Comorbid risk, respondent characteristics and likelihood of pneumococcal vaccination versus no vaccination among older adults in Brazil

Pneumococcal and Influenza Vaccination Rates and Pneumococcal Invasive Disease Rates Set Geographical and Ethnic Population Susceptibility to Serious COVID-19 Cases and Deaths

This study examines the relationship of pneumococcal vaccination rates, influenza, measles-mumps-rubella (MMR) diphtheria-tetanus-pertussis vaccinations (DTP), polio, Haemophilus influenzae type B (Hib), and Bacillus Calmette-Guerin (tuberculosis) vaccination rates to COVID-19 case and death rates for 51 nations that have high rates of COVID-19 testing and for which nearly complete childhood, at-risk adult and elderly pneumococcal vaccination data were available. The study is unique in a large number of nations examined, the range of vaccine controls, in testing effects of combinations of vaccinations, and in examining the relationship of COVID-19 and vaccination rates to invasive pneumococcal disease (IPD). Analysis of Italian regions and the states of the United States were also performed. Significant positive correlations were found between IPD (but not lower respiratory infections) and COVID-19 rates, while significant negative correlations were found between pneumococcal vaccination and COVID-19 rates. Influenza and MMR vaccination rates were negatively correlated with lower respiratory infection (LRI) rates and may synergize with pneumococcal vaccination rates to protect against COVID-19. Pneumococcal and influenza vaccination rates were independent of other vaccination rates. These results suggest that endemic rates of bacterial pneumonias, for which pneumococci are a sentinel, may set regional and national susceptibility to severe COVID-19 disease and death.

Illness representations on pneumonia and pneumococcal vaccination uptake among community-living Chinese people with high-risk conditions aged ≥65 years --- a population-based study

This study investigated the associations between illness representations of pneumonia and pneumococcal vaccination (PV) uptake among a group of community-living aging adults having at least one high-risk condition for severe invasive pneumococcal diseases (IPD). A total of 750 community-living Chinese-speaking individuals aged ≥65 y completed a random telephone survey. This study was based on 483 participants having at least one high-risk condition for severe IPD. The Illness Representation Questionnaire-Revised (IPQ-R) measured four dimensions of illness representations. These dimensions included timeline (whether pneumonia is believed to be acute/chronic), consequences (severity of pneumonia), treatment control (whether pneumonia is under volitional control), and emotional response (anger, guilty, or shame). Using PV uptake (among all participants) and behavioral intention to take up PV (among unvaccinated participants) as the dependent variables, logistic regression models were fitted. Among all participants (n = 483), 17.8% reported PV uptake; 18.6% of unvaccinated participants (n = 397) intended to take up two doses of free PV in the next year. After adjustment for significant background variables, participants who perceived more severe consequences of pneumonia (adjusted odds ratios, AOR: 1.18, 95%CI: 1.01, 1.40) and belief that treatment can control pneumonia (AOR: 1.41, 95%CI: 1.25, 1.58) reported higher PV uptake. Perceived pneumonia to be chronic (AOR: 1.44, 95%CI: 1.16, 1.78), belief that treatment can control pneumonia (AOR: 1.25, 95%CI: 1.12, 1.40) and having negative emotions related to pneumonia (AOR: 1.17, 95%CI: 1.09, 1.25) were positively associated with behavioral intention to take up PV. Results confirmed that illness representations were associated with PV-related behaviors.

Facilitators and barriers to completing recommended doses of pneumococcal vaccination among community-living individuals aged ≥65 years in Hong Kong - a population-based study

Individuals aged ≥65 y are recommended to receive pneumococcal vaccination (PV). PV completion is defined as receiving two doses of PV among those with at least one high-risk condition for severe invasive pneumococcal diseases (IPD) or receiving one dose of PV among those without any high-risk conditions. This study investigated factors associated with PV completion among a random sample of community-living older adults in Hong Kong, China. In addition, factors associated with receiving a single dose of PV among older adults with at least one high-risk condition were also investigated. A total of 750 community-living Chinese-speaking individuals aged ≥65 y in Hong Kong (response rate: 63.4%) completed a random telephone survey from May to July 2019. PV completion was 10% among all participants. Among participants with high-risk condition(s) for severe IPD, 11.4% received a single dose of PV. After adjustment for significant background variables, several Health Belief Model constructs were significantly associated with both dependent variables: (1) perceived risk of contracting pneumococcal diseases, (2) perceived benefits of PV for protecting themselves or others, (3) perceived barriers to PV uptake, (4) being suggested by significant others to take up PV (cue to action), and (5) confidence to take up PV (perceived self-efficacy). In addition, being knowledgeable about pneumococcal diseases and vaccination, and knowing at least one peer of similar age who had taken up PV were also positively associated with both dependent variables. Targeted, theory-based health promotion efforts are needed to increase PV coverage among elderly in Hong Kong.

Understanding the burden of idiopathic generalized epilepsy in the United States, Europe, and Brazil: An analysis from the National Health and Wellness Survey

The aim of this study was to understand the current burden of primary generalized tonic-clonic seizures (PGTCS) associated with idiopathic generalized epilepsy (IGE) as a function of seizure frequency. We analyzed data for (IGE) as a proxy measure of PGTCS. Little is known about the quality of life (QoL), health utility, productivity, healthcare resource utilization (HRU), and cost burden of PGTCS or IGE. Patients were identified from the US (2011, 2012, & 2013), 5EU (2011 & 2013), and Brazil (2011 & 2012) National Health and Wellness Survey, a nationally representative, internet-based survey of adults (18+ years). Patients that self-reported a diagnosis of IGE were categorized into seizure frequencies of: ≥1 seizure per week, 1-3 seizures per month, 1-4 seizures per year, or <1 seizure per year. QoL was measured using the SF-36v2 Mental (MCS) and Physical Component Summary (PCS) scores, health utilities with the SF-6D, productivity with the Work Productivity and Activity Impairment (WPAI) questionnaire, and HRU as reported in the past six months. Unit costs were estimated from the literature and multiplied against HRU values to calculate direct costs and WPAI values to calculate indirect costs. Generalized linear regression was utilized to examine the relationship between seizure frequency and each measure of burden with adjustment for covariates. Out of the general population surveyed, IGE was self-reported in 782 of 176,093 (US), 172 of 30,000 (UK), 106 of 30,001 (Germany), 87 of 30,000 (France), 31 of 12,011 (Spain), 22 of 17,500 (Italy), and 34 of 24,000 (Brazil). Persistent seizures (≥1 per year) were reported in over 40% of patients with IGE (10-15% with ≥1 seizure per week, 10-15% with 1-3 seizures per month, 20-25% with 1-4 seizures per year). Over 75% were treated with antiepileptic drugs (AEDs). Compared with those having <1 seizure per year (reference group), patients in the two most frequent seizure categories reported worse MCS and PCS scores. Patients in the three highest seizure frequency groups consistently reported worse health utility scores, and greater presenteeism (attending work while not physically or mentally capable of working), overall work impairment, activity impairment, HRU, indirect costs, and direct costs than the reference group. Despite the availability of AEDs during the year surveyed, a substantial number of patients experienced persistent seizures. Increasing seizure frequency was clearly associated with worse outcomes. The burden of PGTCS and IGE may be proportionally reduced by newer AEDs which may increase the proportion of seizure-free patients or shift more patients into lower seizure frequency categories.