[Not Available]

The provision of pharmaceutical advice improves patient vaccination status

Aim

To increase vaccination rates in the wealthy industrial nation of Germany. For a variety of reasons there is a substantial deficit in the number of individuals who receive vaccinations in comparison with other industrialized countries.

Methods

In Autumn 2003, a regional vaccination consultation was initiated over a five-week period. Individuals involved in the study provided general information, including their age, health status, and vaccination records, and received an extensive consultation in a pharmacy in Jena, Germany. Participants were provided with a written overview of their vaccination status. After approximately five weeks, the vaccination status of each individual was recorded.

Results

312 of 2500 patients received intensive vaccination education based on their accompanying vaccination documentation. Older individuals, who are known for having the largest vaccination gap in Germany, represented the highest percentage of people who used this service. The five most commonly required vaccinations had increased significantly, five weeks after the consultation. These vaccination rate increases included diphtheria, which rose from 55.8 to 71.2%, tetanus, which rose from 73.1 to 86.5%, influenza, which rose from 46.5 to 74.7%, pneumococcal, which rose from 32.4 to 62.8%, and tick-borne encephalitis, which rose from 31.9 to 42.4% (all p<0.008).

Conclusions

Well structured vaccination consultations help to raise vaccination rates. Thus, pharmacies should consider offering and implementing this preventive measure so as to lower the rates of preventable disease and to save costs.

[Practical problems by implementation of vaccination recommendations]

Patients with inflammatory rheumatic diseases are known to have an increased risk of infections due to the rheumatic disease itself and due to therapy with immunosuppressive agents. The most important procedure to prevent infections is vaccinations, which are usually well-tolerated. The German National Commission for Immunization ( STIKO) has published recommendations for patients with an immunodeficiency. The German Society of Rheumatology (DGRh) has generally implemented these recommendations for patients with chronic inflammatory rheumatic diseases. The immunization status of patients with rheumatic diseases is of increasing importance in routine patient care because some of the recently approved drugs may influence the strength of the immune response to vaccination. However, there is almost no information about the current immunization status and the willingness of patients with rheumatic diseases to undergo vaccination procedures in Germany. There are also no epidemiologic data on the implementation of recommendations for immunization at the level of general practitioners. Here we present the results of a prospective study on the efficacy of standardized recommendations for immunization given to different patient groups with rheumatic diseases treated in a hospital specialized in rheumatology.

Vaccination coverage in immunosuppressed patients: results of a regional health services research study

BACKGROUND

Patients with chronic inflammatory diseases are at elevated risk of infections that can be prevented by vaccination. This elevated risk is due not just to these patients' primary illnesses, but also to the immunosuppressive treatment that they often receive. We studied the vaccination rate in a random sample of patients with two types of inflammatory bowel disease (IBD), namely, Crohn's disease and ulcerative colitis. In particular, we asked unvaccinated patients why they had re-fused the vaccine.

METHODS

From April to September 2009, we gave a 38-item questionnaire to 203 consecutive patients with IBD (57% with Crohn's disease, 63% female, median age 36 years) who had not received vaccination counseling for at least one year, and inspected the patients' vaccination cards. We compared the findings to the current recommendations of the German Federal Standing Committee on Vaccination (Ständige Impfkommission).

RESULTS

83% of the patients had a vaccination card. Substantial deficiencies in vaccination were found. Only 67% of the patients had been immunized against tetanus in the previous 10 years, and only 21% against pertussis. Only 28% were vaccinated against seasonal influenza in 2008, and only 9% had ever received anti-pneumococcal vaccine. A subgroup analysis in which we compared 39 patients taking TNF-blockers to 67 patients who never had any type of immunosuppressive treatment revealed no difference in vaccination rates. 80% of all patients said they were willing to receive all of the officially recommended vaccinations. 22% of all patients said they avoided vaccinations for fear of side effects, while 15% said they did so because their immune system was supposedly "not intact", and 9% because they feared vaccination would worsen their IBD.

CONCLUSION

In this random sample, the vaccination rate fell far behind the recommendations. In particular, there was a marked discrepancy between patients' willingness to be vaccinated and the actual provision of vaccination. These findings imply that physicians need to be more aware of the possibly inadequate vaccination state of their immunosuppressed patients.

[Immunization in children and adolescents with rheumatic diseases]

Vaccinations represent a special problem in children and adolescents with inflammatory rheumatic diseases. There are very limited data on the safety and efficacy of vaccines in these patients, and guidelines for immunization are missing. The immunosuppressive therapy often necessary for these patients gives rise to additional uncertainty. In addition, many colleagues consider vaccination to increase the risk of relapse of the rheumatic illness. As a consequence, there are substantial variations in practicing vaccination in these patients, resulting in insufficient vaccination coverage rates. For example, every third patient with juvenile idiopathic arthritis is incompletely vaccinated; this even includes toxoid vaccines for tetanus and diphtheria. The benefit of vaccinations, which far outweighs their potential risks, is well recognized even in patients with autoimmune diseases. These patients in particular require a special protection from infections due to their immunosuppressive therapies. Therefore, children and adolescents with rheumatic diseases should be immunized according to the Standing Immunization Commission of the Robert Koch Institute recommendations whenever possible. However, the time of vaccination must be carefully selected, taking disease activity and treatment into account.

Increasing coverage and efficiency of measles, mumps, and rubella vaccine and introducing universal varicella vaccination in Europe: a role for the combined vaccine

Universal mass vaccination according to a 2-dose measles-mumps-rubella (MMR) vaccine schedule is recommended by the World Health Organization and is fundamental to the control of these important diseases. Very high coverage (first dose, > or =95%; second dose, > or =80%) is necessary to achieve and sustain high population immunity, and eventually interrupt indigenous transmission of these diseases. In 2006, the Advisory Committee on Immunization Practices issued a recommendation for 2 doses of varicella vaccine to be given universally to children. Coadministration of MMR and varicella vaccines, though efficacious and well tolerated, can be difficult because of the 2 separate injections and associated compliance issues. In addition to the general advantages of a combined vaccine, recently registered measles-mumps-rubella-varicella (MMRV) vaccines could facilitate introduction of varicella universal mass vaccination by simplifying administration and providing the potential to achieve high coverage rates for these 4 diseases.

Durchimpfung und Determinanten des Impfstatus in Deutschland

The level of childhood immunisation is an acknowledged indicator for health prevention. In Germany, vaccination is not compulsive. Continuous representative data derive only from school health examinations. From May 2003 until May 2006 the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) was conducted and vaccination information on 16,460 participants was obtained. Using data on the vaccination cards, it was possible to make detailed analyses of vaccination coverage in children up to the age of 17. Different vaccine types were taken into consideration in defining the term 'immunisation coverage'. The average prevalence of full immunisation for tetanus, diphtheria und polio as well as the coverage for the first dose of measles, mumps and rubella (MMR) vaccination was above 90% in children aged 2-17 years. Vaccination coverage for pertussis, Hib and hepatitis B is higher in younger than in older age groups. Compliance with the recommendation to have a second MMR dose and to make up of hepatitis B and pertussis immunisation is still low, especially in adolescents. In 7- to 17-year-old children the additional booster (recommended for 5- to 6-year-old children) is frequently missing.

Susceptibility to diphtheria in adults: prevalence and relationship to gender and social variables

Recent outbreaks of diphtheria have drawn attention to the re-emergence of this disease. This study investigated susceptibility to diphtheria in north-east Germany and its relationship to gender and social factors. A study population of 4275 individuals recruited for the population-based Study of Health in Pomerania (SHIP) was available for analysis. IgG antibodies against diphtheria toxin were determined by ELISA and were used to define susceptibility to diphtheria (i.e., IgG titres < 0.1 IU/mL). The prevalence of susceptibility to diphtheria was 32.4%. Multivariate analysis revealed 45% increased odds of women being susceptible to diphtheria. Women who had not received diphtheria toxoid vaccination during the previous 10 years had four-fold increased odds of being susceptible to diphtheria toxin compared with unvaccinated men. None of the social factors investigated was associated with susceptibility status. It was concluded that a high proportion of middle-aged adults was susceptible to diphtheria. Women lacked seroprotection more often than men, which might be explained, in part, by gender-specific immune responses following vaccination. There is a need for information campaigns to improve public awareness of these problems.

Measles, mumps, rubella vaccine (Priorix; GSK-MMR): a review of its use in the prevention of measles, mumps and rubella

GSK-MMR (Priorix) is a trivalent live attenuated measles, mumps and rubella (MMR) vaccine which contains the Schwarz measles, the RIT 4385 mumps (derived from the Jeryl Lynn mumps strain) and the Wistar RA 27/3 rubella strains. GSK-MMR as a primary vaccination demonstrated high immunogenicity in clinical trials in >7500 infants aged 9-27 months, and was as immunogenic as Merck-MMR (MMR II). However, antimumps seroconversion rates and geometric mean titres (GMTs) were significantly higher in infants receiving GSK-MMR compared with Berna-MMR (Triviraten trade mark ) recipients. Coadministration of GSK-MMR with a varicella vaccine (Varilrix; GSK-MMR/V) did not significantly affect the immunogenicity of GSK-MMR. A persistent immune response to GSK-MMR has been demonstrated in follow-up data from several randomised trials. GMTs for measles, mumps and rubella antibodies remained high in GSK-MMR recipients 1-2 years post-vaccination and were similar to those in Merck-MMR recipients. The immunogenicity of GSK-MMR was high, and similar to that of Merck-MMR, when used as a second dose in children aged 4-6 or 11-12 years who had received a primary vaccination with Merck-MMR in their second year of life. Although there are no protective efficacy data concerning the GSK-MMR vaccine to date, the rubella Wistar RA 27/3 rubella and Schwarz measles strains have well established protective efficacy; the new RIT 4385 mumps strain is expected to afford similar protection from mumps to that achieved with mumps vaccines that contain the Jeryl Lynn mumps strain (e.g. Merck-MMR). GSK-MMR was well tolerated as a primary or secondary vaccination, and in most clinical studies comparing GSK-MMR with Merck-MMR as a primary vaccination in infants, GSK-MMR was associated with significantly fewer local adverse events (e.g. pain, swelling and redness). The incidence of local adverse events with GSK-MMR, GSK-MMR/V or Berna-MMR was similar. GSK-MMR and Merck-MMR were associated with similar rates of fever, rash and parotid gland swelling, but Berna-MMR was associated with a lower incidence of fever. In conclusion, GSK-MMR is a highly immunogenic MMR vaccine with good tolerability. In clinical trials, the immunogenicity of GSK-MMR was similar to that of Merck-MMR, and the mumps component was more effective at eliciting seroprotection than that of Berna-MMR. Furthermore, GSK-MMR causes fewer injection-site adverse events than Merck-MMR. As such, GSK-MMR is an attractive alternative for immunisation against measles, mumps and rubella.