Abstract
Seasonal influenza epidemics yearly affects 5-15% of the world’s population, resulting in 3-5 million serious cases and up to 650,000 deaths. Elderly, pregnant women and individuals with underlying conditions are at increased risk of complications. According to the Italian National Immunization Prevention Plan 2017-2019, these categories benefit from free vaccination. Influenza coverage rate in Italy are not optimal. The study investigated the coverage rate in five consecutive influenza seasons (2010/2011-2014/2015) in Local Health Unit (LHU) of Ferrara (Italy). The amount of delivered vaccinations was not constant, with a decreasing trend. An increase in coverage with increasing age was observed, but in no immunisation seasons the 75% target of over-65 years old individuals immunised was achieved. As number of delivered doses and coverage rates decreased, the percentage of immunisations delivered by the General Practitioners (GPs) increased. The District with the lowest vaccination coverage was the Western District. In elderly, coverage rates in South-Eastern and North-Central District were higher with a statistically significant difference compared to Western District. Higher levels of immunisation were observed in South-Eastern District in the pediatric age and in North-Central District in adult age group with a statistically significant difference. The trend in the LHU of Ferrara was similar to regional and national data, conditioned in the 2014/2015 season by the spreading of worrying news, although unfounded, on the safety of the vaccine. The GPs were essential in ensuring vaccine uptake, growing the percentage of delivered doses and achieving as much as possible effective elderly immunisation
References
2. World Health Organization (WHO). Review of the 2018–2019 influenza season in the northern hemisphere. Weekly Epidemiological Record 2019; 94: 345–64.
3. Cassini A, Colzani E, Pini A, Mangen MJ, Plass D, McDonald SA, Maringhini G, van Lier A, Haagsma JA, Havelaar AH, Kramarz P, Kretzschmar ME, on behalf of the BCoDE Consortium. Impact of infectious diseases on population health using incidence-based disability-adjusted life years (DALYs): results from the Burden of Communicable Diseases in Europe study, European Union and European Economic Area countries, 2009 to 2013. Euro Surveill 2018; 23(16):pii=17-00454. https://doi.org/10.2807/1560-7917.ES.2018.23.16.17-00454E.
4. Epicentro. Epidemiologia dell’influenza (2019). Available at: https://www.epicentro.iss.it/influenza/epidemiologia-italia. [Accessed on 25/09/2019].
5. Bella A, Castrucci MR. La sorveglianza integrata dell’influenza in Italia: i risultati della stagione 2018-19. Bollettino Epidemiologico Nazionale 2019; luglio-agosto. Available at: https://www.epicentro.iss.it/ben/2019/luglio-agosto/sorveglianza-integrata-influenza-2018-19?utm_source=newsletter&utm_medium=email&utm_campaign=26settembre2019 [Accessed on 30/09/2019].
6. Mertz D, Kim TH, Johnstone J, Lam -P-P, Science M, Kuster SP, Fadel SA, Tran D, Fernandez E, Bhatnagar N, Loeb M. Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis. BMJ. 2013;347:f5061. doi:10.1136/bmj.f5061.
7. Demicheli V, Jefferson T, Di Pietrantonj C, Ferroni E, Thorning S, Thomas RE, Rivetti A. Vaccines for preventing influenza in the elderly. Cochrane Database Syst Rev. 2018;2:CD004876. doi: 10.1002/14651858.CD004876.pub4.
8. World Health Organization (WHO). Vaccines against influenza WHO position paper – November 2012, Weekly epidemiological record 2012; 87: 461-476.
9. World Health Organization (WHO). Influenza. Available at: www.euro.who.int/en/health-topics/communicable-diseases/influenza/vaccination/seasonal-vaccination-policies-and-coverage-in-the-european-region. [Accessed on 19/11/2019].
10. ISTAT. GeoDemo. Available at: demo.istat.it/. [Accessed on 03/09/2019].
11. 2017-2019 National Immunization Plan. Gazzetta Ufficiale della Repubblica Italiana. GU Serie Generale n. 41 del 18 febbraio 2017. Available at: www.salute.gov.it/imgs/C_17_pubblicazioni_2571_allegato.pdf. [Accessed on 19/11/2019].
12. Emilia Romagna Region. Epidemiological report, season 2017/2018. Available at: http://www.quotidianosanita.it/allegati/allegato2729096.pdf [Accessed on 19/11/2019].
13. Ministero della Salute. Dati di copertura della vaccinazione antinfluenzale (2019). Available at: http://www.salute.gov.it/portale/influenza/dettaglioContenutiInfluenza.jsp?lingua=italiano&id=679&area=influenza&menu=vuoto. [Accessed on 24/09/2019].
14. Signorelli C, Odone A, Conversano M, Bonanni P. Deaths after Fluad flu vaccine and the epidemic of panic in Italy. BMJ 2015; 350:h116. doi: 10.1136/bmj.h116.
15. Azienda USL di Ferrara. Profilo di salute della comunità ferrarese. Dicembre 2016. Available at: http://www.ausl.fe.it/azienda/dipartimenti/sanita-pubblica/Profilo_di_salute_della_comunit_ferrarese_2016.pdf [Accessed on 19/11/2019].
16. Mereckiene J Cotter S Nicoll A , et al. Seasonal influenza immunisation in Europe. Overview of recommendations and vaccination coverage for three seasons: pre-pandemic (2008/09), pandemic (2009/10) and post-pandemic (2010/11). Euro Surveill 2014; 19: 20780.
17. Prior L Evans MR Prout H . Talking about colds and flu: the lay diagnosis of two common illnesses among older British people . Soc Sci Med 2011 ; 73 : 922 – 8 .
18. Hoffmann K, Paget J, Wojczewski S, Katic M, Maier M, Soldo D. nfluenza vaccination prevalence and demographic factors of patients and GPs in primary care in Austria and Croatia: a cross-sectional comparative study in the framework of the APRES project. Eur J Public Health. 2016;26(3):395-401. doi: 10.1093/eurpub/ckw006.
19. Gignon M, Idris H, Manaouil C, Ganry O. The waiting room: vector for health education? The general practitioner's point of view. BMC Res Notes. 2012 Sep 18; 5():511.e
20. Rolland MA, Gignon M. Immunization educational game in general practice waiting rooms. A comparative study. Rolland MA, Gignon M Sante Publique 2015; 27(2):159-65.
21. :Berkhout C, Willefert-Bouche A, Chazard E, Zgorska-Maynard-Moussa S, Favre J, Peremans L, et al. (2018) Randomized controlled trial on promotinginfluenza vaccination in general practice waiting rooms. PLoS ONE 13(2): e0192155. https://doi.org/10.1371/journal.pone.0192155
22. Thomas RE, Lorenzetti DL. Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD005188. DOI: 10.1002/14651858.CD005188.pub4.