Factors associated with continued adherence to influenza vaccination in the elderly
Highlights
► We analyzed continued adherence to influenza vaccination in the elderly. ► People previously vaccinated tend to be vaccinated in the following season. ► Recent hospitalization was associated with discontinuing vaccination. ► The treating physician was the most important factor for continuity of vaccination.
Introduction
Recommendations for preventing the morbidity and mortality due to seasonal influenza include annual vaccination of all people aged 65 and over (Fiore et al., 2010). However, the vaccine coverage reached in this population group is far from the 75% target proposed by the World Health Assembly for 2010 (Davidson et al., 2003, World Health Organization, 2003). This highlights the importance of identifying possible ways to widen coverage. Interventions to improve vaccination coverage should emphasize two points: attracting people who do not usually get vaccinated and retaining those who have been vaccinated in previous seasons.
Several studies have described the variables that are associated with influenza vaccination, including sociodemographic, clinical and physician-dependent factors (Abramson and Levi, 2008, Blank et al., 2008, Blank et al., 2009, Chiatti et al., 2011, Frank et al., 1985, Sarriá-Santamera and Timoner, 2003).
Population-based vaccination registries have been shown to be useful in identifying areas with the potential to improve vaccination coverage and in monitoring the results of vaccination campaigns (Centers for Disease Control and Prevention, 2001, Kempe et al., 2004, Rodríguez-Rieiro et al., 2010). In Navarre, Spain, this methodology showed that continual improvements in influenza vaccination coverage among persons aged 65 and over were achieved between the 2006–07 and 2009–10 seasons, but this trend was reversed between the 2009–10 and 2010–11 seasons when coverage fell from 63% to 59%, whereas there was no change in the vaccination program. Continued adherence to influenza vaccination is critical to maintaining high coverage in successive seasons in population groups for whom the vaccine is indicated. Accordingly, we proposed to analyze the factors influencing continued adherence to influenza vaccination in the 2010–11 season among non-institutionalized persons aged 65 years and over who had been vaccinated in the previous season.
Section snippets
Setting, sources of information and influenza vaccination campaign
The Regional Health Service of Navarre, Spain, provides free health care to approximately 97% of the population of the region (636,924 inhabitants). The population is distributed according to place of residence into health districts, each of which has a health care center. A team of 4 to 14 primary care physicians provides medical consultations in each center and coordinates preventive programs. An average of 1176 persons is assigned to each physician who directs all their health care. In 2004
Results
The study included the 64,245 non-institutionalized persons aged 65 and over who had been vaccinated against seasonal influenza in the 2009–10 season. Some 56% were women, and 84% were between 65 and 84 years of age, with a mean age (± standard deviation) of 76.7 (± 7.4) years. About 63% had some type of chronic disease.
Overall, 87% continued to be vaccinated against influenza in the 2010–11 season, a percentage that varied moderately depending on some of the variables analyzed. It was lower in
Discussion
The results show high continued adherence (87%) to influenza vaccination among non-institutionalized persons aged 65 and over who had received the vaccine in the previous season. The fact that the Navarre Health Service recommends the influenza vaccine and offers it free to the entire population aged 65 and over probably contributed to this high adherence, and suggests that health system factors related to patients’ access to vaccination are unlikely to have played an important part.
Despite
Conclusions
The complex nature of this issue is reflected in the multiple causes that have been identified for failure to vaccinate and calls for a multi-faceted approach to reaching unvaccinated patients. Since people vaccinated against influenza in one season are very likely to be vaccinated in the following one, particular emphasis should be put on targeting persons in whom the vacine is indicated but who have not been vaccinated previously. To maintain good adherence to influenza vaccination it is
Conflict of interest statement
The authors declare that there are no conflicts of interest.
Acknowledgments
This work was supported by the I-MOVE (Influenza Monitoring Vaccine Effectiveness in Europe) programme funded by the European Centre for Disease Prevention and Control (ECDC), by the Carlos III Institute of Health (GR09/0028 and PS09/01179) and by the Pharmacy Directorate of the Spanish Ministry of Health (EC11-302).
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