Umsetzung der Influenzaimpfempfehlung in Alten- und Pflegeheimen

[Once vaccinated, always vaccinated? A claims data analysis on repeated influenza vaccinations among individuals aged ≥ 60 years]

BACKGROUND

The Standing Committee on Vaccination recommends the seasonal influenza vaccination as a standard vaccination for individuals aged ≥ 60 years and as an indication vaccination independent of age. Empirical data on repeated vaccination are not available for Germany. The aim of this study was therefore to investigate the frequency and influencing factors of repeated vaccinations.

METHODS

We conducted a longitudinal retrospective observational study with claims data from ≥ 60‑year-olds insured with the statutory health insurance AOK Plus in Thuringia between 2012 and 2018. The number of seasons with influenza vaccination was described and the association with various individual characteristics was analysed in a regression model.

RESULTS

Included were 103,163 individuals with at least one influenza vaccination in the 2014/2015 season, of whom 75.3% had been vaccinated in ≥ 6 of 7 seasons. We found repeated vaccinations more frequently among nursing home residents (rate ratio (RR) 1.27), individuals with increased health risk due to underlying diseases (RR 1.21) and higher age groups (vs. 60-69 years: RR 1.17-1.25). With each additional year of participating in a disease management program, the number of vaccinations increased (RR 1.03). Women (RR 0.91), individuals with nursing care level 1 (vs. no nursing care level: RR 0.90) and people with a comorbidity (vs. no comorbidity: RR 0.97) were less likely to receive repeated vaccinations.

DISCUSSION

A large proportion of individuals aged ≥ 60 years who have been vaccinated against influenza once is likely to repeatedly receive vaccinations. In accordance with vaccination recommendations, nursing home residents and in particular individuals with an increased health risk are vaccinated repeatedly. General practitioners play a central role: non-acute patient contacts should be used to offer vaccinations, especially to women and individuals in need of care who are living at home.

[Influenza]

Influenza is the infectious disease with the highest population-based mortality. It mainly affects those aged 60 years and older, mainly due to immune senescence, which also favors complicated courses and compromises vaccine effectiveness. Therefore, various approaches have been developed for more immunogenic vaccines, which are now available for use. The Ständige Impfkommission (STIKO) has taken this into account in its current recommendation on influenza vaccination and has recommended a quadrivalent, inactivated high-dose vaccine as the standard vaccine for all ≥ 60-year-olds. Despite these successes, vaccination for prevention remains underutilized. Germany has never reached the WHO vaccination target of 75% of the elderly population. The main reasons for this are a lack of confidence in the effectiveness of vaccination, a lack of/restricted risk perception of the disease, and barriers to implementation. Initial approaches to overcoming these barriers, such as low-threshold vaccination services by involving pharmacies, are being implemented. However, further steps are needed to realize the potential of influenza vaccination, especially for such vulnerable groups as older adults.

Vaccination management for elderly patients in primary care settings - documentation and responsibilities during a vaccination campaign

OBJECTIVE

The aims of the current analysis were to evaluate the vaccination status and attitudes towards vaccinations of elderly patients and to explore effects of a vaccination campaign.

METHODS

The data were raised in primary care settings by a physicians network which collected data during routine care from 697 patients and by the analysis of health insurance claims data from the Kassenärztliche Vereinigung Schleswig-Holstein (KVSH/Association of Statutory Health Insurance Physicians of the federal state of Schleswig-Holstein, Germany), regarding vaccinations in the participating practices before and after a vaccination campaign.

RESULTS

Vaccination documentation for tetanus (57.7%), diphtheria (55.7%) and influenza (55.8%) was available for slightly more than half of the study sample. A lower documentation rate was observed for pertussis (33.1%), pneumococcal vaccination (30.3%) and polio (26.3%). Practice assistants were more responsible for determining the vaccination status than physicians. The attitude regarding influenza and pneumococcal vaccine was positive in 72.9% and 56.9% of patients respectively. After the campaign, rates of influenza and pneumococcal vaccine utilization increased by 13.4% and 62.9%, respectively.

CONCLUSIONS

Attitudes regarding vaccination were generally positive. Documentation was missing for almost half of the elderly population. The delegation of vaccine management to practice assistants could increase the immunization rate. Moreover, it can be assumed that a campaign might be helpful in increasing vaccination awareness and vaccine coverage.

Influenza vaccination rates before and after admission to nursing homes in Germany

BACKGROUND

Influenza vaccination is highly recommended for nursing home residents. However, it is known that vaccination coverage is low in the general population.

AIMS

We aim to find out whether influenza vaccination coverage differs for nursing home residents between the year before and after admission and factors determining the chance to receive vaccination.

METHODS

Claims data of the health insurance fund DAK of at least 65-year-olds were used. The proportion of residents with influenza vaccination were compared in the year before and after the admission stratified by several covariates. A multivariate logistic regression analysis was conducted to obtain predictors for influenza vaccination after admission.

RESULTS

Vaccination coverage was overall higher in the year after admission (53.0%) than before (38.3%). Differences in vaccination coverage between most covariates evened out after admission. Differences remained for region of residence and number of comorbidities. The strongest predictor for receiving a vaccination after admission was the vaccination status before admission (OR 3.5; 95% CI 3.3-3.6) followed by region and number of comorbidities.

DISCUSSION

Overall, vaccination coverage of nursing home residents remains lower than recommended. Doctor-patient contacts whether due to care for comorbidities or as a continuation of the relation over the time of admission to the nursing home seem to assure vaccination for residents.

CONCLUSION

Clear and unambiguous evidence of vaccine safety and efficacy for different subgroups within the same age group as well as organizational efforts to increase vaccination within nursing homes would be recommended.