Influenza immunization; vaccine offer, request and uptake in high-risk patients during the 1991/2 season

Abstract

SUMMARYCurrent levels of influenza vaccine uptake in patients considered to be at high risk have been determined by means of a questionnaire survey. During March-April 1992, information was sought from 624 patients in Leicestershire, UK with either chronic cardiovascular or respiratory disease, or diabetes; questions related to current health status and the request, offer and receipt of influenza vaccine in the current and three previous seasons. Ninety-eight percent of all offers of immunization were made in the primary care setting, and vaccine was well tolerated as judged by the fact that 86 % of vaccinees between 1988/9-1990/1 returned for immunization in the following year. However in the 1991/2 season the overall level of vaccine uptake was only about 41 % which is at variance with the stated policies and practices of general practitioners. Opportunities were missed, in both hospitals and general practices, to publicise and offer immunization to individuals with vaccine indications. Future attempts to improve vaccine uptake should focus on increasing the role of hospital staff in influenza prevention, in addition to promoting better vaccine delivery through primary care.

Prevalence of influenza immunisation in Australia and suggestions for future targeting of campaigns

“…For the older age group 90 % of those immunised in 1999 were again immunised in 2000. A high prospective return rate for immunisation has also been reported previously (Nguyen- Van-Tham & Nicholson 1993, Chapman & Coups 1999. If this is a continuous feature of immunisation decision making for the at-risk population, then it would seem that the initial decision to accept immunisation is important.…”

“…Between state differences indicate room for improvement on the part of specific states, nevertheless all states need to make further progress in the level of influenza vaccination coverage. It is however, important to point out that the immunisation rate in Australia appears to be higher than that internationally (Nguyen- Van-Tham & Nicholson 1993;Pregliasco et al 1999; Centres for Disease Control 1988). The second conclusion to be reached is that there is some concurrence between the multivariate associations for both target groups.…”

“…These can be divided into two major clusters of factors. The first cluster relates to the existence and perceived value of a health practitioners' recommendations to immunise and their influence on peoples' decision to seek immunisation (Fiebach&Viscoli 1991;Williams et al 1988;Nguyen-Van-Tham & Nicholson 1993;Nichol et al 1996;Honkanen et al 1996, Litt & Lake 1993. The second cluster relates to the individual's perception of influenza risk and vaccine efficacy.…”

Influenza vaccine in the elderly and chronic obstructive pulmonary disease

“…A stratified, randomized, double-blind, placebo-controlled trial in 2004 in Thailand revealed that the effectiveness of influenza vaccination was not modified by the severity of chronic obstructive pulmonary disease (COPD; mild, moderate, severe) [18••]. The concern among practitioners that influenza vaccine may induce acute exacerbations in those with COPD has contributed to suboptimal rates of vaccine uptake in this group [19,20]. A population-based cohort study of 12,000 elderly individuals with COPD or asthma in 2003 found no increased risk of adverse acute outcomes in the first 2 weeks after influenza vaccination [21].…”

BTS Guidelines for the Management of Community Acquired Pneumonia in Adults

“…Uptake of influenza immunisation by those for whom it is recommended is low in many countries347 348[ III ]. Patients are often concerned about side effects and both doctors and patients may have doubts about the protective efficacy of the vaccine.…”