Validation of self-report of influenza and pneumococcal vaccination status in elderly outpatients

Could Poor Parental Recall of HPV Vaccination Contribute to Low Vaccination Rates?

INTRODUCTION

Rates of initiation and completion of the human papillomavirus (HPV) vaccine series remain below national goals. Because parents are responsible for ensuring vaccination of their children, we examined the accuracy of parental recall of the number of shots their daughters received.

METHODS

Parents/guardians of girls aged 11 to 17 years were asked to recall the number of HPV doses received by their daughters. Dose number was confirmed using provider-verified medical records. Logistic regression assessed variables associated with correct recall.

RESULTS

A total of 79 (63%) parents/guardians correctly identified the number of shots their daughters received. Ninety-one (73%) were aware of whether their daughter started the series at all. The only factor significantly associated with accurate recall in logistic regression models was female gender of parent/guardian.

CONCLUSION

Nearly 40% of parents/guardians inaccurately recalled the number of HPV shots their children received, which may contribute to low rates of vaccine initiation and completion.

A Population-Based, Nationwide Cross-Sectional Study on Influenza Vaccination Status among Cancer Survivors in Korea

Cancer survivors are at increased risk of developing influenza-related complications. The purpose of this study was to investigate the vaccination coverage among cancer survivors in Korea using the Korea National Health and Nutrition Examination Survey (KNHANES). Adult cancer survivors were selected from fourth (2007–2009) and fifth (2010–2012) KNHANES (n = 1156) datasets. General characteristics, cancer-related data, and influenza vaccination status were collected using self-report questionnaires. Chi-square tests and multiple logistic regression analyses were performed to investigate the association between influenza vaccination coverage and associated factors. Overall, 51% of survivors were vaccinated. Vaccine prevalence exceeded 75% in those more than 65 years but was only 26% in survivors aged 19–44. Increasing age, low frequency of alcohol consumption, having poor self-rated health, and having a shorter duration since cancer diagnosis were significant predictors of vaccination status among cancer survivors under 65 years of age. Influenza vaccine coverage remains much lower than recommended among cancer survivors, particularly in the younger age groups. Further study is needed to determine the factors that contribute to the lack of vaccination in cancer survivors, despite their increased risk for influenza.

Self-reported hepatitis A vaccination as a predictor of hepatitis A virus antibody protection in U.S. adults: National Health and Nutrition Examination Survey 2007-2012

OBJECTIVES

To estimate the predictive value of self-reported hepatitis A vaccine (HepA) receipt for the presence of hepatitis A virus (HAV) antibody (anti-HAV) from either past infection or vaccination, as an indicator of HAV protection.

METHODS

Using 2007-2012 National Health and Nutrition Examination Survey data, we assigned participants to 4 groups based on self-reported HepA receipt and anti-HAV results. We compared characteristics across groups and calculated three measures of agreement between self-report and serologic status (anti-HAV): percentage concordance, and positive (PPV) and negative (NPV) predictive values. Using logistic regression we investigated factors associated with agreement between self-reported vaccination status and serological results.

RESULTS

Demographic and other characteristics varied significantly across the 4 groups. Overall agreement between self-reported HepA receipt and serological results was 63.6% (95% confidence interval [CI] 61.9-65.2); PPV and NPV of self-reported vaccination status for serological result were 47.0% (95% CI 44.2-49.8) and 69.4% (95% CI 67.0-71.8), respectively. Mexican American and foreign-born adults had the highest PPVs (71.5% [95% CI 65.9-76.5], and 75.8% [95% CI 71.4-79.7]) and the lowest NPVs (21.8% [95% CI 18.5-25.4], and 20.0% [95% CI 17.2-23.1]), respectively. Young (ages 20-29 years), US-born, and non-Hispanic White adults had the lowest PPVs (37.9% [95% CI 34.5-41.5], 39.1% [95% CI, 36.0-42.3], and 39.8% [36.1-43.7]), and the highest NPVs (76.9% [95% CI 72.2-81.0, 78.5% [95% CI 76.5-80.4)], and 80.6% [95% CI 78.2-82.8), respectively. Multivariate logistic analyses found age, race/ethnicity, education, place of birth and income to be significantly associated with agreement between self-reported vaccination status and serological results.

CONCLUSIONS

When assessing hepatitis A protection, self-report of not having received HepA was most likely to identify persons at risk for hepatitis A infection (no anti-HAV) among young, US-born and non-Hispanic White adults, and self-report of HepA receipt was least likely to be reliable among adults with the same characteristics.

Impact of health insurance status on vaccination coverage among adult populations

INTRODUCTION

Underinsurance is a barrier to vaccination among children. Information on vaccination among adults aged ≥18 years by insurance status is limited. This study assesses vaccination coverage among adults aged ≥18 years in the U.S. in 2012 by health insurance status and access to care characteristics.

METHODS

The 2012 National Health Interview Survey data were analyzed in 2014 to estimate vaccination coverage among adults aged ≥18 years by health insurance status for seven routinely recommended vaccines.

RESULTS

Influenza vaccination coverage among adults aged ≥18 years without or with health insurance was 14.4% versus 44.3%, respectively; pneumococcal vaccination coverage among adults aged 18-64 years with high-risk conditions was 9.8% versus 23.0%; tetanus and diphtheria toxoid (Td) coverage (age ≥18 years) was 53.2% versus 64.5%; tetanus, diphtheria, and acellular pertussis (Tdap) coverage (age ≥18 years) was 8.4% versus 15.7%; hepatitis A (HepA) coverage (age 18-49 years) was 16.6% versus 19.8%; hepatitis B (HepB) coverage (age 18-49 years) was 27.5% versus 38.0%; shingles coverage (age ≥60 years) was 6.1% versus 20.8%; and human papillomavirus (HPV) coverage (women aged 18-26 years) was 20.9% versus 39.8%. In addition, vaccination coverage differed by insurance type, whether respondents had a regular physician, and number of physician contacts.

CONCLUSIONS

Overall, vaccination coverage among adults aged ≥18 years is lower among uninsured populations. Implementation of effective strategies is needed to help improve vaccination coverage among adults aged ≥18 years, especially those without health insurance.

Characteristics and health behaviors of diabetic patients receiving influenza vaccination

OBJECTIVE

Epidemiological research has posited a 'healthy user' bias in patients receiving influenza vaccination; thus we sought to evaluate potential healthy-user attributes and their associations with influenza vaccination.

RESEARCH DESIGN & METHODS

Between 2011 and 2013, adults with type 2 diabetes were enrolled in a prospective cohort in Alberta, Canada. Information collected included sociodemographics, diabetes-related data (e.g., duration, complications), health behaviors (e.g., smoking status), functional health status, and satisfaction with healthcare. Data were collected by a mailed, self-administered survey. Multivariable logistic regression analyses were used to identify potential healthy-user attributes independently associated with influenza vaccination.

RESULTS

From a cohort of 2040 patients, 1287 (63%) reported receiving the influenza vaccine in the previous year. Average age of the cohort was 64 years (standard deviation 11) and 55% were male. In multivariable analysis, attributes independently associated with influenza vaccination included receiving preventive medications: aspirin (64% vs 44%; adjusted odds ratio, aOR 1.65, 95% CI 1.34-2.04); blood pressure medications (76% vs 56%; aOR 1.36, 95% CI 1.07-1.71); and cholesterol-lowering medications (74% vs 53%; aOR 1.50, 95% CI 1.19-1.89), as well as having a healthcare professional check feet for lesions (47% vs 31%; aOR 1.39, 95% CI 1.12-1.74). Additional covariates independently associated with influenza vaccination included: age over 65 years, respiratory disease, the number of additional comorbidities, and higher ratings of healthcare experience.

CONCLUSION

Vaccinated diabetic patients exhibit many postulated attributes of 'healthy users', which has implications for the interpretation of epidemiological studies of influenza vaccine effectiveness, as well as targeting future vaccination campaigns.

Factors associated to vaccination against influenza among elderly in a large Brazilian metropolis

BACKGROUND

This study aimed to estimate coverage and identify factors associated to vaccination against influenza in the elderly population.

METHODS

The study design was cross-sectional and population based. Data was collected in 2010 by the Health, Well-Being and Aging Study. Sample consisted of 1,341 community-dwelling elderly, in São Paulo, Brazil. Association between vaccination and covariates was evaluated by means of prevalence ratios estimated by Poisson regression models.

RESULTS

Self-reported vaccination coverage was 74.2% (95% confidence interval: 71.3-76.9). Remaining physically active and having had recent interaction with health services, mainly with public units of healthcare, were the main incentives to increase vaccination coverage among the elderly; whereas lower age, living alone and absent interaction with health services were the main constraints to influenza vaccination at the community level. These covariates had already been reported to influence influenza vaccination of elders in previous years.

CONCLUSION

Previous knowledge already available on the main constraints to influenza vaccination has not allowed to remove them. Influenza campaigns should be strengthened to increase vaccination coverage, especially in the group more reticent to vaccination. Instructing healthcare providers to recommend vaccine uptake is an important piece of this puzzle.

Differences in adult influenza vaccine-seeking behavior: the roles of race and attitudes

BACKGROUND

Racial/ethnic disparities in influenza vaccination among adults are longstanding, and research suggests they result from multiple factors. Influenza vaccine-seeking behavior may be an important aspect to consider when evaluating disparities in vaccination coverage.

OBJECTIVE

To determine whether there are differences between blacks and whites in influenza vaccine-seeking behavior among adults 65 years and older.

METHODS

Data were analyzed from a national sample of 3138 adults 65 years and older collected through the adult module of the 2007 National Immunization Survey, a random digit dialing telephone survey, which included an oversample of non-Hispanic blacks. Analysis included influenza vaccination rate, location of vaccination, and whether vaccinated individuals specifically went to the location to receive the vaccine (vaccine seekers) by race. The relationship between attitudes about influenza vaccination and vaccine-seeking behavior by race was also examined.

RESULTS

White adults 65 years and older were significantly more likely to receive influenza vaccine than blacks, during the 2006-2007 influenza season (68% ± 4% vs 54% ± 3%, respectively), and a significantly higher proportion of vaccinated whites reported seeking out the vaccine than vaccinated blacks (66% ± 4% vs 47% ± 4%, respectively). Blacks were less likely to be vaccine seekers, regardless of education or poverty levels. Among persons vaccinated in a doctor's office, 52% of whites specifically went there to get vaccinated, compared with 37% of blacks. Among persons who believe the vaccine is very effective, 66% ± 5% of whites versus 50% ± 6% of blacks were vaccine seekers.

CONCLUSIONS

This study points to the importance of improving our understanding of what factors, in addition to beliefs about vaccination, lead to vaccine seeking and reinforces the need for systematically offering vaccine.

Medicare claims versus beneficiary self-report for influenza vaccination surveillance

BACKGROUND

Although self-reported influenza vaccination status is routinely used in surveillance to estimate influenza vaccine coverage, Medicare data are becoming a promising resource for influenza surveillance to inform vaccination program management and planning.

PURPOSE

To evaluate the concordance between self-reported influenza vaccination and influenza vaccination claims among Medicare beneficiaries.

METHODS

This study compared influenza vaccination based upon Medicare claims and self-report among a sample of Medicare beneficiaries (N=9,378) from the 2011 Medicare Current Beneficiary Survey, which was the most recent year of data at the time of analysis (summer 2013). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated using self-reported data as the referent standard. Logistic regression was used to compute the marginal mean proportions for whether a Medicare influenza vaccination claim was present among beneficiaries who reported receiving the vaccination.

RESULTS

Influenza vaccination was higher for self-report (69.4%) than Medicare claims (48.3%). For Medicare claims, sensitivity=67.5%, specificity=96.3%, positive predictive value=97.6%, and negative predictive value=56.7%. Among beneficiaries reporting receiving an influenza vaccination, the percentage of beneficiaries with a vaccination claim was lower for beneficiaries who were aged <65 years, male, non-Hispanic black or Hispanic, and had less than a college education.

CONCLUSIONS

The classification of influenza vaccination status for Medicare beneficiaries can differ based upon survey and claims. To improve Medicare claims-based surveillance studies, further research is needed to determine the sources of discordance in self-reported and Medicare claims data, specifically for sensitivity and negative predictive value.

The influence of partial public reimbursement on vaccination uptake in the older population: a cross-sectional study

Background

Flu vaccination is recommended annually for high risk groups. However, in Ireland, free access to vaccination is not universal for those in high risk groups; the vaccine and consultation are only free for those with a medical card, a means tested scheme. Few private health insurance policies cover the cost of attendance for vaccination in general practice. The aim was to examine the influence of this reimbursement policy on vaccination coverage among older adults.

Methods

Cross-sectional wave 1 data from The Irish Longitudinal Study on Ageing (TILDA) were analysed (2009–2011). TILDA is a nationally representative prospective cohort study of adults aged ≥50, sampled using multistage stratified clustered sampling. Self-reported entitlement to healthcare was categorised as 1) medical card only 2) private health insurance only, 3) both and 4) neither. The outcome was responses to ‘have you ever had a flu shot’. Multivariate logistic regression was used, adjusting for age and need.

Results

68.6% of those defined as clinically high-risk received the flu vaccination in the past (95% CI = 67-71%). Those with a medical card were almost twice as likely to have been vaccinated, controlling for age and chronic illness (OR = 1.9, 95% CI = 1.5-2.5, p = <0.001).

Conclusions

Having a medical card increased the likelihood of being vaccinated, independent of age and need. The mismatch between vaccination guidelines and reimbursement policy is creating unequal access to recommended services among high risk groups.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1356-7) contains supplementary material, which is available to authorized users.

Socioeconomic status and other related factors of seasonal influenza vaccination in the South Korean adult population based on a nationwide cross-sectional study

Purpose

We investigated the association between seasonal influenza vaccination in South Korea and socioeconomic status (SES) as well as other potential related factors.

Methods

The study was based on data obtained in the Korea National Health and Nutrition Examination Survey from 2010 to 2011. Education level and household income were used as indicators for SES. Univariate and multiple logistic regression analyses were used to evaluate SES and other demographic variables as related factors for influenza vaccination, the primary outcome.

Results

Higher household income was positively associated with higher vaccine uptake in the younger (19–49 years) group [adjusted odds ratio (aOR) 1.55, 95% confidence interval (CI) 1.08–2.23], whereas the low-income and low-education group had increased vaccination coverage than the middle-income and middle-education group in the older (≥ 50 years) group (aOR 1.36, 95% CI 1.09–1.69). Current smokers tend to be unvaccinated in all age groups. Among individuals aged ≥ 50, older age, mild to moderate alcohol consumption, regular exercise, and having co-morbidities were positively associated with vaccination, while those who self-reported their health status as good were less likely to be vaccinated.

Conclusions

The relationship between SES and seasonal influenza vaccination coverage differed between the age groups throughout the adult South Korean population. Public health policies need to address these inequalities.

Reasons for failure to receive pneumococcal and influenza vaccinations among immunosuppressed patients with systemic lupus erythematosus

OBJECTIVE

To better understand why immunosuppressed individuals with systemic lupus erythematosus (SLE) fail to receive influenza and pneumococcal vaccines.

METHODS

These cross-sectional data were derived from the 2009 cycle of the Lupus Outcomes Study (LOS), an annual longitudinal telephone survey of individuals with confirmed SLE. Respondents were included in the analysis if they had taken immunosuppressive medications in the past year. We assessed any prior receipt of pneumococcal vaccine and influenza vaccine in the past year, and then elicited reasons for not receiving vaccination. We used bivariate statistics and multivariate logistic regression to assess frequency and predictors of reported reasons for not obtaining influenza or pneumococcal vaccines.

RESULTS

Among 508 respondents who received immunosuppressants, 485 reported whether they had received vaccines. Among the 175 respondents who did not receive an influenza vaccine, the most common reason was lack of doctor recommendation (55%), followed by efficacy or safety concerns (21%), and lack of time (19%). Reasons for not receiving pneumococcal vaccine (N = 159) were similar: lack of recommendation (87%), lack of time (7%), and efficacy or safety concerns (4%). Younger, less-educated, non-white patients with shorter disease duration, as well as those immunosuppressed with steroids alone, were at the greatest risk for not receiving indicated vaccine recommendations.

CONCLUSIONS

The most common reason why individuals with SLE did not receive pneumococcal and influenza vaccines was that physicians failed to recommend them. Data suggest that increasing vaccination rates in SLE will require improved process quality at the provider level, as well as addressing patient concerns and barriers.

Ability of Healthcare Workers to Recall Previous Receipt of Tetanus-Containing Vaccination

Vaccination of healthcare workers (HCWs) is an important strategy in the control and prevention of hospital outbreaks. The decision to vaccinate is often based on self-report of vaccination status. Self-report of previous receipt of tetanus-diphtheria or tetanus toxin vaccination was validated using an electronic medical record. Results showed that HCWs' self-report is reliable during a vaccination campaign.

Antenatal care provider's advice is the key determinant of influenza vaccination uptake in pregnant women

BACKGROUND

Although influenza vaccination is an important component of antenatal care and is recommended and funded by the Australian government, vaccination uptake has been low.

AIMS

This study compared seasonal influenza vaccination uptake among pregnant Western Australian (WA) women and identified factors associated with vaccination uptake.

MATERIALS AND METHODS

Adult women who were pregnant during the 2012 and 2013 influenza vaccination seasons were selected at random and invited to complete a computer-assisted telephone interview survey about whether they received influenza vaccination during pregnancy. Data analyses were weighted to the age distribution of women of reproductive age in WA. Multivariate logistic regression was used to identify factors associated with vaccination uptake.

RESULTS

Between 2012 and 2013, the proportion of WA women whose antenatal care provider recommended influenza vaccination increased from 37.6 to 62.1% and vaccination uptake increased from 23.0 to 36.5%. The antenatal care provider's advice to have influenza vaccine was the single most important factor associated with vaccination (OR 11.1, 95% CI 7.9-15.5). Most women (63.7%) were vaccinated in general practice, 18.8% in a public hospital antenatal clinic and 11.0% at their workplace. Wanting to protect their infant from infection (91.2%) and having the vaccine recommended by their GP (60.0%) or obstetrician (51.0%) were commonly reported reasons for vaccination; worrying about side effects was a common reason for nonvaccination.

CONCLUSIONS

To optimise maternal and infant health outcomes, Australian antenatal care providers and services need to incorporate both the recommendation and delivery of influenza vaccination into routine antenatal care.

Vaccinations against respiratory tract infections at Hajj

The transmission of respiratory tract infections (RTIs) is very high among the Hajj congregation in Mecca, Saudi Arabia. Despite recommendations for vaccinations, pilgrims remain at increased risk of RTIs. In this paper we systematically reviewed available studies assessing the uptake and effectiveness of vaccinations against RTIs among Hajj pilgrims and enumerated important demographic factors, if described, associated with vaccine uptake. Of the 42 included studies, 29 reported on the uptake and effectiveness of influenza vaccine among pilgrims, eight studies reported the uptake of other vaccines, notably pneumococcal, diphtheria and bacillus Calmette-Guérin vaccines, and the remaining five studies described both influenza and non-influenza vaccines. The uptake of seasonal influenza vaccine ranged from 0.7% to 100% across the study populations, with coverage highest in the elderly and those with pre-existing co-morbidities. The effectiveness of influenza vaccine was variable across studies but was significantly effective against laboratory-confirmed influenza (risk ratio 0.56; 95% CI 0.41-0.75; p <0.001) in pooled metadata from six studies. Uptake of diphtheria and pneumococcal vaccines was low, and the only study reporting pertussis among Hajj pilgrims found the presence of pre-Hajj immunity to be significantly protective against disease. Despite favourable evidence of effectiveness, our review shows variable uptake of vaccines across a number of studies with few data available on the uptake of non-influenza vaccines. Mixed-method studies are needed to gauge knowledge, attitudes and practices of Hajj pilgrims regarding vaccination, and randomized controlled trials are required to confirm the efficacy of vaccines and improve uptake in this vulnerable travelling population.

Adult vaccination disparities among foreign-born populations in the U.S., 2012

BACKGROUND

Foreign-born persons are considered at higher risk of undervaccination and exposure to many vaccine-preventable diseases. Information on vaccination coverage among foreign-born populations is limited.

PURPOSE

To assess adult vaccination coverage disparities among foreign-born populations in the U.S.

METHODS

Data from the 2012 National Health Interview Survey were analyzed in 2013. For non-influenza vaccines, the weighted proportion vaccinated was calculated. For influenza vaccination, Kaplan-Meier survival analysis was used to assess coverage among individuals interviewed during September 2011-June 2012 and vaccinated in August 2011-May 2012.

RESULTS

Overall, unadjusted vaccination coverage among U.S.-born respondents was significantly higher than that of foreign-born respondents: influenza, age ≥18 years (40.4% vs 33.8%); pneumococcal polysaccharide vaccine (PPV), 18-64 years with high-risk conditions (20.8% vs 13.7%); PPV, ≥65 years (62.6% vs 40.5%); tetanus vaccination, ≥18 years (65.0% vs 50.6%); tetanus, diphtheria, and acellular pertussis (Tdap), ≥18 years (15.5% vs 9.3%); hepatitis B, 18-49 years (37.2% vs 28.4%); shingles, ≥60 years (21.3% vs 12.0%); and human papilloma virus (HPV), women 18-26 years (38.7% vs 14.7%). Among the foreign born, vaccination coverage was generally lower for non-U.S. citizens, recent immigrants, and those interviewed in a language other than English. Foreign-born individuals were less likely than U.S.-born people to be vaccinated for pneumococcal (≥65 years), tetanus, Tdap, and HPV (women) after adjusting for confounders.

CONCLUSIONS

Vaccination coverage is lower among foreign-born adults than those born in the U.S. It is important to consider foreign birth and immigration status when assessing vaccination disparities and planning interventions.

Potential of the test-negative design for measuring influenza vaccine effectiveness: a systematic review

BACKGROUND

The test-negative design is a variant of the case-control study being increasingly used to study influenza vaccine effectiveness (VE). In these studies, patients with influenza-like illness are tested for influenza. Vaccine coverage is compared between those testing positive versus those testing negative to estimate VE.

OBJECTIVES

We reviewed features in the design, analysis and reporting of 85 published test-negative studies.

DATA SOURCES

Studies were identified from PubMed, reference lists and email updates. Study eligibility: All studies using the test-negative design reporting end-of-season estimates were included.

STUDY APPRAISAL

Design features that may affect the validity and comparability of reported estimates were reviewed, including setting, study period, source population, case definition, exposure and outcome ascertainment and statistical model.

RESULTS

There was considerable variation in the analytic approach, with 68 unique statistical models identified among the studies.

CONCLUSION

Harmonization of analytic approaches may improve the potential for pooling VE estimates.

Influenza vaccination among persons with work-related asthma

BACKGROUND

Seasonal influenza vaccination is recommended for all asthma patients. Persons with work-related asthma may have more severe disease than those with non-work-related asthma and may particularly benefit from receiving influenza vaccination.

PURPOSE

To determine if influenza vaccination coverage differs among individuals aged 18-64 years with work-related and non-work-related asthma.

METHODS

Data from the 2006-2009 Behavioral Risk Factor Surveillance System Asthma Call-Back Survey collected in 38 states and the District of Columbia were analyzed in 2013. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with influenza vaccination among respondents aged 18-64 years with work-related asthma.

RESULTS

Among adults aged 18-64 years with current asthma, an estimated 42.7% received influenza vaccination in the past 12 months. Although influenza vaccination coverage was significantly higher among adults with work-related asthma than those with non-work-related asthma (48.5% vs 42.8%), this association became non-significant after adjustment for demographic and clinical characteristics (prevalence ratio=1.08, 95% CI=0.99, 1.20). Among individuals with work-related asthma, receiving the influenza vaccine was associated with being 50-64 years old, being unemployed in the prior year, and seeking urgent treatment for worsening asthma symptoms.

CONCLUSIONS

Among persons with work-related and non-work-related asthma, less than half received influenza vaccination in the prior year, both below the Healthy People 2010 target of 60%. These results suggest the need for strengthening current vaccination interventions to meet the updated Healthy People 2020 objective of achieving at least 70% influenza vaccination coverage.

Interventions to increase influenza vaccination rates of those 60 years and older in the community

BACKGROUND

The effectiveness of interventions to increase the uptake of influenza vaccination in people aged 60 and older is uncertain.

OBJECTIVES

To assess access, provider, system and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community.

SEARCH METHODS

We searched CENTRAL (2014, Issue 5), MEDLINE (January 1950 to May week 3 2014), EMBASE (1980 to June 2014), AgeLine (1978 to 4 June 2014), ERIC (1965 to June 2014) and CINAHL (1982 to June 2014).

SELECTION CRITERIA

Randomised controlled trials (RCTs) of interventions to increase influenza vaccination uptake in people aged 60 and older.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed study quality and extracted influenza vaccine uptake data.

MAIN RESULTS

This update identified 13 new RCTs; the review now includes a total of 57 RCTs with 896,531 participants. The trials included community-dwelling seniors in high-income countries. Heterogeneity limited meta-analysis. The percentage of trials with low risk of bias for each domain was as follows: randomisation (33%); allocation concealment (11%); blinding (44%); missing data (49%) and selective reporting (100%). Increasing community demand (32 trials, 10 strategies)The interventions with a statistically significant result were: three trials (n = 64,200) of letter plus leaflet/postcard compared to letter (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.07 to 1.15); two trials (n = 614) of nurses/pharmacists educating plus vaccinating patients (OR 3.29, 95% CI 1.91 to 5.66); single trials of a phone call from a senior (n = 193) (OR 3.33, 95% CI 1.79 to 6.22), a telephone invitation versus clinic drop-in (n = 243) (OR 2.72, 95% CI 1.55 to 4.76), a free groceries lottery (n = 291) (OR 1.04, 95% CI 0.62 to 1.76) and nurses educating and vaccinating patients (n = 485) (OR 152.95, 95% CI 9.39 to 2490.67).We did not pool the following trials due to considerable heterogeneity: postcard/letter/pamphlets (16 trials, n = 592,165); tailored communications (16 trials, n = 388,164); customised letter/phone-call (four trials, n = 82,465) and client-based appraisals (three trials, n = 4016), although several trials showed the interventions were effective. Enhancing vaccination access (10 trials, six strategies)The interventions with a statistically significant result were: two trials (n = 2112) of home visits compared to clinic invitation (OR 1.30, 95% CI 1.05 to 1.61); two trials (n = 2251) of free vaccine (OR 2.36, 95% CI 1.98 to 2.82) and one trial (n = 321) of patient group visits (OR 24.85, 95% CI 1.45 to 425.32). One trial (n = 350) of a home visit plus vaccine encouragement compared to a home visit plus safety advice was non-significant.We did not pool the following trials due to considerable heterogeneity: nurse home visits (two trials, n = 2069) and free vaccine compared to no intervention (two trials, n = 2250). Provider- or system-based interventions (17 trials, 11 strategies)The interventions with a statistically significant result were: two trials (n = 2815) of paying physicians (OR 2.22, 95% CI 1.77 to 2.77); one trial (n = 316) of reminding physicians about all their patients (OR 2.47, 95% CI 1.53 to 3.99); one trial (n = 8376) of posters plus postcards (OR 2.03, 95% CI 1.86 to 2.22); one trial (n = 1360) of chart review/feedback (OR 3.43, 95% CI 2.37 to 4.97) and one trial (n = 27,580) of educational outreach/feedback (OR 0.77, 95% CI 0.72 to 0.81).Trials of posters plus postcards versus posters (n = 5753), academic detailing (n = 1400) and increasing staff vaccination rates (n = 26,432) were non-significant.We did not pool the following trials due to considerable heterogeneity: reminding physicians (four trials, n = 202,264) and practice facilitators (three trials, n = 2183), although several trials showed the interventions were effective. Interventions at the societal level We identified no RCTs of interventions at the societal level.

AUTHORS' CONCLUSIONS

There are interventions that are effective for increasing community demand for vaccination, enhancing access and improving provider/system response. Heterogeneity limited pooling of trials.

Determinants of uptake of influenza vaccination among pregnant women - a systematic review

BACKGROUND

Pregnant women have the highest priority for seasonal influenza vaccine. However, suboptimal coverage has been repeatedly noted in this population. To improve vaccine uptake, reviewing the determinants of vaccination is of increasing importance.

METHODS

A detailed literature search was performed up to November 30, 2013 to retrieve articles related to uptake of influenza vaccination during pregnancy.

RESULTS

Forty-five research papers were included in the review. Twenty-one studies assessed the coverage of seasonal influenza vaccination, 13 studies assessed coverage of A/H1N1 pandemic vaccination and 11 studies assessed both. Vaccination uptake ranged from 1.7% to 88.4% for seasonal influenza, and from 6.2% to 85.7% for A/H1N1 pandemic influenza. Many pregnant women were unaware that they were at high risk for influenza and its complications during pregnancy. They were also more likely to underestimate the threat of influenza to themselves and their fetus. Moreover, they had substantial concerns about the safety and efficacy of the influenza vaccine during pregnancy. Negative media reports contributed to the perception that influenza vaccination during pregnancy was risky and could result in adverse pregnancy outcomes. Although health care providers' (HCPs) recommendations were consistently associated with vaccine uptake, most did not recommend the vaccine to their pregnant clients.

CONCLUSIONS

Influenza vaccination uptake among pregnant women is suboptimal and HCPs rarely recommend it. Positive vaccination recommendations from HCPs as well as direct access to the vaccine would likely substantially improve vaccination acceptance.

Monitoring receipt of seasonal influenza vaccines with BRFSS and NHIS data: challenges and solutions

Despite the availability of vaccines that mitigate the health risks associated with seasonal influenza, most individuals in the U.S. remain unvaccinated. Monitoring vaccination uptake for seasonal influenza, especially among disadvantaged or high-risk groups, is therefore an important public health activity. The Behavioral Risk Factor Surveillance System (BRFSS) - the largest telephone-based health surveillance system in the world - is an important resource in monitoring population health trends, including influenza vaccination. However, due to limitations in the question that measures influenza vaccination status, difficulties arise in estimating seasonal vaccination rates. Although researchers have proposed various methodologies to address this issue, no systematic review of these methodologies exists. By subjecting these methods to tests of sensitivity and specificity, we identify their strengths and weaknesses and advance a new method for estimating national and state-level vaccination rates with BRFSS data. To ensure that our findings are not anomalous to the BRFSS, we also analyze data from the National Health Interview Survey (NHIS). For both studies, we find that restricting the sample to interviews conducted between January and September offers the best balance of sensitivity (>90% on average), specificity (>90% on average), and statistical power (retention of 92.2% of vaccinations from the target flu season) over other proposed methods. We conclude that including survey participants from these months provides a simple and effective way to estimate seasonal influenza vaccination rates with BRFSS and NHIS data, and we discuss potential ways to better estimate vaccination rates in future epidemiologic surveys.

Pneumococcal vaccination of the elderly during visits to acute care providers: who are vaccinated?

OBJECTIVE

Many elderly remain unvaccinated against invasive pneumococcal disease yet frequently visit acute care providers where they have an opportunity to receive the pneumococcal vaccine. We describe factors associated with pneumococcal vaccination in adults aged 65 years and older during visits to acute care providers.

METHOD

The study included all elderly aged 65 years of age and older enrolled in a health insurance registry in a large Canadian city in 2009. Pneumococcal vaccination status was determined using a vaccination administrative database. Unvaccinated elderly were linked to ambulatory and inpatient care databases to determine acute care visits. Logistic regression was used to determine odds ratios for vaccination during a first visit to an acute care provider in 2009.

RESULTS

Of 53,249 unvaccinated elderly, 23,574 presented to at least one acute care provider in 2009. Acute care visits were significantly associated with receipt of pneumococcal vaccine (11.0% vs. 7.8%, risk adjusted odds ratio [OR]=1.53; 95% confidence interval [CI]=1.44,1.62), particularly ambulatory care visits during influenza season (OR=4.36; 95% CI=2.86,6.66) and inpatient visits with lengths of stay >14 days (OR=7.71, 95% CI=4.41,13.47).

CONCLUSION

Acute care visits were associated with greater pneumococcal vaccine uptake for the elderly during the annual influenza season and long hospital stays.

Cigarette smoking and cancer screening underutilization by state: BRFSS 2010

INTRODUCTION

To quantify the impact of current smokers' underutilization of colorectal cancer (CRC) and breast cancer screenings on overall cancer screening prevalence at the state level.

METHODS

Behavioral Risk Factor Surveillance System 2010 data were used to calculate states' prevalence of screening for breast cancer and CRC overall and by current smoking status. To quantify the effect of underutilization of screening by current smokers on the overall breast cancer and CRC screening prevalence in each state, we derived a cancer screening underutilization (CSU) measure.

RESULTS

CRC screening rates among adults aged 50 years and older ranged from 38.3% in Oklahoma to 59.5% in Rhode Island for current smokers and from 58.0% in Idaho to 75.9% in New Hampshire for nonsmokers. Mammography rates among women aged 40 years and older ranged from 26.8% in Utah to 63.6% in the District of Columbia for current smokers and from 50.8% in Utah to 73.0% in Massachusetts for nonsmokers. As a result, CSU values ranged from 2.1% to 6.7% for CRC screening and from 0.3% to 7.9% for mammography. Most states with the largest CSU values were located in the South or Midwest, whereas those with the smallest CSU values were located in the Northeast or West.

CONCLUSIONS

Lower levels of CRC and mammography screening among current smokers substantially contribute to many states' lower overall screening prevalence, particularly in Southern and Midwestern states where smoking prevalence is highest. These findings underscore the potential for more concentrated efforts to promote cessation and screening among smokers as a means to achieving cancer screening goals.

Effectiveness of hospital-based postpartum procedures on pertussis vaccination among postpartum women

OBJECTIVE

Pertussis causes significant morbidity among adults, children, and especially infants. Since 2006, pertussis vaccination has been recommended for women after delivery. We conducted a prospective, controlled evaluation of in-hospital postpartum pertussis vaccination of birth mothers from October 2009 through July 2010 to evaluate the effectiveness of hospital-based procedures in increasing postpartum vaccination.

STUDY DESIGN

The intervention and comparison hospitals are private community facilities, each with 2000-6000 births/year. At the intervention hospital, physician opt-in orders for tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) before discharge were implemented in November 2009, followed by standing orders in February 2010. The comparison hospital maintained standard practice. Randomly selected hospital charts of women after delivery were reviewed for receipt of Tdap and demographic data. We evaluated postpartum Tdap vaccination rates and conducted multivariate analyses to evaluate characteristics that are associated with vaccination. We reviewed 1264 charts (658 intervention hospital; 606 comparison hospital) from women with completed deliveries.

RESULTS

Tdap postpartum vaccination was 0% at both hospitals at baseline. In the intervention hospital, the introduction of the opt-in order was followed by an increase in postpartum vaccination to 18%. The introduction of the standing order approach was followed by a further increase to 69% (P < .0001). No postpartum Tdap vaccinations were documented in the comparison hospital. Postpartum Tdap vaccination in the intervention hospital did not differ by demographic characteristics.

CONCLUSION

In-hospital ordering procedures substantially increased Tdap vaccination coverage in women after delivery. Opt-in orders increased coverage that increased substantially with standing orders.

Immunization rates and vaccine beliefs among patients with inflammatory bowel disease: an opportunity for improvement

BACKGROUND

Immunosuppressive agents used to treat inflammatory bowel disease (IBD) can increase the risk for infections, several of which are preventable through vaccination. Our study aimed to describe vaccine utilization by immunosuppression status, examine reasons for vaccine refusal, and identify characteristics associated with lack of influenza vaccination in patients with IBD.

METHODS

We administered an online survey between February 2012 and April 2012 to an internet-based cohort of patients with IBD in the Crohn's and Colitis Foundation of America Partners program.

RESULTS

During this time, 958 individuals completed the survey. The median age was 45, 72.8% were female, and 62.0% had Crohn's disease. Self-reported vaccination rates were low. Those on immunosuppression (n = 514) were more likely to be counseled to avoid live vaccines (P < 0.01). However, counseling rates were low (3.5%-19.1% for various live vaccines). Among the 776 individuals who received the influenza vaccine, maintaining health (74.1%), importance of prevention (66.1%), and provider recommendation (38%) were the most frequently cited motivations. Factors associated with lack of influenza vaccine included lower education level (P = 0.01), younger age (P = 0.02), and no chronic immunosuppression use (P < 0.01). Five hundred seventy (59.5%) individuals thought that patients were responsible for keeping track of their vaccines, whereas 428 (44.7%) placed responsibility on their gastroenterologist and 595 (62.1%) on their primary care physician.

CONCLUSIONS

Vaccine utilization remains suboptimal in patients with IBD. Educational interventions may increase vaccination rates by clarifying misconceptions. Gastroenterologists can play a more active role in health care maintenance in patients with IBD by counseling patients on which vaccines to receive or avoid.

Effectiveness of 2012-2013 influenza vaccine against influenza-like illness in general population: estimation in a French web-based cohort

Most of the methods used for estimating the influenza vaccine effectiveness (IVE) target the individuals who have an influenza-like illness (ILI) rather than virologically-proven influenza and access the healthcare system. The objective of this study was to estimate the 2012-2013 IVE in general French population, using a cohort of volunteers registered on GrippeNet.fr, an online surveillance system for ILI. The IVE estimations were obtained through a logistic regression, and analyses were also performed by focusing on at-risk population of severe influenza, and by varying inclusion period and ILI definition. Overall, 1996 individuals were included in the analyses. The corrected IVE was estimated to 49% (20 to 67) for the overall population, and 32% (0 to 58) for the at-risk population. Three covariables appeared with a significant effect on the occurrence of at least one ILI during the epidemic: the age (P = 0.045), the presence of a child in the household (P<10(-3)), and the frequency of cold/flu (P<10(-3)). Comparable results were found at epidemic peak time in the hypothesis of real-time feed of data. In this study, we proposed a novel, follow-up, web-based method to reveal seasonal vaccine effectiveness, which enables analysis in a portion of the population that is not tracked by the health care system in most VE studies.

Influenza vaccination and its association with clinic use of evidence-based practices and individual patient characteristics, San Diego County, 2009

CONTEXT

In 2008, about 40% of the US population eligible for influenza vaccine was vaccinated, which was below Healthy People 2020 goals. Little emphasis has been put on late-season vaccination efforts by medical providers.

OBJECTIVE

Evaluate use of evidence-based practices (EBP) and their association with influenza vaccination for children younger than 5 years and adults aged 50 years and older.

DESIGN

Patient surveys and medical clinic information were collected between January and April 2009. Influenza coverage rates and logistic regressions are used to measure associations.

SETTING

Nineteen medical clinics serving children, adults, or both in San Diego County participated.

PARTICIPANTS

Parents of children aged 6 months to 5 years and adults aged 50 years and over seen by a primary care provider during January through March 2009.

MAIN OUTCOME

Influence of clinic EBP use on child and adult influenza vaccination status.

MEASURES

Patient-reported influenza vaccination and clinic coverage rates and clinics' use of EBP and patient demographic characteristics.

RESULTS

Coverage rates varied by clinic; 50% to 82% (children) and 48% to 85% (adults). Child clinics using the immunization registry, or those that were private practices or medical groups and adult clinics that used influenza vaccination clinics, provider prompts, or electronic medical records had higher coverage. Surveys from 831 children and 1038 adults documented influenza vaccination rates of 64% and 63% respectively. Receiving a reminder or having two or more visits during influenza season was positively associated with child and adult influenza vaccination. Child vaccination was associated with children younger than 2 years. Adult vaccination was associated adults aged 65 years or older, having a high-risk condition, or being female.

CONCLUSIONS

Given the low use of EBP, clinics have opportunities to implement EBP appropriate for their settings and patient populations. Along with other strategies, public health departments and medical groups should encourage medical providers to implement EBP to improve influenza vaccination rates.

Tetanus, diphtheria and acellular pertussis (Tdap) vaccination among healthcare personnel-United States, 2011

BACKGROUND

Health-care personnel (HCP) are at risk for exposure to and possible transmission of vaccine-preventable diseases. Receiving recommended vaccines is an essential prevention practice for HCP to protect themselves and their patients. The tetanus, diphtheria and acellular pertussis vaccine (Tdap) was recommended by the Advisory Committee on Immunization Practices (ACIP) for HCP in 2006 for protection against pertussis. We assessed the recent compliance of U.S. HCP in receiving Tdap vaccination.

METHODS

To estimate Tdap vaccination coverage among HCP, we analyzed data from the 2011 National Health Interview Survey (NHIS). Multivariable logistic regression and predictive marginal models were performed to identify factors independently associated with vaccination among HCP.

RESULTS

Overall, Tdap vaccination coverage was 26.9% among HCP aged 18-64 years (95% confidence interval (CI)=24.3%, 29.7%), which was significantly higher compared with non-HCP among the same age group (11.1%; 10.5-11.8%). Overall, vaccination coverage was significantly higher among physicians (41.5%) compared with nurses (36.5%) and other types of HCP (range 11.7-29.9%). Vaccination coverage was significantly higher among HCP aged 18-49 years compared with those 50-64 years (30.0% vs. 19.2%, respectively). Characteristics independently associated with an increased likelihood of Tdap vaccination among HCP were: younger age, higher education, living in the western United States, being hospitalized within past year, having a place for routine health care in clinic or health center, and receipt of influenza vaccination in the previous year. Marital status of widowed, divorced, or separated was independently associated with a decreased likelihood of Tdap vaccination among HCP.

CONCLUSIONS

By 2011, Tdap vaccination coverage was only 26.9% among HCP. Vaccination coverage varied widely by types of HCP and demographic characteristics. Emphasizing the benefits of HCP vaccination for staff and patients, providing vaccinations in the workplace and other non-traditional settings, and providing Tdap at no charge may help increase Tdap vaccination among HCP in all health-care settings.

Negative trends from 2008/9 to 2011/12 seasons in influenza vaccination coverages among high risk subjects and health care workers in Spain

OBJECTIVES

We aim to describe influenza vaccination coverage for the Spanish population across four consecutive campaigns (2008/2009 to 2011/2012). The data was analyzed by high risk groups and health care workers (HCWs). Also, coverage trends were analyzed to assess uptake in post-pandemic seasons.

METHODS

We used data from two nation-wide representative health surveys namely the 2009/10 European Health Interview Survey for Spain (N=22,188) and the 2011-12 Spanish National Health Survey (N=21,007) Influenza vaccination status was self-reported. We analyzed influenza vaccine coverage by age, sex, number of chronic conditions, being a heath care worker (HCWs) and nationality. Time trends for campaigns among high risk groups were estimated by a multivariate logistic regression model.

RESULTS

We analyzed data from 43,072 subjects aged ≥ 16 years. As a whole, coverage decreased by 3.31% (22.57-19.26%) between the 2008/2009 and 2011/2012 campaigns with a significant decreasing trend (OR 0.92; 95% CI: 0.90-0.94). Coverage in people under 60 years with a chronic disease decreased significantly (OR 0.92: 95% CI: 0.85-0.99) during the analyzed period from 21.02% in 2008/2009 to 17.40% in 2011/2012. Among HCWs, the highest influenza vaccination coverage was achieved in 2009/2010 (31.08%) in the latest campaign coverage has almost halved (17.88%). For the 2011/2012 season and for all age groups the variables associated with a higher probability of having received the influenza vaccine were older age and presence of associated chronic conditions. Among those aged ≥ 60 years, immigrants had lower uptake (OR 0.60; 95% CI: 0.32-0.99).

CONCLUSIONS

Seasonal influenza vaccine uptake rates in the recommended target groups in Spain are unacceptably low and seem to be decreasing in the post pandemic seasons. Further studies are necessary to precisely identify reasons for non-compliance and barriers to influenza vaccination. Meanwhile urgent strategies to improve seasonal vaccination uptake must be discussed and implemented.

Hepatitis B vaccination coverage among health-care personnel in the United States

OBJECTIVES

We compared self-reported hepatitis B (HepB) vaccine coverage among health-care personnel (HCP) with HepB vaccine coverage among the general population and determined trends in vaccination coverage among HCP.

METHODS

We used the 2010 National Health Interview Survey (NHIS) to determine the weighted proportion of self-reported ≥ 1- and ≥ 3-dose HepB vaccine coverage among HCP aged ≥ 18 years. We used logistic regression to determine independent predictors of vaccination and performed a trend analysis to determine changes in coverage from 2004 to 2010 using data from the 2004-2010 NHIS.

RESULTS

Overall, 69.5% (95% confidence interval [CI] 67.2, 71.8) and 63.4% (95% CI 60.8, 65.9) of HCP reported receiving ≥ 1 and ≥ 3 doses of HepB vaccine, respectively, compared with 27.1% (95% CI 26.1, 28.1%) and 23.0% (95% CI 22.1, 24.0) among non-HCP. Among HCP with direct patient contact, 80.7% (95% CI 78.2, 83.1) and 74.0% (95% CI 71.2, 76.8) received ≥ 1 and ≥ 3 HepB vaccine doses, respectively. Independent predictors of vaccination included direct patient contact, having more than a high school education, influenza vaccination in the past year, and ever having been tested for HIV. There was no significant change in reported coverage from 2004 through 2010.

CONCLUSION

The 2010 HepB vaccine coverage estimate among HCP remained well below the Healthy People 2010 goal of 90%. Efforts to target unvaccinated HCP for preexposure HepB protection should be encouraged.

Seasonal influenza vaccination coverage among adult populations in the United States, 2005-2011

The most effective strategy for preventing influenza is annual vaccination. We analyzed 2005-2011 data from the National Health Interview Survey (NHIS), using Kaplan-Meier survival analysis to estimate cumulative proportions of persons reporting influenza vaccination in the 2004-2005 through 2010-2011 seasons for persons aged ≥18, 18-49, 50-64, and ≥65 years, persons with high-risk conditions, and health-care personnel. We compared vaccination coverage by race/ethnicity within each age and high-risk group. Vaccination coverage among adults aged ≥18 years increased from 27.4% during the 2005-2006 influenza season to 38.1% during the 2010-2011 season, with an average increase of 2.2% annually. From the 2005-2006 season to the 2010-2011 season, coverage increased by 10-12 percentage points for all groups except adults aged ≥65 years. Coverage for the 2010-2011 season was 70.2% for adults aged ≥65 years, 43.7% for adults aged 50-64 years, 36.7% for persons aged 18-49 years with high-risk conditions, and 55.8% for health-care personnel. In most subgroups, coverage during the 2010-2011 season was significantly lower among non-Hispanic blacks and Hispanics than among non-Hispanic whites. Vaccination coverage among adults under age 65 years increased from 2005-2006 through 2010-2011, but substantial racial/ethnic disparities remained in most age groups. Targeted efforts are needed to improve influenza vaccination coverage and reduce disparities.

Seasonal influenza vaccination coverage rate of target groups in selected cities and provinces in China by season (2009/10 to 2011/12)

Background

The objectives of the survey were to identify the level of influenza vaccination coverage in China in three influenza seasons 2009/10 to 2011/12, and to find out potential predictors for seasonal influenza vaccination.

Methods

In September and October 2011, representative urban household telephone surveys were conducted in five provinces in China with a response rate of 6%. Four target groups were defined for analysis: 1) children ≤5 years old; 2) elderly persons aged ≥60 years old; 3) health care workers (persons working in the medical field) and 4) chronically ill persons.

Results

The overall mean vaccination rate was 9.0%. Among the four target groups, the rate of vaccination of children aged ≤5 years old (mean = 26%) was highest and the rate of elderly people aged ≥60 years old (mean = 7.4%) was the lowest, while the rates of persons who suffer from a chronic illness (mean = 9.4%) and health care workers (9.5%) were similar. A subsidy for influenza vaccination, age group, health care workers, suffering from a chronic illness and living in Eastern China were independent significant predictors for influenza vaccination.

Conclusions

The seasonal influenza vaccination coverage rates among urban populations in selected cities and provinces in China were far below previously reported rates in developed countries. Influenza vaccination coverage rates differed widely between different target groups and provinces in China. Subsidy policy might have a positive effect on influenza vaccination rate, but further cost-effectiveness studies, as well as the vaccination rate associated factors studies are still needed to inform strategies to increase coverage.

An assessment of the performance of self-reported vaccination status for hepatitis B, National Health and Nutrition Examination Survey 1999-2008

OBJECTIVES

We sought to assess the performance of self-reported vaccination with hepatitis B vaccine (HepB) compared with serological status for hepatitis B markers in the general US civilian population.

METHODS

Using 1999 through 2008 National Health and Nutrition Examination Survey data, we calculated 3 measures of agreement between self-reported HepB vaccination status and serological status: percent concordance, and positive (PPV) and negative predictive values (NPV) of self-report. Logistic regression was used to identify factors associated with agreement between self-report and serological status.

RESULTS

Overall agreement was 83% (95% CI = 82.3, 83.7), NPV of self-report was high (0.95; 95% CI = 0.93, 0.95) and PPV was low (0.53; 95% CI = 0.51, 0.54). Birth year relative to the 1991 recommendation for universal infant HepB vaccination had a strong association with agreement, however, the association was positive for those who reported receiving at least 3 doses and negative for those who reported receiving no doses.

CONCLUSIONS

Although the low PPV in our study could be attributable in part to waning of vaccine-induced anti-HBs over time, national adult HepB vaccination coverage may be lower than previously estimated because national estimates usually depend on self-report of vaccine receipt.

Influenza A (H1N1) 2009 monovalent and seasonal influenza vaccination among adults 25 to 64 years of age with high-risk conditions--United States, 2010

BACKGROUND

Seasonal influenza vaccination has been routinely recommended for adults with high-risk conditions. The Advisory Committee on Immunization Practices recommended that persons 25 to 64 years of age with high-risk conditions be one of the initial target groups to receive H1N1 vaccination during the 2009-2010 season.

METHODS

We used data from the 2009-2010 Behavioral Risk Factor Surveillance System survey. Vaccination levels of H1N1 and seasonal influenza vaccination among respondents 25 to 64 years with high-risk conditions were assessed. Multivariable logistic regression models were performed to identify factors independently associated with vaccination.

RESULTS

Overall, 24.8% of adults 25 to 64 years of age were identified to have high-risk conditions. Among adults 25 to 64 years of age with high-risk conditions, H1N1 and seasonal vaccination coverage were 26.3% and 47.6%, respectively. Characteristics independently associated with an increased likelihood of H1N1 vaccination were as follows: higher age; Hispanic race/ethnicity; medical insurance; ability to see a doctor if needed; having a primary doctor; a routine checkup in the previous year; not being a current smoker; and having high-risk conditions other than asthma, diabetes, and heart disease. Characteristics independently associated with seasonal influenza vaccination were similar compared with factors associated with H1N1 vaccination.

CONCLUSION

Immunization programs should work with provider organizations to review efforts made to reach adults with high-risk conditions during the recent pandemic and assess how and where they can increase vaccination coverage during future pandemics.

Effect of the conditional cash transfer program Oportunidades on vaccination coverage in older Mexican people

Background

Immunization is one of the most effective ways of preventing illness, disability and death from infectious diseases for older people. However, worldwide immunization rates are still low, particularly for the most vulnerable groups within the elderly population. The objective of this study was to estimate the effect of the Oportunidades -an incentive-based poverty alleviation program- on vaccination coverage for poor and rural older people in Mexico.

Methods

Cross-sectional study, based on 2007 Oportunidades Evaluation Survey, conducted in low-income households from 741 rural communities (localities with <2,500 inhabitants) of 13 Mexican states. Vaccination coverage was defined according to three individual vaccines: tetanus, influenza and pneumococcal, and for complete vaccination schedule. Propensity score matching and linear probability model were used in order to estimate the Oportunidades effect.

Results

12,146 older people were interviewed, and 7% presented cognitive impairment. Among remaining, 4,628 were matched. Low coverage rates were observed for the vaccines analyzed. For Oportunidades and non-Oportunidades populations were 46% and 41% for influenza, 52% and 45% for pneumococcal disease, and 79% and 71% for tetanus, respectively. Oportunidades effect was significant in increasing the proportion of older people vaccinated: for complete schedule 5.5% (CI_95% 2.8-8.3), for influenza 6.9% (CI_95% 3.8-9.6), for pneumococcal 7.2% (CI_95% 4.3-10.2), and for tetanus 6.6% (CI_95% 4.1-9.2).

Conclusions

The results of this study extend the evidence on the effect that conditional transfer programs exert on health indicators. In particular, Oportunidades increased vaccination rates in the population of older people. There is a need to continue raising vaccination rates, however, particularly for the most vulnerable older people.

Self-report compared to electronic medical record across eight adult vaccines: do results vary by demographic factors?

Immunizations are crucial to the prevention of disease, thus, having an accurate measure of vaccination status for a population is an important guide in targeting prevention efforts. In order to comprehensively assess the validity of self-reported adult vaccination status for the eight most common adult vaccines we conducted a survey of vaccination receipt and compared it to the electronic medical record (EMR), which was used as the criterion standard, in a population of community-dwelling patients in a large healthcare system. In addition, we assessed whether validity varied by demographic factors. The vaccines included: pneumococcal (PPSV), influenza (Flu), tetanus diphtheria (Td), tetanus diphtheria pertussis (Tdap), Human Papilloma Virus (HPV), hepatitis A (HepA), hepatitis B (HepB) and herpes zoster (shingles). Telephone surveys were conducted with 11,760 individuals, ≥18, half with documented receipt of vaccination and half without. We measured sensitivity, specificity, positive and negative predictive value, net bias and over- and under-reporting of vaccination. Variation was found across vaccines, however, sensitivity and specificity did not vary substantially by either age or race/ethnicity. Sensitivity ranged between 63% for HepA to over 90% (tetanus, HPV, shingles and Flu). Hispanics were 2.7 times more likely to claim receipt of vaccination compared to whites. For PPSV and Flu those 65+ had low specificity compared to patients of younger ages while those in the youngest age group had lowest specificity for HepA and HepB. In addition to racial/ethnic differences, over-reporting was more frequent in those retired and those with household income less than $75,000. Accurate information for vaccination surveillance is important to estimate progress toward vaccination coverage goals and ensure appropriate policy decisions and allocation of resources for public health. It was clear from our findings that EMR and self-report do not always agree. Finding approaches to improve both EMR data capture and patient awareness would be beneficial.

Uptake of influenza vaccine by pregnant women: a cross-sectional survey

OBJECTIVES

To determine influenza vaccination coverage among pregnant women in New South Wales, and factors associated with vaccine uptake during pregnancy.

DESIGN, SETTING AND PARTICIPANTS

Quantitative self-administered survey of pregnant women, using a non-random, stratified sample from antenatal clinics at three demographically diverse hospitals in NSW during the influenza season of 2011.

MAIN OUTCOME MEASURES

Self-reported influenza vaccine uptake while pregnant; and attitudes, barriers and facilitators to vaccine acceptance during pregnancy.

RESULTS

Of 939 women approached, 815 participated (87%). Influenza vaccine uptake in pregnant women was 27%. Women who had received a recommendation to have the vaccine were 20.0 times (95% CI, 10.9-36.9) more likely to have been vaccinated. Forty-two per cent recalled receiving a recommendation to be vaccinated. Other factors associated with vaccination were study site, perceived infection severity, overall feelings toward vaccination during pregnancy, vaccine accessibility, and willingness to take up the vaccine if recommended. Concern about the baby's safety was negatively associated with vaccination (odds ratio, 0.5; 95% CI, 0.2-0.9), but 68% (95% CI, 63%-71%) of women who expressed concern agreed they would have the vaccine if their health care professional recommended it.

CONCLUSION

Recommendation from a health care provider is strongly associated with influenza vaccine uptake among pregnant women and can overcome their concerns about safety, but less than half the women surveyed reported receiving such a recommendation. Educational material targeting pregnant women and professional education and support for antenatal health care providers are needed to increase awareness and recommendation.

Risk perception, preventive behaviors, and vaccination coverage in the Korean population during the 2009-2010 pandemic influenza A (H1N1): comparison between high-risk group and non-high-risk group

Background

This study was carried out to estimate the vaccination coverage, public perception, and preventive behaviors against pandemic influenza A (H1N1) and to understand the motivation and barriers to vaccination between high-risk and non–high-risk groups during the outbreak of pandemic influenza A (H1N1).

Methodology/Principal Findings

A cross-sectional nationwide telephone survey of 1,650 community-dwelling Korean adults aged 19 years and older was conducted in the later stage of the 2009–2010 pandemic influenza A (H1N1) outbreak. The questionnaire identified the demographics, vaccination status of participants and all household members, barriers to non-vaccination, perceived threat, and preventive behaviors. In Korea, the overall rate of pandemic influenza vaccination coverage in the surveyed population was 15.5%; vaccination coverage in the high-risk group and non–high-risk group was 47.3% and 8.0%, respectively. In the high-risk group, the most important triggering event for vaccination was receiving a notice from a public health organization. In the non–high-risk group, vaccination was more strongly influenced by previous experience with influenza or mass media campaigns. In both groups, the most common reasons for not receiving vaccination was that their health was sufficient to forgo the vaccination, and lack of time. There was no significant difference in how either group perceived the threat or adopted preventive behavior. The predictive factors for pandemic influenza vaccination were being elderly (age ≥65 years), prior seasonal influenza vaccination, and chronic medical disease.

Conclusions/Significance

With the exception of vaccination coverage, the preventive behaviors of the high-risk group were not different from those of the non–high-risk group during the 2009–2010 pandemic. For future pandemic preparedness planning, it is crucial to reinforce preventive behaviors to avoid illness before vaccination and to increase vaccination coverage in the high-risk group.

Determinants of suboptimal hepatitis B vaccine uptake among men in the Republic of Korea: where should our efforts be focused: results from cross-sectional study

Background

Liver cancer is the second most-frequent cause of cancer death in Korea. Hepatitis B virus (HBV) infection is a major cause of liver cancer, and this disease is effectively prevented by HBV vaccination. This study was conducted to investigate factors associated with the lack of HBV vaccine uptake in the general adult male population in Korea.

Methods

Data of men who participated in a nationwide cross-sectional interview survey were analyzed. A total of 2,174 men 40 years of age and older were interviewed between 2006 and 2008. None of the participants was infected with HBV or was experiencing sequelae of an HBV infection.

Results

Only half (50.4%) of the men received one or more dose of the three-dose series of HBV vaccinations, and 32.5% received all three doses. Compared with men who had completed the vaccination regimen, non-vaccinated men were more likely to lack supplemental medical insurance for cancer (odds ratio = 0.66, 95% confidence interval: 0.52–0.84), have lower incomes (p-trend = 0.010), and be less educated (p-trend = 0.021). Lower education was also more prevalent in the non-vaccinated group compared with the incompletely vaccinated group. Those who had completed the vaccination regimen were likely to be more educated than those in the incompletely vaccinated group (p-trend = 0.044). The most commonly cited reason for not obtaining the HBV vaccine was lack of knowledge regarding the need for the vaccination. The number of men who cited this reason decreased as a function of education.

Conclusions

It is important to develop strategic interventions targeted at less-educated men to increase uptake of a complete three-dose series of HBV vaccinations as a primary approach to preventing liver cancer.

Hepatitis A vaccination coverage among adults 18-49 years traveling to a country of high or intermediate endemicity, United States

BACKGROUND

Since 1996, hepatitis A vaccine (HepA) has been recommended for adults at increased risk for infection including travelers to high or intermediate hepatitis A endemic countries. In 2009, travel outside the United States and Canada was the most common exposure nationally reported for persons with hepatitis A virus (HAV) infection.

OBJECTIVE

To assess HepA vaccination coverage among adults 18-49 years traveling to a country of high or intermediate endemicity in the United States.

METHODS

We analyzed data from the 2010 National Health Interview Survey (NHIS), to determine self-reported HepA vaccination coverage (≥1 dose) and series completion (≥2 dose) among persons 18-49 years who traveled, since 1995, to a country of high or intermediate HAV endemicity. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with HepA vaccine receipt.

RESULTS

In 2010, approximately 36.6% of adults 18-49 years reported traveling to high or intermediate hepatitis A endemic countries; among this group unadjusted HepA vaccination coverage was 26.6% compared to 12.7% among non-travelers (P-values<0.001) and series completion were 16.9% and 7.6%, respectively (P-values<0.001). On multivariable analysis among all respondents, travel status was an independent predictor of HepA coverage and series completion (both P-values<0.001). Among travelers, HepA coverage and series completion (≥2 doses) were higher for travelers 18-25 years (prevalence ratios 2.3, 2.8, respectively, P-values<0.001) and for travelers 26-39 years (prevalence ratios 1.5, 1.5, respectively, P-value<0.001, P-value=0.002, respectively) compared to travelers 40-49 years. Other characteristics independently associated with a higher likelihood of HepA receipt among travelers included Asian race/ethnicity, male sex, never having been married, having a high school or higher education, living in the western United States, having greater number of physician contacts or receipt of influenza vaccination in the previous year. HepB vaccination was excluded from the model because of the significant correlation between receipt of HepA vaccination and HepB vaccination could distort the model.

CONCLUSIONS

Although travel to a country of high or intermediate hepatitis A endemicity was associated with higher likelihood of HepA vaccination in 2010 among adults 18-49 years, self-reported HepA vaccination coverage was low among adult travelers to these areas. Healthcare providers should ask their patients' upcoming travel plans and recommend and offer travel related vaccinations to their patients.

Adherence and factors associated with influenza vaccination among subjects with asthma in Spain

PURPOSE

Influenza has a high morbidity and mortality rate and an increased risk of complications in vulnerable individuals. Children and adults with asthma have a high risk of complications, hospitalisation and even death. The objectives of this study were as follows: to compare influenza vaccination coverage in Spain in a population of asthmatics aged ≥ 16 years with an equivalent population of non-asthmatics; to identify the factors that influence vaccination coverage among patients with asthma; and to compare coverage during the period 2006/2007 with that of 2009/2010.

METHODS

We used data from the 2009 European Health Survey (EHS), which included a population of 22,188 individuals (≥ 16 years of age), of whom 1,669 [7.5 %; 95 % confidence interval (CI), 7.13-7.98] had asthma. The dependent variable was the answer (yes/no) to a question asking whether or not the interviewed person had been vaccinated against seasonal (not pandemic) influenza in the previous season. As independent variables, we analysed socio-demographic characteristics, health-related variables and the use of health care services.

RESULTS

Vaccination coverage was 35.2 % (95 % CI, 32.5-37.9) among asthmatics and 22.1 % (95 % CI, 21.4-22.7) among non-asthmatics (p < 0.001). The probability of being vaccinated is almost twice as high for asthmatics as it is for non-asthmatics [odds ratio (OR), 1.92; 95 % CI, 1.69-2.17]. Among asthmatics, vaccination coverage increased with age, worse self-rated health status and not smoking. No significant change in coverage was observed between the study periods.

CONCLUSIONS

Seasonal influenza vaccination coverage among Spanish asthmatics is lower than desired and has not improved in recent years. Urgent strategies are necessary in order to increase vaccination coverage among asthmatics.

Human papillomavirus vaccine initiation and awareness: U.S. young men in the 2010 National Health Interview Survey

BACKGROUND

In 2009, the quadrivalent human papillomavirus (HPV) vaccine was licensed by the U.S. Food and Drug Administration for use in men/boys aged 9-26 years. In 2009, the Advisory Committee on Immunization Practices (ACIP) provided a permissive recommendation allowing HPV vaccine administration to this group.

PURPOSE

To assess HPV vaccination initiation and coverage, evaluate awareness of HPV and HPV vaccine, and identify factors independently associated with such awareness among men aged 18-26 years.

METHODS

Data from the 2010 National Health Interview Survey were analyzed in 2011.

RESULTS

In 2010, HPV vaccination initiation among men aged 18-26 years was 1.1%. Among the 1741 men interviewed in this age group, nearly half had heard of HPV (51.8%). Overall, about one third of these men had heard of the HPV vaccine (34.8%). Factors independently associated with a higher likelihood of awareness of both HPV and HPV vaccine among men aged 18-26 years included having non-Hispanic white race/ethnicity; a higher education level; a U.S. birthplace; more physician contacts; private health insurance; received other vaccines; and reported risk behaviors related to sexually transmitted diseases, including HIV.

CONCLUSIONS

HPV vaccination initiation among men aged 18-26 years in 2010 was low. HPV and HPV vaccine awareness were also low, and messages in this area directed to men are needed. Since ACIP published a recommendation for routine use of HPV4 among men/boys in December 2011, continued monitoring of HPV vaccination uptake among men aged 18-26 years is useful for evaluating the vaccination campaigns, and planning and implementing strategies to increase coverage.

Influenza vaccination coverage rates among diabetes sufferers, predictors of adherence and time trends from 2003 to 2010 in Spain

A descriptive cross-sectional study was conducted for adults (aged ≥ 50 y) with diabetes. Data was obtained from the 2009 European Health Interview Survey for Spain and the 2003 and 2006 Spanish National Health Surveys. To assess influenza vaccination status, we considered the response (yes or no) to the question "Have you received the influenza vaccine in the previous season?" Both dependent and independent variables were based on the survey questionnaires. The independent variables analyzed included socio-demographic characteristics, health-related variables and use of health care services. The coverage among adults with diabetes in 2010 was 65.0% (95% CI: 62.1-67.7) compared with 41.2% (95% CI 40.0-42.4) for those without diabetes (p<0.01) adjusted OR 1.67 (95% CI: 1.40-1.99). The positive predictors of vaccine uptake among diabetic adults were: higher age, being male, the presence of associated chronic conditions and physician visits in the last 2 wk. The vaccine uptake among adults with diabetes was 61.4% (95% CI: 57.9-64.8) in 2003 and 63.8% (95% CI: 60.7-66.8) in 2006.The adjusted OR of having been vaccinated in 2010 with respect to 2003 was not significant 1.18 (95% CI: 0.97-1.44). We conclude that the levels of influenza vaccination coverage are below desirable levels among adults with diabetes. Furthermore, trend analysis in influenza vaccination coverage indicates that influenza vaccination rates in adults with diabetes have not improved in recent years. Urgent strategies for increasing vaccination coverage among diabetes sufferers are necessary especially for those aged 50-59, women, those without chronic conditions and those who are not frequent users of health care services.

Agreement between patients' self-report and medical records for vaccination: the PGRx database

PURPOSE

Patients' self-reported vaccine exposure (PS) may be subject to memory errors and other biases. Physicians' prescription records and other medical records (MR) do not capture noncompliance with vaccination. This study compared PS with MR for influenza, 23-valent pneumococcal, and human papillomavirus (HPV) vaccines.

METHODS

The Pharmacoepidemiologic General Research Extension (PGRx) database uses a network of over 300 general practitioners across France, who systematically recruit an age- and sex-stratified sample of patients (≥ 14 years old), without reference to their diagnoses or prescriptions. Patients received a structured telephone interview, combined with an interview guide listing vaccines commonly given. Patients' self-reported vaccination in the 3 years before their recruitment was compared with medical records kept by the physician or the patient.

RESULTS

Concordance between PS and MR was assessed for 7613 patients for whom both sources of information were available. Agreement within 3 years before the recruitment date was substantial for influenza vaccines (prevalence and bias-adjusted kappa [PABAK] = 0.74, sensitivity PS relative to MR 81.5%) and high for 23-valent pneumococcal vaccines (PABAK = 0.98, sensitivity PS 49.6) and HPV vaccines (PABAK = 0.92, sensitivity PS 91.6). In adjusted analyses, agreement varied with sociodemographic and health-related factors, particularly for influenza and 23-valent pneumococcal vaccines.

CONCLUSIONS

The PGRx method for drug exposure assessment is a new tool in pharmacoepidemiology that shows substantial to high agreement between PS and MR for exposure to various vaccines. Our finding of high agreement between PS and MR for HPV vaccination status in young women is a significant addition to the literature.

Prevalence of influenza and adherence to the anti-flu vaccination among elderly

INTRODUCTION: The flu, a condition that can affect the elderly by increasing the risk of serious complications can be prevented through vaccination. Estimate the prevalence of signs and symptoms suggestive of influenza in a group of elderly either vaccinated or unvaccinated against influenza was the objective this study. METHODS: This is a cross-sectional study performed in a Brazilian City. A structured questionnaire was employed to identify the presence of signs and symptoms of influenza in individuals aged 60 years or over. For analysis of associations between variables the prevalence ratio (PR) and its 95% confidence interval (95% CI) were used. RESULTS: One hundred ninety-six participants were interviewed, of whom 57.7% were female. The average age was 69.7 years. About 25% of the vaccinated and 20% of the unvaccinated in 2009, and 25% of the vaccinated and 22.5% of the unvaccinated in 2010 reported having the flu. Among the vaccinated and unvaccinated in 2009 and 2010, there was no verified association between vaccination and influenza (PR=1.24; [95% CI: 0.63-2.43] and PR=1.11; [95% CI: 0.59-2.09], respectively). CONCLUSIONS: This study suggests that, among the elderly selected, the vaccination coverage for influenza is below the ideal, even with projection of the best indices for 2011 (~ 84%). The data on vaccination and disease protection needs further research; however, the results point to the need for measures to better clarify to this population about the disease, its complications and the benefits of vaccination, in addition to combatting the stigma related to low adherence.

Barriers to pandemic influenza vaccination and uptake of seasonal influenza vaccine in the post-pandemic season in Germany

BACKGROUND

In Germany, annual vaccination against seasonal influenza is recommended for certain target groups (e.g. persons aged ≥60 years, chronically ill persons, healthcare workers (HCW)). In season 2009/10, vaccination against pandemic influenza A(H1N1)pdm09, which was controversially discussed in the public, was recommended for the whole population. The objectives of this study were to assess vaccination coverage for seasonal (seasons 2008/09-2010/11) and pandemic influenza (season 2009/10), to identify predictors of and barriers to pandemic vaccine uptake and whether the controversial discussions on pandemic vaccination has had a negative impact on seasonal influenza vaccine uptake in Germany.

METHODS

We analysed data from the 'German Health Update' (GEDA10) telephone survey (n=22,050) and a smaller GEDA10-follow-up survey (n=2,493), which were both representative of the general population aged ≥18 years living in Germany.

RESULTS

Overall only 8.8% of the adult population in Germany received a vaccination against pandemic influenza. High socioeconomic status, having received a seasonal influenza shot in the previous season, and belonging to a target group for seasonal influenza vaccination were independently associated with the uptake of pandemic vaccines. The main reasons for not receiving a pandemic vaccination were 'fear of side effects' and the opinion that 'vaccination was not necessary'. Seasonal influenza vaccine uptake in the pre-pandemic season 2008/09 was 52.8% among persons aged ≥60 years; 30.5% among HCW, and 43.3% among chronically ill persons. A decrease in vaccination coverage was observed across all target groups in the first post-pandemic season 2010/11 (50.6%, 25.8%, and 41.0% vaccination coverage, respectively).

CONCLUSIONS

Seasonal influenza vaccination coverage in Germany remains in all target groups below 75%, which is a declared goal of the European Union. Our results suggest that controversial public discussions about safety and the benefits of pandemic influenza vaccination may have contributed to both a very low uptake of pandemic vaccines and a decreased uptake of seasonal influenza vaccines in the first post-pandemic season. In the upcoming years, the uptake of seasonal influenza vaccines should be carefully monitored in all target groups to identify if this trend continues and to guide public health authorities in developing more effective vaccination and communication strategies for seasonal influenza vaccination.

Influenza vaccination coverage across ethnic groups in Canada

BACKGROUND

The success of influenza vaccination campaigns may be suboptimal if subgroups of the population face unique barriers or have misconceptions about vaccination. We conducted a national study to estimate influenza vaccine coverage across 12 ethnic groups in Canada to assess the presence of ethnic disparities.

METHODS

We pooled responses to the Canadian Community Health Survey between 2003 and 2009 (n = 437 488). We estimated ethnicity-specific self-reported influenza vaccine coverage for the overall population, for people aged 65 years and older, and for people aged 12-64 years with and without chronic conditions. We used weighted logistic regression models to examine the association between ethnicity and influenza vaccination, adjusting for sociodemographic factors and health status.

RESULTS

Influenza vaccination coverage ranged from 25% to 41% across ethnic groups. After adjusting for sociodemographic factors and health status for people aged 12 years and older, all ethnic groups were more likely to have received a vaccination against influenza than people who self-identified as white, with the exception of those who self-identified as black (odds ratio [OR] 1.01, 95% confidence interval [CI] 0.88-1.15). Compared with white Canadians, Canadians of Filipino (OR 2.00, 95% CI 1.67-2.40) and Southeast Asian (OR 1.66, 95% CI 1.36-2.03) descent had the greatest likelihood of having received vaccination against influenza.

INTERPRETATION

Influenza vaccine coverage in Canada varies by ethnicity. Black and white Canadians have the lowest uptake of influenza vaccine of the ethnic groups represented in our study. Further research is needed to understand the facilitators, barriers and misconceptions relating to vaccination that exist across ethnic groups, and to identify promotional strategies that may improve uptake among black and white Canadians.