| Abstract |
Nowadays there is a great reduction in morbidity and mortality from infections that can be prevented by vaccination in the pediatric population. In contrast, in adults, although recommendations have been issued for the necessary preventive vaccination, it is often neglected and not taken as a priority. A large number of deaths and the rising cost of hospitalization for infections, which can be effectively prevented by vaccination in the elderly, such as influenza, pneumococcal disease, shingles and others, create the need to further improve vaccination coverage in the older age group. Given the economic recession in our country, promoting measures to improve vaccination rates for adults is considered essential. Vaccine coverage assessment studies are a necessary and important tool to guide health professionals in practicing effective preventive medicine. They make it easier to identify the factors responsible for their inadequate vaccination and provide evidence for a future intervention to improve the level of immunization in the community.
Purpose
The purpose of the study is to assess the vaccination coverage of older adults of a rural and remote area of Crete, in the area of responsibility of the local Health Center of Anogeia, Crete. The assessment concerns the general population vaccines as recommended by the adult national immunization program of 2017 - 2018: Vaccines coverage estimates are surveyed for seasonal influenza 2017 - 2018, pneumococcal vaccines with either the polysaccharide PPSV23 vaccine or the conjugated one PCV13, shingles vaccine ( Herpes Zoster Live Attenuated vaccine ), any tetanus toxoid containing vaccine and for tetanus toxoid, reduced dipftheria and acellular pertussis vaccine ( Tdap ). It will also be assessed whether various socio-economic factors, demographic characteristics and individual medical history of the participants affect the level of immunization in this population.
Methods:
The study population concerns all adults over 60 years of age who have one of the 14 communities of responsibility of the Anogeia Health Center as their permanent residence. These are the communities of Anogeia, Zoniana, Livadia, Kalyvos, Agios Ioannis, Axos, Veni, Krana, Gonies, Astyraki, Kamarioti, Sisarxa, Aidonohori and Livada. According to the Hellenic Statistic Agency, the total population meeting the prerequisites for participation in the survey consists of 1911 people. An appropriate anonymous questionnaire containing relevant questions about the vaccination coverage of the general population over the age of 60 in the area according to their medical condition, age, sex, marital status, occupation and permanent residence. The questionnaire was collected through an interview with home visits from 1/7/2018 to 31/11/2018 from 14 communities in the area of responsibility of the Anogeia Health Center. Data entry, validation and statistical analysis were performed using the Microsoft EXCEL 325 Spreadsheet, 2017 and IBM SPSS statistics 24.0
Results
A total of 944 questionnaires were collected from subjects who met the selection criteria for the study, the sample proportion of the total population meeting the prerequisites for participation in the survey was 49.4% (944/1911 individuals) median age 77 years (age range 60 - 103 years). Of all participants, 58.6% ( 554/944 ) stated that they had been vaccinated for influenza during the winter season 2017-2018. 26% of the participants in the survey ( 246/944 ) were found to have been vaccinated with at least one of the pneumococcal vaccines. Those over 65 years of age fully vaccinated for the pneumococcal disease with a single dose of the polysaccharide 23-valent vaccine and a dose of conjugate 13-valent vaccine were found with only 2% ( 17/836 ) coverage. Patients with chronic respiratory diseases, chronic heart disease and diabetes mellitus, coverage with the influenza vaccine was found 75.7% ( 106/140 ), 73.8% ( 150/203 ) and 71.2% ( 151/212 ) respectively, whereas for the anti pneumococcal vaccines for the above groups coverage ranged from 36,7% - 43.5%. Subjects with obesity in our sample were found with 69% ( 58/84 ) coverage for the influenza vaccine and 29.7% for pneumoccocal vaccination, while smokers 50.2% for the influenza vaccine and 17.6% ( 34/193 )coverage with at least one of the available pneumococcal vaccines respectively. Vaccination coverage with the tetanus vaccine with any of the available tetanus vaccines was found 1.5% ( 14/944 ). Vaccination coverage with the herpes zoster vaccine was found 0.8% ( 8/944 ), while for the booster dose with the combined vaccine against tetanus, diphtheria and accellular pertussis (Tdap) vaccine coverage was found nil.
Male sex, younger age limits, and those without chronic medical conditions were found to have the lower vaccination coverage rates for influenza and anti-pneumococcal vaccines. ( p< 0.05 ) There was no statistically significant difference between communities with a different distance from the Anogeia Health Center and their level of vaccination. ( p>0.05 )
Conclusions
The vaccination coverage of adults over the age of 60 for the vaccines recommended by the 2017 - 2018 national adult vaccination program in the area of responsibility of the Anogeia Health Center seems inadequate. Vaccine coverage in the overall study population was found to be at similar levels over previous studies from the same geographical area since 2014, indicating a stagnation in improving the implementation of vaccination programs with this vaccine in recent years. Except for those with chronic respiratory diseases found to have exceeded the lowest European target with the influenza vaccine, all other subgroups of high-risk individuals were found to have insufficient coverage with both the influenza vaccine and the pneumococcal vaccines.
Vaccination coverage with pneumococcal disease vaccines seems to be also inadequate and we found a decrease in coverage levels compared to earlier studies from the same geographical area. Vaccine coverage with tetanus toxoid (TT) and shingles vaccine was found to be almost non-existent, while coverage with the tetanus -diphtheria-pertussis vaccine (Tdap) was found to be nil. The unmarried status, male gender, younger age groups, people without chronic illness, and smokers found with the lowest coverage rates for both the influenza vaccine and the pneumococcal disease vaccine. At the same time, awareness of the necessity for vaccination with the above vaccines was found to be extremely low, and respondents were poorly informed about their knowledge of the adequacy of their vaccination dosage regimen for pneumococcal disease. The above findings highlight the important role of Primary Health Care in delivering appropriate interventions and promoting actions to improve community-based prevention programs.
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Εμβολιαστική κάλυψη ενηλίκων άνω των 60 ετών στην περιοχή ευθύνης του Κέντρου Υγείας Ανωγείων.
