Trends in influenza vaccination coverage in Portugal from 1998 to 2010: effect of major pandemic threats

BMC Public Health

José Marinho Falcão¹  Maria João Branco¹  Baltazar Nunes¹  Cátia Sousa Pinto² 

[1] Department of Epidemiology, National Institute of Health Doutor Ricardo Jorge, Avenida Padre Cruz, Lisbon, Portugal;Public Health Unit, North Lisbon Health Care Center, Largo Professor Arnaldo Sampaio, Lisbon, Portugal

关键词: Vaccination trends;    Vaccine coverage;    Influenza;   

Others  :  1161503
DOI  :  10.1186/1471-2458-13-1130

 received in 2012-05-20, accepted in 2013-11-27,  发布年份 2013

【 摘 要 】

Background

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.

Methods

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.

Results

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).

Conclusions

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.

【 授权许可】

   
2013 Pinto et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Nichol KL: Influenza vaccination in the elderly: impact on hospitalisation and mortality. Drugs Aging 2005, 22(6):495-515.
• [2]Mair M, Grow RW, Mair JS, Radanovich LJ: Universal influenza vaccination: the time to act is now. Biosecur Bioterror 2006, 4(1):20-40.
• [3]World Health Organisation, Global Influenza Programme: Public health research agenda for influenza: version1. Geneva; 2009. http://apps.who.int/csr/disease/influenza/research_agenda/en/index.html webcite, accessed on January 19, 2013
• [4]Centers for Disease Control and Prevention: Prevention and control of seasonal influenza with vaccines: recommendations of the advisory committee on immunization practices (ACIP). MMWR 2009, 58(RR- 8):1-52.
• [5]World Health Organization: Global Pandemic Influenza Action Plan to Increase Vaccine Supply: Progress Report 2008. Geneva; 2009. http://www.who.int/vaccine_research/Global_Pandemic_Influenza.pdf webcite, accessed January 20, 2013
• [6]Tam D, Lee S, Lee S: Impact of severe acute respiratory syndrome and the perceived avian influenza epidemic on the increased rate of influenza vaccination among nurses in Hong Kong. Infect Control Hosp Epidemiol 2008, 3(29):256-261.
• [7]Wilder-Smith A, Ang B: The role of influenza vaccine in healthcare workers in the era of severe acute respiratory syndrome. Ann Acad Med 2003, 5(32):573-575.
• [8]Sahly H, Keitel W: Pandemic H5N1 vaccine development: an update. Expert Rev Vaccines 2008, 7(2):241-247.
• [9]Seale H, Heywood AE, McLaws M, Ward KF, Lowbridge CP, Van D, MacIntyre CR: Why do I need it? I am not at risk! public perceptions towards the pandemic (H1N1) 2009 vaccine. BMC Infect Dis 2010., 10(99) http://www.biomedcentral.com/content/pdf/1471-2334-10-99.pdf webcite, accessed December 2, 2013
• [10]Schwarzinger M, Flicoteaux R, Cortarenoda S, Obadia Y, Moatti J-P: Low acceptability of a/H1N1 pandemic vaccination in French adult population: did public health policy fuel public dissonance? PLoS One 2010., 5(4) http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0010199 webcite, accessed December 2,2013
• [11]Arda B, Durusoy R, Yamazhan T, Sipahi OR, Taşbakan M, Pullukçu H, Erdem E, Ulusoy S: Did the pandemic have an impact on influenza vaccination attitude? a survey among health care workers. BMC Infect Dis 2011., 11(87) http://www.ncbi.nlm.nih.gov/pubmed/21473763 webcite, accessed December2, 2013.
• [12]World Health Organization: WHO recommends influenza vaccine composition for Northern Hemisphere 2005–2006 influenza season. http://www.who.int/mediacentre/news/notes/2005/np05/en/ webcite, accessed on June 5, 2008
• [13]Ministério da Saúde. Direcção-Geral da Saúde: Gripe: vacinação contra a gripe em 2005/2006. Lisboa: Circular Informativa Nº: 48/DT. 19/09/05; 2005.
• [14]Ministério da Saúde. Direcção-Geral da Saúde: Gripe: vacinação contra a gripe em 2006/2007. Lisboa: Circular Informativa Nº: 40/DIR/G. 21/09/06; 2006.
• [15]Ministério da Saúde. Direcção-Geral da Saúde: Vacinação contra a gripe sazonal em 2009/2010. Lisboa: Circular Informativa Nº: 33/DSPCD; 2009.
• [16]Ministério da Saúde. Direcção‒Geral da Saúde: Campanha de vacinação contra a infecção pelo vírus da gripe pandémica (H1N1) 2009. Lisboa: Circular normativa N.º: 17A/DSPCD.13/11/09; 2009.
• [17]Contreiras T, Nunes B, Branco MJ: Em casa, pelo telefone, observamos saúde: Descrição e avaliação de uma metodologia. Instituto Nacional de Saúde Dr. Ricardo Jorge. Lisboa: Observatório Nacional de Saúde; 2003.
• [18]Kennedy C: Evaluating the effects of screening for telephone service in dual frame RDD surveys. Public Opin Q 2007, 71(5):750-771.
• [19]Brick J: Nonresponse bias in dual frame sample of cell and landline numbers. Public Opin Q 2006, 70(5):780-793.
• [20]Rao JNK, Scott AJ: On chi-squared tests for multiway contingency tables with cell proportions estimated from survey data. Ann Stat 1984, 12:46-60.
• [21]Rao JNK, Thomas DR: Analysis of categorical response data from complex surveys: an upraise and update. In Analysis of Survey Data. Edited by Chambers R, Skinner C. New York: John Wiley & Sons; 2003.
• [22]SPSS Inc: Statistical Package for the Social Sciences [computer program]. Chicago: SPSS; 2007. Ver. 16 (SPSS Ver. 16.0)
• [23]StataCorp: Stata Statistical Software: Release 12[computer program]. College Station, TX: StataCorp LP; 2011.
• [24]Vaux S, Cauteren DV, Guthmann JP, Le Strat Y, Vaillant V, Valk H, Lévy-Bruhl D: Influenza vaccination coverage against seasonal and pandemic influenza and their determinants in France: a cross-sectional survey. BMC Public Health 2011, 11:30. http://www.biomedcentral.com/1471-2458/11/30 webcite, accessed March 13, 2013 BioMed Central Full Text
• [25]Holm MV, Blank PR, Szucs TD: Developments in influenza vaccination coverage in England, Scotland and Wales covering five consecutive seasons from 2001 to 2006. Vaccine 2007, 25:7931-7938.
• [26]Kronemana MW, van Essen GA, Tacken MAJB, Paget WJ, Verheij R: Does a population survey provide reliable influenza vaccine uptake rates among high-risk groups? a case-study of the Netherlands. Vaccine 2004, 22:2163-2170.
• [27]Blank PR, Szucs TD: Seasonal Influenza Vaccination in Europe: 2006/2007 Coverage Rate in 11 European Countries. Switzerland: Institute of Social and Preventive Medicine, University of Zurich; http://www.eswi.org/myUploadData/files/Seasonal%20Influenza%20Vaccination%20in%20Europe.pdf webcite, accessed on July 6, 2008
• [28]Mereckiene J, Cotter S, Weber JT, Nicoll A, Lévy-Bruhl D, Ferro A, Tridente G, Zanoni G, Berra P, Salmaso S, O’Flanagan D: Low coverage of seasonal influenza vaccination in the elderly in many European countries. Eurosurveillance 2008, 13:41.
• [29]Blank PR, Schwenkglenks M, Sucks TD: Vaccination coverage rates in eleven European countries during two consecutive influenza seasons. J Infect 2009, 58:441-453.
• [30]World Health Organization: Influenza Vaccination for the 2003–2004 Season: Recommendation in the Context of Concern about SARS. http://www.who.int/influenza/vaccines/sars/en/index.html webcite, accessed on June 5, 2010
• [31]Holm HV, Blank PR, Szucs TH: Trends in influenza vaccination coverage rates in Germany over five seasons 2001 to 2006. BMC Infect Dis 2007, 7:144. BioMed Central Full Text
• [32]Brewer NT, Chapman GB, Gibbons FX, Gerard M, McCaul KD, Weinstein ND: Meta-analysis of the relationship between risk perception and health behaviour: the example of vaccination. Health Psychol 2007, 26:136-145. http://www.unc.edu/~ntbrewer/pubs/2007,%20brewer,%20chpaman,%20gibbons,%20et%20al.pdf webcite, accessed January 5, 2011
• [33]Leppin A, Aro AR: Risk perceptions related to SARS and avian influenza: theoretical foundations of current empirical research. Int J Behav Med 2009, 16:7-29.
• [34]Brandt C, Rabenau HF, Bornmann S, Gottschalk R, Wicker S: The impact of the 2009 influenza A (H1N1) pandemic on attitudes of healthcare workers toward seasonal influenza vaccination 2010/11. Euro Surveill 2011., 16http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19854 webcite, accessed on December 5, 2012
• [35]Schwarzinger M, Flicoteaux R, Cortarenoda S, Obadia Y, Moatti JP: Low acceptability of a/H1N1 pandemic vaccination in French adult population: did public health fuel public dissonance? PLoS One 2010, 5(4):e10199. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0010199 webcite, accessed January 5, 2013