Factors affecting repeated influenza vaccination among older people in Taiwan

Objective

This study identifies factors that influence repeated influenza vaccination among people aged 65 years and older in Taiwan.

Methods

Data of this retrospective cohort study were drawn from the 2005 National Health Interview Survey and the 2005–2007 National Health Insurance claims data; a sample of 1384 older people was analyzed. The pattern of repeated influenza vaccination was divided into 3 groups: unvaccinated all 3 years, vaccinated 1–2 times over 3 years, and vaccinated all 3 years. Multinomial logistic regression analyses were performed.

Results

Only 20.6% of older people were vaccinated all 3 years. Those 70–74 years of age (odds ratio [OR] = 1.81), living in rural areas (OR = 2.47), having one (OR = 2.07) or more (OR = 2.41) chronic conditions, frequent outpatient visits (OR = 1.48), and undergoing preventive health examinations (OR = 2.22) were more likely to have repeated vaccinations. However, those with difficulties performing one or more activities of daily living (ADL difficulty) (OR = 0.41) and seeking care from alternative medicine (OR = 0.48) were less likely to undergo regular vaccinations.

Conclusion

The repeated influenza vaccination rates in our Taiwan sample were far from optimal. Factors identified in this analysis may help to improving influenza vaccination programs.     

Factors affecting influenza vaccine uptake among health care workers

BACKGROUND: In 2000, the UK Departments of Health recommended influenza immunization to employees directly involved in patient care. Uptake of this immunization had tended to be variable and usually low. AIMS: To assess personal and organizational factors associated with influenza immunization uptake among Health Care Workers (HCWs). METHODS: A cross-sectional survey of all HCWs within the Health and Social Care Trusts in Northern Ireland and a parallel-group study of nursing staff within Elderly Care using self-administered questionnaires. RESULTS: Of 203 nurses working in elderly care units 76(37%) were immunized and 127(63%) declined. Almost 70% of those not immunized perceived themselves to be 'healthy' and gave this reason for declining immunization. Nurses were more likely to be immunized by a factor of four if they believed there was benefit for healthy HCWs, three if they felt at-risk of contracting influenza and nine on a recommendation from the occupational health (OH) unit. Fifteen OH units participated in a survey of HCWs at the time of immunization. Five thousand two hundred and thirty (9.7%) HCWs were immunized. Increased uptake was correlated with immunization in area of work (r=0.74, P=0.02) and when provided out of hours (r=0.83; P<0.001) and by a factor of two with individual targeting of availability (P<0.001) and when individuals had been previously immunized (P<0.001). CONCLUSION: Uptake of influenza immunization is low. Attitudes to one's health and to the value of influenza immunization affect the uptake as does the delivery of the immunization programme.     

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

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

Effectiveness of influenza vaccine in reducing hospital admissions in people with diabetes.

The effectiveness of influenza vaccination in reducing hospitalization of people with diabetes for influenza, pneumonia, or diabetic events during influenza epidemics was assessed in a case control study in Leicestershire, England. Cases were 80 patients on the Leicestershire Diabetes Register who were admitted and discharged from hospital with International Classification of Disease codes for pneumonia, bronchitis, influenza, diabetic ketoacidosis, coma and diabetes, without mention of complications, during the influenza epidemics of 1989-90 and 1993. One hundred and sixty-controls, who were not admitted to hospital during this period, were randomly selected from the Register. Immunization against influenza was assessed in 37 cases and 77 controls for whom consent was obtained to access their clinical notes and for whom notes were available. Significant association was detected between reduction in hospitalization and influenza vaccination during the period immediately preceding an epidemic. Multiple logistic regression analysis estimated that influenza vaccination reduced hospital admissions by 79% (95% CI 19-95%) during the two epidemics, after adjustment for potential confounders.     

A systematic review of factors affecting vaccine uptake in young children

BackgroundMany parents make a conscious decision not to vaccinate their child. Multiple beliefs and perceptions surround this choice. If uptake of routine child vaccination is to increase, public health communications about vaccines must be informed by evidence on the factors affecting uptake.MethodWe conducted a systematic review to investigate psychological, social and contextual factors associated with uptake of routine vaccines in young children. Studies were included if they reported analyses of the association between psychological factors and uptake or included parents’ self-reported reasons for or against vaccination.ResultsOur search identified 9110 citations after deduplication. Sixty-eight citations describing sixty-four studies were included in the review. The quality of the studies was mixed. There is strong evidence for an association between vaccination uptake and: not perceiving vaccines to cause adverse effects; general positive attitudes towards vaccination; positive vaccine recommendations; and perceiving fewer practical difficulties of vaccination. While there was good evidence for an association between vaccination and perceived susceptibility to the illness, evidence for an association between perceived severity of an illness and vaccination was weak. Other factors associated with vaccination include knowledge about the vaccine, social influences and trust in the healthcare profession. Having increased information about the vaccine was associated with vaccination, but the influence of different sources of information needs more research.ConclusionUnderstanding which factors are consistently associated with the decision to vaccinate one’s child is important to identify messages which should be targeted by public health communications about routine child vaccinations.     

Inequalities in influenza vaccine uptake among people aged over 74 years in Britain

BACKGROUND: In the UK, payments to providers (General Practitioners) for vaccinating all people aged over 64 years old against influenza commenced in 2000. Little information exists on the relationship between uptake and need. We assessed factors influencing uptake and equity in uptake in over 74 year olds. METHODS: We analysed cohort data from 5572 subjects in a community-based trial. Analyses took into account clustering and location of general practices in terms of Underprivileged Area (UPA) Score and area Standardised Mortality Ratio (SMR). RESULTS: Vaccine uptake in practices in the most deprived tertile was 0.88 (95% CI 0.80-0.96) that of the least deprived and mid tertile, adjusted for confounding. Within each deprivation tertile, uptake in the mid and highest SMR tertile was 0.86 (95% CI 0.79, 0.94) and 0.87 (95% CI 0.81, 0.95) that of the lowest respectively. Uptake was 10% lower at the most in individuals with poorer quality housing. Higher uptake if married or with respiratory conditions and lower uptake if smoked had cognitive impairment or depression did not explain the socioeconomic differentials. CONCLUSIONS: Lower uptake in practices in deprived areas supports targeting of resources. At the individual level, those who are more isolated require support to access influenza vaccination.     

Older adults' vaccine hesitancy: Psychosocial factors associated with influenza,pneumococcal, and shingles vaccine uptake

Influenza, pneumococcal disease, and shingles (herpes zoster) are more prevalent in older people. These illnesses are preventable via vaccination, but uptake is low and decreasing. Little research has focused on understanding the psychosocial reasons behind older adults’ hesitancy towards different vaccines. A cross-sectional survey with 372 UK-based adults aged 65–92 years (M = 70.5) assessed awareness and uptake of the influenza, pneumococcal, and shingles vaccines. Participants provided health and socio-demographic data and completed two scales measuring the psychosocial factors associated with vaccination behaviour. Self-reported daily functioning, cognitive difficulties, and social support were also assessed. Participants were additionally given the opportunity to provide free text responses outlining up to three main reasons for their vaccination decisions. We found that considerably more participants had received the influenza vaccine in the last 12 months (83.6%), relative to having ever received the pneumococcal (60.2%) and shingles vaccines (58.9%). Participants were more aware of their eligibility for the influenza vaccine, and were more likely to have been offered it. Multivariate logistic regression analyses showed that a lower sense of collective responsibility independently predicted lack of uptake of all three vaccines. Greater calculation of disease and vaccination risk, and preference for natural immunity, also predicted not getting the influenza vaccine. For both the pneumococcal and shingles vaccines, concerns about profiteering further predicted lack of uptake. Analysis of the qualitative responses highlighted that participants vaccinated to protect their own health and that of others. Our findings suggest that interventions targeted towards older adults would benefit from being vaccine-specific and that they should emphasise disease risks and vaccine benefits for the individual, as well as the benefits of vaccination for the wider community. These findings can help inform intervention development aimed at increasing vaccination uptake in future.     

Seasonal influenza vaccine uptake among adults with disabilities in Korea

BackgroundPrevious research on vaccination among people with disabilities has focused on children or adolescents.ObjectiveTo examine variations in seasonal influenza vaccination (SIV) uptake according to disability type and age group and explore the vulnerable groups and risk factors of non-vaccination to identify areas of policy support in Korea.MethodsThis pooled cross-sectional study included adults who participated in the 2011, 2014, and 2017 National Survey of Persons with Disabilities. The dependent variable was SIV uptake. Age-stratified multivariate logistic regression was conducted to assess its relationship with disability characteristics.ResultsAmong 18,069 adults with disabilities, the overall SIV uptake rate increased with age (33.8%, 50.1%, and 85.3% in 20–49, 50–65, and ≥65 years, respectively). In the multivariate analyses (reporting the adjusted odds ratio and 95% confidence interval), severe disability was associated with lower and higher SIV uptake rates in older adults and younger age-groups (0.88, 0.76–1.01; 1.62, 1.42–1.86; and 1.54, 1.24–1.92 in those aged ≥65; 50–64; and 20–49 years), respectively. Health behaviors (regular doctor visits, general health examinations, and non-smoking) were significantly associated with higher odds of SIV uptake. After adjusting for covariates (age, medical conditions, functional ability, and behavioral factors), individuals with brain, epileptic, and psychiatric disabilities showed lower odds of SIV uptake compared to those with internal organ disabilities across all age groups.ConclusionsPolicy initiatives that can improve the health behaviors of people with disabilities (especially the elderly and people with intellectual, brain, epilepsy, and psychiatric disabilities) to promote SIV uptake are needed.     

Cross-sectional study on factors associated with influenza vaccine uptake and pertussis vaccination status among pregnant women in Germany

Pregnant women and their newborns are at increased risk for influenza-related complications; the latter also have an increased risk for pertussis-related complications. In Germany, seasonal influenza vaccination is recommended for pregnant women since 2010. A dose of pertussis-containing vaccine has been recommended since 2004 for women of childbearing age if they have not been vaccinated within the past 10 years. We conducted a nationwide cross-sectional survey among pregnant women in February/March 2013 to assess knowledge, attitudes, and practices related to influenza vaccination during pregnancy and to identify factors associated with their pertussis vaccination status. In total, 1025 pregnant women participated and provided information through a self-administered questionnaire. Of these, 23.2% were vaccinated against seasonal influenza during the 2012/13 season; 15.9% during their pregnancy. Major reasons for being unvaccinated (n = 686 respondents) were lack of confidence in the vaccine (60.4%) and the perception that vaccination was not necessary (40.3%). Influenza vaccination during pregnancy was independently associated with having received influenza vaccine in the previous season, having received a recommendation from a physician, a high level of vaccine-related knowledge and of perceived disease severity. In contrast, knowledge of the recommendation for regular hand-washing to prevent influenza and the perception that vaccine-related side effects were likely to occur or likely to be severe were negatively associated with vaccine uptake. Receipt of a pertussis vaccine in the past 10 years was reported by 22.5% of participants. Pertussis vaccine uptake was independently associated with living in the Eastern federal states and receiving seasonal influenza vaccination annually, while a migration background was associated with a lower uptake. To enhance vaccine uptake in pregnant women and women of childbearing age, special efforts must be undertaken to improve knowledge of both recommendations and the benefits of vaccination. Gynecologists could serve as important facilitators.     

Response to influenza vaccine in people with non-protective HI antibody titers

The purpose of the study was to determine which factors correlate directly with response to vaccination in such a group of subjects with non-protective HI antibody titers before vaccination. Two vaccines were used, a subunit virus vaccine adjuvanted with MF59 and a split virus vaccine. The analysis indicated that immunization with vaccine adjuvanted with MF59 was an independent variable for immune response against A/H3N2 (OR: 3.51; 95% CI: 1.81–6.79) and B (OR: 2.31; 95% CI: 1.37–3.89). The results suggest that antibody response to vaccine is satisfactory in elderly people previously lacking a protective antibody titer, and that the adjuvanted vaccine reveals a better immunogenicity.     

Influenza vaccination in older people with diabetes and their household contacts

BackgroundPeople with diabetes are at a higher risk of influenza infections and severe complications. The vaccination of close contacts could offer indirect protection to people with diabetes; this is known as “herd immunity.” The aim of this study is to investigate the vaccination rates of people with diabetes and their household contacts in Hong Kong.Research design and methodsFace-to-face interviews with 158 patients diagnosed with Type 2 diabetes and aged ⩾65 years were conducted in clinics. Telephone interviews were then conducted with 281 adult household contacts.ResultsSeasonal influenza vaccination rates were 54.5% and 27.4%, in people with diabetes and their contacts, respectively. The vaccination status of patients was not significantly associated with the vaccination of their household contacts (p = 0.073). Among household contacts, children or the elderly, the partners or couples of patients, and those with more hours of daily contact, or with chronic conditions, were associated with higher vaccination rates. However, only age remained significant after adjusting for confounding factors in logistic regression models.ConclusionsThe low vaccination rates of people with diabetes and their close contacts highlight the need to promote vaccination in susceptible populations and to educate the public about herd immunity.     

Psychological factors associated with uptake of the childhood influenza vaccine and perception of post-vaccination side-effects: A cross-sectional survey in England

ObjectivesTo identify predictors of: uptake of the childhood influenza vaccine in the 2015–2016 influenza season, parental perceptions of side-effects from the influenza vaccine and intention to vaccinate one's child for influenza in the 2016–2017 influenza season.DesignCross-sectional online survey.SettingData were collected in England shortly after the end of the 2015–2016 immunization campaign.Participants1001 parents or guardians of children aged between two and seven.Main outcome measuresSelf-reported uptake of the childhood influenza vaccine in the 2015–2016 influenza season, perception of side-effects from the influenza vaccine and intention to vaccinate one's child in the 2016–2017 influenza season.ResultsSelf-reported uptake of the childhood influenza vaccine was 52.8%. Factors strongly positively associated with uptake included the child having previously been vaccinated against influenza, perceiving the vaccine to be effective and perceiving the child to be susceptible to flu. Factors strongly negatively associated with uptake included perceiving the vaccine to be unsafe, to cause short-term side-effects or long-term health problems and believing that yearly vaccination may overload the immune system. Predictors of intended vaccine uptake in 2016–2017 were similar. Participants who perceived side-effects after the 2015–2016 vaccination reported being less likely to vaccinate their child next year.Side-effects were more likely to be reported in first-born children, by participants who knew another child who had side-effects, those who thought that the vaccine would interact with medication that the child was currently taking, and those who believed the vaccine causes short-term side-effects.ConclusionsPerceptions about the childhood influenza vaccine show strong associations with uptake, intended uptake and perception of side-effects. Attempts to improve uptake rates from their current low levels must address these perceptions.     

Strategies to maximize influenza vaccine impact in older adults

Older adults are disproportionately affected by influenza morbidity and mortality. In most high income countries, influenza vaccine policies target persons age ≥65 years for influenza vaccination. Many low-resource settings do not utilize seasonal influenza vaccination. Barriers to influenza prevention among older adults around the globe are multiple and some vary between high- and low-resource settings. To maximize influenza prevention in the older adult population, gaps in influenza vaccination coverage and improvements in vaccine efficacy are needed. The focus of this article is on the data for currently available vaccine strategies to maximize influenza vaccine impact, with a focus on high-resource settings. We also discuss novel influenza vaccine strategies needed for older adults worldwide.     

Attitude,knowledge and factors associated with influenza and pneumococcal vaccine uptake in a large cohort of patients with secondary immune deficiency

BackgroundImmunocompromised patients are at increased risk for severe influenza and invasive pneumococcal diseases. Population-specific vaccine recommendations are thus warranted. This study aimed to estimate the prevalence and predictors of influenza and pneumococcal vaccine uptake in a large cohort of patients with secondary immune deficiency.MethodsAn anonymous online survey was submitted to the members of 11 French associations of immunocompromised patients. The questionnaire included questions concerning underlying disease, care and treatment, flu and pneumococcal vaccine uptake, attitudes and knowledge about vaccination. Factors associated with vaccine uptake were assessed by multivariate logistic regression.ResultsAmong the 10,897 solicited patients, 3653 agreed to participate (33.5%): 75% were female, 20% aged 65+, 79% were followed for an autoimmune disease, 13% were solid organ recipients or waiting for transplantation and 8% were treated for hematological malignancies. 3109 (85%) participants were treated with immunosuppressive therapy. Self-reported vaccine uptake was 59% (95%CI [57–60]) against seasonal influenza and 49% (95%CI [47–50]) against pneumococcal diseases. Better knowledge of and favorable attitudes toward vaccination were positively associated with vaccine uptake while being treated with a biological therapy was negatively associated.ConclusionDespite specific recommendations regarding immunocompromised patients, influenza and pneumococcal vaccination rates do not reach recommended levels. Targeted information campaigns on vaccination toward these populations should be implemented to improve vaccine coverage and thus reduce the burden of infections.     

Key priorities in managing glucose control in older people with diabetes

Older people with diabetes represent a major and increasing proportion of our elderly population and their care requires better organisation. Targets for risk factor control and pathways of care must be adjusted to the subject’s general health status. It is thus advisable to screen for frailty. We have carried out a detailed literature review of the studies published on diabetes in older people since 1990. Studies were considered if they included groups or subgroups of diabetic patients >65 years old. This review discusses the elaboration of general targets for care, the approach to risk factor control, the screening and the specific prevention or management of complications, the integration of geriatric concepts in diabetes care and the specificity of education with respect to frailty status.     

Behavioral change with influenza vaccination: factors influencing increased uptake of the pandemic H1N1 versus seasonal influenza vaccine in health care personnel

Background

Many health care personnel (HCP) choose not to get vaccinated against influenza despite recommendations to do so. The pH1N1 epidemic gave a unique opportunity to evaluate the attitudes to influenza vaccination of a group of HCP who routinely choose not to get vaccinated, but accepted the pH1N1 vaccine.

Methods

HCP employed at a tertiary care hospital in Winnipeg, Canada who received the pH1N1 vaccine were invited to participate in an online survey asking about attitudes and experiences regarding seasonal and pH1N1 influenza and vaccination. Those eligible included primarily nurses, other clinical staff, and support staff, as few physicians work as employees.

Results

Of the 684 respondents (29% return rate), 504 reported routinely getting vaccinated (RV) for seasonal influenza and 180 reported routinely not getting vaccinated (NRV). These two groups had different attitude towards the two strains of influenza, with markedly lower level of concern about seasonal influenza than pH1N1 for the NRV group. The contrast was especially notable regarding the NRV's view of the seriousness of the illness, their sense of exposure risk, and their confidence in the vaccine effectiveness (for all, seasonal < pH1N1, p < 0.001). The most common motivators for getting vaccinated for both NRV and RV groups related to concerns about personal or family safety, while the choice to decline seasonal vaccination related primarily to lack concern about the illness and concerns about vaccine effectiveness and safety. Coworkers were influential in the decision to get the pH1N1 vaccine for the NRV group.

Conclusion

For HCP who do not routinely get the seasonal vaccination, perception of risk outweighing side effect concerns appeared to be a major influence in going ahead with the pH1N1 vaccine. Educational campaigns that focus on personal benefit, engage peer champions, and address concerns about the vaccine may improve influenza vaccine uptake among health care personnel.