Introducing a pneumococcal vaccine to an existing influenza immunization program: vaccination rates and predictors of noncompliance.

PURPOSE: Influenza vaccination has been recommended for all elderly people in The Netherlands since 1996, with greater than 80% compliance. It is unknown, however, if the addition of another vaccine to this immunization program will affect compliance. SUBJECTS AND METHODS: General practitioners offered a pneumococcal vaccine together with the yearly influenza vaccination to 3365 patients aged 65 years and older. A questionnaire was then mailed to a stratified sample (n = 972) of these patients. Factors associated with noncompliance with vaccination were assessed using polytomous logistic regression. RESULTS: A total of 2529 patients (75%) received the pneumococcal vaccine and 2812 (84%) received the influenza vaccine. Predictors of noncompliance with the pneumococcal vaccine were perceived lack of recommendation by the general practitioner (odds ratio [OR] = 4.6; 95% confidence interval [CI], 2.6 to 8.3) and fear of local side effects (OR = 2.8; 95% CI, 1.6 to 4.6). Predictors of noncompliance with both vaccinations also included unwillingness to comply with the doctor's advice (OR = 6.1; 95% CI, 2.4 to 15.4), the belief that vaccinations weaken one's natural defenses (OR = 2.7; 95% CI, 1.4 to 5.3) or that influenza is not dangerous (OR = 2.9; 95% CI, 1.5 to 5.4), and the fear of becoming sick from pneumococcal vaccination (OR = 2.9; 95% CI, 1.1 to 7.9). People who felt healthy, found it difficult to visit the doctor's office, had private medical insurance, or were younger than 75 years of age also had a greater risk of not being vaccinated. CONCLUSION: Introducing a pneumococcal vaccine to an existing influenza immunization program resulted in high pneumococcal and influenza vaccination rates. A wider diversity of patient characteristics and attitudes was present when neither vaccination was received.     

Physician, heal Thyself? Regular source of care and use of preventive health services among physicians

BACKGROUND: Little is known about the regular source of care (RSOC) among physicians, a group whose self-care may reflect the attitudes and recommendations they convey to their patients. METHODS: We performed a cohort study of physicians who graduated from the Johns Hopkins School of Medicine from 1948 through 1964 to identify predictors of not having an RSOC, and to determine whether not having an RSOC was associated with subsequent receipt of preventive services. The RSOC was assessed in a 1991 survey; use of cancer screening tests and the influenza vaccine was assessed in 1997. RESULTS: The response rate in 1991 was 77% (915 respondents); 35% (312) had no RSOC. Internists (odds ratio [OR], 3.26; 95% confidence interval [CI], 1.58-6.74), surgeons (OR, 2.42; 95% CI, 1.17-5.02), and pathologists (OR, 5.46; 95% CI, 2.09-14.29) were significantly more likely to not have an RSOC than pediatricians. Not having an RSOC was inversely related to the belief that health is determined by health professionals (OR, 0.45; 95% CI, 0.29-0.68) and directly related to the belief that chance (OR, 1.90; 95% CI, 1.28-2.82) determines health. Not having an RSOC in 1991 predicted not being screened for breast, colon, and prostate cancer, as well as not receiving an influenza vaccine at 6 years of follow-up. CONCLUSIONS: A large percentage of physicians in our sample had no RSOC, and this was associated with both medical specialty and beliefs about control of health outcomes. Not having an RSOC was significantly associated with failure to use preventive services several years later. Arch Intern Med. 2000;160:3209-3214.     

Strategies to increase influenza vaccine uptake among health care workers in Greece

The aim of the current study was to investigate the contribution of various strategies to increase influenza vaccine uptake among health care workers (HCWs) working in hospitals in Greece during the 2005-2006 season. A total of 132 Greek public hospitals participated in the study. The mean HCWs vaccination rate against influenza during 2005-2006 was 16.36% compared with 1.72% during the previous season. Logistic regression analysis showed that the implementation of the following strategies was significantly associated with influenza vaccination rates above the mean vaccination rate: a mobile vaccination team (OR 2.942, 95% CI 1.154-5.382, p-value 0.016) and lectures on influenza and influenza vaccine (OR 2.386, 95% CI 0.999-5.704, p-value 0.036). In conclusion, in Greece influenza vaccination rates among HCWs remain low; however, the implementation of specific strategies was associated with increased vaccine uptakes.     

Patient acceptance of influenza vaccination

PURPOSE: To determine whether patients' demographic, medical, and personal characteristics, including attitudes and beliefs about vaccination, health, and medical providers, are associated with acceptance of influenza vaccine. PATIENTS AND METHODS: Nine hundred sixty-five patients attending a university hospital-based general medicine clinic during the fall influenza vaccination period, including 624 patients for whom influenza vaccine was indicated, were observed in a prospective cohort study. In addition, 58 patients who refused influenza vaccine and an equal number who accepted it were interviewed over the telephone to examine their beliefs and behaviors in greater detail. RESULTS: Seventy-five percent of patients for whom influenza vaccine was indicated received it. Prospectively assessed patient characteristics that were significantly associated with nonvaccination included not believing vaccine prevents "flu" (relative risk [RR] 5.3), never received pneumococcal vaccine (RR 3.5), not vaccinated against influenza the previous year (RR 3.5), never vaccinated against influenza (RR 2.3), and felt sick after previous influenza vaccination (RR 2.3). Demographic characteristics and medical diagnoses were not significantly related to vaccination. Almost one half of 58 interviewed subjects who refused influenza vaccine cited fear of a reaction. Among retrospectively determined attitudes and beliefs significantly associated with refusal of influenza vaccine were not believing the vaccine works well (odds ratio [OR] 11.6), concern about a reaction (OR 9.3), and perception that the medical provider had not recommended it (OR 5.8). CONCLUSION: Demographic characteristics of patients and their medical diagnoses were not associated with acceptance of influenza vaccination. Among patients who were not vaccinated, doubts about the efficacy of influenza vaccine and fear of its side effects were common, and their perceptions of the medical provider's recommendation of vaccine appeared to be an important factor in the decision whether to accept it.     

Analysis of the Influenza A (H1N1) 2009 Pandemic Infection in Japanese Asthmatic Patients: Using a Questionnaire-Based Survey

BackgroundInfluenza infection is known to be an exacerbating factor in the control of asthma, therfore its prevention is critical in managing asthma. The aim of this study was to investigate the influenza A H1N1 2009 pandemic virus (H1N1 pdm09) infection in adult asthmatic patients.MethodsData were obtained from a questionnaire-based survey of asthmatic patients conducted from September to October 2010 in Niigata Prefecture. Patient background, H1N1 pdm09 infection, vaccination status, and asthma exacerbation due to influenza infection were analyzed.ResultsIn total, 2,555 cases were analyzed. The incidence of the infection was 6.7% (95% confidence interval [CI]: 5.7-7.6), and the rate of vaccination was 63.9% (95% CI: 62.1-65.8). The odds ratio (OR) for vaccination against the infection among adult patients and younger patients (≤ the median age) were 0.61 (95% CI: 0.45-0.84) and 0.62 (95% CI: 0.42-0.90), respectively. However, OR among the older patient (> median age) were 1.38 (95%CI: 0.66-2.89). The rate of infection-induced asthma exacerbation was 23.2% (95% CI: 18.6-29.6), and the OR for vaccination against the infection-induced asthma exacerbation was 1.42 (95% CI: 0.69-2.92).ConclusionsThe effectiveness of the vaccination against the H1N1 pdm09 virus was confirmed during the first pandemic season, but it was limited. Further investigation on H1N1 pdm09 virus infection in asthmatics will be required.     

Pneumococcal and influenza vaccine uptake in adults with inflammatory bowel disease in France: Results from a web-based study

BackgroundDespite specific immunization guidelines for immunocompromised patients, there is a dearth of studies on inflammatory bowel disease (IBD) population in France.AimsTo estimate the prevalence and predictors of influenza and pneumococcal vaccination rates in a sample of French IBD adults.MethodsAn anonymous online survey was submitted to members of several French immunocompromised patients’ associations during the winter 2016.ResultsOverall, there were 199/1625 (12%) participants with an IBD. Among these, 32% were <30 years old, 85% were male, and 62% were treated with immunosuppressive therapy. Self-reported influenza vaccine uptake was 34% (95% CI [28–41]) and 38% (95% CI [31–44]) for pneumococcal vaccines. Healthcare provider’s (HCP) recommendation for vaccination (adjusted OR 12.7 95% CI [5.6–28.8]), immunosuppressive therapy (aOR 2.3 [1.1–5.3]), better knowledge of vaccination (aOR 3.2 [1.1–9.2]) and favorable attitudes towards vaccination (aOR 3.4 [1.2–9.5]) were positively associated with influenza vaccine uptake. Vaccine recommendation by HCPs was the only independently associated factor with pneumococcal vaccines uptake (OR 187.7 [24.8–1422.5]).ConclusionImmunization rates in our sample do not reach recommended levels. Factors associated with vaccination included high knowledge, favorable attitudes towards vaccination and recommendation for vaccination. This underlines the role of health care providers in contact with IBD patients.     

Racial similarities in response to standardized offer of influenza vaccination

BACKGROUND: Despite known benefits of influenza vaccination and coverage by Medicare Part B, elderly minority patients are less likely to receive influenza vaccination than whites. OBJECTIVES: To test whether a nonphysician-initiated standardized offer of influenza vaccination to all elderly primary care patients would result in similar proportions of African-American and white patients accepting vaccine. DESIGN: In 7 metropolitan Detroit primary care practices during the 2003 influenza vaccination season, medical assistants assessed influenza immunization status of all patients 65 years and older and collected limited demographic data. Eligible patients were offered vaccination. MEASUREMENTS: Proportion of patients accepting influenza vaccination by race and predictors of vaccine acceptance. RESULTS: Four hundred and fifty-four eligible patients with complete racial information were enrolled: 40% African American, 52% white, 8% other race/ethnicity. Similar proportions of African Americans and whites had already received the 2003 vaccine (11.6% and 11.0%, respectively) or stated vaccination as the reason for visit (23.8% and 30.5%, respectively). Among the remainder, there also were similar proportions who accepted vaccination: 68.9% white and 62.1% African-American patients. History of previous vaccination was the only statistically significant predictor of vaccine acceptance (odds ratio [OR] 8.64, 95% confidence interval [CI] 4.17, 17.91, P<.001). After adjusting for history of previous vaccination, age, gender, and education, the odds of vaccine acceptance were no different for whites and African Americans (OR 1.20, 95% CI 0.63, 2.29, P=.57). CONCLUSIONS: Vaccination acceptance differed little between African-American and white elderly patients. Using nonphysician personnel to identify and offer influenza vaccine to eligible patients is easily accomplished in primary care offices and has the potential to eliminate racial disparities in influenza vaccination.     

COVID-19 vaccination intention among healthcare workers in Vietnam

Objective:To assess the acceptance of coronavirus disease(COVID-19)vaccine among healthcare workers at two general hospitals in Vietnam when it is available.Methods:A cross-sectional study was conducted using a convenience sampling from January to February 2021 among 410 healthcare workers at two general hospitals in Vietnam via a selfadministered questionnaire.A multivariable regression analysis was performed to determine predictors of vaccine acceptance including the demographic factors,COVID-19 knowledge,and vaccine beliefs based on the domains of Health Belief Model.Results:Among 410 healthcare workers,76.10%showed vaccination willingness.Predictors of acceptance were determined that the group reporting as“vaccine acceptance”was more likely to be positive towards the perceived susceptibility and severity of COVID-19(OR 2.45;95%CI 1.48-4.06,P<0.05),perceived benefits of vaccination,and cues to action(OR 4.36;95%CI 2.35-8.09,and OR 5.49;95%CI 2.84-10.61,respectively,all P<0.001),but less likely to have the perceived barriers to vaccination(OR 0.19;95%CI 0.09-0.38;P<0.001)compared with the no acceptance group.Besides,people who had a good knowledge regarding the severity of illness were 3.37 times more likely to have identified as vaccine acceptance(OR 3.37;95%CI 1.04-10.86,P<0.05).The demographic factors were also associated with willingness to receive the vaccine,with participants who were staff and received COVID-19 information from relatives were less likely to accept the vaccine over those who were doctors and not receiving information from relatives(OR 0.36;95%CI 0.13-0.96,and OR 0.37;95%CI 0.17-0.78,respectively,all P<0.05).Conclusions:A rate of willingness to get vaccinated against COVID-19 was relatively high with discrepancies between occupation,receiving information from relatives,knowledge toward the severity of illness,and the elements of Health Belief Model.The findings will provide information for the management authorities to develop relevant interventions to promote COVID-19 vaccination uptake.     

Low rates of vaccination in listed kidney transplant candidates

Despite clear consensus and strong recommendations, vaccination rates of kidney transplant (KT) recipients have remained below targets. As vaccination is most effective if it is given prior to transplantation and the initiation of immunosuppression, patients should ideally have their vaccination status assessed and optimized in the pre‐transplant period. We performed a retrospective chart review to characterize vaccination rates and factors associated with gaps in vaccination in a single‐center population of waitlisted patients being evaluated for kidney transplantation. We evaluated 362 KT patients. Three‐quarters were receiving dialysis at the time of evaluation. Immunization rates were low with 35.9% of patients having completed vaccination for Pneumococcus, 55% for influenza, 6.9% for zoster, and 2.5% for tetanus. On multivariable analysis, patients who received other vaccines, including influenza, tetanus, or zoster vaccine (odds ratio [OR] 10.55, 95% confidence interval [CI] 5.65–19.71) were more likely to receive pneumococcal vaccine. Blacks (OR 0.24, 95% CI 0.12–0.47) were less likely to receive pneumococcal vaccine compared to whites. Patients on dialysis, and those active on the waiting list were more likely to receive pneumococcal vaccine than other groups (OR 2.81, 95% CI 1.44–5.51, and OR 1.84, 95% CI 1.08–3.14, respectively). We found that the overall immunization rate against common vaccine‐preventable infections was low among patients evaluated for kidney transplantation. A significant gap remains between recommendations and vaccine uptake in clinical practice among this high‐risk population.     

Audit of influenza and pneumococcal vaccination uptake in diabetic patients attending secondary care in the Northern Region.

AIMS: To document uptake of influenza and pneumococcal vaccination in diabetic patients attending secondary care in the Northern Region, and to explore influencing factors. METHODS: Diabetic patients attending out-patients in Middlesbrough, Gateshead and Newcastle were questioned from October 1999 to March 2000. Physicians inquired about influenza and pneumococcal vaccination status using a standardized questionnaire. Data collected included age, year of diagnosis, duration of diabetes, type of diabetes, and the presence of other recognized indications for vaccination. RESULTS: Two hundred and sixty-eight diabetic patients, 42% (113/268) with Type 1 diabetes, 34% (91/268) with ischaemic heart disease, 10% (26/268) with chronic pulmonary disease (CPD) and 10% (27/268) with chronic renal disease, were questioned. Thirty-five percent (93/268) of patients received both influenza and pneumococcal vaccines, 24% (64/268) received only influenza vaccine, and none received pneumococcus vaccine alone. Most vaccinees received advice about influenza and pneumococcal vaccination from their general practitioner (90% (142/157) and 87% (81/93), respectively). A large number of non-vaccinees were unaware of the need for influenza and pneumococcal vaccination (69% (76/111) and 91% (159/175), respectively). Using multiple logistic regression co-existing CPD increased the odds of receiving influenza (odds ratio (OR) (95% confidence interval (CI)) = 1.99 (1.07-14.12)) or pneumococcal (OR = 3.77 (1.69-21.76)) vaccination. Furthermore, each 1-year increase in age increased the chance of receiving influenza or pneumococcal vaccination by 22% (OR = 1.22 (1.09-1.67) and 29% (OR = 1.29 (1.07-1.72)), respectively. CONCLUSIONS: Vaccination rates in these diabetic patients are unsatisfactory. Secondary care health professionals might increase rates by raising the topic in consultations. Diabet. Med. 18, 599-603 (2001)     

Factors associated with vaccination of medicare beneficiaries in five U.S. communities: Results from the racial and ethnic adult disparities in immunization initiative survey, 2003

OBJECTIVES: To examine vaccination in seniors in the five U.S. communities of the Racial and Ethnic Adult Disparities in Immunization Initiative. DESIGN: Cross-sectional telephone survey in spring 2003 using stratified sampling by ZIP code and race/ethnicity. SETTING: New York, Texas, Wisconsin, Illinois, and Mississippi. PARTICIPANTS: Four thousand five hundred seventy-seven Medicare beneficiaries. MEASUREMENTS: Outcomes were pneumococcal vaccination ever and influenza vaccination in 2002/03 and were determined according to race/ethnicity, awareness of vaccination, and provider recommendation. Survey questions also asked about future plans for vaccination, whether respondents believed they had become sick from prior influenza vaccination, and whether unvaccinated respondents would be vaccinated if a health professional recommended it. RESULTS: Pneumococcal vaccination coverage was 70.3% for whites, 40.8% for blacks, and 53.2% for Hispanics, and the proportion reporting provider recommendation for vaccination differed significantly according to race/ethnicity. In multivariate regression, provider recommendation (risk ratio (RR) = 2.32, 95% confidence intervals (CI) = 2.10-2.57) and awareness of vaccination (RR = 1.60, 95% CI = 1.40-1.82) were associated with greater pneumococcal vaccination. Influenza vaccination coverage was 76.2% for whites, 50.7% for blacks, and 65.7% for Hispanics. A little more than half of respondents reported provider recommendation for influenza vaccination, with no differences according to race/ethnicity. Provider recommendation was associated with influenza vaccination (RR = 1.31, 95% CI = 1.25-1.38). More blacks and Hispanics believed they had become sick from prior influenza vaccination than whites, and this belief was associated with lower vaccination rates. CONCLUSION: This survey details vaccination patterns in an ethnically and geographically diverse sample of seniors and identifies some differences between blacks, Hispanics, and whites that may contribute to disparities in vaccination coverage. Survey findings highlight the importance of provider vaccination recommendations.     

Response to influenza vaccination in community and in nursing home residing elderly: relation to clinical factors

Intramuscular (IM) influenza vaccines are about 50% effective in preventing respiratory illness among the elderly. The aim of this study was to identify factors associated with immune response to influenza vaccination among nursing home and community-residing elderly. 114 nursing home (NHE) and 62 community residing elderly (CE) were vaccinated with a commercial IM vaccine. Serum antibodies were evaluated by HIA, and the impact of subjects' clinical characteristics on seroconversion was determined. Factors that were associated with low seroconversion among NHE, included: type II diabetes [for B/Harbin: p=0.044, OR 0.12, (CI: 0.015-0.94)], and antibody titer prior to vaccination A/(H1N1): p=0.03, OR 2.38, (CI: 1.09-5.22); A/(H3N2): p=0.015, OR 2.68 (CI: 1.22-5.92), B/Harbin: p=0.057, OR 4.46 (CI: 0.96-20.85)]. Factors that were associated with lower seroconversion CE elderly, included older age [A/(H1N1): p=0.008, OR 0.846, (CI 0.75-0.96), B/Harbin: p=0.016, OR 0.812, (CI:0.69-0.96)], and antibody titer prior to vaccination A/(H1N1): p=0.029, OR 4.08, (CI: 1.16-14.37); A/(H3N2): p<0.0001, OR 11.495 (CI: 3.18-41.55)]. There was no significant difference in seroconversion between nursing home residing elderly and community elderly. We conclude that Type-II diabetes and antibody titer>1:40 prior to vaccination are associated with reduced response to the influenza vaccination in nursing home elderly.     

The association of sociodemographic factors and patient attitudes on influenza vaccination rates in older persons

BACKGROUND: To determine how patient attitudes, beliefs, knowledge, and sociodemographic characteristics relate to influenza vaccine acceptance in an older patient population. METHODS: We conducted a mail survey of patients enrolled in a geriatrics clinic at a university-affiliated county hospital in Seattle, WA. We surveyed senior citizens' demographic background, health status, previous experiences, and beliefs about influenza and influenza vaccine. We determined the vaccination rates for influenza season 2001-2002 stratified by race, other sociodemographic factors, and attitudes toward influenza vaccination. RESULTS: Surveys were mailed to 572 enrollees in SeniorCare Clinic. Three hundred twenty-four (57%) responded to the survey, 256 (79%) of whom reported receipt of influenza vaccination. Influenza vaccination rates did not vary significantly by race in this patient population: 80% for white persons, 70% for black persons, and 84% for Asians. Receipt of vaccination was associated with survey responses that indicated a discussion about the influenza shot with a health care provider and a positive attitude toward the influenza shot. History of side effects and negative attitude toward the influenza shot were associated with failure to receive the vaccine. CONCLUSIONS: In patients served by a university-affiliated geriatrics clinic, we found no statistically significant difference in influenza vaccination rate between white persons and other racial groups. Attitudes, beliefs, knowledge, and prior experiences toward the influenza shot were predictors of influenza vaccination. Physician recommendation and patient participation strongly correlated with vaccination acceptance.     

Asthma and influenza vaccination in elderly hospitalized patients: Matched case-control study in Spain

Objectives: Influenza infection is an exacerbating factor for asthma, and its prevention is critical in managing asthmatic patients. We investigated the effect of influenza vaccination on asthmatic and non-asthmatic patients hospitalized with laboratory-confirmed influenza in Spain. Methods: We made a matched case-control study to assess the frequency of hospitalization for influenza in people aged ≥65 years. Hospitalized patients with unplanned hospital admissions were recruited from 20 hospitals representing seven Spanish regions. Cases were defined as those hospitalized due to a laboratory-confirmed influenza infection and controls were matched by age, sex, and hospital. Data were obtained from clinical records, and patients stratified by clinical asthma history. Vaccination status and asthma due to influenza infection were analyzed according to sociodemographic variables and medical risk conditions. Multivariable analysis was made using conditional logistic regression models. Results: 582 hospitalized patients with influenza (15.8% asthmatic) and 1,570 hospitalized patients without influenza (7.9% asthmatic) were included. In the multivariable conditional logistic regression using unvaccinated and non-asthmatic patients as the reference group, vaccination significantly prevented influenza in non-asthmatic patients (aOR = 0.63; 95% CI: 0.45, 0.88) and also showed a trend for a possibly protective effect in asthmatic patients (aOR = 0.79; 95% CI: 0.34, 1.81). Conclusion: Our results suggest that influenza vaccination could be a protective factor for asthmatic patients, although the results are inconclusive and further research is required. Practically, given the better clinical evolution of vaccinated asthma cases, and the lack of better evidence, the emphasis on vaccination of this group should continue.     

Brief report: Risk factors for pneumococcal vaccine refusal in adults

Background: Invasive pneumococcal disease is a significant cause of morbidity and mortality in the United States. Despite availability of an effective vaccine, many patients refuse vaccination.
Objective: To investigate patient characteristics and features of the patient–provider relationship associated with pneumococcal vaccine refusal.
Design: Case–control study using chart review.
Patients: Five hundred adults from the medical clinics of a 1,000-bed inner-city teaching hospital.
Measurements and Main Results: Independent risk factors for pneumococcal vaccine refusal included patient–provider gender discordance (odds ratio (OR)=2.09, 95% confidence interval (CI) 1.07 to 4.09); a visit to a not-usual provider at the time of vaccine offering (OR=2.26, 95% CI 1.13 to 4.49); never having received influenza vaccination (OR=7.44, 95% CI 3.76 to 14.76); prior pneumococcal vaccine refusals (OR=3.45, 95% CI 1.60 to 7.43); and a history of ever having refused health maintenance tests (OR=2.86, 95% CI 1.40 to 5.84).
Conclusions: We have identified both patient factors and factors related to the patient–provider relationship that are risk factors for pneumococcal vaccine refusal. By identifying patients at risk for pneumococcal vaccine refusal, efforts to increase vaccination rates can be better targeted.     

Correlates of hepatitis B vaccination in a high-risk population: an Internet sample

PURPOSE: We sought to identify factors associated with hepatitis B virus vaccination, including knowledge and attitudes about hepatitis vaccination, and sexual and nonsexual risk behaviors among at-risk homosexual and bisexual men. SUBJECTS AND METHODS: Internet electronic communications were used to collect data from homosexual and bisexual men from the United States, using a 31-item online questionnaire accessible for 1 month.RESULTS: The mean (+/- SD) age of the 336 respondents was 38 +/- 11 years. Nearly 42% (142) reported at least one dose of vaccine; the remainder were completely unvaccinated. About 21% (n = 71) reported having no information about hepatitis. Approximately 72% (242) of respondents reported never using condoms during oral intercourse, and 26% (n = 87) reported using condoms during less than half of their episodes of anal intercourse. In multivariate analysis, variables associated with vaccination were younger age (odds ratio [OR] 0.7 per 10-year increase in age; 95% confidence interval [CI] 0.59 to 0.84, P = 0.002), high level of knowledge about the vaccine (OR 1.4; 95% CI: 1.03 to 1.83, P = 0.007), communication with a health-care provider about hepatitis (OR 1.98; 95% CI 1.31 to 2.98, P = 0.006), and professional training that included hepatitis education (OR 2.77; 95% CI 1.7 to 4.5, P = 0.001).CONCLUSIONS: Our findings underscore the need for health care providers to emphasize vaccine efficacy and safety, and to encourage high-risk patients to receive vaccination, particularly among men at high risk based on sexual and drug use behaviors.     

Adult immunization in university-based primary care and specialty practices

The purpose of this study was to assess vaccination status of adults in primary and specialty care practices in a retrospective review of medical records from 1997 to 2000 at one university medical center. Eligible patients were aged 50 and older and had two or more visits to primary and specialty care practices (N=14,556). Outcomes were receipt of pneumococcal vaccine once, tetanus booster within 10 years, and influenza vaccine in 2 of the 3 years. Vaccination rates for patients aged 65 and older were 59% for pneumococcal, 51% for tetanus, and 32% for influenza. Asians, Latinos, and African Americans were more likely than whites to have received influenza, pneumococcal, or tetanus vaccinations. Patients seen in primary care (41%) or in both primary care and specialty practices (42%) were more likely to receive adequate vaccination than those in specialty practices (17%) (P<.001). For pneumococcal vaccinations, relative to patients receiving specialty care only, patients receiving primary care only had an adjusted odds ratios (OR) of 6.6 (95% confidence interval (CI)=5.6-7.7) and patients in both primary care and specialty care had an OR of 7.2 (95% CI=6.2-8.3). For influenza, the corresponding ORs were 3.9 and 4.8, respectively, and for tetanus, 4.6 and 5.2. Patients who received care only from specialty practices were less likely than those with some primary care to receive adequate adult vaccinations. With the exception of Russian immigrants, the study did not find that racial and ethnic minorities had lower rates of vaccination than whites.     

Factors influencing influenza vaccination among South Korean adult asthma patients: A nationwide population-based cross-sectional study

Background: It is important to identify factors associated with influenza vaccination. This study was performed to investigate factors associated with vaccination coverage among asthma patients in Korea. Methods: Data were obtained from 229,121 participants (5,989 with asthma and 223,132 without asthma) in the 2010 Korean Community Health Survey. The demographic characteristics and socioeconomic status of respondents with and without asthma were compared. Univariate and multiple logistic regression analyses were used to evaluate socioeconomic status and other demographic variables potentially related to influenza vaccination in asthma patients. Results: The vaccination rates of young (19–49 years) and middle-aged (50–64 years) asthma patients were only 28.3 and 49.5%, respectively, whereas that of elderly (≥65 years) asthma patients was 81.5%. After regression, older age (odds ratio [OR], 5.53; 95% confidence interval [95% CI], 3.56–8.59), poor self-rated health status (OR, 1.43; 95% CI, 1.01–2.03), and regular health check-ups (OR, 2.07, 95% CI, 1.64–2.60) were associated with increased influenza vaccination rates in asthma patients. Conclusions: It is important to improve influenza vaccination coverage for non-elderly patients with asthma, especially those who do not engage in regular exercise or undergo regular health check-ups and those who consider themselves to be healthy.     

Risk factors for pneumonia and other lower respiratory tract infections in elderly residents of long-term care facilities.

BACKGROUND: Little is known about the risk factors, outcome, and impact of pneumonia and other lower respiratory tract infections (LRTIs) in residents of long-term care facilities. OBJECTIVE: To determine the risk factors and the effect of these infections on functional status and clinical course. METHODS: Active surveillance for these infections was conducted for 475 residents in 5 nursing homes from July 1, 1993, through June 30, 1996. Information regarding potential risk factors for these infections, functional status, transfers to hospital, and death was also obtained. RESULTS: Two hundred seventy-two episodes of pneumonia and other LRTIs occurred in 170 residents during 228 757 days of surveillance for an incidence of 1.2 episodes per 1000 resident-days. Multivariable analysis revealed that older age (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.1-2.6 per 10-year interval; P = .01), male sex (OR, 1.9; 95% CI, 1.1-3.5; P = .03), swallowing difficulty (OR, 2.0; 95% CI, 1.2-3.3; P = .01), and the inability to take oral medications (OR, 8.3; 95% CI, 1.4-50.3; P = .02) were significant risk factors for pneumonia; receipt of influenza vaccine (OR, 0.4; 95% CI, 0.3-0.5; P = .01) was protective. Age (OR, 1.6 [95% CI, 1.0-2.5] per 10-year interval; P = .05) and immobility (OR, 2.6; 95% CI, 1.8-3.8; P = .01) were significant risk factors for other LRTIs, and influenza vaccination was protective (OR, 0.3; 95% CI, 0.2-0.4; P = .01). Residents with pneumonia (OR, 0.7; 95% CI, 0.3-1.4; P = .31) or with other LRTIs (OR, 0.5; 95% CI, 0.2-1.1; P = .43) were no more likely to have a deterioration in functional status than individuals in whom infection did not develop. CONCLUSIONS: Swallowing difficulty and lack of influenza vaccination are important, modifiable risks for pneumonia and other LRTIs in elderly residents of long-term care facilities. Our findings challenge the commonly held belief that pneumonia leads to long-term decline in functional status in this population.     

Influenza vaccination status and influenza-related perspectives and practices among US physicians

BACKGROUND AND OBJECTIVE: The influenza vaccination rate among US healthcare workers (HCWs) remains low. This survey was designed to assess influenza vaccination status and related knowledge, attitudes, and beliefs among a national sample of primary care physicians and subspecialists likely to see patients at high risk for complications from influenza. METHODS: We used a mail survey of a national random sample of 495 family physicians (FPs), 491 internists (IMs), 498 geriatricians (GERs), and 497 pulmonologists (PUDs). RESULTS: The overall response rate was 38%. Almost all respondents (87%) reported receiving an influenza vaccine during the 2003-2004 influenza season, with no significant difference across specialty groups (84% FPs, 87% IMs, 87% GERs, 91% PUDs). In a multivariate model, adjusted for physician specialty and age group, significant predictors of vaccination were: strong agreement that HCWs have professional responsibility to be vaccinated, access to vaccination on site and free of charge, strong worksite recommendation for HCWs to be vaccinated, and strong agreement that benefits of vaccination outweigh risk of side effects. CONCLUSIONS: Physicians reported a high influenza vaccination rate. To improve these rates further, with likely benefits for other HCWs, worksite policies that facilitate access to vaccination and documentation of reductions in nosocomial influenza associated with HCW vaccination should continue to be pursued.