Audit of influenza and pneumococcal vaccination uptake in diabetic patients attending secondary care in the Northern Region

Current Vaccination Practice in Diabetic (Diabetes I) Patients

The worldwide prevalence of diabetes, an endocrine condition, is rising quickly. The alarming rise of diabetes in recent years has emerged as a major contributor to premature death and illness among persons of working age. The potential use of immunomodulatory drugs to prevent diabetes has been a source of worry in light of recent advances in our understanding of the role of autoimmune responses in the development of diabetes. Vaccines can work in a variety of ways, including by eliminating autoreactive T-cells or by blocking the connections between immune cells. Most diabetes vaccines that have been created so far have only been evaluated in animal models, with just a small number having undergone successful human trials. In this article, the authors also look at the clinical trial research that are currently being conducted to create a prototype diabetes vaccine.

Vaccination coverage of patients with type 2 diabetes mellitus: Challenging issues from an outpatient secondary care setting in Greece

Background

Increased morbidity/mortality due to vaccine preventable diseases (VPD) is encountered in type 2 diabetes (T2D) people. Aim of this study was to assess their vaccination coverage and describe trends possibly affecting compliance.

Methods

Information on vaccination coverage was retrieved from either documents or interview provided by patients, and/or their vaccination record card at a specialized outpatient diabetes center. The selection of the patients was arbitrary.

Results

An increasing vaccination rate for influenza was observed from 2018 to 2020 among 372 participants. The vaccination coverage for S.pneumoniae was 67.2% (PCV13), 20.4% (PPSV23), 26.3% for herpes zoster in individuals ≥60 years, 1.9% for tetanus-diphtheria-pertussis and 1.1% for hepatitis B. A 10.2% of participants were found to be unvaccinated. Vaccination uptake for influenza and PCV13 was related to age, ≥3 comorbidities and long-term follow-up. T2D individuals consecutively vaccinated for influenza were 3.78 times more likely to be also vaccinated with PCV13.

Conclusions

Vaccination rates of patients with T2D show an increasing trend, especially for influenza and S. pneumoniae, although the one for S. pneumoniae was low. Older people seem more prone to vaccination, the one for herpes zoster was low with infected patients remaining unvaccinated while significantly low coverage was observed for other VPDs. The findings are important to improve effectiveness of preventative services.

Assessing Vaccine Protection for Older Adults with Diabetes: A Systematic Review

Immunosenescence and comorbidities increase the susceptibility of older adults with diabetes mellitus (DM) to vaccine-preventable diseases, hospitalization, disability, or death. This systematic review synthesizes research on protecting older adults with DM during pandemics, exploring vaccine safety, tolerance, and vaccination uptake by older adults in anticipation of seasonal influenza outbreaks during the current COVID-19 threat. Addressed were: (a) age-related factors influencing the effectiveness of vaccines against infectious disease in older adults; (b) vaccine safety, tolerance, effectiveness for older persons with DM; and (c) issues affecting older adults accepting immunization recommendations. Medline and CINAHL databases yielded 214 studies with 43 meeting inclusion criteria (32 descriptive and 11 controlled trials). Findings show altered glycemic control stimulates proinflammatory mediators, increasing infection risk, vaccines, and annual revaccinations safely reduce hospitalization rates, mortality outcomes, without affecting glycemic control. However, vaccines fail to evoke optimal antibody responses in older adults. Unawareness, fear of side effects, tend to lower vaccination participation.

Vaccination adherence to influenza, pneumococcal and hepatitis B virus in adult type 1 diabetes mellitus patients

AIM

To document adherence to influenza, pneumococcal and hepatitis B virus (HBV) vaccination programme in adult type 1 diabetes mellitus (T1DM) patients.

MATERIALS AND METHODS

Observational retrospective study using data obtained from computerized clinical records. We contacted all adult T1DM registered in our database from a tertiary diabetes care hospital. Primary efficacy outcome was to describe influenza, pneumococcal and HBV vaccination status.

RESULTS

Three hundred patients were analyzed (male 53%). Mean age was 40.0±14.4years and T1DM duration was 19.7±11.8years. Thirty-five percent of the patients had complementary indications for studied vaccines. Adherence to vaccination program for influenza, pneumococcal and HBV was achieved by 55%, 18% and 17% of the patients, respectively. Only 3% of the subjects were vaccinated against the three microorganisms. Predictor of correct vaccination were: age, shorter diabetes duration, insulin pump treatment, better diabetes control and being a health professional. We detected 17 sick leaves, 127 lost working days and 3 hospitalizations due to flue during the follow-up.

CONCLUSIONS

The uptake of recommended vaccinations against influenza, pneumococcal and HBV in adult T1DM patients was below desirable levels. A special effort is required to all health professionals to implement immunization among adult people with T1DM. Clinical Trials NCT03478254.

Prevalence of influenza and pneumococcal vaccine uptake in Saudi type 2 diabetic individuals

Introduction:

Individuals with diabetes are at particularly at high risk for many of the negative health consequences associated with influenza and pneumococcal infections. This study aimed to determine the prevalence of influenza and pneumococcal vaccination among a population of type 2 diabetic patients in Saudi Arabia and to determine the factors associated with vaccine uptake.

Methods:

A cross-sectional survey was conducted among patients with type 2 diabetes at Security Forces Hospital, Riyadh in Saudi Arabia. The survey asked basic demographic questions as well as questions about awareness, vaccination status, and beliefs about the influenza and pneumococcal vaccines.

Results:

From a total number of 422 responses, 360 participants were ultimately included in the final sample. The overall prevalence of influenza and pneumococcal vaccination in this population were 47.8% and 2.8%, respectively. In general, there was a very low awareness of the pneumococcal vaccine. Older individuals, unmarried individuals, those with less education, and those living with certain chronic conditions were less likely to have gotten the influenza vaccine. Beliefs in the importance of vaccination for people with diabetes, the efficacy of the influenza vaccine, and not being worried about the side effect of the vaccine were strongly associated with having received the vaccine.

Conclusions:

Attention should be given to increasing awareness of the pneumococcal vaccine among people living with diabetes. Particular consideration should also be paid to increasing access and awareness to both vaccines among those groups that have the lowest prevalence of vaccination and may be at the highest risk for the negative consequences associated with these infections. Finally, education interventions should be used to increase the understanding of the safety and efficacy of the influenza vaccine.

Factors associated with pneumococcal vaccination in 2040 people with type 2 diabetes: A cross-sectional study

AIMS

Pneumococcal vaccination is recommended in diabetes because of the high risk for invasive pneumococcal disease and mortality; however, vaccination rates are below recommended targets. This study was conducted to identify possible reasons behind the low rate of vaccine uptake.

METHODS

We examined baseline information from the Alberta Caring for Diabetes study, a prospective cohort study of 2040 adults with type 2 diabetes. Patients were recruited between December 2011 and December 2013. The baseline survey collected information on a wide range of socio-demographic characteristics, disease and management information, as well as health status measurements and health service utilization. Multivariable logistic regression analyses were conducted to identify factors associated with self-reported pneumococcal vaccination status.

RESULTS

Mean age was 64 (SD 11) years, 45% were women, mean duration of diabetes was 12 (SD 10) years, and 1090 (53%) were vaccinated. Age≥65 years (adjusted odds ratio [aOR] 2.52; 95% CI: 1.98-3.20), respiratory disease (aOR 1.50; 95% CI: 1.17-1.93), and cancer (aOR 1.45; 95% CI: 1.08-1.94) were independently associated with pneumococcal vaccination. In addition, women, retirees, people with diabetes≥10 years, people using antihypertensive medications or insulin, and those who had their HbA_1c, kidney function, or their weight or waist circumference measured by a healthcare professional in the past year were more likely to have been vaccinated.

CONCLUSION

Based on this information, future programs aimed at people aged<65 years old, men, those who are currently working, those recently diagnosed with diabetes, and those with few comorbidities could have the most potential for improving pneumococcal vaccine uptake in people with diabetes.

The coverage rates for influenza vaccination and related factors in Korean adults aged 50 and older with chronic disease: based on 2016 Community Health Survey data

OBJECTIVES

This study aims to identify the coverage rates for influenza vaccination and related factors depending on chronic disease in Korean adults aged 50 and older.

METHODS

The 2016 Korea Community Health Survey was used for analysis. Chi-square test was performed to investigate the coverage rates for influenza vaccination depending on chronic disease, and a multiple logistic regression analysis was used to identify the factors associated with influenza vaccination, by chronic disease.

RESULTS

In men with ≥1 chronic disease, 39.8% of 50-64 years of age, and 86.8% of elderly (over 65 years of age) received influenza vaccination. In women with ≥1 chronic disease, 58.7% of 50-64 years of age, and 89.9% of elderly (over 65 years of age) received influenza vaccination (p<0.001). The chronic diseases associated with influenza vaccination were hypertension (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.19 to 1.37), diabetes (OR, 1.41; 95% CI, 1.28 to 1.55) in men aged 50-64, hypertension (OR, 1.34; 95% CI, 1.20 to 1.49), diabetes (OR, 1.17; 95% CI, 1.02 to 1.33), chronic cardiovascular disease (OR, 1.31; 95% CI, 1.07 to 1.60) in elderly (over 65 years of age). In women aged 50-64, hypertension (OR, 1.39; 95% CI, 1.30 to 1.49), diabetes (OR, 1.51; 95% CI, 1.35 to 1.68), chronic cardiovascular disease (OR, 1.31; 95% CI, 1.05 to 1.64), and hypertension (OR, 1.55; 95% CI, 1.40 to 1.71), diabetes (OR, 1.27; 95% CI, 1.12 to 1.43) in elderly (over 65 years of age).

CONCLUSIONS

Populations in aged 50-64 are recommendation subject for vaccination or classified as high-risk group in case with chronic disease. Though subject over 60 years old is age close to the elderly, the coverage rates for vaccination was low. It is necessary to devise strategies to raise the coverage rates for vaccination.

Flu vaccination among patients with diabetes: motives, perceptions, trust, and risk culture - a qualitative survey

Background

Vaccination against seasonal influenza (SIV) is recommended for patients with diabetes, but their vaccination coverage is unsatisfactory in France and elsewhere. This qualitative survey of people with diabetes sought to explore 1) the extent to which SIV-related behaviour is more or less automatic; 2) reasons they choose/reject SIV; 3) their trust/distrust in authorities, science, and medicine.

Methods

We conducted semi-structured in-depth interviews of 19 adults with diabetes in 2014. We recruited them through physicians or patient associations and implemented an analysis of thematic content.

Results

Eight patients were vaccinated against flu in the preceding flu season and 11 were not. SIV uptake and refusal were stable over time and justified by multiple arguments. Coupons for free vaccines and regular doctor visits contributed to the habit of vaccination. Vaccination decisions were frequently anchored in past experiences of influenza and its vaccine. Patients often justified non-vaccination with attitudes of trivialisation/relativisation of influenza-associated risks and the perception that these can be controlled by means other than vaccination (e.g., through the avoidance of exposure). Some misbeliefs (e.g., SIV causes influenza) and doubts about SIV effectiveness and safety also existed. Several patients reported increased mistrust of SIV since the A/H1N1 pandemic in 2009. Patients trusted their doctors strongly regardless of their SIV behaviour, but unvaccinated patients had little trust in the government and pharmaceutical companies. Some discordances were found between perceptions and behaviour (e.g., remaining vaccinated despite doubts about SIV effectiveness or remaining unvaccinated despite feelings of vulnerability towards influenza complication), suggesting the existence of some vaccine hesitancy among patients.

Conclusion

This study among patients with diabetes suggest that SIV uptake is stable, thanks to a favourable environment. Nonetheless, SIV refusal is also stable over time. Unvaccinated patients used multiple arguments to justify SIV refusal, including compensatory health beliefs. Physicians should take every opportunity to recommend SIV. The necessary individualised patient education regarding SIV requires better physician training in patients priorities. While almost all patients strongly trust their doctors, unvaccinated patients distrust distal stakeholders: it is absolutely essential to restore trust in them and to develop new more effective influenza vaccines.

Influenza vaccination coverage rates among diabetes sufferers, predictors of adherence and time trends from 2003 to 2010 in Spain

A descriptive cross-sectional study was conducted for adults (aged ≥ 50 y) with diabetes. Data was obtained from the 2009 European Health Interview Survey for Spain and the 2003 and 2006 Spanish National Health Surveys. To assess influenza vaccination status, we considered the response (yes or no) to the question "Have you received the influenza vaccine in the previous season?" Both dependent and independent variables were based on the survey questionnaires. The independent variables analyzed included socio-demographic characteristics, health-related variables and use of health care services. The coverage among adults with diabetes in 2010 was 65.0% (95% CI: 62.1-67.7) compared with 41.2% (95% CI 40.0-42.4) for those without diabetes (p<0.01) adjusted OR 1.67 (95% CI: 1.40-1.99). The positive predictors of vaccine uptake among diabetic adults were: higher age, being male, the presence of associated chronic conditions and physician visits in the last 2 wk. The vaccine uptake among adults with diabetes was 61.4% (95% CI: 57.9-64.8) in 2003 and 63.8% (95% CI: 60.7-66.8) in 2006.The adjusted OR of having been vaccinated in 2010 with respect to 2003 was not significant 1.18 (95% CI: 0.97-1.44). We conclude that the levels of influenza vaccination coverage are below desirable levels among adults with diabetes. Furthermore, trend analysis in influenza vaccination coverage indicates that influenza vaccination rates in adults with diabetes have not improved in recent years. Urgent strategies for increasing vaccination coverage among diabetes sufferers are necessary especially for those aged 50-59, women, those without chronic conditions and those who are not frequent users of health care services.

The rate of seasonal influenza vaccination in diabetic children, the effect of recommendation and the factors influencing the acceptance of recommendation: an interventional study

OBJECTIVE

To investigate the vaccination rate of influenza in diabetic children and the effect of recommendation and other factors on vaccination rate.

MATERIAL AND METHODS

On July 2011, 144 diabetic children and their families were informed about and were recommended to receive the influenza vaccine every year, in September. On December 2011, parents were questioned about the vaccination.

RESULTS

Influenza vaccination rate of the previous season (28.3%) increased to 50.0% (p<0.05). Receiving the vaccine in 2010 was the only contributing factor to the recommendation success. The reasons given by the non-receivers were; forgetting (50.0%), fear of adverse-effects (26.4%), not believing in usefulness (15.2%), rejection by the child (4.2%) and effects of media (4.2%). 88.9% of those who forgot declared that they would receive if they were reminded at the beginning of the season.

CONCLUSION

The rate of influenza vaccination was low. The majority of those who didn't recieve the vaccination declared that they would if they were reminded at the beginning of the season and the fact that "receiving the vaccine in 2010" was the only factor influencing the recommendation success indicate that recommending isn't enough but that reminding and giving detailed information about the vaccine will increase vaccination rates independent of other factors.

Predictors of Tetanus–Diphtheria– Acellular Pertussis Vaccination Among Adults Receiving Tetanus Vaccine in the United States

Background. The incidence of pertussis in the United States has been increasing. Adult vaccination is important to reduce disease burden and prevent transmission to infants at high risk of complications. The tetanus–diphtheria–acellular pertussis (Tdap) vaccine has been available in the United States since 2005 and is indicated as a one-time replacement for the routine tetanus–diphtheria (Td) booster. However, among adults receiving tetanus vaccination, only about half receive Tdap. Purpose. To identify predictors of adult Tdap vaccination among individuals who receive tetanus vaccine. Methods. National Health Interview Survey data from 2008 were analyzed in 2011. Respondents were 18 to 64 years old, received tetanus vaccination during 2005-2008, and were aware if it contained pertussis. Predictors of Tdap vaccination were identified with multivariate logistic regression using procedures for complex survey methods. Results. Overall, 51.1% of respondents received Tdap. Vaccination was less likely for those 50 to 64 years old compared with those 18 to 24 years old (odds ratio [OR] = 0.61, 95% confidence interval [CI] = 0.38-0.96). Some college education was associated with higher odds of vaccination compared with lower education levels (OR = 1.55, 95% CI = 1.16-2.07). Having 2 to 3 office visits (OR = 2.01, 95% CI = 1.32-3.06) or 4 to 9 office visits (OR = 1.60, 95% CI = 1.06-2.42) in the previous year increased the odds of vaccination compared with no visits. Individuals with functional limitation due to illness had lower odds compared with no limitation (OR = 0.70, 95% CI = 0.54-0.91). Conclusions. In 2008, 51.1% of adult Td vaccinations included pertussis, suggesting continued efforts to remove barriers are needed. Interventions should target older, functionally impaired, and educationally disadvantaged populations.

Pneumococcal polysaccharide vaccination for adults: new perspectives for Europe

Vaccination is the only public-health measure likely to reduce the burden of pneumococcal diseases. In 2010, a group of European experts reviewed evidence on the burden of pneumococcal disease and the immunogenicity, clinical effectiveness and cost-effectiveness of vaccination with 23-valent pneumococcal polysaccharide vaccine (PPV23). They also considered issues affecting the future use of PPV23 and pneumococcal conjugate vaccines in the elderly and adults at high risk of pneumococcal disease. PPV23 covers 80-90% of the serotypes responsible for invasive pneumococcal disease in Europe. Primary vaccination and revaccination with PPV23 are well tolerated, induce robust, long-lasting immune responses in elderly adults and are cost effective. Ensuring protection against pneumococcal disease requires monitoring of the changing epidemiology of pneumococcal serotypes causing invasive pneumococcal disease and improving vaccine coverage. In the future, it will be critically important for pneumococcal vaccination recommendations for elderly adults to be based on comparative evaluations of PPV23 and newer pneumococcal conjugate vaccines with regard to their long-term immunogenicity, clinical effectiveness and cost-effectiveness.

Coverage and predictors of influenza vaccination among adults with diabetes in Spain

Based on data drawn from the 2003 National Health Survey (NHS), we sought to: (1) estimate influenza vaccination coverages among Spanish diabetic adults; (2) analyze which sociodemographic, health-related, and use of health-care services variables were associated with the likelihood of Spanish diabetes sufferers being vaccinated; and (3) analyze the time-trend in coverage for the period 2001-2003. We analyzed data on the 1295 adults suffering diabetes included in the 2003 NHS. The reply to the question "Were you vaccinated against influenza in the last vaccination campaign?" was taken as the dependent variable. Vaccination coverage was calculated and the influence of sociodemographic, health-related, and use of health-care services variables assessed. The proportion of vaccinated diabetic adults in 2003 amounted to 57%. Multivariate adjustment showed that the variables which increased the likelihood of being vaccinated were: higher age; male gender; presence of respiratory or heart diseases; and physician visits in the last 2 weeks. Influenza coverages had significantly increased from 2001 (48.8%) to 2003. We conclude that influenza vaccination coverages among Spanish diabetic adults have improved but still remain below desirable levels and, thereby making it necessary for strategies to be implemented aimed at improving the use of influenza vaccine among diabetic patients, especially those less than 50 years, females and without other chronic conditions.

Uptake of pneumococcal polysaccharide vaccine in at-risk populations in England and Wales 1999-2005

The UK has had a pneumococcal polysaccharide vaccination (PPV) programme for groups at higher risk of invasive disease since 1992. This paper presents data from a sample of primary-care practices (Q-RESEARCH) of PPV uptake in patients according to their risk status. Of 2.9 million registered patients in 2005, 2.1% were vaccinated with PPV in the preceding 12 months and 6.5% in the preceding 5 years. Twenty-nine per cent of the registered population fell into one or more risk groups. The proportion of each risk group vaccinated in the previous 5 years ranged from 69% (cochlear implants), 53.4% (splenic dysfunction), 36.5% (chronic heart disease), 34.7% (diabetes), 22.9% (immunosuppressed), 28.7% (chronic renal disease), 15.9% (sickle cell disease) to 12.6% (chronic respiratory disease). Uptake was lower in areas where the non-white proportion of population was >10%. In conclusion, there remain large gaps in the uptake of PPV in several high-risk populations in the United Kingdom. Effective strategies need to be developed to address these deficiencies.

Does a population survey provide reliable influenza vaccine uptake rates among high-risk groups? A case-study of The Netherlands

All European countries have recommendations for influenza vaccination among the elderly and chronically ill. However, only a few countries are able to provide data on influenza uptake among these groups. The aim of our study is to investigate whether a population survey is an effective method of obtaining vaccination uptake rates in the different risk groups and to find out what reasons people give as to why they have accepted or refused influenza vaccination and whether this varies among the risk groups. A mail questionnaire was sent out to households in The Netherlands, the response rate was 73%. This resulted in data for 4037 individuals on influenza and influenza vaccination during the 2001-2002 influenza season. The uptake rates and size of different risk groups from the panel survey were comparable with other national representative sources (from the National Information Network of GPs (LINH) and Statistics Netherlands (CBS)). The main reason cited for undergoing vaccination was the existence of a chronic condition. The main reasons for refraining from vaccination were having enough resistance to flu and ignorance about the recommendations. In The Netherlands, the GP is the main administrator of influenza vaccines. We believe that population surveys may be useful for revealing influenza vaccination uptake rates for the groups at risk. When combined with questions about reasons for undergoing vaccination, the results may provide useful policy information and can be used to direct vaccination campaigns at under-vaccinated risk groups or to target the information campaign more effectively.

The influence of health professionals on the uptake of the influenza immunization

Influenced by the Department of Health's aim to increase the uptake of the influenza immunization to 70% among those eligible, this study aimed to compare three methods of promoting influenza immunization among over 65 year old patients in a GP practice, and to identify if a particular promotion method was more effective among either of two defined age groups. The sample (n = 90) was randomly allocated into three intervention groups, and then subdivided into two age groups. A different subject experimental design was used to compare the groups. Statistical analysis of the data showed no significant difference in influenza immunization uptake between the three intervention groups, or the age-defined sub-groups. However, although not significant at 5% significance level, participants aged 72 years and over showed a greater uptake among those visited by a health professional. The findings suggest that a larger study using the same interventions would produce significant results.