Review ArticleDeterminants of influenza and pneumococcal vaccination in elderly people: a systematic review
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,
References (46)
- et al.
Influenza vaccination in 2000: recommendations and vaccine use in 50 developed and rapidly developing countries
Vaccine
(2003) - et al.
Factors associated with self-reported pneumococcal immunization among adults 65 years of age or older in the Minneapolis—St. Paul metropolitan area
Prev Med
(2001) - et al.
Why do older people not get immunised against influenza? A community survey
Vaccine
(2003) - et al.
Prevalence and determinants of influenza vaccination in Australians aged 40 years and over—a national survey
Aust N Z J Public Health
(2005) - et al.
Does a population survey provide reliable influenza vaccine uptake rates among high-risk groups? A case-study of The Netherlands
Vaccine
(2004) - et al.
Validation of self-report of influenza and pneumococcal vaccination status in elderly outpatients
Am J Prev Med
(1999) - et al.
Sensitivity and specificity of patient self-report of influenza and pneumococcal polysaccharide vaccinations among elderly outpatients in diverse patient care strata
Vaccine
(2003) Characteristics of survey participants with and without a telephone: findings from the third National and Nutrition Examination Survey
J Clin Epidemiol
(1998)- et al.
Influenza and pneumococcal vaccination in Scottish nursing homes: coverage, policies and reasons for receipt and non-receipt of vaccine
Vaccine
(2002) - et al.
Influenza vaccination in 18 developed countries, 1980–1992
Vaccine
(1995)
Clinical efficacy of pneumococcal vaccine in the elderly: a randomized, single-blind population-based trial
Am J Med
Pneumococcal polysaccharide vaccine: a systematic review of clinical effectiveness in adults
Vaccine
Adult immunization. Summary of the National Vaccine Advisory Committee Report
JAMA
Immunization of adults
N Engl J Med
MMWR Recomm Rep
MMWR Recomm Rep
Mortality associated with influenza and respiratory syncytial virus in the United States
JAMA
Critical appraisal of the health research literature: prevalence or incidence of a health problem
Chronic Dis Can
Comparison between cohorts vaccinated and unvaccinated against influenza and pneumococcal infection
Epidemiol Infect
Influenza vaccination coverage in elderly people, Campania (Italy), 1999
Euro Surveill
Prevalence of influenza vaccination in a high-risk population
J Ambul Care Manage
Compliance with influenza and pneumococcal vaccinations in Israel, 1999–2002
Public Health Rev
Evaluation of a population-based prevention program against influenza among Swiss elderly people
Swiss Med Wkly
Cited by (0)
- 1
Equally contributed.