Elsevier

Public Health

Volume 121, Issue 10, October 2007, Pages 742-751
Public Health

Review Article
Determinants of influenza and pneumococcal vaccination in elderly people: a systematic review

https://doi.org/10.1016/j.puhe.2007.02.011Get rights and content

Summary

Objectives

Despite strong national and international recommendations on immunization practices, rates for influenza (IV) and pneumococcal vaccinations (PV) are low. We aimed to review international immunization rates and to analyze attitudes and beliefs regarding IV and PV.

Study design

Systematic review.

Method

The MEDLINE database search comprised articles from 1966 to October 2005. Fourteen surveys evaluating a total number of 49 292 participants in nine different countries were included into the analysis.

Results

Vaccination rates among risk groups do vary significantly between different countries, reaching highest rates in the USA (IV, 82%; PV, 71%) and lowest in former West-Germany for IV (37%) and in Israel for PV (20%). Recommendations by doctors play a central role in promoting IV and PV. The main reason for not being vaccinated was lack of information.

Conclusion

Specific strategies targeted at groups are needed to increase the knowledge of IV and PV, and thereby decrease incidences of acute lung diseases.

Introduction

Despite strong recommendations for influenza and pneumococcal vaccinations, immunization rates are alarmingly low. In several countries, compliance is gradually increasing, but is still suboptimal, especially for pneumococcal vaccinations.

Pneumococcal disease accounts for more deaths than any other vaccine-preventable bacterial disease1, 2 and, in the USA, an estimated 40 000 deaths occur annually due to pneumococcal infections.3

Official vaccination recommendations vary slightly between different countries, but all cover elderly people, mostly defined as people aged 65 years or older.4 Older adults account for more than 90% of deaths attributed to pneumonia and influenza.1, 5, 6 Pneumonia ranges among the 10 leading causes of death. According to the Federal Statistical Office in Germany, 18 395 people died from pneumonia in 2004, which equals 2.2% of all deaths.

Recommendations targeted at specific groups by the STIKO (German Advisory Committee on Immunization Practices) cover people older than 60 years of age, children and adults with chronic diseases and other people at increased risk (e.g. healthcare workers or people who are in close contact with unvaccinated risk groups). Target vaccination rates among the risk groups are 80% for influenza and pneumococcal vaccination.

The aim of this systematic review is to identify international studies exploring influenza and pneumococcal vaccination coverage and analyzing reasons for accepting or refraining from immunization as well as other determining factors.

Section snippets

Search strategy

For searching the Medline database (January 1966 to October 2005; access 31 October 2005), the following strategy was used: (‘immunization’ [MESH] OR immunization OR vaccine* OR vaccina*) AND (‘pneumonia’ [MESH] OR pneumoni* OR pneumococ* OR influenza OR flu) AND (‘motivation’ [MESH] OR motivat* OR acceptance OR attitude OR behaviour OR practice) OR (‘vaccination rate’ OR ‘vaccination rates’) NOT (measles OR antibiotic* OR animal*) NOT Randomized Controlled Trial (1369 hits). In addition,

Study populations

Fourteen studies were included in this review. Of these, 10 evaluated vaccination rates for influenza only, one for pneumococcal vaccination rates only and three for both influenza and pneumococcal vaccinations. Basic characteristics of the included and assessed studies are given in Table 1.

Methodological appraisal of the studies included

Christenson and Lundbergh8 compared cohorts that were vaccinated or unvaccinated against influenza and pneumococcal infection. A representative study population of 9999 people aged 65 years or older from the

Discussion

Although people older than 60 years19 to 65 years8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 20, 21 should be vaccinated against influenza and pneumococcus, poor overall vaccination rates are reported in most countries. For the purpose of this systematic review, we identified 14 international studies. Vaccination motivations and factors influencing non-use of influenza or pneumococcal immunizations among the elderly people were analyzed. Age, health conditions and the central role of general

Conclusion

Differing healthcare systems and cultural factors have to be considered, and therefore varying interventions are needed to improve vaccination uptakes. An aim should be to develop strategies targeted at groups to increase knowledge of vaccinations and thereby decrease incidences of acute lung diseases. By looking at the alarmingly low vaccination rates among elderly people in several countries, strategies are still needed to improve the information rates, provide well-founded recommendations,

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