No effect of 2008/09 seasonal influenza vaccination on the risk of pandemic H1N1 2009 influenza infection in England

This study reports effectiveness of trivalent influenza vaccine (TIV) against confirmed pandemic influenza infection in England using a retrospective test-negative case-control study. Cases and controls were frequency matched by age, swabbing-week and region. On univariable and multivariable analysis adjusted for underlying clinical risk factors, cases were no more or less likely than controls to be vaccinated with 2008-09 or 2007-08 season TIV. Adjusted vaccine effectiveness for the former was −6% (−43% to 22%). Vaccine effectiveness did not differ significantly by age-group or hospitalisation status. There was no evidence prior vaccination with TIV significantly altered subsequent risk of pandemic influenza H1N1 2009 infection.     

Seasonal influenza and 2009 H1N1 influenza vaccination coverage among pregnant women--10 states, 2009-10 influenza season

Because pregnant women are at increased risk for severe disease associated with influenza infection, the American College of Obstetricians and Gynecologists and the Advisory Committee on Immunization Practices have recommended seasonal influenza vaccination for women while pregnant, regardless of trimester. In 2009, a novel strain of influenza A (H1N1) virus was identified, and pregnant women also were found to be at greater risk for influenza-related complications from this new virus. As a result, during the 2009--10 influenza season, two separate influenza vaccines were recommended to pregnant women: inactivated trivalent 2009--10 seasonal vaccine and influenza A (H1N1) 2009 monovalent vaccine. To estimate influenza vaccination coverage among pregnant women during the 2009--10 influenza season, CDC analyzed data from 10 states from the Pregnancy Risk Assessment Monitoring System (PRAMS). This report summarizes the results of that analysis, which determined that vaccination coverage for pregnant women among the 10 states combined was 50.7% for seasonal influenza and 46.6% for 2009 H1N1. In addition, women to whom vaccination was offered or recommended by their health-care provider were significantly more likely to report being vaccinated against seasonal influenza (relative risk [RR] = 3.3) and 2009 H1N1 (RR = 10.1). These results indicate substantially higher influenza vaccination coverage among pregnant women than has been reported for previous influenza seasons and support previous findings that receipt of influenza vaccination can be influenced greatly by health-care providers offering or recommending influenza vaccination.     

Influenza vaccination coverage among pregnant women - 29 States and New York City, 2009-10 season

Because influenza can be especially severe during pregnancy, the American College of Obstetricians and Gynecologists (ACOG) and the Advisory Committee on Immunization Practices (ACIP) recommend influenza vaccination for women who will be pregnant during the influenza season, regardless of trimester. During the 2009-10 influenza season, pregnant women were at increased risk for severe disease and mortality from influenza A (H1N1)pdm09 (pH1N1) pandemic virus infection. Anticipating this risk, both the inactivated trivalent seasonal and monovalent pH1N1 vaccinations were recommended for pregnant women. To estimate state-specific seasonal and pH1N1 influenza vaccination coverage among pregnant women, CDC analyzed data from the Pregnancy Risk Assessment Monitoring System (PRAMS). This report provides estimates from 29 states and New York City (NYC) for women who had live births during September 2009-May 2010. Median state coverage was 47.1% for seasonal and 40.4% for pH1N1 influenza vaccination. Overall, women who reported that a health-care provider offered them influenza vaccination or told them to get it during their pregnancy were more likely to be vaccinated than those without an offer or recommendation (prevalence ratio [PR] = 5.2 for seasonal, and PR = 14.4 for pH1N1). Substantial variation across areas was observed for prevalence of a provider offer or recommendation during pregnancy and for influenza vaccination. These findings highlight the need for state-specific strategies that optimize provider involvement to increase influenza vaccination of pregnant women.     

Correlates of 2009 H1N1 influenza vaccination among day care-aged children, Miami-Dade County

Background

The aim of this study was to assess factors influencing 2009 H1N1 influenza vaccination among a demographically diverse group of day care-aged children. Day care children were chosen because they were an initial target group for vaccination and are at higher risk of influenza infection than children cared for at home.

Methods

A cross-sectional study was conducted from March to May 2010 among parents of day care aged children in 13 day care facilities in Miami-Dade County. Data was collected by an anonymous self-administered two-page 20 question survey which consisted of demographic variables and information regarding 2009 H1N1 influenza vaccine knowledge, attitude and acceptance. Data was analyzed using SAS to conduct both bivariate and multivariate analyses.

Results

There were 773 participants in the study. The response rate ranged from 42% to 72.2% among day care centers. A total of 172 parents (22.3%) and 225 (29.1%) children had received the 2009 H1N1 influenza vaccine. Non-Hispanic White and Black parents were more likely to vaccinate their children than Hispanic and Haitian parents. Primary reasons for non-vaccination included vaccine safety (36.7%) and side effects (27.1%). Among parents who spoke with a health care professional, 274 (61.4%) stated the health care professional recommended the vaccine.

Conclusion

Misperceptions about influenza vaccination among parents created a barrier to 2009 H1N1 influenza vaccination. Parents who got the vaccine, who believed the vaccine was safe and whose children had a chronic condition were more likely to immunize their children. Clear, reliable and consistent vaccine information to the public and health care providers and initiatives targeting minority groups may increase vaccination coverage among this population.     

Seasonal influenza vaccination predicts pandemic H1N1 vaccination uptake among healthcare workers in three countries

The aim of this study was to identify the common barriers and facilitators for acceptance of pandemic influenza vaccination across different countries. This study utilized a standardized, anonymous, self-completed questionnaire-based survey recording the demographics and professional practice, previous experience and perceived risk and severity of influenza, infection control practices, information of H1N1 vaccination, acceptance of the H1N1 vaccination and reasons of their choices and opinions on mandatory vaccination. Hospital-based doctors, nurses and allied healthcare workers in Hong Kong (HK), Singapore (SG) and Leicester, United Kingdom (UK) were recruited. A total of 6318 (HK: 5743, SG: 300, UK: 275) questionnaires were distributed, with response rates of 27.1% (HK), 94.7% (SG) and 94.5% (UK). The uptake rates for monovalent 2009 pandemic H1N1 vaccine were 13.5% (HK), 36.2% (SG) and 41.3% (UK). The single common factor associated with vaccine acceptance across all sites was having seasonal influenza vaccination in 2009. In UK and HK, overestimation of side effect reduced vaccination acceptance; and fear of side effect was a significant barrier in all sites. In HK, healthcare workers with more patient contact were more reluctant to accept vaccination. Drivers for vaccination in UK and HK were concern about catching the infection and following advice from health authority. Only a small proportion of respondents agreed with mandatory pandemic influenza vaccination (HK: 25% and UK: 42%), except in Singapore where 75.3% were in agreement. Few respondents (<5%) chose scientific publications as their primary source of information, but this group was more likely to receive vaccination.The acceptance of pandemic vaccine among healthcare workers was poor (13-41% of respondents). Breaking barriers to accept seasonal influenza vaccination should be part of the influenza pandemic preparedness plan. Mandatory vaccination even during pandemic is likely to arouse substantial discontent.     

High effectiveness of pandemic influenza A (H1N1) vaccination in healthcare workers from a Portuguese hospital

Objectives

Vaccination of healthcare workers (HCWs) was made a high priority during the phase six pandemic of the novel influenza A H1N1 (pH1N1) virus. We surveyed adherence to pH1N1 vaccination and the incidence of pH1N1 infection between vaccinated and unvaccinated HCWs.

Methods

Employees at the S. Jo?o Hospital in Porto, Portugal, were offered pH1N1 vaccinations free of charge. Pandemrix^? was the vaccine administered. As part of the pandemic plan, employees with influenza-like symptoms (ILS) were called upon to take an RT-PCR H1N1 test. If the test results were positive, they had to stay off work for at least 7?days. Sociodemographic data, vaccination status, contact with infectious patients, ILS and pH1N1 test results were documented in a standardised manner.

Results

The survey population comprised 5,592 employees. The vaccination rate was 30.8% (n?=?1,720) for pH1N1 and 50.4% (n?=?2,819) for the 2009/2010 seasonal trivalent inactivated influenza vaccine (TIV). One mild anaphylactic reaction occurred after pH1N1 vaccination. Minor local side effects occurred more often after pH1N1 vaccination than after 2009/2010 seasonal TIV (38.0% vs. 12.3%). Pandemic H1N1 infection was diagnosed in 97 HCWs (1.7%). Compared to employees with no regular patient contact, nurses (2.8%) had the highest risk of pH1N1 infection (adjusted OR 3.8; 95% CI 1.2–6.8). Vaccination reduced the pH1N1 infection risk (OR 0.12; 95% CI 0.05–0.29). Vaccine effectiveness was 90.4% (95% CI 73.5–97.3%).

Conclusion

Vaccination reduced the pH1N1 infection risk considerably. The pandemic plan to contain the pH1N1 infection was successful. Nurses had the highest risk of pH1N1 infection and are therefore a target group for vaccination measures.     

Nurses' vaccination against pandemic H1N1 influenza and their knowledge and other factors

This study aimed to estimate the vaccination coverage against the pandemic H1N1 influenza in a group of nurses and determine the factors associated with their vaccination behaviours. An anonymous, self-administered questionnaire was distributed to a convenience sample of nurses who were enrolled on continuing professional education courses in a university in London. The survey response rate was 77.7% (n=522). A total of 172 (35.2%) nurses reported receiving the pandemic H1N1 vaccine in the 2009-2010 influenza season and only 22.3% of them had the intent to accept the vaccine in the next season. Compared to nurses with low knowledge scores, those with high knowledge scores were more likely to receive the pandemic H1N1 vaccine (p=0.017), recommend the vaccine to their patients (p=0.003), and have the willingness to recommend vaccination to patients in the future (p=0.009). There was a higher vaccination rate among nurses with higher risk perception scores than with lower scores (p=0.001). A small, positive correlation between H1N1 knowledge and risk perception scores was identified (p<0.001) indicating that a high knowledge level was associated with high levels of risk perception. More male nurses received the H1N1 vaccine than females (p<0.001) and there were a significant differences in the uptake among nurses from different clinical specialty groups (p<0.001). About half of the vaccinated nurses reported the intent to be vaccinated again but only 8.1% of the unvaccinated nurses had the intent to receive the vaccine in the next season (p<0.001). The pandemic H1N1 2009 influenza vaccination coverage among this nurse sample was sub-optional. Lack of knowledge and risk perception were predictors associated with the nurses' vaccination behaviours. The identified knowledge items should be addressed in future vaccination campaigns. The hindrances associated with continuing vaccination decision-making and factors contributing to the different vaccination coverage among clinical specialty groups require further exploration.     

Pandemic influenza A (H1N1) 2009 in a critical care and theatre setting: beliefs and attitudes towards staff vaccination

West Midlands was particularly affected by the 2009 H1N1 influenza A (pH1N1) pandemic. Vaccination of frontline healthcare professionals (HCPs) aimed to prevent spread to vulnerable patients, minimise service disruption and protect staff. HCPs involved in upper airway management are particularly at risk of aerosol exposure. We assessed the attitudes of these HCPs towards pandemic influenza A (H1N1) 2009 vaccination uptake: primary reasons for acceptance, barriers to vaccination, and knowledge surrounding pH1N1 influenza. We performed a voluntary, anonymous questionnaire survey based in two West Midlands National Health Service Trusts, one month after introduction of the vaccine. In all, 187 useable responses were received (60.5% response rate); 43.8% (N=82) had/intended to receive vaccination. Concern over long term side-effects was the main deterrent (37.4%, N=70). Primary reasons for potentially accepting vaccination were: to protect themselves (36.9%, N=69), to protect family (35.3%, N=66), and to protect patients (10.2%, N=19). Of responders, 76.5% were unsure that the vaccines had undergone suitably rigorous clinical trials to ensure safety; 20.9% correctly identified reported vaccine efficacy. We conclude that pH1N1 vaccination uptake among high risk HCPs remained low, although twice that of peak seasonal influenza vaccination rates. HCPs' knowledge of vaccine efficacy is poor. Barriers to vaccination include concerns over safety profile given the short chronological time-span between the pandemic being declared and vaccine introduction. Side-effects, both acute and chronic, are a significant barrier to vaccination. Further reassurance/education surrounding vaccine safety/efficacy at the time of any future pandemic may improve uptake rates.     

Factors influencing the uptake of 2009 H1N1 influenza vaccine in a multiethnic Asian population

The study aimed to determine factors influencing the uptake of 2009 H1N1 influenza vaccine in a multiethnic Asian population. Population-based, cross-sectional survey was conducted between October and December 2009. Approximately 70% of overall participants indicated willingness to be vaccinated against the 2009 H1N1 influenza. Participants who indicated positive intention to vaccinate against 2009 H1N1 influenza were more likely to have favorable attitudes toward the 2009 H1N1 vaccine. A halal (acceptable to Muslims) vaccine was the main factor that determined Malay participants’ decision to accept vaccination, whereas safety of the vaccine was the main factor that influenced vaccination decision for Chinese and Indian participants. The study highlights the challenges in promoting the 2009 H1N1 vaccine. Ethnic-sensitive efforts are needed to maximize acceptance of H1N1 vaccines in countries with diverse ethnic communities and religious practices.     

Effectiveness of the monovalent influenza A(H1N1)2009 vaccine in Navarre, Spain, 2009-2010: cohort and case-control study

We defined a population-based cohort (596,755 subjects) in Navarre, Spain, using electronic records from physicians, to evaluate the effectiveness of the monovalent A(H1N1)2009 vaccine in preventing influenza in the 2009-2010 pandemic season. During the 9-week period of vaccine availability and circulation of the A(H1N1)2009 virus, 4608 cases of medically attended influenza-like illness (MA-ILI) were registered (46 per 1000 person-years). After adjustment for sociodemographic covariables, outpatient visits and major chronic conditions, vaccination was associated with a 32% (95% CI: 8-50%) reduction in the overall incidence of MA-ILI. In a test negative case-control analysis nested in the cohort, swabs from 633 patients were included, and 123 were confirmed for A(H1N1)2009 influenza. No confirmed case had received A(H1N1)2009 vaccine versus 9.6% of controls (p<0.001). The vaccine effectiveness in preventing laboratory-confirmed influenza was 89% (95% CI: 36-100%) after adjusting for age, health care setting, major chronic conditions and period. Pandemic vaccine was effective in preventing MA-ILI and confirmed cases of influenza A(H1N1)2009 in the 2009-2010 season.     

Factors associated with 2009 monovalent H1N1 vaccine coverage: A cross sectional study of 1308 patients with psoriasis in France

BACKGROUND: Patients with immune-mediated inflammatory diseases like psoriasis are at increased risk of infection. Specific recommendations are available regarding vaccinations however the vaccination coverage in patients with chronic inflammatory diseases has received limited attention and studies are not available in patients with psoriasis. OBJECTIVES: To assess the coverage of 2009 monovalent H1N1 vaccination and to identify factors associated with vaccination among patients with psoriasis. METHODS: Patients member of the French psoriasis patients association were sent a self administrated anonymous questionnaire. It consisted in socio-demographic data, history of psoriasis, seasonal and vaccination status. Factors associated with vaccination for A/H1N1 influenza were identified and adjusted odds ratios (ORa) and prevalence ratios (PRa) were estimated with their 95% confidence intervals (95% CIs) using logistic regression models. RESULTS: 1308 psoriasis patients with a mean age of 58.2 years completed the study between September and December 2010. A total of 240 (19%) patients received the 2009 monovalent H1N1 vaccine. 25 out of 75 patients treated with biologics (33%) received the vaccine. Previous influenza seasonal (ORa (PRa)=10.2 (6.6) [6.1 (4.1)-16.9 (10.7)]), pneumococcal (ORa (PRa)=2.0 (1.6) [1.2 (1.1)-3.3 (2.3)]) and hepatitis B (ORa (PRa)=2.2 (1.7) [1.4 (1.1)-3.5 (2.5)]) vaccinations were independently associated with being vaccinated for influenza A(H1N1). CONCLUSION: This is the largest study conducted to assess the coverage of 2009 monovalent H1N1 vaccine among patients with psoriasis, a highly prevalent chronic inflammatory disease. This vaccination coverage is more than twice the one in the French general population, but still remained low for patients receiving immunosuppressants. The limited impact of specific recommendations, free vaccines and the massive national campaign warrant alternative strategies in case of future pandemics.     

Monitoring pandemic influenza A(H1N1) vaccination coverage in Germany 2009/10 - results from thirteen consecutive cross-sectional surveys

To monitor pandemic influenza A(H1N1) vaccine uptake during the vaccination campaign in Germany 2009/10, thirteen consecutive cross-sectional telephone-surveys were performed between November 2009 and April 2010. In total 13,010 household-interviews were conducted. Vaccination coverage in persons >14 years of age remained low, both in the general population (8.1%; 95%CI: 7.4-8.8) and in specific target groups such as healthcare workers and individuals with underlying chronic diseases (12.8%; 95%CI: 11.4-14.4). Previous vaccination against seasonal influenza was a main factor independently associated with pandemic influenza vaccination (Odds ratio = 8.8; 95%CI: 7.2-10.8). The campaign failed to reach people at risk who were not used to receive their annual seasonal influenza shot.     

Increased extent of and risk factors for pandemic (H1N1) 2009 and seasonal influenza among children, Israel

During the pandemic (H1N1) 2009 outbreak in Israel, incidence rates among children were 2× higher than that of the previous 4 influenza seasons; hospitalization rates were 5× higher. Children hospitalized for pandemic (H1N1) 2009 were older and had more underlying chronic diseases than those hospitalized for seasonal influenza.     

Effectiveness of H1N1/09 monovalent and trivalent influenza vaccines against hospitalization with laboratory-confirmed H1N1/09 influenza in Australia: a test-negative case control study

We aimed to estimate the effectiveness of H1N1/09 containing influenza vaccines against hospitalization from influenza in Australia. We performed a test-negative case control study in patients hospitalized in 15 sentinel Australian hospitals between March and November 2010, comparing influenza vaccination (H1N1/09 monovalent or 2010 seasonal trivalent) in hospitalized patients with PCR-confirmed influenza compared to PCR-negative controls. Between March and November 2010, 1169 hospitalized patients were tested for suspected influenza, of which influenza vaccine status was ascertained in 165/238 patients with H1N1/09 influenza, 40/64 with seasonal influenza and 558/867 test negative controls; 24% of H1N1/09 cases, 43% of seasonal influenza cases and 54% of controls were vaccinated. VE against hospitalisation with H1N1/09 influenza after adjusting for age, medical comorbidities and pregnancy status was estimated at 49% (95% CI: 13%, 70%). Influenza vaccination was associated with a reduction in hospitalisation caused by H1N1/09 influenza in the 2010 southern hemisphere winter season.     

Efficacy of seasonal live attenuated influenza vaccine against virus replication and transmission of a pandemic 2009 H1N1 virus in ferrets

In March 2009, a swine origin influenza A (2009 H1N1) virus was introduced into the human population and quickly spread from North America to multiple continents. Human serologic studies suggest that seasonal influenza virus vaccination or infection would provide little cross-reactive serologic immunity to the pandemic 2009 H1N1 virus. However, the efficacy of seasonal influenza infection or vaccination against 2009 H1N1 virus replication and transmission has not been adequately evaluated in vivo. Here, ferrets received one or two doses of the US licensed 2008-2009 live attenuated influenza vaccine (LAIV) intranasally. An additional group of ferrets were inoculated with the A/Brisbane/59/07 (H1N1) virus to model immunity induced by seasonal influenza virus infection. All vaccinated and infected animals possessed high titer homologous hemagglutination-inhibition (HI) and neutralizing antibodies, with no demonstrable cross-reactive antibodies against 2009 H1N1 virus. However, in comparison to non-immune controls, immunized ferrets challenged with pandemic A/Mexico/4482/09 virus displayed a significant reduction in body temperature and virus shedding. The impact of single-dose LAIV inoculation on 2009 H1N1 disease and virus transmission was also measured in vaccinated ferrets that were challenged with pandemic A/Netherlands/1132/09 virus. Although a single dose of LAIV reduced virus shedding and the frequency of transmission following homologous seasonal virus challenge, it failed to reduce respiratory droplet transmission of 2009 H1N1 virus. The results demonstrate that prior immunization with seasonal LAIV or H1N1 virus infection provides some cross-protection against the 2009 H1N1 virus, but had no significant effect on the transmission efficiency of the 2009 H1N1 virus.     

Are Kenyan healthcare workers willing to receive the pandemic influenza vaccine? Results from a cross-sectional survey of healthcare workers in Kenya about knowledge, attitudes and practices concerning infection with and vaccination against 2009 pandemic influenza A (H1N1), 2010

Over 1200 cases of 2009 pandemic influenza A H1N1 (pH1N1) have been identified in Kenya since the first case in June 2009. In April 2010 the Kenyan government launched a program to immunize high-risk groups and healthcare workers (HCWs) with pH1N1 vaccines donated by the World Health Organization. To characterize HCWs’ knowledge, attitudes and practices regarding pH1N1 vaccination, we conducted a quantitative and qualitative survey in 20 healthcare facilities across Kenya between January 11 and 26, 2010. Of 659 HCWs interviewed, 55% thought there was a vaccine against pH1N1, and 89% indicated that they would receive pH1N1 vaccine if it became available. In focus group discussions, many HCWs said that pH1N1 virus infection did not cause severe disease in Kenyans and questioned the need for vaccination. However, most were willing to accept vaccination if they had adequate information on safety and efficacy. In order for the influenza vaccination campaign to be successful, HCWs must understand that pH1N1 can cause severe disease in Kenyans, that pH1N1 vaccination can prevent HCWs from transmitting influenza to their patients, and that the vaccine has been widely used globally with few recognized adverse events.     

Maternal and infant outcomes among severely ill pregnant and postpartum women with 2009 pandemic influenza A (H1N1)--United States, April 2009-August 2010

Pregnant women with influenza are at increased risk for hospitalization and death. Since 2004, the Advisory Committee on Immunization Practices (ACIP) has recommended inactivated influenza vaccine for all women who are pregnant during influenza season, regardless of trimester. Nonetheless, after the 2004 recommendation, estimated annual influenza vaccination coverage among pregnant women was approximately 15%, before increasing to nearly 50% during the 2009 influenza A (H1N1) pandemic. Since April 2009, CDC has collaborated with state and local health departments to conduct enhanced surveillance for severe influenza among pregnant and postpartum women. To assess maternal and infant outcomes among severely ill pregnant and postpartum women with 2009 H1N1 during the 2009 H1N1 pandemic, CDC analyzed data for the period April 15, 2009 to August 10, 2010. This report summarizes the results of that analysis, which found that, among 347 severely ill pregnant women, 75 died from 2009 H1N1, and 272 were admitted to an intensive-care unit (ICU) and survived. Women who survived received antiviral treatment sooner after symptom onset than women who died. Pregnant women with severe influenza who delivered during their influenza hospitalization were more likely to deliver preterm and low birth weight infants than those in the general U.S. population; infants born after their mother's influenza hospitalization discharge were more likely to be small for gestational age. These data document the severe effects of 2009 H1N1 on pregnant women and their infants, emphasize the importance of vaccinating pregnant women against influenza, and demonstrate the value of prompt administration of antivirals to pregnant women with suspected or confirmed influenza.     

Coverage and side effects of influenza A(H1N1) 2009 monovalent vaccine among primary health care workers

In June 2009, WHO declared the maximum phase alert against H1N1 pandemic flu. Health care workers (HCWs) are considered a strategic target for prevention of the occurrence of H1N1 influenza since they had the greatest risk of acquiring infection. The objectives of our study were (1) identifying the uptake of influenza A(H1N1) 2009 monovalent vaccine by primary health care workers in the southern part of Cordoba, and (2) reporting of the adverse events occurred after vaccination. We followed 240 HCWs in 12 primary health care centres at southern part of Cordoba for vaccine uptake and the occurrence of adverse events. The coverage rate with H1N1 vaccine was 20.5% which was lower compared to seasonal influenza vaccination rate 44.2% in 2009. Males had higher H1N1 vaccination rate compared to females with no significant difference. Senior HCWs complied more with seasonal influenza vaccine while this finding was not consistent with H1N1 vaccination. Multivariate analysis showed that the only independent variable that affected H1N1 vaccine was the compliance to the seasonal flu vaccine in the past three years with OR 5.1 and 95% CI (2.4-10.8). Adverse events occurred among 26.5% of those who complied with H1N1 vaccination. Those were local pain, irritation and induration at site of injection (38.5%), fever (15.4%), fever cough and rhinorrhea (15.4%) generalized pain and lumber pains (23.1%). The low vaccination rate in this study is consistent with previous studies done in many parts of the world and in Spain. Further studies should be done to explore the factors that hindered the uptake and resistance of HCWs to vaccination to H1N1 vaccine.     

Central European Vaccination Advisory Group (CEVAG) guidance statement on recommendations for 2009 pandemic influenza A(H1N1) vaccination

The 2009 influenza A(H1N1) pandemic is markedly different from seasonal influenza with the disease affecting the younger population and a larger than expected number of severe or fatal cases has been seen in pregnant women, obese people and in people who were otherwise healthy. In Europe, influenza activity caused by the 2009 influenza A(H1N1) virus has passed the winter peak with nearly all countries now reporting lower influenza activity. However, although the rate of 2009 pandemic influenza A(H1N1) is declining, fatal cases continue to be reported and the future is hard to predict. The most effective protection against influenza is vaccination and increasing vaccine coverage is the only way to eliminate uncertainties regarding possible future waves of 2009 pandemic influenza A(H1N1). Recommendations have been developed for several central European countries but there is no clear or uniform definition with respect to priority groups or age groups who should receive vaccination. This paper contains the Central European Vaccination Advisory Group (CEVAG) guidance statement on recommendations for the vaccination of adults and children against 2009 pandemic influenza A(H1N1). CEVAG recommends vaccination of all health-care workers, pregnant women, children ≥6 months and <2 years of age and people with chronic medical conditions as a first priority.     

The perceptions of and disincentives for receiving influenza A (H1N1) vaccines among chronic renal disease patients in Hong Kong

This article aims to demonstrate the perceptions of patients with chronic renal disease in Hong Kong towards the new vaccine for influenza A (H1N1), as well as the main disincentives. Little is known about the views of chronically ill patients on the H1N1 vaccine and even less about the underlying factors that motivate its low acceptance by this group. To explore these issues, this study adopted a qualitative approach by conducting in-depth, semi-structured interviews with 40 chronic renal disease patients in Hong Kong from December 2009 to March 2010. The participants were selected by purposive sampling from a patient with renal disease self-help alliance, which has over 4000 members with chronic renal diseases coming from nine public hospitals. Data were analysed using thematic content analysis. Although vaccination was portrayed as one of the most effective methods to prevent influenza A (H1N1), chronically ill participants in this study showed reluctance towards it. Six disincentives for them to receive H1N1 vaccines were identified: perceptions of H1N1 vaccine as unsafe, cultural perception of vaccines as harmful, the belief that seasonal influenza vaccines provided immunity against influenza A (H1N1), inaccessibility for receiving the H1N1 vaccine, worries in contracting infectious diseases from vaccination locations and the financial cost. As chronically ill patients are one of the high-risk groups who can suffer from severe complications from influenza, understanding the underlying social, cultural and perceptual factors that prevent their immunisation is crucial to the design of a public health policy responsive to their needs.