Self-report compared to electronic medical record across eight adult vaccines: Do results vary by demographic factors?

Abstract

Immunizations are crucial to the prevention of disease, thus, having an accurate measure of vaccination status for a population is an important guide in targeting prevention efforts. In order to comprehensively assess the validity of self-reported adult vaccination status for the eight most common adult vaccines we conducted a survey of vaccination receipt and compared it to the electronic medical record (EMR), which was used as the criterion standard, in a population of community-dwelling patients in a large healthcare system. In addition, we assessed whether validity varied by demographic factors. The vaccines included: pneumococcal (PPSV), influenza (Flu), tetanus diphtheria (Td), tetanus diphtheria pertussis (Tdap), Human PapillomaVirus (HPV), hepatitis A (HepA), hepatitis B (HepB) and herpes zoster (shingles). Telephone surveys were conducted with 11,760 individuals, ≥ 18, half with documented receipt of vaccination and half without. We measured sensitivity, specificity, positive and negative predictive value, net bias and over-and under-reporting of vaccination. Variation was found across vaccines, however, sensitivity and specificity did not vary substantially by either age or race/ethnicity. Sensitivity ranged between 63% for HepA to over 90% (tetanus, HPV, shingles and Flu). Hispanics were 2.7 times more likely to claim receipt of vaccination compared to whites. For PPSV and Flu those 65+ had low specificity compared to patients of younger ages while those in the youngest age group had lowest specificity for HepA and HepB. In addition to racial/ethnic differences, over-reporting was more frequent in those retired and those with household income less than $75,000. Accurate information for vaccination surveillance is important to estimate progress toward vaccination

Correlates of influenza vaccine uptake among community-dwelling older adults in Brazil

“…In spite of this observation, we argue that previous studies considered the self-report of vaccine uptake as highly sensitive and moderately specific. 39,40 However, it is important to mention that misclassification may be related to demographic characteristics. The specificity of selfreport of influenza vaccine uptake was lower among individuals aged 65 years or more when compared with individuals of younger ages.…”

“…Moreover, under and over-reporting of vaccine uptake related to a combination of 7 vaccines were found to be associated with socioeconomic factors. 40 …”

Fatores associados à adesão à vacinação anti-influenza em idosos não institucionalizados, São Paulo, Brasil

“…Participants were asked whether they had been vaccinated in 2006, but this information was not checked against their vaccination cards or other medical and administrative records. This strategy is not free of recall bias; however, the question on vaccination was asked for the same reference year, and previous studies have provided favorable evaluation of the elderly's self-reported information on vaccination 43,44 . Since the study followed a probabilistic sampling plan, the results can be considered representative of community-dwelling elderly in the city of São Paulo.…”

Noninfluenza Vaccination Coverage Among Adults—United States, 2011

“…However, adult self-reported vaccination status has been shown to be sensitive for all six vaccines in this report and specific for all except tetanus vaccination (9). Fourth, the Tdap estimate is subject to considerable uncertainty.…”