Coverages and factors associated with influenza vaccination among subjects with chronic respiratory diseases in Spain

BACKGROUND: The main influenza complications particularly affect patients over the age of 65 years and those with associated chronic diseases, such as respiratory disorders. This study aims to assess vaccination coverage among Spanish children and adults with chronic respiratory diseases (CRDs), and to describe the factors associated with vaccination in 2003. METHODS: We analysed 28,113 records of individuals (6869 children and 21,244 adults) included in the Spanish National Health Survey (NHS) for 2003. As a dependent variable, we used the reply ('yes' or 'no') to the question: 'Did you have a 'flu shot in the latest campaign?' We calculated influenza vaccine coverage as the percentage of individuals with a respiratory disorder (asthma and/or chronic bronchitis and/or emphysema) who reported having been vaccinated against influenza in the most recent campaign. We analysed the influence of sociodemographic, health-status, medical visits and lifestyle variables on vaccination. RESULTS: Vaccination coverage was 19.9% in children and 54.7% in adults suffering CRD. In both age groups, coverages were significantly higher than those observed for non-CRD sufferers. Among adults, older age, not smoking and medical visits to their physician in the preceding 2 weeks were the variables independently and significantly associated with a higher likelihood of receiving the vaccine. Among children, financial factors influence vaccination. CONCLUSIONS: Vaccination coverage among children with CRDs is very low. Also among adult CRD sufferers, vaccination remains below the desired level, thereby making it necessary for strategies to be implemented aimed at improving the use of influenza vaccine.     

Influenza vaccination among cardiovascular disease sufferers in Spain: related factors and trend, 1993-2003

Based on data drawn from the 1993 and 2003 National Health Surveys (NHS), we sought to: estimate influenza vaccination coverages among Spanish cardiovascular disease (CVD) sufferers; study which variables were associated with the likelihood of being vaccinated; analyze the time-trend in coverage for the period 1993-2003. For study purposes, a CVD sufferer was defined as any adult who reported suffering from high blood pressure and/or heart disease. The proportion of vaccinated adult CVD sufferers in 1993 and 2003 totalled 39.96% and 51.73%, respectively. The following variables increased the likelihood of being vaccinated: higher age; male gender; presence of respiratory chronic diseases; non-smoker status. Coverages for CVD sufferers had improved significantly from 1993 to 2003 but still remain below desirable levels. The improvement over time is mainly due to the subgroup aged >64 years. Strategies must be implemented to improve the use of influenza vaccine among CVD sufferers in Spain in general, and among the younger age-groups in particular.     

Influenza vaccination coverage in the geriatric population of the State of Geneva, Switzerland

Background: In Switzerland, every year the Federal Office ofPublic Health publishes recommendations for the use of influenzavaccine in people over 65 years, patients of all ages sufferingfrom chronic conditions or immunosuppression, families of thelatter and health professionals. However, prior to the presentstudy, there has been no evaluation of the degree to which theserecommendations are implemented. The purpose of the survey describedin this article was to evaluate flu vaccination coverage ofthe geriatric population living in the community, to obtainqualitative information on the motivation for receiving vaccinationand to understand the network of communication on flu prevention.Methods: The study was performed on a random sample of 1,200residents of the State of Geneva aged 65 years or older. Itinvolved a mail questionnaire and semi-structured telephoneinterviews on a subsample of respondents. Results: The estimatedvaccination coverage for 1994 was equal to 35.5% in persons65 years-old or older. Receiving information from a physicianwas the major determinant in the decision to be vaccinated.Misconceptions about flu were common. Conclusions: The resultsof this study indicate that national recommendations concerningvaccination of elderly people are insufficiently observed inthe State of Geneva. It is necessary to reinforce preventivemessages that explain why flu vaccination should be performed.These messages should aim at correcting and completing elementsof information already present in the at-risk population.     

August 2003 heat wave in France: risk factors for death of elderly people living at home

The August 2003 heat wave in France resulted in many thousandsof excess deaths particularly of elderly people. Individualand environmental risk factors for death among the community-dwellingelderly were identified. We conducted a case–control surveyand defined cases as people aged 65 years and older who livedat home and died from August 8 through August 13 from causesother than accident, suicide, or surgical complications. Controlswere matched with cases for age, sex, and residential area.Interviewers used questionnaires to collect data. Satellitepictures provided profiles of the heat island characteristicsaround the homes. Lack of mobility was a major risk factor alongwith some pre-existing medical conditions. Housing characteristicsassociated with death were lack of thermal insulation and sleepingon the top floor, right under the roof. The temperature aroundthe building was a major risk factor. Behaviour such as dressinglightly and use of cooling techniques and devices were protectivefactors. These findings suggest people with pre-existing medicalconditions were likely to be vulnerable during heat waves andneed information on how to adjust daily routines to heat waves.In the long term, building insulation and urban planning mustbe adapted to provide protection from possible heat waves.     

Influenza vaccination in old adults in Spain

BACKGROUND: to describe population patterns of influenza vaccination, and to analyse the effect of a set of demographic, socio-economic status, lifestyles, health status, and health services variables, on the likelihood of being vaccinated in the those > or = 65 years. METHODS: Cross-sectional study. From the 1997 National Health Survey those > or = 65 years old were selected. Adjusted odds ratios were calculated through multiple logistic regression models, reporting having an influenza vaccination last season as a dependent variable. RESULTS: A total sample of 1148 was analysed: 51.3% of subjects reported having received a vaccination last year. Adjusted odds ratios showed that the risk of not having been vaccinated was higher for people from 65-69 years (OR: 1.70; 95% CI [1.32-2.19]), women (OR: 1.48; 95% CI [1.14-1.92]), residents in cities of more than 1 million inhabitants (OR: 1.74; 95% CI [1.12-2.70]), smokers (OR: 1.92; 95% CI [1.24-2.96]), having high-risk chronic conditions (OR: 1.41; 95% CI [1.08-1.85]), and for those whose last physician visit was between 2 weeks and 6 months ago (OR: 1.40; 95% CI [1.07-1.85]), and more than 6 months ago (OR: 2.13; 95% CI [1.52-2.98]). CONCLUSION: Influenza vaccination levels are sub-optimal. Factors that have been identified as barriers to receiving this effective intervention are: younger age, female sex, less contact with the health care system, smokers, and not having high-risk chronic conditions. No effect was found for socio-economic status or variables related with health, functional status or other health-related behaviours. This study may contribute to identifying population groups who could be targeted for health promotion interventions aimed to improve their influenza vaccination uptake.     

Injury mortality in the European Union 1984-1993: An overview

Background: Approximately 190,000 European Union (EU) citizensdie annually as a result of an injury. In response, the EuropeanCommission identified accidents and injuries as a priority areafor action in the field of public health in 1993. In 1984, theWorld Health Organization (WHO) Health for All targets wereset in Europe to reduce unintentional injuries by 25% and reversethe rising trends in suicide by the year 2000. The aim of thisstudy was to examine the trends in mortality due to externallycaused physical injuries between 1984 and 1993 in the 15 countrieswhich are currently members of the EU. Methods: Injury mortalitydata for all countries were obtained from the WHO and nationalgovernment agencies. Age-standardized mortality rates were calculatedfor both unintentional and intentional injuries and examinedover time. Results: Downward trends in age-standardized injurymortality due to unintentional injuries were identified in mostcountries. Marked variations were observed between countries,with low rates in the UK, The Netherlands and Sweden and highrates in Finland, Portugal and France. Age-standardized suiciderates decreased In most countries over the study period, withmarked variations between countries. In general, countries innorthern Europe experienced higher suicide rates than countriesin southern Europe. Mortality rates due to homicide and otherviolent causes were low and relatively stable over the studyperiod. Conclusions: Most countries appear to be on track tomeet the WHO targets for unintentional injury mortality andsuicide mortality. However, disparities between countries remain,for reasons that are unclear. While mortality data were valuablein describing the epidemiology of fatal injury in Europe, agreementon standardized practices of data collection, coding and analysiswould improve the comparability of data between countries.     

Determinants of health service use and expenditure among the elderly Finnish population

Background: There is a need to identify significant determinantsof physician and public health nurse visits, hospital in-patientand home care, use of prescribed medication and total expenditureamong elderly people for planning of health policy. Methods:The data were obtained from three annual computer-assisted telephoneinterview surveys in 1992–1994. Each year a systematicsample of approximately 2,300 non-institutionalized people aged25-79 years were interviewed. The 60-79 year old respondentswere included in our analysis (n=1,707); the response ratesin this age group were approximately 75% each year. In thisstudy we tested the suitability of four regression models: Poisson,negative binomial, logit plus zero-truncated Poisson and logitplus zero-truncated negative binomial. Results: The use of servicesincreased with age, particularly hospital in-patient and homecare. Although women were more likely to use services, particularlyprimary care, their share of total expenditure was lower thanthat for men. Significant predictors of higher expenditure wereown personal doctor, other specific doctor, perceived healthstatus, psychosomatic symptoms, chronic illness and difficultiesin functional ability. Those living alone had significantlyhigher expenditures. Conclusion: It emerged that, while a largenumber of elderly people had used services, only a small minorityhad accounted for the majority of expenditure. Although thepersonal doctor system may produce high quality of care, itcannot achieve cost savings.     

Serogroup B meningococcal disease in the Norwegian armed forces: What can we learn from an inconclusive vaccine protection trial?

Military recruits serving in the armed forces were severelyaffected during the latest serogroup B meningococcal epidemicin Norway. The risk of developing systemic meningococcal disease(SMD) proved highest during the first 12 weeks of service. Adouble-blind, placebo-controlled protection trial with a meningococcalouter membrane vesicle vaccine took place between 1988 and 1991,but the number of proven SMD cases was too low to allow forany conclusions. However, the results of a parallel efficacystudy of the same vaccine among students in secondary school,cross-society examinations for asymptomatic throat carriageof meningococci and recent immunogenicity studies after two-and three-dose vaccination schedules, suggest that a basic immunizationof young teenagers followed by a booster injection at enrolmentwould contribute significantly to preventing SMD in the armedforces.     

Random capillary whole blood glucose test as a screening test for diabetes mellitus in an elderly population

We assessed the adequacy of the random capillary whole bloodglucose (RCBG) test as a screening test for estimating the prevalenceof diabetes mellitus in an elderly Finnish population (aged70 years or over). Both the screening test and a standard 2h oral glucose tolerance test made according to the WHO criteriawere administered to all participants. By using a cut-off pointof 7.4 mmol/l for men, 7.1 mmol/l for women and 7.2 mmol/l forthe total population, the RCBG test determined the prevalenceof diabetes accurately. The prevalence determined by the RCBGtest was 25.8% (men 21.0% and women 28.6%) and that determinedby the 2 h oral glucose tolerance test 26.1% (men 21.7% andwomen 28.6%). The study also indicated that the RCBG levelselevated with the increase of the severity and duration of diabetesand with the presence of hypertension. The conclusion is thatthe RCBG test with a proper cut-off point is an optimal testfor the estimation of the prevalence of diabetes and that theother properties of the test should be assessed according tothe clinical outcomes and later signs of the disease.     

Changes in cardiovascular risk factors among adolescents from 1995 to 2004 in the Republic of Karelia, Russia

BACKGROUND: In Russia, cardiovascular mortality is among the highest in the world. Behaviours related to the development of cardiovascular disease are usually adopted in childhood and adolescence. Very little information exists on prevalence and trends of risk factors among Russian youth. This study aims to investigate changes in the prevalence of cardiovascular risk factors among adolescents in the Republic of Karelia, Russia, from 1995 to 2004. METHODS: Cross-sectional surveys on chronic disease risk factors were carried out among 15-year-old adolescents in Pitk?ranta region, in the Republic of Karelia. The surveys were conducted in all 10 secondary schools in the Pitk?ranta region. All ninth-grade students in 1995 (N = 385, response rate 95%) and in 2004 (N = 395, response rate 85%) were included in the survey samples. RESULTS: Systolic blood pressure decreased statistically significantly among boys (from 119 to 116 mmHg). Diastolic blood pressure decreased statistically significantly among both girls (from 64 to 59 mmHg) and boys (from 62 to 59 mmHg). Total cholesterol increased statistically significantly only among girls (from 3.9 to 4.1 mmol/l). Body mass index did not exhibit any significant changes in both genders. Daily smoking rate doubled statistically significantly among girls from 7% to 15%. CONCLUSION: The study results show changes in the prevalence of cardiovascular disease risk factors among adolescents in the Republic of Karelia occurring over the last decade. Active measures need to be taken to prevent the increase in smoking prevalence, especially among girls, and to avert the unfavourable development of other risk factors in the future.     

Risk factors of institutionalization in an elderly disabled population

Due to increased life expectancy and demographic ageing an increasingnumber of elderly people have to spend the eve of their lifein institutional settings, which is often associated with adversepsychosocial and financial consequences. The purpose of thisprospective study is to assess the extent and determinants ofinstitutionalization in a population sample of severely disabledelderly people from south Germany. The study population includedall non-institutionalized persons in a defined region who metthe criteria of permanent nursing dependency set by the Germanstatutory health insurance system. Study participants were recruitedin 1991–1993 and followed for a mean of 1.7 years. Rateratios of Institutionalization for potential risk factors werecalculated using Cox's proportional hazards model. Out of 1,583study participants 159 aged 60 years or older were admittedto a nursing home during the follow-up period. Old age, femalegender, living In urban compared to rural areas, professionalprovider of nursing care compared to family members as maincare givers and cognitive impairments independently increasedthe rate of institutionalization In multivariable analysis.There was no relationship between limitations in basic activitiesof daily living and the rate of institutionalization. Theseempirical data extend the scarce database in Germany, whichis needed for further planning of nursing care facilities inthe community in order to improve the situation of disabledpeople, in particular to prevent nursing home admission.     

甲型H1N1流感疫苗大规模人群应急接种分析

目的 控制甲型H1N1流感疫情的传播,为规范有序地应急接种提供依据.方法 按照分步实施、保证重点、知情同意、自愿接种的原则,分4个批次对浙江省象山县重点人群进行应急接种.结果 从2009年11月1日-2010年4月30日,共接种40 734人,接种率达49.83%,其中学生接种26 595人,接种率为64.34%,占总接种人数的65.29%;累计报告预防接种疑似异常反应(AEFI)15例,AEFI报告发生率为34.93/10万.结论 应用甲型H1N1流感疫苗(简称甲流疫苗)对易感人群进行应急接种是防控甲流疫情的有效手段,人群大规模甲流疫苗接种安全可行.     

Influenza vaccination uptake among Victorian healthcare workers: evaluating the success of a statewide program

Objective : Annual influenza vaccination is recommended for all Australian healthcare workers (HCWs). In 2014, a target vaccination uptake of 75% was set for Victorian healthcare facilities. This study aimed to determine the 2014 uptake, describe trends over time and propose an enhanced reporting framework. Methods : Annual data submitted to the Victorian Healthcare Associated Infection Surveillance System (VICNISS) regarding HCW influenza were evaluated for 2005–2014. Faculty uptake – the number of vaccinations administered divided by total number of staff employed – was reported as a statewide aggregate and stratified by facility size (number of staff employed). Results : In 2014, 78,885 HCWs were vaccinated across 93 healthcare facilities, corresponding to an overall uptake of 72.2%. During 2005–2014, small facilities (<100 HCWs) generally reported highest uptake while larger facilities (≥800 HCWs) recorded lowest uptake. Larger facilities recorded the greatest increase (+13.9%) when 2013 and 2014 seasons were compared. For all healthcare facility size categories, the highest uptake was observed in 2014. Conclusion : Influenza vaccination uptake in HCWs has successfully been introduced as a performance indicator in Victorian healthcare facilities and a peak uptake was reported in 2014. Varied trends are evident when uptake is stratified by number of employed HCWs, providing a feasible and meaningful method for benchmarking.     

北京市部分优先接种甲型H1N1流感疫苗人群接种意向调查

2009年9月2日由我国自行研制生产的首批甲型H1N1流感疫苗获得国家食品药品监督管理局批准注册.为配合疫苗上市后的大规模使用,北京市疾病预防控制中心(CDC)受卫生部委托对优先接种人群进行了甲型H1N1流感疫苗的接种意向调查,现将结果报道如下.     

Physician and practice factors related to influenza vaccination among the elderly

BACKGROUND: Influenza vaccination rates among adults, especially in minority populations, remain below national goals of 90%. This study investigated in diverse settings, facilitators of and barriers to patient influenza vaccination from the physician's perspective. METHODS: Two-stage, stratified, random-cluster sampling was employed to select 71 clinicians from inner-city, rural, suburban, and Veterans Affairs (VA) practices, and a random sample of 925 of their patients aged >/=65 years. Questionnaires and interviews based on the PRECEDE-PROCEED framework assessed clinician factors. Associations among clinician beliefs, practice characteristics, patient beliefs, and self-reported influenza vaccination status were determined. RESULTS: The clinician response rate was 85% (60/71). Several factors of the PRECEDE-PROCEED framework were associated with higher influenza vaccination rates. For instance, patients at practices with express vaccination clinics had higher vaccination rates than at clinics without such immunization programs (87% v 76%, p =0.01). Using multivariate models, influenza vaccination status was related to several patient factors, including plans to receive influenza vaccination next year (p <0.001); belief that those who are not vaccinated will contract influenza (p =0.049); and history of being screened for colon cancer (p =0.023). Influenza vaccination status was also related to several physician factors, including awareness of recommendation to vaccinate asthmatics (p =0.024); agreement with these recommendations (p =0.004); and practice type and setting ("strata"), of which the VA was highest. CONCLUSION: Through proactive office systems and education, physicians may influence patients' intentions to be vaccinated and thereby increase influenza vaccination rates.     

上海市1999～2003年流行性感冒流行特征分析

目的了解上海市流感流行特征，探讨流感病毒优势株的变化，为流感防制提供科学依据。方法选择流感监测点，采用流行病学、病原学和血清学方法进行调查。结果1999年流感样病例春秋两季高峰明显．2000年以来季节发病高峰减弱。流感病毒优势株为B型和H1N1型，分别占总病毒分离数的62．81％和32．23％．H3N2亚型活动弱，仅4．96％。1999年主要流行株为B型，2000年为H1N1亚型，2001年以来H1N1亚型和B型交替成为优势株。H1N1亚型病毒抗原性存在某些变异，B型病毒抗原性未发生变异。一般人群流感抗体水平保持较高水平，H3N2、H1N1和B型几何平均滴度(GMT)分别为70．00，67．33和87．67，但小年龄和老年龄组的抗体水平低于成年人。结论上海市近5年流感发病高峰减弱，以B型和H1N1亚型为优势株，其抗原性末发生明显的变异。与我国北方等省H3N2亚型为优势株不同。小年龄和老年人为易感人群。需加强H3N2亚型流感病毒监测，注意H3N2亚型病毒变异引起流行的可能性。