tetano
Editor, Senior Moderator
Trends in seasonal influenza vaccine coverage of target groups in France, 2006/07 to 2015/16: Impact of recommendations and 2009 influenza A(H1N1) pandemic
In most high-income countries, seasonal influenza vaccination (SIV) is recommended as a direct protection for elderly individuals (generally those aged ≥ 65 years) and for people aged ≥ 6 months at clinical risk [1,2]. Vaccinating the people likely to infect them (healthcare professionals especially) is also recommended (indirect protection of those at risk).
In 2009, the European Council recommended that national plans be developed and implemented to reach an SIV uptake (SIVU) rate of at least 75% in each of the at-risk groups by the 2014/15 season [3], an objective already included in the 2004 French Public Health Policy Act [4]. In Europe, most countries have established publicly funded programmes to enable the target groups to obtain this vaccine free of charge [5].
In France, most influenza vaccinations are performed by private practitioners, but all the insurance funds that make up the National Health Insurance Fund (NHIF) send a voucher to members of the target groups identified as such (based on long-term illness (LTI) status) and ensured by them. The voucher enables these individuals to obtain the vaccine free of charge at the pharmacy, without a doctor's prescription. They must then make an appointment with either a doctor or a nurse for the vaccine administration. People in the target groups not identified in the NHIF databases (i.e. persons in a risk group but who do not have LTI status) can obtain a voucher from their doctor but this makes their pathway to vaccination more complex as it requires first a doctor's appointment to get a voucher for free vaccine, then going to the pharmacy for delivery, and then a second appointment for the actual vaccine injection.
Despite programmes to provide vaccination access, few countries have reached the objective of 75% uptake of the at-risk groups; Northern Ireland being an exception [1]. On the contrary, a notable trend towards reduction of SIVU has been observed in several countries among different at-risk groups: in the Netherlands, between 2008/09 and 2013/14, for the at-risk groups overall [6]; in Spain between 2008/09 and 2011/12 among those younger than 60 years with a chronic disease [7]; in France, between 2009/10 and 2011/12, in those aged ≥ 65 years and in some of the younger at-risk groups, such as those with diabetes [8,9]. SIVU rates in Canada are also far below the national target of 80% and decreased between 2006/07 and 2013/14 among those aged ≥ 65 years [10]. The causes of these observations are probably multiple and different from one country to another. They include (but are not limited to) media controversies about the effectiveness of the vaccine [6], epidemics that are less marked than in the past [6], and reactions to the vaccination campaign for the expected pandemic in 2009, especially in France, where this campaign was strongly decried [9]. To understand SIVU trends, a first question is how these evolve over the years and for different target groups.
A further question is to what extent the publication of new influenza vaccination recommendations might affect SIVU rates. In France, new recommendations were introduced after the 2009 influenza A(H1N1) pandemic – in March 2011 and then in April 2013 (see the methods section) – to expand the list of chronic underlying diseases considered to pose a risk for influenza. The NHIF had already targeted some of these and had been sending annual vouchers to patients with such diseases for several years. In this group we can study the effect of the publication of the recommendations, separately from the effect of the voucher. For others (such as for persons with chronic liver diseases), the NHIF did not begin sending free vouchers until the new recommendations were published.
Our study sought to: (i) describe trends in SIVU over 10 consecutive seasons in France among different target groups (objective 1); and (ii) examine how they were affected by the 2009 influenza A(H1N1) pandemic (objective 2a) and the publication of new SIV recommendations (objective 2b).
full article
https://www.eurosurveillance.org/con...Lj8Cf3GC6dWr9c
- Pierre Verger[SUP]1,2,3[/SUP], Lisa Fressard[SUP]2[/SUP], S?bastien Cortaredona[SUP]1,2[/SUP], Daniel L?vy-Bruhl[SUP]4[/SUP], Pierre Loulergue[SUP]3,5,6,7[/SUP], Florence Galtier[SUP]3,8[/SUP], Aur?lie Bocquier[SUP]1,2[/SUP]
In most high-income countries, seasonal influenza vaccination (SIV) is recommended as a direct protection for elderly individuals (generally those aged ≥ 65 years) and for people aged ≥ 6 months at clinical risk [1,2]. Vaccinating the people likely to infect them (healthcare professionals especially) is also recommended (indirect protection of those at risk).
In 2009, the European Council recommended that national plans be developed and implemented to reach an SIV uptake (SIVU) rate of at least 75% in each of the at-risk groups by the 2014/15 season [3], an objective already included in the 2004 French Public Health Policy Act [4]. In Europe, most countries have established publicly funded programmes to enable the target groups to obtain this vaccine free of charge [5].
In France, most influenza vaccinations are performed by private practitioners, but all the insurance funds that make up the National Health Insurance Fund (NHIF) send a voucher to members of the target groups identified as such (based on long-term illness (LTI) status) and ensured by them. The voucher enables these individuals to obtain the vaccine free of charge at the pharmacy, without a doctor's prescription. They must then make an appointment with either a doctor or a nurse for the vaccine administration. People in the target groups not identified in the NHIF databases (i.e. persons in a risk group but who do not have LTI status) can obtain a voucher from their doctor but this makes their pathway to vaccination more complex as it requires first a doctor's appointment to get a voucher for free vaccine, then going to the pharmacy for delivery, and then a second appointment for the actual vaccine injection.
Despite programmes to provide vaccination access, few countries have reached the objective of 75% uptake of the at-risk groups; Northern Ireland being an exception [1]. On the contrary, a notable trend towards reduction of SIVU has been observed in several countries among different at-risk groups: in the Netherlands, between 2008/09 and 2013/14, for the at-risk groups overall [6]; in Spain between 2008/09 and 2011/12 among those younger than 60 years with a chronic disease [7]; in France, between 2009/10 and 2011/12, in those aged ≥ 65 years and in some of the younger at-risk groups, such as those with diabetes [8,9]. SIVU rates in Canada are also far below the national target of 80% and decreased between 2006/07 and 2013/14 among those aged ≥ 65 years [10]. The causes of these observations are probably multiple and different from one country to another. They include (but are not limited to) media controversies about the effectiveness of the vaccine [6], epidemics that are less marked than in the past [6], and reactions to the vaccination campaign for the expected pandemic in 2009, especially in France, where this campaign was strongly decried [9]. To understand SIVU trends, a first question is how these evolve over the years and for different target groups.
A further question is to what extent the publication of new influenza vaccination recommendations might affect SIVU rates. In France, new recommendations were introduced after the 2009 influenza A(H1N1) pandemic – in March 2011 and then in April 2013 (see the methods section) – to expand the list of chronic underlying diseases considered to pose a risk for influenza. The NHIF had already targeted some of these and had been sending annual vouchers to patients with such diseases for several years. In this group we can study the effect of the publication of the recommendations, separately from the effect of the voucher. For others (such as for persons with chronic liver diseases), the NHIF did not begin sending free vouchers until the new recommendations were published.
Our study sought to: (i) describe trends in SIVU over 10 consecutive seasons in France among different target groups (objective 1); and (ii) examine how they were affected by the 2009 influenza A(H1N1) pandemic (objective 2a) and the publication of new SIV recommendations (objective 2b).
full article
https://www.eurosurveillance.org/con...Lj8Cf3GC6dWr9c