Impact of influenza vaccination programmes among the elderly population on primary care, Portugal, Spain and the Netherlands: 2015/16 to 2017/18 influenza seasons

Background To increase the acceptability of influenza vaccine, it is important to quantify the overall benefits of the vaccination programme. Aim To assess the impact of influenza vaccination in Portugal, Spain and the Netherlands, we estimated the number of medically attended influenza-confirmed cases (MAICC) in primary care averted in the seasons 2015/16 to 2017/18 among those ≥ 65 years. Methods We used an ecological approach to estimate vaccination impact. We compared the number of observed MAICC (n) to the estimated number that would have occurred without the vaccination programme (N). To estimate N, we used: (i) MAICC estimated from influenza surveillance systems, (ii) vaccine coverage, (iii) pooled (sub)type-specific influenza vaccine effectiveness estimates for seasons 2015/16 to 2017/18, weighted by the proportion of virus circulation in each season and country. We estimated the number of MAICC averted (NAE) and the prevented fraction (PF) by the vaccination programme. Results The annual average of NAE in the population ≥ 65 years was 33, 58 and 204 MAICC per 100,000 in Portugal, Spain and the Netherlands, respectively. On average, influenza vaccination prevented 10.7%, 10.9% and 14.2% of potential influenza MAICC each season in these countries. The lowest PF was in 2016/17 (4.9–6.1%) with an NAE ranging from 24 to 69 per 100,000. Conclusions Our results suggest that influenza vaccination programmes reduced a substantial number of MAICC. Together with studies on hospitalisations and deaths averted by influenza vaccination programmes, this will contribute to the evaluation of the impact of vaccination strategies and strengthen public health communication.

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The impact of a national routine immunisation programme initiated in 1999 on Hepatitis A incidence in Israel, 1993 to 2012

Eurosurveillance ◽

10.2807/1560-7917.es2015.20.7.21040 ◽

2015 ◽

Vol 20 (7) ◽

Cited By ~ 19

Author(s):

H Levine ◽

E Kopel ◽

E Anis ◽

N Givon-Lavi ◽

R Dagan

Keyword(s):

Vaccination Programme ◽

Hepatitis A ◽

Vaccine Coverage ◽

Immunisation Programme ◽

Surveillance Systems ◽

Routine Immunisation ◽

Long Term Impact ◽

The Impact ◽

Routine Immunisation Programme

Data on long-term impact of universal national vaccination programmes against hepatitis A are lacking. We aimed at evaluating the impact on hepatitis A incidence of the Israeli toddlers-only universal routine two-dose vaccination programme against hepatitis A initiated in 1999. All hepatitis A episodes reported to the national surveillance system from 1993 to 2012 were analysed in relation to the vaccination programme and coverage. Mean vaccine coverage in Israel between 2003 and 2010 was 92% for the first dose, given at 18 months of age, and 88% for the second dose, given at 24 months. The annual hepatitis A incidence declined from a mean of 50.4 per 100,000 in the period between 1993 and 1998 to a mean of?<1.0, during the period from 2008 to 2012, representing a reduction of?>98%. The decline was evident in all ages and ethnicity groups, including unvaccinated populations. Of the 1,247 cases reported nationwide between 2002 and 2012, the vaccination status could be ascertained in 1,108 (89%). Among them, only 20 (2%) were reported be vaccinated with one dose and three (<1%) received two doses. The sustained results of this long-term impact study suggest that a toddlers-only universal routine two-dose vaccination programme is highly effective and practical. These findings underscore the importance of sustainability in both the surveillance systems and vaccination programmes and will aid to determine vaccination policies.

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Influenza and pneumococcal vaccine distribution and use in primary care and hospital settings in Scotland: coverage, practice and policies

Epidemiology and Infection ◽

10.1017/s0950268802006891 ◽

2002 ◽

Vol 128 (3) ◽

pp. 445-455 ◽

Cited By ~ 11

Author(s):

M. H. KYAW ◽

B. WAYNE ◽

J. CHALMERS ◽

I. G. JONES ◽

H. CAMPBELL

Keyword(s):

Primary Care ◽

Influenza Vaccine ◽

Pneumococcal Vaccine ◽

Vaccine Coverage ◽

Hospital Setting ◽

Pneumococcal Vaccination ◽

The Elderly ◽

Risk Patients ◽

General Practices ◽

Vaccine Distribution

A survey of the coverage, distribution and the factors associated with use of influenza and pneumococcal vaccines among general practitioners (GPs) in primary care and in hospital settings was carried out in 53 general practices in Scotland taking part in the ‘Continuous Morbidity Recording’ (CMR) programme. The annual vaccine distribution increased substantially among 53 general practices from 1993 to 1999 and in Scotland as a whole from 1984 to 1999. From the questionnaire, overall coverage was 43% (95% CI 38–48) for influenza vaccine in the 2000–1 season and 13% (95% CI 9–16) for pneumococcal vaccine in the last 5 year period, in high-risk patients recommended for these vaccines by the Department of Health (DoH). Influenza vaccine coverage was highest in the elderly (65 years of age and above) at 62% (95% CI 59–74). Although pneumococcal vaccination is not currently recommended for all elderly, coverage of this vaccine was also higher in this group (22%, 95% CI 16–29). In the majority of patients (influenza vaccine, 98% and pneumococcal vaccine, 94%), vaccination was carried out in general practice. Only 2% of patients had received pneumococcal vaccination in a hospital setting. The level of influenza and pneumococcal vaccination varied with the level of deprivation. Most GPs considered that the responsibility for influenza and pneumococcal vaccination lay with them. Forty-five percent of GPs reported having a written policy with set target for influenza vaccination and 11% for pneumococcal vaccination.

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Long time trends in influenza-like illness and associated determinants in The Netherlands

Epidemiology and Infection ◽

10.1017/s095026880800126x ◽

2008 ◽

Vol 137 (4) ◽

pp. 473-479 ◽

Cited By ~ 45

Author(s):

F. DIJKSTRA ◽

G. A. DONKER ◽

B. WILBRINK ◽

A. B. VAN GAGELDONK-LAFEBER ◽

M. A. B. VAN DER SANDE

Keyword(s):

The Netherlands ◽

Influenza Vaccination ◽

The Elderly ◽

Influenza Viruses ◽

Vaccine Uptake ◽

Contributing Factors ◽

Influenza Like Illness ◽

Long Time ◽

Epidemiological Trends ◽

The Impact

SUMMARYWe analysed long-term epidemiological trends in influenza-like illness (ILI) in The Netherlands and used an ecological analysis to estimate its relationship with age, influenza vaccination, and virological aspects. This study used data from weekly ILI consultation reports from sentinel general practitioners (1986/1987 to 2006/2007), virological data from sentinel ILI patients (1992/1993 to 2006/2007), and data for influenza vaccine uptake (1991–2005). The incidence of ILI consultations, although varying during the study period, was estimated to decrease in the total population by 12·2/10 000 persons each season (95% CI 8·6–15·9). Uptake of influenza vaccination in people aged ⩾65 years (elderly) increased from 28% in 1991 to >70% since 1997. ILI incidence in the elderly declined by 1·7/10 000 persons (P=0·05) per percentage vaccine uptake per season. The decline in ILI incidence over the last 20 years could be related to the increased vaccine uptake. However, insufficient data were present to assess the impact of other potential contributing factors, such as diminished fitness of influenza viruses and changes in consulting behaviour.

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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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Long-term effectiveness of elderly health care voucher scheme strategies: a system dynamics simulation analysis

BMC Public Health ◽

10.1186/s12889-021-11280-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ka Chun Chong ◽

Hong Fung ◽

Carrie Ho Kwan Yam ◽

Patsy Yuen Kwan Chau ◽

Tsz Yu Chow ◽

...

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Public Sector ◽

System Dynamics ◽

The Elderly ◽

Healthcare Services ◽

Dynamics Simulation ◽

Public And Private ◽

The Public ◽

The Impact

Abstract Background The elderly healthcare voucher (EHCV) scheme is expected to lead to an increase in the number of elderly people selecting private primary healthcare services and reduce reliance on the public sector in Hong Kong. However, studies thus far have reported that this scheme has not received satisfactory responses. In this study, we examined changes in the ratio of visits between public and private doctors in primary care (to measure reliance on the public sector) for different strategic scenarios in the EHCV scheme. Methods Based on comments from an expert panel, a system dynamics model was formulated to simulate the impact of various enhanced strategies in the scheme: increasing voucher amounts, lowering the age eligibility, and designating vouchers for chronic conditions follow-up. Data and statistics for the model calibration were collected from various sources. Results The simulation results show that the current EHCV scheme is unable to reduce the utilization of public healthcare services, as well as the ratio of visits between public and private primary care among the local aging population. When comparing three different tested scenarios, even if the increase in the annual voucher amount could be maintained at the current pace or the age eligibility can be lowered to include those aged 60 years, the impact on shifts from public-to-private utilization were insignificant. The public-to-private ratio could only be marginally reduced from 0.74 to 0.64 in the first several years. Nevertheless, introducing a chronic disease-oriented voucher could result in a significant drop of 0.50 in the public-to-private ratio during the early implementation phase. However, the effect could not be maintained for an extended period. Conclusions Our findings will assist officials in improving the design of the EHCV scheme, within the wider context of promoting primary care among the elderly. We suggest that an additional chronic disease-oriented voucher can serve as an alternative strategy. The scheme must be redesigned to address more specific objectives or provide a separate voucher that promotes under-utilized healthcare services (e.g., preventive care), instead of services designed for unspecified reasons, which may lead to concerns regarding exploitation.

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Structural inequities in seasonal influenza vaccination rates

BMC Public Health ◽

10.1186/s12889-021-11179-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lara I. Brewer ◽

Mark J. Ommerborn ◽

Augustina Le Nguyen ◽

Cheryl R. Clark

Keyword(s):

Primary Care ◽

Health Insurance ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

American Indian ◽

Low Socioeconomic Status ◽

Behavioral Risk ◽

Vaccination Rates ◽

Access To Primary Care ◽

Structural Inequities

Abstract Background Influenza immunization is a highly effective method of reducing illness, hospitalization and mortality from this disease. However, influenza vaccination rates in the U.S. remain below public health targets and persistent structural inequities reduce the likelihood that Black, American Indian and Alaska Native, Latina/o, Asian groups, and populations of low socioeconomic status will receive the influenza vaccine. Methods We analyzed correlates of influenza vaccination rates using the 2019 Behavioral Risk Factor Surveillance System (BRFSS) in the year 2020. Our analysis compared influenza vaccination as the outcome of interest with the variables age, sex, race, education, income, geographic location, health insurance status, access to primary care, history of delaying care due to cost, and comorbidities such as: asthma, cardiovascular disease, hypertension, body mass index, cancer and diabetes. Results Non-Hispanic White (46.5%) and Asian (44.1%) participants are more likely to receive the influenza vaccine compared to Non-Hispanic Black (36.7%), Hispanic (33.9%), American Indian/Alaskan Native (36.6%), and Native Hawaiian/Other Pacific Islander (37.9%) participants. We found persistent structural inequities that predict influenza vaccination, within and across racial and ethnic groups, including not having health insurance [OR: 0.51 (0.47–0.55)], not having regular access to primary care [OR: 0.50 (0.48–0.52)], and the need to delay medical care due to cost [OR: 0.75 (0.71–0.79)]. Conclusion As COVID-19 vaccination efforts evolve, it is important for physicians and policymakers to identify the structural impediments to equitable U.S. influenza vaccination so that future vaccination campaigns are not impeded by these barriers to immunization.

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Impact of national influenza vaccination strategy in severe influenza outcomes among the high-risk Portuguese population

BMC Public Health ◽

10.1186/s12889-019-7958-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Ausenda Machado ◽

Irina Kislaya ◽

Amparo Larrauri ◽

Carlos Matias Dias ◽

Baltazar Nunes

Keyword(s):

High Risk ◽

Influenza Vaccination ◽

Seasonal Influenza ◽

Vaccine Coverage ◽

Vaccination Strategy ◽

High Risk Population ◽

Risk Population ◽

Seasonal Influenza Vaccination ◽

Severe Influenza ◽

The Impact

Abstract Background All aged individuals with a chronic condition and those with 65 and more years are at increased risk of severe influenza post-infection complications. There is limited research on cases averted by the yearly vaccination programs in high-risk individuals. The objective was to estimate the impact of trivalent seasonal influenza vaccination on averted hospitalizations and death among the high-risk population in Portugal. Methods The impact of trivalent seasonal influenza vaccination was estimated using vaccine coverage, vaccine effectiveness and the number of influenza-related hospitalizations and deaths. The number of averted events (NAE), prevented fraction (PF) and number needed to vaccinate (NVN) were estimated for seasons 2014/15 to 2016/17. Results The vaccination strategy averted on average approximately 1833 hospitalizations and 383 deaths per season. Highest NAE was observed in the ≥65 years population (85% of hospitalizations and 95% deaths) and in the 2016/17 season (1957 hospitalizations and 439 deaths). On average, seasonal vaccination prevented 21% of hospitalizations in the population aged 65 and more, and 18.5% in the population with chronic conditions. The vaccination also prevented 29% and 19.5% of deaths in each group of the high-risk population. It would be needed to vaccinate 3360 high-risk individuals, to prevent one hospitalization and 60,471 high-risk individuals to prevent one death. Conclusion The yearly influenza vaccination campaigns had a sustained positive benefit for the high-risk population, reducing hospitalizations and deaths. These results can support public health plans toward increased vaccine coverage in high-risk groups.

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Influenza Vaccine Uptake and Associated Factors in Aged Care Facilities

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19003108 ◽

2019 ◽

Vol 34 (s1) ◽

pp. s140-s140

Author(s):

Mohana Kunasekaran ◽

Mallory Trent ◽

Elisa Lai ◽

HaoYi Tan ◽

Abrar Chughtai ◽

...

Keyword(s):

High Risk ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Aged Care ◽

Vaccine Uptake ◽

Care Staff ◽

Age Related ◽

Care Facilities ◽

Aged Care Facilities ◽

The Impact

Introduction:Influenza vaccine is recommended for high-risk populations in Australia (including those aged over 65 years) but is less effective in the elderly due to a progressive and predictable age-related decline in immune function, referred to as immunosenescence. Aged care facilities (ACF) are known to be at high risk of explosive outbreaks of influenza (even in highly vaccinated populations) and may reflect a higher intensity of transmission within the closed setting of ACF, as well as lower immunity and immunosenescence in the frail elderly.Methods:To measure the impact of influenza in aged-care staff (ACS) and residents as well as vaccine effectiveness, a prospective observational epidemiological study was conducted in collaboration with an aged-care provider with multiple sites from March to October 2018. Weekly active surveillance on influenza-like symptoms and questionnaires were used to collect data on two groups: ACS and residents. A range of variables was examined against their 2018 influenza vaccination status in statistical analysis.Results:Vaccination rates were high in residents and consistent with other studies. Vaccine rates in aged-care staff were lower and consistent with other studies.Discussion:Residents and relatives are unlikely to change their minds about vaccination from year to year unless there is targeted effort to persuade them to so, and negative perception of the vaccine is likely to persist. Workplace influenza vaccination programs targeted at staff could be an effective method of raising vaccine uptake.

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