[Opinions and attitudes on the topic of vaccination of established physicians, pharmacists and their personnel and current vaccination status of these groups]

Promoting vaccinations - an analysis of measures taken by German statutory health insurers

INTRODUCTION

Prophylactic vaccinations play a significant role in health care. As a relatively cost-effective preventive measure they can help to avert transmissible diseases and thus protect not only the vaccinated individuals themselves but also those who have not been vaccinated. In order to achieve this, a high vaccination rate is necessary; for many prophylactic vaccinations this rate is not reached in Germany. In order to counteract this trend the importance of prophylactic vaccinations was upgraded in 2007 within the scope of the reform of the health system. The reimbursement of patients' vaccination fees was made compulsory for the statutory health insurance companies and statutory requirements were imposed on the insurers to ensure a nationwide provision of prophylactic vaccinations for insured persons. The objective of this paper is to evaluate to what extent the health insurance companies promote the increasing of vaccination coverage rate today and what measures are being used to present this topic to the public.

METHODS

In order to assess the public presentation of the topic "prophylactic vaccinations" we have examined the websites of 68 statutory health insurance companies. We have assessed the attitude of the companies towards the promotion of participation in vaccination programs by conducting qualitative, structured interviews with representatives of 8 health insurers.

RESULTS

Measures to promote vaccinations, such as information, recall offers, projects to educate people or even monetary incentives, are employed relatively extensively by the health insurers and are considered important. However, it became clear that the discussion about prophylactic vaccinations, in particular concerning the costs and benefits thereof, had not been completed yet within the companies. Vaccination-specific data is not collected or evaluated on a regular or even isolated basis. There are no concrete targets concerning specific vaccination rates and incentives are neither evaluated nor compared with one another.

CONCLUSIONS

The relatively extensive range of measures used to promote the vaccination rate contrasts with insufficient knowledge about their efficacy and efficiency. There is an urgent requirement for more research here.

Obligatory occupational health check increases vaccination rates among medical students

In October 2002 an obligatory occupational health check for all preclinical students at the University of Erlangen-Nuremberg was introduced. Over the period 2005 to 2007, medical students started their clinical year either with or without a health check during their preclinical years. The aim of the study was to evaluate the efficacy of health checks for preclinical students with respect to vaccination rates. At the beginning of the clinical year we examined 242 consecutive students, 121 with and 121 without a preceding preclinical occupational health check. The immunisation rate against hepatitis B increased during medical education from 50% to 96% in women and from 58% to 96% in men. In medical students without an initial occupational health check, vaccination rates were significantly lower (85% in women and 81% in men). A significant benefit from the preclinical check was seen in men regarding immunisation status for hepatitis B, tetanus, diphtheria, polio, rubella and mumps and in women for hepatitis B and rubella. This study demonstrates that it is possible to significantly increase vaccination rates, particularly for men. Even in medical students starting their clinical training, an individual occupational health check is necessary to optimise immunisation against infectious diseases. Routine occupational health checks could make an important contribution to closing gaps in vaccination coverage.

Influenza vaccination in Austria, 1982-2003

Since the past decade influenza vaccination is becoming an increasingly important aspect of public health programs. In the early 1990s independent investigators began to gather information on the comparative use of influenza vaccine in developed countries. The annual level of influenza vaccine distributed in each country was calculated as the number of doses distributed per 1000 total resident population. During the first period of research in 18 developed countries influenza vaccine was widely underused. From 1980 to 1992 the annual vaccination rates increased in most of the 18 countries. But Austria (Switzerland and Finland) showed little change (20 doses/1000 in 1982 and 23 doses in 1992). When in 1992-1995 four new countries were included, doses increased slightly in Austria, too, to about 52 doses/1000 in 1995, but the country still belonged to the low-use countries compared to Spain 160 doses/1000, although vaccination was recommended for all elderly people <65 years and persons with high-risk medical conditions. Self-payment was usual, and there was no reimbursement within the national or social health insurance schemes. From 1996 (77 doses/1000), to 2000 (118 doses/1000) and 2003 (127 doses/1000), vaccination increased slightly, but Austria remained one of the lowest three Western European countries reported, together with Sweden (127) and Norway (102). Possible reasons for the low usage in Austria may be the following: people mistake influenza for an influenza-like illness, a lack of effective social marketing, costs are not taken over by social or private insurance and discordance in the Austrian medical fraternity about the importance of vaccination. Especially in view of a possible new influenza pandemic, public awareness of the importance of vaccination must increase.

Hepatitis B vaccination status among healthy adults in Germany

OBJECTIVES

The hepatitis B vaccination policy in Germany was intensified by the implementation of hepatitis B vaccination for adolescents in the vaccination calendar in 1995. To investigate the effect of this measure on the hepatitis B vaccination coverage of healthy adults, we analysed the hepatitis B vaccination status of blood donors. Furthermore, the reasons for vaccination and the relationship between vaccination status and age, sex, and current profession were studied.

METHOD

Using a standardised questionnaire, randomly incoming whole blood donors were asked for hepatitis B vaccination status, the reason for vaccination, gender, age and current profession. Multiple logistic regression analysis with vaccination status as dependent variable and age, gender and current profession as explanatory variables was performed.

RESULTS

Overall, 1519 (22.3%) of the 6812 interviewed whole blood donors were vaccinated against hepatitis B. Younger age was significantly associated with higher acceptance of hepatitis B vaccination with already 44.1% of whole blood donors aged 18-29 years being hepatitis B immunised. Beside health care workers, teaching professions and students showed the highest hepatitis B vaccination rate. Foreign travel was nearly an equivalently important reason for hepatitis B vaccination as occupational risks.

CONCLUSION

The high hepatitis B vaccination coverage among young and healthy adults indicates the success of the intensified hepatitis B vaccination policy since 1995. However, concentrating education measures on individuals with lower educational level and intensifying hepatitis B vaccination in the context of foreign travel could further increase the acceptance of hepatitis B vaccination.