Influenza vaccination: the persuasiveness of messages among people aged 65 years and older

About 90% of all influenza-related deaths occur among people aged 65 years and older. Vaccination remains the primary option for preventing influenza infection. This study examined the efficacy of messages designed to increase the uptake of influenza vaccination. Two messages, narrative and didactic, were created based on the Extended Parallel Process Model (EPPM). The study employed a one-factor between-subjects experimental design with participants assigned randomly to three conditions: no message, didactic communication, and narrative communication. Participants were 311 Italian people aged 65 years or older. The results showed that, compared to no message and didactic communication, narrative communication was related to higher risk perception of influenza, to higher perception of the efficacy of the vaccine, and to self-efficacy related to vaccination, controlling for social trust, previous flu shot, and demographic variables. There were no differences among the three conditions with respect to the intention to receive the influenza vaccine. Findings suggest that narrative communication based on EPPM may have a persuasive effect on people aged 65 years or older.     

Influenza vaccination health impact and cost effectiveness among adults aged 50 to 64 and 65 and older

BACKGROUND: Influenza causes approximately 36,000 deaths per year in the United States despite the presence of an effective vaccine. This assessment of the value of influenza vaccination to the U.S. population is part of an update to the 2001 ranking of clinical preventive services recommended by the U.S. Preventive Services Task Force. The forthcoming ranking will include the new recommendation of the Advisory Committee on Immunization Practices to extend influenza vaccination to adults aged 50 to 64 years. METHODS: This service is evaluated on the two most important dimensions: burden of disease prevented and cost effectiveness. Study methods, described in a companion article, are designed to ensure consistency across many services. RESULTS: Over the lifetime of a birth cohort of 4 million, it is estimated that about 275,000 quality-adjusted life years (QALYs) would be saved if influenza vaccination were offered annually to all people after age 50. Eighty percent of the QALYs saved (220,000) would be achieved by offering the vaccine only to persons aged 65 and older. In year 2000 dollars, the cost effectiveness of influenza vaccination is $980 per QALY saved in persons aged 65 and older, and $28,000 per QALY saved in persons aged 50 to 64. When the costs of patient time and travel are excluded, the cost effectiveness ratio of vaccinating 50- to 64-year-olds decreases to $7200 per QALY saved, and vaccinating those aged 65 and older saves $17 per person vaccinated. CONCLUSIONS: Influenza vaccination is a high-impact, cost-effective service for persons aged 65 and older. Vaccinations are also cost effective for persons aged 50 to 64.     

Immunization program against influenza for adults 65 years or older at a community pharmacy in Puerto Rico

Evaluate the educational needs of adults over 65 years or more with regards to the vaccine, vaccination and immunization against the influenza, design strategies to assist the educational needs and implant and evaluate an immunization program at an independent community pharmacy. A study divided into three phases: Phase I--evaluation of the educational needs related to the vaccine, vaccination and immunization. Phase II--designing of strategies to assist the needs. Phase III--a random longitudinal controlled study to evaluate an immunization program against the influenza implanted at an independent community pharmacy. One hundred (100) patients participated, randomly assigned to a controlled and experimental group. Three months into the study's Phase III, a 68% of the experimental group had been vaccinated and showed a tendency to improvement in knowledge; in the controlled group, a 32% had been vaccinated and did not show a tendency in improvement of knowledge. A year into the study's Phase III, a 76% of the experimental group had been vaccinated and 24% of the controlled group was vaccinated. The satisfaction average of the experimental group towards the pharmacist was 3.94 +/- 0.18 and, in the controlled group was 3.98 +/- 0.20, whiting a scale of 0-04. People who participated in an educational activity offered by a pharmacist showed: more knowledge, remembered what they learned and an increase in influenza vaccination.     

The timing of influenza vaccination for older adults (65 years and older)

While studies have found influenza vaccination to be cost-effective in older adults (65 years or older), they have not looked at how the vaccine's economic value may vary with the timing of vaccine administration. We developed a set of computer simulation models to evaluate the economic impact of vaccinating older adults at different months. Our models delineated the costs and utility losses in delaying vaccination past October and suggest that policy makers and payors may consider structuring incentives (≤$2.50 per patient) to vaccinate in October. Our results also suggest that vaccination is still cost-effective through the end of February.     

Public health and aging: influenza vaccination coverage among adults aged > or =50 years and pneumococcal vaccination coverage among adults aged > or =65 years--United States, 2002

Vaccination of persons at risk for complications from influenza and pneumococcal disease is a key public health strategy in preventing morbidity and mortality in the United States. During the 1990-1999 influenza seasons, approximately 36,000 deaths were attributed annually to influenza infection, with approximately 90% of deaths occurring among adults aged > or =65 years. In 1998, an estimated 3,400 adults aged > or =65 years died as a result of invasive pneumococcal disease. One of the national health objectives for 2010 is to achieve 90% coverage of noninstitutionalized adults aged > or =65 years for both influenza and pneumococcal vaccinations (objective no. 14.29). In 2000, the Advisory Committee on Immunization Practices (ACIP) broadened the universal recommendations for influenza vaccination to include adults aged 50-64 years in addition to adults aged > or =65 years. To assess progress toward achieving the 2010 national health objective and implementing the ACIP recommendations, CDC analyzed data from the 2002 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicate that influenza and pneumococcal vaccination levels among adults aged > or =65 years and influenza vaccination levels among adults aged 50-64 years varied widely among states/areas and racial/ethnic populations. Innovative approaches are needed to increase vaccination coverage, particularly among certain populations.     

Influenza vaccination levels among persons aged > or =65 years and among persons aged 18-64 years with high-risk conditions--United States, 2003

Influenza vaccination is an effective tool for preventing hospitalization and death among persons aged > or =65 years and among persons aged 18-64 years with medical conditions that increase the risk for influenza-related complications. Two national health objectives for 2010 are to increase influenza vaccination coverage to 90% among persons aged > or =65 years and to 60% among persons aged 18-64 years who have one or more high-risk conditions (objectives 14-29a and 14-29c, respectively). To determine influenza vaccination coverage among persons in both targeted groups, CDC analyzed data from the 2003 National Health Interview Survey (NHIS). This report summarizes the results of that analysis, which determined that influenza vaccination coverage among persons aged > or =65 years and persons aged 18-64 years with high-risk conditions remains substantially below 2010 target levels. In addition, racial/ethnic disparities in coverage levels persist in both targeted populations. To improve overall influenza vaccination coverage and reduce racial/ethnic disparities, combinations of evidence-based effective interventions should be implemented, and the influenza vaccine supply should be stabilized.     

Predictors of vaccination behavior among persons ages 65 years and older.

We estimated influenza vaccination coverage of 32 percent among persons 65 years of age and older from the 1987 Behavioral Risk Factor Surveillance System survey. Race other than White, obesity, lack of seatbelt use, and current smoking were associated with decreased likelihood of having been vaccinated. Controlling for these factors, the best predictor of having received influenza vaccination was having had a medical checkup within the last year (Odds Ratio = 2.40, 95% confidence interval = 1.84, 3.14).     

Pneumococcal vaccination patterns among persons aged 65 years or older in the United States: A retrospective database analysis

ObjectiveThis study investigated the patterns of pneumococcal disease vaccination, the time between two different pneumococcal vaccine doses and factors associated with series completion.MethodsA retrospective claims database analysis was conducted using the Clinformatics DataMart™ database. Adults who turned 65 years between January 1st, 2013 to June 30th, 2017 and were continuously enrolled (≥15 months) in the Medicare Advantage plans to June 30th, 2017 were included in this study. Pneumococcal vaccination patterns included: PCV13-PPV23, PPV23-PCV13, or receiving PPV23 or PCV13 only. Pneumococcal vaccination series completion was defined as receiving PCV13-PPV23 or PPV23-PCV13 from 65 years old to June 30th, 2017 while non-completion was defined as receiving only PCV13 or only PPV23 from 65 years old to June 30th, 2017. A multivariable logistic regression model was used to identify factors associated with pneumococcal vaccination series completion.ResultsA total of 224,132 adults were included in this study. Most received no pneumococcal vaccination (49%), while 34.3% received only one vaccine. Series completion occurred in 16.8% of adults. Some adults received only one vaccination: 11.6% received PPV23 and 22.7% received PCV13. The mean time between vaccinations was 420.8 days (approximately 14 months) for the PCV-PPV23 series, and 595.5 days (approximately 20 months) for the PPV23-PCV13 series. Adults were significantly more likely to complete pneumococcal vaccination series if they had at least one doctor’s office, outpatient visit, or pharmacy visit versus no visits, or received an influenza vaccination in the first year after turning 65 years than those who did not (All: P < 0.001).ConclusionDespite the 2014 recommendation, percentages of pneumococcal vaccination series completion were found to be low, aligning with recent literature. This highlights the need to improve series completion, given the increased risk and associated economic burden of pneumococcal disease in adults aged ≥65 years.     

Influenza vaccination acceptance among health-care workers: a nationwide survey

We conducted a nationwide survey to investigate reasons for influenza vaccine uptake or refusal among health-care workers (HCWs) in Greece. Vaccination rates increased with increasing age, and among HCWs working in Northern Greece, in direct contact with patients, and with influenza vaccination in the past. Self-protection was the main reason for vaccination (89.1%), whereas 55.2% of HCWs reported vaccination to protect patients. Main reasons for refusing vaccination were perception of not being at risk for influenza (43.2%) and fear of vaccine adverse effects (33.4%).     

Influenza in older adults: Impact of vaccination of school children

The extent to which immunizing school children reduce the burden of influenza in adults is controversial. We enrolled a systematic sample of adults ≥50 years hospitalized with respiratory symptoms in two counties, one with and one without a school-based immunization program. We tested all subjects for influenza by polymerase chain reaction. Hospitalizations per 1000 adults aged ≥50 years were 1.28 (95% CI 0.59, 2.04) in the intervention county and 1.53 (95% CI 0.71, 2.34) in the control county. These rates did not differ significantly except in the subgroup aged 50–64 years where rates in the intervention county were significantly lower.     

Influenza and pneumococcal vaccination coverage among persons aged > or =65 years and persons aged 18-64 years with diabetes or asthma--United States, 2003

Vaccination of persons at risk for complications from influenza and pneumococcal disease is a key public health strategy for preventing associated morbidity and mortality in the United States. Risk factors include older age and medical conditions that increase the risk for complications from infections. During the 1990-1999 influenza seasons, more than 32,000 deaths each year among persons aged > or =65 years were attributed to complications from influenza infection. National health objectives for 2010 call for 90% influenza and pneumococcal vaccination coverage among noninstitutionalized persons aged > or =65 years and 60% coverage among noninstitutionalized persons aged 18-64 years who have risk factors (e.g., diabetes or asthma) for complications from infections. To estimate influenza and pneumococcal vaccination coverage among these populations, CDC analyzed data from the 2003 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of that analysis, which indicated that 1) influenza vaccination levels among adults aged 18-64 with diabetes or asthma, 2) pneumococcal vaccination levels among adults aged 18-64 years with diabetes, and 3) influenza and pneumococcal vaccination levels among adults aged > or =65 years all were below levels targeted in the national health objectives for 2010. Moreover, vaccination coverage levels varied among states for both vaccines and both age groups. Innovative approaches and adequate, reliable supplies of vaccine are needed to increase vaccination coverage, particularly among adults with high-risk conditions.     

Influenza vaccination in the 2009-2010 pandemic season: the experience of primary care physicians

Objectives

Determine among a representative sample of pediatricians (Peds), family medicine (FM), and general internal medicine (GIM) physicians in the 2009-2010 influenza season physicians’: 1) practices and experiences with delivery of seasonal and pH1N1 influenza vaccines; and 2) anticipated and experienced barriers.

Methods

Two US national surveys administered 7/2009-10/2009 (before pH1N1 distribution) and 3/2010-6/2010 (after pH1N1 distribution) to 416 Peds, 424 FM and 432 GIM.

Results

Of respondents who received both surveys, 62% (776/1253) completed both. Overall, 98% reported administering seasonal influenza vaccine and 86% pH1N1, with 70% reporting that working with public health in delivery of pH1N1 was a positive experience. Due to limited supplies of pH1N1, 63% of providers reported prioritizing who received vaccine even within high risk groups. Pre-distribution, 71% perceived that patient/parental safety concerns about pH1N1 would be a barrier, and post-distribution 72% perceived it had been a barrier. Physician concern about safety decreased, with 44% reporting safety a barrier pre-distribution and 12% post-distribution (p < 0.001).

Conclusions

In the setting of a pandemic most primary care physicians collaborated with public health in delivery of pH1N1. Physicians faced challenges with patient/parent safety concerns about pH1N1 and supply issues with pH1N1 that required physicians to prioritize who received vaccine.     

Influenza and pneumococcal vaccination of adults aged > or = 65: racial/ethnic differences

BACKGROUND: Influenza and pneumococcal polysaccharide vaccination (PPV) rates among persons aged > or = 65 years are significantly below national objectives of 90%, particularly among blacks and Hispanics. This study of the 2002-2003 influenza season examines factors that may be associated with low coverage. METHODS: A national sample of 1839 community-dwelling adults aged > or = 65 years was surveyed by telephone during January-May 2003. Outcomes analyzed in 2004-2005 included self-reported influenza vaccination and PPV; place of vaccination; and among the unvaccinated, main reasons for nonvaccination, awareness of vaccination, and receipt of provider recommendation for vaccination. RESULTS: Influenza vaccine coverage was 67.8%, and PPV coverage was 60%. Coverage among blacks and Hispanics was > or = 15 percentage points below that of whites. Half (52%) of persons who had not received PPV were aware it was recommended for persons their age, and < 10% had received a recent physician recommendation for PPV. Concern about side effects and not thinking that they needed the vaccine were the most frequently cited reasons for not receiving an influenza vaccination. In each racial/ethnic group, prevalence of potential missed opportunities (recent doctor visit, but no vaccine recommendation from provider and no influenza vaccination) was higher than prevalence of potential vaccine refusal (recent doctor visit and vaccine recommendation from provider, but no vaccine): blacks, 26.9% versus 7.9%; Hispanics, 19.9% versus 12.1%; and white non-Hispanics, 16.2% versus 6.1%. CONCLUSIONS: Improved adherence to vaccination guidelines by healthcare providers could substantially raise coverage in all racial/ethnic groups. Multiple factors contribute to racial/ethnic disparities, and their relative contributions should be further quantified.     

Influenza vaccination: a collaborative effort to improve the health of the community.

BACKGROUND: The need to improve influenza vaccination delivery in our community became painfully clear during the winter of 1997-1998 when high rates of respiratory illness led to congestion in the emergency department and a critical shortage of hospital beds. In response, the local hospital and the Department of Health launched a collaborative program to increase influenza vaccine coverage in the community. METHODS: The partnership was designed to increase the number of citizens receiving influenza vaccine and to moderate the severity of lower respiratory tract illness during the winter season. A variety of methods were used to increase public awareness, enhance vaccine delivery, and create a relatively seamless service for the community. RESULTS: During three seasons, influenza vaccination rates increased by a relative 150%. This represented immunization of 16% of the entire community and more than 75% of residents older than 65 years. Hospital employee vaccination rates also rose from 34% to 58%. When compared with other hospitals in the county, the campaign reduced the average number of annual visits to the emergency department for all respiratory diagnoses by 34% and exacerbations of chronic obstructive pulmonary disease by 46%. CONCLUSIONS: This influenza vaccination program illustrates the potential for synergy that exists between local departments of health and community hospitals in successfully increasing vaccine delivery to the community. Furthermore, it also suggests that such efforts can be successful in reducing use of the emergency department, resulting in a positive impact on the health of the community.     

中国65岁及以上老年人睡眠时长与认知功能受损的关联研究

目的探索我国65岁及以上老年人每日睡眠时长与认知功能受损之间的关联。方法数据来自中国老年健康影响因素跟踪调查在2017-2018年调查的数据集,最终共纳入14966名研究对象,同时收集社会经济状况、社会参与、行为、饮食营养、生活习惯、家庭结构、疾病状况、心理健康、认知功能等数据。用简易精神状态评价量表(MMSE)评价老年人的认知功能。采用广义线性混合效应模型分析睡眠时长与认知功能受损之间的关联,并进一步分析不同年龄组(65~79岁、80~89岁、90~99岁和≥100岁)、性别研究对象睡眠时长和认知功能受损间的关联。结果14966名研究对象中,65~79岁、80~89岁、90~99岁和≥100岁的研究对象分别有5148名(34.40%)、3777名(25.24%)、3322名(22.20%)和2719名(18.16%);女性有8455名(56.49%);每日睡眠时长≤5 h和≥9 h的老年人分别有2704名(18.94%)和3883名(27.19%);认知功能受损者有3748名(25.04%)。广义线性混合效应模型的结果显示,与自报每日睡眠时长为7 h者相比,睡眠时长≤5 h和睡眠时长≥9 h与认知功能受损有关联,OR值(95%CI)分别为1.35(1.09~1.68)和1.70(1.39~2.07)。分层分析的结果显示,睡眠时长与认知功能受损之间的关联在65~79岁老年人和男性老年人中更为显著。结论老年人睡眠时长过短或过长可增加认知功能受损的发生风险。     

Hepatitis B vaccination coverage among high-risk adults 18-49 years, U.S., 2009

Background

Approximately 43,000 new hepatitis B virus (HBV) infections occurred in 2007. Although hepB vaccination has been recommended for adults at high-risk for incident HBV infection for many years, coverage remains low.

Methods

We used the 2009 National Health Interview Survey to assess self-reported HepB vaccine uptake (≥1 dose), series completion (≥3 dose), and independent predictors of vaccination among high-risk adults aged 18-49 years. High-risk adults were defined as those reporting male sex with men; injection drug use; hemophilia with receipt of clotting factors; sexually transmitted disease in prior five years; sex for money or drugs; HIV positive; sex with persons having any above risk factors; or who “felt they were at high risk for HIV”. Persons with none of the aforementioned risk factors were considered non-high risk. Bivariate analysis was conducted to assess vaccination coverage. Independent predictors of vaccine uptake and series completion were determined using a logistic regression.

Results

Overall, 7.0% adults aged 18-49 years had high-risk behaviors. Unadjusted coverage with ≥1 dose was 50.5% among high-risk compared to 40.5% among non-high-risk adults (p-values <0.001) while series completion (≥3 doses) was 41.8% and 34.2%, respectively (p-values <0.001). On multivariable analysis, ≥1 dose coverage, but not series completion, was higher (Risk Ratio 1.1, 95% CI = 1.0-1.2, p-value = 0.021) among high-risk compared to non-high risk adults. Other characteristics independently associated with a higher likelihood of HepB vaccination among persons 18-49 years included younger age groups, females, higher education, ≥2 physician contacts in the past year, ever tested for HIV, health care personnel, received influenza vaccination in the previous year, and ever received hepatitis A vaccination. Vaccine uptake with ≥1 dose increased by 5.1% (p = 0.047) among high-risk adults between 2004 and 2009.

Conclusions

A small increase in ≥1 dose HepB vaccination coverage among high-risk adults compared with non-high risk adults was documented for the first time in 2009. Higher coverage among persons 18-30 years may reflect aging of persons vaccinated when they were children and adolescents. To improve protection against hepatitis B among high-risk adults, healthcare providers should offer hepatitis B vaccination to persons at high risk and those who seek vaccination to protect themselves and facilitate timely completion of the three (3) dose HepB series.     

Factors associated with self-reported pneumococcal immunization among adults 65 years of age or older in the Minneapolis-St. Paul metropolitan area

BACKGROUND: As part of a 3-year demonstration project to improve pneumococcal polysaccharide vaccine (PPV) coverage among older adults, the Minnesota Department of Health conducted a baseline evaluation of knowledge, attitudes, and beliefs among the general public regarding PPV. METHODS: A random-digit dialing telephone survey was conducted among community-dwelling adults age 65 years or older in three metropolitan counties in Minnesota during April through June 1998. RESULTS: Three hundred fifty-three interviews were completed; self-reported PPV coverage was 59% (95% CI 54%, 64%). Nearly all (94%) respondents reported at least one medical visit in the past year. Unvaccinated respondents expressed willingness to be vaccinated if they knew about PPV's safety, dosage, and preventive role. In a final multivariate regression model, factors associated with PPV vaccination included awareness of PPV (OR 7.8; CI 2.1, 29.2; P = 0.002), opinion that receiving PPV is "very important" (OR 8.3; CI 3.2, 21.6; P < 0.001), awareness that Medicare covers PPV (OR 5.1; CI 1.9, 13.8; P = 0.001), physician ever offering PPV (OR 21.7; CI 6.2, 76.6; P < 0.001), and physician regularly offering PPV (OR 3.9; CI 1.1, 13.7; P = 0.03). CONCLUSIONS: Respondents were significantly influenced by their physician offering PPV. Therefore, providers' practices are a critical target for improving PPV coverage. Educational efforts to inform patients about PPV and to address misconceptions (e.g., safety, efficacy, Medicare coverage) also may improve vaccination levels.     

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

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