1
|
Abouqal R, Beji M, Chakroun M, Marhoum El Filali K, Rammaoui J, Zaghden H. Trends in Adult and Elderly Vaccination: Focus on Vaccination Practices in Tunisia and Morocco. Front Public Health 2022; 10:903376. [PMID: 35844850 PMCID: PMC9286557 DOI: 10.3389/fpubh.2022.903376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/09/2022] [Indexed: 11/25/2022] Open
Abstract
Vaccine preventable diseases (VPDs) are a prevailing concern among the adult population, despite availability of vaccines. Unlike pediatric vaccination programs, adult vaccination programs lack the required reach, initiative, and awareness. Clinical studies and real-world data have proven that vaccines effectively reduce the disease burden of VPDs and increase life expectancy. In Tunisia and Morocco, the national immunization program (NIP) focuses more on pediatric vaccination and have limited vaccination programs for adults. However, some vaccination campaigns targeting adults are organized. For example, influenza vaccination campaigns prioritizing at risk adults which includes healthcare professionals, elderly, and patients with comorbidities. Women of childbearing age who have never been vaccinated or whose information is uncertain are recommended to receive tetanus vaccination. Tunisia NIP recommends rubella vaccine mainly for women of childbearing age, while in Morocco, national vaccination campaigns were organized for girls and women (up to 24 years of age) to eliminate rubella. Further, travelers from both countries are recommended to follow all requirements and recommendations in the travel destination. The objective of this manuscript is to provide an overview of the global disease burden of common VPDs including (but not limited to) meningococcal diseases, pneumococcal diseases, hepatitis, and influenza. The review also provides an overview of clinical data and guidelines/recommendations on adult vaccination practices, with special focus on Tunisia and Morocco. Some European and North American countries have concrete recommendations and strategies for adult vaccination to keep the VPDs in check. In Morocco and Tunisia, although, there are sporadic adult vaccination initiatives, the efforts still need upscaling and endorsements to boost vaccination awareness and uptake. There is a need to strengthen strategies in both countries to understand the disease burden and spread awareness. Additional studies are needed to generate economic evidence to support cost-effectiveness of vaccines. Integration of private and public healthcare systems may further improve vaccination uptake in adults.
Collapse
Affiliation(s)
- Redouane Abouqal
- Laboratory of Biostatistics, Clinical and Epidemiological Research, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
- Acute Medical Unit, Ibn Sina University Hospital, Rabat, Morocco
| | - Maher Beji
- Department of Internal Medicine, Military Hospital Bizerte, Bizerte, Tunisia
- Faculty of Medicine of Tunis, University El Manar, Tunis, Tunisia
- Tunisian Society of Tropical Medicine and Travel, Tunis, Tunisia
| | - Mohamed Chakroun
- Infectious Diseases Department, University Hospital, Monastir, Tunisia
| | | | | | | |
Collapse
|
2
|
Bell MR, Kutzler MA. An old problem with new solutions: Strategies to improve vaccine efficacy in the elderly. Adv Drug Deliv Rev 2022; 183:114175. [PMID: 35202770 DOI: 10.1016/j.addr.2022.114175] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/09/2022] [Accepted: 02/18/2022] [Indexed: 11/01/2022]
Abstract
Vaccination is the most effective measure to protect against infections. However, with increasing age, there is a progressive decline in the ability of the immune system to both protect against infection and develop protective immunity from vaccination. This age-related decline of the immune system is due to age-related changes in both the innate and adaptive immune systems. With an aging world population and increased risk of pandemics, there is a need to continue to develop strategies to increase vaccine responses in the elderly. Here, the major age-related changes that occur in both the innate and adaptive immune responses that impair the response to vaccination in the elderly will be highlighted. Existing and future strategies to improve vaccine efficacy in the elderly will then be discussed, including adjuvants, delivery methods, and formulation. These strategies provide mechanisms to improve the efficacy of existing vaccines and develop novel vaccines for the elderly.
Collapse
|
3
|
Autran B. [Alterations in responses to vaccines in older people]. Rev Mal Respir 2019; 36:1047-1056. [PMID: 31522947 DOI: 10.1016/j.rmr.2019.07.008] [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: 06/04/2019] [Accepted: 07/08/2019] [Indexed: 11/28/2022]
Abstract
The aging population raises a number of public health issues including a need to address the severity and frequency of infections observed in older people. Vaccines play an important role in prevention. However, immunosenescence alters the intensity and quality of vaccine responses, thus limiting the impact of recommendations directed after 65 years for vaccination against flu, pneumococci, pertussis, tetanus and zoster. Immunosenescence, aggravated by co-morbidities, varies with age, becoming apparent after 60-65 years and more profound after 85 years. All stages of vaccine responses are affected by immunosenescence, from the innate immunity required to activate these responses to the induction of protective antibody responses and immune memory. Nevertheless, the capacity to develop new responses to primary vaccination is more affected than the ability to respond to recalls, although this is also impaired. Responses to vaccines are differentially altered depending on vaccine and age. Influenza vaccines are modestly immunogenic and several meta-analyses agree an estimate for efficacy of about 50% against virologically-proven flu and 40% against flu-related deaths. The anti-pneumococcal 23-valent non-conjugated vaccine does not induce memory while the 13-valent conjugated one does, but their efficacy are likely to be similar between 70 to 52% before 75 years. A sequential vaccination program with the 13-valent primo-vaccination followed by the 23-valent, recommended in immune-suppressed patients, is currently being studied in France. The waning of immunity to pertussis makes recalls necessary in the elderly who develop good antibody responses. Several research avenues are currently being pursued to try improve the degree of protection conferred by these vaccines in elderly.
Collapse
Affiliation(s)
- B Autran
- Sorbonne-université, 75005 Paris, France; UMR-S Inserm/UPMC 1135), CIMI-Paris (centre de recherches immunité maladies infectieuses), 83, boulevard de l'Hôpital, 75013 Paris, France.
| |
Collapse
|
4
|
Harrington CC. Evidence-Based Practice Guideline: Assessing Heart Failure in Long-Term Care Facilities. J Gerontol Nurs 2019; 45:18-24. [PMID: 30985905 DOI: 10.3928/00989134-20190409-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Evidence suggests the most crucial elements to successful heart failure (HF) management in long-term care (LTC) include improving staffs' HF knowledge to recognize and intervene in early symptom exacerbations, embedding an effective and integrated interprofessional communication system into daily care processes, risk stratification, and anticipatory advanced care planning. Despite a large body of evidence describing best practices, quality HF management remains elusive in LTC facilities. Studies have shown that care quality and outcomes improve when the entire team, including direct caregivers, have an active role in residents' care planning and implementation. The current article summarizes a revised evidence-based practice guideline on assessing HF, addressing a systematic approach to care delivery, and implementing evidence-based best practices for HF quality improvement initiatives in LTC, post-acute care, and short-term rehabilitation settings. [Journal of Gerontological Nursing, 45(7), 18-24.].
Collapse
|
5
|
Wang S, Hu YJ, Little P, Wang Y, Chang Q, Zhou X, Moore M, Harwell JI. The impact of the national action plan on the epidemiology of antibiotic resistance among 352,238 isolates in a teaching hospital in China from 2015 to 2018. Antimicrob Resist Infect Control 2019; 8:22. [PMID: 30728954 PMCID: PMC6352357 DOI: 10.1186/s13756-019-0473-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/14/2019] [Indexed: 12/16/2022] Open
Abstract
Background We sought to understand the epidemiology and characteristics of antimicrobial resistance (AMR) and the impact of the National Action Plan (NAP) on AMR. This information will be critical to develop interventions and strengthen antibiotic stewardship in hospital settings in China. Methods Cross-sectional data collection from the hospital information management system from 1 January 2015 to 30 August 2018. Variables included patient age, sex, diagnosis, hospital department and antibiotic sensitivity test. T-test for two samples method was applied to compare the results before and after NAP implementation. Multivariate analysis with binary logistic regression was conducted to examine the associations of risk factors for antimicrobial resistance. Results In total there were 352,238 isolates in the final analysis after excluding contamination strains and isolates with incomplete information. More than 50% of patients were > 66 years old. 62% were male. 40% of the total samples were sputum. Among the total sample, the total resistance rate was 42% among all isolates. The rate of resistance to all antibiotics declined by 5.3% (95% CI 4.96-5.64%, p < 0.0001) and culture positivity rate declined by 9.8% (95% CI 9.22-10.34%, p < 0.0001) after NAP. Logistical regression showed that the NAP had effect with an adjusted odds ratio of 0.76 (95% CI 0.71-0.81, p = 0.002). Being male, age > 65 years, ICU department, diagnosed with certain diseases were more likely to be associated with antimicrobial resistance. Conclusions Antibiotic resistance rates were high in this teaching hospital. However, the introduction of the China NAP since 2016 followed by hospital policy emphasis was associated with a declining AMR trend. Policies will need to incorporate antimicrobial stewardship with a focus on certain departments, with infection control practices and with increases in vaccination coverage among elderly.
Collapse
Affiliation(s)
- Shanjuan Wang
- Shanghai General Practice Medical Education and Research Center, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, No 1 Chengbei Rd, Jiading, Shanghai, 201800 China
| | - Yanhong Jessika Hu
- School of Public Health, The University of Hong Kong, G/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST UK
| | - Yifei Wang
- Shanghai General Practice Medical Education and Research Center, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, No 1 Chengbei Rd, Jiading, Shanghai, 201800 China
| | - Qing Chang
- Shanghai General Practice Medical Education and Research Center, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, No 1 Chengbei Rd, Jiading, Shanghai, 201800 China
| | - Xudong Zhou
- School of Public Health, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058 Zhejiang China
| | - Michael Moore
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST UK
| | - Joseph Irvin Harwell
- Clinical Science Team, Clinton Health Access Initiative, 383 Dorchester Ave, Boston, MA 02127 USA
| |
Collapse
|
6
|
Lundgren FLC. Getting to know our pneumococcus. J Bras Pneumol 2018; 44:343-344. [PMID: 30517332 PMCID: PMC6467601 DOI: 10.1590/s1806-37562018000050002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Fernando Luiz Cavalcanti Lundgren
- . Coordenador de Residência em Pneumologia, Hospital Otávio de Freitas, Recife (PE) Brasil.,. Presidente da Sociedade Brasileira de Pneumologia e Tisiologia, Brasília (DF) Brasil
| |
Collapse
|
7
|
Jolin J, van Aalst R, Volpp B, Taylor T, Cohen E. Using an Inpatient Quality Improvement Curriculum for Internal Medicine Residents to Improve Pneumococcal Conjugate Vaccine Administration Rates. Jt Comm J Qual Patient Saf 2018; 44:328-333. [PMID: 29793882 DOI: 10.1016/j.jcjq.2017.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/15/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND Pneumococcal infections are an important source of morbidity and mortality in older adults and persons with compromised immune systems. New recommendations from the Advisory Committee on Immunization Practices (ACIP) became available September 2014, which included recommendations for the use of the 13-valent pneumococcal conjugate vaccine (PCV13). A study was conducted to increase the PCV13 vaccination rates of hospitalized patients at the White River Junction Veterans Affairs Medical Center (White River Junction, Vermont) through the use of a resident-driven quality improvement (QI) project. METHODS From December 2014 through April 2016, 16 internal medicine inpatient residents addressed inpatient PCV13 vaccination rates by participating in the facility's QI curriculum. Eight Plan-Do-Study-Act cycles were used, including discharge template editing, electronic reminders, and the discovery of a vaccination administration documentation error in the record through data validation. The measure was the monthly percentage of patients who received PCV13 vaccination (vaccination completion rate) of those discharged from the hospital medicine service who were due for PCV13 vaccination. RESULTS The percentage of veterans discharged with an up-to-date PCV13 vaccination on discharge increased from approximately 30% to 87% and was sustained. CONCLUSION Despite being driven by many different residents, this project demonstrates that continuous improvement can be achieved through a structured and iterative process while providing active learning of core QI concepts to residents. It also displays a method in which new guidelines can be incorporated into practice in an effective manner. Finally, this project is an example of how resident-driven data validation can lead to further improvement.
Collapse
|
8
|
Morton JB, Morrill HJ, LaPlante KL, Caffrey AR. Predictors of Mortality Among U.S. Veterans With Streptococcus Pneumoniae Infections. Am J Prev Med 2017; 52:769-777. [PMID: 27988089 DOI: 10.1016/j.amepre.2016.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 09/13/2016] [Accepted: 10/14/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Serious Streptococcus pneumoniae infections, encompassing pneumonia, bacteremia, and meningitis, are a major cause of mortality. However, literature regarding mortality is often limited to invasive pneumococcal disease, excluding pneumonia. This study sought to identify predictors of mortality among adults with serious pneumococcal disease, including pneumonia and invasive pneumococcal disease. METHODS This was a nested case-control study of unvaccinated older Veterans with positive S. pneumoniae cultures (blood, cerebrospinal fluid, respiratory) admitted to Veterans Affairs medical centers nationally between 2002 and 2011. Patients vaccinated against pneumococcal disease were excluded. Using multivariable logistic regression, predictors of 30-day mortality were identified, including patient demographics, comorbidities during admission, and medical history within the previous year. RESULTS Among 9,468 patients, there were 9,730 serious pneumococcal infections; 1,764 (18.6%) resulted in death within 30 days (cases), whereas 7,966 did not (controls). Pneumonia accounted for half (49.4%, n=871) of all deaths. Mortality predictors consistent with vaccine recommendations included dialysis (during hospitalization, OR=3.35, 95% CI=2.37, 4.72), moderate to severe liver disease (during hospitalization, OR=2.47, 95% CI=1.53, 3.99; within 1 year, OR=1.49, 95% CI=1.01, 2.20), and neutropenia (during hospitalization, OR=2.67, 95% CI=1.32, 5.42). Predictors not included in current recommendations included dementia (during hospitalization, OR=1.8, 95% CI=1.23, 2.61) and neurologic disorders (during hospitalization, OR=1.86, 95% CI=1.42, 2.45; within 1 year, OR=1.28, 95% CI=1.02, 1.59). CONCLUSIONS Several mortality predictors among unvaccinated Veterans with serious pneumococcal disease were consistent with pneumococcal vaccine recommendations, including organ or immune system dysfunction-related conditions. Other predictors, including neurologic disorders or dementia, may warrant expanded vaccination recommendations.
Collapse
Affiliation(s)
- Jacob B Morton
- Veterans Affairs Medical Center, Infectious Diseases Research Program and Center of Innovation in Long Term Services and Supports, Providence, Rhode Island; Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island
| | - Haley J Morrill
- Veterans Affairs Medical Center, Infectious Diseases Research Program and Center of Innovation in Long Term Services and Supports, Providence, Rhode Island; Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island
| | - Kerry L LaPlante
- Veterans Affairs Medical Center, Infectious Diseases Research Program and Center of Innovation in Long Term Services and Supports, Providence, Rhode Island; Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island; Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Aisling R Caffrey
- Veterans Affairs Medical Center, Infectious Diseases Research Program and Center of Innovation in Long Term Services and Supports, Providence, Rhode Island; Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island; Brown University School of Public Health, Providence, Rhode Island.
| |
Collapse
|
9
|
Blasi F, Akova M, Bonanni P, Dartois N, Sauty E, Webber C, Torres A. Community-acquired pneumonia in adults: Highlighting missed opportunities for vaccination. Eur J Intern Med 2017; 37:13-18. [PMID: 27756499 DOI: 10.1016/j.ejim.2016.09.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 09/28/2016] [Accepted: 09/29/2016] [Indexed: 11/26/2022]
Abstract
Pneumococcal pneumonia remains a clear unmet medical need for adults worldwide. Despite advances in vaccine technology, vaccination coverage remains low, putting many people at risk of significant morbidity and mortality. The herd effect seen with paediatric vaccination is not enough to protect all older and vulnerable people in the community, and more needs to be done to increase the uptake of pneumococcal vaccination in adults. Several key groups are at increased risk of contracting pneumococcal pneumonia, and eligible patients are being missed in clinical practice. At present, community-acquired pneumonia costs over €10 billion annually in Europe alone. Pneumococcal conjugate vaccination could translate into preventing 200,000 cases of community-acquired pneumonia every year in Europe alone. This group calls on governments and decision makers to implement consistent age-based vaccination strategies, and for healthcare professionals in daily clinical practice to identify eligible patients who would benefit from vaccination strategies.
Collapse
Affiliation(s)
- Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Murat Akova
- Infectious Diseases Department, Hacettepe University School of Medicine, Ankara, Turkey
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Italy
| | | | | | - Chris Webber
- Pfizer Vaccine Clinical Research, Maidenhead, UK
| | - Antoni Torres
- Pulmonology Department, Hospital Clinic, University of Barcelona, IDIBAPS. CIBERES, Barcelona, Spain
| |
Collapse
|
10
|
Zhang YY, Tang XF, Du CH, Wang BB, Bi ZW, Dong BR. Comparison of dual influenza and pneumococcal polysaccharide vaccination with influenza vaccination alone for preventing pneumonia and reducing mortality among the elderly: A meta-analysis. Hum Vaccin Immunother 2016; 12:3056-3064. [PMID: 27629584 PMCID: PMC5215556 DOI: 10.1080/21645515.2016.1221552] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The purpose of this study was to perform a meta-analysis comparing the effectiveness of influenza vaccination alone versus influenza plus pneumococcal dual vaccination for the prevention of pneumonia and mortality in adults ≥ 65 years of age. Medline, Cochrane, CENTRAL, EMBASE, and Google Scholar databases were searched. Inclusion criteria were: 1) Randomized controlled trials (RCTs), 2-arm prospective studies, or retrospective cohort studies; 2) Patients were ≥ 65 years of age with or without chronic respiratory disease; 3) Patients received the influenza vaccine alone or dual pneumococcal and influenza vaccination; 4) Results included incidence of recurrent respiratory tract infections, length of hospital stay, and overall mortality rate. The outcomes were pneumonia and all-cause mortality rates. Of 142 studies identified in the database searches, 6 were ultimately included in the systematic review, and 5 were included in meta-analysis. The number of patients that received the influenza vaccination alone ranged from 211 to 29,346 (total = 53,107), and the number that received influenza+pneumococcal vaccination ranged from 246 to 72,107 (total = 102,068). Influenza+pneumococcal vaccination was associated with a significantly lower pneumonia rate than influenza vaccination alone (relative risk [RR] = 0.835, 95% confidence interval [CI]: 0.718–0.971, P = 0.019), and with a significantly lower all-cause mortality rate than influenza vaccination alone (relative risk [RR] = 0.771, 95% confidence interval [CI]: 0.707–0.842, P = 0.001). In conclusion, the results of this study support concomitant pneumococcal and influenza vaccination of the elderly as a dual vaccination strategy is associated with lower pneumonia and all-cause mortality rates.
Collapse
Affiliation(s)
- Yan-Yang Zhang
- a Henan Center for Disease Control and Prevention , Zhengzhou, Henan , China
| | - Xue-Feng Tang
- b Sichuan Center for Disease Control and Prevention , Chengdu, Sichuan , China.,c The Center of Gerontology and Geriatrics , West China Medical School/West China Hospital, Sichuan University , Chengdu, Sichuan , China
| | - Chang-Hui Du
- d Chengdu Center for Disease Control and Prevention , Chengdu, Sichuan , China
| | - Bin-Bing Wang
- e Anhui Center for Disease Control and Prevention , Hefei, Anhui , China
| | - Zhen-Wang Bi
- f Institute of Bacterial Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention , Jinan, Shandong , China
| | - Bi-Rong Dong
- c The Center of Gerontology and Geriatrics , West China Medical School/West China Hospital, Sichuan University , Chengdu, Sichuan , China
| |
Collapse
|
11
|
Ozisik L, Tanriover MD, Rigby S, Unal S. ADVICE for a healthier life: Adult Vaccination Campaign in Europe. Eur J Intern Med 2016; 33:14-20. [PMID: 27185062 DOI: 10.1016/j.ejim.2016.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/18/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
Immunization is one of the most effective public health measures to prevent disease. Despite relatively good vaccination rates in childhood in many parts of the world, vaccines to prevent diseases are underused in the adult population and adult vaccination rates are still far below the target. The European Federation of Internal Medicine (EFIM), declared that 'internal medicine must focus on better care for individuals, better health care for populations and lower costs'. Adult vaccination is a good example of a public health initiative aimed at reducing morbidity and mortality, but awareness of the need for adult vaccination and uptake of the programs across Europe is variable. The Adult Vaccination Campaign in Europe (ADVICE) was developed with an aim to raise awareness for adult vaccination and to understand the dynamics of the vaccination practices and the possible barriers against achieving targeted vaccination rates in Europe. In order to reach vaccination targets, we need evidence based, up to date guidelines; recommendations at national and international levels; surveillance for vaccination rates; and opportunities to provide vaccines more readily. Leadership at a European level and a firm research and action agenda are crucial. The European Federation of Internal Medicine can take the lead as it declared its interest on 'better care for individuals, better health care for populations'. Hence, we consider ADVICE a very timely and very valuable initiative to draw a roadmap to improve adult vaccination rates in Europe.
Collapse
Affiliation(s)
- Lale Ozisik
- Hacettepe University, Department of Internal Medicine, Ankara, Turkey
| | | | - Shirley Rigby
- Consultant Internal Medicine, South Warwickshire NHS Foundation Trust, Warwick CV34 5BW, UK
| | - Serhat Unal
- Hacettepe University, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| |
Collapse
|
12
|
MacDougall DM, Halperin SA. Immunization in Canada: Update for 2015. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2016; 60:6-12. [PMID: 27069261 PMCID: PMC4807675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Donna M MacDougall
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; School of Nursing, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| |
Collapse
|
13
|
Clinical and economic burden of community-acquired pneumonia in the Veterans Health Administration, 2011: a retrospective cohort study. Infection 2015; 43:671-80. [PMID: 25980561 PMCID: PMC4656694 DOI: 10.1007/s15010-015-0789-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/25/2015] [Indexed: 01/31/2023]
Abstract
Purpose The burden of community-acquired pneumonia (CAP) is not well described in the US Veterans Health Administration (VHA). Methods CAP was defined as having a pneumonia diagnosis with evidence of chest X-ray, and no evidence of prior (90 days) hospitalization/long-term care. We calculated incidence rates of adult CAP occurring in inpatient or outpatient VHA settings in 2011. We also estimated the proportion of VHA CAP patients who were hospitalized, were readmitted within 30 days of hospital discharge, and died (any cause) in the year following diagnosis. Incremental costs during the 90 days following a CAP diagnosis were estimated from the perspective of the VHA. Results In 2011, 34,101 Veterans developed CAP (35,380 episodes) over 7,739,757 VHA person-years. Median age of CAP patients was 65 years (95 % male). CAP incidence rates were higher for those aged ≥50 years. A majority of Veterans aged 50–64 (53 %) and ≥65 (66 %) years had ≥1 chronic medical (moderate risk) or immunocompromising (high risk) condition. Compared to those at low-risk (healthy), moderate- and high-risk Veterans were >3 and >6 times more likely to develop CAP, respectively. The percentage of CAP patients who were hospitalized was 45 %, ranging from 12 % (age 18–49, low risk) to 57 % (age ≥65, high risk). One-year all-cause mortality rates ranged from 1 % (age 18–49, low risk) to 36 % (age ≥65, high risk). Annual VHA medical expenditure related to CAP was estimated to be $750 million (M) ($415M for those aged ≥65 years). Conclusion A focus on CAP prevention among older Veterans and those with comorbid or immunocompromising conditions is important. Electronic supplementary material The online version of this article (doi:10.1007/s15010-015-0789-3) contains supplementary material, which is available to authorized users.
Collapse
|