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Cilloniz C, Torres A. Diabetes Mellitus and Pneumococcal Pneumonia. Diagnostics (Basel) 2024; 14:859. [PMID: 38667504 PMCID: PMC11049506 DOI: 10.3390/diagnostics14080859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Currently, there are more than 500 million people suffering from diabetes around the world. People aged 65 years or older are the most affected by this disease, and it is estimated that approximately 96% of diabetes cases worldwide are type 2 diabetes. People with diabetes mellitus are at an increased risk of infections such as pneumonia, due to a series of factors that may contribute to immune dysfunction, including hyperglycemia, inhibition of neutrophil chemotaxis, impaired cytokine production, phagocytic cell dysfunction, altered T cell-mediated immune responses and the co-existence of chronic comorbidities. Rates of infection, hospitalization and mortality in diabetic patients are reported to be higher than in the general population. Research into the risk of infectious diseases such as pneumonia in these patients is very important because it will help improve their management and treatment.
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Affiliation(s)
- Catia Cilloniz
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Faculty of Health Sciences, Continental University, Huancayo 12001, Peru
| | - Antoni Torres
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Pulmonary Department, Hospital Clinic of Barcelona, C/Villarroel 170, 08036 Barcelona, Spain
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Mastrovito B, Lardon A, Dubromel A, Nave V, Beny K, Dussart C. Understanding the gap between guidelines and influenza vaccination coverage in people with diabetes: a scoping review. Front Public Health 2024; 12:1360556. [PMID: 38706547 PMCID: PMC11066301 DOI: 10.3389/fpubh.2024.1360556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
Background Diabetes affects millions of people worldwide, making them more vulnerable to infections, including seasonal influenza. It is therefore particularly important for those suffering from diabetes to be vaccinated against influenza each year. However, influenza vaccination coverage remains low in this population. This review primarily aims to identify the determinants of influenza vaccination in people with diabetes (T1D or T2D). Secondly, it aims to assess main recommendations for influenza vaccination, vaccine effectiveness, vaccination coverage, and how education and pharmacists can encourage uptake of the vaccine in the diabetic population. Methods A scoping review was conducted in January 2022 to systematically review evidence on influenza vaccination in people with diabetes using data from PubMed, Science Direct, and EM Premium with terms such as "Diabetes mellitus," "Immunization Programs," "Vaccination," and "Influenza Vaccines." Quality assessment and data extraction were independently conducted by two authors. Disagreements between the authors were resolved through discussion and consensus, and if necessary, by consulting a third author. Results Of the 333 records identified, 55 studies met the eligibility criteria for inclusion in this review. Influenza vaccination was recommended for people ≥6 months. Despite effectiveness evidence showing a reduction in mortality and hospitalizations in people with diabetes vaccinated vs. non-vaccinated ones, very few studies reported a coverage rate ≥ 75%, which is WHO's target objective. Determinants such as advanced age, presence of comorbidities and healthcare givers' advice were associated with increased vaccination uptake. On the contrary, fear of adverse reactions and concerns about vaccine effectiveness were significant barriers. Finally, education and pharmacists' intervention played a key role in promoting vaccination and increasing vaccination uptake. Conclusion Influenza vaccination coverage in people with diabetes remains low despite recommendations and evidence on vaccine effectiveness. Motivators and barriers as well as several socio-demographic and clinical factors have been identified to explain this trend. Efforts are now needed to increase the number of diabetics vaccinated against influenza, mainly through education and the involvement of healthcare givers.
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Affiliation(s)
- Brice Mastrovito
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Alexia Lardon
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Amelie Dubromel
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Viviane Nave
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Karen Beny
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Claude Dussart
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
- EA 4129 P2S Parcours Santé Systémique, Claude Bernard University Lyon 1, Lyon, France
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Galanos G, Dimitriou H, Pappas A, Perdikogianni C, Symvoulakis EK, Galanakis E, Lionis C. Vaccination coverage of patients with type 2 diabetes mellitus: Challenging issues from an outpatient secondary care setting in Greece. Front Public Health 2022; 10:921243. [PMID: 35979460 PMCID: PMC9376377 DOI: 10.3389/fpubh.2022.921243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/13/2022] [Indexed: 01/31/2023] Open
Abstract
Background Increased morbidity/mortality due to vaccine preventable diseases (VPD) is encountered in type 2 diabetes (T2D) people. Aim of this study was to assess their vaccination coverage and describe trends possibly affecting compliance. Methods Information on vaccination coverage was retrieved from either documents or interview provided by patients, and/or their vaccination record card at a specialized outpatient diabetes center. The selection of the patients was arbitrary. Results An increasing vaccination rate for influenza was observed from 2018 to 2020 among 372 participants. The vaccination coverage for S.pneumoniae was 67.2% (PCV13), 20.4% (PPSV23), 26.3% for herpes zoster in individuals ≥60 years, 1.9% for tetanus-diphtheria-pertussis and 1.1% for hepatitis B. A 10.2% of participants were found to be unvaccinated. Vaccination uptake for influenza and PCV13 was related to age, ≥3 comorbidities and long-term follow-up. T2D individuals consecutively vaccinated for influenza were 3.78 times more likely to be also vaccinated with PCV13. Conclusions Vaccination rates of patients with T2D show an increasing trend, especially for influenza and S. pneumoniae, although the one for S. pneumoniae was low. Older people seem more prone to vaccination, the one for herpes zoster was low with infected patients remaining unvaccinated while significantly low coverage was observed for other VPDs. The findings are important to improve effectiveness of preventative services.
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Affiliation(s)
- Georgios Galanos
- Postgraduate Program “Vaccines and Prevention of Infectious Diseases,” School of Medicine, University of Crete, Heraklion, Greece,Health Center of Arkalohori, 7th Health District of Crete, Crete, Greece
| | - Helen Dimitriou
- Postgraduate Program “Vaccines and Prevention of Infectious Diseases,” School of Medicine, University of Crete, Heraklion, Greece,Laboratory of Child Health, School of Medicine, University of Crete, Heraklion, Greece,*Correspondence: Helen Dimitriou
| | - Angelos Pappas
- Diabetic Center, Venizeleion General Hospital of Heraklion, Crete, Greece
| | - Chrysoula Perdikogianni
- Postgraduate Program “Vaccines and Prevention of Infectious Diseases,” School of Medicine, University of Crete, Heraklion, Greece,Department of Pediatrics, University Hospital, School of Medicine, University of Crete, Heraklion, Greece
| | - Emmanouil K. Symvoulakis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Emmanouil Galanakis
- Postgraduate Program “Vaccines and Prevention of Infectious Diseases,” School of Medicine, University of Crete, Heraklion, Greece,Department of Pediatrics, University Hospital, School of Medicine, University of Crete, Heraklion, Greece
| | - Christos Lionis
- Postgraduate Program “Vaccines and Prevention of Infectious Diseases,” School of Medicine, University of Crete, Heraklion, Greece,Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
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Low Levels of Influenza Vaccine Uptake among the Diabetic Population in Spain: A Time Trend Study from 2011 to 2020. J Clin Med 2021; 11:jcm11010068. [PMID: 35011809 PMCID: PMC8745480 DOI: 10.3390/jcm11010068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: In this work, we aim to describe influenza vaccine uptake among the diabetic population in Spain to assess the time trend from 2011 to 2020 and identify predictors of vaccine uptake among diabetes patients. (2) Methods: We conducted a descriptive cross-sectional study using the European Health Interview Survey for Spain (2014 and 2020) and the Spanish National Health Surveys (2011 and 2017). The independent variables analysed included socio-demographic characteristics, health-related variables and lifestyle variables. We matched each participant with diabetes with a non-diabetic participant based on age, sex, place of residence and year of survey. (3) Results: The overall coverage among diabetic adults was 52.1% compared to 40.6% for matched participants without diabetes (p < 0.01). The vaccine uptake among adults with diabetes was 52.6% in 2011, 54.38% in 2014 and 53.4% in 2017. The adjusted OR of having been vaccinated in 2020, with respect to 2011, was not significant at 0.87 (95% CI: 0.72–1.06). Factors such as being male, higher age, being affected by respiratory disease or cancer and being physically active were identified as positive predictors for influenza vaccination uptake, while smoking was a negative predictor. (4) Conclusions: The influenza vaccine uptake is below desirable levels among the adult diabetic population in Spain and has not improved from 2011 to 2020. More efforts should be made to increase influenza vaccine uptake in this high-risk group, especially for women, those aged 18–64 years, without other high-risk conditions and smokers.
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Janssen RS, Bruxvoort K, Jacobsen SJ, Slezak J, David C, Hyer R, Poland GA. Considerations for estimating real-world outcomes and value in vaccination: A case study with adult hepatitis B virus vaccination. Vaccine 2021; 39:5666-5672. [PMID: 34404556 DOI: 10.1016/j.vaccine.2021.07.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND In the absence of field efficacy studies, estimating the real-world effectiveness of vaccines may consider immunogenicity from randomized controlled clinical trials and real-world adherence. Combining seroprotection rates (SPRs) with regimen completion rates gives an estimate of an effective vaccine protection rate (eVPR), which can be leveraged to evaluate real-world cost-effectiveness by linking it with vaccine costs to estimate the cost-per-protected patient (CPP). METHODS This study evaluated eVPR and CPP as estimates of vaccine clinical- and cost-effectiveness of two-dose (HepB-CpG) and three-dose (HepB-Alum) hepatitis B virus (HBV) vaccines in the general adult population and a subpopulation with diabetes mellitus. eVPR was calculated from head-to-head SPR data from phase 3 clinical trials directly comparing HepB-CpG and HepB-Alum vaccine regimens and real-world head-to-head adherence data. CPP was calculated as the average cost of each regimen divided by eVPR. RESULTS Higher eVPR in the adult population was achieved with HepB-CpG (68.0%) versus HepB-Alum (41.6%), reflecting the combination of higher SPR and vaccine regimen completion. The CPP for HepB-CpG ($331.31) was $45.67 (95% CI: $36.66, $55.19) less than HepB-Alum ($377.09). Greater savings were observed among persons with diabetes, with CPP $149.60 (95% CI: $80.29, $195.63) lower with HepB-CpG ($367.57) than HepB-Alum ($517.37). CONCLUSIONS Metrics estimating vaccine real-world effectiveness and value may guide informed decisions in vaccine selection. For example, using eVPR and CPP, HepB-CpG represents a more effective, value-advantaged approach than HepB-Alum toward reducing HBV infection.
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Affiliation(s)
- Robert S Janssen
- Clinical Development, Dynavax Technologies, 2100 Powell St, Emeryville, CA 94608, USA.
| | - Katia Bruxvoort
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Jeff Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Coline David
- Market Access and Policy, Dynavax Technologies, 2100 Powell St, Emeryville, CA 94608, USA
| | - Randall Hyer
- Medical Affairs, Dynavax Technologies, 2100 Powell St, Emeryville, CA 94608, USA
| | - Gregory A Poland
- Mayo Vaccine Research Group, Mayo Clinic, 200 1st St, SW Rochester, MN 55905, USA
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Dallagiacoma G, Allora A, Salvati S, Cocciolo G, Capraro M, Lamberti A, Senatore S, Gentile L, Gianfredi V, Laurenzi A, Molinari C, Caretto A, Faccini M, Signorelli C, Scavini M, Odone A. Type 1 Diabetes Patients' Practice, Knowledge and Attitudes towards Influenza Immunization. Vaccines (Basel) 2021; 9:vaccines9070707. [PMID: 34210044 PMCID: PMC8310009 DOI: 10.3390/vaccines9070707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022] Open
Abstract
Diabetic patients are at higher risk of developing infectious diseases and severe complications, compared to the general population. Almost no data is available in the literature on influenza immunization in people with type 1 diabetes mellitus (T1DM). As part of a broader project on immunization in diabetic patients, we conducted a cross-sectional study to: (i) report on seasonal influenza coverage rates in T1DM patients, (ii) explore knowledge, attitudes, and practices (KAPs) towards seasonal influenza in this population, and (iii) identify factors associated with vaccine uptake, including the role of family doctors and diabetologists. A survey was administered to 251 T1DM patients attending the Diabetes Clinic at San Raffaele Research Hospital in Milan, Italy and individual-level coverage data were retrieved from immunization registries. Self-reported seasonal influenza immunization coverage was 36%, which decreased to 21.7% when considering regional immunization registries, far below coverage target of 75%. More than a third (36.2%) of T1DM patients were classified as pro-vaccine, 30.7% as hesitant, 17.9% as uninformed, and 15.1% as anti-vaccine. Diabetologists resulted to be the most trusted source of information on vaccines’ benefits and risks (85.3%) and should be more actively involved in preventive interventions. Our study highlights the importance of developing tailored vaccination campaigns for people with diabetes, including hospital-based programs involving diabetes specialists.
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Affiliation(s)
- Giulia Dallagiacoma
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.D.); (L.G.)
| | - Agnese Allora
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.A.); (S.S.); (G.C.); (M.C.); (V.G.); (C.S.)
| | - Stefano Salvati
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.A.); (S.S.); (G.C.); (M.C.); (V.G.); (C.S.)
| | - Giulia Cocciolo
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.A.); (S.S.); (G.C.); (M.C.); (V.G.); (C.S.)
| | - Michele Capraro
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.A.); (S.S.); (G.C.); (M.C.); (V.G.); (C.S.)
| | - Anna Lamberti
- Agency for Health Protection of Metropolitan Area of Milan (ATS), 20121 Milan, Italy; (A.L.); (S.S.); (M.F.)
| | - Sabrina Senatore
- Agency for Health Protection of Metropolitan Area of Milan (ATS), 20121 Milan, Italy; (A.L.); (S.S.); (M.F.)
| | - Leandro Gentile
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.D.); (L.G.)
| | - Vincenza Gianfredi
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.A.); (S.S.); (G.C.); (M.C.); (V.G.); (C.S.)
| | - Andrea Laurenzi
- Diabetes Research Institute, San Raffaele Hospital, 20132 Milan, Italy; (A.L.); (C.M.); (A.C.); (M.S.)
| | - Chiara Molinari
- Diabetes Research Institute, San Raffaele Hospital, 20132 Milan, Italy; (A.L.); (C.M.); (A.C.); (M.S.)
| | - Amelia Caretto
- Diabetes Research Institute, San Raffaele Hospital, 20132 Milan, Italy; (A.L.); (C.M.); (A.C.); (M.S.)
| | - Marino Faccini
- Agency for Health Protection of Metropolitan Area of Milan (ATS), 20121 Milan, Italy; (A.L.); (S.S.); (M.F.)
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.A.); (S.S.); (G.C.); (M.C.); (V.G.); (C.S.)
| | - Marina Scavini
- Diabetes Research Institute, San Raffaele Hospital, 20132 Milan, Italy; (A.L.); (C.M.); (A.C.); (M.S.)
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.D.); (L.G.)
- Correspondence:
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Comparative cost-effectiveness of a 2-dose versus 3-dose vaccine for hepatitis B prevention in selected adult populations. Vaccine 2021; 39:4733-4741. [PMID: 34030898 DOI: 10.1016/j.vaccine.2021.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 12/22/2022]
Abstract
The hepatitis B virus is highly infectious and can cause incurable liver disease, leading to high morbidity rates, increased healthcare utilization, and high mortality. Multiple preventative hepatitis B vaccine options have been available for decades, but adherence to the traditional 6-month vaccine schedule for the approved 3-dose series remains low in adult populations at risk of hepatitis B exposure. A 2-dose hepatitis B vaccine (HEPLISAV-B) approved by the US Food and Drug Administration in 2017 induces rapid seroprotection within 1 month and has a safety profile comparable to a commonly used 3-dose vaccine. In a previous cost-effectiveness study, HEPLISAV-B had a favorable cost-effectiveness profile for multiple at-risk populations. The goal of the current analysis was to update and extend previous findings by evaluating cost-effectiveness of HEPLISAV-B compared with a 3-dose vaccine (Engerix-B) in selected adult populations, including patients with diabetes, chronic liver or kidney disease, end-stage renal disease, healthcare personnel, travelers to countries with endemic hepatitis B, and a public health population. Cost-effectiveness was measured as incremental cost-effectiveness ratios using a health economics Markov model that accounts for adherence rates, seroprotection rates, healthcare costs, and current pricing considerations. Patients progressed between a series of health states, and the difference in lifetime spending and survival for individuals receiving either HEPLISAV-B or Engerix-B was estimated from the perspective of a US managed care payer, HEPLISAV-B had favorable cost-effectiveness profiles for patients with diabetes, healthcare personnel, travelers, and patients with chronic liver disease and dominant incremental cost-effectiveness ratios for patients with chronic kidney disease and end-stage renal disease. A probabilistic sensitivity analysis supported the robustness of the cost-effectiveness profiles, and an additional analysis indicated that HEPLISAV-B was cost-effective in the general adult population. Overall, HEPLISAV-B was cost-effective in multiple adult populations recommended for HBV vaccination in the United States.
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Boey L, Bosmans E, Ferreira LB, Heyvaert N, Nelen M, Smans L, Tuerlinckx H, Roelants M, Claes K, Derdelinckx I, Janssens W, Mathieu C, Van Cleemput J, Vos R, Vandermeulen C. Vaccination coverage of recommended vaccines and determinants of vaccination in at-risk groups. Hum Vaccin Immunother 2020; 16:2136-2143. [PMID: 32614656 PMCID: PMC7553698 DOI: 10.1080/21645515.2020.1763739] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Upon exposure to vaccine-preventable diseases, certain individuals are at increased risk for complications due to preexisting diseases, age or immunosuppressive treatment. Vaccination against influenza, pneumococcal disease and hepatitis B (for some groups) is advised in addition to standard vaccination against diphtheria, tetanus and pertussis. We estimated the vaccination coverage and determinants of recommended vaccinations in patients with diabetes mellitus type 1 (n = 173) and type 2 (n = 177), chronic kidney disease (CKD) (n = 138), heart failure (n = 200), chronic obstructive pulmonary disease (COPD) (n = 187), HIV (n = 201) or solid organ transplantation (SOT) (n = 201) in a monocentric study. Vaccination data were retrieved from documents provided by patients and general practitioners, and from the Flemish vaccination register. Less than 10% had received all recommended vaccines. Overall, 29% of subjects were vaccinated against diphtheria-tetanus, 10% against pertussis, 44% against influenza, 32% against pneumococcal disease and 24% of HIV patients and 31% of CKD patients against hepatitis B. Age was positively associated with vaccination against influenza (OR:2.0, p < .01) and pneumococcal disease (OR:2.6, p < .001). Patients with COPD, HIV and SOT were more likely to be vaccinated against influenza (OR:2.8, p < .001, OR:1.8, p < .05; OR:2.0, p < .001, respectively) and pneumococcal disease (OR:2.9, p < .001, OR:25.0, p < .001; OR:2.6, p < .001, respectively) than patients with heart failure. Reason for non-vaccination were concerns about effectiveness, necessity and side effects of influenza vaccines, and not being aware of the recommendation for pneumococcal disease. Initiatives to monitor the vaccination status of vulnerable patients are needed, which is why we advocate systematic vaccination registration and frequent communication about vaccination.
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Affiliation(s)
- Lise Boey
- Leuven University Vaccinology Center , Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Eline Bosmans
- Leuven University Vaccinology Center , Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Liane Braz Ferreira
- Leuven University Vaccinology Center , Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Nathalie Heyvaert
- Leuven University Vaccinology Center , Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Melissa Nelen
- Leuven University Vaccinology Center , Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Lisa Smans
- Leuven University Vaccinology Center , Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Hanne Tuerlinckx
- Leuven University Vaccinology Center , Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Mathieu Roelants
- Environment and Health, Department of Public Health and Primary Care, KU Leuven , Leuven, Belgium
| | - Kathleen Claes
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven , Leuven, Belgium
| | - Inge Derdelinckx
- Department of General Internal Medicine, University Hospitals of Leuven , Leuven, Belgium
| | - Wim Janssens
- Department of Respiratory Diseases, University Hospitals of Leuven , Leuven, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals of Leuven , Leuven, Belgium
| | - Johan Van Cleemput
- Department of Cardiology, University Hospitals of Leuven , Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases - Lung Transplantation Unit, University Hospitals of Leuven , Leuven, Belgium
| | - Corinne Vandermeulen
- Leuven University Vaccinology Center , Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Environment and Health, Department of Public Health and Primary Care, KU Leuven , Leuven, Belgium
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