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Ando T, Ibuka Y, Goto R, Haruta J, Le DD, Fujishima S. Effect of influenza vaccine subsidies for older adults on vaccination coverage and mortality before and during the COVID-19 pandemic: an ecological study in Japan. Public Health 2023; 224:152-158. [PMID: 37797561 DOI: 10.1016/j.puhe.2023.08.031] [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: 03/24/2023] [Revised: 08/01/2023] [Accepted: 08/30/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE We aimed to determine how municipal subsidies for seasonal influenza vaccines for the elderly affected vaccination coverage and health outcomes and how responses to vaccine prices changed during the COVID-19 pandemic. STUDY DESIGN AND METHODS This ecological study includes 1245 municipalities in Japan between 2019 and 2020. Fixed-effects regression analysis was performed to evaluate the effect of influenza vaccine cost subsidy for people aged 65 years or older on vaccination coverage, all-cause mortality, and influenza-related mortality. RESULTS The vaccination rate increased when patients' copayments decreased, and reducing the copayment by 1000 Japanese Yen (JPY) was estimated to increase the vaccination rate by 6.3% (95% confidence interval [CI] 4.5-8.2%) in the adjusted model. When examining the additional effect of a zero price compared to a nearly zero price, we found that a zero price increased the immunization rate by 6.4% (95% CI 1.4-11.5%). The effect of copayment on the increase in vaccination coverage was significantly lower during the pandemic than in the pre-pandemic period. The municipal and prefectural analyses found no association between influenza vaccine copayments and all-cause, influenza, or pneumonia mortality. CONCLUSION Cost subsidies and the zero-price effect were shown to increase vaccination coverage but were not associated with relevant mortality measures. Although the impact was attenuated under pandemic conditions, cost subsidy effectively increases the vaccination rate.
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Affiliation(s)
- T Ando
- Center for General Medicine Education, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Y Ibuka
- Department of Economics, Keio University, 2-15-45 Mita, Minato-ku, Tokyo, 108-8345, Japan
| | - R Goto
- Graduate School of Business Administration, Keio University, 4-1-1 Hiyoshi, Yokohama, Kanagawa, 223-8521, Japan
| | - J Haruta
- Center for General Medicine Education, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Medical Education Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - D D Le
- Department of Economics, Keio University, 2-15-45 Mita, Minato-ku, Tokyo, 108-8345, Japan
| | - S Fujishima
- Center for General Medicine Education, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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2
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Pham TH, Beck E, Postma MJ, Németh B, Ágh T, de Waure C, Salisbury DM, Nutma N, van der Schans J. Country score tool to assess readiness and guide evidence generation of immunization programs in aging adults in Europe. Front Public Health 2023; 10:1080678. [PMID: 36699900 PMCID: PMC9869118 DOI: 10.3389/fpubh.2022.1080678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
Objectives Delaying of policies for immunization of aging adults, low vaccine uptake, and the lack of supportive evidence at the national level could diminish the value in health and economics of such programs. This study aims to develop a "country score tool" to assess readiness and to facilitate evidence generation for aging adult immunization programs in Europe, and examine the comprehensiveness, relevance, acceptability, and feasibility of the tool. Methods The tool was developed in two phases. First, a modified Delphi process was used to construct the tool. The process included a literature review, stakeholder consultations, and a three-round Delphi study. The Delphi panel included researchers, supra-national and national decision-makers of immunization programs recruited from five countries, using snowball sampling method. The consensus was predefined at the agreement rate of 70%. Pilot testing of the tool was conducted in the Netherlands, Germany, Serbia, and Hungary involving researchers in the field of health technology assessment. After assessing the countries' readiness, researchers evaluated four features, namely comprehensiveness, relevance, acceptability, and feasibility of the tool via an online survey that included 5-scale Likert questions. The percentages of affirmative answers including "agree" and "totally agree" choices were presented. Results The review identified 16 tools and frameworks that formed the first version of our tool with 14 items. Eight experts were involved in the Delphi panel. Through three Delphi rounds, four items were added, one was dropped, and all others were amended. The consensus was achieved on the tool with 17 items divided into decision-making and implementation parts. Each item has a guiding question, corresponding to explanations and rationales to inform assessment with readiness scores. Eight researchers completed the pilot testing. The tool was rated as comprehensive (75%), relevant (100%), acceptable (75%), and feasible (88%) by participants. Conclusion Through a thorough and transparent process, a country score tool was developed helping to identify strengths, weaknesses, and evidential requirements for decision-making and implementation of immunization programs of aging adults. The tool is relevant for different European contexts and shows good comprehensiveness, acceptability, and feasibility.
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Affiliation(s)
- Thi Hao Pham
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, Groningen, Netherlands,Asc Academics, Groningen, Netherlands,Thi Hao Pham ✉
| | - Ekkehard Beck
- Department of Vaccines Value Evidence, GlaxoSmithKline, Wavre, Belgium
| | - Maarten J. Postma
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, Groningen, Netherlands,Department of Economics, Econometrics & Finance, University of Groningen, Groningen, Netherlands,Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | | | - Tamás Ágh
- Syreon Research Institute, Budapest, Hungary
| | - Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - David M. Salisbury
- Royal Institute International Affairs, Chatham House, London, United Kingdom
| | - Nynke Nutma
- RIVM, The Dutch National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Jurjen van der Schans
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, Groningen, Netherlands,Department of Economics, Econometrics & Finance, University of Groningen, Groningen, Netherlands,*Correspondence: Jurjen van der Schans ✉
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3
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Jiang B, Wang Z, Jia M, Yan H, Su Z, Liu S, Yang W, Qiao YL, Feng L. Awareness, knowledge and attitude toward influenza vaccination in several population groups in China: A cross-sectional study. Front Public Health 2022; 10:950532. [PMID: 36330121 PMCID: PMC9624296 DOI: 10.3389/fpubh.2022.950532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/26/2022] [Indexed: 01/21/2023] Open
Abstract
Background We aimed to comprehensively analyze awareness, knowledge and attitude toward influenza vaccine and the factors associated to vaccine acceptance among the young and middle-aged general population, healthcare workers, and health-related administrators in China. The factors influencing the promotion of influenza vaccination were also evaluated among healthcare workers and administrators. Methods This is a multicenter, cross-sectional study. General population adults, healthcare workers (HCWs), and health administrators were enrolled in seven regions across China during the 2020-2021 flu season. Data were collected via an online questionnaire, which included information request as to awareness, knowledge, and attitude toward influenza vaccination. Statistical significance set at p-values < 0.05. Results A total of 3,239 individuals were included in our analyses. There were gaps in consciousness to action, especially between awareness (87.1%) and knowledge (57.7%), and between willingness (57.3%) and vaccination (22.3%). The downward trends were similar in all three groups. HCW group and the health administrator group showed more positive propensity to accept influenza vaccines than the general population group. For the general population group, those with a lower educational level (lower than a bachelor's degree) were less likely to be vaccinated (aOR = 0.66, 95% CI: 0.45-0.96). For the HCW group, practitioners older than 45 years were more reluctant to be vaccinated than those under 25 years (aOR = 0.41, 95% CI: 0.19-0.86). For the health administrator group, personnel aged 26 years and above were less inclined to be vaccinated (aORs = 0.17-0.20). In all groups, people who had received influenza vaccines in the past 5 years (aOR = 1.72, 95% CI: 1.31-2.26 in general population group, 13.05, 95% CI: 7.71-22.10 in HCW group, and 19.30, 95% CI: 9.66-42.63 in health administrator group) were more likely to be vaccinated in future seasons. People who were not covered by the free program or those without awareness of the related programs were less likely to be vaccinated (aORs < 0.63). Most (70.8%) of HCWs showed intention to recommend the influenza vaccine. Clinical doctors, those who had flu shots themselves, and those who had more knowledge, were more like to make recommendations. Health administrators stated that insufficient budget resources and workforce, and low public awareness are main difficulties in the promotion of influenza vaccine. Conclusion The influencing factors of the attitude toward influenza vaccination vary across populations. Governments need to carry out focused vaccination promotion programs, especially for healthcare workers, to improve the coverage of influenza vaccination.
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Affiliation(s)
- Binshan Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhenzhong Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengmeng Jia
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Mengmeng Jia
| | - Huijiao Yan
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Su
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shujun Liu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weizhong Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - You-lin Qiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,Luzhao Feng
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Damm O, Krefft A, Ahlers J, Kramer R, Witte J, Batram M, Schelling J, Greiner W. Prevalence of chronic conditions and influenza vaccination coverage rates in Germany: Results of a health insurance claims data analysis. Influenza Other Respir Viruses 2022; 17:e13054. [PMID: 36181357 PMCID: PMC9835435 DOI: 10.1111/irv.13054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/25/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The significant annual burden caused by seasonal influenza has led to global calls for increased influenza vaccination coverage rates (VCRs). We aimed to estimate the proportion of the German population at high risk of serious illness from influenza due to chronic conditions and to estimate age-specific VCRs of people with/without chronic conditions. METHODS Using health insurance claims data covering nine influenza seasons (2010-2019), we assessed up to 7 million insured individuals per season across all German regions. Individuals were classified according to age and presence of chronic health conditions. VCRs were estimated using outpatient healthcare utilization documentation. RESULTS In the 2018-2019 influenza season, 47.3% of individuals had ≥1 chronic condition. Most common were circulatory disorders, accounting for more than a third of individuals with ≥1 condition. Prevalence of chronic diseases, and therefore the proportion of high-risk individuals, increased slightly over time across most age groups. A downward trend in influenza VCRs was observed in all age groups until the 2017-2018 season, followed by a noticeable increase in the 2018-2019 season. Highest VCRs occurred among individuals of ≥60 years, with a 38.5% VCR for this age group in the 2018-2019 season. Several factors, including age, chronic condition type, and geographical location, affected VCRs. CONCLUSIONS Influenza VCRs in individuals at high risk of severe complications from influenza infection are insufficient. Our results suggest that intensified public health efforts are necessary to reach the World Health Organization vaccination coverage target of 75%.
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Affiliation(s)
- Oliver Damm
- Sanofi‐Aventis Deutschland GmbHBerlinGermany
| | - Anya Krefft
- Sanofi‐Aventis Deutschland GmbHBerlinGermany
| | | | - Rolf Kramer
- Sanofi‐Aventis Deutschland GmbHBerlinGermany
| | - Julian Witte
- School of Public HealthBielefeld UniversityBielefeldGermany,Vandage GmbHBielefeldGermany
| | | | - Jörg Schelling
- Medical FacultyLudwig‐Maximilians‐UniversityMunichGermany
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Jones RP, Ponomarenko A. Trends in Excess Winter Mortality (EWM) from 1900/01 to 2019/20-Evidence for a Complex System of Multiple Long-Term Trends. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063407. [PMID: 35329098 PMCID: PMC8953800 DOI: 10.3390/ijerph19063407] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022]
Abstract
Trends in excess winter mortality (EWM) were investigated from the winter of 1900/01 to 2019/20. During the 1918–1919 Spanish flu epidemic a maximum EWM of 100% was observed in both Denmark and the USA, and 131% in Sweden. During the Spanish flu epidemic in the USA 70% of excess winter deaths were coded to influenza. EWM steadily declined from the Spanish flu peak to a minimum around the 1960s to 1980s. This decline was accompanied by a shift in deaths away from the winter and spring, and the EWM calculation shifted from a maximum around April to June in the early 1900s to around March since the late 1960s. EWM has a good correlation with the number of estimated influenza deaths, but in this context influenza pandemics after the Spanish flu only had an EWM equivalent to that for seasonal influenza. This was confirmed for a large sample of world countries for the three pandemics occurring after 1960. Using data from 1980 onward the effect of influenza vaccination on EWM were examined using a large international dataset. No effect of increasing influenza vaccination could be discerned; however, there are multiple competing forces influencing EWM which will obscure any underlying trend, e.g., increasing age at death, multimorbidity, dementia, polypharmacy, diabetes, and obesity—all of which either interfere with vaccine effectiveness or are risk factors for influenza death. After adjusting the trend in EWM in the USA influenza vaccination can be seen to be masking higher winter deaths among a high morbidity US population. Adjusting for the effect of increasing obesity counteracted some of the observed increase in EWM seen in the USA. Winter deaths are clearly the outcome of a complex system of competing long-term trends.
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Affiliation(s)
- Rodney P. Jones
- Healthcare Analysis & Forecasting, Wantage OX12 0NE, UK
- Correspondence:
| | - Andriy Ponomarenko
- Department of Biophysics, Informatics and Medical Instrumentation, Odessa National Medical University, Valikhovsky Lane 2, 65082 Odessa, Ukraine;
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Roller-Wirnsberger R, Lindner S, Kolosovski L, Platzer E, Dovjak P, Flick H, Tziraki C, Illario M. The role of health determinants in the influenza vaccination uptake among older adults (65+): a scope review. Aging Clin Exp Res 2021; 33:2123-2132. [PMID: 33587270 PMCID: PMC7882864 DOI: 10.1007/s40520-021-01793-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/11/2021] [Indexed: 02/06/2023]
Abstract
Background Although the burden of influenza infection is the highest in older adults, vaccination coverage remains low, despite this age group being more vulnerable than others. Aims Given the current pandemic of SARS-CoV-2, it was the aim of this scope review to update knowledge on factors affecting seasonal influenza vaccine uptake among older adults to strengthen prevention approaches in the context of an overall burden of infectious diseases. Methods We searched bibliographic databases from 2012 to 2019. All studies reviewed one or more social determinant of health listed by WHO, or factors affecting the decision-making process whether to accept influenza vaccine or not. Results Overall, 44 studies were included, 41 determinants were extracted and summarized into six categories. Older age and constitutional factors including multiple chronic diseases as well as preventive lifestyle and frequent routine healthcare utilization positively affected vaccination uptake (VU). Living and working conditions are also researched determinants of influenza vaccine uptake. A small number of studies explored the role of social inclusion and system-based interventions. Discussion and conclusions This scope review provides a comprehensive overview on factors affecting seasonal influenza vaccination uptake among older citizens. The review also clearly shows gaps for evidence on system-based level or political strategies to improve vaccination uptake. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-01793-3.
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Bhugra P, Grandhi GR, Mszar R, Satish P, Singh R, Blaha M, Blankstein R, Virani SS, Cainzos-Achirica M, Nasir K. Determinants of Influenza Vaccine Uptake in Patients With Cardiovascular Disease and Strategies for Improvement. J Am Heart Assoc 2021; 10:e019671. [PMID: 34315229 PMCID: PMC8475658 DOI: 10.1161/jaha.120.019671] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Influenza infection is associated with an increased risk of cardiovascular events (myocardial infarction, stroke, and heart failure exacerbation) and mortality, and all‐cause mortality in patients with CVD. Infection with influenza leads to a systemic inflammatory and thrombogenic response in the host body, which further causes destabilization of atherosclerotic plaques. Influenza vaccination has been shown to be protective against cardiovascular and cerebrovascular events in several observational and prospective studies of at‐risk populations. Hence, many international guidelines recommend influenza vaccination for adults of all ages, especially for individuals with high‐risk conditions such as CVD. Despite these long‐standing recommendations, influenza vaccine uptake among US adults with CVD remains suboptimal. Specifically, vaccination uptake is strikingly low among patients aged <65 years, non‐Hispanic Black individuals, those without health insurance, and those with diminished access to healthcare services. Behavioral factors such as perceived vaccine efficacy, vaccine safety, and attitudes towards vaccination play an important role in vaccine acceptance at the individual and community levels. With the ongoing COVID‐19 pandemic, there is a potential threat of a concurrent epidemic with influenza. This would be devastating for vulnerable populations such as adults with CVD, further stressing the need for ensuring adequate influenza vaccination coverage. In this review, we describe a variety of strategies to improve the uptake of influenza vaccination in patients with CVD through improved understanding of key sociodemographic determinants and behaviors that are associated with vaccination, or the lack thereof. We further discuss the potential use of relevant strategies for COVID‐19 vaccine uptake among those with CVD.
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Affiliation(s)
| | | | - Reed Mszar
- Center for Outcomes Research and EvaluationYale New Haven Health New Haven CT
| | - Priyanka Satish
- Department of CardiologyHouston Methodist Hospital Houston TX
| | - Rahul Singh
- Department of Internal Medicine Houston Methodist Hospital Houston TX
| | - Michael Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Baltimore MD
| | - Ron Blankstein
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center Houston TX.,Baylor College of Medicine Houston TX
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness Department of CardiologyHouston Methodist DeBakey Heart & Vascular Center Houston TX.,Center for Outcomes Research Yale University New Haven CT
| | - Khurram Nasir
- Division Health Equity & Disparities Research Center for Outcomes Research Houston Methodist Hospital Houston TX.,Division of Cardiovascular Prevention and Wellness Department of Cardiovascular MedicineHouston Methodist DeBakey Heart & Vascular Center Houston TX.,Center for Cardiovascular Computational & Precision Health (C3-PH) Department of Cardiovascular Medicine Houston Methodist DeBakey Heart & Vascular Center Houston TX.,Division of Cardiology Yale University New Haven CT
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Influenza Vaccination Status and Its Affecting Factors among Stroke Survivors: Findings from the Korea National Health and Nutrition Examination Survey. Vaccines (Basel) 2021; 9:vaccines9070763. [PMID: 34358179 PMCID: PMC8310036 DOI: 10.3390/vaccines9070763] [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: 05/24/2021] [Revised: 06/25/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
Few studies have examined the influenza vaccination rates among stroke survivors despite the importance of vaccines in preventing influenza- and stroke-related complications. Thus, we investigated the vaccination rates and the associated factors among stroke survivors using the representative Korea National Health and Nutrition Examination Survey 2014–2018. We measured and compared the vaccination rates of 591 stroke survivors and 17,997 non-stroke survivors. Multivariate logistic regression analyses of all stroke survivors and age subgroups (<65 and ≥65 years) were performed to identify the factors influencing vaccination. The overall vaccination rate was significantly higher in the stroke survivors (64.8%) than in the non-stroke survivors (41.1%), but it was low compared to global standards. Among stroke survivors aged <65 years, the rate was low (37.5%), but it improved in those aged ≥65 years (85.6%). Age ≥ 65 years, the eligible age for the national free vaccination program was the most prominent predictor of vaccination for all stroke survivors, while smoking was a negative predictor. No significant factors were found in the subgroup analyses according to age (<65 and ≥65 years). Therefore, implementing strategic public health policies, such as expanding the free vaccination program to stroke survivors aged <65 years, may improve vaccine coverage.
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Yan S, Wang Y, Zhu W, Zhang L, Gu H, Liu D, Zhu A, Xu H, Hao L, Ye C. Barriers to influenza vaccination among different populations in Shanghai. Hum Vaccin Immunother 2021; 17:1403-1411. [PMID: 33270473 PMCID: PMC8078689 DOI: 10.1080/21645515.2020.1826250] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/16/2020] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Seasonal influenza vaccination coverage remains low in most areas of China. Its influencing factors and barriers in various populations receiving influenza vaccinations need to be well understood to promote vaccination. METHODS A cross-sectional survey was conducted with residents in 48 communities. Vaccination status in the 2018-2019 influenza season and reasons for or against vaccination were surveyed. The potential factors influencing vaccination uptake were determined using bivariate logistic regression. RESULTS In total, 1301 of the 11053 respondents received an influenza vaccine during the 2018-2019 season with a coverage rate of 11.8% (95% CI, 11.2-12.4). The vaccine coverage was highest among children (26.6%, 95%CI: 24.8-28.5), followed by adults (8.2%, 95%CI: 7.4-9.0) and elderly people (7.3%, 95%CI: 6.5-8.1) (p < .001). Those with chronic underlying conditions all had higher vaccine coverage than did those without for different groups (p < .001). Among the three groups, the most common reason for being unvaccinated was worrying about the side effects (45.0%), believing they were healthy and did not need to get vaccinated (42.2%), and lack of influenza vaccine awareness (48.3%). Low education level and lack of awareness were identified as predictors of low coverage rate. CONCLUSION Influenza vaccination coverage is low among different populations in Shanghai. Our study highlights the need for appropriate influenza vaccination strategies and programmes targeting different populations.
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Affiliation(s)
- Sijin Yan
- Division of Infectious Disease Prevention and Disinfection Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Yuanping Wang
- Division of Infectious Disease Prevention and Disinfection Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Weiping Zhu
- Division of Infectious Disease Prevention and Disinfection Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Li Zhang
- Division of Infectious Disease Prevention and Disinfection Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Huozheng Gu
- Division of Infectious Disease Prevention and Disinfection Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Dan Liu
- Division of Infectious Disease Prevention and Disinfection Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Aiqin Zhu
- Division of Infectious Disease Prevention and Disinfection Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Hongmei Xu
- Division of Infectious Disease Prevention and Disinfection Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Lipeng Hao
- Division of Infectious Disease Prevention and Disinfection Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Chuchu Ye
- Division of Infectious Disease Prevention and Disinfection Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
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Adongo CA, Amenumey EK, Kumi-Kyereme A, Dubé E. Beyond fragmentary: A proposed measure for travel vaccination concerns. TOURISM MANAGEMENT 2021; 83:104180. [PMID: 32952254 PMCID: PMC7487078 DOI: 10.1016/j.tourman.2020.104180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/19/2020] [Accepted: 06/24/2020] [Indexed: 05/05/2023]
Abstract
The travel medicine literature points to travelers' concerns as significant promoters of their under-vaccinations. Therefore, this study researches the hitherto understudied concept of vaccination concern and its theoretical scope in the international travel space. It attempts a conceptualization of the concept by delimiting its theoretical scope and proposes a measure for it. An exploratory sequential mixed-methods design was used to conduct four interlocking studies using data from a netnography, field interviews, and surveys among varied international travelers. A scale with six dimensions, comprising safety, efficacy, cost, time, access, and autonomy concerns were revealed. The scale significantly explained mainstream and segments-based tourists' uptake attitudes and behavior for their eligible vaccines. The findings suggest that anti-travel vax sentiments and public vax sentiments despite conceptually similar are considerably distinct. The broad nature of the scale and its prediction of travelers' vaccine uptake make it clinically relevant for tracking and resolving concerns for increased vaccine uptake.
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Affiliation(s)
- Charles Atanga Adongo
- College of Humanities and Legal Studies, Faculty of Social Sciences, Department of Hospitality and Tourism Management, University of Cape Coast, Cape Coast, Ghana
| | - Edem Kwesi Amenumey
- College of Humanities and Legal Studies, Faculty of Social Sciences, Department of Hospitality and Tourism Management, University of Cape Coast, Cape Coast, Ghana
| | - Akwasi Kumi-Kyereme
- College of Humanities and Legal Studies, Faculty of Social Sciences, Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Eve Dubé
- Quebec National Institute of Public Health, Research Center of the CHU de Quebec, Canada
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11
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Where are the keys to improve vaccine uptake in adults and elders in European countries? Aging Clin Exp Res 2021; 33:1123-1131. [PMID: 31900875 DOI: 10.1007/s40520-019-01443-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 12/09/2019] [Indexed: 11/27/2022]
Abstract
Improving vaccination of the elderly is one of the most important challenges in the coming years, as it was for infant's decades ago. Insufficient vaccine uptake in the elderly can be considered a concern with regard to the burden of vaccine preventable diseases in this growing population. The purpose of this paper is to have an overview on the different steps involved in decision policy making from the regulatory agencies until people are vaccinated. Examples of different policies within European countries will be compared for influenza, streptococcal and zoster infections. For each step, key improvements to increase vaccine uptake in this specific population will be proposed.
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12
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Understanding the Influence of Individual and Systemic Factors on Vaccination Take-Up in European Citizens Aged 55 or Older. Vaccines (Basel) 2021; 9:vaccines9020169. [PMID: 33671437 PMCID: PMC7922776 DOI: 10.3390/vaccines9020169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 01/10/2023] Open
Abstract
Background: High vaccination coverage provides extensive public health benefits. Hence, increasing vaccination rates is an important policy goal within the EU and worldwide. We aim to evaluate individual and systemic parameters associated with vaccination in European Union citizens aged 55 or older, using data from the Special Eurobarometer 488. Methods: Linear probability and probit models are estimated to analyze the determinants of vaccination take-up. Further, descriptive analyses are used to explore how the reasons for not having a vaccination differ by welfare regime. Results: High knowledge about the effectiveness and safety of vaccination increases the probability of receiving a vaccination during the past five years by 26 percentage points (pp), medium knowledge increases it by 15 pp. Focusing on the specific case of the flu, official recommendations increase this probability by, on average, 6 pp; while having to pay out-of-pocket for a recommended vaccination decreases it by, on average, 10 pp. Furthermore, the differences for no vaccination differ widely across welfare systems and television is the primary source for information about vaccination. Conclusions: Reported vaccination rates in Europe fall far below targets set by official recommendations. Increasing vaccination knowledge and offering vaccinations free of charge can help to increase vaccination rates. A specific focus should be put on reaching individuals with potential difficulties of access such as those living alone and unemployed.
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Kassianos G, Banerjee A, Baron-Papillon F, Hampson AW, McElhaney JE, McGeer A, Rigoine de Fougerolles T, Rothholz M, Seale H, Tan LJ, Thomson A, Vitoux O. Key policy and programmatic factors to improve influenza vaccination rates based on the experience from four high-performing countries. Drugs Context 2021; 10:2020-9-5. [PMID: 33456480 PMCID: PMC7789908 DOI: 10.7573/dic.2020-9-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/02/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Many countries consistently fail to achieve the target influenza vaccine coverage rate (VCR) of 75% for populations at risk of complications, recommended by the World Health Organization and European Council. We aimed to identify factors for achieving a high VCR in the scope of four benchmark countries with high influenza VCRs: Australia, Canada, UK and USA. METHODS Publicly available evidence was first reviewed at a global level and then for each of the four countries. Semi-structured interviews were then conducted with stakeholders meeting predefined criteria. Descriptive cluster analyses were performed to identify key factors and pillars for establishing and maintaining high VCRs. RESULTS No single factor led to a high VCR, and each benchmark country used a different combination of tailored approaches to achieve a high vaccine coverage. In each country, specific triggers were important to stimulate changes that led to improved vaccine coverage. A total of 42 key factors for a successful influenza vaccination programme were identified and clustered into five pillars: (1) Health Authority accountability and strengths of the influenza programme, (2) facilitated access to vaccination, (3) healthcare professional accountability and engagement, (4) awareness of the burden and severity of disease and (5) belief in influenza vaccination benefit. Each benchmark country has implemented multiple factors from each pillar. CONCLUSION A wide range of factors were identified from an evaluation of four high-performing benchmark countries, classified into five pillars, thus providing a basis for countries with lower VCRs to tailor their own particular solutions to improve their influenza VCR.
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Affiliation(s)
| | | | | | - Alan W Hampson
- Federation University, Mount Helen, VIC, Australia
- Immunisation Coalition, Melbourne, Australia
| | | | - Allison McGeer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Sinai Health System, Toronto, ON, Canada
| | | | | | - Holly Seale
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Litjen J Tan
- Immunization Action Coalition, Saint Paul, MN, USA
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Baj-Rogowska A. Mapping of the Covid-19 Vaccine Uptake Determinants From Mining Twitter Data. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2021; 9:134929-134944. [PMID: 34786320 PMCID: PMC8545202 DOI: 10.1109/access.2021.3115554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/22/2021] [Indexed: 05/12/2023]
Abstract
Opinion polls on vaccine uptake clearly show that Covid-19 vaccine hesitancy is increasing worldwide. Thus, reaching herd immunity not only depends on the efficacy of the vaccine itself, but also on overcoming this hesitancy of uptake in the population. In this study, we revealed the determinants regarding vaccination directly from people's opinions on Twitter, based on the framework of the 6As taxonomy. Covid-19 vaccine acceptance depends mostly on the characteristics of new vaccines (i.e. their safety, side effects, effectiveness, etc.), and the national vaccination strategy (i.e. immunization schedules, quantities of vaccination points and their localization, etc.), which should focus on increasing citizens' awareness, among various other factors. The results of this study point to areas for potentially improving mass campaigns of Covid-19 immunization to increase vaccine uptake and its coverage and also provide insight into possible directions of future research.
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Affiliation(s)
- Anna Baj-Rogowska
- Department of Informatics in ManagementGdañsk University of Technology 80-233 Gdañsk Poland
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Machado A, Santos AJ, Kislaya I, Larrauri A, Nunes B. Understanding influenza vaccination among Portuguese elderly: the social ecological framework. Health Promot Int 2020; 35:1427-1440. [DOI: 10.1093/heapro/daaa011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
This study intended to identify and quantify the social ecological model (SEM) levels associated to seasonal IV uptake in the Portuguese elderly population. Data from the 2014 National Health Survey was restricted to individuals aged 65+ years (n = 5669). Twenty-three independent variables were allocated to the SEM levels: individual, interpersonal, organizational, community and policy. Sex stratified and age adjusted analysis using Poisson regression were performed for each level and for a fitted full model. Relative reduction in pseudo R magnitude measured marginal contribution of each level. For men and women, older groups (85+ vs. 65–69; men, PR = 1.59 and women, PR = 1.56); having 3+ chronic conditions (men, PR = 1.39 and women, PR = 1.35); previous 4 weeks GP and outpatient visits were associated to higher IV uptake. For men, only 2 SEM levels were associated (individual and organizational) while for women the community level was also relevant. Main marginal contribution came from individual (17.9% and 16.3%) and organizational (30.7% and 22.7%) levels. This study highlights the importance of individual characteristics, access and use of health care services for the IV uptake and the sex differential behaviour.
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Affiliation(s)
- Ausenda Machado
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisbon
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Ana João Santos
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisbon
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Irina Kislaya
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisbon
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Amparo Larrauri
- National Centre of Epidemiology, Institute of Health Carlos III, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Baltazar Nunes
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisbon
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
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Vaccination Programs for Adults in Europe, 2019. Vaccines (Basel) 2020; 8:vaccines8010034. [PMID: 31968652 PMCID: PMC7157239 DOI: 10.3390/vaccines8010034] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 11/17/2022] Open
Abstract
Background: While all European countries implement vaccination programs for children, there are gaps in terms of vaccination programs for adults. Methods: We studied the 2019 vaccination policies for adults in 42 European countries. Results: Vaccination programs for adults were in place in all countries. However, there were considerable differences between countries in terms of number of vaccinations, target populations and frame of implementation (recommended or mandatory vaccinations). In particular the following vaccination policies were in place: influenza (42 countries), tetanus (31), diphtheria (30), pneumococcus (29), hepatitis B (20), pertussis (18), measles (14), human papilloma virus (14), meningococcus tetravalent A,C,W,Y (14), rubella (13), hepatitis A (11), mumps (11), poliomyelitis (10), herpes zoster (9), varicella (8), tick-born encephalitis (8), meningococcus B (6), rabies (6), Haemophilus influenzae type b (5), tuberculosis (3), typhoid fever (3), meningococcus C (2), and yellow fever (1). Seventeen countries implement mandatory vaccinations, mainly against diphtheria, tetanus and hepatitis B. Conclusions: There are significant differences in vaccination programs for adults in Europe. Routine vaccination programs for adults need to be strengthened. A consensus-based vaccination program is needed.
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Fabiani M, Volpe E, Faraone M, Bella A, Rizzo C, Marchetti S, Pezzotti P, Chini F. Influenza vaccine uptake in the elderly population: Individual and general practitioner's determinants in Central Italy, Lazio region, 2016-2017 season. Vaccine 2019; 37:5314-5322. [PMID: 31331778 DOI: 10.1016/j.vaccine.2019.07.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Elderly people are a priority target group for influenza vaccination and their decision to be vaccinated might partly depend on advice received from general practitioners (GP). This study aims to investigate the association between influenza vaccine uptake in the elderly residents in the Lazio region of Italy and the demographic and professional characteristics of their GPs, taking simultaneously into account the elderly's individual characteristics. METHODS We used data retrieved from different administrative sources to retrospectively analyse the cohort of 1,255,657 elderly residents aged ≥65 years who were alive and registered in the regional healthcare service at the beginning of the 2016-2017 influenza vaccination campaign (1 Oct. 2016-31 Jan. 2017). We assessed influenza vaccine uptake at the end of the vaccination campaign and evaluated its association with both individual and GP-related characteristics through a multilevel Poisson regression models accounting for clustering at physician level. RESULTS Overall, vaccination coverage at the end of vaccination campaign was 50.6%. Elderly residents who were male, older, vaccinated in the previous seasons, living in smaller provinces, and spending more money for specialist medical care showed a significantly increased probability to be vaccinated. Vaccine uptake was also significantly higher in the elderly residents assisted by GPs who got master's degree more recently, assisted a relatively high proportion of elderly patients, received influenza vaccination, had a computer assistant, and were associated with other physicians. CONCLUSIONS Our results indicate that influenza vaccination coverage in the elderly residents of the Lazio region is still unsatisfactorily low. We identified several determinants of influenza vaccine uptake, related to both individual and GP characteristics. Understanding how GP characteristics affected influenza vaccine uptake in the elderly population might provide insight on GPs' attitudes and concerns regarding influenza vaccination, allowing the implementation of targeted evidence-based interventions to sensitise GPs and increase vaccination coverage.
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Affiliation(s)
- Massimo Fabiani
- Department of Infectious Diseases, Italian National Institute of Health (ISS), Viale Regina Elena 299, 00161 Rome, Italy.
| | - Enrico Volpe
- Regional Directorate for Health and Social Policy, Lazio Region, Via R. Raimondi Garibaldi 7, 00145 Rome, Italy
| | - Maurizio Faraone
- Regional Directorate for Health and Social Policy, Lazio Region, Via R. Raimondi Garibaldi 7, 00145 Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, Italian National Institute of Health (ISS), Viale Regina Elena 299, 00161 Rome, Italy
| | - Caterina Rizzo
- Bambino Gesù Paediatric Hospital, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Stefano Marchetti
- Italian National Institute of Statistics (ISTAT), Via Cesare Balbo 16, 00184 Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Italian National Institute of Health (ISS), Viale Regina Elena 299, 00161 Rome, Italy
| | - Francesco Chini
- Regional Directorate for Health and Social Policy, Lazio Region, Via R. Raimondi Garibaldi 7, 00145 Rome, Italy
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Interventions to improve vaccine acceptance among rheumatoid arthritis patients: a systematic review. Clin Rheumatol 2019; 38:1537-1544. [PMID: 30648228 PMCID: PMC6544587 DOI: 10.1007/s10067-019-04430-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/01/2019] [Indexed: 01/05/2023]
Abstract
Introduction/objective National guidelines emphasize the importance of annual immunization for patients living with rheumatoid arthritis (RA), but vaccination rates remain suboptimal in this population. Evaluating the efficacy of patient and/or provider-targeted interventions to improve vaccination uptake among RA patients could inform practice. Methods We conducted a systematic review (SR) to examine the efficacy of interventions (exposure) aiming to improve vaccination uptake in patients with RA (outcome). English and French language, peer-reviewed interventional studies to improve vaccination rates in RA patients published between 2009 and 2018 were included. Results The search yielded a total of 450 records. Five articles met inclusion criteria. All interventions focused on changing provider behavior using some form of vaccination reminder as the primary intervention strategy, though only two studies reported provider prescribing behavior as an outcome (which was 4% and 58%). Overall, studies varied greatly regarding intervention delivery mode (e.g., educational sessions, e-mail reminders, best practice alerts), and behavior change techniques used to encourage providers to prescribe vaccination (e.g., feedback and monitoring, shaping knowledge, self-regulation). For influenza, pneumococcal and herpes zoster, post-intervention (mean 12–16 months follow-up) vaccination rates increased by a mean of 16.6% (± 15.4%). Conclusions Interventions to enhance vaccine uptake in RA focused almost exclusively on improving provider prescription of vaccines using reminder-type interventions. Although effective in improving vaccination rates, those studies used heterogeneous interventions and behavior change techniques. Few studies measured provider prescribing behavior as an outcome. Future studies targeting providers should measure relevant provided-related outcomes and their impact on patient outcomes, to determine overall efficacy.
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Wang Q, Yue N, Zheng M, Wang D, Duan C, Yu X, Zhang X, Bao C, Jin H. Influenza vaccination coverage of population and the factors influencing influenza vaccination in mainland China: A meta-analysis. Vaccine 2018; 36:7262-7269. [DOI: 10.1016/j.vaccine.2018.10.045] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/26/2018] [Accepted: 10/10/2018] [Indexed: 12/20/2022]
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Blank PR, van Essen GA, Ortiz de Lejarazu R, Kyncl J, Nitsch-Osuch A, Kuchar EP, Falup-Pecurariu O, Maltezou HC, Zavadska D, Kristufkova Z, Kassianos G. Impact of European vaccination policies on seasonal influenza vaccination coverage rates: An update seven years later. Hum Vaccin Immunother 2018; 14:2706-2714. [PMID: 29923782 PMCID: PMC6314402 DOI: 10.1080/21645515.2018.1489948] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Seasonal influenza can have serious morbid consequences and can even result in death, particularly in at-risk populations, including healthcare professionals (HCPs), elderly and those living with a medical risk condition. Although in Europe recommendations exist for annual influenza vaccination in these populations in most countries, the vaccination coverage rate (VCR) is often well below the World Health Organization target of 75% coverage. In our previous survey in 2009 we showed that some elements of national vaccination policies, e.g. reminder systems, strong official recommendation, and easy access, seemed to contribute to achieving higher influenza VCRs among elderly. We repeated the survey in 2016, using the same methodology to assess changes in influenza VCRs among the elderly and in the impact of policy elements on these VCRs. In addition, we collected information about VCRs among HCPs, and those living with a medical risk condition. The median VCR in the 21 countries that had recommendations for influenza vaccination in the elderly was 35.3%, ranging from 1.1% in Estonia to 74.5% in Scotland. The average VCRs for HCPs and those living with medical risk conditions, available in 17 and 10 countries, respectively, were 28.3% (range 7% in Czech Republic to 59.1% in Portugal) and 32.2% (range from 20.0% in the Czech Republic and Hungary to 59.6% in Portugal), respectively. Fewer countries were able to provide data from HCP and those living with medical risk conditions. Since the initial survey during the 2007–2008 influenza season, VCRs have decreased in the elderly in the majority of countries, thus, achieving high VCRs in the elderly and the other target groups is still a major public health challenge in Europe. This could be addressed by the identification, assessment and sharing of best practice for influenza vaccination policies.
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Affiliation(s)
- Patricia R Blank
- a University of Zurich, Epidemiology, Biostatistics and Prevention Institute (EBPI) , Zürich , Switzerland
| | | | - Raúl Ortiz de Lejarazu
- c Valladolid National Influenza Center, Microbiology and Immunology Department, Hospital Clinicon , Valladolid , Spain
| | - Jan Kyncl
- d Department of Infectious Diseases Epidemiology , National Institute of Public Health , Prague , Czech Republic.,e Department of Epidemiology and Biostatistics, Third Faculty of Medicine , Charles University , Prague , Czech Republic
| | - Aneta Nitsch-Osuch
- f Department of Social Medicine and Public Health , Medical University of Warsaw , Warsaw , Poland
| | - Ernest Piotr Kuchar
- g Department of Paediatrics with Clinical Assessment Unit , Medical University of Warsaw , Warsaw , Poland
| | - Oana Falup-Pecurariu
- h Department of Pediatrics, Children's Clinic Hospital, Faculty of Medicine , Transilvania University Brasov , Brasov , Romania
| | - Helena C Maltezou
- i Hellenic Center for Disease Control and Prevention , Athens , Greece
| | - Dace Zavadska
- j Department of Pediatrics , Riga Stradins University , Riga , Latvia
| | - Zuzana Kristufkova
- k Faculty of Public Health , Slovak Medical University , Bratislava , Slovak Republic
| | - George Kassianos
- l Royal College of General Practitioners , Wokingham , Berkshire , UK
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Vaccine Effectiveness against Influenza in 2015/16 in Hospital and Ambulatory Medical Care Facilities: Polish Results of the European I-MOVE+ Multicenter Study. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018. [PMID: 28730379 DOI: 10.1007/5584_2017_69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Influenza vaccination is the best measure available to prevent seasonal influenza infection. The majority of studies on vaccine effectiveness in the 2015/16 season conducted in the European I-MOVE+ Project, show that a match between the circulating influenza strains in the general public and those included in the vaccine for the Northern Hemisphere was low to moderate. As part of I-MOVE+, Poland has implemented a case control negative study design and molecular biology methods, such as real time RT-PCR, to assess the vaccine match and effectiveness. The research described herein consisted of two major influenza vaccine effectiveness investigations conducted in Poland in the 2015/16 season. The general practice part of the study included 228 cases consisting of 159 type A, 65 type B, and 4 coinfections (types A + B), and 312 negative control cases. The hospital study part included 26 cases consisting of 21 type A, 2 type B, and 3 coinfections, and 13 negative control cases. The data were collected from patients of all ages recruited by 46 volunteering doctors in 15 Poland's provinces and three hospitals, respectively. In both study parts, only were seven patients and 12 control subjects vaccinated. Low vaccine coverage, a major limitation of the Polish study, makes the calculation of vaccine effectiveness for the Polish population hardly applicable statistically. Despite the crudeness of data, they were included into the common European analysis. The overall vaccine effectiveness amounted to 21.0% (95% CI: 74-122). It was somehow better for type B virus: 53.9% (95% CI: 47-87) and type A virus: 23.6% (95% CI: 83-185). A larger sample size is needed to achieve a desired interpretation of results on influenza vaccine effectiveness in Poland.
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Esposito S, Franco E, Gavazzi G, de Miguel AG, Hardt R, Kassianos G, Bertrand I, Levant MC, Soubeyrand B, López Trigo JA. The public health value of vaccination for seniors in Europe. Vaccine 2018; 36:2523-2528. [PMID: 29615269 DOI: 10.1016/j.vaccine.2018.03.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 11/09/2017] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
Longer life expectancy and decreasing fertility rates mean that the proportion of older people is continually increasing worldwide, and particularly in Europe. Ageing is associated with an increase in the risk and severity of infectious diseases. These diseases are also more difficult to diagnose and manage in seniors who often have at least one comorbid condition (60% of seniors have two or more conditions). Infectious diseases increase the risk of hospitalization, loss of autonomy and death in seniors. Effective vaccines are available in Europe for infectious diseases such as influenza, pneumococcal diseases, herpes zoster, diphtheria, tetanus and pertussis. Their effectiveness has been demonstrated in terms of reducing the rates of hospitalization, disability, dependency and death. The prevention of diseases in seniors also results in savings in healthcare and societal costs each year in Europe. Despite the availability of vaccines, vaccine-preventable diseases affect millions of European citizens annually, with the greatest burden of disease occurring in seniors, and the medical and economic benefits associated with are not being achieved. Vaccination coverage rates must be improved to achieve the full benefits of vaccination of seniors in Europe.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy.
| | - Elisabetta Franco
- Dipartimento di Biomedicina e Prevenzione - Università Degli Studi di Roma Tor Vergata, Roma, Italy.
| | - Gaetan Gavazzi
- Université de Grenoble-Alpes et GREPI, Clinique universitaire de médecine gériatrique, CHU de Grenoble, La Tronche, France.
| | - Angel Gil de Miguel
- Catedrático de Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, Spain.
| | - Roland Hardt
- Department of Geriatric Medicine, St. Hildegardis-Hospital, Mainz, Germany.
| | - George Kassianos
- Royal College of General Practitioners Immunisation Lead, President British Global & Travel Health Association and General Practitioner, Bracknell, UK.
| | | | | | | | - Jose Antonio López Trigo
- Spanish Society of Geriatrics and Gerontology President, Committee Member Vaccines of SEGG, Malaga, Spain.
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Doherty TM, Connolly MP, Del Giudice G, Flamaing J, Goronzy JJ, Grubeck-Loebenstein B, Lambert PH, Maggi S, McElhaney JE, Nagai H, Schaffner W, Schmidt-Ott R, Walsh E, Di Pasquale A. Vaccination programs for older adults in an era of demographic change. Eur Geriatr Med 2018; 9:289-300. [PMID: 29887922 PMCID: PMC5972173 DOI: 10.1007/s41999-018-0040-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/02/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Populations are aging worldwide. This paper summarizes some of the challenges and opportunities due to the increasing burden of infectious diseases in an aging population. RESULTS Older adults typically suffer elevated morbidity from infectious disease, leading to increased demand for healthcare resources and higher healthcare costs. Preventive medicine, including vaccination can potentially play a major role in preserving the health and independence of older adults. However, this potential of widespread vaccination is rarely realized. Here, we give a brief overview of the problem, discuss concrete obstacles and the potential for expanded vaccination programs to promote healthy aging. CONCLUSION The increasing healthcare burden of infectious diseases expected in aging populations could, to a large extent, be reduced by achieving higher vaccination coverage among older adults. Vaccination can thus contribute to healthy aging, alongside healthy diet and physical exercise. The available evidence indicates that dedicated programs can achieve substantial improvements in vaccination coverage among older adults, but more research is required to assess the generalizability of the results achieved by specific interventions (see Additional file 1).
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Affiliation(s)
| | - Mark P Connolly
- Global Market Access Solutions, St-Prex, Switzerland
- Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | | | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
- Division of Gerontology and Geriatrics, KU Leuven, Leuven, Belgium
| | - Jorg J Goronzy
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | | | | | - Stefania Maggi
- CNR Institute of Neuroscience, Aging Branch, Padua, Italy
| | | | - Hideaki Nagai
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | | | | | - Edward Walsh
- Department of Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
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Fall E, Izaute M, Chakroun-Baggioni N. How can the health belief model and self-determination theory predict both influenza vaccination and vaccination intention ? A longitudinal study among university students. Psychol Health 2017; 33:746-764. [PMID: 29132225 DOI: 10.1080/08870446.2017.1401623] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background and objective Seasonal influenza is frequent among students and often responsible for impaired academic performance and lower levels of general health. However, the vaccination rate in this population is very low. As the seasonal influenza vaccine is not compulsory in France, it is important to improve the vaccination uptake by identifying predictors of both intention and behaviour. This study investigated the effect of decisional balance, motivation and self-efficacy on vaccination acceptance using the Extended Health Belief Model (HBM) and Self-Determination Theory (SDT). Design and Main Outcome Measures University students were invited to fill in an online survey to answer questions about their influenza vaccination intention, and HBM and SDT constructs. A one-year longitudinal follow-up study investigated vaccination behaviour. Results Autonomous motivation and self-efficacy significantly influenced the intention to have the influenza vaccine, and vaccine behaviour at one-year follow-up. Intention predicted a significant proportion of variation (51%) in behaviour, and mediated the effect of these predictors on vaccination behaviour. Conclusion These results suggest that motivation concepts of the Self-Determination Theory can be adequately combined with the Health Belief Model to understand vaccination behaviour.
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Affiliation(s)
- Estelle Fall
- a Université de Lorraine, EA 4360 APEMAC, équipe psychologie de la santé , Metz , France
| | - Marie Izaute
- b LAPSCO , Université Clermont Auvergne, CNRS , Clermont-Ferrand , France
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Torner N, Navas E, Soldevila N, Toledo D, Navarro G, Morillo A, Pérez MJ, Domínguez A. Costs associated with influenza-related hospitalization in the elderly. Hum Vaccin Immunother 2017; 13:412-416. [PMID: 27925855 PMCID: PMC5328227 DOI: 10.1080/21645515.2017.1264829] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Seasonal influenza epidemics remain a considerable burden in adults, especially in those at higher risk of complications. The aim of this study was to determine the costs associated with influenza-related hospitalization in patients aged ≥65 y admitted to 20 hospitals from 7 Spanish regions during the 2013-14 and 2014-15 influenza seasons. Bivariate analysis was used to compare costs in vaccinated and unvaccinated cases. Costs were calculated according to the Spanish National Health System diagnosis-related group tables for influenza and other respiratory system conditions (GRD 89 and GRD 101). A total of 728 confirmed influenza cases were recorded: 52.9% were male, 46.7% were aged 75-84 years, and 49.3% received influenza vaccine ≥15 d prior to hospital admission. Influenza-related mean hospitalization costs (MHC) were € 1,184,808 in unvaccinated and € 1,152,333 in vaccinated cases (2.75% lower). Influenza vaccination showed significant protection against ICU admission (OR 0.35, 95%CI 0.21-0.59; p < 0001); mechanical ventilation (OR 0.56, 95%CI 0.39-0.80; p = 0.002); secondary bacterial pneumonia (OR 0.61, 95%CI 0.39-0.98; p = 0.04) and a higher degree of dependence (OR 0.74, 95%CI 0.55-0.99; p = 0.04). No association was observed for the Charlson comorbidity index or the mean hospital stay. Although influenza vaccination of the elderly may not achieve significant savings in mean hospitalization costs, it may lessen the degree of severity and avoid complications.
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Affiliation(s)
- Núria Torner
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, Public Health Unit. University of Barcelona, Barcelona, Spain
- Public Health Agency of Catalonia, Barcelona, Spain
| | | | - Núria Soldevila
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Diana Toledo
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Gemma Navarro
- Epidemiology Unit, Corporació Sanitària i Universitaria Parc Taulí, Sabadell, Spain
| | - Aurea Morillo
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Preventive Medicine and Public Health Department, University Hospital Virgen del Rocio, Seville, Spain
| | - Maria José Pérez
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Preventive Medicine and Public Health Department, University Hospital of Valme, Seville, Spain
| | - Angela Domínguez
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, Public Health Unit. University of Barcelona, Barcelona, Spain
| | - the Working Group of the Project PI12/02079
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, Public Health Unit. University of Barcelona, Barcelona, Spain
- Public Health Agency of Catalonia, Barcelona, Spain
- Epidemiology Unit, Corporació Sanitària i Universitaria Parc Taulí, Sabadell, Spain
- Preventive Medicine and Public Health Department, University Hospital Virgen del Rocio, Seville, Spain
- Preventive Medicine and Public Health Department, University Hospital of Valme, Seville, Spain
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Kang J, Song YM. Factors associated with vaccination status among Korean submariners who are eligible for free non-mandatory influenza vaccination. Vaccine 2016; 34:6181-6186. [DOI: 10.1016/j.vaccine.2016.10.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/14/2016] [Accepted: 10/28/2016] [Indexed: 11/29/2022]
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Raina MacIntyre C, Menzies R, Kpozehouen E, Chapman M, Travaglia J, Woodward M, Jackson Pulver L, Poulos CJ, Gronow D, Adair T. Equity in disease prevention: Vaccines for the older adults - a national workshop, Australia 2014. Vaccine 2016; 34:5463-5469. [PMID: 27686835 DOI: 10.1016/j.vaccine.2016.09.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/31/2016] [Accepted: 09/19/2016] [Indexed: 01/09/2023]
Abstract
On the 20th June, 2014 the National Health and Medical Research Council's Centre for Research Excellence in Population Health "Immunisation in under Studied and Special Risk Populations", in collaboration with the Public Health Association of Australia, hosted a workshop "Equity in disease prevention: vaccines for the older adults". The workshop featured international and national speakers on ageing and vaccinology. The workshop was attended by health service providers, stakeholders in immunisation, ageing, primary care, researchers, government and non-government organisations, community representatives, and advocacy groups. The aims of the workshop were to: provide an update on the latest evidence around immunisation for the older adults; address barriers for prevention of infection in the older adults; and identify immunisation needs of these groups and provide recommendations to inform policy. There is a gap in immunisation coverage of funded vaccines between adults and infants. The workshop reviewed provider misconceptions, lack of Randomised Control Trials (RCT) and cost-effectiveness data in the frail elderly, loss of autonomy, value judgements and ageism in health care and the need for an adult vaccination register. Workshop recommendations included recognising the right of elderly people to prevention, the need for promotion in the community and amongst healthcare workers of the high burden of vaccine preventable diseases and the need to achieve high levels of vaccination coverage, in older adults and in health workers involved in their care. Research into new vaccine strategies for older adults which address poor coverage, provider attitudes and immunosenescence is a priority. A well designed national register for tracking vaccinations in older adults is a vital and basic requirement for a successful adult immunisation program. Eliminating financial barriers, by addressing inequities in the mechanisms for funding and subsidising vaccines for the older adults compared to those for children, is important to improve equity of access and vaccination coverage. Vaccination coverage rates should be included in quality indicators of care in residential aged care for older adults. Vaccination is key to healthy ageing, and there is a need to focus on reducing the immunisation gap between adults and children.
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Affiliation(s)
- C Raina MacIntyre
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Robert Menzies
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Elizabeth Kpozehouen
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Michael Chapman
- St Vincent Health, 41 Victoria Parade, Fitzroy, VIC, Australia.
| | - Joanne Travaglia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Michael Woodward
- Continuing Care Clinical Service Unit, Austin Health, University of Melbourne, West Heidelberg, VIC 3081, Australia.
| | - Lisa Jackson Pulver
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Christopher J Poulos
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia; Hammond Care Centre for Positive Ageing, 4 Spicer Ave, Hammondville, NSW 2170, Australia.
| | - David Gronow
- Sydney Pain Management Centre, 20 Macquarie Street, Parramatta, NSW 2150, Australia.
| | - Timothy Adair
- National Seniors Australia, 215 Adelaide St, Brisbane, QLD 4000, Australia.
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Kassianos G, Blank P, Falup-Pecurariu O, Kuchar E, Kyncl J, De Lejarazu RO, Nitsch-Osuch A, van Essen GA. Influenza vaccination: key facts for general practitioners in Europe-a synthesis by European experts based on national guidelines and best practices in the United Kingdom and the Netherlands. Drugs Context 2016; 5:212293. [PMID: 27540408 PMCID: PMC4974050 DOI: 10.7573/dic.212293] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Indexed: 12/29/2022] Open
Abstract
Currently there is no influenza vaccination guidance for European general practitioners. Furthermore, although the European Council recommends a target seasonal influenza vaccination rate of 75% in the elderly (65 years and above) and in anyone aged >6 months with a chronic medical condition, there remain wide discrepancies throughout Europe. A harmonised guideline regarding not only vaccination strategy but also for the consistent diagnosis of influenza across Europe is essential to support a common approach for the implementation of seasonal influenza vaccination across Europe. This document is based on pre-existing guidelines available in the UK and Netherlands and has been approved by a group of European experts for use throughout Europe. As well as providing a standardised influenza diagnosis, it also reviews the current recommendations for influenza vaccination, the types of vaccine available, the contraindications, vaccine use in special populations (in pregnancy, children, and in those with egg allergy), and concomitant administration with other vaccines. The effectiveness, safety, and timing of the seasonal influenza vaccine are also reviewed. A second section provides practical guidance for general practitioners for the implementation of a seasonal influenza vaccination program, including the selection and notification of those eligible for vaccination, as well as suggestions for the organisation of a vaccination programme. Finally, suggested responses to common patient misconceptions and frequently asked questions are included. The aim of this article is to harmonise the diagnosis of seasonal influenza and the approach of European general practitioners to seasonal influenza vaccination in order to better identify influenza outbreaks and to move towards reaching the target vaccination rate of 75% throughout Europe.
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Affiliation(s)
| | - Patricia Blank
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Hirschengraben 84, CH-8001 Zurich
| | - Oana Falup-Pecurariu
- Department of Pediatrics, Children’s Clinic Hospital, Faculty of Medicine, Transilvania University, Brasov, Romania
| | - Ernest Kuchar
- Department of Paediatrics with Clinical Assessment Unit, Medical University of Warsaw, Poland
| | - Jan Kyncl
- Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic
- Department of Epidemiology, Third Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Raul Ortiz De Lejarazu
- Head of Microbiology and Immunology Service, Hospital Clinico Universitario, Director National Influenza Center, Valladolid, Spain
| | - Aneta Nitsch-Osuch
- Department of Social Medicine and Public Health, Medical University of Warsaw, Poland
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Li T, Lv M, Lei T, Wu J, Pang X, Deng Y, Xie Z. Who benefits most from influenza vaccination policy: a study among the elderly in Beijing, China. Int J Equity Health 2016; 15:45. [PMID: 26956154 PMCID: PMC4784370 DOI: 10.1186/s12939-016-0332-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 02/29/2016] [Indexed: 11/24/2022] Open
Abstract
Background Influenza continues to have a major impact on vulnerable populations worldwide, particularly among the elderly (≥60 years of age). Vaccination for targeted groups is recommended by the WHO as the most effective way to control influenza infections. Since 2009, the Beijing municipal government has provided influenza vaccination to the elderly at no out-of-pocket cost to reduce influenza threats and improve related health equality. The study aims to evaluate the equality of the policy, and to analyze factors that bring influences to equality. Methods Based on data from a household survey, concentration index (CI) was calculated to measure the socioeconomic inequality in influenza vaccination. A Logit regression model was used to decompose CI, in which the contribution of each determinant was calculated and the percentages of these contribution were obtained. Results Free influenza vaccination at point of use shows significant pro-poor distribution among the elderly in Beijing (CI = −0.115). After the decomposition of CI, the elderly with lower income, higher education, and living in rural areas were more likely to get the influenza vaccination, in which place of residence (contribution percentage = 57 %) held the most contribution of variance. Conclusions Beijing’s free influenza vaccination strategy at point of use could provide the poor elderly with equal opportunities to receive preventive health service, showing a significant pro-poor distribution. The poor elderly, who live in rural areas with high education, benefit most from the policy. Further policy interventions should target the population living in urban areas in order to improve the utilization of public health services and health equality.
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Affiliation(s)
- Tongtong Li
- School of Public Health, Peking University, Beijing, 100191, P.R. China
| | - Min Lv
- Beijing Center for Disease Prevention and Control, Beijing, 100013, P.R. China
| | - Trudy Lei
- Columbia University Mailman School of Public Health, New York, 10032, USA
| | - Jiang Wu
- Beijing Center for Disease Prevention and Control, Beijing, 100013, P.R. China
| | - Xinghuo Pang
- Beijing Center for Disease Prevention and Control, Beijing, 100013, P.R. China
| | - Ying Deng
- Beijing Center for Disease Prevention and Control, Beijing, 100013, P.R. China
| | - Zheng Xie
- School of Public Health, Peking University, Beijing, 100191, P.R. China.
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Lv M, Fang R, Wu J, Pang X, Deng Y, Lei T, Xie Z. The free vaccination policy of influenza in Beijing, China: The vaccine coverage and its associated factors. Vaccine 2016; 34:2135-40. [PMID: 26917011 DOI: 10.1016/j.vaccine.2016.02.032] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 01/17/2016] [Accepted: 02/10/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND In order to improve influenza vaccination coverage, the coverage rate and reasons for non-vaccination need to be determined. In 2007, the Beijing Government published a policy providing free influenza vaccinations to elderly people living in Beijing who are older than 60. This study examines the vaccination coverage after the policy was carried out and factors influencing vaccination among the elderly in Beijing. METHODS A cross-sectional survey was conducted through the use of questionnaires in 2013. A total of 1673 eligible participants were selected by multistage stratified random sampling in Beijing using anonymous questionnaires in-person. They were surveyed to determine vaccination status and social demographic information. RESULTS The influenza vaccination coverage was 38.7% among elderly people in Beijing in 2012. The most common reason for not being vaccinated was people thinking they did not need to have a flu shot. After controlling for age, gender, income, self-reported health status, and the acceptance of health promotion, the rate in rural areas was 2.566 (95% confidence interval [CI], 1.801-3.655, P<0.010) times greater than that in urban areas. Different mechanisms of health education and health promotion have different influences on vaccination uptake. Those whom received information through television, community boards, or doctors were more likely to get vaccinated compared to those who did not (Odds Ratio [OR]=1.403, P<0.010; OR=1.812, P<0.010; OR=2.647, P<0.010). CONCLUSION The influenza vaccine coverage in Beijing is much lower than that of developed countries with similar policies. The rural-urban disparity in coverage rate (64.1% versus 33.5%), may be explained by differing health provision systems and personal attitudes toward free services due to socioeconomic factors. Methods for increasing vaccination levels include increasing the focus on primary care and health education programs, particularly recommendations from doctors, to the distinct target populations, especially with a focus on expanding these efforts in urban areas.
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Affiliation(s)
- Min Lv
- Beijing Center for Disease Prevention and Control, Beijing 100013, PR China
| | - Renfei Fang
- School of Public Health, Peking University, Beijing 100191, PR China
| | - Jiang Wu
- Beijing Center for Disease Prevention and Control, Beijing 100013, PR China
| | - Xinghuo Pang
- Beijing Center for Disease Prevention and Control, Beijing 100013, PR China
| | - Ying Deng
- Beijing Center for Disease Prevention and Control, Beijing 100013, PR China
| | - Trudy Lei
- School of Public Health of Columbia University, NY 10032, USA
| | - Zheng Xie
- School of Public Health, Peking University, Beijing 100191, PR China.
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McGuire A, Drummond M, Keeping S. Childhood and adolescent influenza vaccination in Europe: A review of current policies and recommendations for the future. Expert Rev Vaccines 2016; 15:659-70. [DOI: 10.1586/14760584.2016.1138861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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32
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Thomson A, Robinson K, Vallée-Tourangeau G. The 5As: A practical taxonomy for the determinants of vaccine uptake. Vaccine 2015; 34:1018-24. [PMID: 26672676 DOI: 10.1016/j.vaccine.2015.11.065] [Citation(s) in RCA: 242] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/24/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
Abstract
Suboptimal vaccine uptake in both childhood and adult immunisation programs limits their full potential impact on global health. A recent progress review of the Global Vaccine Action Plan stated that "countries should urgently identify barriers and bottlenecks and implement targeted approaches to increase and sustain coverage". However, vaccination coverage may be determined by a complex mix of demographic, structural, social and behavioral factors. To develop a practical taxonomy to organise the myriad possible root causes of a gap in vaccination coverage rates, we performed a narrative review of the literature and tested whether all non-socio-demographic determinants of coverage could be organised into 4 dimensions: Access, Affordability, Awareness and Acceptance. Forty-three studies were reviewed, from which we identified 23 primary determinants of vaccination uptake. We identified a fifth domain, Activation, which captured interventions such as SMS reminders which effectively nudge people towards getting vaccinated. The 5As taxonomy captured all identified determinants of vaccine uptake. This intuitive taxonomy has already facilitated mutual understanding of the primary determinants of suboptimal coverage within inter-sectorial working groups, a first step towards them developing targeted and effective solutions.
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Affiliation(s)
| | - Karis Robinson
- Department of Psychology, Kingston University, Kingston upon Thames, UK
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The Austrian Vaccination Paradox: Tick-borne Encephalitis Vaccination Versus Influenza Vaccination. Cent Eur J Public Health 2015; 23:223-6. [DOI: 10.21101/cejph.a4169] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Maltezou HC, Lionis C. The financial crisis and the expected effects on vaccinations in Europe: a literature review. Infect Dis (Lond) 2015; 47:437-46. [PMID: 25739315 DOI: 10.3109/23744235.2015.1018315] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Starting in 2008 several European countries experienced a financial crisis. Historically, diseases whose prevention and treatment depend highly on the continuity of healthcare re-emerge during political and financial crises. Evidence suggests that the current financial crisis has had an impact on the health and welfare of Europeans and that population health status and morbidity as well as mortality patterns may change in the coming years. At the same time decisions about expenditure for health services may impact the ability of public health providers to respond. It is expected that the current crisis will further exacerbate socioeconomic and health inequalities and novel vulnerable groups will emerge in addition to existing ones. We review the available evidence and discuss how the current crisis may have an impact on vaccine-preventable diseases and influence vaccination coverage rates in Europe.
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Affiliation(s)
- Helena C Maltezou
- From the 1 Department for Interventions in Health Care Facilities, Hellenic Center for Disease Control and Prevention , Athens
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35
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Mc Hugh SM, Browne J, O'Neill C, Kearney PM. The influence of partial public reimbursement on vaccination uptake in the older population: a cross-sectional study. BMC Public Health 2015; 15:83. [PMID: 25652743 PMCID: PMC4328256 DOI: 10.1186/s12889-015-1356-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 01/05/2015] [Indexed: 11/30/2022] Open
Abstract
Background Flu vaccination is recommended annually for high risk groups. However, in Ireland, free access to vaccination is not universal for those in high risk groups; the vaccine and consultation are only free for those with a medical card, a means tested scheme. Few private health insurance policies cover the cost of attendance for vaccination in general practice. The aim was to examine the influence of this reimbursement policy on vaccination coverage among older adults. Methods Cross-sectional wave 1 data from The Irish Longitudinal Study on Ageing (TILDA) were analysed (2009–2011). TILDA is a nationally representative prospective cohort study of adults aged ≥50, sampled using multistage stratified clustered sampling. Self-reported entitlement to healthcare was categorised as 1) medical card only 2) private health insurance only, 3) both and 4) neither. The outcome was responses to ‘have you ever had a flu shot’. Multivariate logistic regression was used, adjusting for age and need. Results 68.6% of those defined as clinically high-risk received the flu vaccination in the past (95% CI = 67-71%). Those with a medical card were almost twice as likely to have been vaccinated, controlling for age and chronic illness (OR = 1.9, 95% CI = 1.5-2.5, p = <0.001). Conclusions Having a medical card increased the likelihood of being vaccinated, independent of age and need. The mismatch between vaccination guidelines and reimbursement policy is creating unequal access to recommended services among high risk groups. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1356-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sheena M Mc Hugh
- Department of Epidemiology & Public Health, Western Gateway Complex, University College Cork, Western Rd, Cork, Ireland.
| | - John Browne
- Department of Epidemiology & Public Health, Western Gateway Complex, University College Cork, Western Rd, Cork, Ireland.
| | - Ciaran O'Neill
- School of Business and Economics, National University of Ireland, Galway, Ireland.
| | - Patricia M Kearney
- Department of Epidemiology & Public Health, Western Gateway Complex, University College Cork, Western Rd, Cork, Ireland.
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Kassianos G. Willingness of European healthcare workers to undergo vaccination against seasonal influenza: current situation and suggestions for improvement. Drugs Context 2015; 4:212268. [PMID: 25657810 PMCID: PMC4316812 DOI: 10.7573/dic.212268] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 12/18/2014] [Accepted: 12/19/2014] [Indexed: 11/21/2022] Open
Abstract
Uptake of vaccination against seasonal influenza in healthcare workers (HCWs) is, in general, low (vaccine coverage of 6-54%), as is awareness of its importance, and has been decreasing in most European Union (EU) countries in recent years. By virtue of their working environment, HCWs are at an increased risk of influenza infection and of subsequently transmitting the virus to vulnerable patients, in whom disease burden is significant. It could be argued that a similar or higher target vaccination rate to that recommended for older age groups and people with chronic medical conditions (75%) should be applied to HCWs, and the European Council recommends Member States to improve vaccination coverage in this population. In this context, better education of HCWs is needed to increase awareness and highlight the importance of HCW vaccination for the benefit of public health, particularly for their patients, who may be at risk of serious complications that could lead to disability or death. Secondary to these professional responsibilities, personal benefits (as well as benefits to close family and friends) should also be emphasised. Misconceptions that create barriers to vaccination need to be discussed openly and objections placed in the context of public health.
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Affiliation(s)
- George Kassianos
- President, British Global and Travel Health Association, Wokingham, Berkshire, UK
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Preaud E, Durand L, Macabeo B, Farkas N, Sloesen B, Palache A, Shupo F, Samson SI. Annual public health and economic benefits of seasonal influenza vaccination: a European estimate. BMC Public Health 2014; 14:813. [PMID: 25103091 PMCID: PMC4141103 DOI: 10.1186/1471-2458-14-813] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 07/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccination is currently the most effective means of preventing influenza infection. Yet evidence of vaccine performance, and the impact and value of seasonal influenza vaccination across risk groups and between seasons, continue to generate much discussion. Moreover, vaccination coverage is below recommended levels. METHODS A model was generated to assess the annual public health benefits and economic importance of influenza vaccination in 5 WHO recommended vaccination target groups (children 6 - 23 months of age; persons with underlying chronic health conditions; pregnant women; health care workers; and, the elderly, 65 years of age) in 27 countries of the European Union. Model estimations were based on standard calculation methods, conservative assumptions, age-based and country-specific data. RESULTS Out of approximately 180 million Europeans for whom influenza vaccination is recommended, only about 80 million persons are vaccinated. Seasonal influenza vaccination currently prevents an annual average of between 1.6 million and 2.1 million cases of influenza, 45,300 to 65,600 hospitalizations, and 25,200 to 37,200 deaths. To reach the 75% vaccination coverage target set by the EU Council Recommendation in 2009, an additional 57.4 million person would need to be vaccinated in the elderly and other risk groups. By achieving the 75% target rate set in EU-27 countries, average annual influenza- related events averted would increase from current levels to an additional +1.6 to +1.7 million cases, +23,800 to +31,400 hospitalization, +9,800 to +14,300 deaths, +678,500 to +767,800 physician visits, and +883,800 to +1,015,100 lost days of work yearly. Influenza-related costs averted because of vaccination would increase by an additional + €190 to + €226 million yearly, in vaccination target groups. CONCLUSIONS Full implementation of current influenza vaccination recommendations of 75% vaccination coverage rate (VCR) in Europe by the 2014-2015 influenza season could immediately reduce an important public health and economic burden.
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Affiliation(s)
| | - Laure Durand
- />Sanofi Pasteur, 2, Avenue Pont Pasteur, Lyon, 69007 France
| | | | - Norbert Farkas
- />Novartis Vaccines & Diagnostics AG, Lichtstrasse 35, 4056 Basel, Switzerland
| | | | - Abraham Palache
- />Abbott, C.J. van Houtenlaan 36, 1381 CP Weesp, The Netherlands
| | - Francis Shupo
- />Creativ-Ceutical Ltd, The Bank Chambers, Borough High Street, London, SE1 9QQ UK
| | | | - on behalf of Vaccines Europe influenza working group
- />Sanofi Pasteur MSD, 162 av Jean Jaures, Lyon, 69367 France
- />Sanofi Pasteur, 2, Avenue Pont Pasteur, Lyon, 69007 France
- />Novartis Vaccines & Diagnostics AG, Lichtstrasse 35, 4056 Basel, Switzerland
- />GlaxoSmithKline, Rue de l’Institut 89, Rixensart, Belgium
- />Abbott, C.J. van Houtenlaan 36, 1381 CP Weesp, The Netherlands
- />Creativ-Ceutical Ltd, The Bank Chambers, Borough High Street, London, SE1 9QQ UK
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Milanetti F, Germano V, Nisini R, Donatelli I, Di Martino A, Facchini M, Ferlito C, Cappella A, Crialesi D, Caporuscio S, Biselli R, Rossi F, Salemi S, D'Amelio R. Safety and immunogenicity of co-administered MF59-adjuvanted 2009 pandemic and plain 2009-10 seasonal influenza vaccines in rheumatoid arthritis patients on biologicals. Clin Exp Immunol 2014; 177:287-94. [PMID: 24666311 DOI: 10.1111/cei.12292] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2014] [Indexed: 11/28/2022] Open
Abstract
Rheumatoid arthritis (RA) patients under immunosuppressive therapy are particularly susceptible to infections, mainly of the respiratory tract, thus vaccination may represent a strategy to reduce their incidence in this vulnerable population. In the 2009-10 influenza season, the safety and immunogenicity of co-administered non-adjuvanted seasonal and MF59-adjuvanted pandemic influenza vaccines were evaluated in this study in 30 RA patients under therapy with anti-tumour necrosis factor (TNF)-α agents or Abatacept and in 13 healthy controls (HC). Patients and HC underwent clinical and laboratory evaluation before (T0), 1 (T1) and 6 months (T2) after vaccinations. No severe adverse reactions, but a significant increase in total mild side effects in patients versus HC were observed. Both influenza vaccines fulfilled the three criteria of the Committee for Proprietary Medicinal Products (CPMP). Seroconversion rate for any viral strain in patients and HC was, respectively, 68 versus 45 for H1-A/Brisbane/59/07, 72 versus 81 for H3-A/Brisbane/10/07, 68 versus 54 for B/Brisbane/60/08 and 81 versus 54 for A/California/7/2009. A slight increase in activated interferon (IFN)-γ-, TNF-α- or interleukin (IL)-17A-secreting T cells at T1 compared to T0, followed by a reduction at T2 in both patients and HC, was registered. In conclusion, simultaneous administration of adjuvanted pandemic and non-adjuvanted seasonal influenza vaccines is safe and highly immunogenic. The largely overlapping results between patients and HC, in terms of antibody response and cytokine-producing T cells, may represent further evidence for vaccine safety and immunogenicity in RA patients on biologicals.
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Affiliation(s)
- F Milanetti
- Department of Clinical and Molecular Medicine, S. Andrea University Hospital, 'Sapienza' University of Rome, Rome, Italy
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39
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Rouveix E, Greffe S, Dupont C, Gherissi Cherni D, Beauchet A, Sordet Guepet H, Gavazzi G, Gaillat J. Faible taux de couverture vaccinale contre la grippe des sujets âgés hospitalisés en France. Rev Med Interne 2013; 34:730-4. [DOI: 10.1016/j.revmed.2013.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 12/24/2012] [Accepted: 02/02/2013] [Indexed: 10/27/2022]
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Kovács G, Kovács G, Kaló Z, Kaló Z, Jahnz-Rozyk K, Jahnz-Rozyk K, Kyncl J, Kyncl J, Csohan A, Csohan A, Pistol A, Pistol A, Leleka M, Leleka M, Kipshakbaev R, Kipshakbaev R, Durand L, Durand L, Macabeo B, Macabeo B. Medical and economic burden of influenza in the elderly population in central and eastern European countries. Hum Vaccin Immunother 2013; 10:428-40. [PMID: 24165394 PMCID: PMC4185899 DOI: 10.4161/hv.26886] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 10/09/2013] [Accepted: 10/19/2013] [Indexed: 12/14/2022] Open
Abstract
Influenza affects 5-15% of the population during an epidemic. In Western Europe, vaccination of at-risk groups forms the cornerstone of influenza prevention. However, vaccination coverage of the elderly (> 65 y) is often low in Central and Eastern Europe (CEE); potentially because a paucity of country-specific data limits evidence-based policy making. Therefore the medical and economic burden of influenza were estimated in elderly populations in the Czech Republic, Hungary, Kazakhstan, Poland, Romania, and Ukraine. Data covering national influenza vaccination policies, surveillance and reporting, healthcare costs, populations, and epidemiology were obtained via literature review, open-access websites and databases, and interviews with experts. A simplified model of patient treatment flow incorporating cost, population, and incidence/prevalence data was used to calculate the influenza burden per country. In the elderly, influenza represented a large burden on the assessed healthcare systems, with yearly excess hospitalization rates of ~30/100,000. Burden varied between countries and was likely influenced by population size, surveillance system, healthcare provision, and vaccine coverage. The greatest burden was found in Poland, where direct costs were over EUR 5 million. Substantial differences in data availability and quality were identified, and to fully quantify the burden of influenza in CEE, influenza reporting systems should be standardized. This study most probably underestimates the real burden of influenza, however the public health problem is recognized worldwide, and will further increase with population aging. Extending influenza vaccination of the elderly may be a cost-effective way to reduce the burden of influenza in CEE.
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Affiliation(s)
| | | | - Zoltán Kaló
- Syreon Research Institute; Budapest, Hungary
| | - Zoltán Kaló
- Syreon Research Institute; Budapest, Hungary
| | | | | | - Jan Kyncl
- National Institute of Public Health; Department of Infectious Diseases Epidemiology; Prague, Czech Republic
| | - Jan Kyncl
- National Institute of Public Health; Department of Infectious Diseases Epidemiology; Prague, Czech Republic
| | - Agnes Csohan
- Bela Johan National Center for Epidemiology; Budapest, Hungary
| | - Agnes Csohan
- Bela Johan National Center for Epidemiology; Budapest, Hungary
| | | | | | - Mariya Leleka
- I. Ya.Horbachevsky Ternopil State Medical University; Ternopil, Ukraine
| | - Mariya Leleka
- I. Ya.Horbachevsky Ternopil State Medical University; Ternopil, Ukraine
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41
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Shin HN, Jun JK, Lee KS, Park EC. Influenza vaccination in Korea. J Infect 2013; 68:190-3. [PMID: 24096240 DOI: 10.1016/j.jinf.2013.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Han Na Shin
- Health Insurance Review and Assessment Service, Seoul, South Korea
| | - Jae Kwan Jun
- Korea National Cancer Center, Goyang, South Korea
| | - Kwang-Sig Lee
- Department of Preventive Medicine and Institute of Health Services Research, Yonsei University, Seoul, South Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine and Institute of Health Services Research, Yonsei University, Seoul, South Korea.
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42
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Influenza vaccination in Austria from 1982 to 2011: A country resistant to influenza prevention and control. Vaccine 2013; 31:5099-103. [PMID: 24012564 DOI: 10.1016/j.vaccine.2013.08.050] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 08/13/2013] [Accepted: 08/21/2013] [Indexed: 11/23/2022]
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Zhou L, Su Q, Xu Z, Feng A, Jin H, Wang S, Feng Z. Seasonal influenza vaccination coverage rate of target groups in selected cities and provinces in China by season (2009/10 to 2011/12). PLoS One 2013; 8:e73724. [PMID: 24040041 PMCID: PMC3767785 DOI: 10.1371/journal.pone.0073724] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 07/22/2013] [Indexed: 11/22/2022] Open
Abstract
Background The objectives of the survey were to identify the level of influenza vaccination coverage in China in three influenza seasons 2009/10 to 2011/12, and to find out potential predictors for seasonal influenza vaccination. Methods In September and October 2011, representative urban household telephone surveys were conducted in five provinces in China with a response rate of 6%. Four target groups were defined for analysis: 1) children ≤5 years old; 2) elderly persons aged ≥60 years old; 3) health care workers (persons working in the medical field) and 4) chronically ill persons. Results The overall mean vaccination rate was 9.0%. Among the four target groups, the rate of vaccination of children aged ≤5 years old (mean = 26%) was highest and the rate of elderly people aged ≥60 years old (mean = 7.4%) was the lowest, while the rates of persons who suffer from a chronic illness (mean = 9.4%) and health care workers (9.5%) were similar. A subsidy for influenza vaccination, age group, health care workers, suffering from a chronic illness and living in Eastern China were independent significant predictors for influenza vaccination. Conclusions The seasonal influenza vaccination coverage rates among urban populations in selected cities and provinces in China were far below previously reported rates in developed countries. Influenza vaccination coverage rates differed widely between different target groups and provinces in China. Subsidy policy might have a positive effect on influenza vaccination rate, but further cost-effectiveness studies, as well as the vaccination rate associated factors studies are still needed to inform strategies to increase coverage.
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Affiliation(s)
- Lei Zhou
- Public Health Emergency Center, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (LZ); (ZF)
| | - Qiru Su
- Public Health Emergency Center, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhen Xu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ao Feng
- Public Health Emergency Center, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Jin
- School of Public Health, Southeast University, Nanjing, China
| | - Shiyuan Wang
- School of Public Health, Southeast University, Nanjing, China
| | - Zijian Feng
- Public Health Emergency Center, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (LZ); (ZF)
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Loebermann M, Voss U, Meyer S, Bosse D, Fritzsche C, Klammt S, Frimmel S, Riebold D, Reisinger EC. Clinical trial to evaluate the safety and immunogenicity of a trivalent surface antigen seasonal influenza vaccine produced in mammalian cell culture and administered to young and elderly adults with and without A(H1N1) pre-vaccination. PLoS One 2013; 8:e70866. [PMID: 23976960 PMCID: PMC3745456 DOI: 10.1371/journal.pone.0070866] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 06/19/2013] [Indexed: 11/27/2022] Open
Abstract
UNLABELLED Vaccination against influenza is an important means of reducing morbidity and mortality in subjects at risk. The prevalent viral strains responsible for seasonal epidemics usually change annually, but the WHO recommendations for the 2011/2012-season in the Northern hemisphere included the same antigens as for the previous season. We conducted a single-center, single-arm study involving 62 younger (18-60 years) and 64 older (>60 years) adults to test the immunogenicity, safety and tolerability of a trivalent surface antigen, inactivated influenza vaccine produced in mammalian cell-culture. The vaccine contained 15 µg hemagglutinin of each of the virus strains recommended for the 2011-2012 Northern hemisphere winter season (A/California/7/09 (H1N1)-; A/Perth/16/09 (H3N2)-; B/Brisbane/60/08-like strain) in a non-adjuvanted preservative-free formulation. Antibody response was measured by hemagglutination inhibition 21 days after immunization. Adverse events and safety were assessed using subject diary cards and telephone interviews. Seroconversion or a 4-fold antibody increase in antibody titers was detectable against A(H1N1) in 68% of both younger and older adults, against A(H3N2) in 53% and 27%, and against the B influenza strain in 35% and 17%. Antibody titers of 40 or more were observed against A(H1N1) in 87% and 90% of younger and older adults, against A(H3N2) in 98% and 98%, and against the B influenza strain in 93% and 90%. Pre-vaccination antibody titers were protective against A(H1N1), A(H3N2) and B in 38%, 58% and 58%, respectively, of younger and in 43%, 88% and 70% of older adults. Among subjects with previous A(H1N1) vaccination only 48% of younger and 47% of older adults had protective A(H1N1) antibodies at inclusion. Adverse reactions were generally mild. The most frequently reported reactions were pain at the injection site, myalgia and fatigue. The vaccine generated protective antibodies against all three viral strains and had an acceptable safety profile in both younger and older adults. TRIAL REGISTRATION ClinicalTrials.govNCT01422512.
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Affiliation(s)
- Micha Loebermann
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University of Rostock, Rostock, Germany
| | - Ulrich Voss
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University of Rostock, Rostock, Germany
| | - Seetha Meyer
- Novartis Vaccines and Diagnostics GmbH, Marburg, Germany
| | - Dietrich Bosse
- Novartis Vaccines and Diagnostics GmbH, Marburg, Germany
| | - Carlos Fritzsche
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University of Rostock, Rostock, Germany
| | - Sebastian Klammt
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University of Rostock, Rostock, Germany
| | - Silvius Frimmel
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University of Rostock, Rostock, Germany
| | - Diana Riebold
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University of Rostock, Rostock, Germany
| | - Emil C. Reisinger
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University of Rostock, Rostock, Germany
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Feldman C, Abdulkarim E, Alattar F, Al Lawati F, Al Khatib H, Al Maslamani M, Al Obaidani I, Al Salah M, Farghaly M, Husain EH, Mokadas E. Pneumococcal disease in the Arabian Gulf: recognizing the challenge and moving toward a solution. J Infect Public Health 2013; 6:401-9. [PMID: 23999349 DOI: 10.1016/j.jiph.2013.06.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 06/06/2013] [Accepted: 06/09/2013] [Indexed: 02/08/2023] Open
Abstract
Pneumococcal disease has substantial incidence, morbidity and mortality in older adults. Decreased birth rates and longer lifespans indicate that the global population is aging, although rates of aging differ between countries [1]. In 2010, the proportion of the population aged >60 years in the general Arab Region was 7%, and this proportion is expected to rise to 19% by 2050 for the region as a whole [2]; the United Nations estimates for the individual countries of the Arabian Gulf by 2050 are 25.7%, 24.9%, 20.7%, 26.7% and 10.5% in the Kuwait, Bahrain, Qatar, United Arab Emirates (UAE) and Oman, respectively, which are comparable to the 26.9% predicted for the USA and lower than that predicted in European countries, in which the 2050 estimates are 32.7%, 34.0% and 38.1% for France, the UK and Germany, respectively [1]. Globally and in the Gulf Region, pneumococcal disease is an increasingly important public health burden in the elderly. The burden of pneumococcal disease can be reduced by effective vaccination programs, but the recommendations on pneumococcal vaccination in adults vary widely. The major barriers to vaccine implementation among healthcare professionals are an incomplete awareness of pneumococcal disease and the vaccination options in adults. The Gulf Advocate Group calls for healthcare providers in the countries of the Arabian Gulf (Kuwait, Bahrain, Qatar, United Arab Emirates and Oman) to support awareness and education programs about adult pneumococcal disease, particularly in high-risk groups such as those >65 years of age, those with type 2 diabetes mellitus, hematological malignancy, organ and bone marrow transplantation or chronic kidney or lung diseases and pilgrims undertaking the Hajj to improve pneumococcal disease surveillance and optimize and disseminate recommendations for adult vaccination. The Gulf Advocate Group recommends following the U.S. Centers for Disease Control and Prevention (CDC) guidelines for pneumococcal vaccination [3,4].
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Affiliation(s)
- Charles Feldman
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Blank PR, Schwenkglenks M, Sardos CS, Patris J, Szucs TD. Population access to new vaccines in European countries. Vaccine 2013; 31:2862-7. [PMID: 23632307 DOI: 10.1016/j.vaccine.2013.04.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 04/06/2013] [Accepted: 04/16/2013] [Indexed: 11/28/2022]
Abstract
Time from registration to population access to new vaccines can take considerable time in European countries. Reasons might be found in the regulatory framework, decision-making processes or the assessment of vaccines by evaluating bodies. The aim of this study was to determine whether some decision-making processes can explain between-country differences in the time to population access to new vaccination programs. Information gathered from a survey among European National Vaccine Industry Groups was combined with information from official health authorities, vaccine manufacturers and literature published. Firstly, a retrospective survey was conducted to measure access time to new vaccines against three diseases in 17 European countries. Secondly, qualitative information on the country-specific decision-making frameworks for the introduction of new "vaccination programs" was identified in a cross-sectional survey. Spearman's rank correlation coefficients (ρ) were used for data analysis. The median access time to new vaccines was 6.4 years (95% confidence interval: 5.7-7.1 years) post marketing authorization. National assessments underlying immunization policy decisions (recommendation phase) absorbed most of the access time. Correlation analysis suggested that processes with established timelines and clarity in regard to vaccine evaluation criteria used could ameliorate the effectiveness of the decision-making process. In order to reduce the time to access for new, beneficial vaccines, the underlying vaccination recommendation, implementation and funding process needs to be understood and optimized, where necessary.
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Affiliation(s)
- Patricia R Blank
- Institute of Pharmaceutical Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland.
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Chen J, Li YT, Gu BK, Yuan ZA. Estimation of the direct cost of treating people aged more than 60 years infected by influenza virus in Shanghai. Asia Pac J Public Health 2012; 27:NP936-46. [PMID: 23034399 DOI: 10.1177/1010539512460269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Influenza is a common, vaccine preventable, viral respiratory infection with potentially serious consequences in persons aged 60 years and above. In China, influenza vaccination is recommended but not reimbursed for people. Therefore, we studied management of influenza episode, healthcare resource use and costs associated with influenza infection in people aged over 60 in Shanghai. METHODS A prospective, observational study was conducted over the 2008-2009 influenza season. Persons aged 60 years and above presenting to a study center with acute onset of influenza-like illness (ILI) were enrolled and tested by PCR for influenza virus. Laboratory confirmed influenza (LCI) patients were visited 2 weeks later for detail information. RESULTS From January 2009 to December 2009, 1,946 subjects were recruited. Among them 1,777 patients met the inclusion criteria, 395 (22.2%) tested positive. 341 (86%) patients received ambulatory care only while 54 (14%) were hospitalized. Most patients had been prescribed at least one medication (94%), and had had at least one laboratory test (92%). An outpatient cost a mean of USD 47 per case. Once hospitalized, the average length of stay was 17.0 days (SD = 13.82) and the mean total inpatient cost reached USD 1,601. The public health insurance paid 69% and 79% of the mean outpatient and inpatient costs per patient respectively. CONCLUSION This study described the management of a LCI case in people aged more than 60 years in Shanghai and estimated the economic burden in particular from the public healthcare system perspective, showing expensive consequences among hospitalized patients.
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Affiliation(s)
- Jian Chen
- School of Public Health, Fudan University, Shanghai, China Shanghai Municipal Center For Disease Control and Prevention (SCDC), Shanghai, China
| | - Yan-ting Li
- Shanghai Municipal Center For Disease Control and Prevention (SCDC), Shanghai, China
| | - Bao-ke Gu
- Shanghai Municipal Center For Disease Control and Prevention (SCDC), Shanghai, China
| | - Zheng-an Yuan
- School of Public Health, Fudan University, Shanghai, China Shanghai Municipal Center For Disease Control and Prevention (SCDC), Shanghai, China
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