Prevalence of influenza immunisation in Australia and suggestions for future targeting of campaigns

Summary Objectives: Reports on the results of a national survey conducted in Australia, in 2000. The objectives were to determine national estimates of influenza vaccination coverage for each state and territory of Australia, to obtain information related to attitudes towards and influences on immunisation decisions and explain the factors involved with failure to immunise.Method: The survey was conducted using the Computer Assisted Telephone Interview (CATI) system. The overall participation rate for the survey was 88.6% and the final number of completed interviews across Australia was n=10505.Results: Two target groups, those aged 65 years and over and those at risk of influenza aged between 40 and 64 years were defined. The overall immunisation rates in these two groups were 74% and 32% resp. The rate of immunisation among females generally exceeded that of males. A multivariate model provided the best joint set of explanatory variables for not getting immunised. These include sex, income, general practitioner recommendation, and general perceptions regarding the influenza injection.Conclusion: This study identified important issues in the decisions of people to immunise. It also highlighted the need to target the findings in effective immunisation policies and strategies to improve health outcomes for those at risk of adverse influenza events.Population Health Division, Commonwealth Department of Health and Aged Care     

Perceptions of influenza and pneumococcal vaccine uptake by older persons in Australia

BackgroundInfluenza and pneumococcal vaccinations reduce adverse health outcomes in older adults. The Australian National Immunisation Program (NIP) provides free seasonal influenza and pneumococcal vaccinations for adults ≥65 y. Guidelines recommend all adults ≥65 y receive one dose of 23-valent pneumococcal polysaccharide vaccine (23vPPV) regardless of their risk of invasive pneumococcal disease. However, the reported rate of vaccination against pneumococcal disease is much lower than seasonal influenza. Identifying and understanding the perspective of older people on vaccination is important to informing effective promotional strategies for this age group.MethodsUsing a purposive and snowball recruitment strategy, 36 participants aged between 65 and 84 years of age were recruited in south-east Queensland and northern New South Wales. Face-to-face qualitative interviews conducted between July 2017 and January 2018 were recorded, transcribed and thematically analysed.ResultsIn this sample, the uptake of the influenza vaccine (n = 28, 78%) was greater than for the pneumococcal vaccine (n = 14, 39%). Five key themes identified were health practitioner influence; anti-vaccination influence; social responsibility; work-based vaccination; and perceptions of age. The influences on uptake were complex and multi-faceted.ConclusionsFindings provide new insights, in particular, the role of social responsibility, the long-term impact of workplace vaccinations, and how older people do not necessarily consider themselves old.     

Low vaccination coverage for seasonal influenza and pneumococcal disease among adults at-risk and health care workers in Ireland, 2013: The key role of GPs in recommending vaccination

The World Health Organization (WHO), and European Agencies recommend influenza vaccination for individuals at-risk due to age (≥65 years), underlying diseases, pregnancy and for health care workers (HCWs) in Europe. Pneumococcal vaccine is recommended for those at-risk of pneumococcal disease. In Ireland, vaccination uptake among at-risk adults is not routinely available. In 2013, we conducted a national survey among Irish residents ≥18 years of age, to estimate size and vaccination coverage of at-risk groups, and identify predictive factors for influenza vaccination.We used computer assisted telephone interviews to collect self-reported information on health, vaccination status, attitudes towards vaccination. We calculated prevalence and prevalence ratios (PR) using binomial regression.Overall, 1770 individuals participated. For influenza, among those aged 18–64 years, 22% (325/1485) [95%CI: 17%–20%] were at-risk; 28% [95%CI: 23%–33%] were vaccinated. Among those aged ≥65 years, 60% [95%CI: 54%–66%] were vaccinated. Influenza vaccine uptake among HCWs was 28% [95%CI: 21%–35%]. For pneumococcal disease, among those aged 18–64 years, 18% [95%CI: 16%–20%] were at-risk; 16% [95%CI: 12%–21%] reported ever-vaccination; among those aged ≥65 years, 36% [95%CI: 30%–42%] reported ever-vaccination. Main reasons for not receiving influenza vaccine were perceptions of not being at-risk, or not thinking of it; and among HCWs thinking that vaccination was not necessary or they were not at-risk. At-risk individuals were more likely to be vaccinated if their doctor had recommended it (PR 3.2; [95%CI: 2.4%-4.4%]) or they had access to free medical care or free vaccination services (PR 2.0; [95%CI: 1.5%-2.8%]).Vaccination coverage for both influenza and pneumococcal vaccines in at-risk individuals aged 18–64 years was very low. Influenza vaccination coverage among individuals ≥65 years was moderate. Influenza vaccination status was associated with GP vaccination recommendation and free access to vaccination services. Doctors should identify and recommend vaccination to at-risk patients to improve uptake.     

宁波市成年人群的慢性肾脏病流行病学调查

目的了解宁波市成人慢性肾脏病(CKD)患病率及相关危险因素。方法采用多阶段分层整群随机抽样法随机抽取宁波市18岁以上常住居民2 296人,进行CKD及相关危险因素的问卷调查、体格检查及实验室检查。经人口年龄、性别校正后计算CKD患病率,分别采用t检验及χ2检验进行计量及计数数据比较,采用logistic回归分析CKD相关危险因素。结果本次调查有效样本2 110例,经人口年龄、性别校正后,CKD总患病率9.81%,主要集中在CKD早期(82.87%),知晓率11.11%。CKD患病与年龄呈正相关(r=0.254,P=0.000);且女性的CKD患病率显著高于男性(χ2=22.618,P=0.000)。多因素logistic回归结果显示,年龄、女性、糖尿病、高尿酸血症和高血压是CKD的独立危险因素。高脂血症与体质指数与CKD的发生无关。结论宁波市成人CKD总患病率9.81%,知晓率11.11%。年龄、女性、糖尿病、高尿酸血症和高血压是CKD的独立危险因素。     

慢性阻塞性肺疾病患者流感疫苗和23价肺炎球菌多糖疫苗接种研究进展

近年来国内外慢性阻塞性肺疾病（COPD）患者流感疫苗和23价肺炎球菌多糖疫苗（PPV23）接种有效性的相关研究发现,接种流感疫苗和PPV23可显著降低COPD患者的流感和肺炎感染风险,减少疾病的急性加重以及与之相关的住院,尤其是接种流感疫苗还可降低患者诱发缺血性心脏病、急性冠脉综合征、室性心律失常、肺癌、痴呆和死亡的风险,二者联合接种保护作用更加显著。国内外权威指南、共识均建议COPD患者接种流感疫苗和PPV23。目前国内流感疫苗和肺炎球菌疫苗接种率均偏低,且在COPD患者中的应用研究较少。应采取有效措施加强知识普及和指南宣传,提高疫苗接种率。同时还应进一步加强COPD患者接种流感和PPV23的临床研究,尤其是联合接种的临床效益分析,以切实改善COPD患者的生存现状和预后。     

Role of social determinants of health in pneumococcal vaccination among high-risk adults

ObjectivesTo determine the influence of select social determinants of health on uptake of and time to pneumococcal vaccination among those deemed high-risk.MethodsUsing nationwide claims data for years 2013–2016, adult patients (aged 18–64 years) were followed from their first diagnosis for a condition deeming them high-risk for invasive pneumococcal disease through the subsequent 365 days and observed for pneumococcal vaccination in outpatient clinics and pharmacies. Publicly-available data on select social determinants of health were incorporated into analyses, guided by the WHO vaccine hesitancy matrix. Controlling for baseline demographic and clinical characteristics, logistic regression determined predictors of vaccination and a general linear model compared days to being vaccinated.ResultsA total of 173,712 patients were analyzed of which approximately one quarter (25.3%) were vaccinated against invasive pneumococcal disease within the first year of being deemed high risk, nearly all of which (98.5%) were received in outpatient clinics. The odds of vaccination were higher among urban residents (OR: 1.18; 95% CI: 1.144–1.223), areas of higher health literacy (OR: 1.02; 95% CI: 1.019–1.025), and more Democratic-voting communities (OR: 1.5; 95% CI: 1.23–1.88). Conversely, the likelihood of vaccination was particularly low in areas of higher poverty (OR: 0.14; 95% CI: 0.068–0.304) and with limited Internet access (OR: 0.14; 95% CI: 0.062–0.305) as well as among adults who did not also get a seasonal influenza vaccine (OR: 0.05; 95% CI: 0.048–0.052). Time to vaccination was longer in rural residents (B = 8.3, p < 0.0001) and communities with less Internet access (B = 75.6, p < 0.001).ConclusionSocial determinants may be influencing pneumococcal vaccine-seeking behavior among those deemed high-risk, but a more formal and comprehensive framework must be assessed to determine the full impact of these factors across vaccines recommended in adults.     

Hepatitis A and hepatitis B vaccination coverage among adults with chronic liver disease

BackgroundInfection with hepatitis A and hepatitis B virus can increase the risk of morbidity and mortality in persons with chronic liver disease (CLD). The Advisory Committee on Immunization Practices recommends hepatitis A (HepA) and hepatitis B (HepB) vaccination for persons with CLD.MethodsData from the 2014 and 2015 National Health Interview Surveys (NHIS), nationally representative, in-person interview surveys of the non-institutionalized US civilian population, were used to assess self-reported HepA (≥1 and ≥2 doses) and HepB vaccination (≥1 and ≥3 doses) coverage among adults who reported a chronic or long-term liver condition. Multivariable logistic regression was used to identify factors independently associated with HepA and HepB vaccination among adults with CLD.ResultsOverall, 19.4% and 11.5% of adults aged ≥ 18 years with CLD reported receiving ≥1 dose and ≥2 doses of HepA vaccine, respectively, compared with 14.7% and 9.1% of adults without CLD (p < .05 comparing those with and without CLD, ≥1dose). Age, education, geographic region, and international travel were associated with receipt of ≥2 doses HepA vaccine among adults with CLD. Overall, 35.7% and 29.1% of adults with CLD reported receiving ≥1 dose and ≥3 doses of HepB vaccine, respectively, compared with 30.2% and 24.7% of adults without CLD (p < .05 comparing those with and without CLD, ≥1 dose). Age, education, and receipt of influenza vaccination in the past 12 months were associated with receipt of ≥3 doses HepB vaccine among adults with CLD. Among adults with CLD and ≥10 provider visits, only 13.8% and 35.3% had received ≥2 doses HepA and ≥3 doses HepB vaccine, respectively.ConclusionsHepA and HepB vaccination among adults with CLD is suboptimal and missed opportunities to vaccinate occurred. Providers should adhere to recommendations to vaccinate persons with CLD to increase vaccination among this population.     

深圳市福田区高血压和糖尿病流行特征 及疾病经济负担研究

摘要:目的　研究深圳市福田区居民高血压和糖尿病流行特征以及疾病经济负担,为开展慢性病防控工作提供科学依据。方法　采用整群随机抽样方法,共抽取1191名18岁以上常住居民。通过问卷调查和体格测量获得个人资料及血压、血糖值,利用第四次卫生服务调查数据,估算福田区高血压和糖尿病疾病经济负担。结果　深圳市福田区居民高血压患病率12.5%（标化患病率14.6%）,糖尿病患病率5.6%（标化患病率6.6%）;福田区高血压直接经济负担11791.17万元,糖尿病直接经济负担8097.33万元。结论　深圳市福田区慢性病患病率增长迅速,疾病经济负担高,建议巩固医疗改革“保基本”的方针,深化慢性病防控工作。     

Informing the design of a whole of life immunisation register for Australia

Introduction: In 2016, Australia launched a whole life immunisation register, the Australian Immunisation Register (AIR), building on a universal childhood register established in 1997. Immunisation Information Systems are well established in Europe, the US and elsewhere. However, a national system covering immunisation across the lifespan, with complete capture of the population and satisfactory data quality, is rare. Methods: A national workshop was convened in 2016 with key stakeholders from the government, new and existing vaccine users, and vaccine providers to review the ideal features of the AIR to ensure optimal effectiveness. This workshop focused on the functionality needed to identify population groups newly included in the register and support the achievement of high immunisation coverage in these groups eligible for National Immunisation Program vaccines. Results: Key recommendations included the need for bidirectional data flow between the AIR and providers; systematic approaches to the capture and recording of accurate and complete data to ascertain important denominators for subpopulations, includingAboriginal and Torres Strait Islander status, medical risk factors, occupation, ethnicity, country of birth, and vaccines given during pregnancy; linkage with other government datasets including notifiable diseases; the capture of adverse events following immunisation; ease of access by patients, providers; and by researchers. Conclusions: Some recommendations from the workshop have informed the development and future utility of the AIR. Some recommendations from the workshop have been integrated into the current iteration of the AIR, which is more important than ever given the roll-out of COVID-19 vaccines. The accuracy and validity of data have subsequently improved through data entry controls, data integrity checks and reporting requirements. Access to AIR data for research remains protracted and costly, limitingresearch potential.     

Kawasaki disease and immunisation: A systematic review

BackgroundKawasaki disease is a complex and potentially serious condition. It has been observed in temporal relation to immunisation.MethodsWe conducted a systematic literature review using various reference sources to review the available evidence published in the literature.ResultsWe identified twenty seven publications reporting a temporal association between immunisation and Kawasaki disease. We present a systematic review of data drawn from randomised controlled trials, observational studies, case series and reports, and reviews. Overall there was a lack of standardised case definitions, making data interpretation and comparability challenging.ConclusionsAlthough a temporal relationship between immunisation and Kawasaki disease is suggested, evidence for an increased risk or a causal association is lacking. Implementation of a standardised Kawasaki disease case definition would increase confidence in the findings and add value to future studies of pre- or post-licensure vaccine safety studies.     

Predictors of pneumococcal vaccination among Australian adults at high risk of pneumococcal disease

BackgroundAlthough nearly all Australian children are vaccinated against pneumococcal disease, pneumococcal vaccine uptake is low among high-risk adults. This study aimed to identify perceived barriers to pneumococcal vaccination among high-risk adults.MethodsThis paper reports combined data on pneumococcal vaccination collected from three different online, cross-sectional surveys that were administered in Australia between August 2019 and September 2020. Using Poisson regression, we identified characteristics and beliefs associated with self-reported pneumococcal vaccination among adults aged 65 and over or with chronic health conditions.ResultsThe weighted estimate for pneumococcal vaccine coverage was 24% for high-risk adults under 65 and 53% for adults aged 65 and over. Nearly half of those under 65 reported they had never heard of the pneumococcal vaccine, while 26% of those aged 65 and over had never heard of the vaccine. Among those under 65, pneumococcal vaccination was associated with high perceived disease susceptibility (PR = 1.97, 95% CI: 1.23, 3.18), not having heard of the pneumococcal vaccine (PR = 0.44, 95% CI: 0.28–0.69), awareness that their chronic health condition puts them at increased risk of pneumonia (PR = 2.44, 95% CI: 1.51–3.98), and having a doctor recommend the vaccine (PR = 3.02, 95% CI: 2.05–4.44). Among adults aged 65 and over, self-reported pneumococcal vaccination was associated with influenza vaccination in the previous 12 months (PR = 4.28, 95% CI: 2.85–6.44) and awareness that they are eligible for free pneumococcal vaccination (PR = 5.02, 95% CI: 2.34–10.77).ConclusionAwareness of pneumococcal vaccines was low among adults at high risk of pneumococcal disease, which appears to be contributing to low vaccine uptake. A doctor’s recommendation was associated with increased uptake of pneumococcal vaccine, so interventions should be developed to promote pneumococcal vaccine uptake in GP practices.     

中国居民慢性阻塞性肺疾病监测意义重大

2014年我国开展了中国居民COPD监测,获得全国代表性数据结果。COPD监测对于掌握中国≥40岁居民COPD患病及其危险因素的流行状况与变化趋势,制定国家COPD防控政策,评估防控效果,建立COPD综合监测系统以及建设专业的COPD监测与防控队伍具有重要意义。本期重点号文章介绍了COPD监测的方法与内容,报告了中国≥40岁人群肺功能检查率及COPD知识知晓率,分析了该人群的烟草烟雾暴露、职业粉尘暴露、生物燃料和煤燃料暴露等主要COPD危险因素的流行状况,以及COPD高危人群分布特征,为我国开展COPD综合防控工作提供了基础数据。     

The additive benefits of influenza and pneumococcal vaccinations during influenza seasons among elderly persons with chronic lung disease

Uncertainty regarding the benefits of pneumococcal vaccination may contribute to the under use of this vaccine. The present study was conducted to clarify the benefits of influenza and pneumococcal vaccinations during 3 influenza seasons among elderly persons with chronic lung disease. All elderly members of a large managed care organization with a prior diagnosis of chronic lung disease were included in a cohort that was followed over three influenza seasons (1993–1994, 1994–1995, and 1995–1996). Data obtained from the administrative data bases of the health care organization included baseline demographic and health characteristics, influenza vaccination status for each season, date of pneumococcal vaccination, and outcomes for each season including hospitalization for pneumonia and death. Cox proportional hazards regression and Poisson regression with repeated measures were used to compare the risk of outcomes among vaccinated and unvaccinated persons while controlling for covariates and confounders. During the three influenza seasons, influenza vaccination alone was associated with a 52% reduction (95% CI 18–72) in hospitalizations for pneumonia and a 70% reduction (95% CI 57–89) in death. Pneumococcal vaccination alone during the three influenza seasons was associated with a 27% reduction (95% CI 13–52) in hospitalizations for pneumonia and a 34% reduction (95% CI 6–54) in death. Both vaccinations together demonstrated additive benefits. When both vaccinations had been received, there was a 63% reduction (95% CI 29–80) in hospitalizations for pneumonia and an 81% reduction (95% CI 68–88) in death versus when neither had been received. These findings suggest pneumococcal vaccination is associated with substantial benefits for elderly persons with chronic lung disease.     

Risk of underlying chronic medical conditions for invasive pneumococcal disease in adults

PurposeIn the United States, the 13-valent pneumococcal conjugate vaccine is recommended in persons ⩾65 years of age, and persons ⩽65 years of age with immunocompromising (IC) conditions. For invasive pneumococcal disease (IPD) prevention in those ⩽65 with non-IC medical conditions, the 23-valent polysaccharide vaccine is recommended. This group is at higher risk of IPD than the general population, but the level of risk is not well-quantified. We estimated IPD risk by individual underlying medical conditions, and by total number of conditions, for persons ⩾18 years of age. We calculated the relative risks (RR) of various medical conditions, comparing the incident IPD cases to the general study population, and used Poisson regression models to estimate an IPD RR, adjusting for other conditions. We also examined IPD incidence by number of conditions diagnosed in each calendar year, using a risk-stacking model.ResultsUnderlying medical conditions with the highest adjusted RR for IPD were chronic liver disease (RR 2.1, 95% CI 1.5–2.8) and chronic obstructive pulmonary disease (COPD; RR 2.1, 95% CI 1.8–2.5). IPD risk increased with increasing number of medical conditions: adjusted RR, 2.2 (95% CI 1.9–2.5) 1 condition, 2.9 (2.5–3.5) for 2 conditions, and 5.2 (4.4–6.1) for 3 conditions.ConclusionsFor persons with a single, non-IC medical condition, IPD risk was twice that for the general KPNC population. Persons with multiple, non-IC chronic conditions exhibited increased IPD risk with each additional condition. Such information may inform discussions on recommendations for adult pneumococcal immunization and prevention.     

Effects of maternal and infant co-infections, and of maternal immunisation, on the infant response to BCG and tetanus immunisation

Some vaccines show poor efficacy in tropical countries. Within a birth cohort in Uganda, we investigated factors that might influence responses to BCG and tetanus immunisation. Whole blood assay responses to crude culture filtrate proteins of Mycobacterium tuberculosis (cCFP)) and tetanus toxoid (TT) were examined among 1506 and 1433 one-year-olds, respectively. Maternal Mansonella perstans infection was associated with higher interleukin (IL)-10 responses to both immunogens but no reduction in gamma interferon (IFN-γ), IL-5 and IL-13 responses; other maternal helminth infections showed little effect. Tetanus immunisation during pregnancy was associated with higher infant responses to TT; maternal BCG scar (from past immunisation) with lower infant IL-5 and IL-13 responses to cCFP. IFN-γ, IL-5 and IL-13 to TT were reduced in HIV-exposed-uninfected infants; infant malaria and HIV were associated with lower IFN-γ, IL-5 and IL-13 responses to both immunogens. We conclude that maternal helminth infections are unlikely to explain poor vaccine efficacy in the tropics. Effects of maternal immunisation on infant responses to vaccines should be explored. Prevention of infant malaria and HIV could contribute to effectiveness of immunisation programmes.     

Vitamin D deficiency is associated with poor response to active hepatitis B immunisation in patients with chronic kidney disease

Vitamin D deficiency is highly prevalent in patients suffering from chronic kidney disease. At present it is not known whether this condition is associated with poor response to hepatitis B vaccination in these patients. We performed a retrospective analysis of 200 patients with chronic kidney disease stages 3-5D, who had undergone hepatitis B vaccination with three 40 μg recombinant hepatitis B vaccine doses in a single centre. Anti-HBs antibody titres and 25-hydroxyvitamin D (25(OH)D) levels were measured by chemiluminescence immunoassays. Vitamin D deficiency with serum levels <10 ng/mL was found in 35.5% of patients. These patients had a lower seroconversion rate than did patients with levels ≥10 ng/mL (45% vs 64%; P = 0.011) and their median (25th, 75th percentile) anti-HBs antibody titres were lower (0 (0, 117) IU/L vs 48 (0, 236.5) IU/L). Non-responders had lower 25(OH)D concentrations than did responders (12.9 ± 6.5 ng/mL vs 15.1 ± 7.4 ng/mL; P = 0.034). Treatment with a vitamin D receptor activator had no influence on the immune response. In a multiple logistic regression analysis vitamin D deficiency (OR 0.480; P = 0.023) and diabetes (OR 0.496; P = 0.038) remained independent and significant negative predictors of seroconversion. In conclusion, in patients with chronic kidney disease vitamin D deficiency is associated with a poor antibody formation upon hepatitis B vaccination.     

浙江省台州市成人慢性病行为危险因素调查

目的了解台州市成人慢性病相关行为危险因素的分布和发生水平,为制定有针对性的综合干预措施提供依据。方法采用多阶段随机抽样方法抽取30个社区751名15~69岁当地户口居民进行问卷调查。结果调查人群超重率、肥胖率分别为24.0%和6.5%,男、女性超重肥胖率分别为31.1%和30.0%;吸烟率为26.8%（标化吸烟率18.8%）,男性为52.3%,女性为1.3%,男性高于女性（χ^2=248.522,P=0.000）。被动吸烟率为46.0%,女性（50.9%）高于男性（35.8%）。饮酒率为31.4%,男性为52.0%,女性为10.9%,男性高于女性（χ^2=147.141,P=0.000）。规律锻炼率为15.4%、高脂饮食率为18.1%、高盐饮食率为21.6%;自报高血压、高血脂和糖尿病的患病率分别为16.2%、7.6%和5.6%,高血压、高血脂、糖尿病健康知识的知晓率不高。结论台州市居民中普遍存在吸烟、被动吸烟、不合理膳食、超重肥胖、缺少体育运动等行为危险因素,应积极采取相应的行为干预措施,以降低慢性病发病率。