Factors driving choices between types and brands of influenza vaccines in general practice in Austria, Italy, Spain and the UK

Abstract

Influenza vaccine effectiveness (IVE) assessment is increasingly stratified by vaccine type or brand, such as done by the European network of DRIVE. In 2019/2020, eleven influenza vaccines were licensed in Europe. If more than one vaccine type is recommended or if more than one vaccine brand is available for a specific risk group, it is not clear which factors affect the choice of a specific vaccine (type or brand) by a health practitioner for individual patients. This is important for IVE assessment. A survey tailored to the 2019/20 local vaccine recommendations was conducted among GPs in four European countries (Austria, Italy, Spain, UK) to understand how influenza vaccine is offered to recommended risk groups and, if GPs have a choice between 2 or more vaccines, what factors influence their vaccine choice for patients. Overall, 360 GPs participated. In Austria, Italy and Spain GPs indicated that influenza vaccines are commonly offered when patients present for consultation, whereas in the UK all GPs indicated that all relevant patients are contacted by letter. In Austria and Italy, roughly 80% of GPs had only one vaccine type available for patients <65y. The use of any specific vaccine type in this age group is mostly determined by the availability of specific vaccine type(s) at the clinic. GPs frequently reported availability of more than one vaccine type for patients ≥65y in Austria (45%), Italy (70%) and Spain (79%). In this group, patient characteristics played a role in choice of vaccine, notably older age and presence of (multiple) comorbidities. Knowing that a non-patient related factor usually determines the vaccine type a patient receives in settings where more than one vaccine type is recommended for risk groups <65y, simplifies IVE assessment in this age group. However, patient characteristics need careful consideration when assessing IVE in those ≥65y.

Rollout of the 2022/2023 Seasonal Influenza Vaccination and Correlates of the Use of Enhanced Vaccines among Italian Adults

“…This study was among the first to investigate determinants of the use of the so-called “enhanced” influenza vaccines, and may be of interest for policymakers, since it was conducted in a region in which all SIV types were available to a significant extent, and in a season in which no national preferential recommendation [ 12 ] for either specific SIV type was in place. The choice of a more appropriate SIV type for older adults is still controversial, and recommendations issued by different countries differ [ 14 , 25 , 37 , 38 , 39 ]. As we mentioned earlier, both hdQIV and aQIV are preferentially recommended in the US [ 14 ].…”

“…Conversely, in Canada and Germany, only hdQIV is preferentially recommended to the elderly, and this recommendation is primarily based on the available experimental evidence of the superior efficacy of hdQIV over QIVe [ 25 , 37 ]. Still other countries have no explicit guidelines on the choice between several SIV types [ 39 ]. These latter countries could point to a higher SIV uptake at a lower overall SIV campaign cost [ 40 ].…”

“…Mannino et al [ 42 ] reported that many Italian GPs recommended aTIV to more frail, older adults, such as the oldest and those with multiple co-morbidities. Similarly, a survey by Stuurman et al [ 39 ] documented that apart from vaccine availability issues, older age and the presence of multiple health conditions are the key factors that influence the choice of a particular SIV type by GPs in Italy and some other European countries. Specifically, only 69.8% of Italian GPs had more than one SIV type available for older adults, and some of them pointed out insufficient numbers of aTIV doses provided by local health authorities.…”

“…Specifically, only 69.8% of Italian GPs had more than one SIV type available for older adults, and some of them pointed out insufficient numbers of aTIV doses provided by local health authorities. GPs also declared that compared with older adults aged ≥ 75 years, aTIV was less frequently administered to adults aged 65–74 years (85.5% vs. 50.7%) [ 39 ]. In this regard, it should be stressed that eQIVs provide consistently high protection across different age and co-morbidity subgroups.…”