Influenza vaccination coverage against seasonal and pandemic influenza and their determinants in France: A cross-sectional survey

Department of infectious diseases, Institut de Veille Sanitaire, French Institute for Public Health Surveillance, Saint-Maurice, France.
BMC Public Health (Impact Factor: 2.26). 01/2011; 11(1):30. DOI: 10.1186/1471-2458-11-30
Source: PubMed


Following the emergence of the influenza A(H1N1)2009 virus, the French ministry of health decided to offer free vaccination against pandemic influenza to the entire French population. Groups of people were defined and prioritised for vaccination.
We took a random sample of the population of mainland France and conducted a retrospective cross-sectional telephone survey to estimate vaccination coverage against seasonal and pandemic influenza and to identify determinants of these vaccinations.
10,091 people were included in the survey. Overall seasonal influenza vaccination coverage (IVC) remained stable in the population from the 2008-2009 season to the 2009-2010 season reaching 20.6% and 20.8% respectively. Overall pandemic IVC in the French population is estimated to be 11.1% (CI95%: 9.8 - 12.4). The highest pandemic IVC was observed in the 0-4 years age group. For individuals with health conditions associated with higher risk of influenza, pandemic IVC was estimated to be 12.2% (CI95%: 9.8 - 15.1). The main determinants associated with pandemic influenza vaccine uptake were: living in a household with a child < 5 years ORadj: 2.0 (CI95%: 1.3 - 3.1) or with two children < 5 years or more, ORadj: 2.7 (CI95%: 1.4 - 5.1), living in a household where the head of the family is university graduate (>2 years), ORadj: 2.5 (CI95%: 1.5 - 4.1), or has a higher professional and managerial occupation, ORadj: 3.0 (CI95%: 1.5 - 5.5) and being vaccinated against seasonal influenza, ORadj: 7.1 (CI95%: 5.1 - 10.0). Being an individual with higher risk for influenza was not a determinant for pandemic influenza vaccine uptake. These determinants are not the same as those for seasonal influenza vaccination.
Overall A(H1N1)2009 influenza vaccine uptake remained low, particularly among individuals with higher risk for influenza and was lower than that observed for seasonal influenza. The reasons behind people's reluctance to be vaccinated need to be investigated further.

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    • "This result is consistent with the fact that seasonal vaccine recommendations did not change throughout this period. Unchanged seasonal coverage rates were also observed in an elderly population in France [24]. "
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    ABSTRACT: Vaccination is the key measure available for prevention of the public health burden of annual influenza epidemics. This article describes national trends in seasonal influenza vaccine (IV) coverage in Portugal from 1998/99 to 2010/11, analyzes progress towards meeting WHO 2010 coverage goals, and addresses the effect of major public health threats of the last 12 years (SARS in 2003/04, influenza A (H5N1) in 2005/06, and the influenza A (H1N1)2009 pandemic) on vaccination trends. The National Institute of Health surveyed (12 times) a random sample of Portuguese families. IV coverage was estimated and was adjusted for age distribution and country region. Independence of age and sex coverage distribution was tested using a modified F-statistic with a 5% significance level. The effect of SARS, A (H5N1), and the A (H1N1)2009 pandemic was tested using a meta-regression model. The model was adjusted for IV coverage in the general population and in the age groups. Between 1998/99 and 2010/11 IV, coverage in the general population varied between 14.2% (CI 95%: 11.6%--16.8%) and 17.5% (CI 95%: 17.6%--21.6%). There was no trend in coverage (p = 0.097). In the younger age group (<15 years) a declining trend was identified until 2008/09 (p = 0.005). This trend reversed in 2009/10. There was also a gradual and significant increase in seasonal IV coverage in the elderly (p for trend < 0.001). After 2006/07, IV coverage remained near 50%. Adjusting for baseline trends, there was significantly higher coverage in the general population in 2003/04 (p = 0.032) and 2005/06 (p = 0.018). The high coverage observed in the <15-year age group in season 2009/10 was also significant (p = 0.015). IV coverage in the elderly population displayed an increasing trend, but the 75% WHO 2010 target was not met. This result indicates that influenza vaccination strategy should be improved to meet the ambitious WHO coverage goals. The major pandemic threats of the past decade had a modest but significant effect on seasonal influenza vaccination. There was an increase in vaccine uptake proportion in the general population in 2003/04 and in 2005/06, and in individuals <15 years old in 2009/10.
    BMC Public Health 12/2013; 13(1):1130. DOI:10.1186/1471-2458-13-1130 · 2.26 Impact Factor
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    • "Of the PHCWs vaccinated in any previous season, 29.8% had not been vaccinated in the 2011–2012 season. The steepest decline in coverage was recorded in the two post-pandemic seasons, which could be explained by a rebound effect after the disappearance of the pandemic alert and by the rejection of the 2009 pandemic vaccine by some health workers (Arda et al., 2011; Rachiotis et al., 2010; Sánchez-Payá et al., 2012; Vaux et al., 2011). However, this trend goes back at least to the 2008–2009 season and has continued through the 2011–2012 season, which could also suggest that there may be causes unrelated to the pandemic. "
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    ABSTRACT: To evaluate trends in seasonal influenza vaccination coverage in primary healthcare workers (PHCWs) in Spain between 2008 and 2011. METHODS: We made an anonymous web survey of PHCWs in 2012. Information on attitudes towards and knowledge of influenza vaccine, and immunization in previous seasons was collected. Self-reported vaccination coverage and factors related to vaccination continuity were analysed. RESULTS: Of 5433 workers contacted, 2625 (48.3%) responded to the survey: 47.0% were general practitioners, 10.3% paediatricians and 42.7% nurses. Their reported vaccination rates from seasons 2008-2009 to 2011-2012 decreased over time: 58.4%, 57.4%, 53.2% and 49.3% (linear trend, p<0.001). Among workers vaccinated in any previous season, 70.2% were vaccinated again in 2011-2012, compared with 5.2% among those not previously vaccinated (p<0.001). Continuity of vaccination increased with age and with the worker or cohabitant having a major chronic condition. Vaccination was higher in workers who recognized vaccination as effective and those worried about being infected or infecting patients. CONCLUSION: Influenza vaccination coverage in PHCWs has declined, especially after the pandemic. Intensive interventions are needed to change this trend. Knowledge of vaccination should be reinforced by stressing the effectiveness of the vaccine and the risks of influenza for workers and patients.
    Preventive Medicine 09/2013; 57(3):206-11. DOI:10.1016/j.ypmed.2013.05.021 · 3.09 Impact Factor
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    • "The analysis of determinants in the target groups showed that VC for seasonal influenza in 2010–2011 was related to previous vaccinations and the number of risk factors for severe influenza illnesses. This significant association between vaccine uptakes was shown previously [31]. "
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    ABSTRACT: Background Three main categories of persons are targeted by the French influenza vaccination strategy: all persons aged 65 years or over, those aged less than 65 years with certain underlying medical conditions and health care workers. The main objective of this study was to estimate rates of influenza immunization in these target groups attending a medical consultation for two consecutive influenza seasons: 2009–2010 (seasonal and pandemic vaccines) and 2010–2011 (seasonal vaccine). Methods A standardized questionnaire was mailed to 1323 general practitioners (GPs) of the Sentinelles Network, collecting data on all patients seen on a randomly assigned day. For every patient, following information was collected: age, gender, BMI, presence of any medical condition that increases risk of severe influenza illness, and vaccination status for the three vaccines mentioned. Results Two hundred and three GPs agreed to participate and included 4248 patients. Overall, in persons with high risk of severe influenza, the estimated vaccine coverages (VC) were 60%, (95% CI = 57%; 62%) for the seasonal vaccine in 2010–2011, 61% (59%; 63%) for the seasonal vaccine in 2009–2010 and 23% (21%; 25%), for the pandemic vaccine in 2009–2010. Among people aged 65 years and over (N=1259, 30%) VC was estimated for seasonal vaccines at 72% (70%; 75%) in 2010–2011 and 73% (71%; 76%) in 2009–2010, and 24% (22%; 26%) for the pandemic vaccine. The lowest seasonal VC were observed in younger persons (<65 years) with underlying medical conditions, in particular pregnant women (<10%) and overweight persons (<30%). Conclusions Our study shows that influenza vaccination coverage among patients of the French Sentinelles general practitioners remains largely below the target of 75% defined by the 2004 French Public Health Law, and underscores the need for the implementation of public health interventions likely to increase vaccination uptake.
    BMC Public Health 03/2013; 13(1):246. DOI:10.1186/1471-2458-13-246 · 2.26 Impact Factor
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