Influenza Vaccination Coverage Among Polish Patients with Chronic Diseases

Changes in vaccination uptake against pneumococcal disease, influenza, and coronavirus disease 2019 (COVID-19) before and after a Head and Neck cancer diagnosis

BACKGROUND

Pneumonia is one of the main contributors to non-cancer mortality among patients with head and neck cancer (HNC). This study aimed to determine the vaccine uptake for pneumococcal polysaccharide and conjugate vaccines, quadrivalent influenza vaccines, and mRNA COVID-19 vaccines before and after an HNC diagnosis. Furthermore, the study investigated the timing of vaccination after a cancer diagnosis.

MATERIALS & METHODS

This register based multicentre study included Danish patients ≥ 18y diagnosed with HNC between 2018 and 2021. The vaccine uptake was assessed by calculating cumulative incidence (CI), while the timing of vaccination after an HNC diagnosis was explored by calculating incidence rates of vaccination the first and second half year after a cancer diagnosis.

RESULTS

The cumulative incidence of vaccine uptake for pneumococcal vaccines was estimated to be 8 % and 16 % one year before and after an HNC diagnosis, respectively. The CIs were 36 % and 38 % for quadrivalent influenza vaccines, respectively, whereas the CIs of vaccine uptake for mRNA COVID-19 vaccines were 60 % and 89 %. The IR of mRNA COVID-19 vaccinations the first half year after HNC diagnosis were 273 per 1000 person-months of follow-up (PMFU) and 111 per 1000 PMFU the second half year, respectively (IRR: 0.38, p < 0.001). Comparing the same periods, the IR of quadrivalent influenza vaccination was 28 per 1000 PMFU and 51 per 1000 PMFU (IRR: 1.95, 0 < 0.001). The IRs of pneumococcal vaccinations were 11 per 1000 PMFU and 14 per 1000 PMFU (IRR 1.28, p = 0.21).

CONCLUSIONS

Although our study shows a significant increase in pneumococcal and COVID-19 vaccine uptake after HNC diagnosis, a gap remains in vaccine uptake before diagnosis, underscoring the need for increased awareness of vaccination options and recommendations. Our findings could serve as a reference for future recommendations.

The Heat about Cultured Meat in Poland: A Cross-Sectional Acceptance Study

Cultured meat, produced by culturing animal cells in vitro, is gaining increasing interest. The first products obtained using this technology were authorized for human consumption in Singapore and the United States, and more are likely to follow in other parts of the world. Therefore, it is important to assess the attitudes toward such meat in various populations and understand the grounds for its acceptance and rejection. The present cross-sectional online study of adult Poles (n = 1553) aimed to evaluate knowledge of cultured meat, the main reasons and fears associated with its production and consumption, and willingness to buy it and factors influencing such willingness. Most respondents (63%) were familiar with the concept of cultured meat, and 54% declared to purchase it when available. However, concerns over safety were expressed by individuals accepting (39%) and rejecting (49%) such meat. The main motivations for choosing it included limiting animal suffering (76%) and environmental impacts of meat consumption (67%), although over half of responders willing to buy these products were driven by curiosity (58%). Multiple logistic regression revealed that odds (OR; 95%CI) for accepting cultured meat were significantly increased for adults aged 18-40 (1.8; 1.2-2.7); women (1.8; 1.2-2.7); meat eaters (8.7; 5.6-13.6); individuals convinced that animal farming adversely affects the climate (7.6; 3.1-18.3), surface waters (3.1; 1.2-8.1), and air quality (3.0; 1.2-7.6); those familiar with cultured meat concept (4.2, 2.2-8.4); and those revealing high openness to experience (1.7; 1.2-2.4). The results highlight that the Polish population may be moderately ready to accept cultured meat and identify the groups resistant to accepting it. Well-designed and transparent promotion of these products is required to increase the general public's understanding of the potential benefits and challenges of cultured meat technology.

The Influence of Recommendation of Medical and Non-Medical Authorities on the Decision to Vaccinate against Influenza from a Social Vaccinology Perspective: Cross-Sectional, Representative Study of Polish Society

Vaccination against seasonal flu is crucial to prevention of illness in modern societies. The level of influenza vaccination in Poland is low and, for many years, has hovered around a few percent of the general population. For this reason, it is crucial to understand the reasons for such a low level of vaccination and to assess the influence of medical and social authorities on the decision to vaccinate against influenza from the perspective of social vaccinology. For this purpose, a representative survey was conducted in 2022 among adult Poles (N = 805), orchestrated with the CAWI technique based on the author's questionnaire. The most significant authority in the context of influenza vaccination is held by physicians, especially among the oldest part of the population, over 65 years of age-in this group, 50.4% of respondents declare a very high level of respect for physicians on the issue of recommended influenza vaccination (p < 0.001), and the second-highest authority group for which seniors have respect in the aspect of influenza vaccination is pharmacists (p = 0.011). It was also shown that pharmacists have more authority on the issue of influenza vaccination than nurses, especially in the group that declared themselves opponents of vaccination (p < 0.001). The survey indicates the need to strengthen the authority of physicians and pharmacists regarding influenza vaccination, and, in the case of pharmacists, the need for changing the law to allow them to qualify for influenza vaccination.

Association between the Seroprevalence of Antibodies against Seasonal Alphacoronaviruses and SARS-CoV-2 Humoral Immune Response, COVID-19 Severity, and Influenza Vaccination

The present study assesses the seroprevalence of antibodies against seasonal human alphacoronaviruses 229E and NL63 among adult patients infected with SARS-CoV-2, and its association with the humoral response to SARS-CoV-2 infection and its severity, and influenza vaccination. A serosurvey was conducted to quantify the presence of IgG antibodies against the nucleocapsid of 229E (anti-229E-N) and NL63 (anti-NL63-N), and anti-SARS-CoV-2 IgG antibodies (against nucleocapsid, receptor-binding domain, S2 domain, envelope, and papain-like protease) for 1313 Polish patients. The seroprevalence of anti-229E-N and anti-NL63 in the studied cohort was 3.3% and 2.4%. Seropositive individuals had a higher prevalence of anti-SARS-CoV-2 IgG antibodies, higher titers of the selected anti-SARS-CoV2 antibodies, and higher odds of an asymptomatic SARS-CoV-2 infection (OR = 2.5 for 229E and OR = 2.7 for NL63). Lastly, the individuals vaccinated against influenza in the 2019/2020 epidemic season had lower odds of seropositivity to 229E (OR = 0.38). The 229E and NL63 seroprevalence was below the expected pre-pandemic levels (up to 10%), likely due to social distancing, increased hygiene, and face masking. The study also suggests that exposure to seasonal alphacoronaviruses may improve humoral responses to SARS-CoV-2 while decreasing the clinical significance of its infection. It also adds to accumulating evidence of the favorable indirect effects of influenza vaccination. However, the findings of the present study are of a correlative nature and thereby do not necessarily imply causation.

Influenza and Other Prophylactic Vaccination Coverage in Polish Adult Patients Undergoing Allergen Immunotherapy-A Survey Study among Patients and Physicians

Vaccines against infectious diseases may raise safety concerns in patients undergoing allergen immunotherapy (AIT). The objective of our study was to investigate influenza vaccine and other selected prophylactic vaccines coverage in patients treated with AIT and the attitude of physicians towards vaccinations in this group of patients. We conducted a questionnaire-based study among patients undergoing AIT and physicians. The patients’ survey evaluated influenza and other prophylactic vaccines coverage. The physicians’ survey assessed their experience and opinions on prophylactic vaccinations during AIT. In total, 176 patients (aged 18−79 years) and 120 doctors filled the questionnaires. Patients were assigned to two groups—inhaled allergens group (n = 101) and insect venoms group (n = 68). The number of patients who received any dose (36% and 45%, p = 0.26), as well as two or more doses (17% and 22%, p = 0.43) of influenza vaccine was comparable between two groups. However, in both groups there was a significant (p < 0.0001) decrease in influenza vaccine uptake after the beginning of AIT. Patients from the inhaled allergens group declared a higher tetanus vaccine rate (41% vs. 19%, p = 0.004). The groups did not differ in the pneumococcal and tick-borne encephalitis vaccination coverage. A majority of doctors believe that prophylactic vaccinations in patients undergoing AIT are safe and effective (96% and 94%, respectively); however, as many as 87% of them identify with the need to create clear recommendations regarding vaccinating patients undergoing AIT. Prophylactic vaccine coverage is not satisfactory among Polish adult patients undergoing AIT. Polish doctors are convinced of the validity of prophylactic vaccinations during AIT.

Does Hospitalization Change the Perception of COVID-19 Vaccines among Unvaccinated Patients?

The COVID-19 vaccination has been the subject of unprecedented misinformation, false news, and public concerns. This study presents a unique analysis comprising persons who were not vaccinated and became ill. It investigates reasons for not vaccinating and evaluates how the personal experience of COVID-19 affected further attitudes and decisions related to health. The study included 730 consecutive unvaccinated patients hospitalized in 12 centers in Poland during the autumn 2021 pandemic wave. The most frequent reason behind the refusal to receive the vaccine was concern over the adverse effects, disbelief that the vaccine was sufficiently tested, and one’s conviction that COVID-19 will not affect a patient. Online information, friends, spouse, children/grandchildren, and other family members were most often the source of discouragement from vaccination. Most individuals regretted their decision not to receive a vaccine (66.0%), declared to promote COVID-19 vaccination after discharge (64.0%), and to receive a COVID-19 vaccine in the time recommended for convalescents (69.5%). Individuals expressing no regrets of vaccine refusal more frequently revealed conspiracy beliefs. The study shows that personal experience with severe COVID-19 can influence the perception of vaccination, but approximately one-third of unvaccinated hospitalized patients still appear to express vaccine hesitancy.

Willingness to Receive the Booster COVID-19 Vaccine Dose in Poland

COVID-19 vaccinations are essential to mitigate the pandemic and prevent severe SARS-CoV-2 infections. However, the serum antibody levels in vaccinated individuals gradually decrease over time, while SARS-CoV-2 is undergoing an evolution toward more transmissible variants, such as B.1.617.2, ultimately increasing the risk of breakthrough infections and further virus spread. This cross-sectional online study of adult Poles (n = 2427) was conducted in September 2021 (before a general recommendation to administer a booster COVID-19 vaccine dose in Poland was issued) to assess the attitude of individuals who completed the current vaccination regime toward a potential booster dose of the COVID-19 vaccine and identify potential factors that may influence it. Overall, 71% of participants declared willingness to receive a booster COVID-19 dose, with a low median level of fear of receiving it of 1.0 (measured by the 10-point Likert-type scale), which was increased particularly in those having a worse experience (in terms of severity of side effects and associated fear) with past COVID-19 vaccination. The lowest frequency of willingness to receive a booster dose (26.7%) was seen in the group previously vaccinated with Ad26.COV2.S. The majority of individuals vaccinated previously with mRNA vaccines wished to receive the same vaccine, while in the case of AZD1222, such accordance was observed only in 9.1%. The main reasons against accepting a booster COVID-19 dose included the side effects experienced after previous doses, the opinion that further vaccination is unnecessary, and safety uncertainties. Women, older individuals (≥50 years), subjects with obesity, chronic diseases, and pre-vaccination and post-vaccination SARS-CoV-2 infections, and those with a history of vaccination against influenza were significantly more frequently willing to receive a booster COVID-19 dose. Moreover, the majority of immunosuppressed individuals (88%) were willing to receive an additional dose. The results emphasize some hesitancy toward potential further COVID-19 vaccination in the studied group of Poles and indicate the main groups to be targeted with effective science communication regarding the booster doses.

The Perception and Attitudes toward COVID-19 Vaccines: A Cross-Sectional Study in Poland

Vaccine hesitancy is a major threat to the success of COVID-19 vaccination programs. The present cross-sectional online survey of adult Poles (n = 1020) expressing a willingness to receive the COVID-19 vaccine was conducted between February and March 2021 and aimed to assess (i) the general trust in different types of vaccines, (ii) the level of acceptance of the COVID-19 vaccines already in use in Poland (BNT162b2 by BioNTech/Pfizer, mRNA-1273 by Moderna and AZD1222 by Oxford/AstraZeneca) as well as eight vaccines approved outside European Union (EU) or in advanced stages of clinical trials, (iii) level of fear of vaccination against COVID-19, and (iv) main sources of information on COVID-19 vaccination. Among all major vaccine technology, the highest level of trust was observed for the mRNA platform, with a considerable number of surveyed (>20%) not aware of the existence of vaccines produced using the traditional approach (inactivated and live attenuated vaccines). The age of participants was the main factor differentiating the level of trust in a particular vaccine type. Both BNT162b and mRNA-1273 received a high level of acceptance, contrary to AZD1222. From eight vaccines unauthorized in the EU at the moment of study, the CVnCoV (mRNA; CureVac) was met with the highest level of trust, followed by Ad26.COV2.S (vector; Janssen/Johnson&Johnson) and NVX-CoV2373 (protein; Novavax). Sputnik V (vector; Gamaleya Research Institute) was decidedly the least trusted vaccine. The median level of fear (measured by the 10-point Likert-type scale) in the studied group was 4.0, mostly related to the risk of serious allergic reactions, other severe adverse events and unknown long-term effects of vaccination. Female, individuals with a lower level of education and those not seeking any information on the COVID-19 vaccines revealed a higher fear of vaccination. Experts' materials were the major source of information on COVID-19 vaccines in the studied group. The study shows the level of trust in COVID-19 vaccines can vary much across the producers while the mRNA vaccines are received with a high level of acceptance. It also emphasizes the need for effective and continuous science communication when fighting the pandemic as it may be an ideal time to increase the general awareness of vaccines.

Knowledge, Attitudes and Practices of Flu Vaccination in Hemodialysis Patients

BACKGROUND

Hemodialysis (HD) patients have an increased risk of morbidity and mortality due to infections. Despite the positive effect of vaccinations, the implementation of this method of prophylaxis is low.

OBJECTIVES

This study aimed to explore the knowledge, attitudes and practices of flu vaccination among HD patients of two different dialysis centers.

METHODS

A total of 193 patients (mean age 63.6 years), who voluntarily agreed to participate in an anonymous survey related to influenza vaccination, were enrolled in this cross-sectional study.

RESULTS

A total of 45% of patients declared that they took regular, annual flu vaccination. In this group, 87.4% believed that vaccinations were effective. This opinion strongly correlated with the frequency of regular vaccinations (r = 0.56, p < 0.01). Multivariate logistic regression revealed that this opinion is an independent predictor of regular vaccinations with adjusted OR 9.86 (95% CI 4.36, 22.33). Groups of patients who had been irregularly or never vaccinated reject vaccinations for the following reasons: fear of adverse events-29.2%, conviction that vaccination was ineffective-26.4%, and lack of information about vaccination-22.6%.

CONCLUSION

Knowledge among HD patients about the benefits of vaccinations is poor. Therefore, educational activities are required. Active vaccination promotion and education of patients rejecting this method of prevention play a key role in improving standards of care for HD patients.

Influenza vaccination rate among high risk group patients in primary health care in Greece

OBJECTIVE

Seasonal influenza vaccination is the main method for influenza prevention. The main objective of this study is to estimate the frequency of vaccinations in patients with chronic illnesses presented to a primary health care (PHC) centre.

METHODS

This cross-sectional study was performed in patients admitted to the Kapandriti Health Centre. Their vaccination status with an influenza vaccine and their underlying diseases were recorded.

RESULTS

34.8% of the subjects had been vaccinated against seasonal influenza. Vaccination coverage was found to be 53.9% in pulmonary, 55.6% in chronic kidney disease, 43.7% in cardiovascular disorders, 40.6% in diabetes, 40.6% in any kind of malignancy, and finally 33.3% in neurological patients. The most significant predictors for vaccination were the age group of 60 to 79 years (OR = 3.08, 95% CI: 1.79-5.29), age over 80 years (OR = 2.91, 95% CI: 1.58-5.36), respiratory disease (OR = 2.25, 95% CI: 1.33-3.76), cardiovascular disorder (OR = 1.46, 95% CI: 1.02-2.10), and 3 to 5 visits to the unit annually (OR = 1.57, 95% CI: 1.12-2.24). Finally, it was discovered that coexistence of one to three diseases reduced the likelihood ratio for vaccine uptake (OR = 0.15, 95% CI: 0.03-0.79, p < 0.05).

CONCLUSIONS

The influenza vaccination rate for the population of the present study has been found higher than that reported previously in literature. We believe that there is a need to implement new and more effective strategies such as educating vulnerable groups on the benefits of vaccination and so reducing the incidence of influenza and its complications especially in vulnerable groups.

Influenza coverage rates in subjects with chronic heart diseases: results obtained in four consecutive immunisation seasons in the Local Health Unit of Ferrara (North Italy)"

Background

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. According to the 2017–2019 Italian National Immunisation Plan, free immunisation is offered to the categories at increased risk of experience the complications of the infection (over 65 years old subjects, pregnant women and individuals with underlying conditions, including chronic heart diseases). Rising evidence suggests that influenza can trigger adverse cardiovascular events therefore the vaccination is recommended for secondary prevention of cardiovascular diseases. Despite this, the influenza coverage rate in subjects with chronic heart disease is underestimated.

Methods

The study investigated the coverage rate in four consecutive influenza seasons (from 2011/2012 to 2014/2015) in subjects that benefit from exemption from paying healthcare costs for chronic heart disease living in Local Health Unit (LHU) of Ferrara (Italy), comparing the databases of exemptions and immunisations.

Results

The levels of influenza vaccine uptake were unstable, reaching the 50.3% in 2011/2012 immunisation season and falling to 42.2% in the following year. Coverage rates increased with increasing age, without achieving the 75% target, neither in over 65 years old subjects. The logistic regression analysis showed that influenza coverage rates were statistically significant different (p < 0.0001, 0.003 only for category of disease in 2011/2012 immunisation season) according to age, district of residence, category of chronic heart disease and length of exemption, but not influenced by gender.

Conclusions

The recommendation of influenza immunisation was weakly followed in individuals with chronic heart diseases. A collaboration between cardiologists, GPs, scientific societies and patient associations could successfully support influenza vaccine uptake.

Impact of an influenza information pamphlet on vaccination uptake among Polish pupils in Edinburgh, Scotland and the role of social media in parental decision making

BACKGROUND

In Edinburgh, Scotland, lower influenza vaccine uptake has been observed in primary school children in the Polish community.

METHODS

To address this disparity, the Polish-language version of the NHS Health Scotland influenza information pamphlet was updated and distributed in 2018 to all identified Polish pupils attending three pilot schools. The impact of the revised pamphlet was evaluated by examining changes in vaccine uptake in these schools as compared to a control group of schools, and a questionnaire was issued to all Polish parents in the pilot schools to explore their opinions of the pamphlet and preferred sources of immunisation information.

RESULTS

On average uptake was 7.4% (95% CI 1.0-13.8%, p < 0.05) higher in the three pilot schools in which the Polish-language pamphlet was distributed (28.7%) than control schools (21.3%). The questionnaire feedback was that 37.3% of respondents felt better-informed about the influenza vaccine following the pamphlet. The respondents reported that the most important information source in deciding whether to vaccinate is previous experience. Healthcare professionals were ranked lower in importance when making a decision. Parents, who refused consent (n = 65) were more likely to source information from social media, friends and family, and Polish websites compared with those who consented (n = 45).

CONCLUSIONS

These findings suggest that issuing new Polish health literature was associated with a large increase in consent form return rate and a modest increase in uptake of the influenza vaccine by Polish pupils in the pilot schools. Social media and Polish websites were found to have a greater influence over Polish parents' decision to immunise than UK healthcare staff and health authority information. Intensive effort is required to encourage parents towards information sources where more accurate pro-vaccination messages can be promulgated by national health services and independent expert groups. The role of social media for migrant communities requires careful consideration, especially for vaccine programmes not delivered in their country of birth.

Trends, Coverage and Influencing Determinants of Influenza Vaccination in the Elderly: A Population-Based National Survey in Spain (2006-2017)

Influenza is a significant public health problem and the elderly are at a greater risk of contracting the disease. The vaccination coverage of the elderly is below the Spanish target of 65% for each influenza season. The aims of this study were to report the coverage of influenza vaccination in Spain among the population aged ≥65 years and high-risk groups for suffering chronic diseases, to analyze the time trends from 2006 to 2017 and to identify the factors which affect vaccination coverage. A nationwide cross-sectional study was conducted including 20,753 non-institutionalized individuals aged ≥65 years who had participated in the Spanish National Health Surveys in 2006, 2011/2012, and 2017. Sociodemographic, health-related variables, and influenza vaccination data were used. A logistic regression analysis was performed to determine the variables associated with influenza vaccination. Influenza vaccination coverage was 60%. By chronic condition, older people with high cholesterol levels and cancer had the lowest vaccination coverage (62.41% and 60.73%, respectively). This coverage declined from 2006 to 2017 in both groups. Higher influenza vaccination was associated with males, Spanish nationality, normal social support perceived, polypharmacy, worse perceived health, participation in other preventive measures, and increasing age and the number of chronic diseases.

Quadrivalent Influenza Vaccine-Induced Antibody Response and Influencing Determinants in Patients ≥ 55 Years of Age in the 2018/2019 Season

The effects of immunization with subunit inactivated quadrivalent influenza vaccine (QIV) are not generally well assessed in the elderly Polish population. Therefore, this study evaluated vaccine-induced antibody response and its determinants. Methods: Consecutive patients ≥ 55 years old, attending a Primary Care Clinic in Gryfino, Poland, received QIV (A/Michigan/ 45/2015(H1N1)pdm09, A/Singapore/INFIMH-16-0019/2016 (H3N2), B/Colorado/06/2017, B/Phuket/ 3073/2013) between October-December 2018. Hemagglutination inhibition assays measured antibody response to vaccine strains from pre/postvaccination serum samples. Geometric mean titer ratio (GMTR), protection rate (PR) and seroconversion rate (SR) were also calculated. Results: For 108 patients (54.6% males, mean age: 66.7 years) the highest GMTR (61.5-fold) was observed for A/H3N2/, then B/Colorado/06/2017 (10.3-fold), A/H1N1/pdm09 (8.4-fold) and B/Phuket/ 3073/2013 (3.0-fold). Most patients had post-vaccination protection for A/H3N2/ and B/Phuket/3073/ 2013 (64.8% and 70.4%, respectively); lower PRs were observed for A/H1N1/pdm09 (41.8%) and B/Colorado/06/ 2017 (57.4%). The SRs for A/H3N2/, A/H1N1/pdm09, B Victoria and B Yamagata were 64.8%, 38.0%, 46.8%, and 48.2%, respectively. Patients who received QIV vaccination in the previous season presented lower (p < 0.001 and p = 0.03, respectively) response to B Victoria and B Yamagata. Conclusions: QIV was immunogenic against the additional B lineage strain (B Victoria) without significantly compromising the immunogenicity of the other three vaccine strains, therefore, adding a second B lineage strain in QIV could broaden protection against influenza B infection in this age group. As the QIV immunogenicity differed regarding the four antigens, formulation adjustments to increase the antigen concentration of the serotypes that have lower immunogenicity could increase effectiveness. Prior season vaccination was associated with lower antibody response to a new vaccine, although not consistent through the vaccine strains.

School life and influenza immunization: A cross-sectional study on vaccination coverage and influencing determinants among Polish teachers

OBJECTIVE

The general public influenza vaccination coverage in Poland is one of the lowest in the EU (3.7% in 2017/2018). Teachers have the potential to be a target group for immunization programs against influenza infection, however, there is yet to be a study in Poland, or even in the EU that has assessed influenza vaccine uptake among this group. The study objective was to evaluate influenza vaccination coverage and to assess influencing determinants amongst Polish teachers.

METHOD

A cross-sectional questionnaire-based study was conducted among 277 teachers from 9 primary schools of two regional capitals of two Polish regions: Szczecin and Lublin.

RESULTS

A quarter of teachers have ever received influenza vaccine; 4.5% reported receiving vaccination in the 2018/2019 season. The main reasons for not being vaccinated were a lack of confidence in its effectiveness (56.9%) and concerns related to adverse effects (30.6%). Forty four percent (43.8%) of teachers believed that they are at risk of influenza infection, only 62.5% indicated vaccination as an effective method of preventing influenza. Previous information about influenza (OR = 15.70), high knowledge level about influenza (OR = 2.56), family physician recommendation (OR = 2.39), belief that influenza vaccination should be mandatory for teachers (OR = 3.29), and having a vaccinated family member (OR = 2.68) were each associated with higher odds of immunization. Willingness to be vaccinated against influenza in the next season was strongly associated with current vaccination status (OR = 7.16).

CONCLUSIONS

Influenza vaccination coverage among Polish teachers is alarmingly low; vaccine receipt was associated with teacher attitudes and beliefs. Future interventions related to maximizing vaccination coverage in this group should take advantage of the involvement of family physicians and specifically focus on teachers who have never been vaccinated before. As knowledge about influenza positively influences vaccination decisions, education strategies should focus on reducing knowledge gaps to alter attitudes and increase uptake.

Decreasing influenza vaccine coverage among adults with high-risk chronic diseases in Spain from 2014 to 2017

The objectives of this study were to estimate coverage of influenza vaccination in Spain among adults suffering chronic conditions, to assess time trends from 2014 to 2017 and to identify vaccine uptake predictors. We used individualized data of persons ≥15 y interviewed in the 2017 Spanish National Health Survey. Vaccine uptake and the presence of the chronic conditions analyzed (diabetes; cancer; chronic respiratory disease; chronic heart disease and cerebrovascular disease) were self-reported. Independent variables included sex, age and nationality. In 2017 overall influenza vaccination uptake among subjects with high-risk chronic conditions remained low (40.3%) and decreased significantly from 2014 (41.7%, adjusted OR 0.98 95%CI 0.84-0.98). The highest coverage was found among those with cerebrovascular disease (52.2%), diabetes (51.5%) and heart disease (51.4%) and the lowest figures for those suffering cancer (34.9%) and respiratory disease (35.1%). Coverage for cancer patients declined a 25% from 2014 to 2017. Older persons had higher coverages whereas females and immigrant population had lower uptakes.We conclude that influenza vaccination coverage among the high-risk population in Spain for suffering chronic conditions remains at a low level and has decreased significantly from 2014 to 2017, this affects more intensely to females and immigrants.

Klug S, Gensichen J. Increasing Influenza Vaccination Rates in People With Chronic Illness

BACKGROUND

The safety and efficacy of influenza vaccination for the chronically ill are clearly supported by the evidence, yet vaccination rates in this vulnerable popu- lation remain low. This leads to many avoidable hospitalizations and deaths in Germany every year. The goal of this systematic review is to identify measures in primary care medicine that can be used to increase influenza vaccination rates among the chronically ill.

METHODS

This review was carried out as recommended in the PRISMA statement. A systematic literature search was performed. Only randomized, controlled trials were included in the analysis. Details can be found in the study protocol (PROSPERO, CRD42018114163).

RESULTS

15 trials were included in the analysis. Training sessions for medical practice teams focusing on a particular disease raised the vaccination rates by as much as 22%. A financial incentive had the greatest effect (relative risk [RR]: 2.79; 95% confidence interval: [1.18; 6.62]). Reminders via text message yielded a maximum 3.8% absolute increase in vaccination rates. Complex interventions were not found to be of any greater benefit than simple ones.

CONCLUSION

A variety of approaches can be effective. Focusing training sessions for medical practice teams on certain diseases may be of greater benefit than vacci- nation-centered training sessions. Reminder systems for doctors should be more reliably implemented. Simple strategies are perhaps the most suitable ones in the heterogeneous population of chronically ill persons. The limitations of this system- atic review include the heterogeneity of the studies that we examined and the small number of studies in each category.

Knowledge Regarding Influenza and Influenza Vaccination in General Population: Results of a National Survey in Poland

For the past 10 years, influenza vaccination coverage rate in Poland remains at a low 3% threshold. This low rate may be related to the unsatisfactory knowledge of vaccination, influenza, and misperception of health risks in the general population. To examine these issues, we used an online questionnaire consisting of 12 closed questions. The basic knowledge on influenza and vaccination was examined. The questionnaire was completed by 1669 persons, mostly young women. Generally, 73% of respondents passed the threshold of 70% correct answers, but important gaps in their knowledge were identified concerning the persons at risk of developing the infection (7.9% of correct answers) and the timing of vaccination (8.4% of correct answers). Although most respondents did identify the etiologic agent correctly (91.1% knew influenza is caused by a virus), only 12.3% knew that the vaccines registered in Poland contain fragments of viruses or its antigens, while 63.1% thought the vaccines contain live bacteria. In conclusion, the knowledge on influenza vaccination is deficient in the general population. Education on immunization should be prioritized to increase vaccination coverage rate in Poland.

[Prevalence of influenza vaccination in elderly Brazilian with chronic diseases]

This study aimed to estimate the prevalence of influenza vaccination in elderly Brazilians with specific chronic diseases. The sample included individuals 60 years or older (n = 23,815) participating in the National Health Survey (PNS) in 2013. The study estimated the prevalence rates for influenza vaccination and the respective 95% confidence intervals (95%CI). The associations were verified with the chi-square test (Rao-Scott) with 5% significance. Prevalence of influenza vaccination in the elderly was 73.1% (95%CI: 72.0-74.1), and there was no significant difference in prevalence rates between men and women (p = 0.237). Statistically significant differences were observed in prevalence rates for elderly that reported arterial hypertension, 75% (p < 0.001), diabetes mellitus, 76.5% (p = 0.009), cardiac disease, 79.2% (p < 0.001), and lung disease or chronic obstructive pulmonary disease (COPD), 87% (p = 0.001). The results showed low prevalence of vaccination in elderly with some specific chronic diseases for whom there is formal recommendation to receive the vaccine, suggesting the need for a vaccination campaign to extrapolate the age cutoff (elderly) and better targeting to these specific subgroups.

Prevalence of influenza vaccination in adults and elderly with chronic respiratory diseases

The objective was to estimate the prevalence of influenza vaccination in adults and elderly with chronic respiratory diseases (CRDs). The sample included individuals 20 to 59 years of age (n = 23,329) and ≥ 60 years (n = 9,019) that participated in the Brazilian National Survey on Access, Utilization, and Promotion of Rational Use of Medicines (PNAUM) in 2013-2014. We estimated influenza vaccination prevalence rates and respective 95% confidence intervals (95%CI). Associations were verified with the Rao-Scott chi-square test, with significance set at 5%. For all adults and elderly with CRD, prevalence of vaccination was 42.1% (95%CI: 37.2-47.1), with a statistically difference between the two age groups (p < 0.001). The adult population showed significant differences according to marital status (p < 0.05), and the elderly population showed higher vaccination prevalence in the South of Brazil compared to the Northeast (p < 0.05). For the sample as a whole, chronic bronchitis was the most frequently reported disease (43.5%). Considering each specific disease, the percentage of vaccinated adults was low, varying from 25% (other respiratory diseases) to 42% (chronic bronchitis), without a statistically significant difference (p = 0.330). Individuals with respiratory diseases and the elderly in general (≥ 60 years) are priority groups for influenza vaccination; in general, in all the subgroups, prevalence rates were below the target set by the Brazilian Ministry of Health. The recommendation that the vaccine should be applied by a health professional may explain this low adherence to vaccination by the elderly.

Using Routine Data Sources to Feed an Immunization Information System for High-Risk Patients-A Pilot Study

Background

Vaccine-preventable diseases among high-risk patients are a public health priority in high-income countries. Most national immunization programs have included vaccination recommendations for these population groups but they remain hard-to-reach and coverage data are poorly available. In a pilot study, we developed and tested an automated approach for identifying individuals with underlying medical conditions to feed an immunization information system (IIS).

Methods

We reviewed published recommendations on medical conditions that indicate vaccination against influenza, pneumococcal disease, meningococcal disease, hepatitis A, and hepatitis B. For each medical condition, we identified the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes, the user fee exempt codes and the Anatomical Therapeutic Chemical Classification System codes and we reported these data in correspondence tables. Using these tables, we extracted three lists of patients recorded in three current data sources between 2001 and 2010 in the Apulia region of Italy: the hospital discharge registry, the user fee exempt registry, and the drug prescription registry. Using a unique personal identification number, we linked these three lists of patients with the regional IIS (2012 database), obtaining a list of patients with chronic diseases eligible for vaccination. We tested completeness, sensitivity, and positive predictive value (PPV) of this approach by asking a sample of 28 general practitioners (GPs) to evaluate the matching between a sublist of patients with clinical recommendations for influenza vaccination and the GPs individual subjects medical records.

Results

We included a total of 1,204,496 subjects with underlying medical conditions eligible to receive any of the aforementioned vaccinations. Of these, 9% were identified in all three data sources, 18% in two sources, and 73% in one source. The completeness of this automated process in identifying GPs high-risk patients eligible for influenza vaccination was 88.9% [95% confidence intervals (95% CI): 88.1–89.8%], with a sensitivity of 69.2% (95% CI: 67.7–70.6%) and a PPV of 85.7% (95% CI: 84.4–86.8%).

Conclusion

The high completeness of the methodology used for identifying high-risk patients in current data sources encouraged us to apply this approach for feeding the regional IIS.