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Lapi F, Marconi E, Fallani E, Salvatore M, Cambiaggi M, Rossi A, Cricelli C. Time lapses between distribution of influenza vaccines to health authorities and their administration by General Practitioners (GPs) to older adults: a retrospective study over five influenza seasons in Italy. Expert Rev Vaccines 2024; 23:8-15. [PMID: 38078867 DOI: 10.1080/14760584.2023.2291184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Delays in influenza vaccine delivery and administration can hinder vaccine coverage and protection. This study examines the differentials in distributing and administering adjuvanted trivalent (aTIV) and quadrivalent influenza vaccines (aQIV) to older adults in Italy's primary care setting and its potential impact on hospitalization risk over 5 epidemic seasons. METHODS Using a primary care database, individuals aged ≥ 65 years were selected. The proportion of vaccine distribution to regional authorities and subsequent administration by GPs was estimated using census data. Using quantile (median) regression, we examined the relationship between velocities of vaccine distribution and administration (doses/week) and the incidence of hospitalizations. RESULTS Over the 5 influenza seasons, the velocity of distribution and administration of aTIV/aQIV ranged 341-833 and 152-270 median doses/week; no trend was yielded for the difference between these velocities (p = 0.189) or vaccine coverage (p = 0.142). An association was observed for each differential dose/week between distributed and administered vaccines and all-cause hospitalizations with a 10% increase in 2017-2018, 54% in 2018-2019, and 12% in 2020-2021 season. CONCLUSIONS These findings highlight the importance of minimizing the time lapse between vaccine distribution and administration to mitigate the impact of influenza and address factors that contribute to vaccination barriers.
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Affiliation(s)
- Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Ettore Marconi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Elettra Fallani
- Seqirus S.r.l. 53035, Monteriggioni, Siena, Italy
- Department of Life Sciences; University of Siena, Siena, Italy
| | - Marco Salvatore
- Seqirus S.r.l. 53035, Monteriggioni, Siena, Italy
- Department of Life Sciences; University of Siena, Siena, Italy
| | | | - Alessandro Rossi
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
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Domnich A, Orsi A, Panatto D, Ogliastro M, Barca A, Bert F, Cereda D, Chironna M, Costantino C, Fiacchini D, Pariani E, Rizzo C, Volpe E, Icardi G. Population-level benefits of increasing influenza vaccination uptake among Italian older adults: results from a granular panel model. Front Public Health 2023; 11:1224175. [PMID: 37601177 PMCID: PMC10435743 DOI: 10.3389/fpubh.2023.1224175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Background The impact of seasonal influenza vaccination (SIV) on mortality is still controversial; some studies have claimed that increasing vaccination coverage rates is beneficial, while others have found no significant association. This study aimed to construct a granular longitudinal dataset of local VCRs and assess their effect on pneumonia- and influenza-related (P&I) mortality among Italian adults aged ≥ 65 years. Methods NUTS-3 (nomenclature of territorial units for statistics) level data on SIV coverage were collected via a survey of local data holders. Fixed- and random-effects panel regression modeling, when adjusted for potential confounders, was performed to assess the association between local SIV coverage rates and P&I mortality in older adults. Results A total of 1,144 local VCRs from 2003 to 2019 were ascertained. In the fully adjusted fixed-effects model, each 1% increase in vaccination coverage was associated (P < 0.001) with a 0.6% (95% CI: 0.3-0.9%) average over-time decrease in P&I mortality. With an annual average of 9,293 P&I deaths in Italy, this model suggested that 56 deaths could have been avoided each year by increasing SIV coverage by 1%. The random-effects model produced similar results. The base-case results were robust in a sensitivity analysis. Conclusion Over the last two decades, Italian jurisdictions with higher SIV uptake had, on average, fewer P&I deaths among older adults. Local policy-makers should implement effective strategies to increase SIV coverage in the Italian senior population.
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Affiliation(s)
- Alexander Domnich
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Andrea Orsi
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
| | - Donatella Panatto
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
| | - Matilde Ogliastro
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Alessandra Barca
- Directorate for Health and Social Policy, Lazio Region, Rome, Italy
| | - Fabrizio Bert
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Hygiene and Infection Control Unit, ASL TO3, Turin, Italy
| | - Danilo Cereda
- Directorate General for Health, Lombardy Region, Milan, Italy
| | - Maria Chironna
- Department of Interdisciplinary Medicine, University of Bari, Aldo Moro Policlinico, Bari, Italy
| | - Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D'Alessandro, ” University of Palermo, Palermo, Italy
| | | | - Elena Pariani
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Caterina Rizzo
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Enrico Volpe
- Directorate for Health and Social Policy, Lazio Region, Rome, Italy
| | - Giancarlo Icardi
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
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Matsuki E, Kawamoto S, Morikawa Y, Yahagi N. The Impact of Cold Ambient Temperature in the Pattern of Influenza Virus Infection. Open Forum Infect Dis 2023; 10:ofad039. [PMID: 36789010 PMCID: PMC9915965 DOI: 10.1093/ofid/ofad039] [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: 10/17/2022] [Accepted: 01/25/2023] [Indexed: 01/29/2023] Open
Abstract
Background Prior literature suggests that cold temperature strongly influences the immune function of animals and human behaviors, which may allow for the transmission of respiratory viral infections. However, information on the impact of cold stimuli, especially the impact of temporal change in the ambient temperature on influenza virus transmission, is limited. Methods A susceptible-infected-recovered-susceptible model was applied to evaluate the effect of temperature change on influenza virus transmission. Results The mean temperature of the prior week was positively associated with the number of newly diagnosed cases (0.107 [95% Bayesian credible interval {BCI}, .106-.109]), whereas the mean difference in the temperature of the prior week was negatively associated (-0.835 [95% BCI, -.840 to -.830]). The product of the mean temperature and mean difference in the temperature of the previous week were also negatively associated with the number of newly diagnosed cases (-0.192 [95% BCI, -.197 to -.187]). Conclusions The mean temperature and the mean difference in temperature affected the number of newly diagnosed influenza cases differently. Our data suggest that high ambient temperature and a drop in the temperature and their interaction increase the risk of infection. Therefore, the highest risk of infection is attributable to a steep fall in temperature in a relatively warm environment.
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Affiliation(s)
- Eri Matsuki
- Correspondence: Naohisa Yahagi, MD, PhD, Keio University, Graduate School of Media and Governance, 5322 Endo, Fujisawa-shi, Kanagawa 252-0882, Japan (); Eri Matsuki, MD, PhD, MPH, Keio University School of Medicine, Clinical and Translational Research Center, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan ()
| | - Shota Kawamoto
- Graduate School of Media and Governance, Keio University, Kanagawa, Japan
| | - Yoshihiko Morikawa
- Graduate School of Media and Governance, Keio University, Kanagawa, Japan
| | - Naohisa Yahagi
- Correspondence: Naohisa Yahagi, MD, PhD, Keio University, Graduate School of Media and Governance, 5322 Endo, Fujisawa-shi, Kanagawa 252-0882, Japan (); Eri Matsuki, MD, PhD, MPH, Keio University School of Medicine, Clinical and Translational Research Center, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan ()
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Song S, Li Q, Shen L, Sun M, Yang Z, Wang N, Liu J, Liu K, Shao Z. From Outbreak to Near Disappearance: How Did Non-pharmaceutical Interventions Against COVID-19 Affect the Transmission of Influenza Virus? Front Public Health 2022; 10:863522. [PMID: 35425738 PMCID: PMC9001955 DOI: 10.3389/fpubh.2022.863522] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Influenza shares the same putative transmission pathway with coronavirus disease 2019 (COVID-19), and causes tremendous morbidity and mortality annually globally. Since the transmission of COVID-19 in China, a series of non-pharmaceutical interventions (NPIs) against to the disease have been implemented to contain its transmission. Based on the surveillance data of influenza, Search Engine Index, and meteorological factors from 2011 to 2021 in Xi'an, and the different level of emergence responses for COVID-19 from 2020 to 2021, Bayesian Structural Time Series model and interrupted time series analysis were applied to quantitatively assess the impact of NPIs in sequent phases with different intensities, and to estimate the reduction of influenza infections. From 2011 to 2021, a total of 197,528 confirmed cases of influenza were reported in Xi'an, and the incidence of influenza continuously increased from 2011 to 2019, especially, in 2019-2020, when the incidence was up to 975.90 per 100,000 persons; however, it showed a sharp reduction of 97.68% in 2020-2021, and of 87.22% in 2021, comparing with 2019-2020. The highest impact on reduction of influenza was observed in the phase of strict implementation of NPIs with an inclusion probability of 0.54. The weekly influenza incidence was reduced by 95.45%, and an approximate reduction of 210,100 (95% CI: 125,100-329,500) influenza infections was found during the post-COVID-19 period. The reduction exhibited significant variations in the geographical, population, and temporal distribution. Our findings demonstrated that NPIs against COVID-19 had a long-term impact on the reduction of influenza transmission.
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Affiliation(s)
- Shuxuan Song
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi'an, China
| | - Qian Li
- Department of Infectious Disease Control and Prevention, Xi'an Center for Disease Prevention and Control, Xi'an, China
| | - Li Shen
- School of Remote Sensing and Information Engineering, Wuhan University, Wuhan, China
| | - Minghao Sun
- School of Remote Sensing and Information Engineering, Wuhan University, Wuhan, China
| | - Zurong Yang
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi'an, China
| | - Nuoya Wang
- School of Remote Sensing and Information Engineering, Wuhan University, Wuhan, China
| | - Jifeng Liu
- Department of Infectious Disease Control and Prevention, Xi'an Center for Disease Prevention and Control, Xi'an, China
| | - Kun Liu
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi'an, China
| | - Zhongjun Shao
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi'an, China
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Reñosa MDC, Landicho J, Wachinger J, Dalglish SL, Bärnighausen K, Bärnighausen T, McMahon SA. Nudging toward vaccination: a systematic review. BMJ Glob Health 2021; 6:bmjgh-2021-006237. [PMID: 34593513 PMCID: PMC8487203 DOI: 10.1136/bmjgh-2021-006237] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/19/2021] [Indexed: 12/21/2022] Open
Abstract
Background Vaccine hesitancy (VH) and the global decline of vaccine coverage are a major global health threat, and novel approaches for increasing vaccine confidence and uptake are urgently needed. ‘Nudging’, defined as altering the environmental context in which a decision is made or a certain behaviour is enacted, has shown promising results in several health promotion strategies. We present a comprehensive synthesis of evidence regarding the value and impact of nudges to address VH. Methods We conducted a systematic review to determine if nudging can mitigate VH and improve vaccine uptake. Our search strategy used Medical Subject Headings (MeSH) and non-MeSH terms to identify articles related to nudging and vaccination in nine research databases. 15 177 titles were extracted and assessed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The final list of included articles was evaluated using the Mixed Methods Appraisal Tool and the Grading of Recommendations, Assessment, Development and Evaluations framework. Findings Identified interventions are presented according to a framework for behaviour change, MINDSPACE. Articles (n=48) from 10 primarily high-income countries were included in the review. Nudging-based interventions identified include using reminders and recall, changing the way information is framed and delivered to an intended audience, changing the messenger delivering information, invoking social norms and emotional affect (eg, through storytelling, dramatic narratives and graphical presentations), and offering incentives or changing defaults. The most promising evidence exists for nudges that offer incentives to parents and healthcare workers, that make information more salient or that use trusted messengers to deliver information. The effectiveness of nudging interventions and the direction of the effect varies substantially by context. Evidence for some approaches is mixed, highlighting a need for further research, including how successful interventions can be adapted across settings. Conclusion Nudging-based interventions show potential to increase vaccine confidence and uptake, but further evidence is needed for the development of clear recommendations. The ongoing COVID-19 pandemic increases the urgency of undertaking nudging-focused research. PROSPERO registration number CRD42020185817.
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Affiliation(s)
- Mark Donald C Reñosa
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jeniffer Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jonas Wachinger
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Sarah L Dalglish
- Institute for Global Health, University College London, London, UK
- International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kate Bärnighausen
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- School of Public Health, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Ferreira PCDS, Oliveira NGN, Tavares DMDS, Machado DCM. Analysis of the vaccination status of older adults. Rev Esc Enferm USP 2021; 55:e03723. [PMID: 34161442 DOI: 10.1590/s1980-220x2020007403723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 11/09/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To describe the sociodemographic characteristics, functional capacity and vaccination status of older adults, and to verify the factors associated with the incomplete vaccination status and the absence of the vaccination card. METHOD Cross-sectional and analytical study conducted with older adults living in the city of Uberaba (MG). The following analyzes were carried out: descriptive, bivariate and multinomial logistic regression (p<0.05). RESULTS A total of 576 older adults participated. Most of them were women, in the 70-80 age group, with partner, low education and income, living with someone, independent in basic activities of daily living and with partial dependence on instrumental activities. The highest percentage was for older adults who had incomplete vaccination status, especially regarding the absence of immunization for Hepatitis B. Individual monthly income < 1 minimum wage (p=0.002) and single-person housing arrangement (p=0.010) were associated with the incomplete vaccination status, and the absence of the vaccination card, with the lowest level of education (p=0.039). CONCLUSION Low income and education, as well as living alone, are factors associated with inadequate vaccination status among older adults in the community. The need for primary care nurses to develop strategies to increase vaccination coverage among older adults with these characteristics is emphasized.
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Pastorino R, Villani L, Mariani M, Ricciardi W, Graffigna G, Boccia S. Impact of COVID-19 Pandemic on Flu and COVID-19 Vaccination Intentions among University Students. Vaccines (Basel) 2021; 9:70. [PMID: 33498282 PMCID: PMC7909275 DOI: 10.3390/vaccines9020070] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 01/27/2023] Open
Abstract
Flu vaccination for the general population, and specifically for vulnerable subgroups, brings the potential to reduce the impact of the COVID-19 pandemic in terms of mobility, mortality, and hospitalizations. In Italy, flu vaccination is recommended to all ≥6 months of age, even if it is only free of charge for specific categories. We investigated the intentions towards flu and COVID-19 vaccinations from a sample of 436 Italian university students. Results of a web-based survey show that 77.52% of them were willing to get the flu vaccine and 94.73% were willing to be vaccinated against COVID-19 when available. We identified positive predictive factors to undertake flu vaccination as being a medical student, having undertaken a previous vaccination against flu, and having a high level of concern and perceived vulnerability to the COVID-19 pandemic. Reinforced public health activities might consider engaging university students a as possible "positive influencer" towards flu and COVID-19 vaccination programs.
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Affiliation(s)
- Roberta Pastorino
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.P.); (W.R.); (S.B.)
| | - Leonardo Villani
- Section of Hygiene, University Department of Life Sciences and Public Health—Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Marco Mariani
- Section of Hygiene, University Department of Life Sciences and Public Health—Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Walter Ricciardi
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.P.); (W.R.); (S.B.)
- Section of Hygiene, University Department of Life Sciences and Public Health—Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Guendalina Graffigna
- Dipartimento di Psicologia—Università Cattolica del Sacro Cuore, 20123 Milan, Italy;
- EngageMinds HUB—Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, 26100 Cremona, Italy
| | - Stefania Boccia
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.P.); (W.R.); (S.B.)
- Section of Hygiene, University Department of Life Sciences and Public Health—Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
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Friedler A. Sociocultural, behavioural and political factors shaping the COVID-19 pandemic: the need for a biocultural approach to understanding pandemics and (re)emerging pathogens. Glob Public Health 2020; 16:17-35. [PMID: 33019889 DOI: 10.1080/17441692.2020.1828982] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although there has been increasing focus in recent years on interdisciplinary approaches to health and disease, and in particular the dimension of social inequalities in epidemics, infectious diseases have been much less focused on. This is especially true in the area of cultural dynamics and their effects on pathogen behaviours, although there is evidence to suggest that this relationship is central to shaping our interactions with infectious disease agents on a variety of levels. This paper makes a case for a biocultural approach to pandemics such as COVID-19. It then uses this biocultural framework to examine the anthropogenic dynamics that influenced and continue to shape the COVID-19 pandemic, both during its initial phase and during critical intersections of the pandemic. Through this understanding of biocultural interactions between people, animals and pathogens, a broader societal and political dimension is drawn as a function of population level and international cultures, to reflect on the culturally mediated differential burden of the pandemic. Ultimately, it is argued that a biocultural perspective on infectious disease pandemics will allow for critical reflection on how culture shapes our behaviours at all levels, and how the effects of these behaviours are ultimately foundational to pathogen ecology and evolution.
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Affiliation(s)
- Anna Friedler
- Département des sciences humaines et sociales, École des Hautes Études en Santé Publique - Campus de Paris, Saint-Denis, France.,l'Unité des Virus Emergents, Aix-Marseille Université, Marseille, France
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Aleta A, Ferraz de Arruda G, Moreno Y. Data-driven contact structures: From homogeneous mixing to multilayer networks. PLoS Comput Biol 2020; 16:e1008035. [PMID: 32673307 PMCID: PMC7386617 DOI: 10.1371/journal.pcbi.1008035] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/28/2020] [Accepted: 06/09/2020] [Indexed: 12/22/2022] Open
Abstract
The modeling of the spreading of communicable diseases has experienced significant advances in the last two decades or so. This has been possible due to the proliferation of data and the development of new methods to gather, mine and analyze it. A key role has also been played by the latest advances in new disciplines like network science. Nonetheless, current models still lack a faithful representation of all possible heterogeneities and features that can be extracted from data. Here, we bridge a current gap in the mathematical modeling of infectious diseases and develop a framework that allows to account simultaneously for both the connectivity of individuals and the age-structure of the population. We compare different scenarios, namely, i) the homogeneous mixing setting, ii) one in which only the social mixing is taken into account, iii) a setting that considers the connectivity of individuals alone, and finally, iv) a multilayer representation in which both the social mixing and the number of contacts are included in the model. We analytically show that the thresholds obtained for these four scenarios are different. In addition, we conduct extensive numerical simulations and conclude that heterogeneities in the contact network are important for a proper determination of the epidemic threshold, whereas the age-structure plays a bigger role beyond the onset of the outbreak. Altogether, when it comes to evaluate interventions such as vaccination, both sources of individual heterogeneity are important and should be concurrently considered. Our results also provide an indication of the errors incurred in situations in which one cannot access all needed information in terms of connectivity and age of the population.
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Affiliation(s)
| | | | - Yamir Moreno
- ISI Foundation, Turin, Italy
- Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, Zaragoza, Spain
- Department of Theoretical Physics, University of Zaragoza, Zaragoza, Spain
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Zhang Y, Wang X, Li Y, Ma J. Spatiotemporal Analysis of Influenza in China, 2005-2018. Sci Rep 2019; 9:19650. [PMID: 31873144 PMCID: PMC6928232 DOI: 10.1038/s41598-019-56104-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 12/04/2019] [Indexed: 12/14/2022] Open
Abstract
Influenza is a major cause of morbidity and mortality worldwide, as well as in China. Knowledge of the spatial and temporal characteristics of influenza is important in evaluating and developing disease control programs. This study aims to describe an accurate spatiotemporal pattern of influenza at the prefecture level and explore the risk factors associated with influenza incidence risk in mainland China from 2005 to 2018. The incidence data of influenza were obtained from the Chinese Notifiable Infectious Disease Reporting System (CNIDRS). The Besag York Mollié (BYM) model was extended to include temporal and space-time interaction terms. The parameters for this extended Bayesian spatiotemporal model were estimated through integrated nested Laplace approximations (INLA) using the package R-INLA in R. A total of 702,226 influenza cases were reported in mainland China in CNIDRS from 2005–2018. The yearly reported incidence rate of influenza increased 15.6 times over the study period, from 3.51 in 2005 to 55.09 in 2008 per 100,000 populations. The temporal term in the spatiotemporal model showed that much of the increase occurred during the last 3 years of the study period. The risk factor analysis showed that the decreased number of influenza vaccines for sale, the new update of the influenza surveillance protocol, the increase in the rate of influenza A (H1N1)pdm09 among all processed specimens from influenza-like illness (ILI) patients, and the increase in the latitude and longitude of geographic location were associated with an increase in the influenza incidence risk. After the adjusting for fixed covariate effects and time random effects, the map of the spatial structured term shows that high-risk areas clustered in the central part of China and the lowest-risk areas in the east and west. Large space-time variations in influenza have been found since 2009. In conclusion, an increasing trend of influenza was observed from 2005 to 2018. The insufficient flu vaccine supplements, the newly emerging influenza A (H1N1)pdm09 and expansion of influenza surveillance efforts might be the major causes of the dramatic changes in outbreak and spatio-temporal epidemic patterns. Clusters of prefectures with high relative risks of influenza were identified in the central part of China. Future research with more risk factors at both national and local levels is necessary to explain the changing spatiotemporal patterns of influenza in China.
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Affiliation(s)
- Yewu Zhang
- Center for Public Health Surveillance and Information Service, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaofeng Wang
- Center for Public Health Surveillance and Information Service, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yanfei Li
- Center for Public Health Surveillance and Information Service, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiaqi Ma
- Center for Public Health Surveillance and Information Service, Chinese Center for Disease Control and Prevention, Beijing, China.
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Riccò M, Vezzosi L, Gualerzi G, Odone A, Signorelli C. Knowledge, attitudes, and practices of influenza and pneumococcal vaccines among agricultural workers: results of an Italian a cross-sectional study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:439-450. [PMID: 31910168 PMCID: PMC7233756 DOI: 10.23750/abm.v90i4.7631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Working age is increasing across Europe. Seasonal influenza (SID) and pneumococcal disease (PND) immunization programmes might be successfully implemented at the workplace. We conducted a cross-sectional survey among to assess SID and PND vaccine status, as well as knowledge, attitudes and practices (KAP) in a representative sample of agricultural workers (AWs) aged ≥55 years in North-Eastern Italy. METHODS A structured questionnaire was administered in person by trained personnel. Bivariate and multivariate logistic regression analyses were carried out to identify behavioral and work-related factors associated with SID and PND vaccine uptake. RESULTS Among 707 participants, 238 were aged 55 years or more (33.7% of total). Of them, 39.1% had an up-to-date immunization status towards influenza, and 17.6% towards pneumococcus. Factors associated with inadequate immunization were doubts about influenza vaccine safety (40.0%) and the confidence in natural immunity towards pneumococcus (30.8%). Attitude towards vaccinations was somehow favorable in 44.5% of participants for SID, and 37.8% for PND. Overall, 37.4% and 21.8% workers were aware of national recommendations on SID and PND immunization, respectively. This factor was characterized as a significant predictor for SID vaccination (multivariated Odds Ratio, OR 32.688 95%CI 12.015-88.930), as well as the perception of SID as a severe disease (OR 7.539 95%CI 3.312-17.164), and the perceived value of preventing new infections (OR 3.215 95%CI 1.205-8.578). A somehow favorable attitude towards vaccinations was the main predictor (OR 39.214 95%CI 10.179-151.1) for PND vaccination. CONCLUSIONS Our study indicates that older workers lack appropriate knowledge of national recommendations and correct risk perception of SID and PND infections, but also vaccines' side effects. As the latter has been recognized as predictive factor for SID vaccination, our results stress the importance for tailored informative interventions in the workplaces aimed to increase risk perception and vaccine acceptance. (www.actabiomedica.it).
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Affiliation(s)
- Matteo Riccò
- Azienda USL di Reggio EmiliaV.le Amendola n.2 - 42122 REServizio di Prevenzione e Sicurezza negli Ambienti di Lavoro (SPSAL)Dip. di Prevenzione.
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12
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Park JE, Son WS, Ryu Y, Choi SB, Kwon O, Ahn I. Effects of temperature, humidity, and diurnal temperature range on influenza incidence in a temperate region. Influenza Other Respir Viruses 2019; 14:11-18. [PMID: 31631558 PMCID: PMC6928031 DOI: 10.1111/irv.12682] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/13/2019] [Accepted: 09/13/2019] [Indexed: 01/13/2023] Open
Abstract
Background The effect of temperature and humidity on the incidence of influenza may differ by climate region. In addition, the effect of diurnal temperature range on influenza incidence is unclear, according to previous study findings. Objectives The aim of this study was to analyze the effects of temperature, humidity, and diurnal temperature range on the incidence of influenza in Seoul, Republic of Korea, which is located in a temperate region. Methods We used Korean National Health insurance data to assess the weekly influenza incidence between 2010 and 2016, and used meteorological data from Seoul. To investigate the effect of temperature, relative humidity, and diurnal temperature range levels on influenza incidence, we used a distributed lag non‐linear model. Results The risk of influenza incidence was significantly increased with low daily temperatures of 0‐5°C and low (30%–40%) or high (70%) relative humidity. We found a positive significant association between diurnal temperature range and influenza incidence in this study. Conclusions Influenza incidence increased with low temperature and low/high humidity in a temperate region. Influenza incidence also increased with high diurnal temperature range, after considering temperature and humidity.
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Affiliation(s)
- Ji-Eun Park
- Korea Institute of Oriental Medicine, Daejeon, Korea.,Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Korea
| | - Woo-Sik Son
- Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Korea.,National Institute for Mathematical Science, Daejeon, Korea
| | - Yeonhee Ryu
- Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Soo Beom Choi
- Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Korea.,Biomedical Prediction Technology Laboratory, Korea Institute of Science and Technology Information, Daejeon, Korea
| | - Okyu Kwon
- Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Korea.,National Institute for Mathematical Science, Daejeon, Korea
| | - Insung Ahn
- Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Korea.,Biomedical Prediction Technology Laboratory, Korea Institute of Science and Technology Information, Daejeon, Korea.,Department of Data-centric Problem Solving Research, Korea Institute of Science and Technology Information, Daejeon, Korea
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13
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Luy M, Di Giulio P, Di Lego V, Lazarevič P, Sauerberg M. Life Expectancy: Frequently Used, but Hardly Understood. Gerontology 2019; 66:95-104. [PMID: 31390630 DOI: 10.1159/000500955] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/14/2019] [Indexed: 11/19/2022] Open
Abstract
Period life expectancy is one of the most used summary indicators for the overall health of a population. Its levels and trends direct health policies, and researchers try to identify the determining risk factors to assess and forecast future developments. The use of period life expectancy is often based on the assumption that it directly reflects the mortality conditions of a certain year. Accordingly, the explanation for changes in life expectancy are typically sought in factors that have an immediate impact on current mortality conditions. It is frequently overlooked, however, that this indicator can also be affected by at least three kinds of effects, in particular in the situation of short-term fluctuations: cohort effects, heterogeneity effects, and tempo effects. We demonstrate their possible impact with the example of the almost Europe-wide decrease in life expectancy in 2015, which caused a series of reports about an upsurge of a health crisis, and we show that the consideration of these effects can lead to different conclusions. Therefore, we want to raise an awareness concerning the sensitivity of life expectancy to sudden changes and the menaces a misled interpretation of this indicator can cause.
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Affiliation(s)
- Marc Luy
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/ÖAW, WU), Vienna, Austria, .,Vienna Institute of Demography, Austrian Academy of Sciences, Vienna, Austria,
| | - Paola Di Giulio
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/ÖAW, WU), Vienna, Austria.,Vienna Institute of Demography, Austrian Academy of Sciences, Vienna, Austria
| | - Vanessa Di Lego
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/ÖAW, WU), Vienna, Austria.,Vienna Institute of Demography, Austrian Academy of Sciences, Vienna, Austria
| | - Patrick Lazarevič
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/ÖAW, WU), Vienna, Austria.,Vienna Institute of Demography, Austrian Academy of Sciences, Vienna, Austria
| | - Markus Sauerberg
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/ÖAW, WU), Vienna, Austria.,Vienna Institute of Demography, Austrian Academy of Sciences, Vienna, Austria
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14
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VUKOVIC V, LILLINI R, ASTA F, CHINI F, DE WAURE C. Analysis of influenza vaccination coverage among the elderly living in Rome, based on a deprivation index, 2009-2013. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2018; 59:E31-E37. [PMID: 31016265 PMCID: PMC6419302 DOI: 10.15167/2421-4248/jpmh2018.59.4s2.1142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 12/20/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Elderly people are more likely to develop influenza-related complications. However, despite the recommendations, the optimal vaccination coverage is not reached. The use of deprivation indexes can help to identify subgroups with lower vaccination uptake. We analyzed vaccination coverage among elderly subjects living in the city of Rome on the basis of their socioeconomic characteristics by using a local deprivation index. METHODS We focused on the population aged ≥ 65 years living in the city of Rome from 2009 to 2013. Information on vaccination coverage was collected from general practitioners. A combination of multivariate techniques, including multiple linear regression, factor and cluster analysis, was used to construct a composite area-based Index of Socio-Economic and Health Deprivation (SEHDI). The index was calculated for each census tract on the basis of data from the 2001 Italian census. RESULTS The majority of elderly subjects living in Rome belonged to the medium (40.4%) and medium-high (24%) deprivation groups; only 4.5% of the population was in the low-deprivation group. An inverse relationship was found between influenza vaccination coverage and the deprivation index: elderly subjects in the low-deprivation group displayed lower coverage (55.45%) than those in the high-deprivation group (57.59%). Specifically, vaccination coverage decreased with the increase of replacement index, employment rate and the percentage of: single and divorced individuals; university and high-school graduates; employees, entrepreneurs and freelancers, family assistants, students; foreigners and stateless persons residing in Italy; families consisting of one person. CONCLUSIONS Our results show an inverse relationship between deprivation and vaccination coverage and may help to identify subgroups that could benefit from targeted initiatives to increase vaccination coverage.
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Affiliation(s)
- V. VUKOVIC
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - R. LILLINI
- Department of Health Sciences (DISSAL), University of Genoa, Italy
- Analytical Epidemiology & Health Impact, Fondazione IRCCS “Istituto Nazionale Tumori”, Milan, Italy
| | - F. ASTA
- Department of Epidemiology Lazio Regional Health Service - ASL Roma 1, Rome, Italy
| | - F. CHINI
- Regional Directorate for Health and Social Policy, Lazio Region, Rome, Italy
| | - C. DE WAURE
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Experimental Medicine, University of Perugia, Italy
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15
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VERCELLI M, LILLINI R, ARATA L, ZANGRILLO F, BAGNASCO A, SASSO L, MAGLIANI A, GASPARINI R, AMICIZIA D, PANATTO D. Analysis of influenza vaccination coverage among the elderly in Genoa (Italy) based on a deprivation index, 2009-2013. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2018; 59:E11-E17. [PMID: 31016262 PMCID: PMC6419309 DOI: 10.15167/2421-4248/jpmh2018.59.4s2.1171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/01/2018] [Indexed: 12/18/2022]
Abstract
Introduction The elderly suffer the most influenza-related complications, and 90% of deaths due to influenza occur in older subjects. Consequently, the elderly are among the main targets of influenza vaccination campaigns. The use of deprivation indexes can help to identify subgroups with lower vaccination uptake. This study analyzed influenza vaccination coverage in elderly persons living in Genoa (Italy) in relation to a local Index of Socio-Economic and Health Deprivation (SEHDI) in order to identify population subgroups needing specific intervention to improve vaccination coverage. Methods The study targeted subjects aged ≥ 65 years living in Genoa in the period 2009-2013. Information on vaccination coverage was provided by general practitioners and Local Health Units. A combination of linear regression, factor analysis and cluster analysis was used to construct the SEHDI at Census Tract (CT) level, on the basis of data from the 2011 Italian census. Results In 2011, people aged ≥ 65 years accounted for the 27.7% of the population of Genoa. Most elderly subjects were assigned to either the medium (45.3%) or medium-high (32%) deprivation groups, while the percentages in the extreme tails were low (3.6% high deprivation; 1.3% low deprivation). Significant, non-linear (p < 0.05 NL) relationships were observed in both sexes with regard to mortality due to all respiratory diseases (RD) and chronic obstructive pulmonary disease (COPD), with the highest Standardized Mortality Ratio (SMR) values in women in the high deprivation group of women (1.81, p < 0.05 RD; 1.79, p < 0.05 COPD). The SMRs for influenza and pneumonia showed a positive linear trend in women (p < 0.05) with the highest value in the high deprivation group (1.97, p < 0.05), while in men the trend was NL (p < 0.05). A positive linear trend (p < 0.05) was found with regard to vaccination coverage, which grew weakly as deprivation increased, up to the medium-high deprived group (from 34.6% to 44.4%). However, the high deprivation group showed the lowest value (33.3%). Conclusions The results revealed a relationship between deprivation and influenza vaccination coverage in the elderly. This finding should be taken into account in the organization of vaccination campaigns and should prompt differentiated intervention in each local area.
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Affiliation(s)
- M. VERCELLI
- Department of Health Sciences (DISSAL), University of Genoa, Italy
| | - R. LILLINI
- Department of Health Sciences (DISSAL), University of Genoa, Italy
- Analytical Epidemiology & Health Impact, Fondazione IRCCS “Istituto Nazionale Tumori”, Milan, Italy
- Roberto Lillini, Analytical Epidemiology & Health Impact, Fondazione IRCCS “Istituto Nazionale Tumori”, Milan, Italy - Tel. +39 02 23903564 - E-mail: .
| | - L. ARATA
- Department of Health Sciences (DISSAL), University of Genoa, Italy
| | - F. ZANGRILLO
- Department of Health Sciences (DISSAL), University of Genoa, Italy
| | - A. BAGNASCO
- Department of Health Sciences (DISSAL), University of Genoa, Italy
| | - L. SASSO
- Department of Health Sciences (DISSAL), University of Genoa, Italy
| | - A. MAGLIANI
- Department of Statistics, Liguria Region, Genoa, Italy
| | - R. GASPARINI
- Department of Health Sciences (DISSAL), University of Genoa, Italy
| | - D. AMICIZIA
- Department of Health Sciences (DISSAL), University of Genoa, Italy
| | - D. PANATTO
- Department of Health Sciences (DISSAL), University of Genoa, Italy
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LAI A, PISANU L, CASULA L, MINERBA L, LILLINI R, VERCELLI M. Influenza vaccination coverage and deprivation among the elderly in the municipality of Cagliari: results and perspectives. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2018; 59:E65-E70. [PMID: 31016269 PMCID: PMC6419306 DOI: 10.15167/2421-4248/jpmh2018.59.4s2.1197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/14/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The elderly are among the main targets of influenza vaccination campaigns. Previous studies have shown that socio-economic status influences compliance with influenza vaccination, particularly in the elderly. Deprivation indexes can therefore be useful in identifying population groups with lower vaccination uptake and guide targeted intervention to improve vaccination coverage. We analysed the correlation between influenza vaccination coverage and levels of socio-economic and health deprivation among the population of Cagliari, by means of an Index of Socio-Economic and Health Deprivation (SEHDI) specifically tailored to the city, in order to identify population subgroups needing specific intervention to improve vaccination coverage. METHODS A combination of linear regression, factor analysis and cluster analysis was adopted in order to build the SEHDI at the Census Tract (CT) level; data were taken from the 2011 Italian Census. Mortality among subjects aged ≥ 65 years in Cagliari in the period 2013-2015 was used to select the SEHDI variables. On the basis of the SEHDI, his population was classified into five normalised deprivation groups. Information on vaccination coverage was provided by general practitioners and Local Health Units. Cause-specific mortality and information on vaccination coverage in the deprivation groups were analysed by means of ANOVA (F test at p < 0.05). RESULTS Around 20% of the Cagliari population was seen to be living in disadvantaged conditions. The trends in Standard Mortality Rates (SMRs) for all causes and for respiratory diseases, chronic obstructive pulmonary diseases (COPD), influenza and pneumonia were analysed across the deprivation groups. Pneumonia and flu mortality rates displayed a non-linear trend in men and a positive linear trend in women. Flu vaccination uptake rates were low: 27%. Coverage proved to be lower in the two extreme categories and higher in the medium deprivation ones. CONCLUSIONS The correlation between low vaccination coverage and socio-economic deprivation not only underlines the important role of vaccination in safeguarding health, but also the fact that it can be considered a factor in ensuring the system's equality, thanks to its role in limiting health impacts on those living in the most problematic or disadvantaged circumstances. It also stresses the characteristics which contribute to low compliance. Therefore, this finding should be taken into account in the organization of vaccination campaigns and should prompt differentiated interventions in each local area.
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Affiliation(s)
- A. LAI
- Department of Medical Science and Public Health, University of Cagliari, Italy
- Alberto Lai, Department of Medical Science and Public Health, University of Cagliari, Italy - E-mail:
| | - L. PISANU
- Department of Medical Science and Public Health, University of Cagliari, Italy
| | - L. CASULA
- Department of Medical Science and Public Health, University of Cagliari, Italy
| | - L. MINERBA
- Department of Medical Science and Public Health, University of Cagliari, Italy
| | - R. LILLINI
- Department of Health Sciences (DISSAL), University of Genoa, Italy
- Analytical Epidemiology & Health Impact, Fondazione IRCCS “Istituto Nazionale Tumori”, Milan, Italy
| | - M. VERCELLI
- Department of Health Sciences (DISSAL), University of Genoa, Italy
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