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1.
Background
In 2010, use of seasonal trivalent influenza vaccine (TIV) in children <5 years of age was suspended in Australia following reports of vaccine-related febrile convulsions. We investigated the utility of data on primary care [general practice (GP)] consultations for any reason within three days of receipt of influenza vaccine as recorded on the Australian Childhood Immunisation Register (ACIR) as a means of signal detection.Methods
Data on GP consultations were obtained from Medicare Australia (Australian Government Department of Human Services) for children recorded on the ACIR as receiving either TIV or monovalent influenza vaccine. Rates of GP consultation by day following ACIR-recorded receipt of influenza vaccine were compared by year (2008–2010), vaccine type, age and region.Results
In 2010, GP encounter rates on the day after receipt of the TIV manufactured by bioCSL (formerly CSL Biotherapies (Fluvax®) were significantly higher than both bioCSL TIVs in the previous two years [rate ratio (RR) 1.9; 95% CI: 1.7–2.2] and Sanofi Pasteur TIV, Vaxigrip® [RR 1.6, 95% CI 1.4–1.7] in 2009–2010. Encounter rates were also higher than for CSL Monovalent influenza vaccine, Panvax® [RR 1.9, 95% CI 1.7–2.2] in 2009–2010. These findings were robust to adjustment for age group (≤2, >2 years) and region (Western Australia vs other Australian states/territories).Conclusions
A primary care consultation on the day after vaccine receipt is a reasonable proxy for early reactogenicity and has potential for use in various settings. 相似文献2.
Brendan Klick Sunita Durrani Kwok-Hung Chan Dennis K.M. Ip Erica S.K. Chou Henry K.H. Kwok Sophia Ng Susan S. Chiu J.S. Malik Peiris Gabriel M. Leung Benjamin J. Cowling 《Vaccine》2013
Background
The novel influenza A(H1N1pdm09) virus emerged in North America in early 2009 and rapidly spread worldwide. In this study we report the efficacy of the live attenuated monovalent H1N1pdm09 vaccine and 2009–10 seasonal influenza vaccine in a randomized double-blind placebo-controlled trial.Methods
We enrolled 703 children aged 7–11. Each child was randomly allocated in the ratio 3:2 to receive one dose of live attenuated monovalent H1N1pdm09 vaccine or saline placebo between November 2009 and January 2010, followed after 3–10 weeks by independent random allocation to one dose of live attenuated trivalent 2009–10 seasonal influenza vaccine or saline placebo in the same ratio. Children were followed up through September 2010 with biweekly telephone calls and symptom diaries. Seasonal and pandemic influenza infections were confirmed by virologic testing of nose and throat swabs collected during acute respiratory illnesses.Results
Overall, 30 children had confirmed influenza including 3 (0.43%) H1N1pdm09, 10 (1.4%) seasonal A(H3N2), and 17 (2.4%) influenza B. There were no significant differences in incidence rates of H1N1pdm09 or A(H3N2) between the four study arms, but receipt of the seasonal influenza vaccine was associated with a significant reduction in risk of influenza B (p < 0.01). Vaccine efficacy against confirmed H1N1pdm09 infection associated with receipt of the monovalent H1N1pdm09 vaccine was 65% (95% confidence interval, CI: −281%, 97%). Vaccine efficacies against confirmed seasonal influenza A(H3N2) and B infection associated with receipt of the seasonal influenza vaccine were 31% (95% CI: −138%, 80%) and 96% (95% CI: 67%, 99%) respectively.Conclusions
Vaccine efficacy was consistent with other studies of the monovalent H1N1pdm09 vaccine and seasonal influenza vaccines. Our study was underpowered to provide precise estimates of vaccine efficacy due to low incidence of influenza A viruses during the study period. 相似文献3.
Introduction
This study aimed to determine the effectiveness of seasonal influenza vaccine in pre- and full-term children aged 6–23 months.Methods
We examined a cohort of 683,354 young children (7.7% preterm) over five influenza seasons (2004–2005 to 2008–2009) in Ontario, Canada. Vaccine effectiveness was estimated using influenza-coded ambulatory visits during virologically-confirmed influenza season periods as the outcome and multivariable Cox proportional hazards modeling.Results
Full vaccination was associated with a 19% reduction in influenza-coded ambulatory visits (HR = 0.81; 95% CI, 0.68–0.97) in all children, and an 18% reduction in full-term children (HR = 0.82; 95% CI, 0.68–0.99). We did not find significant vaccine effectiveness for preterm children. No benefit was found for partial vaccination.Conclusions
In children younger than two years, only full influenza vaccination is associated with reduced influenza-coded ambulatory visits. Since the effectiveness of influenza vaccination in preterm children remains uncertain, further study of this highly vulnerable population is warranted. 相似文献4.
Background and study aims
this study aims to identify the determinants of perceived changes in protective behaviors against seasonal influenza and the intent to receive the seasonal influenza vaccine among Taiwanese in 2011.Methods
During the early 2011–2012 influenza season, we conducted a nationwide survey with randomly stratified samples and collected 1400 self-reported questionnaires from respondents aged 15 years and above using the computer-aided telephone interviewing software in Taiwan.Results
One-third of the respondents intended to receive the seasonal influenza vaccine. Knowledge of protective behaviors against influenza was the most common predictor of perceived changes in different protective behaviors and the intent to receive the seasonal influenza vaccine. Older respondents were significantly more inclined to perceive changes in protective behaviors than younger respondents (adjusted odds ratio [AOR] ranging from 1.7 to 2.5). Female respondents were significantly more likely to change their behavior in wearing a face mask (AOR = 1.5; 95% CI, 1.09 to 2.07) and buying antimicrobial products (AOR = 1.45; 95% CI, 1.09 to 1.92) compared with males. Furthermore, recipients of past H1N1 (AOR = 4.45; 95% CI, 3.03 to 6.53) and seasonal influenza vaccines (AOR = 6.1; 95% CI, 3.31 to 11.23) were more likely to obtain the seasonal influenza vaccine. In contrast, individuals aged 30–49 (AOR = 0.53; 95% CI, 0.38 to 0.74) and females (AOR = 0.65; 95% CI, 0.48 to 0.87) were significantly less likely to intend to receive the seasonal influenza vaccine.Conclusions
The findings suggest that the predictors of perceived changes in protective behaviors and intent to receive the seasonal influenza vaccine differ. We provide perspectives and suggestions for overcoming the perceived barriers and for developing targeted risk-communication campaigns. 相似文献5.
Introduction
Home health aides (HAs) receive limited training and reach many older patient populations highly susceptible to influenza virus. We sought to examine socio-demographic correlates of seasonal flu vaccination receipt among HAs.Methods
We analyzed data from the 2007 U.S. National Home Health Aide Survey, a nationally representative sample of HAs reporting on occupational status, job and demographic characteristics and receipt of seasonal flu vaccine (n = 3377).Results
Seasonal flu vaccine receipt was low among all types of HAs (43.9%). After adjustment for socio-demographic indicators (i.e. age, gender, race and health insurance), home health, home care, hospice and personal care attendants were significantly less likely to report receiving seasonal flu vaccine as compared to licensed nursing assistants (adjusted odds ratio, AOR = 0.42, 95% CI [0.20–0.85]; 0.41, [0.17–0.99]; 0.50, [0.26–0.97], and 0.53, [0.26–0.99], respectively).Conclusion
Targeted effective vaccination campaigns are needed to improve vaccination rates among home health aides. 相似文献6.
Background
Understanding factors affecting trainee physician choices about vaccination may permit the design of more effective vaccination programmes.Methods
To identify factors associated with seasonal and pandemic influenza vaccination, an online questionnaire based on the health belief model was sent to trainee physicians registered at the post-graduate medical education office at the University of Toronto in September 2011.Results
963 complete responses were received from 1884 trainee physicians (51%); 28 (2.9%) reported an allergy to vaccine components and were excluded from further analysis. Reported seasonal influenza vaccination rates in 2008, 2009 and 2010 were 69% (648/935), 75% (708/935) and 76% (703/935), respectively; 788 (84%) reported receiving the A(H1N1)pdm09 vaccine. In multivariable analysis, number of years of post-graduate training (OR for 4+ versus 1–3 post-graduate years 2.2 (95% CL 1.3, 3.8)) was associated with receipt of the 2009 pandemic vaccine, as were four components of the health belief model: odds ratios were 4.7 (95% CL 3.0, 7.5) for perceived severity, 1.9 (95% CL 1.2, 2.9) for perceived benefits, .35 (95% CL .21, .59) for perceived barriers, and 5.8 (95% CLI 3.6, 9.1) for external cues to action. Both vaccinated and unvaccinated respondents reported that their decisions were significantly influenced by encouragement from their colleagues, families and employers.Conclusion
Self-reported vaccination coverage among trainee physicians was high. External cues to action appear to be particularly important in trainee physician vaccination decisions: active institutional promotion may increase influenza vaccination rates in trainees. 相似文献7.
Rémi Flicoteaux Céline Pulcini Patrizia Carrieri Michael Schwarzinger Catherine Leport Pierre Verger 《Vaccine》2014
Background
General practitioners’ (GPs) recommendations to their patients regarding influenza vaccination is a key determinant of patient uptake of influenza vaccination.Objectives
To study factors associated with GPs’ recommendations regarding pandemic vaccination (pvaccination) to adults ≤65 years of age (hereafter referred to as adults) at risk and not at risk of severe complications of the 2009–2010 A/H1N1 influenza.Patients/Methods
National cross-sectional survey of 1431 French GPs. Pvaccination recommendations by GPs to adults were studied according to three categories: recommended pvaccination to at-risk adults only; recommended pvaccination to all adults; recommended against pvaccination or did not provide any advice to any adult.Results
GPs were more likely to recommend pvaccination to at-risk than not-at-risk adults (73.4% vs 40.1%, p < 0.01). GPs who consulted official sources of information rather than news media during the pandemic were more likely to recommend pvaccination to at-risk adults only (OR = 1.78; CI 95% = 1.27–2.48) and to all adults (OR = 2.03; CI 95% = 1.42–2.92) than other GPs. GPs’ unfavorable perceptions of the risk/efficacy balance of the pandemic vaccine (pvaccine) together with their perceptions of the low severity of the disease were negatively associated with recommending pvaccination. Hospitalization of GPs’ patients because of the influenza was specifically associated with pvaccine recommendation to all adults (OR = 2.81; CI 95% = 1.98–3.99) but not with pvaccine recommendation to at-risk adults only.Conclusion
In the pandemic context, GPs’ perceptions of disease severity and the risk/efficacy balance of the pvaccine were the major determinants of French GPs recommending pvaccination or not. To increase the general public's acceptability of vaccination policies, GPs should be adequately informed about the course of the epidemics and the safety of the vaccine. 相似文献8.
Lavanya Vasudevan Alain B. Labrique Sucheta Mehra Lee Wu Orin Levine Danny Feikin Rolf Klemm Parul Christian Keith P. West Jr. 《Vaccine》2014
Background
Timely vaccination, i.e., the receipt of all scheduled vaccinations in an age-appropriate fashion, is critical for the prevention of deadly diseases in infants and achievement of the UN Millennium Development Goal to reduce infant mortality. Infants, especially in rural or underprivileged settings often receive delayed vaccinations leaving them susceptible to vaccine-preventable illnesses early in the first year of life. In this study, we examined rates of timely vaccination among 24,435 infants born in Gaibandha and Rangpur rural districts of Bangladesh from 2001 to 2007.Methods
Vaccinations due by 14 weeks of age and administered through routine government immunization services were assessed using interviews with enrolled mothers between 11 and 18 weeks postpartum. We created a Timely Vaccination (TV) score to classify infants as vaccinated fully and on schedule (TV = 1) or not (TV = 0), and used multivariable logistic regression to identify maternal characteristics associated with infant's timely vaccination status.Results
Our results suggest that only 19% of infants in this cohort received scheduled vaccinations on time by 11–18 weeks postpartum. Mothers’ engagement in paid employment [OR = 1.13, 95% CI: 1.03–1.23], receipt of tetanus toxoid vaccination [OR = 1.24, 95% CI: 1.11–1.38], history of antenatal care [OR = 1.22, 95% CI: 1.12–1.32], or higher socioeconomic status [OR = 1.07, 95% CI: 1.03–1.11] were positively associated with timely vaccination of their infants. Mother's perception of small infant size at birth was negatively associated with timely vaccination [OR = 0.89, 95% CI: 0.82–0.97].Conclusion
Timely vaccination coverage of infants in rural Gaibandha and Rangpur districts is extremely low. This analysis identifies important shortcomings associated with the 1-year vaccination benchmark of routine immunization performance and suggests the need for specific interventions based on potential maternal determinants as well as known system and programmatic barriers of timely vaccination among infants in rural Bangladesh. 相似文献9.
Tran Hien Nguyen Minh Huong Vu Van Cuong Nguyen Lien Huong Nguyen Kohei Toda Tuyet Nga Nguyen Sang Dao Kathleen A. Wannemuehler Karen A. Hennessey 《Vaccine》2014
Background
Vietnam has high endemic hepatitis B virus infection with >8% of adults estimated to have chronic infection. Hepatitis B vaccine was first introduced in the national childhood immunization program in 1997 in high-risk areas, expanded nationwide in 2002, and included birth dose vaccination in 2003. This survey aimed to assess the impact of Vietnam's vaccination programme by estimating the prevalence of hepatitis B surface antigen (HBsAg) among children born during 2000–2008.Methods
This nationally representative cross-sectional survey sampled children based on a stratified three-stage cluster design. Demographic and vaccination data were collected along with a whole blood specimen that was collected and interpreted in the field with a point-of-care HBsAg test.Results
A total of 6,949 children were included in the survey analyses. The overall HBsAg prevalence among surveyed children was 2.70% (95% confidence interval (CI): 2.20–3.30). However, HBsAg prevalence was significantly higher among children born in 2000–2003 (3.64%) compared to children born 2007–2008 (1.64%) (prevalence ratio (PR: 2.22, CI 1.55–3.18)). Among all children included in the survey, unadjusted HBsAg prevalence among children with ≥3 doses of hepatitis B vaccine including a birth dose (1.75%) was significantly lower than among children with ≥3 doses of hepatitis B vaccine but lacked a birth dose (2.98%) (PR: 1.71, CI: 1.00–2.91) and significantly lower than among unvaccinated children (3.47%) (PR: 1.99, CI: 1.15–3.45). Infants receiving hepatitis B vaccine >7 days after birth had significantly higher HBsAg prevalence (3.20%) than those vaccinated 0-1 day after birth (1.52%) (PR: 2.09, CI: 1.27–3.46).Conclusion
Childhood chronic HBV infection prevalence has been markedly reduced in Vietnam due to vaccination. Further strengthening of timely birth dose vaccination will be important for reducing chronic HBV infection prevalence of under 5 children to <1%, a national and Western Pacific regional hepatitis B control goal. 相似文献10.
Tuen-Ching Chan Ivan Fan-Ngai Hung James Ka-Hay Luk Patrick Chiu-Yat Woo Leung-Wing Chu Felix Hon-Wai Chan 《Journal of the American Medical Directors Association》2013,14(12):889-894
Objective
To examine the clinical efficacy of the trivalent seasonal influenza vaccination among Chinese older adults residing in a nursing home.Design
A 12-month prospective cohort study. Participants were divided into 2 groups based on their own choice on vaccination of trivalent seasonal influenza vaccine: vaccinated group and unvaccinated group.Setting
Fifty-eight nursing homes in Hong Kong.Participants
A total of 1859 older adults residing in a nursing home.Measurements
All-cause mortality, pneumonia-related mortality, all-cause hospitalization, and pneumonia-related hospitalization.Results
A total of 1859 older adults residing in a nursing home were included: 1214 (65.3%) in the vaccinated group and 645 (34.7%) in the unvaccinated group. At 12 months of study, for all-cause mortality, 14.6% (177 of 1214) of the vaccinated group and 20.2% (130 of 645) of the unvaccinated group had died (P < .001). Multivariate analysis showed the hazard ratio for the vaccinated group was 0.72 (95% confidence interval [CI]: 0.54–0.95; P < .01). For pneumonia-related mortality, 9.4% (114 of 1214) of the vaccinated group and 12.7% (82 of 645) of the unvaccinated group died (P = .033). Multivariate analysis showed the hazard ratio for the vaccinated group was 0.80 (CI: 0.62–0.98; P < .05). The median number of all-cause hospitalizations per 1000 person-months was 55 (0–111) for the vaccinated group and 55 (0–167) for the unvaccinated group (P < .01). The median number of pneumonia-related hospitalizations per 1000 person-months was 0 (0–55) for the vaccinated group and 0 (0–111) for the unvaccinated group (P < .01).Conclusions
Vaccination of trivalent seasonal influenza vaccine in Chinese nursing home older adults significantly reduced all-cause and pneumonia-related mortality and hospitalization. 相似文献11.
Background
Guidelines recommend influenza vaccination for pregnant women, but vaccine uptake in this population is far below the goal set by Healthy People 2020. The purpose of this study was to examine predictors of seasonal influenza vaccination among pregnant women.Methods
Between 2009 and 2012, the Vaccines and Medications in Pregnancy Surveillance System (VAMPSS) conducted a prospective cohort study of influenza vaccine safety among pregnant women in the US and Canada that oversampled vaccinated women. Data for the present paper are from an additional cross-sectional telephone survey completed during the 2010–2011 influenza season. We examined predictors of influenza vaccination, focusing on Health Belief Model (HBM) constructs.Results
We surveyed 199 pregnant women, 81% of whom had received a seasonal influenza vaccine. Vaccination was more common among women who felt more susceptible to influenza (OR = 1.82, 95% CI 1.10–3.01), who perceived greater vaccine effectiveness (OR = 3.92, 95% CI 1.48–10.43), and whose doctors recommended they have flu shots (OR = 3.06, 95% CI 1.27–7.38). Those who perceived greater barriers of influenza vaccination had lower odds of vaccination (OR = 0.19, 95% CI 0.05–0.75). Perceived social norms, anticipated inaction regret, and worry also predicted uptake, though demographic characteristics of respondents did not.Conclusion
The HBM provides a valuable framework for exploring influenza vaccination among pregnant women. Our results suggest several potential areas of intervention to improve vaccination rates. 相似文献12.
I-Kuan Wang Cheng-Li Lin Yi-Chih Chang Po-Chang Lin Chih-Chia Liang Yao-Lung Liu Chiz-Tzung Chang Tzung-Hai Yen Chiu-Ching Huang Fung-Chang Sung 《Vaccine》2013
Purpose
Studies regarding the clinical benefits of influenza vaccination in diabetic patients are limited. This study evaluated if the elderly diabetic patients who have had influenza vaccination would have benefits such as reduced medical care and mortality.Methods
We used the universal insurance claims data from 2001 to 2009 in Taiwan to identify annual elderly patients with diabetes cohorts with (N = 4454) and without (N = 4571) influenza vaccination. The risk of developing pneumonia or influenza, respiratory failure, intensive care, hospitalization, and mortality were measured and compared between cohorts within one year of follow-up.Results
The vaccine cohort had lower incidences of pneumonia or influenza and respiratory failure compared with the non-vaccine cohort. More importantly, the vaccine cohort had a hospitalization rate that was 11% less than the non-vaccine cohort (29.6 vs. 33.1 per 100 person-years) with an adjusted hazard ratio (HR) of 0.88 (95% CI 0.81–0.96). The vaccine cohort was also less likely to be admitted to the intensive care unit (ICU) [0.58 vs. 2.05 per 100 person-year; adjusted HR 0.30 (95% CI 0.19–0.47)] and less likely to expire [3.13 vs. 7.96 per 100 person-year; adjusted HR 0.44 (95% CI 0.36–0.54)]. Influenza vaccination reduced the hospitalization cost by 1282.6 USD, compared with patients without influenza vaccination (95% CI −2210.3, −354.8).Conclusion
Influenza vaccination is associated with a reduced risk of morbidity, hospitalization, ICU admissions, and mortality. In addition, the hospitalization cost is reduced. 相似文献13.
Sophia R. Newcomer Simon J. Hambidge David L. McClure Matthew F. Daley Nicola P. Klein Jason M. Glanz 《Vaccine》2013
Background
Previously published studies reported an increased risk of gastrointestinal illness in the 14 days following trivalent influenza vaccination (TIV) in young children. While gastrointestinal illness may be a true adverse effect of TIV, other factors may influence this observed association, such as seasonal illness patterns and children being exposed to gastrointestinal pathogens at medical visits. The objective of this study was to examine factors influencing the association between TIV and gastrointestinal illness. Specifically, using data from a previous influenza vaccine safety study, we examined the association between medical encounters without TIV and gastrointestinal illness.Methods
Using electronic health record (EHR) data from 6 managed care organizations (MCOs), we identified medically attended gastrointestinal illness cases among children 24–59 months in the 2002–2006 influenza seasons. We matched each case to four controls on sex, birthdate (month/year), MCO, influenza season, and presence of a chronic condition. We then looked 1–14 days prior to the index date (gastrointestinal illness diagnosis date) to determine whether the child had a medical encounter. We excluded previous medical encounters with gastrointestinal-related diagnoses or TIV. Conditional logistic regression was used to calculate odds ratios and 95% confidence intervals.Results
We identified 2062 gastrointestinal illness cases and matched them to 8248 controls. We observed increased odds of gastrointestinal illness within 14 days after a medical encounter (odds ratio = 1.9; 95% confidence interval [CI]: 1.7–2.2) among children without chronic conditions. Among children with chronic conditions, the odds ratio was 3.9 (95% CI: 2.5–6.2).Conclusions
We demonstrated that another exposure related to vaccination, medical visits, is also associated with increased odds for gastrointestinal illness. This study highlights challenges of interpreting results from observational vaccine safety studies when there are co-occurring exposures, and the importance of investigating confounding in EHR data, which are an essential resource for vaccine safety research. 相似文献14.
Yanbing Zeng Zhipeng Yuan Jiahui Yin Yaofeng Han Cheng-I. Chu Ya Fang 《Vaccine》2019,37(11):1449-1456
Background
The impact of influenza in children under 5 can be severe and fatal. However, the influenza vaccination uptake in China remains suboptimal. The objectives of this study were to investigate parents’ perceptions on influenza vaccination and to assess vaccination promotional factors.Methods
A cross-sectional survey among 1506 parents with children in kindergarten was conducted in two areas with different policies: self-paid vaccination and free vaccination. The questionnaire was based on the structure of the Health Belief Model (HBM). Multiple logistic regression was used to analyze the determinants of parental vaccination intention. Odds ratios (OR) and respective 95% confidence intervals (95% CI) are reported.Results
Within the free policy group versus the non-free group, vaccination intention rates were 76.3% versus 83.4%, and vaccination rates were 34.2% versus 3.1%. Results from multivariate analysis showed that parents with high scores for perceived susceptibility (OR?=?1.44; 95% CI: 1.09–1.91), perceived benefits (OR?=?1.80; 95% CI: 1.30–2.50) and cues to action (OR?=?3.32; 95% CI: 2.47–4.46) were more likely to get their children vaccinated, while those perceived more barriers (OR?=?0.50; 95% CI: 0.37–0.68) had lower vaccination intention. More knowledge (OR?=?1.74; 95% CI: 1.18–2.56) and preferable attitudes (higher perceived necessity: OR?=?1.84; 95% CI: 1.53–2.22; less safety worry: OR?=?1.35; 95% CI: 1.10–1.66) were associated with significantly higher vaccination intention. Adjusted for parents’ gender, age, education, income and children’s age, the same significant factors were found. Parental intention was found to be influenced by different vaccination policies. Under a free policy, past influenza vaccination uptake (OR?=?4.52; 95% CI: 1.07–19.02) greatly promoted parents’ willingness to vaccinate their children.Conclusion
Parents had high intention to get their kindergarten children vaccinated with the influenza vaccine in spite of the low uptake rate. Our results indicate that offering free influenza vaccines and parental education over the next years may increase the influenza vaccination rate. 相似文献15.
Peng-jun Lu Alissa O’HalloranHelen Ding Walter W. WilliamsCarolyn B. Bridges Erin D. Kennedy 《Vaccine》2014
Background
Annual influenza vaccination has been recommended for all persons ≥6 months since the 2010–11 season. New partnerships between public health agencies and medical and nonmedical vaccination providers have increased the number of vaccination providers and locations where vaccination services are delivered.Methods
Data from the 2011–12 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. Point estimates of place of vaccination and 95% confidence intervals were calculated. Multivariable logistic regression and predictive marginal modeling were conducted to identify factors associated with vaccination settings.Results
Among adults vaccinated during the 2011–12 influenza season, a doctor's office was the most common place (38.4%) for receipt of influenza vaccination, with stores (e.g., supermarkets or drug stores) (20.1%) the next common, and workplaces (17.6%) the third common. Overall, reported vaccination in nonmedical settings by state ranged from 32.2% in California to 60.4% in Nevada, with a median of 45.8%. Characteristics significantly associated with an increased likelihood of receipt of vaccination in nonmedical settings were higher education, not having certain identified high-risk conditions, not having had a routine checkup in the previous 12 months, and not having a primary doctor for health care. Being a member of a racial/ethnic minority group, unemployed or not in the work force were significantly associated with a decreased likelihood of receipt of vaccination in nonmedical settings.Conclusion
Doctor's offices were the most common medical setting for adult influenza vaccination; workplaces and stores were important nonmedical settings. Increasing access to vaccination services in medical and nonmedical settings should be considered as important strategies for improving vaccination coverage. These results also can help guide development of strategies for achieving Healthy People 2020 objectives for influenza vaccination of adult populations. 相似文献16.
J. Puig-Barberà A. Natividad-Sancho J. Calabuig-Pérez J.A. Lluch-Rodrigo E. Pastor-Villalba S. Martínez-Úbeda J. Díez-Domingo 《Vaccine》2014
Background
The use of intradermal vaccination or virosomal vaccines could increase protection against influenza among the vulnerable population of older adults. Studies assessing the comparative effectiveness of these two influenza vaccine types in this age group are lacking.Methods
We conducted a retrospective cohort study to estimate the comparative effectiveness of intradermal seasonal trivalent-influenza vaccine (TIV) delivered by a microneedle injection system and a virosomal-TIV intramuscularly delivered for prevention of influenza hospitalization in non-institutionalized adults aged ≥65 years. We obtained administrative data on immunization status and influenza hospitalization for the 2011–2012 influenza season, and used Cox regression models to assess comparative effectiveness. We estimated crude and adjusted (age, sex, comorbidity, pharmaceutical claims, recent pneumococcal vaccination and number of hospitalizations for all causes other than influenza between the previous and current influenza seasons) hazard ratios (HR).Results
Overall, 164,021 vaccinated subjects were evaluated. There were 127 hospitalizations for influenza among 62,058 subjects, contributing 914,740 person-weeks at risk in the virosomal-TIV group, and 133 hospitalizations for influenza among 101,963 subjects, contributing 1,504,570 person-weeks at risk in the intradermal-TIV group. The crude HR of intradermal-TIV relative to virosomal-TIV was 0.64 (95% confidence interval (CI): 0.50–0.81), and the adjusted Cox estimated HR was 0.67 (95% CI: 0.52–0.85).Conclusions
During the 2011–2012 influenza season the risk of hospitalization for influenza was reduced by 33% in non-institutionalized elderly adults who were vaccinated with intradermal-TIV compared with virosomal-TIV. 相似文献17.
Hurley LP Wortley P Allison MA O'Leary S Daley MF Babbel C Crane LA Stokley S Beaty B Dickinson LM Kempe A 《Vaccine》2011,29(47):8649-8655
Background
Less than half of adults for whom seasonal influenza vaccine is recommended receive the vaccine. Little is known about physician willingness to collaborate with community vaccinators to improve delivery of vaccine.Objectives
To assess among general internists and family medicine physicians: (1) seasonal influenza vaccination practices, (2) willingness to collaborate with community vaccinators, (3) barriers to collaboration, and (4) characteristics associated with unwillingness to refer patients to community sites for vaccination.Design
Mail and Internet-based survey.Setting
National survey conducted during July-October 2009.Participants
General internists and family medicine physicians.Measurements
Survey responses on vaccination practices, willingness to collaborate to deliver vaccine and barriers to collaboration.Results
Response rates were 78% (337/432 general internists) and 70% (298/424 family medicine physicians). Ninety-eight percent of physicians reported giving influenza vaccine in their practice during the 2008-2009 season. Most physicians reported willingness to refer certain patients to other community vaccinators such as public clinics or pharmacies (79%); to collaborate with public health entities in holding community vaccination clinics (76%); and set up vaccination clinics with other practices (69%). The most frequently reported barriers to collaboration included concerns about record transfer (24%) and the time and effort collaboration would take (21%). Reporting loss of income (RR 1.40, 95% CI 1.03-1.89) and losing opportunities to provide important medical services to patients with chronic medical conditions (RR 1.77, 95% CI 1.25-2.78) were associated with unwillingness to refer patients outside of the practice for vaccination.Limitations
Surveyed physicians may not be representative of all physicians.Conclusions
The majority of physicians report willingness to collaborate with other community vaccinators to increase influenza vaccination rates although some will need assurance that collaboration will be financially feasible and will not compromise care. Successful collaboration will require reliable record transfer and must not be time consuming. 相似文献18.
Background
Influenza infection in HIV-infected individuals is associated with increased severity of illness. We performed a systematic review of the available evidence on efficacy, effectiveness and safety of seasonal influenza vaccination in HIV-infected individuals.Design
Systematic review, meta-analysis and assessment of evidence quality.Methods
Using a previous systematic review as starting point, we searched MEDLINE, EMBASE and Cochrane data base for studies on efficacy, effectiveness or safety of trivalent inactivated influenza vaccines (TIV) in HIV-infected individuals. Evidence quality was assessed for each outcome using the GRADE methodology.Results
Three randomized-controlled trials and three cohort studies were identified, including a total of 1562 HIV-infected individuals. In adults, TIV prevented laboratory-confirmed influenza with a pooled efficacy of 85% (95% CI, 22–97%) (evidence quality: moderate), but no significant effects on other clinical outcomes were observed (evidence quality: moderate to low). One cohort study showed an effectiveness of 71% (95% CI, 44–85%) for prevention of laboratory-confirmed influenza, whereas no effect on influenza-like illness was found. However, risk of bias was high in all observational studies. In children aged 6–59 months, efficacy of TIV in preventing laboratory-confirmed influenza was 11% (95% CI, −30 to 54%) (evidence quality: moderate). Regarding other endpoints, no statistically significant effects were reported (evidence quality: moderate to low). No severe adverse events following influenza vaccination were observed in these studies.Conclusion
This systematic review indicates that TIV is effective in preventing influenza infection in HIV-infected adults but not in young children. For both age-groups, only limited evidence exists for other outcomes, indicating a need for further studies. 相似文献19.
Rodrigo Jiménez-García Cristina Rodríguez-Rieiro Valentín Hernandez-Barrera Pilar Carrasco Garrido Ana López de Andres María D. Esteban-Vasallo Maria Felicitas Domínguez-Berjón Jenaro Astray-Mochales 《Vaccine》2014
Objectives
We aim to describe influenza vaccination coverage for the Spanish population across four consecutive campaigns (2008/2009 to 2011/2012). The data was analyzed by high risk groups and health care workers (HCWs). Also, coverage trends were analyzed to assess uptake in post-pandemic seasons.Methods
We used data from two nation-wide representative health surveys namely the 2009/10 European Health Interview Survey for Spain (N = 22,188) and the 2011–12 Spanish National Health Survey (N = 21,007) Influenza vaccination status was self-reported. We analyzed influenza vaccine coverage by age, sex, number of chronic conditions, being a heath care worker (HCWs) and nationality. Time trends for campaigns among high risk groups were estimated by a multivariate logistic regression model.Results
We analyzed data from 43,072 subjects aged ≥16 years. As a whole, coverage decreased by 3.31% (22.57–19.26%) between the 2008/2009 and 2011/2012 campaigns with a significant decreasing trend (OR 0.92; 95% CI: 0.90–0.94).Coverage in people under 60 years with a chronic disease decreased significantly (OR 0.92: 95% CI: 0.85–0.99) during the analyzed period from 21.02% in 2008/2009 to 17.40% in 2011/2012. Among HCWs, the highest influenza vaccination coverage was achieved in 2009/2010 (31.08%) in the latest campaign coverage has almost halved (17.88%). For the 2011/2012 season and for all age groups the variables associated with a higher probability of having received the influenza vaccine were older age and presence of associated chronic conditions. Among those aged ≥60 years, immigrants had lower uptake (OR 0.60; 95% CI: 0.32–0.99).Conclusions
Seasonal influenza vaccine uptake rates in the recommended target groups in Spain are unacceptably low and seem to be decreasing in the post pandemic seasons. Further studies are necessary to precisely identify reasons for non-compliance and barriers to influenza vaccination. Meanwhile urgent strategies to improve seasonal vaccination uptake must be discussed and implemented. 相似文献20.