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Moser K, Massag J, Frese T, Mikolajczyk R, Christoph J, Pushpa J, Straube J, Unverzagt S. German primary care data collection projects: a scoping review. BMJ Open 2024; 14:e074566. [PMID: 38382948 PMCID: PMC10882319 DOI: 10.1136/bmjopen-2023-074566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The widespread use of electronic health records (EHRs) has led to a growing number of large routine primary care data collection projects globally, making these records a valuable resource for health services and epidemiological and clinical research. This scoping review aims to comprehensively assess and compare strengths and limitations of all German primary care data collection projects and relevant research publications that extract data directly from practice management systems (PMS). METHODS A literature search was conducted in the electronic databases in May 2021 and in June 2022. The search string included terms related to general practice, routine data, and Germany. The retrieved studies were classified as applied studies and methodological studies, and categorised by type of research, subject area, sample of publications, disease category, or main medication analysed. RESULTS A total of 962 references were identified, with 241 studies included from six German projects in which databases are populated by EHRs from PMS. The projects exhibited significant heterogeneity in terms of size, data collection methods, and variables collected. The majority of the applied studies (n = 205, 85%) originated from one database with a primary focus on pharmacoepidemiological topics (n = 127, 52%) including prescription patterns (n = 68, 28%) and studies about treatment outcomes, compliance, and treatment effectiveness (n = 34, 14%). Epidemiological studies (n = 77, 32%) mainly focused on incidence and prevalence studies (n = 41, 17%) and risk and comorbidity analysis studies (n = 31, 12%). Only 10% (n = 23) of studies were in the field of health services research, such as hospitalisation. CONCLUSION The development and durability of primary care data collection projects in Germany is hindered by insufficient public funding, technical issues of data extraction, and strict data protection regulations. There is a need for further research and collaboration to improve the usability of EHRs for health services and research.
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Affiliation(s)
- Konstantin Moser
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Institute of General Practice and Family Medicine, Halle, Germany
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Institute of Medical Epidemiology, Biometrics, and Informatics, Halle, Germany
| | - Janka Massag
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Institute of Medical Epidemiology, Biometrics, and Informatics, Halle, Germany
| | - Thomas Frese
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Institute of General Practice and Family Medicine, Halle, Germany
| | - Rafael Mikolajczyk
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Institute of Medical Epidemiology, Biometrics, and Informatics, Halle, Germany
| | - Jan Christoph
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Junior Research Group (Bio-)Medical Data Science, Halle, Germany
| | - Joshi Pushpa
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Institute of General Practice and Family Medicine, Halle, Germany
| | - Johanna Straube
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Institute of General Practice and Family Medicine, Halle, Germany
| | - Susanne Unverzagt
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Institute of General Practice and Family Medicine, Halle, Germany
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Plate A, Bagnoud C, Rosemann T, Senn O, Di Gangi S. Influenza vaccination uptake among at-risk patients in Switzerland-The potential of national claims data for surveillance. Influenza Other Respir Viruses 2023; 17:e13206. [PMID: 37840841 PMCID: PMC10570900 DOI: 10.1111/irv.13206] [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: 04/14/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023] Open
Abstract
Background Swiss national surveillance of influenza vaccination uptake rates (VURs) relies on self-reported vaccination status. The aim of this study was to determine VURs among at-risk patients, namely, patients ≥65 of age and adult patients with chronic diseases, using claims data, instead of self-reported measures, to investigate factors of vaccine uptake, and to assess different methodological approaches to conduct vaccination surveillance. Methods In this retrospective cross-sectional analysis, we determined VURs in three influenza seasons (2015/2016-2017/2018). Medication, diagnosis, or medical services claims were used as triggers to identify patients. For the calculation of VURs in patients with chronic diseases, we identified those by triggers in the given season only (Model 1) and in the given and previous seasons (Model 2). Regression analysis was used to identify factors associated with vaccination status. Results Data from 214,668 individual patients were analyzed. VURs over all seasons ranged from 18.4% to 19.8%. Most patients with chronic diseases were identified with the medication trigger, and we found no clinical significant differences in VURs comparing both models. Having a chronic disease, age, male gender, and regular health care provider visits were associated with increased odds of being vaccinated. Conclusions VURs were below the recommended thresholds, and our analysis highlighted the need for efforts to increase VURs. We assessed the identification of chronic diseases by medication claims and the calculation of VURs based on data of the given season only as an effective approach to conduct vaccination surveillance. Claims data-based surveillance may complete the national surveillance.
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Affiliation(s)
- Andreas Plate
- Institute of Primary CareUniversity of Zurich and University Hospital ZurichZurichSwitzerland
| | | | - Thomas Rosemann
- Institute of Primary CareUniversity of Zurich and University Hospital ZurichZurichSwitzerland
| | - Oliver Senn
- Institute of Primary CareUniversity of Zurich and University Hospital ZurichZurichSwitzerland
| | - Stefania Di Gangi
- Institute of Primary CareUniversity of Zurich and University Hospital ZurichZurichSwitzerland
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Storch J, Meissner F, Böde M, Kwetkat A, Pletz MW, Freytag A. [Once vaccinated, always vaccinated? A claims data analysis on repeated influenza vaccinations among individuals aged ≥ 60 years]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:953-961. [PMID: 37291252 PMCID: PMC10249936 DOI: 10.1007/s00103-023-03716-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/04/2023] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- Josephine Storch
- Universitätsklinikum Jena, Institut für Allgemeinmedizin, Friedrich-Schiller-Universität, Bachstr. 18, 07743, Jena, Deutschland.
- Internationale Graduierten Akademie, Medizinische Fakultät, Institut für Gesundheits- und Pflegewissenschaft, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - Franziska Meissner
- Universitätsklinikum Jena, Institut für Allgemeinmedizin, Friedrich-Schiller-Universität, Bachstr. 18, 07743, Jena, Deutschland
| | - Monique Böde
- Universitätsklinikum Jena, Institut für Allgemeinmedizin, Friedrich-Schiller-Universität, Bachstr. 18, 07743, Jena, Deutschland
| | - Anja Kwetkat
- Klinik für Geriatrie und Palliativmedizin, Klinikum Osnabrück, Osnabrück, Deutschland
| | - Mathias W Pletz
- Universitätsklinikum Jena, Institut für Infektionsmedizin und Krankenhaushygiene, Friedrich-Schiller-Universität, Jena, Deutschland
| | - Antje Freytag
- Universitätsklinikum Jena, Institut für Allgemeinmedizin, Friedrich-Schiller-Universität, Bachstr. 18, 07743, Jena, Deutschland
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Influenza Vaccination among Multiple Sclerosis Patients during the COVID-19 Pandemic. Vaccines (Basel) 2022; 10:vaccines10101766. [PMID: 36298631 PMCID: PMC9612003 DOI: 10.3390/vaccines10101766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
In the context of the COVID-19 pandemic, the co-circulation of influenza and SARS-CoV-2 viruses may have severe complications for vulnerable populations. For this reason, the World Health Organization pointed to the 2020-2021 anti-influenza campaign as being of special relevance. Our aim was to assess the 2020-2021 influenza vaccination coverage, and its associated factors, among patients in a Spanish multiple sclerosis (MS) unit. A cross-sectional study was conducted. People attending the MS unit of the Clinical Hospital of Zaragoza during 2020 were included. Variables were obtained by reviewing records. Associations with 2020-2021 influenza vaccination were analyzed using bivariate analysis and a multiple logistic regression model. A total of 302 patients were studied; 62.6% were women, whose mean age (standard deviation) was 47.3 (11.5) years. The 2020-2021 influenza vaccination coverage was 55.3% (59.8% in women and 47.8% in men). A total of 89.7% had at least one other indication for vaccination (e.g., immunosuppressive treatment in 225 patients). The variables associated with getting vaccinated were being female (adjusted odds ratio (95% confidence interval) (aOR (95%CI) = 2.12 (1.12-3.99)), having received the 2019-2020 influenza vaccine (aOR (95%CI) = 31.82 (14.71-68.86)) and being born in Spain (aOR (95%CI) = 12.91 (1.07-156.28)). Coverage is moderate compared to other countries. It is necessary to develop strategies to improve it, especially in men and those born outside Spain.
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Damm O, Krefft A, Ahlers J, Kramer R, Witte J, Batram M, Schelling J, Greiner W. Prevalence of chronic conditions and influenza vaccination coverage rates in Germany: Results of a health insurance claims data analysis. Influenza Other Respir Viruses 2022; 17:e13054. [PMID: 36181357 PMCID: PMC9835435 DOI: 10.1111/irv.13054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/25/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The significant annual burden caused by seasonal influenza has led to global calls for increased influenza vaccination coverage rates (VCRs). We aimed to estimate the proportion of the German population at high risk of serious illness from influenza due to chronic conditions and to estimate age-specific VCRs of people with/without chronic conditions. METHODS Using health insurance claims data covering nine influenza seasons (2010-2019), we assessed up to 7 million insured individuals per season across all German regions. Individuals were classified according to age and presence of chronic health conditions. VCRs were estimated using outpatient healthcare utilization documentation. RESULTS In the 2018-2019 influenza season, 47.3% of individuals had ≥1 chronic condition. Most common were circulatory disorders, accounting for more than a third of individuals with ≥1 condition. Prevalence of chronic diseases, and therefore the proportion of high-risk individuals, increased slightly over time across most age groups. A downward trend in influenza VCRs was observed in all age groups until the 2017-2018 season, followed by a noticeable increase in the 2018-2019 season. Highest VCRs occurred among individuals of ≥60 years, with a 38.5% VCR for this age group in the 2018-2019 season. Several factors, including age, chronic condition type, and geographical location, affected VCRs. CONCLUSIONS Influenza VCRs in individuals at high risk of severe complications from influenza infection are insufficient. Our results suggest that intensified public health efforts are necessary to reach the World Health Organization vaccination coverage target of 75%.
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Affiliation(s)
- Oliver Damm
- Sanofi‐Aventis Deutschland GmbHBerlinGermany
| | - Anya Krefft
- Sanofi‐Aventis Deutschland GmbHBerlinGermany
| | | | - Rolf Kramer
- Sanofi‐Aventis Deutschland GmbHBerlinGermany
| | - Julian Witte
- School of Public HealthBielefeld UniversityBielefeldGermany,Vandage GmbHBielefeldGermany
| | | | - Jörg Schelling
- Medical FacultyLudwig‐Maximilians‐UniversityMunichGermany
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Influenza Vaccination Coverage among Multiple Sclerosis Patients: Evolution over Time and Associated Factors. Vaccines (Basel) 2022; 10:vaccines10071154. [PMID: 35891321 PMCID: PMC9322179 DOI: 10.3390/vaccines10071154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/01/2022] [Accepted: 07/18/2022] [Indexed: 02/05/2023] Open
Abstract
Our objective was to determine the influenza vaccination rate in a Spanish cohort of multiple sclerosis (MS) patients. A retrospective cohort study was carried out. Patients who attended the MS unit of the Lozano Blesa Hospital of Zaragoza between January 2015 and 2020 were included. The variables were obtained by reviewing the specialized and primary care records. Associations between receiving the vaccine in each flu season and the other variables were analyzed using bivariate analysis and multiple logistic regression models. A total of 260 patients were studied, with a median age of 31 years at the time of diagnosis. A total of 62.3% (162/260) were women. Vaccination coverage ranged from 20.4% in the 2015−2016 and 2016−2017 seasons to 41.5% in the 2019−2020 season (p = 0.000). Having been vaccinated in the previous season (ORa: 16.47−390.22; p = 0.000) and receiving a vaccination recommendation from the hospital vaccination unit (ORa: 2.44−3.96; p < 0.009) were associated with being vaccinated. The coverage is in an intermediate position compared to other countries. It is necessary to improve the referral system of these patients to the hospital vaccination unit because the information obtained by this service contributed to higher vaccination rates.
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Vaccination of Elderly People Affected by Chronic Diseases: A Challenge for Public Health. Vaccines (Basel) 2022; 10:vaccines10050641. [PMID: 35632397 PMCID: PMC9147219 DOI: 10.3390/vaccines10050641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 12/25/2022] Open
Abstract
Elderly people have a limited regenerative capacity and are more susceptible to disease, syndromes, injuries, and illnesses than younger adults [...]
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Effects of Influenza Vaccination in Patients with Interstitial Lung Diseases: An Epidemiological Claims Data Analysis. Ann Am Thorac Soc 2022; 19:1479-1488. [PMID: 35312465 PMCID: PMC9447394 DOI: 10.1513/annalsats.202112-1359oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Rationale Vaccination is the most effective protection against influenza. Patients with interstitial lung diseases (ILDs) represent a high-risk group for influenza complications. Thus, yearly influenza vaccination is recommended, but evidence on its effects is sparse. Objectives This study aimed to compare all-cause mortality and all-cause and respiratory-related hospitalization between vaccinated and unvaccinated patients with ILD. Methods Using data from the largest German statutory health insurance fund (about 27 million insurees in 2020), we analyzed four influenza seasons from 2014–2015 to 2017–2018 and compared vaccinated with unvaccinated patients with ILD. Starting from September 1 of each year, we matched vaccinated and unvaccinated patients in a 1:1 ratio using a rolling cohort design. Mortality and hospitalization were compared with Kaplan-Meier plots, and effects were calculated during the influenza season (in season) with risk ratios. Results Both the vaccinated and the unvaccinated cohorts included 7,503 patients in 2014–2015, 10,318 in 2015–2016, 12,723 in 2016–2017, and 13,927 in 2017–2018. Vaccination rates were low at 43.2% in season 2014–2015 and decreased over time to 39.9% in season 2017–2018. The risk ratios for all-cause mortality were 0.79 (95% confidence interval [CI], 0.65–0.97; P = 0.02) in season 2014–2015, 0.66 (95% CI, 0.54–0.80; P < 0.001) in 2015–2016, 0.89 (95% CI, 0.76–1.04; P = 0.15) in 2016–2017, and 0.95 (95% CI, 0.81–1.12; P = 0.57) in 2017–2018. The effects on all-cause hospitalization and respiratory-related hospitalization were similar in all seasons. Conclusions Although an unequivocally beneficial impact of influenza vaccination in patients with ILD could not be demonstrated, we observed promising results regarding avoidance of all-cause mortality in half of the seasons observed. Given the low vaccination rates, further efforts are necessary to improve vaccination rates in patients with ILD.
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Sanz-Rojo S, Jiménez-García R, López-de-Andrés A, de Miguel-Diez J, Perez-Farinos N, Zamorano-León JJ. Influenza vaccination uptake among high-risk target groups and health care workers in Spain and change from 2017 to 2020. Vaccine 2021; 39:7012-7020. [PMID: 34742593 DOI: 10.1016/j.vaccine.2021.10.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/10/2021] [Accepted: 10/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Using the 2020 European Health Survey for Spain (EHSS2020), which ran from July 2019 to July 2020, we aimed to describe influenza vaccination uptake among the following target groups; individuals aged ≥65 years, health care workers (HCWs), and persons with high-risk chronic medical conditions. We analyzed changes in uptake since the previous Spanish National Health Interview Survey conducted in 2017 and identified variables associated with vaccine uptake. METHODS We performed a cross-sectional study. The primary study variable was the self-reported uptake of influenza vaccine in the previous year. We analyzed sex, age, country of birth, and being an HCW. We identified participants with self-reported respiratory diseases, cardiovascular disease, diabetes, cancer, and cerebrovascular diseases. Multivariable logistic regression was applied to assess changes over time and to identify variables associated with vaccination in target groups. RESULTS Uptake was 19.2% in 22,072 participants aged ≥15 years. Uptake was 54.4% for those aged ≥65 years, 41.6% for those with a high-risk medical condition, and 26.53% among HCWs. Uptake by disease was 52.1% for cerebrovascular diseases, 51.3% for cardiovascular diseases, 48.3% for diabetes, 46.1% for cancer, and 36.2% for respiratory diseases. No significant improvement has been observed since 2017 in any target group, except for participants with cancer, whose uptake increased from 33.2% to 46.1%(p < 0.001). The variables that significantly increased the probability of reporting vaccine uptake were female sex, age ≥35 years, being born in Spain, self-reported respiratory or cardiovascular diseases, diabetes, cancer, and being a HCW. CONCLUSIONS Influenza vaccination uptake among target groups in Spain is below desirable levels and has not improved significantly since 2017. Older age, female sex, and being born in Spain are positive predictors of vaccine uptake. The COVID-19 pandemic highlights the urgent need to implement new strategies to increase influenza vaccine uptake.
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Affiliation(s)
- Sara Sanz-Rojo
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense, Madrid, Spain
| | - Rodrigo Jiménez-García
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense, Madrid, Spain.
| | - Ana López-de-Andrés
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense, Madrid, Spain
| | - Javier de Miguel-Diez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
| | - Napoleón Perez-Farinos
- Public Health and Psychiatry Department, Faculty of Medicine, Universidad de Málaga, Málaga, Spain
| | - José J Zamorano-León
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense, Madrid, Spain
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Loubet P, Rouvière J, Merceron A, Launay O, Sotto A. Patients' Perception and Knowledge about Influenza and Pneumococcal Vaccination during the COVID-19 Pandemic: An Online Survey in Patients at Risk of Infections. Vaccines (Basel) 2021; 9:vaccines9111372. [PMID: 34835303 PMCID: PMC8623007 DOI: 10.3390/vaccines9111372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION The objective of our study was to assess, in an at-risk population, perception and knowledge about influenza and pneumococcal vaccinations. METHODS An anonymous web-based survey was submitted to patients recruited in France, from both an Ipsos internal panel and AVNIR patient associations. The study was conducted between July and October 2020, in the context of the COVID-19 pandemic. RESULTS Overall, 2177 questionnaires from patients at risk of infection were analyzed. Almost all respondents (86%, 1869/2177) declared themselves to be favorable to vaccination. Nearly half of the patients (49%, 1069/2177) were aware of which vaccine was recommended for their specific situation. This percentage was significantly (p < 0.001) higher for members of a patient association and for people affected by multiple chronic conditions and varied according to the type of condition. Almost two-thirds of patients (1373/2177) declared having been vaccinated during the 2019/2020 influenza season, and 41% (894/2177) were certain about being up to date with the pneumococcal vaccination. The main barriers to vaccination for influenza are the fear of side effects, doubt regarding the efficacy of the vaccine and for pneumococcal vaccination, and the absence of suggestions by the healthcare professionals (HCPs), as 64% of respondents were not recommended to obtain pneumococcal vaccination. To improve vaccine coverage, information is of prime importance and GPs are recognized as the main HCP to inform about vaccination. Nearly two-thirds (62%, 1360/2177) of patients declared that the COVID-19 pandemic convinced them to have all the recommended vaccines. CONCLUSION Our study highlighted the nonoptimal vaccine coverage in at-risk populations despite a highly positive perception of vaccines and confirmed that physicians are on the front lines to suggest and recommend these vaccinations, especially in the current pandemic context, which may be used to promote other vaccines.
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Affiliation(s)
- Paul Loubet
- INSERM U1047, Department of Infectious and Tropical Diseases, CHU Nîmes, Université Montpellier, 30900 Nîmes, France;
- Correspondence: ; Tel.: +33-4-66-68-41-49
| | | | | | - Odile Launay
- Faculté de Médecine Paris Descartes, Université de Paris, AP-PH, Inserm, CIC Cochin Pasteur, 75231 Paris, France;
| | - Albert Sotto
- INSERM U1047, Department of Infectious and Tropical Diseases, CHU Nîmes, Université Montpellier, 30900 Nîmes, France;
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Holstiege J, Akmatov MK, Kohring C, Dammertz L, Ng F, Czihal T, von Stillfried D, Bätzing J. Patients at high risk for a severe clinical course of COVID-19 - small-area data in support of vaccination and other population-based interventions in Germany. BMC Public Health 2021; 21:1769. [PMID: 34583657 PMCID: PMC8478008 DOI: 10.1186/s12889-021-11735-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/29/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Research has shown that the risk for a severe course of COVID-19 is increased in the elderly population and among patients with chronic conditions. The aim of this study was to provide estimates of the size of vulnerable populations at high risk for a severe COVID-19 course in Germany based on the currently available risk factor data. METHODS We used nationwide outpatient claims data from the years 2010 to 2019 collected according to § 295 of the Code of Social Law V, covering data for all statutory health insurees (SHI) which is nearly 87% of the entire German population. We considered 15 chronic disorders based on the current state of knowledge about clinically relevant risk factors. Three risk groups for a severe COVID-19 course were defined: 1. individuals in the age group 15 to 59 years with at least two comorbid disorders; 2. individuals aged 60 to 79 years with at least one disorder and 3. all individuals 80 years and older irrespective of the presence of chronic conditions. Regional analysis was conducted at the level of administrative districts (n = 401). RESULTS Overall, 26% of individuals over 15 years were at high risk for a severe COVID-19 course in 2019 amounting to a total number of nearly 18.5 million individuals in Germany. This included 3.8 million individuals in risk group 1, 9.2 million in risk group 2, and 5.4 million in risk group 3, corresponding to 8, 50 and 100% of German inhabitants in the respective age groups. On the level of the 17 administrative regions formed by the Association of SHI Physicians (ASHIP regions), the proportion of individuals at high risk ranged between 21% in Hamburg and 35% in Saxony-Anhalt. Small-area estimates varied between 18% in Freiburg (Baden-Württemberg) and 39% in the district Elbe-Elster (Brandenburg). CONCLUSIONS The present study provides small-area estimates of populations at high risk for a severe COVID-19 course. These data are of particular importance for planning of preventive measures such as vaccination. TRIAL REGISTRATION not applicable.
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Affiliation(s)
- Jakob Holstiege
- Central Research Institute of Ambulatory Health Care, Salzufer 8, 10587, Berlin, Germany.
| | - Manas K Akmatov
- Central Research Institute of Ambulatory Health Care, Salzufer 8, 10587, Berlin, Germany
| | - Claudia Kohring
- Central Research Institute of Ambulatory Health Care, Salzufer 8, 10587, Berlin, Germany
| | - Lotte Dammertz
- Central Research Institute of Ambulatory Health Care, Salzufer 8, 10587, Berlin, Germany
| | - Frank Ng
- Central Research Institute of Ambulatory Health Care, Salzufer 8, 10587, Berlin, Germany
| | - Thomas Czihal
- Central Research Institute of Ambulatory Health Care, Salzufer 8, 10587, Berlin, Germany
| | - Dominik von Stillfried
- Central Research Institute of Ambulatory Health Care, Salzufer 8, 10587, Berlin, Germany
| | - Jörg Bätzing
- Central Research Institute of Ambulatory Health Care, Salzufer 8, 10587, Berlin, Germany
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12
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Steffen A, Rieck T, Siedler A. Monitoring of Influenza Vaccination Coverage among Pregnant Women in Germany Based on Nationwide Outpatient Claims Data: Findings for Seasons 2014/15 to 2019/20. Vaccines (Basel) 2021; 9:vaccines9050485. [PMID: 34064546 PMCID: PMC8150878 DOI: 10.3390/vaccines9050485] [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: 04/13/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022] Open
Abstract
Pregnant women and their infants are at increased risk for severe influenza-related complications. A decade has passed since influenza vaccination was first recommended for pregnant women in Germany in 2010; however, monitoring of vaccination coverage (VC) has not yet been implemented for this target group. Using nationwide outpatient claims data, we here provide results on influenza VC among pregnant women in Germany for seasons 2014/15 to 2019/20. For any given season, pregnant women were defined as women who had undergone prenatal health care in at least two consecutive quarters within a season. VC increased from 9.0% in season 2014/15 to 16.6% in 2019/20 (+84%), while most of the increase occurred from season 2016/17 (VC: 9.9%) onwards (+68%). Consistently across seasons, women in east Germany were 40 to 60% more likely to be vaccinated compared to women residing in west Germany. According to age, the highest VC was observed among women aged 35 to <40 years (2019/20: 18.2%). Despite noticeable increases in influenza VC during recent years, overall coverage remains low among pregnant women. Starting with this analysis, VC among pregnant women in Germany will be monitored on a yearly basis in order to detect trends and identify immunization gaps.
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