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Völker S, Hammerschmidt R, Spura A. [Geographic analyses as a foundation for evidence-based public health interventions: the example identification and typology of risk clusters for mumps, measles, and rubella]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:600-609. [PMID: 33891131 PMCID: PMC8087606 DOI: 10.1007/s00103-021-03318-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/17/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Ideally, health services and interventions to improve immunization rates should be tailored to local target populations, such as spatial clusters. However, to date, little attention has been paid to spatial clusters of underimmunization and have instead been typified based on small-scale data. AIM Using the example of vaccination against measles, mumps, and rubella (MMR) in children, the present study aims to (1) identify the spatial distribution of insufficient MMR vaccination in Westphalia-Lippe on a small scale, (2) identify specific, spatial risk clusters with insufficient vaccination protection, and (3) describe spatial-neighborhood influencing factors of the different risk clusters as starting points for public health interventions. MATERIAL AND METHODS Account data from the Kassenärztliche Vereinigung Westfalen-Lippe (KVWL) were used as a basis. Birth cohorts 2013-2016 of children with statutory health insurance were formed and aggregated at postcode level (n = 410). Statistically significant, spatially compact clusters and relative risks (RRs) of underimmunization were identified. Local risk models were estimated in binary logistic regressions based on spatial-neighborhood variables. RESULTS AND DISCUSSION Two significant clusters of underimmunization were identified for each of the vaccination rates "at least one MMR vaccination" and "both MMR vaccinations." Significant risk factors for low immunization rates included age structure, socioeconomic variables, population density, medical coverage, and value attitude. The proposed methodology is suitable for describing spatial variations in vaccination behavior based on identified typologies for targeted evidence-based interventions.
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Affiliation(s)
- Sebastian Völker
- Stabsbereich Unternehmensentwicklung, Kassenärztliche Vereinigung Westfalen-Lippe (KVWL), Robert-Schimrigk-Str. 4-6, 44141, Dortmund, Deutschland.
- Zentrum für Public Health und Versorgungsforschung, Masterstudiengang Public Health, Paracelsus Medical University, Salzburg, Österreich.
| | - Reinhard Hammerschmidt
- Stabsbereich Unternehmensentwicklung, Kassenärztliche Vereinigung Westfalen-Lippe (KVWL), Robert-Schimrigk-Str. 4-6, 44141, Dortmund, Deutschland
| | - Anke Spura
- Referat 2-24 Fortbildung, Qualifizierung, Hochschulkooperation, Bundeszentrale für gesundheitliche Aufklärung (BZgA), Köln, Deutschland
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Kiltz U, Celik A, Tsiami S, Baraliakos X, Andreica I, Kiefer D, Bühring B, Braun J. [How well are patients with inflammatory rheumatic diseases protected against measles?]. Z Rheumatol 2020; 79:912-921. [PMID: 32930874 PMCID: PMC7647965 DOI: 10.1007/s00393-020-00874-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 01/29/2023]
Abstract
Hintergrund Patienten mit entzündlich rheumatischen Erkrankungen haben aufgrund ihrer Autoimmunerkrankung, aber auch bedingt durch die immunsuppressive Medikation ein erhöhtes Infektrisiko. Obwohl Impfungen in der Primärprophylaxe von Infektionen bekanntermaßen effektiv sind, ist die Impfrate in Deutschland generell zu niedrig. Wegen des zuletzt zunehmenden, teils epidemieartigen Auftretens von Masern ist die Lebendimpfung gegen Masern in Deutschland seit Kurzem gesetzlich vorgeschrieben. Fragestellung Wie viele Patienten mit entzündlich rheumatischen Erkrankungen sind aktuell ausreichend gegen Masern geschützt? Methode Patienten mit entzündlich rheumatischen Erkrankungen des Rheumazentrums Ruhrgebiet wurden zwischen Dezember 2017 und Oktober 2018 prospektiv und konsekutiv eingeschlossen. Dabei wurden Daten zu Erkrankung und Therapie auf Ebene von Substanzklassen sowie die Impf- und Infektanamnese erhoben. Alle Angaben zu Impfungen wurden im Impfpass kontrolliert. Antikörpertiter gegen Masern wurden mit ELISA bestimmt. Als Schwellenwert für einen ausreichenden Schutz gegen Masern wurden 150 mIU/ml festgelegt. Ergebnis Von 975 Patienten konnten 540 (55,4 %) einen Impfausweis vorlegen. Bei 201 Patienten mit Ausweis (37,2 %) lagen dokumentierte Impfungen seit Geburt vor. Insgesamt hatten 45 von 267 nach 1970 geborene Patienten (16,9 %) einen suffizienten Impfschutz gegen Masern. Die anamnestischen Angaben zu einer Masernerkrankung in der Kindheit differenzierten nicht zwischen Patienten mit und ohne protektiven Masern-IgG-Antikörpern. Protektive Masern-IgG-Antikörper wurden bei 901 Patienten von 928 Patienten mit Messung der Masern-IgG-Antikörperspiegel (97,1 %) nachgewiesen. Die unterschiedlichen Wirkprinzipien der aktuellen immunsuppressiven Therapie hatten darauf keinen Einfluss. Diskussion Diese Daten zeigen, dass mindestens 2,9 % der Patienten keinen ausreichenden Schutz gegen Masern haben. Interessanterweise hatte die Mehrheit der nach 1970 geborenen Patienten protektive Antikörper trotz fehlenden Impfschutzes gegen Masern. Die Anstrengungen sowohl im primär- als auch im fachärztlichen Bereich sollten dringend verstärkt werden, um eine adäquate Infektionsprophylaxe bei besonders gefährdeten Patienten gewährleisten zu können.
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Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, St. Elisabeth Gruppe GmbH, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - A Celik
- Klinikum Westfalen, Dortmund, Deutschland
| | - S Tsiami
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, St. Elisabeth Gruppe GmbH, Claudiusstr. 45, 44649, Herne, Deutschland
| | - X Baraliakos
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, St. Elisabeth Gruppe GmbH, Claudiusstr. 45, 44649, Herne, Deutschland
| | - I Andreica
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, St. Elisabeth Gruppe GmbH, Claudiusstr. 45, 44649, Herne, Deutschland
| | - D Kiefer
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, St. Elisabeth Gruppe GmbH, Claudiusstr. 45, 44649, Herne, Deutschland
| | - B Bühring
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, St. Elisabeth Gruppe GmbH, Claudiusstr. 45, 44649, Herne, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, St. Elisabeth Gruppe GmbH, Claudiusstr. 45, 44649, Herne, Deutschland
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Storr C, Sanftenberg L, Schelling J, Heininger U, Schneider A. Measles Status-Barriers to Vaccination and Strategies for Overcoming Them. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:723-730. [PMID: 30518471 DOI: 10.3238/arztebl.2018.0723] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 06/23/2017] [Accepted: 07/09/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The World Health Organization (WHO) set the year 2020 as a target date for the eradication of measles in Europe, yet Germany is still far away from this goal. In this article, we provide an overview of current vaccination gaps and barriers to vaccination among children and adults in Germany, as well as potential strategies for overcoming them. METHODS This review is based on pertinent publications identified by a selective literature search in PubMed (Medline). RESULTS Measles vaccinations are not carried out in the appropriate timely fashion in Germany. Moreover, current vaccination rates among both children and adults are too low to achieve the goal of measles eradication. For example, among children born in 2014, the recommended vaccination rate of more than 95% was only reached when these children were 24 months old. Primary care physicians bear the responsibility for this situation, as they have the greatest influence on the decision to vaccinate. The main causes of vaccination gaps are safety worries and complacen- cy on the patients' part, and partial skepticism regarding vaccination on the part of the caregivers. We identified promising strategies for overcoming these problems: an instructive talk to provide evidence-based information to patients in an atmos- phere of mutual trust, reminder systems, multifactorial interventions, and facilitated access to vaccination, or, as a last resort, the reintroduction of compulsory vacci- nation. CONCLUSION Primary care physicians play a key role in vaccination. The focus of further strategies should lie above all in improved patient education and in targeted reminders for patients who neglect to vaccinate themselves and/or their children.
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Affiliation(s)
- Constanze Storr
- Institute of General Practice, Technische Universität München: The Max Planck Society's Max Planck Institute of Psychiatry, Munich; Institute of General Practice, Ludwig-Maximilians-Universität München; Department of Pediatric Infectiology and Vaccinology, Universitäts-Kinderspital beider Basel (UKBB); Institute of General Practice, Technische Universität München
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Rieck T, Matysiak-Klose D, Hellenbrand W, Koch J, Feig M, Siedler A, Wichmann O. [Compliance with adult measles and pertussis vaccination recommendations : Analysis of data from the national monitoring system KV-Impfsurveillance]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:422-432. [PMID: 30805673 DOI: 10.1007/s00103-019-02902-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The Standing Committee on Vaccination recommends adult measles and pertussis vaccination. The measles vaccine has been recommended since 2010 to adults born after 1970 with less than two doses in childhood, and an acellular pertussis vaccine (ap) since 2009 to be administered to all adults, with the next recommended decennial tetanus (T) and diphtheria (d) booster as a Tdap combination vaccine.We aim to determine the annual uptake of the measles vaccine (vaccination incidence) and its proportion in pediatric and gynecological practices as interdisciplinary services (2009-2016). We further aim to calculate the 10-year ap vaccination coverage and missed vaccination opportunities as the proportion vaccinated with Td only among all Td and Tdap vaccinees (2007-2016).Within the national vaccination monitoring system KV-Impfsurveillance of the Robert Koch Institute and all Associations of Statutory Health Insurance Physicians, all persons receiving the relevant vaccinations were identified in nationwide statutory health insurance claims and related to the numbers of insured persons.The measles vaccination incidence in 2009 was 0.4%, increasing to ≥1.0% annually since 2013. It was higher in western than eastern federal states and higher among women than men. Of all measles vaccinations, 6.8% were given by pediatricians. Men received 2.6% of their vaccinations by gynecologists. The ap vaccination coverage was 32.4%. The proportion of exclusively Td vaccinated adults fell from 84% (2007) to 24% (from 2013 onwards).Since their recommendation, the KV-Impfsurveillance system shows increased uptake of measles and pertussis vaccines with regional and sex differences and is thus instrumental in their evaluation. Analyses of interdisciplinary vaccinations and missed vaccination opportunities provide insight into the potential for increasing uptake.
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Affiliation(s)
- Thorsten Rieck
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland. .,Charité Universitätsmedizin Berlin, Berlin, Deutschland.
| | | | - Wiebke Hellenbrand
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Judith Koch
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Marcel Feig
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Anette Siedler
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Ole Wichmann
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
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Weyers S, Wahl S, Dragano N, Müller-Thur K. Ist der Datenschatz schon gehoben? PRÄVENTION UND GESUNDHEITSFÖRDERUNG 2018. [DOI: 10.1007/s11553-018-0641-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Heterogeneity in coverage for measles and varicella vaccination in toddlers - analysis of factors influencing parental acceptance. BMC Public Health 2017; 17:724. [PMID: 28927384 PMCID: PMC5606112 DOI: 10.1186/s12889-017-4725-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 09/07/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In 2004, routine varicella vaccination was introduced in Germany for children aged 11-14 months. Routine measles vaccination had already been introduced in 1973 for the same age group, but coverage is still too low (<95%) in some areas to eliminate measles. The present study assessed varicella and measles vaccination coverage and determinants of parental acceptance in two study regions, situated in Northern and Southern Bavaria (Germany). METHODS From 2009 to 2011, annual cross-sectional parent surveys were performed on random samples of 600 children aged 18-36 months in the Bavarian regions of both Munich and Würzburg. Logistic regression models were used to identify factors associated with varicella and measles vaccination. RESULTS In 2009, 2010 and 2011, vaccination coverage was lower in Munich than in Würzburg, for both varicella (Munich 53%, 67%, 69% vs. Würzburg 72%, 81%, 83%) and for measles (Munich 88%, 89%, 91% vs. Würzburg 92%, 93%, 95%). Recommendation by the physician was the main independent factor associated with varicella vaccination in both regions (adjusted odd ratios (OR) with 95% confidence interval (CI): Munich OR 19.7, CI 13.6-28.6; Würzburg OR 34.7, CI 22.6-53.2). Attendance at a childcare unit was positively associated with a higher acceptance of varicella vaccination in Munich (OR 1.5, CI 1.1-2.2). Regarding measles vaccination, attendance at a childcare unit was positively associated in both regions (Munich OR 2.0; CI 1.3-3.0; Würzburg OR 1.8; CI 1.1-3.1), and a higher level of parental school education was negatively associated in Würzburg (OR 0.5, CI 0.3-0.9). CONCLUSIONS Vaccination rates differed between regions, with rates constantly higher in Würzburg. Within each region, vaccination rates were lower for varicella than for measles. Measles vaccination status was mainly dependent upon socio-demographic factors (attendance at a childcare unit, parental school education), whereas for the more recently introduced varicella vaccination recommendation by the physician had the strongest impact. Hence, different strategies are needed to further improve vaccination rates for both diseases.
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Yang YT, Bhoobun S, Itani T, Jacobsen KH. Europe Should Consider Mandatory Measles Immunization for School Entry. J Pediatric Infect Dis Soc 2016; 5:319-22. [PMID: 26907813 DOI: 10.1093/jpids/piw003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/09/2016] [Indexed: 11/14/2022]
Affiliation(s)
- Y Tony Yang
- Department of Health Administration and Policy
| | - Shalinee Bhoobun
- Department of Paediatrics, Evelina London Children's Hospital, Westminster, United Kingdom
| | - Taha Itani
- Department of Public Health Medicine, School of Public Health, Bielefeld University, Germany
| | - Kathryn H Jacobsen
- Department of Global and Community Health, George Mason University, Fairfax, Virginia
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Riemenschneider H, Schübel J, Bergmann A, Kugler J, Voigt K. Current vaccination status regarding measles among university students in Dresden, Germany. Am J Infect Control 2015; 43:1363-5. [PMID: 26654238 DOI: 10.1016/j.ajic.2015.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/08/2015] [Accepted: 07/08/2015] [Indexed: 11/29/2022]
Abstract
Germany aimed to eliminate measles by 2015, but vaccination coverage is still insufficient, especially in respect to adolescents and young adults. A cross-sectional survey with 711 students studying a range of subjects showed a high acceptance regarding vaccination. Actual self-reported vaccination rates were lower; only 65.5% of medical students and 25.3%-39.4% of other student groups reported complete vaccination against measles. Of the students, 12.6%-45% did not know their vaccination status. Vaccination acceptance did not correlate with vaccination behavior: accessible vaccination opportunities at universities should be offered.
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Affiliation(s)
- Henna Riemenschneider
- Department of General Practice, Medical Clinic III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Jeannine Schübel
- Department of General Practice, Medical Clinic III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Antje Bergmann
- Department of General Practice, Medical Clinic III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Joachim Kugler
- Department of Health Sciences/Public Health, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Karen Voigt
- Department of General Practice, Medical Clinic III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Bochennek K, Allwinn R, Langer R, Becker M, Keppler OT, Klingebiel T, Lehrnbecher T. Differential loss of humoral immunity against measles, mumps, rubella and varicella-zoster virus in children treated for cancer. Vaccine 2014; 32:3357-61. [DOI: 10.1016/j.vaccine.2014.04.042] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 04/12/2014] [Accepted: 04/17/2014] [Indexed: 11/30/2022]
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