang
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Wei Jiang
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Jian Du
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xiaoping Zhang
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Yuyang Xu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xuechao Zhang
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Jing Wang
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
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14
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Webber BJ, Wheaton AG, Lu PJ, Whitfield GP. Joint Prevalence of Influenza Preventive Behaviors Among Adults-United States, 2020. J Prim Care Community Health 2023; 14:21501319231191681. [PMID: 37571833 PMCID: PMC10422917 DOI: 10.1177/21501319231191681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION/OBJECTIVES The Centers for Disease Control and Prevention recognizes routine vaccination, sufficient sleep, and adequate physical activity as behavioral approaches to reduce the incidence of influenza. We aimed to determine the joint national prevalence of these health behaviors among U.S. adults, which has not been reported. METHODS We used the 2020 National Health Interview Survey to assess prevalence of receiving influenza vaccination in the past 12 months, obtaining sufficient sleep, and achieving adequate physical activity among U.S. adults (n = 30,312). We calculated the joint prevalence overall and by sociodemographic and health-related variables. RESULTS AND CONCLUSIONS The overall joint prevalence was 8.5% (95% CI, 8.0-9.0). Prevalence was lower among older persons (vs younger); Hispanic and non-Hispanic Black persons (vs non-Hispanic White); current and former smokers (vs never smokers); postpartum women (vs neither pregnant nor postpartum); and those with a history of coronary heart disease, hypertension, stroke, diabetes, and chronic obstructive pulmonary disease (vs not having those respective condition). In addition to recommending annual vaccination, primary care providers might encourage sufficient sleep and adequate physical activity-especially among patients who have increased risk for influenza complications and are less likely to achieve these behaviors.
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Affiliation(s)
- Bryant J. Webber
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anne G. Wheaton
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Peng-jun Lu
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Geoffrey P. Whitfield
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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15
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Schwalbe N, Hanbali L, Nunes MC, Lehtimaki S. Use of financial incentives to increase adult vaccination coverage: A narrative review of lessons learned from COVID-19 and other adult vaccination efforts. Vaccine X 2022; 12:100225. [PMID: 36217357 PMCID: PMC9535879 DOI: 10.1016/j.jvacx.2022.100225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/29/2022] [Accepted: 09/29/2022] [Indexed: 10/25/2022] Open
Abstract
To encourage COVID-19 vaccination, governments have offered a wide range of incentives to their populations ranging from cash to cows. Often these programs were rolled out at scale before assessing potential effectiveness. To inform future policy, we conducted a narrative review to understand the evidence base informing these programs and the extent to which they are effective. While we found evidence on cash transfers increasing both the coverage and intention to be vaccinated for COVID-19 and other adult vaccines, improvements in coverage were limited. With mixed evidence, lottery programs did not appear to have a consistent meaningful impact on vaccination for COVID-19, and no evidence was identified on the positive effects of other non-cash incentives for COVID-19 or other adult vaccines. We conclude that the impact of cash transfers in incentivizing adult vaccination is marginal and their effectiveness in addressing vaccine hesitancy remains inconclusive.
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Affiliation(s)
- Nina Schwalbe
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Spark Street Advisors, New York, NY, United States,Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States,Corresponding author at: 722 W 168th St, New York, NY 10032, USA.
| | | | - Marta C. Nunes
- Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases; and South African Medical Research Council, Vaccines & Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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16
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Andreas M, Iannizzi C, Bohndorf E, Monsef I, Piechotta V, Meerpohl JJ, Skoetz N. Interventions to increase COVID-19 vaccine uptake: a scoping review. Cochrane Database Syst Rev 2022; 8:CD015270. [PMID: 35920693 PMCID: PMC9347311 DOI: 10.1002/14651858.cd015270] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Vaccines are effective in preventing severe COVID-19, a disease for which few treatments are available and which can lead to disability or death. Widespread vaccination against COVID-19 may help protect those not yet able to get vaccinated. In addition, new and vaccine-resistant mutations of SARS-CoV-2 may be less likely to develop if the spread of COVID-19 is limited. Different vaccines are now widely available in many settings. However, vaccine hesitancy is a serious threat to the goal of nationwide vaccination in many countries and poses a substantial threat to population health. This scoping review maps interventions aimed at increasing COVID-19 vaccine uptake and decreasing COVID-19 vaccine hesitancy. OBJECTIVES To scope the existing research landscape on interventions to enhance the willingness of different populations to be vaccinated against COVID-19, increase COVID-19 vaccine uptake, or decrease COVID-19 vaccine hesitancy, and to map the evidence according to addressed populations and intervention categories. SEARCH METHODS We searched Cochrane COVID-19 Study Register, Web of Science (Science Citation Index Expanded and Emerging Sources Citation Index), WHO COVID-19 Global literature on coronavirus disease, PsycINFO, and CINAHL to 11 October 2021. SELECTION CRITERIA We included studies that assess the impact of interventions implemented to enhance the willingness of different populations to be vaccinated against COVID-19, increase vaccine uptake, or decrease COVID-19 vaccine hesitancy. We included randomised controlled trials (RCTs), non-randomised studies of intervention (NRSIs), observational studies and case studies with more than 100 participants. Furthermore, we included systematic reviews and meta-analyses. We did not limit the scope of the review to a specific population or to specific outcomes assessed. We excluded interventions addressing hesitancy towards vaccines for diseases other than COVID-19. DATA COLLECTION AND ANALYSIS Data were analysed according to a protocol uploaded to the Open Science Framework. We used an interactive scoping map to visualise the results of our scoping review. We mapped the identified interventions according to pre-specified intervention categories, that were adapted to better fit the evidence. The intervention categories were: communication interventions, policy interventions, educational interventions, incentives (both financial and non-financial), interventions to improve access, and multidimensional interventions. The study outcomes were also included in the mapping. Furthermore, we mapped the country in which the study was conducted, the addressed population, and whether the design was randomised-controlled or not. MAIN RESULTS We included 96 studies in the scoping review, 35 of which are ongoing and 61 studies with published results. We did not identify any relevant systematic reviews. For an overview, please see the interactive scoping map (https://tinyurl.com/2p9jmx24) STUDIES WITH PUBLISHED RESULTS Of the 61 studies with published results, 46 studies were RCTs and 15 NRSIs. The interventions investigated in the studies were heterogeneous with most studies testing communication strategies to enhance COVID-19 vaccine uptake. Most studies assessed the willingness to get vaccinated as an outcome. The majority of studies were conducted in English-speaking high-income countries. Moreover, most studies investigated digital interventions in an online setting. Populations that were addressed were diverse. For example, studies targeted healthcare workers, ethnic minorities in the USA, students, soldiers, at-risk patients, or the general population. ONGOING STUDIES Of the 35 ongoing studies, 29 studies are RCTs and six NRSIs. Educational and communication interventions were the most used types of interventions. The majority of ongoing studies plan to assess vaccine uptake as an outcome. Again, the majority of studies are being conducted in English-speaking high-income countries. In contrast to the studies with published results, most ongoing studies will not be conducted online. Addressed populations range from minority populations in the USA to healthcare workers or students. Eleven ongoing studies have estimated completion dates in 2022. AUTHORS' CONCLUSIONS: We were able to identify and map a variety of heterogeneous interventions for increasing COVID-19 vaccine uptake or decreasing vaccine hesitancy. Our results demonstrate that this is an active field of research with 61 published studies and 35 studies still ongoing. This review gives a comprehensive overview of interventions to increase COVID-19 vaccine uptake and can be the foundation for subsequent systematic reviews on the effectiveness of interventions to increase COVID-19 vaccine uptake. A research gap was shown for studies conducted in low and middle-income countries and studies investigating policy interventions and improved access, as well as for interventions addressing children and adolescents. As COVID-19 vaccines become more widely available, these populations and interventions should not be neglected in research. AUTHORS CONCLUSIONS We were able to identify and map a variety of heterogeneous interventions for increasing COVID-19 vaccine uptake or decreasing vaccine hesitancy. Our results demonstrate that this is an active field of research with 61 published studies and 35 studies still ongoing. This review gives a comprehensive overview of interventions to increase COVID-19 vaccine uptake and can be the foundation for subsequent systematic reviews on the effectiveness of interventions to increase COVID-19 vaccine uptake. A research gap was shown for studies conducted in low and middle-income countries and studies investigating policy interventions and improved access, as well as for interventions addressing children and adolescents. As COVID-19 vaccines become more widely available, these populations and interventions should not be neglected in research.
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Affiliation(s)
- Marike Andreas
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Claire Iannizzi
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Emma Bohndorf
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ina Monsef
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Haematology, Cologne, Germany
| | - Vanessa Piechotta
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nicole Skoetz
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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17
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Szőllősi GJ, Minh NC, Santoso CMA, Zsuga J, Nagy AC, Kardos L. An Exploratory Assessment of Factors with Which Influenza Vaccine Uptake Is Associated in Hungarian Adults 65 Years Old and Older: Findings from European Health Interview Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127545. [PMID: 35742792 PMCID: PMC9224319 DOI: 10.3390/ijerph19127545] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 02/01/2023]
Abstract
Influenza vaccination is an imperative public health task for elderly people due to a higher risk of developing more severe complications. The main aim of our study was to determine the influencing factors of being vaccinated against influenza among subjects aged 65 and above. Data were from the Hungarian implementations of the European Health Interview Survey 2009, 2014 and 2019 studies with a final sample size of 3355. A multivariate logistic regression model with interactions was used to identify the possible factors associated with vaccination. Approximately 32% of the participants were vaccinated for the most recent influenza season. The most important factors were identified that contributed to influenza vaccination among individuals, which were the following: educational attainment, having a partner, the annual frequency of specialist and doctor visits, and having comorbidities. Respondents who thought that they could do a lot for their health had higher odds of being immunized. Being obese seemed to be a risk factor. According to our findings, the current influenza vaccination coverage was considered as low in Hungary; hence, the implementation of minor reformulations in the field of health policy is suggested.
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Affiliation(s)
- Gergő József Szőllősi
- Department of Interventional Epidemiology, Faculty of Public Health, University of Debrecen, 4032 Debrecen, Hungary; (N.C.M.); (C.M.A.S.); (A.C.N.)
- Correspondence:
| | - Nguyen Chau Minh
- Department of Interventional Epidemiology, Faculty of Public Health, University of Debrecen, 4032 Debrecen, Hungary; (N.C.M.); (C.M.A.S.); (A.C.N.)
| | - Cornelia Melinda Adi Santoso
- Department of Interventional Epidemiology, Faculty of Public Health, University of Debrecen, 4032 Debrecen, Hungary; (N.C.M.); (C.M.A.S.); (A.C.N.)
| | - Judit Zsuga
- Department of Habilitational Medicine, Faculty of Public Health, University of Debrecen, 4032 Debrecen, Hungary;
| | - Attila Csaba Nagy
- Department of Interventional Epidemiology, Faculty of Public Health, University of Debrecen, 4032 Debrecen, Hungary; (N.C.M.); (C.M.A.S.); (A.C.N.)
| | - László Kardos
- Department of Biostatistics and Bioinformatics, Faculty of Public Health, University of Debrecen, 4032 Debrecen, Hungary;
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18
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Shin G, Kang D, Cheong HJ, Choi SE. Cost-Effectiveness of Extending the National Influenza Vaccination Program in South Korea: Does Vaccination of Older Adults Provide Health Benefits to the Entire Population? Vaccines (Basel) 2022; 10:vaccines10060932. [PMID: 35746540 PMCID: PMC9228362 DOI: 10.3390/vaccines10060932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023] Open
Abstract
The South Korean government has successfully improved influenza vaccination coverage for individuals aged 65 years or older as part of its National Immunization Program (NIP). Those aged 50–64 years without funded vaccination care have significantly lower vaccination rates and face a substantial risk of influenza-related complications. We use a dynamic epidemiological and economic model to investigate the cost-effectiveness of expanding the universal vaccine fund to include those aged 50–64. The epidemiological model is estimated using the susceptibility-infection-recovery model and influenza and influenza-like illness incidence rates, which were calculated by the National Health Insurance Service–National Sample Cohort from the 2008/09 to 2012/13 influenza seasons but excluding the 2009/10 season for pandemic influenza A (H1N1). The decision tree economic model is assessed from societal and healthcare sector perspectives. The proposed policy would eliminate 340,000 annual influenza cases and prevent 119 unnecessary deaths. From a societal perspective, the proposed policy would reduce costs by USD 68 million. From a healthcare perspective, the cost is USD 4318 per quality-adjusted life years. Within the study range, sensitivity analyses found consistent cost-effectiveness results. The influenza vaccine for adults aged 50–64 appears to be cost-saving or cost-effective and, thus, should be considered for the NIP.
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Affiliation(s)
- Gyeongseon Shin
- College of Pharmacy, Korea University, Sejong City 30019, Korea; (G.S.); (D.K.)
| | - Daewon Kang
- College of Pharmacy, Korea University, Sejong City 30019, Korea; (G.S.); (D.K.)
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Gurodong-ro 148, Seoul 08308, Korea;
| | - Sang-Eun Choi
- College of Pharmacy, Korea University, Sejong City 30019, Korea; (G.S.); (D.K.)
- Correspondence: ; Tel.: +82-44-860-1617
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19
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Seo J, Lim J. The impact of free vaccination policies under the Korean Influenza National Immunization Program: Trends in influenza vaccination rates in South Korea from 2010 to 2019. PLoS One 2022; 17:e0262594. [PMID: 35051210 PMCID: PMC8775253 DOI: 10.1371/journal.pone.0262594] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/30/2021] [Indexed: 01/22/2023] Open
Abstract
Background Annual vaccination for influenza is recommended for high-risk populations for its high morbidity and mortality. South Korea provides free influenza vaccination to some target groups under the National Immunization Program (NIP), and discrepantly high vaccination rates are observed in such populations. In this study, we analyzed the trends in influenza vaccination rates and evaluated the impact of the recent expansion of financial coverage to children ≤12 years and pregnant women. Methods We conducted a cross-sectional study with nationwide survey data from Korea National Health and Nutrition Examination Survey (KNHANES). From 2010 to 2019, we evaluated the trends in influenza vaccination rates of the following four target groups: children ≤12 years, adults ≥65 years, pregnant women, and people with chronic diseases. Results In total, 80,861 individuals were analyzed. From 2017 to 2019, the vaccination coverage of children ≤12 years increased from 66.2% to 83.1%; pregnant women from 44.1% to 68.5% (comparing the mean of 2010–2017 and 2018–2019, P <0.001 for both). The elderly ≥65 years showed the highest rates (85.8% in 2019), while people with chronic diseases marked the lowest (41.9% in 2019). People with liver diseases showed the lowest vaccination rate of 27.8%, while that of other common diseases ranged between 31.7–44.1%. Conclusion The discrepancy between target groups corresponds to their financial coverage under NIP. The recent expansion of financial aids to children ≤12 years and pregnant women was followed by significant increases in vaccination rates in both groups. We suggest that free vaccination policy is one of the most effective strategies to enhance vaccination coverage, and we call for its expansion to other under-vaccinated target groups, especially people with chronic diseases.
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Affiliation(s)
- Jeongmin Seo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Juwon Lim
- International Healthcare Center, Seoul National University Hospital, Seoul, Korea
- * E-mail:
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20
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Training Physicians in Motivational Communication to Address Influenza Vaccine Hesitation: A Proof-of-Concept Study. Vaccines (Basel) 2022; 10:vaccines10020143. [PMID: 35214603 PMCID: PMC8875187 DOI: 10.3390/vaccines10020143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Strategies to support health care professionals on how to address vaccine hesitancy are needed. Methods: We developed a 4-h Motivational Communication (MC) training program tailored to help physicians address hesitancy related to influenza vaccination among patients living with rheumatoid arthritis. Five MC competencies were evaluated at baseline and post-training with a standardized patient using the Motivational Interviewing Treatment Integrity [MITI] scale. Adherence to MC during clinical consultations and changes in vaccine intentions was measured as secondary outcomes. Results: Seven rheumatology physicians participated in the training. MITI scores increased in all participants, and 71% (n = 5) achieved thresholds of clinical competency (i.e., ≥3.5/5 at MITI global score and ≥3/5 on at least 3 individual competency score) post-training. Autonomy/support and empathy competencies reached competency thresholds (+2.4 ± 1.3 to +4.1 ± 0.7 and +2.1 ± 0.7 to +4.1 ± 0.7, respectively). Evocation and collaboration competencies improved but without reaching competency thresholds (+1.4 ± 0.8 to +3.1 ± 1.1; +1.4 ± 0.8 to +2.9 ± 1.1, respectively). Direction did not improve. Among 21 patient consultations post-training, 15 (71%) were MC-consistent. Of the 15 patients, 67% (10/15) intended to receive the influenza vaccine and 33% (5/15) received it. Conclusion: A brief MC training program targeting vaccine hesitancy increased MC competency among rheumatology physicians and promoted behavioral change among patients.
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21
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Murphy RP, Taaffe C, Ahern E, McMahon G, Muldoon O. A meta-analysis of influenza vaccination following correspondence: Considerations for COVID-19. Vaccine 2021; 39:7606-7624. [PMID: 34836661 PMCID: PMC8592234 DOI: 10.1016/j.vaccine.2021.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/18/2021] [Accepted: 11/08/2021] [Indexed: 11/20/2022]
Abstract
Background High vaccination rates are needed to protect against influenza and to end the COVID-19 pandemic. Health authorities need to know if supplementing mass communications with direct correspondence to the community would increase uptake. Objectives The primary objective is to determine if sending a single written message directly to individuals increases influenza vaccine uptake, and a secondary objective is to identify any identified content shown to increase influenza vaccine uptake. Methods MEDLINE, Embase, Cochrane CENTRAL, PsycINFO, and PubMed were searched for RCTs testing a single correspondence for members of the community in OECD countries to obtain influenza vaccination. A meta-analysis with inverse-variance, random-effects modelling was used to estimate a mean, weighted risk ratio effect size measure of vaccine uptake. Studies were quality assessed and analysis was undertaken to account for potential publication bias. Results Twenty-eight randomized controlled trials were included, covering 45 interventions. Of the 45 interventions, 37 (82.2%) report an increase in influenza vaccination rates. A formal meta-analysis shows that sending a single written message increased influenza vaccine uptake by 16%, relative to the no contact comparator group (RR = 1.16, 95% CI [1.13-1.20], Z = 9.25, p < .001). Analysis shows that the intervention is effective across correspondence type, age group, time, and location, and after allowing for risk of publication bias. Limitations The generalizability of results across the OECD may be questioned. Conclusions and implications The implication for public health authorities organizing vaccination programs for influenza, and arguably also for COVID-19, is that sending written vaccination correspondence to members of the community is likely to increase uptake. Keywords: vaccine uptake, COVID-19, influenza, direct correspondence, meta-analysis. This study is pre-registered on osf.io; details can be found at https://osf.io/98mr7
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Affiliation(s)
- Robert P Murphy
- Stirling Management School, University of Stirling, Ireland; Department of Health, Ireland.
| | | | - Elayne Ahern
- School of Psychology, Dublin City University, Ireland
| | - Grace McMahon
- Department of Psychology, University of Limerick, Ireland
| | - Orla Muldoon
- Department of Psychology, University of Limerick, Ireland
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22
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Chia JL, Hartanto A. Cognitive Barriers to COVID-19 Vaccine Uptake Among Older Adults. Front Med (Lausanne) 2021; 8:756275. [PMID: 34765623 PMCID: PMC8576177 DOI: 10.3389/fmed.2021.756275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/05/2021] [Indexed: 12/30/2022] Open
Affiliation(s)
- Jonathan L. Chia
- School of Social Sciences, Singapore Management University, Singapore, Singapore
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23
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Lee JL, Foschini L, Kumar S, Juusola J, Liska J, Mercer M, Tai C, Buzzetti R, Clement M, Cos X, Ji L, Kanumilli N, Kerr D, Montanya E, Müller-Wieland D, Ostenson CG, Skolnik N, Woo V, Burlet N, Greenberg M, Samson SI. Digital intervention increases influenza vaccination rates for people with diabetes in a decentralized randomized trial. NPJ Digit Med 2021; 4:138. [PMID: 34535755 PMCID: PMC8448887 DOI: 10.1038/s41746-021-00508-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 08/25/2021] [Indexed: 11/09/2022] Open
Abstract
People with diabetes (PWD) have an increased risk of developing influenza-related complications, including pneumonia, abnormal glycemic events, and hospitalization. Annual influenza vaccination is recommended for PWD, but vaccination rates are suboptimal. The study aimed to increase influenza vaccination rate in people with self-reported diabetes. This study was a prospective, 1:1 randomized controlled trial of a 6-month Digital Diabetes Intervention in U.S. adults with diabetes. The intervention group received monthly messages through an online health platform. The control group received no intervention. Difference in self-reported vaccination rates was tested using multivariable logistic regression controlling for demographics and comorbidities. The study was registered at clinicaltrials.gov: NCT03870997. A total of 10,429 participants reported influenza vaccination status (5158 intervention, mean age (±SD) = 46.8 (11.1), 78.5% female; 5271 control, Mean age (±SD) = 46.7 (11.2), 79.4% female). After a 6-month intervention, 64.2% of the intervention arm reported influenza vaccination, vers us 61.1% in the control arm (diff = 3.1, RR = 1.05, 95% CI [1.02, 1.08], p = 0.0013, number needed to treat = 33 to obtain 1 additional vaccination). Completion of one or more intervention messages was associated with up to an 8% increase in vaccination rate (OR 1.27, 95% CI [1.17, 1.38], p < 0.0001). The intervention improved influenza vaccination rates in PWD, suggesting that leveraging new technology to deliver knowledge and information can improve influenza vaccination rates in high-risk populations to reduce public health burden of influenza. Rapid cycle innovation could maximize the effects of these digital interventions in the future with other populations and vaccines.
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Affiliation(s)
- J L Lee
- Evidation Health, San Mateo, CA, USA.,Emory University, Atlanta, GA, USA
| | | | - S Kumar
- Evidation Health, San Mateo, CA, USA
| | - J Juusola
- Evidation Health, San Mateo, CA, USA
| | | | - M Mercer
- Sanofi Pasteur, Swiftwater, PA, USA
| | - C Tai
- Evidation Health, San Mateo, CA, USA
| | - R Buzzetti
- Sapienza University of Rome, Rome, Italy
| | - M Clement
- University of British Columbia, Armstrong, British Columbia, Canada
| | - X Cos
- Grup de Recerca Epidemiològica en Diabetis des de l'Atenció Primària (DAP-CAT) Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Primary and Hospital Innovation Department, Innovation Office at Institut Català de la Salut, Barcelona, Spain
| | - L Ji
- Peking University People's Hospital, Beijing, China
| | | | - D Kerr
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | - E Montanya
- Hospital Universitari Bellvitge-IDIBELL, CIBERDEM and University of Barcelona, Barcelona, Spain
| | | | | | - N Skolnik
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - V Woo
- University of Manitoba, Winnipeg, Canada
| | - N Burlet
- Sanofi, Paris, France.,Kyowa Kirin International, Marlow, United Kingdom
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24
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Ananthakrishnan A, Painter C, Teerawattananon Y. A protocol for a systematic literature review of economic evaluation studies of interventions to address antimicrobial resistance. Syst Rev 2021; 10:242. [PMID: 34488879 PMCID: PMC8421239 DOI: 10.1186/s13643-021-01794-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 08/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is accelerated by the widespread and often indiscriminate use of antimicrobials in humans, animals, and the environment. In 2015, the World Health Organization recognised AMR as one of the top ten global health threats, due to its potential to neutralise humanity's advancements in western medicine by enabling the emergence of new strains of existing pathogens, many of which have no available treatments. Over the past decade, several countries, including those in low- and middle-income contexts, have started implementing interventions to tackle AMR. However, economic evidence regarding the cost-effectiveness of these interventions remains weak. To address this evidence gap, we will conduct a systematic literature review to provide a comprehensive summary on the value for money of different AMR interventions. METHODS We aim to conduct a systematic literature review of all available economic evaluations on interventions addressing AMR and will provide a narrative synthesis of our findings. Systematic searches for relevant studies will be performed across all suitable databases as well as in grey literature sources such as unpublished studies, reports, and other relevant documents. All economic evaluation studies will be included as long as they report an economic outcome and have stated that the analysed intervention will reduce antimicrobial resistance or antimicrobial use in the abstract. Those studies reporting clinical endpoints alone will be excluded. Selection for final inclusion and data extraction will be performed by two independent reviewers. DISCUSSION The review will be one of the first of its kind, and the most recent, to systematically review literature on the cost-effectiveness of AMR interventions, an important evidence gap in the economics of AMR. The findings will enable policy and decision-makers, particularly in resource-constrained settings, to better use available resources when selecting interventions to address AMR burdens, SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020190310.
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Affiliation(s)
- Aparna Ananthakrishnan
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Tiwanon Road, Muang District, 11000, Nonthaburi, Thailand.,Overseas Development Institute, London, UK
| | - Chris Painter
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Tiwanon Road, Muang District, 11000, Nonthaburi, Thailand. .,Overseas Development Institute, London, UK.
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Tiwanon Road, Muang District, 11000, Nonthaburi, Thailand
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25
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LUPI SILVIA, STEFANATI ARMANDO, CALIFANO ANNALISA, DE TOGNI ALDO, COSENZA GIUSEPPE, GABUTTI GIOVANNI. Trends in influenza coverage rates in five consecutive immunisation seasons in the Local Health Unit of Ferrara (North Italy). JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E644-E652. [PMID: 34909492 PMCID: PMC8639119 DOI: 10.15167/2421-4248/jpmh2021.62.3.1657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 06/29/2021] [Indexed: 06/14/2023]
Abstract
Seasonal influenza epidemics yearly affects 5-15% of the world's population, resulting in 3-5 million serious cases and up to 650,000 deaths. Elderly, pregnant women and individuals with underlying conditions are at increased risk of complications. According to the Italian National Immunisation Prevention Plan 2017-2019, these categories benefit from free vaccination but coverage rate in Italy are below desirable levels. The study considered the coverage rate in five consecutive influenza seasons (2010/2011-2014/2015) in Local Health Unit (LHU) of Ferrara (Italy). The amount of delivered vaccinations was not constant, with a decreasing trend. Coverage rose with increasing age, but the 75% target of over-65 years old individuals immunised was never achieved. In addition to age, coverage rates varied also according to District (the area of residence within the LHU). The District with the lowest vaccination coverage was the Western District. Higher levels of immunisation were observed in South-Eastern District in the pediatric age and in North-Central District in adult age group with a statistically significant difference. In the considered timespan, the percentage of immunisations delivered by the General Practitioners (GPs) increased. The trend in the LHU of Ferrara was similar to regional and national data, conditioned in the 2014/2015 season by the spreading of worrying news, although unfounded, on the safety of the vaccine. The GPs were essential in ensuring vaccine uptake, growing the percentage of delivered doses and achieving as much as possible effective elderly immunisation.
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Affiliation(s)
- SILVIA LUPI
- University of Ferrara, Department of Medical Sciences, Italy
| | | | | | - ALDO DE TOGNI
- Local Health Unit of Ferrara, Public Health Department, Italy
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26
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Effectiveness of a Multifaceted Informational-Based and Text Message Reminders on Pneumococcal and Influenza Vaccinations in Hospital Emergency Departments: A Cluster-Randomized Controlled Trial. Vaccines (Basel) 2021; 9:vaccines9090962. [PMID: 34579199 PMCID: PMC8473355 DOI: 10.3390/vaccines9090962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives. We aimed to evaluate the effectiveness of a multifaceted procedure in improving pneumococcal and influenza vaccinations 6 months after an emergency department (ED) visit among patients aged 65 years and older. Methods. We conducted a cluster-randomized, controlled, parallel-group, open-label implementation trial in 18 EDs in France and Monaco. Participants were recruited from November 2015 to September 2016. EDs were randomly assigned with a 1:1 ratio to provide either a multifaceted procedure that combined structured information about pneumococcal and influenza vaccines and three text message reminders sent to patients every two weeks (intervention arm) or nonstructured information only (control arm). The outcomes were self-reported pneumococcal vaccination and influenza vaccination rates within 6 months of enrollment. Results. A total of 9 EDs were randomized to the intervention arm (n = 780 patients) and 9 to the control arm (n = 695 patients). The median age for all enrolled patients was 74 years (25–75th percentiles, 69 to 82): 50.1% were male, 34.9% had at least one underlying condition, and 30.7% were at risk for invasive pneumococcal infection. In the intention-to-treat analysis, the multifaceted intervention did not alter the pneumococcal vaccination rate (6.4% versus 4.6%, absolute difference: 1.8; 95% CI: [−0.9 to 4.4]; p = 0.19), whereas it improved the influenza vaccination rate (52.1% versus 40.0%, absolute difference: 12.1; 95% CI: [2.4 to 21.8]; p = 0.01). At 12 months, mortality did not differ between the intervention (9.7%) and control (11.2%) arms (p = 0.35). Conclusions. A multifaceted intervention based on text message reminders provides an opportunity to increase anti-influenza vaccination among elderly patients visiting the ED. Efforts are warranted to provide better information on pneumococcal diseases and the benefits of pneumococcal vaccines, especially in the elderly.
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27
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Roller-Wirnsberger R, Lindner S, Kolosovski L, Platzer E, Dovjak P, Flick H, Tziraki C, Illario M. The role of health determinants in the influenza vaccination uptake among older adults (65+): a scope review. Aging Clin Exp Res 2021; 33:2123-2132. [PMID: 33587270 PMCID: PMC7882864 DOI: 10.1007/s40520-021-01793-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/11/2021] [Indexed: 02/06/2023]
Abstract
Background Although the burden of influenza infection is the highest in older adults, vaccination coverage remains low, despite this age group being more vulnerable than others. Aims Given the current pandemic of SARS-CoV-2, it was the aim of this scope review to update knowledge on factors affecting seasonal influenza vaccine uptake among older adults to strengthen prevention approaches in the context of an overall burden of infectious diseases. Methods We searched bibliographic databases from 2012 to 2019. All studies reviewed one or more social determinant of health listed by WHO, or factors affecting the decision-making process whether to accept influenza vaccine or not. Results Overall, 44 studies were included, 41 determinants were extracted and summarized into six categories. Older age and constitutional factors including multiple chronic diseases as well as preventive lifestyle and frequent routine healthcare utilization positively affected vaccination uptake (VU). Living and working conditions are also researched determinants of influenza vaccine uptake. A small number of studies explored the role of social inclusion and system-based interventions. Discussion and conclusions This scope review provides a comprehensive overview on factors affecting seasonal influenza vaccination uptake among older citizens. The review also clearly shows gaps for evidence on system-based level or political strategies to improve vaccination uptake. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-01793-3.
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28
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Okoli GN, Reddy VK, Lam OLT, Abdulwahid T, Askin N, Thommes E, Chit A, Abou-Setta AM, Mahmud SM. Interventions on health care providers to improve seasonal influenza vaccination rates among patients: a systematic review and meta-analysis of the evidence since 2000. Fam Pract 2021; 38:524-536. [PMID: 33517381 PMCID: PMC8317218 DOI: 10.1093/fampra/cmaa149] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Seasonal influenza vaccination (SIV) rates remain suboptimal in many populations, even in those with universal SIV. OBJECTIVE To summarize the evidence on interventions on health care providers (physicians/nurses/pharmacists) to increase SIV rates. METHODS We systematically searched/selected full-text English publications from January 2000 to July 2019 (PROSPERO-CRD42019147199). Our outcome was the difference in SIV rates between patients in intervention and non-intervention groups. We calculated pooled difference using an inverse variance, random-effects model. RESULTS We included 39 studies from 8370 retrieved citations. Compared with no intervention, team-based training/education of physicians significantly increased SIV rates in adult patients: 20.1% [7.5-32.7%; I2 = 0%; two randomized controlled trials (RCTs)] and 13.4% [8.6-18.1%; I2 = 0%; two non-randomized intervention studies (NRS)]. A smaller increase was observed in paediatric patients: 7% (0.1-14%; I2 = 0%; two NRS), and in adult patients with team-based training/education of physicians and nurses together: 0.9% (0.2-1.5%; I2 = 30.6%; four NRS). One-off provision of guidelines/information to physicians, and to both physicians and nurses, increased SIV rates in adult patients: 23.8% (15.7-31.8%; I2 = 45.8%; three NRS) and paediatric patients: 24% (8.1-39.9%; I2 = 0%; two NRS), respectively. Use of reminders (prompts) by physicians and nurses slightly increased SIV rates in paediatric patients: 2.3% (0.5-4.2%; I2 = 0%; two RCTs). A larger increase was observed in adult patients: 18.5% (14.8-22.1%; I2 = 0%; two NRS). Evidence from both RCTs and NRS showed significant increases in SIV rates with varied combinations of interventions. CONCLUSIONS Limited evidence suggests various forms of physicians' and nurses' education and use of reminders may be effective for increasing SIV rates among patients.
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Affiliation(s)
| | | | - Otto L T Lam
- George and Fay Yee Centre for Healthcare Innovation
| | | | - Nicole Askin
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Canada
| | | | | | - Ahmed M Abou-Setta
- George and Fay Yee Centre for Healthcare Innovation.,Community Health Sciences, Rady Faculty of Health Sciences
| | - Salaheddin M Mahmud
- Community Health Sciences, Rady Faculty of Health Sciences.,Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Canada
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Glenton C, Carlsen B, Lewin S, Wennekes MD, Winje BA, Eilers R. Healthcare workers' perceptions and experiences of communicating with people over 50 years of age about vaccination: a qualitative evidence synthesis. Cochrane Database Syst Rev 2021; 7:CD013706. [PMID: 34282603 PMCID: PMC8407331 DOI: 10.1002/14651858.cd013706.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Infectious diseases are a major cause of illness and death among older adults. Vaccines can prevent infectious diseases, including against seasonal influenza, pneumococcal diseases, herpes zoster and COVID-19. However, the uptake of vaccination among older adults varies across settings and groups. Communication with healthcare workers can play an important role in older people's decisions to vaccinate. To support an informed decision about vaccination, healthcare workers should be able to identify the older person's knowledge gaps, needs and concerns. They should also be able to share and discuss information about the person's disease risk and disease severity; the vaccine's effectiveness and safety; and practical information about how the person can access vaccines. Therefore, healthcare workers need good communication skills and to actively keep up-to-date with the latest evidence. An understanding of their perceptions and experiences of this communication can help us train and support healthcare workers and design good communication strategies. OBJECTIVES To explore healthcare workers' perceptions and experiences of communicating with older adults about vaccination. SEARCH METHODS We searched MEDLINE, CINAHL and Scopus on 21 March 2020. We also searched Epistemonikos for related reviews, searched grey literature sources, and carried out reference checking and citation searching to identify additional studies. We searched for studies in any language. SELECTION CRITERIA We included qualitative studies and mixed-methods studies with an identifiable qualitative component. We included studies that explored the perceptions and experiences of healthcare workers and other health system staff towards communication with adults over the age of 50 years or their informal caregivers about vaccination. DATA COLLECTION AND ANALYSIS We extracted data using a data extraction form designed for this review. We assessed methodological limitations using a list of predefined criteria. We extracted and assessed data regarding study authors' motivations for carrying out their study. We used a thematic synthesis approach to analyse and synthesise the evidence. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We examined each review finding to identify factors that may influence intervention implementation and we developed implications for practice. MAIN RESULTS We included 11 studies in our review. Most studies explored healthcare workers' views and experiences about vaccination of older adults more broadly but also mentioned communication issues specifically. All studies were from high-income countries. The studies focused on doctors, nurses, pharmacists and others working in hospitals, clinics, pharmacies and nursing homes. These healthcare workers discussed different types of vaccines, including influenza, pneumococcal and herpes zoster vaccines. The review was carried out before COVID-19 vaccines were available. We downgraded our confidence in several of the findings from high confidence to moderate, low or very low confidence. One reason for this was that some findings were based on only small amounts of data. Another reason was that the findings were based on studies from only a few countries, making us unsure about the relevance of these findings to other settings. Healthcare workers reported that older adults asked about vaccination to different extents, ranging from not asking about vaccines at all, to great demand for information (high confidence finding). When the topic of vaccination was discussed, healthcare workers described a lack of information, and presence of misinformation, fears and concerns about vaccines among older adults (moderate confidence). The ways in which healthcare workers discussed vaccines with older adults appeared to be linked to what they saw as the aim of vaccination communication. Healthcare workers differed among themselves in their perceptions of this aim and about their own roles and the roles of older adults in vaccine decisions. Some healthcare workers thought it was important to provide information but emphasised the right and responsibility of older adults to decide for themselves. Others used information to persuade and convince older adults to vaccinate in order to increase 'compliance' and 'improve' vaccination rates, and in some cases to gain financial benefits. Other healthcare workers tailored their approach to what they believed the older adult needed or wanted (moderate confidence). Healthcare workers believed that older adults' decisions could be influenced by several factors, including the nature of the healthcare worker-patient relationship, the healthcare worker's status, and the extent to which healthcare workers led by example (low confidence). Our review also identified factors that are likely to influence how communication between healthcare workers and older adults take place. These included issues tied to healthcare workers' views and experiences regarding the diseases in question and the vaccines; as well as their views and experiences of the organisational and practical implementation of vaccine services. AUTHORS' CONCLUSIONS There is little research focusing specifically on healthcare workers' perceptions and experiences of communication with older adults about vaccination. The studies we identified suggest that healthcare workers differed among themselves in their perceptions about the aim of this communication and about the role of older adults in vaccine decisions. Based on these findings and the other findings in our review, we have developed a set of questions or prompts that may help health system planners or programme managers when planning or implementing strategies for vaccination communication between healthcare workers and older adults.
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Affiliation(s)
- Claire Glenton
- Norwegian Institute of Public Health, Oslo, Norway
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Benedicte Carlsen
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Manuela Dominique Wennekes
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
- Athena Institute, Free University, Amsterdam, Netherlands
| | - Brita Askeland Winje
- Norwegian Institute of Public Health, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Renske Eilers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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Long A, Mathew S, Alvarez KS, Smartt J, Shah M, Madden C, Perl TM, Cerise FP, Bhavan KP. Co-Created Messaging for Influenza Vaccination in a High-Risk Hispanic Community Provides Groundwork for COVID-19 Vaccine. Health Equity 2021; 5:345-352. [PMID: 34084986 PMCID: PMC8170719 DOI: 10.1089/heq.2020.0132] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2021] [Indexed: 01/07/2023] Open
Abstract
Purpose: Influenza/pneumonia is the eighth leading cause of death in the United States. The 2020-2021 influenza season is predicted to be further impacted by COVID-19 infections. Historical data reflect disproportionate morbidity and mortality rates in the Hispanic population for influenza and COVID-19. Influenza vaccination rates remain low in the Hispanic community. We aim to improve vaccination through a community-led event, partnering with the Cristo Rey School Dallas, located in a zip code with a higher age-adjusted influenza/pneumonia mortality rate. A survey was administered to adults attending the Influenza vaccine event to understand attitudes and perceptions about influenza, vaccination, and effective messaging strategies for the campaign. Methods: Messaging was cocreated with student health ambassadors to promote immunization and delivered through trusted sources. The health department administered vaccines to individuals >age 3 at no cost. Adults were asked to complete a 19-question survey postvaccination offered in both English and Spanish. Results: Two hundred and forty-one of 394 (61.2%) participants completed the survey. Ninety-eight percent identified as Hispanic/Latino, and the majority of surveys were administered in Spanish. Among Spanish language participants, the church bulletins (57.3%) and Spanish language radio (30.5%) were reported to be most effective modes of messaging versus word of mouth (32.9%) and social media (26.3%) for English-speaking participants. Sixteen percent of participants surveyed had never received an influenza vaccine before this event. Conclusion: Cocreated messaging delivered by trusted sources in the Hispanic community led to a successful Influenza vaccine drive with the Dallas County health department.
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Affiliation(s)
- Apple Long
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sheryl Mathew
- Center for Innovation and Value, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Kristin S Alvarez
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Center for Innovation and Value, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Jillian Smartt
- Center for Innovation and Value, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Monal Shah
- Center for Innovation and Value, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Christopher Madden
- Health Systems Operations Administration, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Trish M Perl
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Fred P Cerise
- Center for Innovation and Value, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Kavita P Bhavan
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Center for Innovation and Value, Parkland Health and Hospital System, Dallas, Texas, USA
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Thomas RE. Reducing Morbidity and Mortality Rates from COVID-19, Influenza and Pneumococcal Illness in Nursing Homes and Long-Term Care Facilities by Vaccination and Comprehensive Infection Control Interventions. Geriatrics (Basel) 2021; 6:48. [PMID: 34066781 PMCID: PMC8162358 DOI: 10.3390/geriatrics6020048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 pandemic identifies the problems of preventing respiratory illnesses in seniors, especially frail multimorbidity seniors in nursing homes and Long-Term Care Facilities (LCTFs). Medline and Embase were searched for nursing homes, long-term care facilities, respiratory tract infections, disease transmission, infection control, mortality, systematic reviews and meta-analyses. For seniors, there is strong evidence to vaccinate against influenza, SARS-CoV-2 and pneumococcal disease, and evidence is awaited for effectiveness against COVID-19 variants and when to revaccinate. There is strong evidence to promptly introduce comprehensive infection control interventions in LCFTs: no admissions from inpatient wards with COVID-19 patients; quarantine and monitor new admissions in single-patient rooms; screen residents, staff and visitors daily for temperature and symptoms; and staff work in only one home. Depending on the vaccination situation and the current risk situation, visiting restrictions and meals in the residents' own rooms may be necessary, and reduce crowding with individual patient rooms. Regional LTCF administrators should closely monitor and provide staff and PPE resources. The CDC COVID-19 tool measures 33 infection control indicators. Hand washing, social distancing, PPE (gowns, gloves, masks, eye protection), enhanced cleaning of rooms and high-touch surfaces need comprehensive implementation while awaiting more studies at low risk of bias. Individual ventilation with HEPA filters for all patient and common rooms and hallways is needed.
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Affiliation(s)
- Roger E Thomas
- Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, AB T2M 1M1, Canada
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Strain WD, Mansi J, Boikos C, Boivin M, Fisher WA. Achieving Influenza Vaccine Uptake Target in Canada via a Pharmacy-Led Telephone Discussion during the 2019-2020 Season. Vaccines (Basel) 2021; 9:vaccines9040312. [PMID: 33810215 PMCID: PMC8065524 DOI: 10.3390/vaccines9040312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/18/2021] [Accepted: 03/20/2021] [Indexed: 01/03/2023] Open
Abstract
Older adults (≥65 years) are at elevated risk of influenza-related morbidity and mortality. Many developed countries do not achieve the World Health Organization influenza immunization target of 75% in people ≥65 years. We aimed to determine whether a brief pharmacy phone call could increase vaccine uptake of standard and enhanced influenza. Twenty-eight community pharmacists across Canada performed a telephone consultation with 643 older adults whose primary care records indicated that they had not received their influenza vaccination from their usual practitioner. Of these 643 adults, 169 (26.3%) had been vaccinated in another setting. Of the remaining 474, 313 (66%) agreed to receive the vaccine. Of those who refused vaccination, 69 provided a rationale for not wanting it, including that the flu shot "causes the flu" (n = 25), "doesn't work" (n = 25), "is too painful" (n = 10), and other (n = 10). Overall, of the 643 individuals who had not received their vaccination from their usual health care provider in the first wave of vaccinations, 75.4% (n = 485) ultimately received their vaccination in the 2019-2020 season. This highlights the important role of the community pharmacist in achieving the World Health Organization (WHO) targets for vaccination.
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Affiliation(s)
- William David Strain
- Diabetes and Vascular Research Centre, University of Exeter Medical School, Exeter EX2 5AX, UK
- Academic Department of Healthcare for Older People, Royal Devon & Exeter Hospital, Exeter EX2 5DW, UK
- Correspondence: ; Tel.: +441-392-403-058; Fax: +441-392-403-027
| | - James Mansi
- Centre for Outcomes Research & Evaluation (CORE), Seqirus, QC H9H 4M7, Canada; (J.M.); (C.B.)
| | - Constantina Boikos
- Centre for Outcomes Research & Evaluation (CORE), Seqirus, QC H9H 4M7, Canada; (J.M.); (C.B.)
| | - Michael Boivin
- Independent Pharmacist Consultant, Barrie, ON L4N 6Z6, Canada;
| | - William A. Fisher
- Department of Obstetrics and Gynaecology, Western University Canada, London, ON N6A 5C2, Canada;
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Regional differences in general practitioners' behaviours regarding influenza vaccination: a cross-sectional study. BMC Health Serv Res 2021; 21:197. [PMID: 33663449 PMCID: PMC7934451 DOI: 10.1186/s12913-021-06177-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization recommends vaccination rates of 75% against seasonal influenza for patients over 65 years old. In the 2013/2014 season, the German vaccination rates ranged between 14 and 65%. This study aimed to compare the attitudes, personal characteristics and vaccination behaviours of general practitioners (GPs) in regions with high and low vaccination rates in Germany. METHODS In May 2016, a questionnaire was sent to 1594 GPs practising in 16 districts with the highest and the lowest vaccination rates in Western and Eastern Germany as described by the Central Research Institute of Ambulatory Health Care in Germany for the 2013/2014 season. Descriptive statistics and multiple regression analyses were computed to identify potential factors associated with high vaccination rates. RESULTS A total response rate of 32% (515/1594 participants) was observed in the study. GPs reported their attitudes towards vaccination in general and vaccination against influenza as mostly 'very positive' (80%, n = 352 and 65%, n = 288, respectively). GPs practising in regions with low vaccination rates reported their attitudes towards vaccinations in general (p = 0.004) and towards influenza vaccination (p = 0.001) more negatively than their colleagues from regions with high vaccination rates. Multiple logistic regression identified an increasing influence of year-dependent changing efficiency on GPs' influenza rates as the strongest factor for predicting GPs from highly vaccinating regions (OR = 4.31 [1.12-16.60]), followed by the patient's vaccination refusal despite GP advice due to already receiving a vaccination from another physician (OR = 3.20 [1.89-5.43]) and vaccination information gathering through medical colleagues (OR = 2.26 [1.19-4.29]). CONCLUSIONS The results of this study suggest a correlation between GPs' attitudes and regional vaccination rates. Beneath GPs' individual attitudes, the regional attitude patterns of patients, colleagues and medical assistants surrounding those GPs seem decisive and should be integrated into future campaigns to increase vaccination rates at a regional level.
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Bartoszko J, Loeb M. The burden of influenza in older adults: meeting the challenge. Aging Clin Exp Res 2021; 33:711-717. [PMID: 31347085 DOI: 10.1007/s40520-019-01279-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/17/2019] [Indexed: 12/20/2022]
Abstract
Influenza is an acute respiratory infection for which vaccination is our best prevention strategy. Small seasonal changes in circulating influenza viruses (antigenic drift) result in the need for annual influenza vaccination, in which the vaccine formulation is updated to better match the predominant circulating influenza viruses that have undergone important antigenic changes. Although the burden of influenza infection and its complications is the highest in older adults, vaccine effectiveness is the lowest in this vulnerable population. This is largely due to waning of the immune response with age known as "immune senescence", and presents an important, unmet challenge. Possible strategies to tackle this include adjuvant and high-dose vaccines, and herd immunity induced by greater vaccine uptake.
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Affiliation(s)
- Jessica Bartoszko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8N 3Z5, Canada
| | - Mark Loeb
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8N 3Z5, Canada.
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Knowledge, attitudes, and practices of seasonal influenza vaccination among older adults in nursing homes and daycare centers, Honduras. PLoS One 2021; 16:e0246382. [PMID: 33571242 PMCID: PMC7877760 DOI: 10.1371/journal.pone.0246382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/16/2021] [Indexed: 12/23/2022] Open
Abstract
Background Older adults represent 70–90% of seasonal influenza-related deaths and 50–70% of influenza-related hospitalizations. Vaccination is the most efficient means of preventing influenza and reducing influenza-related illnesses. We aimed to describe knowledge, attitudes, and practices (KAP) of seasonal influenza vaccination among older adults in Honduras. Methods From August 29–October 26, 2018, we conducted a cross-sectional KAP survey regarding seasonal influenza vaccinations to samples of older adults 1) admitted to nursing homes and 2) attending daycare centers. We used the Minimental State Examination (MMSE) psychometric tool to assess the cognitive status of older adults and included participants with scores of ≥23 points in the survey. We reported frequency distributions for demographics, KAP of influenza virus and vaccination, and vaccination coverage. We used logistic regression to analyze associations between demographics and verified influenza vaccination. Results Of 511 MMSE participants, 341 completed the survey (95 adults in 12 nursing homes and 246 older adults in ten daycare centers). Almost all participants knew that influenza causes severe illness and may be transmitted from person to person, vaccination is safe and protects against disease, and older adults have greater risk of complications. Of 284 participants with verified vaccinations, 81.3% were vaccinated for influenza: 87.9% attending daycare centers and 61.4% in nursing homes. Among all participants, verified current influenza vaccination was associated with self-reported influenza vaccination in previous year (aOR: 14.05; 95% CI: 5.36–36.81); no formal education (aOR: 4.83; 95% CI: 1.63–14.37) or primary school education (aOR: 4.51; 95% CI: 1.79–11.37) having ≥secondary as reference; and indigenous (aOR: 4.55; 95% CI: 1.18–17.49) having Mestizo as reference. Reasons for vaccination were perceived self-benefits, protection against influenza complications, favorable vaccination hours, and healthcare provider recommendations. Conclusion Four-fifths of older adults were vaccinated for seasonal influenza. Educational efforts provided in conjunction with vaccination campaigns resulted in high knowledge of influenza virus, transmission, and vaccination. Further outreach regarding disease risks and vaccine safety needs to be directed towards older adults in nursing homes who had lower knowledge and coverage than older adults in daycare centers.
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Burns VM, Castillo FM, Coldren RL, Prosser T, Howell RL, Kabbur MB. Perceptions of Seasonal Influenza Vaccine Among U.S. Army Civilians and Dependents in the Kaiserslautern Military Community: A Mixed-Methods Survey. Mil Med 2021; 187:e394-e403. [PMID: 33547793 PMCID: PMC7928713 DOI: 10.1093/milmed/usaa572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/23/2020] [Accepted: 01/08/2021] [Indexed: 02/04/2023] Open
Abstract
Introduction Influenza is a globally occurring viral respiratory infection that can lead to hospitalizations and death. An influenza outbreak can interfere with combat readiness in a military setting, as the infection can incapacitate soldiers. Vaccination remains the most effective tool to prevent and mitigate seasonal influenza. Although influenza vaccinations for U.S. Army soldiers can be monitored through military health systems, those systems cannot capture DoD civilians and Army dependents who may not use military health services. This study aims to gauge flu vaccine uptake and perceptions in U.S. Army civilians and dependents. Materials and Methods An online survey was e-mailed to civilian and dependent enrollees of Landstuhl Regional Medical Center. The survey contained 24 questions pertaining to demographics, vaccine history, history of the flu, and beliefs toward vaccines. Chi-square tests, t-tests, and logistic regressions were performed to investigate the association between demographic, behavior, and belief factors with vaccine uptake. Free-text answers were coded and categorized by themes. Results Over 70% of respondents were vaccinated for the flu. There were differences between vaccinated and unvaccinated respondents regarding their perceptions of barriers to vaccination, benefits of the flu vaccine, severity of flu symptoms, and personal risk of getting ill with the flu. After controlling for confounders, flu vaccination in the previous season and healthcare worker status were associated with increased vaccine uptake, while perceived barriers to influenza vaccination were associated with decreased vaccine uptake. Conclusions Flu vaccine uptake may be increased by increasing access to vaccination, promoting vaccination and addressing concerns at the provider level, and engaging positively framed public messaging. Increasing flu vaccine uptake is of particular importance as the flu season approaches during the COVID-19 (Coronavirus disease 2019) pandemic.
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Affiliation(s)
- Veronica M Burns
- U.S. Army Public Health Command Europe, Preventive Medicine Services, Landstuhl, Rhineland-Palatinate 66849, Germany
| | - Fritz M Castillo
- Department of Pathology & Area Laboratory Services, Landstuhl Regional Medical Center, Landstuhl, Rhineland-Palatinate 66849, Germany
| | - Rodney L Coldren
- U.S. Army Public Health Command Europe, Preventive Medicine Services, Landstuhl, Rhineland-Palatinate 66849, Germany
| | | | - Renee L Howell
- U.S. Army Public Health Command Europe, Preventive Medicine Services, Landstuhl, Rhineland-Palatinate 66849, Germany
| | - Mahendra B Kabbur
- U.S. Army Public Health Command Europe, Preventive Medicine Services, Landstuhl, Rhineland-Palatinate 66849, Germany
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Thomas RE. Pneumococcal Pneumonia and Invasive Pneumococcal Disease in Those 65 and Older: Rates of Detection, Risk Factors, Vaccine Effectiveness, Hospitalisation and Mortality. Geriatrics (Basel) 2021; 6:13. [PMID: 33557406 PMCID: PMC7931064 DOI: 10.3390/geriatrics6010013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/17/2022] Open
Abstract
Pneumococcal pneumonia (PP) and invasive pneumococcal disease (IPD) are important causes of morbidity and mortality in seniors worldwide. Incidence rates and serious outcomes worsen with increasing frailty, numbers of risk factors and decreasing immune competence with increasing age. Literature reviews in Medline and Embase were performed for pneumococcal disease incidence, risk factors, vaccination rates and effectiveness in the elderly. The introduction of protein-conjugated pneumoccal vaccines (PCV) for children markedly reduced IPD and PP in seniors, but serotypes not included in vaccines and with previously low levels increased. Pneumococcal polysaccharide (PPV23) vaccination does not change nasal and pharyngeal carriage rates. Pneumococcal and influenza vaccination rates in seniors are below guideline levels, especially in older seniors and nursing home staff. Pneumococcal and influenza carriage and vaccination rates of family members, nursing home health care workers and other contacts are unknown. National vaccination programmes are effective in increasing vaccination rates. Detection of IPD and PP initially depend on clinical symptoms and new chest X ray infiltrates and then varies according to the population and laboratory tests used. To understand how seniors and especially older seniors acquire PP and IPD data are needed on pneumococcal disease and carriage rates in family members, carers and contacts. Nursing homes need reconfiguring into small units with air ventilation externally from all rooms to minimise respiratory disease transmission and dedicated staff for each unit to minimise transmision of infectious diseaases.
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Affiliation(s)
- Roger E Thomas
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
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Li P, Hayat K, Jiang M, Pu Z, Yao X, Zou Y, Lambojon K, Huang Y, Hua J, Xiao H, Du F, Shi L, Zhai P, Ji W, Feng Z, Gong Y, Fang Y. Impact of video-led educational intervention on the uptake of influenza vaccine among adults aged 60 years and above in China: a study protocol for a randomized controlled trial. BMC Public Health 2021; 21:222. [PMID: 33499830 PMCID: PMC7839176 DOI: 10.1186/s12889-021-10220-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 01/12/2021] [Indexed: 11/15/2022] Open
Abstract
Background Influenza is a global health threat to older adults, and the influenza vaccine is the most effective approach to prevent influenza infection. However, influenza vaccination coverage among Chinese older adults is far less than in developed countries such as the United States (4.0% vs. 64.9%). This study aims to increase influenza vaccination coverage in Chinese adults ≥60 years using a video-led educational intervention conducted by medical students. Methods A cluster randomized controlled trial will be conducted in 4 districts of Xi’an city, Shaanxi Province, China, using a stratified sampling approach. Adults aged ≥60 years will be recruited from 8 community hospitals. A self-administered questionnaire of knowledge, attitudes, and practices (KAP) will be employed to record the KAP score. During the 6-month interventional period, participants in the intervention group will receive educational videos focused on influenza and influenza vaccination, coupled with a group discussion conducted by the medical students. For those in the control group, no intervention will be provided. The outcomes measured in both groups will be the influenza vaccination coverage and the KAP scores of all participants. Discussion Medical students are more likely to educate older adults about scientific knowledge of influenza and its vaccine compared to clinical practitioners, who, most of the time, remain over-occupied due to the extensive workload. Video-led counseling and education could be a useful option to optimize older adults’ understanding of influenza and influenza vaccination. This eventually could improve the uptake of influenza vaccine among Chinese older adults. Trial registration Chinese Clinical Trial Registry; ChiCTR2000034330; Registered 3rd July 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10220-1.
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Affiliation(s)
- Pengchao Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, 710061, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, 710061, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, 710061, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, 710061, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China.,Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, 710061, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, 710061, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China
| | - Zhaojing Pu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, 710061, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, 710061, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China
| | - Xuelin Yao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, 710061, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, 710061, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China
| | - Yamin Zou
- Department of Pharmacy, the Hospital of Xi'an Jiaotong University, Xi'an, 710049, China
| | - Krizzia Lambojon
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, 710061, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, 710061, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China
| | - Yifan Huang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, 710061, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, 710061, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China
| | - Jinghua Hua
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, 710061, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, 710061, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China
| | - Hanri Xiao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, 710061, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, 710061, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China
| | - Fulei Du
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, 710061, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, 710061, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China
| | - Li Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, 710061, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, 710061, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China
| | - Panpan Zhai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, 710061, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, 710061, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China
| | - Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, 710061, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, 710061, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China
| | - Zhitong Feng
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, 710061, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, 710061, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China
| | - Yilin Gong
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, 710061, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, 710061, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China. .,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, 710061, China. .,Shaanxi Centre for Health Reform and Development Research, Xi'an, 710061, China. .,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China.
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Phanhdone T, Drummond P, Meisel T, Friede N, Di Rocco A, Chodosh J, Fleisher J. Barriers to Vaccination Among People with Parkinson's Disease and Implications for COVID-19. JOURNAL OF PARKINSON'S DISEASE 2021; 11:1057-1065. [PMID: 33935103 PMCID: PMC8355058 DOI: 10.3233/jpd-202497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patients with Parkinson's disease (PD) are at higher risk of vaccine-preventable respiratory infections. However, advanced, homebound individuals may have less access to vaccinations. In light of COVID-19, understanding barriers to vaccination in PD may inform strategies to increase vaccine uptake. OBJECTIVE To identify influenza and pneumococcal vaccination rates, including barriers and facilitators to vaccination, among homebound and ambulatory individuals with PD and related disorders. METHODS Cross-sectional US-based study among individuals with PD, aged > 65 years, stratified as homebound or ambulatory. Participants completed semi-structured interviews on vaccination rates and barriers, and healthcare utilization. RESULTS Among 143 participants, 9.8% had missed all influenza vaccinations in the past 5 years, and 32.2% lacked any pneumococcal vaccination, with no between-group differences. Homebound participants (n = 41) reported difficulty traveling to clinic (p < 0.01) as a vaccination barrier, and despite similar outpatient visit frequencies, had more frequent emergency department visits (31.7% vs. 9.8%, p < 0.01) and hospitalizations (14.6% vs. 2.9%, p = 0.03). Vaccine hesitancy was reported in 35% of participants, vaccine refusal in 19%, and 13.3% reported unvaccinated household members, with no between-group differences. Nearly 13% thought providers recommended against vaccines for PD patients, and 31.5% were unsure of vaccine recommendations in PD. CONCLUSION Among a sample of homebound and ambulatory people with PD, many lack age-appropriate immunizations despite ample healthcare utilization. Many participants were unsure whether healthcare providers recommend vaccinations for people with PD. In light of COVID-19, neurologist reinforcement that vaccinations are indicated, safe, and recommended may be beneficial.
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Affiliation(s)
- Tiffany Phanhdone
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Patrick Drummond
- Marlene and Paolo Fresco Institute for Parkinson’s and Movement Disorders, Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Talia Meisel
- SUNY Downstate Medical Center College of Medicine, Brooklyn, NY, USA
| | | | | | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University School of Medicine, New York, NY, USA
- VA New York Harbor Healthcare System, Medicine Service, New York, NY, USA
| | - Jori Fleisher
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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Shared Decision Making Enhances Pneumococcal Vaccination Rates in Adult Patients in Outpatient Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239146. [PMID: 33297552 PMCID: PMC7729624 DOI: 10.3390/ijerph17239146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022]
Abstract
Insufficient vaccination rates against pneumococcal disease are a major problem in primary health care, especially in adult patients. Shared decision-making (SDM) may address major barriers to vaccination. The objective of this review was to assess the impact of SDM on pneumococcal vaccination rates in adult patients. We conducted a systematic literature search in MEDLINE, EMBASE, CENTRAL, PsycINFO, and ERIC. RCTs and cluster RCTs were included, if they aimed to enhance pneumococcal vaccination rates in adult patients and comprised a personal interaction between health care provider (HCP) and patient. Three further aspects of the SDM process (patient activation, bi-directional exchange of information and bi-directional deliberation) were assessed. A meta-analysis was conducted for the effects of interventions on vaccination rates. We identified eight studies meeting the inclusion criteria. The pooled effect size was OR (95% CI): 2.26 (1.60–3.18) comparing intervention and control groups. Our findings demonstrate the efficacy of interventions that enable a SDM process to enhance pneumococcal vaccination rates; although, the quality of evidence was low. In exploratory subgroup analyses, we concluded that an impersonal patient activation and an exchange of information facilitated by nurses are sufficient to increase vaccination rates against pneumococcal disease in adult patients. However, the deliberation of options between physicians and patients seemed to be more effective than deliberation of options between nurses and patients.
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Kaneko M, Aoki T, Goto R, Ozone S, Haruta J. Better Patient Experience is Associated with Better Vaccine Uptake in Older Adults: Multicentered Cross-sectional Study. J Gen Intern Med 2020; 35:3485-3491. [PMID: 32939665 PMCID: PMC7728885 DOI: 10.1007/s11606-020-06187-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Older adults' uptake of influenza and pneumococcus vaccines is insufficient worldwide. Although patient experience of primary care is associated with vaccine uptake in children, this relationship remains unclear for older adults. OBJECTIVE This study examined the association between patient experience of primary care and influenza/pneumococcal vaccine uptake in older adults. DESIGN AND METHODS We conducted a multicentered cross-sectional survey involving 25 primary care institutions in urban and rural areas in Japan. Participants were outpatients aged ≥ 65 years who visited one of the participating institutions within the 1-week study period. We assessed patient experience of primary care using the Japanese version of the Primary Care Assessment Tool (JPCAT), which includes six domains: first contact (accessibility), longitudinality (continuity of care), coordination, comprehensiveness (services available), comprehensiveness (services provided), and community orientation. We used a generalized linear mixed-effects model to adjust for clustering within institutions and individual covariates. KEY RESULTS One thousand participants were included in the analysis. After adjusting for clustering within institutions and other possible confounders, influenza and pneumococcal vaccine uptake was positively associated with JPCAT total scores (odds ratio per 1 standard deviation increase: 1.19, 95% confidence interval: 1.01-1.40 and odds ratio: 1.26, 95% confidence interval: 1.08-1.46, respectively). Of the JPCAT domains, coordination and community orientation were associated with influenza vaccine uptake and longitudinality, coordination, and comprehensiveness were associated with pneumococcal vaccine uptake. CONCLUSIONS Influenza and pneumococcal vaccine uptake were positively associated with patient experience of primary care in older adults. Consideration of patient experience, particularly longitudinality, coordination, comprehensiveness, and community orientation, could improve vaccine uptake.
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Affiliation(s)
- Makoto Kaneko
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
- Shizuoka Family Medicine Program, Shizuoka, Japan.
- Primary Care Research Unit, Graduate School of Health Data Science, Yokohama City University, Yokohama, Kanagawa, Japan.
| | - Takuya Aoki
- Division of Clinical Epidemiology, Jikei University School of Medicine, Tokyo, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryohei Goto
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Sachiko Ozone
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Junji Haruta
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- Medical Education Center, School of Medicine, Keio University, Tokyo, Japan
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Dyson L, Bedford H, Condon L, Emslie C, Ireland L, Mytton J, Overend K, Redsell S, Richardson Z, Jackson C. Identifying interventions with Gypsies, Roma and Travellers to promote immunisation uptake: methodological approach and findings. BMC Public Health 2020; 20:1574. [PMID: 33081730 PMCID: PMC7574499 DOI: 10.1186/s12889-020-09614-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 09/27/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In the UK, Gypsy, Roma and Traveller (GRT) communities are generally considered to be at risk of low or variable immunisation uptake. Many strategies to increase uptake for the general population are relevant for GRT communities, however additional approaches may also be required, and importantly one cannot assume that "one size fits all". Robust methods are needed to identify content and methods of delivery that are likely to be acceptable, feasible, effective and cost effective. In this paper, we describe the approach taken to identify potential interventions to increase uptake of immunisations in six GRT communities in four UK cities; and present the list of prioritised interventions that emerged. METHODS This work was conducted in three stages: (1) a modified intervention mapping process to identify ideas for potential interventions; (2) a two-step prioritisation activity at workshops with 51 GRTs and 25 Service Providers to agree a prioritised list of potentially feasible and acceptable interventions for each community; (3) cross-community synthesis to produce a final list of interventions. The theoretical framework underpinning the study was the Social Ecological Model. RESULTS Five priority interventions were agreed across communities and Service Providers to improve the uptake of immunisation amongst GRTs who are housed or settled on an authorised site. These interventions are all at the Institutional (e.g. cultural competence training) and Policy (e.g. protected funding) levels of the Social Ecological Model. CONCLUSIONS The "upstream" nature of the five interventions reinforces the key role of GP practices, frontline workers and wider NHS systems on improving immunisation uptake. All five interventions have potentially broader applicability than GRTs. We believe that their impact would be enhanced if delivered as a combined package. The robust intervention development and co-production methods described could usefully be applied to other communities where poor uptake of immunisation is a concern. STUDY REGISTRATION Current Controlled Trials ISRCTN20019630, Date of registration 01-08-2013, Prospectively registered.
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Affiliation(s)
- Lisa Dyson
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
| | - Helen Bedford
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Louise Condon
- College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP UK
| | - Carol Emslie
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK
| | - Lana Ireland
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK
| | - Julie Mytton
- University of the West of England, Centre for Child and Adolescent Health, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - Karen Overend
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
| | - Sarah Redsell
- Faculty of Health, Social Care and Education, Anglia Ruskin University East Road Campus, Cambridge, CB1 1PT UK
| | - Zoe Richardson
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
| | - Cath Jackson
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
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Valerio V, Bazan MC, Wang M, Mazer BD, Pineau CA, Hazel EM, Bernatsky S, Ward BJ, Colmegna I. A multimodal intervention increases influenza vaccine uptake in rheumatoid arthritis. Clin Rheumatol 2020; 40:575-579. [PMID: 33030631 DOI: 10.1007/s10067-020-05435-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 11/24/2022]
Abstract
Annual influenza vaccination is recommended for patients with rheumatoid arthritis (RA), but coverage is suboptimal. We assessed the impact of an implementation strategy in enhancing vaccination uptake in RA. We evaluated a multimodal implementation strategy at rheumatology clinics that included 3 approaches: patient recalls, a nurse providing vaccines, and physician reminders. We compared patient-reported vaccination rates after implementation with those reported before the implementation strategy in a nonequivalent control group. In multivariate analyses, we assessed factors potentially associated with influenza vaccine uptake. One hundred and sixteen RA patients were vaccinated during the intervention. The influenza vaccination rate in RA increased from 48.5% (65/136) before implementation to 62.6% (67/107) after implementation (difference of 14.1, 95% CI 1.5, 26.1). In multivariate analyses, older age, biologics use, and physician recommendation for vaccination were associated with influenza vaccine uptake. A multimodal intervention was associated with increased influenza vaccine coverage among RA patients. Older patients and those on biologics were more likely to be immunized against influenza. Physician's recommendations are important to promote vaccine coverage. Key Points • Despite current recommendations, influenza vaccine uptake among rheumatoid arthritis (RA) patients is suboptimal. • A multimodal implementation strategy facilitating access to influenza vaccine and raising awareness through vaccination reminders improved immunization uptake in RA. • Physicians play a key role in promoting annual seasonal influenza vaccination. • The reasons for vaccine hesitancy in RA should be addressed to reach a vaccination target of 80% required to reduce the burden of this preventable infection.
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Affiliation(s)
- Valeria Valerio
- The Research Institute of the McGill University Health Centre (MUHC), 1001 Decarie Blvd, Office # EM02-3238, Montreal, QC, H4A 3J1, Canada
| | - Maria Celia Bazan
- The Research Institute of the McGill University Health Centre (MUHC), 1001 Decarie Blvd, Office # EM02-3238, Montreal, QC, H4A 3J1, Canada
| | - Mianbo Wang
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Bruce D Mazer
- The Research Institute of the McGill University Health Centre (MUHC), 1001 Decarie Blvd, Office # EM02-3238, Montreal, QC, H4A 3J1, Canada
| | - Christian A Pineau
- Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Elizabeth M Hazel
- Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Sasha Bernatsky
- Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada.,Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Brian J Ward
- The Research Institute of the McGill University Health Centre (MUHC), 1001 Decarie Blvd, Office # EM02-3238, Montreal, QC, H4A 3J1, Canada.,Division of Infectious Diseases, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Ines Colmegna
- The Research Institute of the McGill University Health Centre (MUHC), 1001 Decarie Blvd, Office # EM02-3238, Montreal, QC, H4A 3J1, Canada. .,Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada.
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Walsh MM, Parker AM, Vardavas R, Nowak SA, Kennedy DP, Gidengil CA. The Stability of Influenza Vaccination Behavior Over Time: A Longitudinal Analysis of Individuals Across 8 Years. Ann Behav Med 2020; 54:783-793. [PMID: 32359063 DOI: 10.1093/abm/kaaa017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Seasonal influenza vaccination is an important behavior with significant individual and public health consequences, yet fewer than half of individuals in the USA are vaccinated annually. To promote vaccination adherence, it is important to understand the factors that affect vaccination behavior. PURPOSE In this research, we focused on one such factor, an individual's vaccination history. We gathered longitudinal data to track and understand the relationship between an individual's vaccination history and their current behaviors. METHODS U.S. adults completed multiple surveys over an 8 year period, which asked about whether they had received the influenza vaccination during the previous flu season. We analyzed the data to determine the strength of the relationship between vaccination decisions across single-year and multiyear intervals. Additionally, we fitted two mathematical models to the data to determine whether individuals were better characterized as having a stable propensity to vaccinate or a stable propensity to repeat their previous decisions. RESULTS Individuals exhibited highly consistent behavior across adjacent years, yet, across the complete extent of the longitudinal study, they were far more likely to repeat the earlier decision to vaccinate. Surprisingly, the results of the mathematical model suggest that individuals are better characterized as having a stable propensity to repeat their previous decisions rather than a stable propensity to vaccinate per se. Although most individuals had an extremely strong tendency to repeat the previous decision, some had a far weaker propensity to do so. CONCLUSIONS This suggests that interventions intended to increase vaccination uptake might be most impactful for those individuals with only a weak tendency to vaccinate or not to vaccinate.
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Affiliation(s)
| | | | | | | | | | - Courtney A Gidengil
- RAND Corporation, Boston, MA, USA.,Boston Children's Hospital, Boston, MA, USA
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Wijesundara JG, Ito Fukunaga M, Ogarek J, Barton B, Fisher L, Preusse P, Sundaresan D, Garber L, Mazor KM, Cutrona SL. Electronic Health Record Portal Messages and Interactive Voice Response Calls to Improve Rates of Early Season Influenza Vaccination: Randomized Controlled Trial. J Med Internet Res 2020; 22:e16373. [PMID: 32975529 PMCID: PMC7547389 DOI: 10.2196/16373] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 06/24/2020] [Accepted: 08/03/2020] [Indexed: 01/30/2023] Open
Abstract
Background Patient reminders for influenza vaccination, delivered via an electronic health record patient portal and interactive voice response calls, offer an innovative approach to engaging patients and improving patient care. Objective The goal of this study was to test the effectiveness of portal and interactive voice response outreach in improving rates of influenza vaccination by targeting patients in early September, shortly after vaccinations became available. Methods Using electronic health record portal messages and interactive voice response calls promoting influenza vaccination, outreach was conducted in September 2015. Participants included adult patients within a large multispecialty group practice in central Massachusetts. Our main outcome was electronic health record–documented early influenza vaccination during the 2015-2016 influenza season, measured in November 2015. We randomly assigned all active portal users to 1 of 2 groups: (1) receiving a portal message promoting influenza vaccinations, listing upcoming clinics, and offering online scheduling of vaccination appointments (n=19,506) or (2) receiving usual care (n=19,505). We randomly assigned all portal nonusers to 1 of 2 groups: (1) receiving interactive voice response call (n=15,000) or (2) receiving usual care (n=43,596). The intervention also solicited patient self-reports on influenza vaccinations completed outside the clinic. Self-reported influenza vaccination data were uploaded into the electronic health records to increase the accuracy of existing provider-directed electronic health record clinical decision support (vaccination alerts) but were excluded from main analyses. Results Among portal users, 28.4% (5549/19,506) of those randomized to receive messages and 27.1% (5294/19,505) of the usual care group had influenza vaccinations documented by November 2015 (P=.004). In multivariate analysis of portal users, message recipients were slightly more likely to have documented vaccinations when compared to the usual care group (OR 1.07, 95% CI 1.02-1.12). Among portal nonusers, 8.4% (1262/15,000) of those randomized to receive calls and 8.2% (3586/43,596) of usual care had documented vaccinations (P=.47), and multivariate analysis showed nonsignificant differences. Over half of portal messages sent were opened (10,112/19,479; 51.9%), and over half of interactive voice response calls placed (7599/14,984; 50.7%) reached their intended target, thus we attained similar levels of exposure to the messaging for both interventions. Among portal message recipients, 25.4% of message openers (2570/10,112) responded to a subsequent question on receipt of influenza vaccination; among interactive voice response recipients, 72.5% of those reached (5513/7599) responded to a similar question. Conclusions Portal message outreach to a general primary care population achieved a small but statistically significant improvement in rates of influenza vaccination (OR 1.07, 95% CI 1.02-1.12). Interactive voice response calls did not significantly improve vaccination rates among portal nonusers (OR 1.03, 95% CI 0.96-1.10). Rates of patient engagement with both modalities were favorable. Trial Registration ClinicalTrials.gov NCT02266277; https://clinicaltrials.gov/ct2/show/NCT02266277
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Affiliation(s)
- Jessica G Wijesundara
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Mayuko Ito Fukunaga
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.,Meyers Primary Care Institute, Worcester, MA, United States.,Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jessica Ogarek
- Center for Gerontology and Healthcare Research, Brown University, Providence, MA, United States
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Lloyd Fisher
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States.,Reliant Medical Group, Worcester, MA, United States
| | | | | | - Lawrence Garber
- Meyers Primary Care Institute, Worcester, MA, United States.,Reliant Medical Group, Worcester, MA, United States
| | - Kathleen M Mazor
- Meyers Primary Care Institute, Worcester, MA, United States.,Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Sarah L Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.,Health Services Research & Development, Center of Innovation, Edith Nourse Rogers Memorial Hospital, Veterans Health Administration, Bedford, MA, United States
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Rondán-Cataluña FJ, Ramírez-Correa PE, Arenas-Gaitán J, Ramírez-Santana M, Grandón EE, Alfaro-Pérez J. Social Network Communications in Chilean Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176078. [PMID: 32825543 PMCID: PMC7503771 DOI: 10.3390/ijerph17176078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 02/08/2023]
Abstract
The growth of older adults in new regions poses challenges for public health. We know that these seniors live increasingly alone, and this impairs their health and general wellbeing. Studies suggest that social networking sites (SNS) can reduce isolation, improve social participation, and increase autonomy. However, there is a lack of knowledge about the characteristics of older adult users of SNS in these new territories. Without this information, it is not possible to improve the adoption of SNS in this population. Based on decision trees, this study analyzes how the elderly users of various SNS in Chile are like. For this purpose, a segmentation of the different groups of elderly users of social networks was constructed, and the most discriminating variables concerning the use of these applications were classified. The results highlight the existence of considerable differences between the various social networks analyzed in their use and characterization. Educational level is the most discriminating variable, and gender influences the types of SNS use. In general, it is observed that the higher the educational level, the more the different social networking sites are used.
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Affiliation(s)
| | | | - Jorge Arenas-Gaitán
- Department Business Management and Marketing, University of Seville, 41004 Sevilla, Spain; (F.J.R.-C.); (J.A.-G.)
| | - Muriel Ramírez-Santana
- Department of Public Health, Faculty of Medicine, Universidad Católica del Norte, Coquimbo 1780000, Chile;
| | - Elizabeth E. Grandón
- Department of Information Systems, Universidad del Bío-Bío, Concepción 4030000, Chile;
| | - Jorge Alfaro-Pérez
- School of Engineering, Universidad Católica del Norte, Coquimbo 1780000, Chile;
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47
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Glenton C, Winje BA, Carlsen B, Eilers R, Wennekes MD, Lewin S. Healthcare workers’ perceptions and experiences of communicating with people over 50 about vaccination: a qualitative evidence synthesis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
| | | | - Benedicte Carlsen
- Department of health promotion and development; University of Bergen; Bergen Norway
| | - Renske Eilers
- Centre for Infectious Disease Control; National Institute for Public Health and the Environment (RIVM); Bilthoven Netherlands
| | | | - Simon Lewin
- Norwegian Institute of Public Health; Oslo Norway
- Health Systems Research Unit; South African Medical Research Council; Cape Town South Africa
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48
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Julio C, Silva N, Ortigoza Á. Multiple mail reminders to increase adherence to influenza vaccination. Medwave 2020; 20:e7963. [PMID: 32678814 DOI: 10.5867/medwave.2020.06.7962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/26/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Different interventions have been proposed to reinforce the use of the influenza vaccine. The use of reminders, whether through letters, phone calls, pamphlets or technological applications, among others, has stood out among those aimed at increasing ad-herence to treatment. However, its effectiveness is not clear. In this summary, which is part of a series of reminder evaluations, we assess the use of multiple mail reminders. METHODS We conducted a search in Epistemonikos, the largest database of systematic health reviews, which is maintained by screening multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. We extracted the data from the identified reviews, analyzed the data from the primary studies, performed a meta-analysis and prepared a summary table of the results using the GRADE method. RESULTS AND CONCLUSIONS We identified eight systematic reviews including 35 primary studies, of which four analyze the use of more than one letter as a reminder. We conclude that the use of multiple mail reminders probably increase adherence to influenza vaccination in patients over 60; while it may make little or no difference in children under 6 years, but the certainty of the evidence is low.
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Affiliation(s)
- Camila Julio
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Nicole Silva
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Ángela Ortigoza
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Medicina Familiar, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Diagonal Paraguay 476, Santiago, Chile
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49
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Li Q, Tang B, Bragazzi NL, Xiao Y, Wu J. Modeling the impact of mass influenza vaccination and public health interventions on COVID-19 epidemics with limited detection capability. Math Biosci 2020; 325:108378. [PMID: 32507746 PMCID: PMC7229764 DOI: 10.1016/j.mbs.2020.108378] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 12/15/2022]
Abstract
The emerging coronavirus SARS-CoV-2 has caused a COVID-19 pandemic. SARS-CoV-2 causes a generally mild, but sometimes severe and even life-threatening infection, known as COVID-19. Currently, there exist no effective vaccines or drugs and, as such, global public authorities have so far relied upon non pharmaceutical interventions (NPIs). Since COVID-19 symptoms are aspecific and may resemble a common cold, if it should come back with a seasonal pattern and coincide with the influenza season, this would be particularly challenging, overwhelming and straining the healthcare systems, particularly in resource-limited contexts, and would increase the likelihood of nosocomial transmission. In the present study, we devised a mathematical model focusing on the treatment of people complaining of influenza-like-illness (ILI) symptoms, potentially at risk of contracting COVID-19 or other emerging/re-emerging respiratory infectious agents during their admission at the health-care setting, who will occupy the detection kits causing a severe shortage of testing resources. The model is used to assess the effect of mass influenza vaccination on the spread of COVID-19 and other respiratory pathogens in the case of a coincidence of the outbreak with the influenza season. Here, we show that increasing influenza vaccine uptake or enhancing the public health interventions would facilitate the management of respiratory outbreaks coinciding with the peak flu season, especially, compensate the shortage of the detection resources. However, how to increase influenza vaccination coverage rate remains challenging. Public health decision- and policy-makers should adopt evidence-informed strategies to improve influenza vaccine uptake.
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Affiliation(s)
- Qian Li
- Department of Applied Mathematics, Xi'an Jiaotong University, Xi'an 710049, PR China; Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
| | - Biao Tang
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
| | - Yanni Xiao
- Department of Applied Mathematics, Xi'an Jiaotong University, Xi'an 710049, PR China
| | - Jianhong Wu
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada.
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50
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Shehadeh F, Zacharioudakis IM, Kalligeros M, Mylona EK, Karki T, van Aalst R, Chit A, Mylonakis E. Varying Vaccination Rates Among Patients Seeking Care for Acute Respiratory Illness: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2020; 7:ofaa234. [PMID: 32685605 PMCID: PMC7357453 DOI: 10.1093/ofid/ofaa234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/11/2020] [Indexed: 11/21/2022] Open
Abstract
Background Complications following influenza infection are a major cause of morbidity and mortality, and the Centers for Disease Control Advisory Committee on Immunization Practices recommends universal annual vaccination. However, vaccination rates have remained significantly lower than the Department of Health and Human Services goal. The aim of this work was to assess the vaccination rate among patients who present to health care providers with influenza-like illness and identify groups with lower vaccination rates. Methods We performed a systematic search of the PubMed and EMBASE databases with a time frame of January 1, 2010, to March 1, 2019 and focused on the vaccination rate among patients seeking care for acute respiratory illness in the United States. A random effects meta-analysis was performed to estimate the pooled seasonal influenza vaccination rate, and we used a time trend analysis to identify differences in annual vaccination over time. Results The overall pooled influenza vaccination rate was 48.61% (whites: 50.87%; blacks: 36.05%; Hispanics: 41.45%). There was no significant difference among gender groups (men: 46.43%; women: 50.11%). Interestingly, the vaccination rate varied by age group and was significantly higher among adults aged >65 (78.04%) and significantly lower among children 9–17 years old (36.45%). Finally, we found a significant upward time trend in the overall influenza vaccination rate among whites (coef. = .0107; P = .027). Conclusions In conclusion, because of the significantly lower influenza vaccination rates in black and Hispanic communities, societal initiatives and community outreach programs should focus on these populations and on children and adolescents aged 9–17 years.
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Affiliation(s)
- Fadi Shehadeh
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ioannis M Zacharioudakis
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU School of Medicine, New York, New York, USA
| | - Markos Kalligeros
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Evangelia K Mylona
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Tanka Karki
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Robertus van Aalst
- Vaccine Epidemiology and Modelling, Sanofi Pasteur, Swiftwater, Pennsylvania, USA.,Faculty of Medical Sciences, University of Groningen, Groningen, the Netherlands
| | - Ayman Chit
- Vaccine Epidemiology and Modelling, Sanofi Pasteur, Swiftwater, Pennsylvania, USA.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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