Vaccination coverage and predictors of influenza, pneumococcal, herpes zoster, tetanus, measles, and hepatitis B vaccine uptake among adults in Greece

OBJECTIVES

Insufficient adult vaccination coverage rates remain an international challenge. This nationwide study aimed at exploring vaccination coverage and predictors of influenza, pneumococcal, herpes zoster, tetanus, measles, and hepatitis B vaccine uptake, following the recommendations of the National Immunization Program for adults.

STUDY DESIGN

This was a multicenter, mixed-methods study conducted at 23 primary care units in six different regions of Greece.

METHODS

A pretested questionnaire was administered to three randomly selected adults who visited each practice daily for 30 consecutive working days.

RESULTS

Among the 1571 participants, vaccination coverage for influenza in the high-risk groups was 55%, 36% for pneumococcal disease, 12% for herpes zoster (HZ), 21% for tetanus, 33% for measles, and 11% for hepatitis B. Perception of low susceptibility to disease due to good health status, concerns about side-effects and vaccines' efficacy, and mistrust in pharmaceutical companies were among common factors associated with the vaccines uptake. The strongest factor associated with the participants' vaccination status was their doctor's recommendation (odds ratio [95% confidence interval] influenza: 6.06 [4.52-8.14], pneumococcal disease: 15.73 [10.98-22.52], HZ: 17.01 [9.05-31.96], tetanus: 23.93 [16.20-35.35], measles: 33.47 [16.85-66.47], and hepatitis B: 73.92 [17.47-312.74]). Being well-informed about each vaccine was also a predictor of its uptake.

CONCLUSIONS

Vaccination coverage was suboptimal and especially low in tetanus, HZ, and hepatitis B immunization. Person-centered approach, with provision of appropriate information about vaccines' safety and efficacy, responding to each patient's needs, as well as physicians' strong recommendation for vaccination are considered crucial to advocate against the spread of vaccine misinformation and increase vaccination coverage.

Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA-MeDALL hypothesis

Asthma, rhinitis and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of "one-airway-one-disease", coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitisation and multimorbidity, (iii) advances in mHealth for novel phenotype definition, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut and neuropsychiatric multimorbidities, is the "Epithelial Barrier Hypothesis". This review determined that the "one-airway-one-disease" concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme "allergic" (asthma) phenotype combining asthma, rhinitis and conjunctivitis. Rhinitis alone and rhinitis and asthma multimorbidity represent two distinct diseases with the following differences: (i) genomic and transcriptomic background (Toll-Like Receptors and IL-17 for rhinitis alone as a local disease; IL-33 and IL-5 for allergic and non-allergic multimorbidity as a systemic disease), (ii) allergen sensitisation patterns (mono- or pauci-sensitisation versus polysensitisation), (iii) severity of symptoms and (iv) treatment response. In conclusion, rhinitis alone (local disease) and rhinitis with asthma multimorbidity (systemic disease) should be considered as two distinct diseases, possibly modulated by the microbiome, and may be a model for understanding the epidemics of chronic and auto-immune diseases.

Factors of traffic incidents at University General Hospital of Heraklion, March-August 2018

Background

Injury caused by a traffic accident is the leading cause of death in all age groups with a significant impact on public health expenditure. One of the highest accident rates in Greece is recorded in Crete

Methods

A retrospective archival study. It was carried out at the University General Hospital of Heraklion recording all the incidents in areas of the region of Heraklion and the transits of patients carried out from the rest of Crete.

Results

From March 2018 to August 2018, 493 cases were recorded in the Orthopedic Clinic by the Emergency Department. 89 incidents related to road accident injuries. Men were more involved in traffic accidents, with an average age of 42.5 years. The monthly allocation was roughly the same for all months. Insurance types were about 73.6% of the public provider, 5.7% of the private body, and 20.7% of the uninsured patients. The two-wheelers had the highest participation with 66.3%, cars with 38.8%, and 3.8% with pedestrians and cyclists. The highest incidence of injuries occurred by 22.7% was about fractures in legs and knees, pelvis, and spine fractures by 19.3%. Hip and thigh fractures followed by 14.8%. As caused factors were referred to the non-use of belts and helmets and alcohol in driving. The average hospitalization duration ranged from 7.6 days to 51 days. The average cost per patient ranged from €1,907 to €18,025. The largest total cost involved the fractures of the legs and knee with €52,315 and the spine and spine fractures with €41,459. The total cost in all three categories of insurance was approximately €25-26,000.

Conclusions

The percentage of road accidents in Crete remains at a high level. The highest incidence of injuries refers to legs and knee, pelvic and spinal fractures. Their hospitalization cost includes larger amounts in other European countries. Accompanied illnesses seem to have an impact on road behavior increasing the risk of a road accident.

Key messages

It is highlighted the implementation of more effective prevention programs aimed at youth. The proper management of the problem can bring huge financial relief to health expenditures.

Mechanisms of altered cell immunity and cytotoxicity in COPD

The lungs of smokers are exposed to the toxic substances of cigarette smoke, but only 10-20% of them will develop chronic obstructive pulmonary disease (COPD). For COPD to develop, cigarette smoke has to bypass or overwhelm the host front lines of defence, i.e. the respiratory tract mucosal epithelium, which serves as an effective physical barrier and the innate immune system, which provides an immediate, yet non-specific response. In this review, we will describe briefly how cigarette smoke succeeds in damaging the physical barrier of mucosal epithelium and the innate immune system, and how it induces effector mechanisms of the adaptive immune system, which are particularly cytotoxic to the host. We will also discuss the role of other stimuli with immunogenic potential, such of the role of pathogens which colonize or evade the lungs of COPD patients and of self tissue antigens, which may lead to autoimmune disease when there is chronic inflammation. Although the primary mechanism(s) of undesirable innate and adaptive immune responses in COPD are still a matter of debate, it is currently accepted that they are the root cause of COPD.