Keywords
Vaccination
Vaccine
Health care workers
High-risk groups
Abstract
Influenza is a respiratory infectious disease that represent one of the main causes of excess winter deaths (EWDs)in Europe. Annual flu epidemics are associated with high morbidity and mortality rates, especially among the elderly, those with underlying health conditions and pregnant women.
Also Health Care Workers (HCWs)are considered an high risk group either for contracting influenza or for preventing transmission of influenza virus to vulnerable patients. Thus, these four target groups are mainly eligible for developing vaccination strategies.
During 2014/2015 season, the excess winter mortality rates observed in northern hemisphere countries (EuroMOMO network) and in Italy (+13%), was strongly related with the intensity of influenza circulation.
Influenza vaccination represents the most important public health intervention to prevent seasonal influenza transmission and infection.
However, to date, influenza vaccination coverages reported in Europe also among high risk groups are still largely unsatisfactory.
This study analyzes the International and European guidelines on influenza vaccination and the rationale which underlies the evidence-based public health intervention for prevention of influenza among the principal high-risk groups: a) the elderly (subjects with 65 years old or older); b) Subjects with underlying health condition; c) pregnant women; d) healthcare workers.
Only the achievement of recommended influenza vaccination coverage in all European Countries among high-risk groups could reduce the burden of disease and minimize the peaks of winter mortality related with influenza virus circulation.
References
Brammer TL, Murray EL, Fukuda K, Hall HE, Klimov A, Cox NJ. Surveillance for influenza – United States, 1997- 98, 1998-99, and 1999-00 seasons. MMWR Surveill Summ 2002;51(7):1-10. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5107a1.htm PubMed PMID: 12418623. [Google Scholar]
Schanzer DL, McGeer A, Morris K. Statistical estimates of res- piratory admissions attributable to seasonal and pandemic in- fluenza for Canada. Influenza Other Respir Viruses 2013;7(5):799-808. Available from: http://doi.wiley.com/10.1111/irv.12011 doi: 10.1111/irv.12011. [Google Scholar]
ECDC Technical Report. Seasonal influenza vaccination in Eu- rope: overview of vaccination recommendations and coverage rates in the EU Member States for the 2012-13 influenza sea- son. Available online at: http://ecdc.europa.eu/en/publications/ Publications/Seasonal-influenza-vaccination-Europe-2012-13. pdf [Accessed 08/02/2016].
Bonmarin I, Belchior E, Lévy-Bruhl D. Impact of influenza vac- cination on mortality in the French elderly population during the 2000-2009 period. Vaccine 2015;33(9):1099-101. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0264410X15000420 doi: 10.1016/j.vaccine.2015.01.023. [Google Scholar]
Molbak K, Espenhain L, Nielsen J, Tersago K, Bossuyt N, Den- issov G, Baburin A, Virtanen M, Fouillet A, Sideroglou T, Gkol- finopoulou K, Paldy A, Bobvos J, van Asten L, de Lange M, Nunes B, da Silva S, Larrauri A, Gomez IL, Tsoumanis A, Jun- ker C, Green H, Pebody R, McMenamin J, Reynolds A, Mazick A. Excess mortality among the elderly in European countries, December 2014 to February 2015. Euro Surveill 2015;20.
Office of National Statistics. Excess Winter Mortality in England and Wales 2014/15 (Provisional) and 2013/14 (Final). Avail- able online at: http://www.ons.gov.uk/ons/dcp171778_425192. pdf [Accessed 08/02/2016].
Michelozzi P, Donato, F. De , Scortichini M, Sario, M. De , Asta F, Agabiti N, et al. On the increase in mortality in Italy in 2015: analysis of seasonal mortality in the 32 municipalities included in the Surveillance system of daily mortality. Epidemiol Prev 2016;40(1):22-8. Available from: http://www.epiprev.it/node/3072 PubMed PMID: 26951698. doi: 10.19191/EP16.1.P022.010. [Google Scholar]
Thiberville SD, Gaudart J, Raoult D, Charrel RN. Influenza- attributable deaths in south-eastern France (1999 to 2010): mortality predictions were undependable. BMC Public Health 2015;15(1):539. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1887-y PubMed PMID: 26049715. doi: 10.1186/s12889-015-1887-y. [Google Scholar]
Nielsen J, Mazick A, Glismann S, Mølbak K. Excess mortality related to seasonal influenza and extreme temperatures in Den- mark, 1994-2010. BMC Infect Dis 2011;11(1):350. Available from: http://www.biomedcentral.com/1471-2334/11/350 doi: 10.1186/1471-2334-11-350. [Google Scholar]
Matias G, Taylor R, Haguinet F, Schuck-Paim C, Lustig R, Shinde V. Estimates of mortality attributable to influenza and RSV in the United States during 1997-2009 by influenza type or subtype, age, cause of death, and risk status. Influenza Other Respir Viruses 2014 Jun;8(5):507-515. Available from: http://dx.doi.org/10.1111/irv.12258 PubMed PMID: 24975705. doi: 10.1111/irv.12258. [Google Scholar]
European monitoring of excess mortality for public health ac- tion network. Available online at: http://www.euromomo.eu/ [Accessed 11/02/2016]
Mølbak K, Espenhain L, Nielsen J, Tersago K, Bossuyt N, Denissov G, et al. EXCESS MORTALITY AMONG THE ELDERLY IN EUROPEAN COUNTRIES, DECEMBER 2014 TO FEBRUARY 2015. . Available from: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21065 [Google Scholar]
ECDC/WHO. FluNews Europe. Joint ECDC/WHO Europe weekly influenza update bulletin. Available online from: http:// www.flunewseurope.org/ (last accessed 11/02/2016)
Signorelli C, Odone A, Conversano M, Bonanni P. Deaths af- ter Fluad flu vaccine and the epidemic of panic in Italy. BMJ 2015;350. [Google Scholar]
Werf, S. van der , Levy-Bruhl D. Influenza – the need to stay ahead of the virus. Euro Surveill 2015;20(5):21030. Available from: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21030 doi: 10.2807/1560-7917.ES2015.20.5.21030. [Google Scholar]
MosnierA,CainiS,DaviaudI,BensoussanJL,Stoll-KellerF, Bui TT, Lina B, Van der Werf S, Cohen JM, , network GROG. Ten influenza seasons in France: distribution and timing of influenza A and B circulation, 2003-2013. BMC Infect Dis 2015;15(1):357. Available from: http://www.biomedcentral.com/1471-2334/15/357 doi: 10.1186/s12879-015-1056-z. [Google Scholar]
Heikkinen T, Ikonen N, Ziegler T. Impact of influenza B lin- eage-level mismatch between trivalent seasonal influenza vaccines and circulating viruses, 1999-2012. Clin Infect Dis 2014;59(11):1519-24. Available from: http://cid.oxfordjournals.org/lookup/doi/10.1093/cid/ciu664 doi: 10.1093/cid/ciu664. [Google Scholar]
Pebody R, Warburton F, Andrews N, Thompson C, von Wis- smann B, , Green HK, et al. Low effectiveness of seasonal influenza vaccine in pre- venting laboratory-confirmed influenza in primary care in the United Kingdom: 2014/15 mid-season results. Euro Surveill 2015;20(5):21025. Available from: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21025 doi: 10.2807/1560-7917.ES2015.20.5.21025. [Google Scholar]
Grohskopf LA, Sokolow LZ, Olsen SJ, Bresee JS, Broder KR, Karron RA. Prevention and control of Influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices, United States, 2015-16 Influenza Season. MMWR Morb Mortal Wkly Rep 2015 Aug;64(30):818-825. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6430a3.htm PubMed PMID: 26247435. doi: 10.15585/mmwr.mm6430a3. [Google Scholar]
ECDC. Seasonal influenza vaccines. Influenza vaccination. Available online from: http://ecdc.europa.eu/en/healthtopics/ seasonal_influenza/vaccines/Pages/influenza_vaccination. aspx#vaccinationstrategies [Accessed 11/02/2016]
Ministero della Salute. Piano Nazionale Prevenzione Vaccinale. Prevenzione e controllo dell’influenza: raccomandazioni per la stagione 2015-2016. Available online from: http://www.salute. gov.it/portale/news/p3_2_1_1_1.jsp?lingua=italiano&menu=n otizie&p=dalministero&id=2218 [Accessed 12/02/2016]
European Centre for Disease Prevention and Control. Seasonal influenza vaccination in Europe: overview of vaccination recom- mendations and coverage rates in the EU Member States for the 2012-13 influenza season. (2015). Available online from: http://ecdc.europa.eu/en/publications/Publications/Seasonal-influenza- vaccination-Europe-2012-13.pdf [Accessed 12/02/2016].
Fischer WA, Gongz M, Bhagwanjeex S, Sevransky J. Global burden of influenza as a cause of cardiopulmonary morbidity and mortality. Glob Heart 2014;9(3):325-336. Available from: http://europepmc.org/abstract/MED/25667184 PubMed PMID: 25667184. doi: 10.1016/j.gheart.2014.08.004. [Google Scholar]
Beck CR, McKenzie BC, Hashim AB. Influenza vaccination for immunocompromised patients: systematic review and meta- analysis by etiology. J Infect Dis 2012;206(8):1250-1259. Available from: http://www.jid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=22904335 PubMed PMID: 22904335. doi: 10.1093/infdis/jis487. [Google Scholar]
SheridanPA,PaichHA,HandyJ,KarlssonEA,Schultz-Cherry S, Hudgens M, Weir S, Noah T, Beck MA . The antibody re- sponse to influenza vaccination is not impaired in type 2 diabet- ics. Vaccine 2015;33(29):3306-13. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0264410X15006957 doi: 10.1016/j.vaccine.2015.05.043. [Google Scholar]
BeckCR,McKenzieBC,HashimAB,HarrisRC,ZanuzdanaA, Agboado G, Orton E, Béchard-Evans L, Morgan G, Stevenson C, Weston R, Mukaigawara M, Enstone J, Augustine G, Butt M, Kim S, Puleston R, Dabke G, Howard R, O’Boyle J, O’Brien M, Ahyow L, Denness H, Farmer S, Figureroa J, Fisher P, Greaves F, Haroon M, Haroon S, Hird C, Isba R, Ishola DA, Kerac M, Parish V, Roberts J, Rosser J, Theaker S, Wallace D, Wiggles- worth N, Lingard L, Vinogradova Y, Horiuchi H, Peñalver J, Nguyen-Van-Tam JS . Influenza vaccination for immunocom- promised patients: summary of a systematic review and meta- analysis. Influenza Other Respir Viruses 2013;7(Suppl 2):72-5. [Google Scholar]
VinogradI,Eliakim-RazN,FarbmanL,BasloR,TahaA,Sakh- nini A, Lador A, Stemmer SM, Gafter-Gvili A, Leibovici L, Paul M . Clinical effectiveness of seasonal influenza vaccine among adult cancer patients. Cancer 2013;119(22):4028-35. Available from: http://doi.wiley.com/10.1002/cncr.28351 doi: 10.1002/cncr.28351. [Google Scholar]
SungLC,ChenCI,FangYA,LaiCH,HsuYP,ChengTH,Mi- ser JS, Liu JC . Influenza vaccination reduces hospitalization for acute coronary syndrome in elderly patients with chronic ob- structive pulmonary disease: a population-based cohort study. Vaccine 2014;32(30):3843-9. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0264410X14006021 doi: 10.1016/j.vaccine.2014.04.064. [Google Scholar]
SiriwardenaAN,AsgharZ,CouplandCC . Influenzaandpneu- mococcal vaccination and risk of stroke or transient ischaemic attack-matched case control study. Vaccine 2014;32(12):1354-61. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0264410X14000619 doi: 10.1016/j.vaccine.2014.01.029. [Google Scholar]
Neuzil KM, Reed GW, Mitchel EF, Simonsen L, Griffin MR. Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women.. Am J Epidemiol 1998 Dec;148(11):1094-1102. Available from: http://aje.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=9850132 PubMed PMID: 9850132. doi: 10.1093/oxfordjournals.aje.a009587. [Google Scholar]
DoddsL,McNeilSA,FellDB,AllenVM,CoombsA,ScottJ, MacDonald N . Impact of influenza exposure on rates of hospital admissions and physician visits because of respiratory illness among pregnant women. CMAJ 2007 Feb;176(4):463-468. Available from: http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=17296958 PubMed PMID: 17296958. doi: 10.1503/cmaj.061435. [Google Scholar]
FreemanDW,BarnoA . DeathsfromAsianinfluenzaassociated with pregnancy. Am J Obstet Gynecol 1959;78:1172-5. [Google Scholar]
RasmussenSA,JamiesonDJ,BreseeS . Pandemicinfluenzaand pregnant women. Emerg Infect Dis 2008;14(1):95-100. Available from: http://wwwnc.cdc.gov/eid/article/14/1/07-0667_article.htm doi: 10.3201/eid1401.070667. [Google Scholar]
Louie JK, Acosta M, Jamieson DJ, Honein MA, , California Pan- demic (H1N1) Working Group . Severe 2009 H1N1 influenza in pregnant and postpartum women in California. N Engl J Med 2010;362(1):27-35. Available from: http://www.nejm.org/doi/abs/10.1056/NEJMoa0910444?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.gov PubMed PMID: 20032319. doi: 10.1056/NEJMoa0910444. [Google Scholar]
Thompson MG, Li DK, Shifflett P, Sokolow LZ, Ferber JR, Kurosky S, Bozeman S, Reynolds SB, Odouli R, Henninger ML, Kauffman TL, Avalos LA, Ball S, Williams JL, Irving SA, Shay DK, Naleway AL, , Workgroup, a.I.P. (Pregnancy) . Effectiveness of seasonal trivalent influenza vaccine for preventing influenza virus illness among pregnant women: a population-based case-control study during the 2010-2011 and 2011-2012 influenza seasons. Clin Inf Dis 2014;58(4):449-457. Available from: http://www.cid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=24280090 PubMed PMID: 24280090. doi: 10.1093/cid/cit750. [Google Scholar]
Kissling E, Valenciano M; Team IMC-CS. Early estimates of seasonal influenza vaccine effectiveness in Europe among tar- get groups for vaccination: results from the I-MOVE multicentre case-control study, 2011/12. Euro Surveill 2012;17.
Madhi SA, Cutland CL, Kuwanda L, Weinberg A, Hugo A, Jones S, Adrian PV, van Niekerk N, Treurnicht F, Ortiz JR, Ven- ter M, Violari A, Neuzil KM, Simões EA, Klugman KP, Nunes MC, , Maternal Flu Trial (Matflu) Team . Influenza vaccination of pregnant women and protection of their infants. N Engl J Med 2014;371(10):918-31. Available from: http://www.nejm.org/doi/abs/10.1056/NEJMoa1401480 doi: 10.1056/NEJMoa1401480. [Google Scholar]
Acs N, Bánhidy F, Puhó E, Czeizel AE. Maternal influenza dur- ing pregnancy and risk of congenital abnormalities in offspring. Birth Defects Res A Clin Mol Teratol 2005;73(12):989-96. Available from: http://doi.wiley.com/10.1002/bdra.20195 doi: 10.1002/bdra.20195. [Google Scholar]
Ludvigsson JF, Ström P, Lundholm C. Maternal vaccination against H1N1 influenza and offspring mortality: population based cohort study and sibling design. BMJ 2015;351:h5 585.
McMillan M, Porritt K, Kralik D, Costi L, Marshall H. Influ- enza vaccination during pregnancy: a systematic review of fe- tal death, spontaneous abortion, and congenital malformation safety outcomes. Vaccine 2015;33(18):2108-17. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0264410X15002686 doi: 10.1016/j.vaccine.2015.02.068. [Google Scholar]
Dolan GP, Harris RC, Clarkson M, Sokal R, Morgan G, Mu- kaigawara M, , et al. Vaccination of health care workers to protect patients at increased risk for acute respira- tory disease. Emerg Infect Dis 2012;18(8):1225-1234. Available from: http://wwwnc.cdc.gov/eid/article/18/8/11-1355_intro.htm doi: 10.3201/eid1808.111355. [Google Scholar]
Amodio E, Restivo V, Firenze A, Mammina C, Tramuto F, Vi- tale F . Can influenza vaccination coverage among healthcare workers influence the risk of nosocomial influenza-like illness in hospitalized patients. J Hosp Infect 2014;86(3):182-187. Available from: https://www.nlm.nih.gov/medlineplus/flu.html PubMed PMID: 24581755. doi: 10.1016/j.jhin.2014.01.005. [Google Scholar]
Elder AG, O’Donnell B, McCruden EAB, Symington IS, Carman WF. Incidence and recall of influenza in a co- hort of Glasgow healthcare workers during the 1993-4 epidemic: results of serum testing and questionnaire. BMJ 1996;313(7067):1241-2. Available from: http://www.bmj.com/cgi/doi/10.1136/bmj.313.7067.1241 doi: 10.1136/bmj.313.7067.1241. [Google Scholar]
BurlsA,JordanR,BartonP,OlowokureB,WakeB,AlbonE, Hawker J . Vaccinating healthcare workers against influenza to protect the vulnerable e is it a good use of healthcare resources? A systematic review of the evidence and an economic evalua- tion. Vaccine 2006;24(19):4212-4221. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0264410X05012946 doi: 10.1016/j.vaccine.2005.12.043. [Google Scholar]
LittleKE,GoodridgeS,LewisH,LingardSW,DinS,TidleyM, Roberts RJ, Williams NS, Hayes S . Occupational vaccination of health care workers: uptake, attitudes and potential solutions. Public Health 2015;129(6):755-762. Available from: https://www.nlm.nih.gov/medlineplus/immunization.html PubMed PMID: 25834928. doi: 10.1016/j.puhe.2015.02.031. [Google Scholar]
Costantino C, Mazzucco W, Azzolini E, Baldini C, Bergomi M, Biafiore AD, Bianco M, Borsari L, Cacciari P, Cadeddu C, Camia P, Carluccio E, Conti A, De Waure C, Di Gregori V, Fa- biani L, Fallico R, Filisetti B, Flacco ME, Franco E, Furnari R, Galis V, Gallea MR, Gallone MF, Gallone S, Gelatti U, Gilardi F, Giuliani AR, Grillo OC, Lanati N, Mascaretti S, Mattei A, Micò R, Morciano L, Nante N, Napoli G, Nobile CG, Palladino R, Parisi S, Passaro M, Pelissero G, Quarto M, Ricciardi W, Romano G, Rustico E, Saponari A, Schioppa FS, Signorelli C, Siliquini R, Trabacchi V, Triassi M, Varetta A, Ziglio A, Zoccali A, Vitale F, Amodio E. Influenza vaccination coverage among medical residents: an Italian multicenter survey. Hum Vaccin Immunother 2014;10:1204-10.
CostantinoC,BattagliaA,D’AstaM,FurnariR,Gimigliano A, Guaccero A, Mallamace N, Marcantoni C, Maringhini, Marsala MGL, Micò R, Biafore A, Papalia R, Pasqua C, Si- mone B, Franchino G . Knowledge, attitudes and behaviors regarding influenza vaccination among hygiene and preven- tive medicine residents in Calabria and Sicily. Euromed Bi- omed J 2012;7:77-83. [Google Scholar]
Costantino C, Amodio E, Vitale F, Maida C, Meringhini G, Asciutto R, et al. Attitudes, behaviours and perceptions of Italian general practitioner trainees towards in- fluenza vaccination in Western Sicily (Italy. Ital J Public Health 2012;9:33-9. [Google Scholar]
Pitts SI, Maruthur NM, Millar KR, Perl TM, Segal J. A system- atic review of mandatory influenza vaccination in healthcare personnel. Am J Prev Med 2014;47(3):330-40. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0749379714002554 doi: 10.1016/j.amepre.2014.05.035. [Google Scholar]
IsaacsD,LeaskJ . Shouldinfluenzaimmunisationbemandatory for healthcare workers? No. BMJ 2008;337. [Google Scholar]
DiGregoriV,FranchinoG,MarcantoniC,SimoneB,Costanti- no C . Logistic regression of attitudes and coverage for influenza vaccination among Italian Public Health medical residents. J Prev Med Hyg 2014;55(4):152-7. Available from: http://europepmc.org/abstract/MED/26137789 PubMed PMID: 26137789. [Google Scholar]
CostantinoC,AmodioE,CalamusaG,VitaleF,MazzuccoW . Could university training and a proactive attitude of cowork- ers be associated with influenza vaccination compliance? A multicentre survey among Italian medical residents. BMC Med Educ 2016;16(1):38. Available from: http://www.biomedcentral.com/1472-6920/16/38 doi: 10.1186/s12909-016-0558-8. [Google Scholar]
Gasparini R, Bonanni P, Amicizia D, Bella A, Donatelli I, Ml, t. (Cris-) , et al. Influenza epidemiology in Italy two years after the 2009-2010 pandemic: need to improve vaccina- tion coverage. Hum Vaccin Immunother 2013;9(3):561-7. Available from: http://www.tandfonline.com/doi/abs/10.4161/hv.23235 doi: 10.4161/hv.23235. [Google Scholar]