Influenza immunisation coverage from 2015 to 2017: A national study of adult patients from Australian general practice

ObjectivesTo assess influenza immunisation rates and coverage in adult patients from Australian general practice and identify whether practice or patients’ characteristics are associated with vaccination uptake.DesignOpen cohort study.Setting550 Australian general practices included in the MedicineInsight database.ParticipantsPatients aged 18+ years who had at least one consultation during influenza season between 2015 and 2017. Two samples were considered: (1) ‘active’ patients (at least three consultations in any two consecutive years) and (2) ‘every year’ patients (at least one consultation per year).Main outcome measuresInfluenza vaccination rates per 1,000 consultations and coverage (% vaccinated among those who consulted) from 2015 to 2017.ResultsBetween 2015 and 2017 the influenza vaccine rate changed from 57.4 to 51.7 and 67.0 per 1,000 consultations, while correspondent values for coverage were 29.3%, 25.2% and 27.6% (in ‘active’ patients). Vaccine coverage was at least 30% higher in inner regional areas, among patients aged 65+ years or those with comorbidities. Similar associations were found among ‘every year’ patients, but average coverage across the three years was higher (41% vs 27%). Aboriginal and Torres Strait Islander people, either with or without comorbidity, showed a vaccine coverage 10–30% higher than non-Indigenous people for those aged less than 65 years (p-value for interaction < 0.001).ConclusionMedicineInsight data is a useful and low-cost method to monitor influenza immunisation coverage. Independent of the sample used, vaccination coverage among Indigenous people or patients with comorbidities could be improved. Targeted strategies for high-risk groups need to be developed.     

Influenza and pneumococcal vaccination: do older people know if they have been vaccinated?

Objective: To estimate influenza and pneumococcal immunisation rates by self‐report and validate this with immunisation providers. Method: A random population telephone survey. This was followed by contacting immunisation providers of those reporting having an influenza vaccination (2009 or 2010 only) and/or pneumococcal vaccination to confirm vaccination or not. Results: A total of 680 people aged 65 and older responded to the telephone survey. Seventy‐five per cent of respondents self‐reported influenza vaccination in 2010 and 26% self‐reported having ever had the pneumococcal vaccination. Following up with immunisation providers, we found recall for influenza vaccination was confirmed in 96% of cases. For the pneumococcal vaccination, recall for vaccination was confirmed in 87% of cases. People saying they were not vaccinated for pneumococcal were subsequently confirmed as vaccinated in 77% of cases. Conclusions: In this study, self‐reported influenza vaccination was reliable. The term ‘pneumococcal vaccination or Pneumovax’ was poorly recognised by our telephone survey respondents as evident by the low rate of self‐reported pneumococcal vaccination compared to a much higher rate of pneumococcal vaccinations recorded by GPs. Implications: While pneumococcal vaccination is an accurate term, researchers should be aware of the terminology used in general practice and the community when designing their survey.     

Importance of patients' perceptions and general practitioners' recommendations in understanding missed opportunities for immunisations in Swiss adults

Over the last decades, tremendous efforts have been made to strengthen childhood immunisation programs. However, the burden of influenza and pneumococcal infections remains disturbingly high in adults and elderly. We conducted a cross-sectional self-administered mail survey to identify characteristics associated with low use of recommended vaccines in adult patients attending routine primary care appointments in Switzerland. Tetanus vaccination was reported by 84% of respondents aged 16–34, and by only 42% of respondents aged 65 or more. For influenza and pneumococcal vaccination, of high-risk patients (age ≥65 or history of diabetes, kidney, heart, or chronic pulmonary disease), only 41% were on schedule for influenza and 6% for pneumococcal vaccination. Compared with patients from the German- and Italian-speaking areas of the country, patients from the French-speaking region were more likely to report past immunisation against influenza and pneumococcal disease or a recent physician's recommendation for immunisation against influenza, but equally likely to have ever refused influenza vaccination. For all three diseases, area of residence, physician's recommendation for immunisation, and patient's perceived usefulness of vaccination were independently and significantly associated with vaccination status. Although patient's opinion is an important determinant of vaccination coverage in adults, lack of physician's encouragement accounted for most missed vaccination opportunities in this study. The higher vaccination coverage among patients from the French-speaking area suggests that the promotion campaigns carried out in this region effectively improved influenza vaccine use. Interventions designed to increase vaccination coverage in adults must help providers incorporate immunisation in routine health care.     

Monitoring county-level vaccination coverage during the 2004-2005 influenza season

BACKGROUND: During the 2004-2005 influenza season, the United States faced a sudden shortage of influenza vaccine. In response, the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) recommended prioritizing vaccination for persons aged 65 and older and others at high risk. To monitor subsequent vaccination coverage, several questions about influenza vaccination were added to the ongoing Behavioral Risk Factor Surveillance System (BRFSS). This study provided real-time county-level estimates of influenza vaccination coverage from the BRFSS each month from October 2004 through January 2005. METHOD: The methods used a variation of small area estimation procedures suitable for situations in which most small areas have few or no survey respondents, and rapid assessment is essential. Both model-based methods and nonparametric spatial-smoothing methods were used in a three-step procedure. RESULTS: The highest vaccination rates during the 2004-2005 influenza season were seen in the upper Midwest and the Southeast. Areas with the lowest vaccination rates were the intermountain West, southern California, portions of Washington and Oregon, and various areas across the Eastern United States, often coinciding with urban areas. Intrastate variations were especially pronounced in the Eastern United States, particularly in Georgia, Florida, Tennessee, Kentucky, North Carolina, Virginia, and New York. These states all had areas with low immunization rates as well as areas with high rates. CONCLUSIONS: The results showed that vaccination coverage varied significantly across states and substate regions. Our findings show that this methodology can provide estimates with reasonable reliability for planning during public health emergencies.     

Efficacy of Influenza Immunisation Programmes Comparison of Two European Systems in One Practice

In many European countries, influenza vaccination is recommended for the elderly (over 65 years) and high-risk groups, and administered by general practitioners. We have studied the variations in rates of uptake in a group practice located in Belgium which also deals with patients from the Netherlands. Comparing immunisation rates for the two parts of the population allowed us to compare the effects of the two different systems for the administration and reimbursement of vaccinations. 75.2% (n=407) of the eligible Dutch patients were immunised versus 64.3% (n=364) of the Belgian patients. For patients over 65 years the corresponding rates were 77.5% (n=244) versus 62% (n=245). Attendance at a special flu immunisation clinic was also higher among Dutch (71.2%) than Belgian (54.7%) patients. Programmatic differences between the Dutch and Belgian systems for flu vaccination are likely to account for these findings.     

Influenza and pneumococcal vaccination coverage among persons aged > or = 65 years--United States, 2004-2005

Vaccination of persons at increased risk for complications from influenza and pneumococcal disease is a key public health strategy in the United States. During the 1990-1999 influenza seasons, approximately 36,000 deaths were attributed annually to influenza infection, with approximately 90% of deaths occurring among adults aged > or = 65 years. In 1998, an estimated 3,400 adults aged > or = 65 years died as a result of invasive pneumococcal disease. One of the Healthy People 2010 objectives is to achieve 90% coverage of noninstitutionalized adults aged > or = 65 years for both influenza and pneumococcal vaccinations (objective 14-29). To assess progress toward this goal, this report examines vaccination coverage for persons interviewed in the 2004 and 2005 Behavioral Risk Factor Surveillance System (BRFSS) surveys. The 2004-05 influenza season was characterized by an influenza vaccine shortage. As a result, the Advisory Committee on Immunization Practices (ACIP) issued recommendations that influenza vaccine be reserved for persons in priority groups, including persons aged > or = 65 years, and that others should defer vaccination until supply was sufficient. The results of this assessment indicated that, overall, influenza vaccination coverage was lower in the 2005 survey year than in 2004, whereas pneumococcal vaccination coverage was nearly unchanged from 2004 to 2005. In both years, influenza and pneumococcal vaccination coverage varied from state to state. Continued measures are needed to increase the proportion of older adults who receive influenza and pneumococcal vaccines; health-care providers should offer pneumococcal vaccine all year and should continue to offer influenza vaccine during December and throughout the influenza season, even after influenza activity has been documented in the community.     

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     

Is immunising all patients with chronic lung disease in the community against influenza cost effective? Evidence from a general practice based clinical prospective cohort study in Utrecht,The Netherlands

STUDY OBJECTIVE: There is little information on the potential benefit of immunising all patients with chronic lung disease in the community against influenza. The clinical effectiveness and economic benefit was established of the influenza vaccination programme in a general practice based cohort of adult patients with chronic lung disease followed up during the 1995/96 influenza A epidemic. DESIGN: A prospective cohort study from October 1995 to March 1996. SETTING: The study was undertaken in the Utrecht General Practices Network with six large group practices, covering a total population of approximately 50,000 patients in the Netherlands. PATIENTS: Computerised medical records of 1696 patients with chronic lung disease aged over 18 years with an indication for vaccination according to the Dutch GP guidelines were reviewed. MAIN RESULTS: The overall attack rate of any complication, including all cause death, low respiratory tract infection, and acute cardiac disease was 15%. Exacerbations of lung disease were most frequent (13%). Death, pneumonia, and acute cardiac disease were mainly limited to patients > or = 65 years. No effectiveness of the immunisation programme could be established in patients 18-64 years (n = 1066), after controlling for baseline prognosis in multivariable logistic regression analysis. In vaccinees > or = 65 years (n = 630), the occurrence of any complication was reduced by 50% (95% CI 17, 70%). The economic benefit was estimated at 50 Pounds per elderly vaccinee. CONCLUSIONS: This study suggests that in the Netherlands immunisation of elderly patients with chronic lung disease against influenza is effective and cost-saving, hence these patients should be given high priority. More, preferably experimental, studies are needed to establish whether adult lung patients under 65 years in the community will also benefit from vaccination.

 

     

Patterns and determinants of influenza and pneumococcal immunisation among adults with chronic disease living in Queensland, Australia

Using findings from a random, computer assisted telephone survey of households, this paper examines influenza and pneumococcal immunisation coverage and predictors of immunisation in 2203 adults with asthma, diabetes or a cardiovascular condition living in Queensland, Australia. 47% and 31% of high-risk persons were immunised against influenza and pnemococcus respectively. Immunisation coverage varied across chronic conditions and increased with age, being significantly higher for those aged 65 years and older and consequently eligible for free vaccination. Poor self reported health status was an independent predictor of pneumococcal vaccination status for people with asthma, diabetes or a cardiovascular condition; however it was only an independent predictor of influenza immunisation status for people with diabetes. Extending free vaccination to all people at risk may increase immunisation rates for younger people with a chronic condition     

Influenza vaccination of recommended adult populations, U.S., 1989-2005

OBJECTIVE: To assess influenza vaccination coverage among recommended adult populations in the United States. METHODS: Data from the 1989 to 2005 National Health Interview Surveys (NHISs), weighted to reflect the civilian, non-institutionalized U.S. population, were analyzed to determine self-reported levels of influenza vaccination among persons aged >or=65 years, persons with high-risk conditions, health care workers (HCW), pregnant women, and persons living in households with at least one identified person at high risk of complications from influenza infection. We stratified data by race/ethnicity to identify racial/ethnic disparities. RESULTS: Vaccination coverage levels among all recommended adult populations peaked in 2004, then declined in 2005 in association with the 2004-2005 vaccine shortage. Coverage for adults >or=65 years of age increased from 30.1% (95% confidence interval [CI]: 28.8-31.3) in 1989 to 70.0% (68.0-71.5) in 2004. In 2004, coverage was 40.7% (39.0-42.5) for all adults 50-64 years, 27.2% (24.6-29.9) for adults aged 18-49 years with high-risk conditions, 43.2% (39.9-46.6) for health care workers, 21.1% (19.1-23.4) for non-high-risk adults aged 18-64 years with a high-risk household member, and 14.4% (8.8-22.9) for pregnant women. Among each of the recommended adult sub-groups, vaccination coverage was higher for non-Hispanic whites compared to minority groups. CONCLUSIONS: By 1997, influenza vaccination coverage had exceeded the national 2000 objective of 60% among persons aged >or=65 years, but by 2004 still remains well below the national 2010 target of 90%. Coverage levels for other groups targeted for influenza vaccination also are far short of the Healthy People 2000 and 2010 goals of 60% for persons aged 18-64 years with high-risk conditions, health care workers, and pregnant women. A concerted effort to increase provider adoption of standards for adult immunization, public awareness, and stable vaccine supplies are needed to improve influenza vaccination rates among recommended groups, and to reduce racial and ethnic disparities.     

Postcard reminders from GPs for influenza vaccine: Are they more effective than an ad hoc approach?

All persons 65 years and older are recommended to be immunised against influenza each autumn. As immunisation rates remain low, we conducted a randomised control trial in a three-partner urban general practice to evaluate the differential effectiveness of a single postcard reminder in a general practice setting compared to usual care. All non-residential patients aged 65 years and over were identified from the age/sex/disease register. After exclusions, 325 patients were stratified by sex (125 men and 200 women) and randomised to receive either a postcard reminder in large print mailed in April or usual care. General practitioners (GPs) were blind to the randomisation. A blinded record audit performed in July demonstrated that the postcard was effective in increasing immunisation for men (X²_1df=3.85; p=0.05) but not for women (X²_1df=0.45; p=0.50). After adjusting for 1995 immunisation status, the effect of the postcard on immunisation rates was even stronger in men (Wald X²_1df=6.20; p=0.01) but remained non-significant in women (Wald x²_1df=1.38; p=0.24). With this adjustment, the odds of having the 1996 flu vaccine for men sent the postcard reminder were three times that of men in the control group (OR=3.0; 95% Cl 1.3–6.9). In a general practice setting, a single postcard reminder appears to be a promising way to boost influenza immunisation rates among ageing men. Replication of the study is recommended.     

Dutch influenza vaccination rate drops for fifth consecutive year

AimTo determine the prevalence and trend of the influenza vaccination-rate of the overall target population in the period 2008–2013, with a specific focus on groups at risk such as patients with cardiovascular diseases, lung diseases, diabetes and aged 60 years and older.MethodsIn an observational longitudinal study electronic medical records data from the Dutch representative network of general practices, LINH, were analyzed. For each influenza vaccination season, 2008–2013, the number of vaccinated and unvaccinated patients at risk are compared by chi-square tests (χ²) for linear trends, linear-by-linear association. The level of significance was set at p < 0.001 based on the large number of available records.ResultsThe influenza vaccination rate of the overall at risk group decreased significantly from 71.5% in the 2008 season, to 59.6% in the 2013 vaccination season. The difference of 11.9% was gradual over the years, with a mean decrease of 2.4% per year. The decrease was seen in all specified groups at risk, but was mainly among patients aged 60–65 years (mean yearly decrease of 3.3%).ConclusionFor the fifth subsequent year, we notice a lowering trend of the influenza vaccination rate in the population at risk. Reports in the mass media on questioning the effectiveness of the vaccination program may have been an influence; as well as the relatively light outbreaks of influenza in the past years, which may have affected the sense of urgency. The gradual decrease in vaccination rates over recent years requires further research and a public health debate is needed on the usefulness and necessity of the vaccination program.     

Developments in influenza vaccination coverage in England, Scotland and Wales covering five consecutive seasons from 2001 to 2006

This study aims at assessing trends in influenza vaccination coverage from 2001 to 2006 in Great Britain, at understanding drivers and barriers to vaccination and at identifying vaccination intentions for influenza season 2006/2007. In seasons 2001/2002 to 2005/2006, telephone-based household surveys representative of the population from age 16 were conducted, with about 2000 interviews per season (10,095 in total). Overall influenza vaccination coverage rate in Great Britain reached 25.9% in season 2005/2006. A sub-analysis showed that the highest coverage was reported in Wales reaching 33.3%. In the elderly recommended vaccination (from age 65), the coverage reached 79% in 2005/2006. Advice from the family doctor and the perception that influenza is a serious illness were the most frequent reasons for getting vaccinated. The most frequent reasons for not getting vaccinated, in persons never vaccinated before, were that they had not considered immunisation or had not received a recommendation from their family doctor. Those vaccinated in the past but not in the current season said they had not thought about vaccination/forgot. A gap continues to exist between those with intention to get vaccinated and those actually vaccinated, indicating a potential to increase vaccination coverage rate in the future. Our study shows that stable vaccination coverage rates were observed from 2002 to 2006 in Great Britain. The coverage had increased in Wales and in Scotland. The coverage among the elderly above 65 years was the highest in Europe. Although Great Britain complies with national and international goals of vaccination coverage rates effort is needed to ensure high vaccination coverage rates at the same level in the future.     

Influenza vaccination coverage among children with asthma--United States, 2004-05 influenza season

In 2005, approximately 8.9% (6.5 million) of U.S. children aged <18 years were reported to have current asthma. Children with asthma are at high risk for complications from influenza, and influenza vaccination has been determined to safely and effectively reduce rates of influenza in these children. Since its establishment in 1964, the Advisory Committee on Immunization Practices (ACIP) has recommended that all children with asthma aged > or =6 months receive vaccination with inactivated influenza vaccine during each influenza season; however, national influenza vaccination coverage rates specifically for children with asthma have not been determined. Previous studies have assessed influenza vaccination rates in children with asthma at the local level using health maintenance organization and clinician group-practice information, with estimates ranging from 10% to 43% for various influenza seasons. Another study used Behavioral Risk Factor Surveillance System (BRFSS) data to estimate influenza vaccination coverage in children aged 2-17 years with one or more conditions putting them at high risk for complications from influenza (including asthma, although asthma was not assessed separately); in that study, the national rate was estimated at 34.8% for the 2004-05 influenza season (based on a sample size of 685, which included all states and the District of Columbia [DC]). To estimate national influenza vaccination coverage rates among children aged 2-17 years with current asthma, CDC analyzed data from the 2005 National Health Interview Survey (NHIS). This report describes the results of that analysis and provides the first national estimates of influenza vaccination coverage among children with asthma. The findings indicated that although children with current asthma were more likely to receive influenza vaccination than children without current asthma, the vaccination coverage rate among children with asthma was low, at 29.0% (95% confidence interval [CI] = 24.5-33.9). These findings underscore the need to increase influenza vaccination coverage in children with asthma aged 2-17 years by identifying and overcoming barriers to vaccination.     

Influenza vaccination coverage rates in the UK: a comparison of two monitoring methods during the 2002-2003 and 2003-2004 seasons

OBJECTIVES: To assess the feasibility of measuring influenza vaccination coverage during 2002-2003 and 2003-2004 seasons using a telephone survey; to compare these findings with routine vaccine uptake monitoring based on data provided by general practitioners. STUDY DESIGN: Telephone-based survey. METHODS: We interviewed a random sample of non-institutionalized individuals representative of the population aged 16 years and over. Four target groups were determined for analysis: (1) people aged 65 years and over; (2) healthcare workers; (3) people under 65 years with chronic illnesses, which placed them at risk for influenza; and (4) a group composed of all three previous groups combined. RESULTS: The overall sample consisted of 4054 people (about 2000 per season). Population influenza vaccine coverage in the UK increased from 22.3% in 2002-2003 to 24.2% in 2003-2004. Vaccine uptake was strongly age dependent, even in people aged 65 years and over (the ages at which all people are routinely targeted). In both seasons, the estimates of vaccine uptake in people aged 65 years and over were remarkably consistent with those obtained through routine monitoring. Vaccine uptake in healthcare workers was markedly suboptimal. CONCLUSIONS: In the UK, a telephone-based system of monitoring influenza vaccine uptake seems robust enough to generate data that are comparable with routine vaccine monitoring undertaken using data provided by general practitioners. Although such a system cannot easily contribute towards monitoring of vaccination at local and regional levels, it offers a validated method of estimating vaccine uptake that is independent of healthcare workers' time. This may be especially important for a pandemic vaccination programme, especially in countries in which healthcare resources are scarce, or where the configuration of healthcare services is less conducive to internal monitoring than is the case in the UK.     

Influenza vaccine uptake and distribution in England and Wales using data from the General Practice Research Database, 1989/90-2003/04

BACKGROUND: Routinely collected data from patients registered with general practices participating in the General Practice Research Database (GPRD) were used to analyse influenza vaccine uptake and distribution in England and Wales between 1989/90 and 1996/97. Major changes to influenza immunization policy were introduced in 1998 and 2000 when immunization of the elderly became age related rather than risk related. This new study examines trends in vaccine uptake for high- and low-risk patients and the impact of the policy changes on uptake in the elderly. METHODS: Between 0.5 and 2.7 million patients registered with practices participating in the GPRD from 1989 to 2004 were included. Data were examined by age group, medical risk group and evidence of vaccination per study year. RESULTS: Vaccine uptake among high-risk persons aged 65 or more increased from 36.7 per cent in 1989/90 to 72.1 per cent in 2003/04. For the same period, uptake rates for high-risk persons under 65 years increased from 10.8 to 24.3 per cent. For those at high risk, uptake by females was higher in all age groups up to 65 years. Of those that were vaccinated, a higher proportion of the 65 and over were vaccinated in October each year compared with the high risk under 65 (p < 0.001). CONCLUSIONS: Coverage among high-risk patients in younger age groups continues to fall well below satisfactory levels, especially among the youngest groups. Government policy should now focus on ways to improve uptake in these patients.     

Couverture par le vaccin de la grippe saisonnière des médecins généralistes et de leurs patients. Enquête de pratique auprès de médecins généralistes français après la campagne de vaccination 2011–2012

BackgroundIn France, vaccination coverage against seasonal influenza for risk groups was inadequate: 55.2% of people aged 65 and older, and 33% of the16–64 year group with chronic targeted disorders were vaccinated in March 2012. Three quarters of general practitioners were vaccinated. Our objective was to estimate the influence of the vaccination status of general practitioners on vaccine coverage of their patients at risk.MethodsA questionnaire was sent in March 2012 to a sample of 500 general practitioners. Their professional characteristics, vaccination status against seasonal influenza and the determinants of these vaccinations were collected and compared to the vaccine coverage of their patients obtained from the French healthcare fund.ResultsSelf-reported vaccination coverage of the 225 general practitioners respondents was 81.3%. There was a positive correlation with age greater than 50 years, high activity level, rural practice and the absence of particular mode of exercise. The doctors wanted to be vaccinated to protect themselves and protect their patients or their family. Of the 42 doctors unvaccinated, 42.5% feared the side effects of the vaccine, 40% considered influenza to be a benign illness and 32.5% considered low risk of catching or spreading it. The vaccination rate for patients aged 65 and older was 62.3% among 147 doctors vaccinated versus 58.3% in unvaccinated 31 physicians (P < 0.0001). These rates were 39% versus 36.7% (P = 0.29) for patients with chronic targeted disorders.ConclusionThis study shows a positive association between the reported vaccination of general practitioners and effective influenza vaccination of their patients aged 65 years and older. This result is less clear for patients with chronic targeted disorders. All this findings argue in favor of promoting seasonal influenza vaccination among general practitioners.     

Estimated influenza vaccination coverage among adults and children--United States, September 1, 2004-January 31, 2005

In response to the unexpected shortfall in the 2004--05 influenza vaccine supply, CDC recommended in October 2004 that vaccine be reserved for persons in certain priority groups, including persons aged > or =65 years and 6--23 months, persons aged 2-64 years with conditions that increased their risk for influenza complications, residents of chronic-care facilities, close contacts of infants aged <6 months, and health-care workers with direct patient contact. In late December 2004, based on declining demand among these groups, two additional groups (i.e., healthy persons aged 50-64 years and household contacts of all persons at high risk) were added to the list of vaccination priority groups. To monitor influenza vaccination coverage during the 2004-05 season, the Behavioral Risk Factor Surveillance System (BRFSS), an ongoing, state-based, telephone survey of civilian, noninstitutionalized persons, added new questions to collect information on priority status and the month and year of vaccination for adults and children. This report is based on analysis of data collected during February 1-27, 2005, regarding respondent-reported receipt of influenza vaccination during September 1, 2004-January 31, 2005. The results of this analysis indicated that influenza vaccination coverage levels through January 2005 among adults in priority groups nearly reached those in recent years, whereas coverage levels among adults not in priority groups were approximately half of levels in 2003, in part because 9.3% of those unvaccinated persons in nonpriority groups declined vaccination this season. The results further suggested that designation of the priority groups successfully directed the nation's influenza vaccine supply to those at highest risk. In addition, vaccination coverage among children aged 6-23 months was notable (48.4%), given that 2004-05 was the first year this group was recommended for influenza vaccination .     

Influenza vaccine uptake in adults aged 50-64 years: policy and practice in England 2003/2004

A small national study was carried out in England in 2003/2004 to ascertain the views of primary care trusts (PCTs) and general practitioners (GPs) on whether influenza immunisation should be extended to all people aged 50-64 years from the current recommendation of 65 years or more. Results showed that as many primary care trusts would be in favour, as would not be in favour. A similarly divided view was expressed by general practitioners. Vaccine uptake rates for high-risk (HR) and low-risk (LR) adults aged 50-64 years in the study population were higher in those practices where the GP was in favour of a more inclusive policy of offering flu vaccine to all persons aged 50 years or more, compared with those that did not favour this policy (60% versus 54% HR (p=0.02) and 16% versus 11% LR (p=0.02)). Higher rates of vaccine uptake for low-risk patients aged 50-64 years were also reported from practices where GPs perceived a greater health benefit of immunisation for this age group. Although policy for recommending vaccine to all patients aged 50 years or more is established elsewhere, opinion on whether such a policy should be adopted in England is currently divided amongst those providing local health services.