Determinants of Influenza Vaccine Uptake in Patients With Cardiovascular Disease and Strategies for Improvement

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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Influenza Vaccination Hesitancy among Healthcare Workers in South Al Batinah Governorate in Oman: A Cross-Sectional Study

Vaccines ◽

10.3390/vaccines8040661 ◽

2020 ◽

Vol 8 (4) ◽

pp. 661

Author(s):

Salah T. Al Awaidy ◽

Zayid K. Al Mayahi ◽

Malak Kaddoura ◽

Ozayr Mahomed ◽

Nathalie Lahoud ◽

...

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Healthcare Workers ◽

Seasonal Influenza ◽

General Medicine ◽

Knowledge Score ◽

Vaccine Uptake ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Increased Risk

Background: Seasonal influenza infections are a major cause of morbidity and mortality worldwide. Healthcare workers (HCWs) are an important target group for vaccination against influenza due to their increased risk of infection and their potential to transmit the infection to their patients, families and communities. The aim of this study was to assess the potential hesitancy and its associated factors towards influenza vaccination amongst HCWs in the South Al Batinah governorate in Oman. Methods: A cross-sectional survey of 390 HCWs with direct or indirect patient contact was conducted in May and June 2019 using a self-administered questionnaire. Associations between HCW characteristics and vaccination status were examined using bivariate and multivariate analyses to identify the likelihood of vaccination against seasonal influenza among HCWs. Results: Overall, 60% of HCWs were vaccinated in the 2018/2019 season; vaccine uptake among nurses was 52% and uptake was higher among women. Self-protection and protection of the community were the most cited reasons for vaccine acceptance, with side effects being the main reason for hesitancy. Vaccinated respondents had a higher mean knowledge score (7.18; standard deviation SD: 2.14) than unvaccinated respondents (6.30; SD: 2.2). Odds of vaccination were highest among respondents who believed influenza vaccine should be mandatory for HCWs (Odds ratio (OR): 2.04 [1.30–3.18]), those working in the general medicine, emergency medicine, or intensive care units (OR: 1.92 [1.20–3.10]), nurses and doctors (OR: 1.75 [1.09–2.79]) and those who believe that HCWs should receive an influenza vaccine (OR: 1.35 [1.07–2.77]). Conclusions: The study provides valuable insights into the enablers and barriers of influenza vaccination practices among HCWs and may inform interventions to increase acceptance of vaccination.

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Ethnic differences in the incidence of clinically diagnosed influenza: an England population-based cohort study 2008-2018

10.1101/2021.01.15.21249388 ◽

2021 ◽

Author(s):

Jennifer A. Davidson ◽

Amitava Banerjee ◽

Rohini Mathur ◽

Mary Ramsay ◽

Liam Smeeth ◽

...

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

South Asian ◽

Infection Risk ◽

Vaccine Uptake ◽

Health Conditions ◽

Influenza Like Illness ◽

White Ethnicity ◽

Vaccine Recommendations ◽

Increased Risk

ABSTRACTWe used primary and linked secondary healthcare data to investigate the incidence of clinically diagnosed influenza/influenza-like-illness (ILI) by ethnicity in England from 2008-2018. We identified higher incidence rate ratios for influenza/ILI among South Asian (1.70, 95% CI 1.66-1.75), Black (1.48, 1.44-1.53) and Mixed (1.22, 1.15-1.30) groups compared to White ethnicity.People from ethnic minority backgrounds are represented disproportionately among patients with severe COVID-19. Recent research has found people of Black and South Asian ethnicity have increased risk of SARS-CoV-2 infection, COVID-19-related hospitalization and death, independent of deprivation, occupation, household size, and underlying health conditions(1,2).The COVID-19 pandemic has reinforced the importance of seasonal influenza vaccination. By preventing influenza-related hospitalization, vaccination can minimize the risk of hospital-acquired COVID-19 (co-) infection for these individuals and reduce health service pressures, particularly the need for isolation of patients with respiratory symptoms awaiting COVID-19 test results.In the UK, influenza vaccine is routinely recommended for adults aged ≥65 years, or people <65 years with underlying health conditions. These recommendations formed the basis of the original guidance to identify patients at moderate- and high-risk of COVID-19. Influenza vaccine recommendations were expanded for the 2020/21 season to include all adults ≥50 years(3). However, vaccine uptake among clinical risk groups is low, particularly for Black and Mixed Black ethnic groups(4). In addition, people of non-White ethnicity have higher risk of severe outcomes following influenza infection(5,6). It is unclear whether this is driven by the risk of infection or complications, with most research focused on distal outcomes rather than initial infection risk.Here we investigate the incidence of influenza and influenza-like-illness (ILI) by ethnicity from 2008-2018 among people not eligible for routine influenza vaccination, to consider disparities in infection risk.

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Tweeting influenza vaccine to cardiovascular health community

European Journal of Cardiovascular Nursing ◽

10.1177/1474515117707867 ◽

2017 ◽

Vol 16 (8) ◽

pp. 704-706 ◽

Cited By ~ 4

Author(s):

Chayakrit Krittanawong ◽

Anusith Tunhasiriwet ◽

Sakkarin Chirapongsathorn ◽

Takeshi Kitai

Keyword(s):

Cardiovascular Disease ◽

Influenza Vaccine ◽

Chronic Conditions ◽

Cardiovascular Events ◽

Cardiovascular Health ◽

Influenza Infection ◽

Health Community ◽

Increased Risk ◽

European Society Of Cardiology ◽

Influenza Vaccinations

Globally, among infectious diseases, influenza is one of the leading causes of morbidity and mortality. Individuals with chronic conditions, including cardiovascular disease and diabetes, are particularly vulnerable to complications of an influenza infection. The European Society of Cardiology recommended annual influenza vaccinations for patients with cardiovascular disease. Numerous studies have suggested a link between influenza and increased risk of cardiovascular events. Despite its proven benefits, little is known about the reason for the underutilization of influenza vaccination. We present the findings of an assessment of patients’ perception of the influenza vaccine and the reason for its underutilization, by data mining from Twitter.

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Influenza hospitalizations in Australian children

Epidemiology and Infection ◽

10.1017/s0950268816003381 ◽

2017 ◽

Vol 145 (7) ◽

pp. 1451-1460 ◽

Cited By ~ 8

Author(s):

J. LI-KIM-MOY ◽

J. K. YIN ◽

C. C. BLYTH ◽

A. KESSON ◽

R. BOOY ◽

...

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Influenza A ◽

Immunization Coverage ◽

Population Level ◽

Vaccine Safety ◽

Vaccine Uptake ◽

Healthy Children ◽

National Immunisation ◽

National Immunisation Program

SUMMARYAustralia's National Immunisation Program (NIP) provides free influenza vaccination for children at high risk of severe influenza; a pilot-funded programme for vaccine in all children aged 6 months to <5 years in one of eight states, has seen poor vaccine impact, related to recent vaccine safety concerns. This retrospective review examined influenza hospitalizations in children aged <16 years from three seasons (2011–2013) at two paediatric hospitals on opposite sides of the country. Comparisons of this cohort were made with state-based data on influenza-coded hospitalizations and national immunization register data on population-level immunization coverage. Of 740 hospitalizations, the majority were aged <5 years (476/740, 64%), and a substantial proportion (57%) involved healthy children, not currently funded for influenza vaccine. Intensive care unit admission occurred in 8·5%, and 1·5% of all children developed encephalitis. Use of antiviral therapy was uncommon (20·5%) and decreasing. Of those hospitalized, only 5·0% of at-risk children, who are currently eligible for free vaccine, and 0·7% of healthy children were vaccinated prior to hospitalization. This was consistent with low population-wide estimates of influenza vaccine uptake. It highlights the need to examine alternative strategies, such as universally funded paediatric influenza vaccination, to address disease burden in Australian children.

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An evaluation of influenza vaccine uptake in UK medical students

Occupational Medicine ◽

10.1093/occmed/kqab014 ◽

2021 ◽

Author(s):

G Gray ◽

J Cooper

Keyword(s):

Medical Students ◽

Influenza Vaccine ◽

Medical School ◽

Influenza Vaccination ◽

Service Evaluation ◽

Vaccination Status ◽

Vaccine Uptake ◽

Vaccination Rates ◽

Increased Risk ◽

The Uk

Abstract Background The annual influenza vaccination is recommended for all front-line healthcare workers in the UK and is a crucial way of reducing mortality for vulnerable patient groups. However, to date the UK government has never explicitly monitored influenza vaccine uptake in medical students. This is important to ascertain, as students regularly move between clinical areas and are both a perfect vector for the spread of influenza and at an increased risk of contracting influenza themselves. Aims This service evaluation was designed to evaluate the effectiveness of an influenza vaccination programme in one UK medical school and make recommendations to increase vaccination rates in the future. Methods This service evaluation collected data about medical student uptake of influenza vaccination in one UK medical school. Two hundred and fifty-one students at different course stages completed questionnaires, answering questions on vaccination status and Likert-scale ‘belief’ questions to assess the subjective reasons behind vaccine refusal. Results There was a substantial difference between year group cohorts (~20%), with significantly higher vaccination rates in the preclinical year group. Two significant negative predictors of vaccination were found (P < 0.001), related to scepticism over the effectiveness of the vaccine and lack of convenient access to the vaccination. Results indicated that integrating information about the influenza vaccine into the curriculum would reduce lack of knowledge over the efficacy of the vaccine. The centralization of vaccination programmes at mandatory university-based learning events would mitigate against the problem of diversity of vaccination locations and lack of central accountability. Conclusions The results of this service evaluation provide significant predictors of vaccination status for medical students and potential occupational health interventions to improve vaccine uptake in this group.

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Seasonal Influenza Vaccine Effectiveness in People With Asthma: A National Test-Negative Design Case-Control Study

Clinical Infectious Diseases ◽

10.1093/cid/ciz1086 ◽

2019 ◽

Vol 71 (7) ◽

pp. e94-e104

Author(s):

Eleftheria Vasileiou ◽

Aziz Sheikh ◽

Chris C Butler ◽

Chris Robertson ◽

Kimberley Kavanagh ◽

...

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Case Control Study ◽

Influenza Infection ◽

Age Groups ◽

Case Control ◽

Vaccine Effectiveness ◽

Vaccine Uptake ◽

Individual Patient Level ◽

Control Study

Abstract Background Influenza infection is a trigger of asthma attacks. Influenza vaccination can potentially reduce the incidence of influenza in people with asthma, but uptake remains persistently low, partially reflecting concerns about vaccine effectiveness (VE). Methods We conducted a test-negative designed case-control study to estimate the effectiveness of influenza vaccine in people with asthma in Scotland over 6 seasons (2010/2011 to 2015/2016). We used individual patient–level data from 223 practices, which yielded 1 830 772 patient-years of data that were linked with virological (n = 5910 swabs) data. Results Vaccination was associated with an overall 55.0% (95% confidence interval [CI], 45.8–62.7) risk reduction of laboratory-confirmed influenza infections in people with asthma over 6 seasons. There were substantial variations in VE between seasons, influenza strains, and age groups. The highest VE (76.1%; 95% CI, 55.6–87.1) was found in the 2010/2011 season, when the A(H1N1) strain dominated and there was a good antigenic vaccine match. High protection was observed against the A(H1N1) (eg, 2010/2011; 70.7%; 95% CI, 32.5–87.3) and B strains (eg, 2010/2011; 83.2%; 95% CI, 44.3–94.9), but there was lower protection for the A(H3N2) strain (eg, 2014/2015; 26.4%; 95% CI, −12.0 to 51.6). The highest VE against all viral strains was observed in adults aged 18–54 years (57.0%; 95% CI, 42.3–68.0). Conclusions Influenza vaccination gave meaningful protection against laboratory-confirmed influenza in people with asthma across all seasons. Strategies to boost influenza vaccine uptake have the potential to substantially reduce influenza-triggered asthma attacks.

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Vaccination Against Influenza Among Lebanese Health Care Workers in the Era of Coronavirus Disease 2019

10.21203/rs.3.rs-150253/v1 ◽

2021 ◽

Author(s):

Dalal Youssef ◽

Linda Abou Abass ◽

Janet Youssef ◽

Atika Berry

Keyword(s):

Health Care ◽

Influenza Vaccine ◽

Health Care Workers ◽

Online Survey ◽

Influenza Infection ◽

Vaccine Uptake ◽

Categorical Variables ◽

Attitudes And Practices ◽

Care Workers ◽

Increased Risk

Abstract Background: Health care workers (HCWs) are at increased risk of influenza infection. Hence, the rationale for immunization to protect them and their patients particularly during the co-circulation of influenza and coronavirus disease 2019 (COVID-19). This study aims to assess knowledge, attitudes, and practices among HCWs towards the influenza vaccine and to identify the determinants of their willingness to vaccinate. Methods: Using an online survey, a cross-sectional study, was conducted in Lebanon between 14th and 28th October 2020 among HCWs. Descriptive statistics were reported using frequency and percentages for categorical variables. Multivariable logistic regression was carried out to identify the factors associated with influenza vaccine uptake. Adjusted odds ratio and their 95% confidence intervals were reported. Results: A total of 560 HCWs participated in the survey of which 72.9% were females. The majority were nurses (63.2%), married (66.1%) and aged between 30-49 years (53.9%). Nearly half of them had a good level of knowledge (≥80%). As perceived by HCWs, the availability of a sufficient quantity of vaccine will be the biggest challenge. Benefits of vaccination in enhancing patient safety, and avoiding co-infection by influenza and COVID-19 were well-acknowledged by HCWs. 32.1% of HCWs have received the influenza vaccine during the last year and 80.2% were willing to vaccinate for the current year. The influenza uptake was higher among HCWs who have received influenza vaccine in the past season (OR = 6.812, CI (3.045-15.239)), having a fair health status (OR = 3.117, CI (1.345-7.220)), good knowledge (OR=3.305, CI (1.155-9.457)), positive attitude (OR=2.305, CI (0.921-5.571)), low perception of barriers (OR= 4.130, CI (1.827-9.334)) and high perception of benefits (OR=6.264, CI (2.919-13.442) and was lower in single and divorced (OR=0.527, CI (0.284-0.978)). ConclusionAddressing misconceptions unveiled in this study through adapted training, along with economic interventions are needed to improve influenza vaccination coverage among HCWs.

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The Rate of Influenza Vaccination after Face-to-Face Interview in Pregnancy

Zeitschrift für Geburtshilfe und Neonatologie ◽

10.1055/a-1332-2623 ◽

2021 ◽

Author(s):

Gokcen Orgul ◽

Ayse Istek Keles ◽

Aykan Yucel ◽

Dilek Sahin

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Pregnant Women ◽

Influenza Infection ◽

Previous History ◽

Vaccine Uptake ◽

Turkish Women ◽

Vaccination Rates ◽

Face To Face ◽

Significant Difference

Abstract Purpose Most societies recommend routine influenza vaccine to all pregnant women. In Turkey, the Ministry of Health provides the influenza vaccine free of charge to pregnant women during the second and third trimesters. Pregnant women may not be willing to accept vaccination despite their knowledge and attitudes. We aimed to investigate the rate and determining factors of influenza vaccine acceptance after receipt of face-to-face information. Methods Pregnant women were informed about the benefits of the influenza vaccine and asked if they would get the vaccine. Results A total of 353 Turkish women were involved, and 191 (54.1%) accepted influenza vaccination. There was no statistically significant difference in terms of maternal age, body mass index, gravida, number of children, socioeconomic status, smoking and occupation between groups. Women in the third trimester had lower vaccination rates compared to first- and second-trimester pregnancies (35.7% vs. 67.7–64.2%). Women with at least a university degree also had lower vaccine uptake rates (58.1% vs. 59.5–36.8%). While 82.2% of women who accepted vaccination believed the benefit of the vaccine to the baby, the rate was 54.9% in the non-vaccinated group. The most common reason for refusal was the belief that influenza was not a serious disease. Vaccination uptake was higher especially for women who understood the benefits of the influenza vaccine for the baby (OR=3.79, 95%Cl=2.34–6.14). Conclusion Women who had enough information, who had a lower education level, who had a previous history of influenza infection, and who had decided to have their babies vaccinated were more likely to accept influenza vaccine.

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Influenza vaccination coverage in a population-based cohort of Australian-born Aboriginal and non-Indigenous older adults

Communicable Diseases Intelligence ◽

10.33321/cdi.2019.43.30 ◽

2019 ◽

Vol 43 ◽

Author(s):

Amalie Dyda ◽

Surendra Karki ◽

Marlene Kong ◽

Heather F Gidding ◽

John M Kaldor ◽

...

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Vaccination Coverage ◽

Torres Strait Islander ◽

Vaccine Coverage ◽

Vaccine Uptake ◽

P Value ◽

Healthy Weight ◽

Medical Risk ◽

Torres Strait

Background: There is limited information on vaccination coverage and characteristics associated with vaccine uptake in Aboriginal and/or Torres Strait Islander adults. We aimed to provide more current estimates of influenza vaccination coverage in Aboriginal adults. Methods: Self-reported vaccination status (n=559 Aboriginal and/or Torres Strait Islander participants, n=80,655 non-Indigenous participants) from the 45 and Up Study, a large cohort of adults aged 45 years or older, was used to compare influenza vaccination coverage in Aboriginal and/or Torres Strait Islander adults with coverage in non-Indigenous adults. Results: Of Aboriginal and non-Indigenous respondents aged 49 to <65 years, age-standardised influenza coverage was respectively 45.2% (95% CI 39.5–50.9%) and 38.5%, (37.9–39.0%), p-value for heterogeneity=0.02. Coverage for Aboriginal and non-Indigenous respondents aged ≥65 years was respectively 67.3% (59.9–74.7%) and 72.6% (72.2–73.0%), p-heterogeneity=0.16. Among Aboriginal adults, coverage was higher in obese than in healthy weight participants (adjusted odds ratio (aOR)=2.38, 95%CI 1.44–3.94); in those aged <65 years with a medical risk factor than in those without medical risk factors (aOR=2.13, 1.37–3.30); and in those who rated their health as fair/poor compared to those who rated it excellent (aOR=2.57, 1.26–5.20). Similar associations were found among non-Indigenous adults. Conclusions: In this sample of adults ≥65 years, self-reported influenza vaccine coverage was not significantly different between Aboriginal and non-Indigenous adults whereas in those <65 years, coverage was higher among Aboriginal adults. Overall, coverage in the whole cohort was suboptimal. If these findings are replicated in other samples and in the Australian Immunisation Register, it suggests that measures to improve uptake, such as communication about the importance of influenza vaccine and more effective reminder systems, are needed among adults.

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22. Description of Hospitalized Patients with Influenza Vaccine Failure

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.067 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S35-S35

Author(s):

Joanna Kimball ◽

Yuwei Zhu ◽

Dayna Wyatt ◽

Helen Talbot

Keyword(s):

Logistic Regression ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Older Patients ◽

Influenza A ◽

Influenza Season ◽

Hospitalized Patients ◽

Vaccine Failure ◽

Increased Risk ◽

Immunosuppressed Patients

Abstract Background Despite influenza vaccination, some patients develop illness and require hospitalization. Many factors contribute to vaccine failure, including mismatch of the vaccine and circulating strains, waning immunity, timing of influenza season, age and patient comorbidities such as immune function. This study compared vaccinated, hospitalized patients with and without influenza. Methods This study used 2015–2019 Tennessee data from the US Hospitalized Adult Influenza Vaccine Effectiveness Network database. Enrolled patients were ≥ 18 years vaccinated for the current influenza season and admitted with an acute respiratory illness. Patient or surrogate interviews and medical chart abstractions were performed, and influenza vaccinations were confirmed by vaccine providers. Influenza PCR testing was performed in a research lab. Statistical analyses were performed with STATA and R using Pearson’s chi-squared, Kruskal-Wallis and Wilcoxon rank-sum tests and multivariate logistic regression. Results 1236 patients met study criteria, and 235 (19%) tested positive for influenza. Demographics, vaccines and comorbidities were similar between the two groups (Table 1) except for morbid obesity, which was more common in influenza negative patients (13% vs 8%, p = 0.04), and immunosuppression, which was more common in the influenza positive (63% vs 54%, p = 0.01). Logistic regression analysis demonstrated older patients (OR 1.47, 95% CI 1.03–2.10) and immunosuppressed patients (OR 1.56, 1.15–2.12) were at increased risk for influenza (Table 2 and Figure 1). Immunosuppression also increased the risk for influenza A/H3N2 (OR 1.86, 95% CI 1.25–2.75). A sensitivity analysis was performed on patients who self-reported influenza vaccination for the current season without vaccine verification and demonstrated increased risk of influenza in older adults (OR 1.66, 95% CI 1.16–2.39). Table 1: Demographics of influenza positive versus influenza negative patients in influenza vaccinated, hospitalized patients. Table 2: Logistic regression analyses of vaccinated, hospitalized influenza positive patients; vaccinated, hospitalized patients with influenza A subtypes and self-reported vaccinated, hospitalized influenza positive patients. Figure 1: Predicted Probability of Hospitalization with Influenza, Influenza A/H1N1 and Influenza A/H3N2 in Vaccinated Patients by Age. Conclusion Our study demonstrated an increased risk of influenza vaccine failure in older patients and immunosuppressed patients. These groups are also at increased risk for influenza complications. To improve protection of these patients against future influenza illnesses, more effective vaccines are needed, and more research on ring vaccination should be pursued. Disclosures All Authors: No reported disclosures

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