Factors that influence influenza vaccination rates among the elderly: nurses' perspectives

Evaluation of vaccine perceptions in Israel's Elderly: A Comparative study of COVID-19 and influenza vaccination attitudes

Purpose

This study aimed to evaluate the attitudes of Israeli elderly population towards COVID-19 and influenza vaccines, and to assess factors contributing to these attitudes.

Methods

Four-hundred and one participants exhibiting symptoms consistent with COVID-19 or influenza were enrolled and filled out a questionnaire. A second questionnaire was filled out for hospitalized patients at discharge. Nasopharyngeal samples were collected and detected for COVID-19 and influenza presence by reverse transcription PCR. Participants were divided into 3 groups according to their attitude towards vaccine- Pro-vaccine, Anti-vaccine and Dependent group, which represented participants whose stance depended on disease infection rate.

Results

Out of 401 participants, 11.2% (45/401) tested positive for COVID-19, 10.5% (42/401) were positive for Influenza A and one (0.2%) patient had Influenza B. The participants expressed varied beliefs about COVID-19 vaccine: 14.7% (59/401) agreed that it causes disease, 25.4% (102/401) doubted vaccine effectiveness and 22.9% (92/401) questioned vaccine safety. A higher percentage of individuals in Pro-Vaccine group (66.3%, 179/270) as compared to Anti-Vaccine (45.3%, 24/53) and to Dependent (60.3%, 47/78) groups had a COVID-19 history. Hospitalization history was significantly more common in Pro-Vaccine (11.1%, 30/270) and Dependent groups (16.7%, 13/78) than in Anti-Vaccine group (1.9%, 1/53).Influenza vaccine effectiveness was doubted by 19.7% (79/401), 18% (72/401) participants questioned safety, and 18.7% (75/401) agreed that the vaccine causes disease. The majority of both Dependent (54.2%, 13/24) and Pro-Vaccine (56.2%, 167/297) groups believed they received sufficient information about the vaccine, while only 25% (20/80) of the Anti-Vaccine group has similar impressions.

Conclusions

This analysis reveals a notable disinclination towards vaccination among some of the elderly, reflecting their deep and ingrained hesitancy. These findings emphasize the need for customized approaches to improve vaccine acceptance in this vulnerable group. Such strategies should consider the various motivations and influences shaping elderly perspectives, from individual health experiences to wider social and cultural factors.

Drivers of and barriers to routine adult vaccination: A systematic literature review

We performed a systematic literature review in PubMed and Embase (2016-2021) to investigate the drivers of and barriers to routine vaccination in adults aged 50 and older globally. A thematic assessment identified three categories across 61 publications: sociodemographic, health-related, and attitudinal. The most common sociodemographic determinants (factors identified in studies; n = 47) associated with vaccination uptake were economic status, age, education, and household composition, which had mixed effects on vaccine uptake. For health-related determinants (n = 27), individuals with comorbidities and health care consumption were the most common factors, both increased vaccine uptake. The most common attitudinal factors (n = 42) were self-efficacy, provider or other's recommendations, and vaccine-preventable disease awareness; across studies, all attitude factors had a positive effect, unlike the sociodemographic and health status categories. Findings suggest that patient and provider awareness and education campaigns are effective ways to increase uptake of routine vaccinations in older adults.

Healthcare workers' perceptions and experiences of communicating with people over 50 years of age about vaccination: a qualitative evidence synthesis

BACKGROUND

Infectious diseases are a major cause of illness and death among older adults. Vaccines can prevent infectious diseases, including against seasonal influenza, pneumococcal diseases, herpes zoster and COVID-19. However, the uptake of vaccination among older adults varies across settings and groups. Communication with healthcare workers can play an important role in older people's decisions to vaccinate. To support an informed decision about vaccination, healthcare workers should be able to identify the older person's knowledge gaps, needs and concerns. They should also be able to share and discuss information about the person's disease risk and disease severity; the vaccine's effectiveness and safety; and practical information about how the person can access vaccines. Therefore, healthcare workers need good communication skills and to actively keep up-to-date with the latest evidence. An understanding of their perceptions and experiences of this communication can help us train and support healthcare workers and design good communication strategies.

OBJECTIVES

To explore healthcare workers' perceptions and experiences of communicating with older adults about vaccination.

SEARCH METHODS

We searched MEDLINE, CINAHL and Scopus on 21 March 2020. We also searched Epistemonikos for related reviews, searched grey literature sources, and carried out reference checking and citation searching to identify additional studies. We searched for studies in any language.

SELECTION CRITERIA

We included qualitative studies and mixed-methods studies with an identifiable qualitative component. We included studies that explored the perceptions and experiences of healthcare workers and other health system staff towards communication with adults over the age of 50 years or their informal caregivers about vaccination.

DATA COLLECTION AND ANALYSIS

We extracted data using a data extraction form designed for this review. We assessed methodological limitations using a list of predefined criteria. We extracted and assessed data regarding study authors' motivations for carrying out their study. We used a thematic synthesis approach to analyse and synthesise the evidence. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We examined each review finding to identify factors that may influence intervention implementation and we developed implications for practice.

MAIN RESULTS

We included 11 studies in our review. Most studies explored healthcare workers' views and experiences about vaccination of older adults more broadly but also mentioned communication issues specifically. All studies were from high-income countries. The studies focused on doctors, nurses, pharmacists and others working in hospitals, clinics, pharmacies and nursing homes. These healthcare workers discussed different types of vaccines, including influenza, pneumococcal and herpes zoster vaccines. The review was carried out before COVID-19 vaccines were available. We downgraded our confidence in several of the findings from high confidence to moderate, low or very low confidence. One reason for this was that some findings were based on only small amounts of data. Another reason was that the findings were based on studies from only a few countries, making us unsure about the relevance of these findings to other settings. Healthcare workers reported that older adults asked about vaccination to different extents, ranging from not asking about vaccines at all, to great demand for information (high confidence finding). When the topic of vaccination was discussed, healthcare workers described a lack of information, and presence of misinformation, fears and concerns about vaccines among older adults (moderate confidence). The ways in which healthcare workers discussed vaccines with older adults appeared to be linked to what they saw as the aim of vaccination communication. Healthcare workers differed among themselves in their perceptions of this aim and about their own roles and the roles of older adults in vaccine decisions. Some healthcare workers thought it was important to provide information but emphasised the right and responsibility of older adults to decide for themselves. Others used information to persuade and convince older adults to vaccinate in order to increase 'compliance' and 'improve' vaccination rates, and in some cases to gain financial benefits. Other healthcare workers tailored their approach to what they believed the older adult needed or wanted (moderate confidence). Healthcare workers believed that older adults' decisions could be influenced by several factors, including the nature of the healthcare worker-patient relationship, the healthcare worker's status, and the extent to which healthcare workers led by example (low confidence). Our review also identified factors that are likely to influence how communication between healthcare workers and older adults take place. These included issues tied to healthcare workers' views and experiences regarding the diseases in question and the vaccines; as well as their views and experiences of the organisational and practical implementation of vaccine services.

AUTHORS' CONCLUSIONS

There is little research focusing specifically on healthcare workers' perceptions and experiences of communication with older adults about vaccination. The studies we identified suggest that healthcare workers differed among themselves in their perceptions about the aim of this communication and about the role of older adults in vaccine decisions. Based on these findings and the other findings in our review, we have developed a set of questions or prompts that may help health system planners or programme managers when planning or implementing strategies for vaccination communication between healthcare workers and older adults.

Fatores determinantes na adesão à vacina contra influenza em pessoas idosas de um município do interior de Mato Grosso do Sul

Resumo Objetivo Identificar os fatores sociodemográficos, de saúde e de conhecimento sobre a vacinação relacionados à adesão de pessoas idosas à vacina contra influenza no ano de 2019, em um município do interior de Mato Grosso do Sul, Brasil. Método Estudo quantitativo e transversal, realizado com 172 indivíduos com 60 anos ou mais, usuários de serviços de saúde e convivência. Aplicou-se um questionário que contemplou dados sociodemográficos, de saúde e de conhecimento sobre vacinação, além da questão sobre a adesão vacinal na campanha de 2019. Utilizou-se regressão log-linear e redes bayesianas de aprendizado para analisar os dados. Resultados Houve predomínio de pessoas idosas do sexo feminino, com companheiro, entre 60-69 anos de idade e ensino fundamental. A taxa de adesão vacinal contra influenza foi 91,28% em 2019. Os idosos com doenças neuropsiquiátricas, que costumavam receber a vacina anualmente e que tinham recebido nos anos de 2018, 2016 e 2015 tiveram maior prevalência de adesão vacinal em 2019 no modelo de regressão. As redes bayesianas para adesão vacinal em 2019 evidenciaram que saber que existe o Programa Nacional de Imunização leva a pessoa idosa a confiar no mesmo, o que culmina na adesão anual à vacina. Conclusão Os profissionais de saúde e meios de comunicação devem fornecer informações válidas para que as pessoas conheçam e confiem no Programa Nacional de Imunização. O trabalho de orientação dos idosos para vacinação contra influenza deve ser anual, já que é importante que o idoso receba a vacina todos os anos para que mantenha a adesão vacinal.

The Contagion of Pneumonia in Older Persons: An Application of the Bass Diffusion Model

This aims to provide an understanding of the spread of pneumonia through analysis of the interaction between infected and potentially infected. Data from 2010 to 2018 on Pneumonia morbidity among older persons age 65 and above was extracted from the Department of Health Field Health Service Information System (FHSIS) annual reports. The data were used to represent the cumulative adopters by fitting them to the Bass diffusion model using the Bass Forecasting Spreadsheet. The number of new adopters was graphed to forecast the diffusion of Pneumonia. The number of cases is expected to increase. The adoption rate in 2024 will be around 45% of the current population. Morbidity of pneumonia is expected to peak in the year 2200, 190 years after the first data. The use of the model provided an insight into the cumulative nature of pneumonia infection due to the interaction between infected and the potentially infected.

O impacto da vacinação contra influenza na morbimortalidade dos idosos nas regiões do Brasil entre 2010 e 2019

Resumo: Devido à importância da vacinação anual contra a gripe em idosos, objetivou-se analisar o impacto da vacinação contra gripe na morbimortalidade por influenza nos idosos no período de 2010 a 2019 nas regiões do Brasil. Trata-se de um estudo epidemiológico ecológico, com dados do Sistema de Informações do Programa Nacional de Imunizações, do Sistema de Informações Hospitalares e do Sistema de Informação sobre Mortalidade, disponíveis por intermédio do Ministério da Saúde. Os dados foram referentes ao Brasil e regiões, e contemplaram as taxas de cobertura vacinal contra gripe em idosos e de morbidade e mortalidade por causas relacionadas à influenza e pneumonia em idosos. Modelos de regressão linear simples foram utilizados para estudar a relação entre as taxas de morbidade e mortalidade e a cobertura vacinal. Houve um aumento da cobertura vacinal no período, e a meta de 80% de cobertura foi atingida em todas as regiões a partir de 2011. Identificou-se uma relação diretamente proporcional entre as variáveis estudadas, sendo que o aumento da cobertura vacinal resultou no aumento da morbimortalidade pelas causas avaliadas. Esses dados podem estar relacionados com a literatura, que mostra que o efeito da vacina é modesto em idosos. Porém, foi visto que o cálculo das taxas não leva em consideração o envelhecimento da população, utilizando dados com estimativas censitárias desatualizadas, e que os dados de internação e óbito podem incluir outros vírus e bactérias circulantes que não a influenza. A manutenção da cobertura vacinal elevada pode prevenir que o impacto da gripe seja ainda maior na morbimortalidade em idosos.

Impact of European vaccination policies on seasonal influenza vaccination coverage rates: An update seven years later

Seasonal influenza can have serious morbid consequences and can even result in death, particularly in at-risk populations, including healthcare professionals (HCPs), elderly and those living with a medical risk condition. Although in Europe recommendations exist for annual influenza vaccination in these populations in most countries, the vaccination coverage rate (VCR) is often well below the World Health Organization target of 75% coverage. In our previous survey in 2009 we showed that some elements of national vaccination policies, e.g. reminder systems, strong official recommendation, and easy access, seemed to contribute to achieving higher influenza VCRs among elderly. We repeated the survey in 2016, using the same methodology to assess changes in influenza VCRs among the elderly and in the impact of policy elements on these VCRs. In addition, we collected information about VCRs among HCPs, and those living with a medical risk condition. The median VCR in the 21 countries that had recommendations for influenza vaccination in the elderly was 35.3%, ranging from 1.1% in Estonia to 74.5% in Scotland. The average VCRs for HCPs and those living with medical risk conditions, available in 17 and 10 countries, respectively, were 28.3% (range 7% in Czech Republic to 59.1% in Portugal) and 32.2% (range from 20.0% in the Czech Republic and Hungary to 59.6% in Portugal), respectively. Fewer countries were able to provide data from HCP and those living with medical risk conditions. Since the initial survey during the 2007–2008 influenza season, VCRs have decreased in the elderly in the majority of countries, thus, achieving high VCRs in the elderly and the other target groups is still a major public health challenge in Europe. This could be addressed by the identification, assessment and sharing of best practice for influenza vaccination policies.