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Doherty TM, Ecarnot F, Gaillat J, Privor-Dumm L. Nonstructural barriers to adult vaccination. Hum Vaccin Immunother 2024; 20:2334475. [PMID: 38629573 PMCID: PMC11028002 DOI: 10.1080/21645515.2024.2334475] [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: 03/07/2024] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
Adult vaccination coverage remains low, despite vaccine recommendations, improved access, and reimbursement. Low vaccination coverage and an aging population at higher risk from vaccine-preventable diseases lead to preventable disability and deaths, straining healthcare systems. An Advisory Board meeting was, therefore, held to identify non-structural barriers to adult vaccination and discuss potential solutions to increase uptake. Many non-structural factors can influence vaccine uptake, such as heterogeneity in the population, (fear of) vaccine shortages, incentives, or mandates for vaccination, understanding of disease burden and personal risks, time and opportunity for healthcare providers (HCPs) to discuss and deliver vaccines during general practice or hospital visits, trust in the health system, and education. To address these barriers, push-pull mechanisms are required: to pull patients in for vaccination and to push HCP performance on vaccination delivery. For patients, the focus should be on lifelong prevention and quality of life benefits: personal conversations are needed to increase confidence and knowledge about vaccination, and credible communication is required to build trust in health services and normalize vaccination. For providers, quality measurements are required to prioritize vaccination and ensure opportunities to check vaccination status, discuss and deliver vaccines are not missed. Financial and quality-based incentives may help increase uptake.
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Affiliation(s)
| | | | | | - Lois Privor-Dumm
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Klüwer B, Rydland KM, Mamelund SE, Gleditsch RN. Drivers and barriers of seasonal influenza vaccination 2015/16 & 2019/20 to 2022/23 - a survey on why most Norwegians don't get the flu vaccine. BMC Public Health 2024; 24:2687. [PMID: 39358784 PMCID: PMC11445999 DOI: 10.1186/s12889-024-20157-w] [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: 06/17/2024] [Accepted: 09/23/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND This study aimed to explore the reasons adults in the general population, influenza risk groups (RGs) and health care workers (HCWs) in Norway give for their vaccination choices and whether these reasons vary between groups or over time in order to further improve influenza vaccination coverage. METHODS Respondents of a nationally representative telephone survey conducted by Statistics Norway were asked "What was the most important reason why you did/did not get vaccinated?". The question on influenza non-vaccination was included in 2016 and in 2020 to 2023 and the question on influenza vaccination in 2021 to 2023. RESULTS The study included 9 705 individuals aged 18-79 years. Influenza vaccination coverage in the RGs increased from 20.6% in 2016 to 63.1% in 2022, before a reduction to 58.3% in 2023. Common reasons for non-vaccination were similar in all groups. The most cited reasons were "no need" for the vaccine and "no specific reason", followed by "not recommended/offered the vaccine", "worry about side effects" and "vaccine refusal". The most frequent reasons for vaccination among the general population and RGs were protection against influenza and belonging to a RG, while the most frequent responses among HCWs were being offered the vaccine at work/work in health care, followed by a desire for protection against influenza. Receiving a vaccine recommendation from a health professional was mentioned in all groups. We also observed that the proportion reporting "no need" for the vaccine decreased over time, especially among HCWs, and that the proportions reporting vaccine refusal and worry about side effects as reasons for non-vaccination were temporarily reduced during the COVID-19 pandemic. CONCLUSIONS The general population and RGs cite protection against influenza as their primary incentive for vaccination, while HCWs mainly refer to their professional role or workplace vaccination. For non-vaccination we see a similar pattern in all groups, with "no need" and "no specific reason" as the main reasons. Of note, worry about side effects and vaccine refusal is as frequent among HCWs as in other groups. Continued efforts to maintain and increase vaccine confidence are needed.
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Affiliation(s)
- Birgitte Klüwer
- Division of Infection Control, Norwegian Institute of Public Health, Skøyen, PO Box 222, Oslo, N-0213, Norway.
| | - Kjersti Margrethe Rydland
- Division of Infection Control, Norwegian Institute of Public Health, Skøyen, PO Box 222, Oslo, N-0213, Norway
| | - Svenn-Erik Mamelund
- Centre for Research on Pandemics & Society (PANSOC), Oslo Metropolitan University, Senter for velferds- og arbeidslivsforskning, OsloMet - storbyuniversitetet, Postboks 4, St. Olavs plass, Oslo, 0130, Norway
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3
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Yang T, Tong F, Tang L, Li P, Li B, Ye L, Zhou J. Repeated vaccination does not appear to significantly weaken the protective effect of influenza vaccine in the elderly: A test-negative case-control study in China. Vaccine 2024; 42:125986. [PMID: 38762359 DOI: 10.1016/j.vaccine.2024.05.034] [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: 02/20/2024] [Revised: 05/02/2024] [Accepted: 05/15/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND The impact of repeated influenza vaccination on vaccine effectiveness has been a topic of debate. Conducting more multinational, multicenter studies in different influenza seasons is crucial for a better understanding of this issue. There is a lack of comprehensive related research reports in China. METHODS Using the Regional Health Information Platform, we conducted a test-negative case-control study to evaluate the impact of repeated vaccination on the prevention of laboratory-confirmed influenza in individuals aged 60 and above in Ningbo during four influenza seasons from 2018-19 to 2021-22. Influenza-positive cases and negative controls were matched in a 1:1 ratio based on the visiting hospital and the date of influenza testing. Propensity score adjustment and multivariable logistic regression were used to estimate risk and address confounding effects. RESULTS During the study period, a total of 30,630 elderly patients underwent influenza virus nucleic acid or antigen testing. After exclusions, we included 1976 cases of influenza-positive and 1976 cases of influenza-negative controls. Multivariable logistic regression analysis revealed that individuals receiving the vaccine in two consecutive seasons did not exhibit a significantly increased risk of influenza illness compared to those receiving the vaccine only in the current season (adjusted odds ratio: 1.22, 95% confidence interval: 0.94-1.58). However, the risk of influenza illness was found to be elevated in individuals who received the vaccine only in the previous season (adjusted odds ratio: 1.56, 95% confidence interval: 1.15-2.10) and even further elevated in those who had not received the vaccine in either of the consecutive two seasons (adjusted odds ratio: 3.39, 95% confidence interval: 2.80-4.09). CONCLUSIONS Regardless of the vaccination history in the previous season, receiving the current season influenza vaccine is the best choice for the elderly population. Our study supports the initiative to vaccinate elderly individuals against influenza annually.
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Affiliation(s)
- Tianchi Yang
- Institute of Immunization and Prevention, Ningbo Municipal Center for Disease Control and Prevention, Zhejiang, China
| | - Feng Tong
- Ningbo Municipal Center for Disease Control and Prevention, Zhejiang, China
| | - Ling Tang
- Ningbo Health Information Center, Zhejiang, China
| | - Pingping Li
- Jiangbei District Center for Disease Control and Prevention, Zhejiang, China
| | - Baojun Li
- Haishu District Center for Disease Control and Prevention, Zhejiang, China
| | - Lixia Ye
- Institute of Immunization and Prevention, Ningbo Municipal Center for Disease Control and Prevention, Zhejiang, China.
| | - Jifang Zhou
- School of International Pharmaceutical Business, China Pharmaceutical University, Jiangsu, China.
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Li Z, Feng L, Long J, Xiong Y, Li T, Jiang B, Yang S, Fu L, Shi Z, Zhao Y, Qi L. Increasing Influenza Vaccination Rates among Patients with Type 2 Diabetes Mellitus in Chongqing, China: A Cross-Sectional Analysis Using Behavioral and Social Drivers Tools. Vaccines (Basel) 2024; 12:898. [PMID: 39204024 PMCID: PMC11360589 DOI: 10.3390/vaccines12080898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 07/31/2024] [Accepted: 08/04/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND Influenza vaccination is essential for type 2 diabetes mellitus (T2DM) patients due to their higher risks of severe complications and mortality from influenza. This study investigated the willingness of T2DM patients in Chongqing, China, to receive the influenza vaccination during the 2023/2024 season, using behavioral and social drivers (BeSD) tools to improve vaccination uptake in this high-risk group. METHODS A multi-stage sampling method was used to select participants, and face-to-face surveys were conducted in community health centers between March 1 and May 1, 2023. Binary logistic regression was used to analyze the factors influencing vaccination willingness, and standardized scores identified barriers and drivers. RESULTS Among 1672 T2DM patients, 11.7% had been vaccinated during the 2022/2023 season, and 59.6% were willing to receive the vaccination in the 2023/2024 season. Higher willingness was associated with ethnic minorities (odds ratio [OR], 3.18, 95% confidence interval [CI]: 1.58-6.39), being unemployed individuals (OR 2.69, 95% CI: 1.60-4.52), higher monthly household income per capita (OR 2.72, 95% CI: 1.65-4.50), having diabetes complications (OR 1.76, 95% CI: 1.23-2.51), sufficient vaccine knowledge (OR 1.87, 95% CI: 1.48-2.37), and previous vaccination (OR 7.75, 95% CI: 4.83-12.44). Concerning BeSDs, fear of infecting friends or family members and trust in vaccine efficacy were the predominant drivers, while high vaccine costs were the greatest barrier. CONCLUSIONS Future strategies should focus on improving vaccine knowledge, supporting healthcare workers and peer recommendations, and enhancing vaccination policies. Key interventions such as health education among high-risk groups, such as unemployed individuals, advocacy campaigns, pay-it-forward strategies, and policies for free vaccination could improve coverage in Chongqing.
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Affiliation(s)
- Zhourong Li
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing 400799, China; (Z.L.); (J.L.); (Y.X.); (T.L.)
- School of Public Health, Chongqing Medical University, Chongqing 400016, China; (S.Y.); (L.F.); (Y.Z.)
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; (L.F.); (B.J.)
| | - Jiang Long
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing 400799, China; (Z.L.); (J.L.); (Y.X.); (T.L.)
- Chongqing Municipal Key Laboratory for High Pathogenic Microbes, Chongqing 400799, China
| | - Yu Xiong
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing 400799, China; (Z.L.); (J.L.); (Y.X.); (T.L.)
- Chongqing Municipal Key Laboratory for High Pathogenic Microbes, Chongqing 400799, China
| | - Tingting Li
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing 400799, China; (Z.L.); (J.L.); (Y.X.); (T.L.)
- Chongqing Municipal Key Laboratory for High Pathogenic Microbes, Chongqing 400799, China
| | - Binshan Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; (L.F.); (B.J.)
| | - Shuang Yang
- School of Public Health, Chongqing Medical University, Chongqing 400016, China; (S.Y.); (L.F.); (Y.Z.)
| | - Lin Fu
- School of Public Health, Chongqing Medical University, Chongqing 400016, China; (S.Y.); (L.F.); (Y.Z.)
| | - Zumin Shi
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar;
| | - Yong Zhao
- School of Public Health, Chongqing Medical University, Chongqing 400016, China; (S.Y.); (L.F.); (Y.Z.)
| | - Li Qi
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing 400799, China; (Z.L.); (J.L.); (Y.X.); (T.L.)
- Chongqing Municipal Key Laboratory for High Pathogenic Microbes, Chongqing 400799, China
- Infectious Disease Control and Prevention, Chongqing Municipal Center for Disease Control and Prevention, Chongqing 400799, China
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Jemna DV, David M, Bonnal L, Oros C. Socio-economic inequalities in the use of flu vaccination in Europe: a multilevel approach. HEALTH ECONOMICS REVIEW 2024; 14:61. [PMID: 39083186 PMCID: PMC11292999 DOI: 10.1186/s13561-024-00535-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 07/15/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND The European-wide statistics show that the use of flu vaccination remains low and the differences between countries are significant, as are those between different population groups within each country. Considerable research has focused on explaining vaccination uptake in relation to socio-economic and demographic characteristics, health promotion and health behavior factors. Nevertheless, few studies have aimed to analyze between-country differences in the use of flu vaccination for the EU population. To address this gap, this study examines the socio-economic inequalities in the use of influenza vaccination for the population aged 15 years and over in all 27 EU Member States and two other non-EU countries (Iceland and Norway). METHODS Using data from the third wave of European Health Interview Survey (EHIS) 2019, we employed a multilevel logistic model with a random intercept for country, which allows controlling simultaneously the variations in individuals' characteristics and macro-contextual factors which could influence the use of flu vaccination. In addition, the analysis considers the population stratified into four age groups, namely adolescents, young adults, adults and elderly, to better capture heterogeneities in flu vaccination uptake. RESULTS The main findings confirm the existence of socio-economic inequalities between individuals in different age groups, but also of significant variation between European countries, particularly for older people, in the use of influenza vaccination. In this respect, income and education are strong proxy of socio-economic status associated with flu vaccination uptake. Moreover, these disparities within each population group are also explained by area of residence and occupational status. Particularly for the elderly, the differences between individuals in vaccine utilization are also explained by country-level factors, such as the type of healthcare system adopted in each country, public funding, personal health expenditure burden, or the availability of generalist practitioners. CONCLUSIONS Overall, our findings reveal that vaccination against seasonal influenza remains a critical public health intervention and bring attention to the relevance of conceiving and implementing context-specific strategies to ensure equitable access to vaccines for all EU citizens.
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Affiliation(s)
- Dănuț-Vasile Jemna
- Faculty of Economics and Business Administration, Alexandru Ioan Cuza University of Iaşi, Bld. Carol I, no. 22, 700506, Iași, Romania.
| | - Mihaela David
- Faculty of Economics and Business Administration, Alexandru Ioan Cuza University of Iaşi, Bld. Carol I, no. 22, 700506, Iași, Romania
| | - Liliane Bonnal
- Laboratoire d'économie de Poitiers (LéP), University of Poitiers, Building A1, 2 Jean Carbonnier Street, TSA 81100, Poitiers Cedex 9, 86073, France
| | - Cornel Oros
- Laboratoire d'économie de Poitiers (LéP), University of Poitiers, Building A1, 2 Jean Carbonnier Street, TSA 81100, Poitiers Cedex 9, 86073, France
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Hussain W, Chaman S, Koser HN, Aun SM, Bibi Z, Pirzadi AN, Hussain J, Zubaria Z, Nabi G, Ullah MW, Wang S, Perveen I. Nanoparticle-Mediated Mucosal Vaccination: Harnessing Nucleic Acids for Immune Enhancement. Curr Microbiol 2024; 81:279. [PMID: 39031239 DOI: 10.1007/s00284-024-03803-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 07/10/2024] [Indexed: 07/22/2024]
Abstract
Recent advancements in in vitro transcribed mRNA (IVT-mRNA) vaccine manufacturing have attracted considerable interest as advanced methods for combating viral infections. The respiratory mucosa is a primary target for pathogen attack, but traditional intramuscular vaccines are not effective in generating protective ion mucosal surfaces. Mucosal immunization can induce both systemic and mucosal immunity by effectively eliminating microorganisms before their growth and development. However, there are several biological and physical obstacles to the administration of genetic payloads, such as IVT-mRNA and DNA, to the pulmonary and nasal mucosa. Nucleic acid vaccine nanocarriers should effectively protect and load genetic payloads to overcome barriers i.e., biological and physical, at the mucosal sites. This may aid in the transfection of specific antigens, epithelial cells, and incorporation of adjuvants. In this review, we address strategies for delivering genetic payloads, such as nucleic acid vaccines, that have been studied in the past and their potential applications.
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Affiliation(s)
- Wajid Hussain
- Advanced Biomaterials & Tissues Engineering Center, College of Life Sciences and Technology, Huazhong University of Sciences and Technology, Wuhan, 430074, China
| | - Sadia Chaman
- University of Veterinary and Animals Sciences, Lahore, Pakistan
| | | | | | - Zainab Bibi
- University of the Punjab, Lahore, 54590, Pakistan
| | | | - Jawad Hussain
- Department of Biotechnology, College of Life Sciences and Technology, Huazhong University of Sciences and Technology, Wuhan, 430074, China
| | | | - Ghulam Nabi
- Institute of Nature Conservation, Polish Academy of Sciences, Krakow, Poland
| | - Muhammad Wajid Ullah
- Biofuels Institute, School of the Environment and Safety Engineering, Jiangsu University, Zhenjiang, 212013, People's Republic of China
| | - Shenqi Wang
- Advanced Biomaterials & Tissues Engineering Center, College of Life Sciences and Technology, Huazhong University of Sciences and Technology, Wuhan, 430074, China.
| | - Ishrat Perveen
- GenEd and Molecular Biology Labs, Food and Biotechnology Research Centre, Pakistan Council of Scientific and Industrial Research Centre, Lahore, 54000, Pakistan.
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Falsey AR, Maggi S, Biering-Sørensen T. Podcast: Need for Quality Evidence for Decision-Making on Seasonal Influenza Vaccines. Infect Dis Ther 2024; 13:659-666. [PMID: 38485847 PMCID: PMC11058138 DOI: 10.1007/s40121-024-00932-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/26/2024] [Indexed: 04/30/2024] Open
Abstract
Seasonal influenza is usually considered an acute respiratory infection with a full recovery within a week. In addition to the traditional outcomes, there is now evidence of indirect effects in terms of neurological and functional complications. Major organ systems can be affected, underlining the need for preventative measures against infection. The aim of this podcast, featuring Dr. Ann Falsey, Dr. Stefania Maggi, and Dr. Tor Biering-Sørensen, is to outline influenza complications beyond acute respiratory disease, as well as discussing the need for quality of evidence when evaluating influenza vaccines. Assessing the benefits of vaccination can be challenging. To ensure a high quality of evidence, the innovative randomization of patients within the study design to avoid bias and the assessment of additional outcomes beyond immunogenicity as well as the inclusion of a broad population-including frail or vulnerable individuals-are essential. Studies leveraging nationwide registries such as the DANFLU-2 trial in Denmark highlight the advantages of a digitalized healthcare system for conducting large-scale randomized trials. Furthermore, large-scale trials such as the Gravenstein study have supplied a sizable body of evidence supporting the use of high-dose influenza vaccine in older adults. In conclusion, achieving a high quality of evidence is key for decision-making on seasonal influenza vaccines.
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Affiliation(s)
- Ann R Falsey
- Department of Medicine, Infectious Diseases, University of Rochester Medical Center, Rochester, USA.
| | - Stefania Maggi
- Aging Branch, CNR Institute of Neuroscience, Padua, Italy
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
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Rio P, Caldarelli M, Chiantore M, Ocarino F, Candelli M, Gasbarrini A, Gambassi G, Cianci R. Immune Cells, Gut Microbiota, and Vaccines: A Gender Perspective. Cells 2024; 13:526. [PMID: 38534370 DOI: 10.3390/cells13060526] [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: 02/17/2024] [Revised: 03/11/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024] Open
Abstract
The development of preventive and therapeutic vaccines has played a crucial role in preventing infections and treating chronic and non-communicable diseases, respectively. For a long time, the influence of sex differences on modifying health and disease has not been addressed in clinical and preclinical studies. The interaction of genetic, epigenetic, and hormonal factors plays a role in the sex-related differences in the epidemiology of diseases, clinical manifestations, and the response to treatment. Moreover, sex is one of the leading factors influencing the gut microbiota composition, which could further explain the different predisposition to diseases in men and women. In the same way, differences between sexes occur also in the immune response to vaccines. This narrative review aims to highlight these differences, focusing on the immune response to vaccines. Comparative data about immune responses, vaccine effectiveness, and side effects are reviewed. Hence, the intricate interplay between sex, immunity, and the gut microbiota will be discussed for its potential role in the response to vaccination. Embracing a sex-oriented perspective in research may improve the efficacy of the immune response and allow the design of tailored vaccine schedules.
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Affiliation(s)
- Pierluigi Rio
- Department of Translational Medicine and Surgery, Catholic University of Rome, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Mario Caldarelli
- Department of Translational Medicine and Surgery, Catholic University of Rome, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Monica Chiantore
- Department of Translational Medicine and Surgery, Catholic University of Rome, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Francesca Ocarino
- Department of Translational Medicine and Surgery, Catholic University of Rome, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Marcello Candelli
- Department of Emergency, Anesthesiological and Reanimation Sciences, Catholic University of Rome, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Department of Translational Medicine and Surgery, Catholic University of Rome, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Giovanni Gambassi
- Department of Translational Medicine and Surgery, Catholic University of Rome, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Rossella Cianci
- Department of Translational Medicine and Surgery, Catholic University of Rome, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
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Malița MA, Manolescu LSC, Perieanu VȘ, Babiuc I, Marcov EC, Ionescu C, Beuran IA, Prasacu I, Perieanu MV, Voinescu I, Radu MC, Burlibasa L, Dumitrescu AI, Burlibasa M. COVID-19 and flu vaccination in Romania, post pandemic lessons in healthcare workers and general population. PLoS One 2024; 19:e0299568. [PMID: 38451954 PMCID: PMC10919663 DOI: 10.1371/journal.pone.0299568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/13/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Influenza and corona viruses generate vaccine preventable diseases and have pandemic potential, frequently dramatic. A co-infection with these viruses, may be a new worldwide threat, researchers name it flurona. The aim of our study is to assess flu and COVID-19 Romanian vaccination for 2022-2023 season and the factor associated with higher odds to receive flu and COVID-19 vaccine. METHODS An analytical cross-sectional observational survey was conducted in the general population; a self-administered questionnaire was used. RESULTS 1056 responders were analyzed, mean age 32.08 ±13.36 years (limits:18-76), majority, 880 (83.33%), from urban areas, 608 (57.58%), high school graduated, 400 (37.88%) parents. More than half of the responders were healthcare workers, 582 (55.11%), also considered study population. In the study group, 796 (73.37%) responders consider flurona vaccination useful; and 872 (82.57%) responders consider that no sanctions are needed for not flurona vaccinating. In the 2022-2023 season, 162 (15.34%) responders vaccinated against the flu and 300 (28.41%) against COVID-19. The factor associated with higher odds to receive flu and COVID-19 vaccine was the habit of flu vaccination: for flu (OR = 58.43; 95% CI: (34.95-97.67)) and for COVID-19 (OR = 1.67; 95% CI: (1.21-2.31)). Other factors such as having university degree (OR = 1.46; 95% CI: (1.08-1.98)) and being a healthcare worker, (OR = 1.41; 95% CI: (1.07-1.87)) were influencing factors only for adult COVID-19 vaccination in the 2022-2023 season. In the parents' group, in 2022-2023 season, only 48 (12%) vaccinated their children against the flu and 68 (17%) against COVID-19, mostly parents that vaccinated themselves, p<0.001. In the 2022-2023 season, there were only 82 (7.65%) responders vaccinated against both diseases. Logistic regression analysis showed that no factor analyzed influenced the flurona vaccinated parent's decision to vaccinate their children for flu and for COVID-19. CONCLUSIONS In the season 2022-2023, in Romania, the vaccination against flu and COVOD-19 is low, in adults and children as well. More efforts must be done to increase flurona vaccination, public health educational programs are strongly needed. Children, that are at greater risk when co-infecting with these viruses, must be vaccinated, school vaccination programs should be considered.
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Affiliation(s)
- Mădălina Adriana Malița
- Department of Dental Technology, Faculty of Midwifery and Nursing, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Loredana Sabina Cornelia Manolescu
- Department of Microbiology, Parasitology and Virology, Faculty of Midwifery and Nursing, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Viorel Ștefan Perieanu
- Department of Dental Technology, Faculty of Midwifery and Nursing, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Iuliana Babiuc
- Department of Dental Technology, Faculty of Midwifery and Nursing, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Elena Cristina Marcov
- Department of Restorative Dentistry, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Camelia Ionescu
- Department of Dental Prostheses, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Irina Adriana Beuran
- Department of Dental Technology, Faculty of Midwifery and Nursing, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Irina Prasacu
- Department of Fundamental Sciences, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Mădălina Violeta Perieanu
- Department of Restorative Dentistry, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Ioana Voinescu
- Department of Dental Technology, Faculty of Midwifery and Nursing, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihaela Corina Radu
- Department of Microbiology, Parasitology and Virology, Faculty of Midwifery and Nursing, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Liliana Burlibasa
- Department of Genetics, Faculty of Biology, University of Bucharest, Bucharest, Romania
| | - Anca Irina Dumitrescu
- Department of Fundamental Sciences, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihai Burlibasa
- Department of Dental Technology, Faculty of Midwifery and Nursing, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Lasagna A, Brunello A, Silvestris N, Pedrazzoli P, Di Maio M, Cinieri S. Italian oncologists and vaccinations against infectious diseases: Results of a survey of the Italian Association of Medical Oncology. TUMORI JOURNAL 2024; 110:60-68. [PMID: 37586016 PMCID: PMC10851644 DOI: 10.1177/03008916231191547] [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: 02/28/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Patients with cancer present a higher risk of vaccine-preventable diseases. Recommended vaccinations are the most cost-effective measure to reduce the risk of transmission and related complications. Nevertheless, vaccination rates are inadequate. Oncologists have a central role in tailored vaccine communication to their patients. We present the results of a survey conducted by AIOM in 2022, focusing on the perception of the problem by oncologists. MATERIALS AND METHODS An anonymous 31-item online questionnaire was shared on 15 September 2022 on the AIOM website. The objectives of this survey were to examine the perception of Italian oncologists on vaccine-preventable diseases and the main available vaccines, their attitude towards recommending vaccines and the COVID-19 pandemic impact on their habits regarding vaccine-preventable diseases. RESULTS Between September 2022 and January 2023, 114 medical oncologists (5% of the members) completed the anonymous questionnaire. At the first oncological visit, only 30% of respondents usually propose a vaccination schedule to all their patient, 41% do not usually discuss vaccinations at the first visit and 29% recommend vaccines exclusively to specific categories of patients. For 56% of respondents, patients are more aware of the benefits of vaccines, whereas 36% reported that patients are worried of receiving too many vaccines. CONCLUSION This is the first survey conducted among Italian oncologists to better understand the perception and attitudes towards the vaccination. It highlights the urgent issues of educating and training oncologists in vaccine-preventable diseases and vaccine awareness and the need to build (or implement) a network of multidisciplinary collaborations.
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Affiliation(s)
- Angioletta Lasagna
- Department of Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonella Brunello
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - Paolo Pedrazzoli
- Department of Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
| | - Saverio Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
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Santos AJ, Kislaya I, Matias-Dias C, Machado A. Health beliefs and attitudes toward Influenza and COVID-19 vaccination in Portugal: a study using a mixed-method approach. Front Public Health 2024; 11:1331136. [PMID: 38312138 PMCID: PMC10834706 DOI: 10.3389/fpubh.2023.1331136] [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: 10/31/2023] [Accepted: 12/21/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Vaccination is one of the most effective population strategies to prevent infectious diseases and mitigate pandemics, and it is important to understand vaccine uptake determinants since vaccine hesitancy has been increasing for the past few decades. The Health Belief Model (HBM) has been widely used for understanding vaccination behavior. The current study aimed to assess influenza vaccine (IV) non-uptake and attitudes toward COVID-19 vaccination, two important respiratory diseases with similar symptoms, and routes of transmission in the Portuguese population. Methods We conducted a cross-sectional study using a panel sample of randomly chosen Portuguese households. A total of 1,050 individuals aged 18 years and over responded to a telephone or online questionnaire. Through a mixed-method approach, we employed thematic content analysis to describe reasons for not taking the IV, considering the HBM dimensions, and quantitative statistical analysis to estimate IV and COVID-19 vaccine coverage. Results The IV uptake for the overall population was 30.7% (CI 95%: 26.5, 35.2). Susceptibility was found to be a main factor for IV non-uptake, followed by barriers, such as stock availability and fear of adverse effects. The uptake of the COVID-19 vaccine was very high in the study population (83.1%, CI 95%: 13.6%-20.9%). There was a high perception of COVID-19-associated severity and fear of the consequences. Individuals who reported IV uptake seemed to perceive a higher severity of COVID-19 and a higher benefit of taking the COVID-19 vaccine for severe complications. Discussion Thus, the population does not seem to consider influenza to be a health risk, as opposed to COVID-19, which is considered to be a possibly severe disease. The association between IV uptake and COVID-19 perceptions highlights that an overall attitude toward vaccination in general may be an important individual determinant.
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Affiliation(s)
- Ana João Santos
- CINTESIS@RISE, Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Irina Kislaya
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- Epidemiology Department, National Institute of Health Doctor Ricardo Jorge, Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA University of Lisbon, Lisbon, Portugal
| | - Carlos Matias-Dias
- Epidemiology Department, National Institute of Health Doctor Ricardo Jorge, Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA University of Lisbon, Lisbon, Portugal
- Public Health Research Centre, National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | - Ausenda Machado
- Epidemiology Department, National Institute of Health Doctor Ricardo Jorge, Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA University of Lisbon, Lisbon, Portugal
- Public Health Research Centre, National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
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12
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Colombo L, Hadigal S, Nauta J, Kondratenko A, Rogoll J, Van de Witte S. Influvac Tetra: clinical experience on safety, efficacy, and immunogenicity. Expert Rev Vaccines 2024; 23:88-101. [PMID: 38088157 DOI: 10.1080/14760584.2023.2293241] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION This paper summarizes the safety and immunogenicity data of Influvac Tetra across all age groups starting from 6 months of age, obtained during its clinical development program. AREAS COVERED The article covers the clinical development program of Influvac Tetra based on five registration studies that included different age groups, different comparators, and participants from Europe and Asia. Safety and immunogenicity were assessed in all studies and in one study, the efficacy of Influvac Tetra was assessed. EXPERT OPINION Seasonal influenza is a vaccine-preventable disease that can cause serious complications. Several types of influenza vaccines are available, including egg-based (standard dose, high dose, and adjuvanted), cell-based, and recombinant. The COVID-19 pandemic has stimulated innovation in the development such as mRNA vaccines. However, these vaccines are still in development and the true value still has to be proven. Regardless of the type of vaccine, it is also important to increase overall vaccination coverage. ECDC recommends that EU Member States implement action plans and policies aimed at reaching 75% coverage in at-risk groups and healthcare workers. Even so, vaccine coverage is still far from recommended.
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Affiliation(s)
| | | | - Jos Nauta
- Innovation & Development, Abbott, Weesp, The Netherlands
| | | | - Jutta Rogoll
- Global Pharmacovigilance, Abbott, Hannover, Germany
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13
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Shivamadhu S, Jalal AM, Sandhu AS, Persad N, Satram C, Nalajala N, Osorio Tapia LM, Vera E, Sunkara SM, Salazar EF, Khan A, Ehsan M, Swed S. Immunizing hearts: exploring the vaccination frontier in heart failure management. Ann Med Surg (Lond) 2024; 86:300-307. [PMID: 38222749 PMCID: PMC10783278 DOI: 10.1097/ms9.0000000000001486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/30/2023] [Indexed: 01/16/2024] Open
Abstract
Heart failure (HF) is a widespread clinical condition that affects numerous individuals globally and is a leading cause of hospitalization, particularly in the elderly population. Despite efforts to manage HF using various pharmacological and nonpharmacological interventions, mortality and hospitalization rates remain alarmingly high. Preventive vaccination has emerged as a key measure endorsed by cardiology societies for reducing the morbidity and mortality associated with HF. This study undertakes an extensive review of existing literature to explore the role of vaccination in managing HF, focusing specifically on the immunological pathways involved and potential benefits offered by immunization in this context. This article highlights the role of various vaccines, including influenza, pneumococcal, and COVID-19 vaccines, in reducing HF-related hospitalization, mortality, and overall disease burden. Additionally, this article will delve into specific vaccines that have shown promise in HF management, such as influenza, pneumococcal, and COVID-19 vaccines, along with the rationale for their use, clinical trials, meta-analyses, and real-world data supporting their effectiveness in patients with HF. This article also considers potential challenges and obstacles to widespread vaccination in individuals with HF, which include vaccine hesitancy, accessibility, and adverse events related to vaccines.
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Affiliation(s)
| | - Aysha M. Jalal
- Department of Internal Medicine, Royal College of Surgeons in Ireland, Busaiteen, Bahrain
| | - Arshbeer S. Sandhu
- Department of Internal Medicine, Shaheed Bhai Mani Singh Civil Hospital, Bathinda, India
| | - Narendra Persad
- Department of General Surgery, Sangre Grande Hospital, Sangre Grande, Trinidad and Tobago, Caribbean
| | - Christena Satram
- Department of Surgery, Lincoln American University, Georgetown, Guyana
| | - Navya Nalajala
- Department of Geriatric Medicine, University of Arkansas for Medical Sciences, Little Rock
| | | | - Emiliano Vera
- Department of Internal Medicine, Universidad Autónoma de Guadalajara, Guadalajara, Mexico
| | - Sree M. Sunkara
- Master of Public Health (MPH), University of New Haven, West Haven
| | | | - Anila Khan
- Behavioral Health Program Manager, Asia American Health Coalition dba HOPE Clinic, Houston, USA
| | - Muhammad Ehsan
- Department of Internal Medicine, Mayo Hospital, Lahore, Pakistan
| | - Sarya Swed
- Department of Medicine, Aleppo University, Aleppo, Syria
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14
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Porreca A, Di Nicola M. Flu vaccination coverage in Italy in the COVID-19 era: A fuzzy functional k-means (FFKM) approach. J Infect Public Health 2023; 16:1742-1749. [PMID: 37738690 DOI: 10.1016/j.jiph.2023.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/17/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND In Europe, flu vaccination coverage has decreased, and there are complex barriers to overcome to vaccinate against flu. Many studies have been conducted to estimate vaccination coverage. The COVID-19 pandemic threatens to disrupt immunization programs in many countries, including Italy, where vaccination against the flu is recommended but not mandatory. This paper aims to understand changes in flu vaccine uptake in Italian regions. METHODS Using functional data analysis and fuzzy functional k-means clustering, we investigated changes in flu vaccine coverage in Italian regions before (2010-2019) and after (2020-2022) the COVID-19 vaccination period. RESULTS The period of COVID-19 pandemic brought an increase in vaccine coverage globally. Elbow's method determined that the optimal number of clusters in vaccination uptake is 2. Apulia, Basilicata, Emilia Romagna, Liguria, Molise, Tuscany, and Umbria in 2019 belong less to the group with low flu vaccination uptake (G1) but increase their tendency to belong to this group over time: they decrease their propensity to be vaccinated for flu. For others, it seems that COVID-19 served as a push to increase flu vaccination coverage rates. Sicily appears to be the region that has responded best to the pandemic, changing its membership value from 2019 to 2022. CONCLUSION The present study highlights that the COVID-19 era has resulted in a higher flu vaccination coverage rate. Moreover, the regional level's improvement or worsening in flu vaccination coverage rate is not affected by the historical gap and socio-cultural and economic differences prevailing among Italian regions.
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Affiliation(s)
- Annamaria Porreca
- Department Of Medical, Oral and Biotechnological Sciences, Chieti, Italy.
| | - Marta Di Nicola
- Department Of Medical, Oral and Biotechnological Sciences, Chieti, Italy
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15
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Maleki F, Welch V, Lopez SMC, Cane A, Langer J, Enstone A, Markus K, Wright O, Hewitt N, Whittle I. Understanding the Global Burden of Influenza in Adults Aged 18-64 years: A Systematic Literature Review from 2012 to 2022. Adv Ther 2023; 40:4166-4188. [PMID: 37470942 PMCID: PMC10499696 DOI: 10.1007/s12325-023-02610-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Adults aged 18-64 years comprise most of the working population, meaning that influenza infection can be disruptive, causing prolonged absence from the workplace, and reduced productivity and the ability to care for dependents. Influenza vaccine uptake is relatively low, even among the older adults in this population (i.e., aged 50-64 years), reflecting a lack of perceived need for vaccination. This systematic literature review (SLR) aimed to characterize the global burden of influenza in the 18-64 years population. METHODS An electronic database search was conducted and supplemented with conference and gray literature searches. Eligible studies described at least one of clinical, humanistic, or economic outcomes in adults aged 18-64 years and conducted across several global regions. Included studies were published in English, between January 1, 2012, and September 20, 2022. RESULTS A total of 40 publications were included, with clinical, humanistic, and economic outcomes reported in 39, 5, and 15, respectively. Risk of influenza-associated clinical outcomes were reported to increase with age among the 18-64 years population, including hospitalizations (Yamana et al. in Intern Med 60:3401-3408, 2021; Derqui et al. in Influenza Other Respir Viruses 16:862-872, 2022; Fuller et al. in Influenza Other Respir Viruses 16:265-275, 2022; Ortiz et al. in Crit Care Med 42:2325-2332, 2014; Yandrapalli et al. in Ann Transl Med 6:318, 2018; Zimmerman et al. in Influenza Other Respir Viruses 16:1133-1140, 2022). ICU admissions, mortality, ER/outpatient visits, and use of mechanical ventilation were recorded. Adults aged 18-64 years with underlying comorbidities were at higher risk of influenza-related hospitalizations, ICU admission, and mortality than otherwise healthy individuals. Length of hospital stay increased with age, although a lack of stratification across other economic outcomes prevented identification of further trends across age groups. CONCLUSIONS High levels of hospitalization and outpatient visits demonstrated a clinical influenza-associated burden on patients and healthcare systems, which is exacerbated by comorbidities. Considering the size and breadth of the general population aged 18-64 years, the limited humanistic and economic findings of this SLR likely reflect an underreported burden. Greater investigation into indirect costs and prolonged absenteeism associated with influenza infection is required to fully understand the economic burden in this population.
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Affiliation(s)
| | - Verna Welch
- Pfizer Vaccines Medical and Scientific Affairs, Collegeville, PA, USA
| | | | - Alejandro Cane
- Pfizer Vaccines Medical and Scientific Affairs, Collegeville, PA, USA
| | - Jakob Langer
- Pfizer Global Access and Value, Lisbon, Portugal
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16
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Prada-García C, Toquero-Asensio M, Fernández-Espinilla V, Hernán-García C, Sanz-Muñoz I, Calvo-Nieves MD, Eiros JM, Castrodeza-Sanz J. The Impact of the COVID-19 Pandemic on Influenza Vaccination Attitudes and Actions in Spain's Adult Population. Vaccines (Basel) 2023; 11:1514. [PMID: 37896918 PMCID: PMC10611015 DOI: 10.3390/vaccines11101514] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Seasonal influenza is an acute respiratory infection caused by the influenza virus which constitutes a significant public health issue associated with high morbidity and mortality. The aim of this study was to investigate changes in attitudes, perceptions, and practices regarding influenza vaccination in the Spanish adult population during the COVID-19 pandemic, as well as their vaccination intentions, with special attention paid to those over 65 years old and in high-risk groups. To this end, a cross-sectional study was conducted through 2219 telephone interviews, and the results were compared with results obtained a year earlier. Regarding the reasons for deciding to get vaccinated in the 2022/23 season, a significant increase was observed in vaccine confidence (36.7% vs. 42.8%), social responsibility (32.5% vs. 43.8%), and in awareness of the importance of vaccination due to COVID-19 (21.7% vs. 25.4%). Advanced age (OR 2.8, 95% CI 2.0-3.9), belonging to high-risk groups (OR 2.7, 95% CI 2.0-3.7), and prior vaccination (OR 25.3, 95% CI 19.5-32.7) emerged as significant predictors for the intent to receive the influenza vaccine in the 2022/23 season. Continuously observing shifts in perceptions and behaviors related to influenza immunization is crucial to pinpoint factors that may influence the willingness to receive the vaccine and, in this way, design public health strategies that achieve a greater acceptance of it.
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Affiliation(s)
- Camino Prada-García
- Department of Preventive Medicine and Public Health, University of Valladolid, 47005 Valladolid, Spain; (V.F.-E.); (C.H.-G.); (J.C.-S.)
- National Influenza Centre, Edificio Rondilla, Hospital Clínico Universitario de Valladolid, 47009 Valladolid, Spain; (M.T.-A.); (I.S.-M.); (J.M.E.)
- Dermatology Service, Complejo Asistencial Universitario de León, 24008 León, Spain
| | - Marina Toquero-Asensio
- National Influenza Centre, Edificio Rondilla, Hospital Clínico Universitario de Valladolid, 47009 Valladolid, Spain; (M.T.-A.); (I.S.-M.); (J.M.E.)
- Preventive Medicine and Public Health Service, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Virginia Fernández-Espinilla
- Department of Preventive Medicine and Public Health, University of Valladolid, 47005 Valladolid, Spain; (V.F.-E.); (C.H.-G.); (J.C.-S.)
- National Influenza Centre, Edificio Rondilla, Hospital Clínico Universitario de Valladolid, 47009 Valladolid, Spain; (M.T.-A.); (I.S.-M.); (J.M.E.)
- Preventive Medicine and Public Health Service, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Cristina Hernán-García
- Department of Preventive Medicine and Public Health, University of Valladolid, 47005 Valladolid, Spain; (V.F.-E.); (C.H.-G.); (J.C.-S.)
- National Influenza Centre, Edificio Rondilla, Hospital Clínico Universitario de Valladolid, 47009 Valladolid, Spain; (M.T.-A.); (I.S.-M.); (J.M.E.)
- Preventive Medicine and Public Health Service, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Iván Sanz-Muñoz
- National Influenza Centre, Edificio Rondilla, Hospital Clínico Universitario de Valladolid, 47009 Valladolid, Spain; (M.T.-A.); (I.S.-M.); (J.M.E.)
- Instituto de Estudios de Ciencias de la Salud de Castilla y León, ICSCYL, 24002 Soria, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFECC), 28029 Madrid, Spain
| | - María Dolores Calvo-Nieves
- Department of Clinical Laboratory, Hospital Clínico Universitario de Valladolid, 47009 Valladolid, Spain;
| | - Jose M. Eiros
- National Influenza Centre, Edificio Rondilla, Hospital Clínico Universitario de Valladolid, 47009 Valladolid, Spain; (M.T.-A.); (I.S.-M.); (J.M.E.)
- Microbiology Service, Hospital Universitario Río Hortega, 47012 Valladolid, Spain
| | - Javier Castrodeza-Sanz
- Department of Preventive Medicine and Public Health, University of Valladolid, 47005 Valladolid, Spain; (V.F.-E.); (C.H.-G.); (J.C.-S.)
- National Influenza Centre, Edificio Rondilla, Hospital Clínico Universitario de Valladolid, 47009 Valladolid, Spain; (M.T.-A.); (I.S.-M.); (J.M.E.)
- Preventive Medicine and Public Health Service, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
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