Flu vaccination rates among elderly, chronically ill, and medical staff

January 28, 2014
Deputy John Deasy asked the Minister for Health if he is concerned that Ireland is falling short of the 75% flu vaccination target for older age groups, according to a progress report on the 2009 EU Council Recommendation; and the reason Ireland’s vaccination coverage dropped from 70% in 2008/09 to 56.3% in 2011/2012.

REPLY / Minister James Reilly:
In Ireland the Health Protection Surveillance Centre (HPSC) collates influenza vaccine uptake statistics in those aged 65 years and older based on data obtained from the Primary Care Reimbursement Service (PCRS), HSE- Finance Shared Services. These data provide information on the number of patients vaccinated with influenza vaccine (by age group and HSE-Area of residence), attendance at GP clinics and pharmacies for vaccination and the number of registered medical and GP visit cardholders aged 65 years and older. The number of patients vaccinated with influenza vaccine refers to GP and pharmacy paid claims for influenza vaccination reported by the PCRS and so are dependent on GPs’ and pharmacist’s claims for reimbursement.  Data from pharmacies are only available for the 2012/2013 influenza season when administration of influenza vaccine by pharmacists commenced.

As highlighted, the uptake of influenza vaccine in those aged 65 years and older decreased from 70% in the 2008/2009 to  56.9% in 2011/2012. These estimates are based on PCRS data received by HPSC.  The uptake in the season 2008/2009 was the highest uptake reported. The reason for this decline is unknown but as previously stated may be due to data received by PCRS which is dependent on GPs’ and pharmacist’s claims for reimbursement. Data from pharmacies were only available for the 2012/2013 influenza season when administration of influenza vaccine by pharmacists commenced which may have influenced 2011/2012 season data. In addition, during the period 2011/2012 data reported were not complete as PCRS did not report vaccinations administered by GPs and claimed through the new vaccination claiming system. The 2012/2013 dataset is not fully complete from PCRS and it may improve when the complete dataset is received.  In 2008/2009 there were a number of high profile avian influenza H5N1 outbreaks in UK and other European countries.  It is also possible that the higher uptake noted that year reflected a mistaken belief that seasonal influenza vaccine would protect against H5N1 avian influenza. 

Of note is that a national telephone survey undertaken after the 2012/2013 influenza season measuring influenza vaccine uptake reports 59.9% coverage (provisional data) in those aged 65 years and over which is similar to the uptake recorded in the previous season i.e. 2011/2012 season. This survey also explored the reasons for non-vaccination among respondents. Respondents in the age group 65 years and over perceived themselves as not needing the influenza vaccine and of not being at risk of contracting influenza.  In those who were vaccinated, recommendation by the GP was a strong predictor of influenza vaccination. 

As pointed out the influenza vaccine coverage in this age group is below the WHO target of 75% and this is of concern. Efforts to improve flu vaccine uptake in those aged 65 years and older are made annually by launching the influenza vaccination campaign (media and written materials by the National Immunisation Office) at the start of the influenza season.  In addition, HSE areas communicate to all nursing homes and residential care units at the start of each flu season regarding the importance of improving influenza vaccine uptake among elderly residents. 

---

Table 1: Cumulative percentage seasonal influenza vaccine uptake in Medical Card Holders aged 65 years and older by season (September – August), attending GP clinics. (Click table to enlarge view)


Deputy Deasy asked the Minister for Health the reason flu vaccination rates for Irish persons with chronic medical conditions/risk groups were just below 29% in 2009/2010 the most recent available data compared to 70% in the Netherlands; and the reason vaccination rates among healthcare workers here reached only 18% in 2011/12 down from 26.5% in 2009/10.

REPLY / Minister James Reilly:
I am informed by the HSE that provisional data from the National Telephone Survey 2013 indicates that among those in the age group 18 - 64 years, with chronic medical conditions, self-reported influenza uptake for the 2012 - 2013 season was 28.4%.  There has been little change from uptake in this group previously reported from the National Telephone Survey undertaken in 2010 (for the 2009 - 2010 season).  In general, data from previous surveys has found that low uptake among groups recommended vaccine is based on lack of self-perceived risk and need for vaccination.  A GP or clinician recommending influenza vaccine is a predictor of vaccine acceptance (source: National Telephone Survey 2010). 

Based on data from a European survey (VENICE II survey, 2011 - 2012 influenza season), only three of 28 EU member states (UK, the Netherlands, France) were able to provide administrative data relating to influenza immunisation among individuals with clinical risk (aged 6 months - 64 years).  The influenza vaccine uptake in this group ranged from 29.7% (France) to 73.6% (the Netherlands).  An additional three countries provided survey based data for that season (Portugal, Norway and France).  The range of uptake was 31% (Portugal) to 45.6% (France- estimated based on a number of surveys).

Possible reasons for higher uptake in the Netherlands may be related to the fact that both vaccine and vaccine administration are free for all, whereas in Ireland although the vaccine is free for all, those individuals without medical or GP only cards are required to pay for administration.  It is well documented in international literature that payment for preventive care services (such as vaccination) negatively impacts on vaccination uptake.  Additionally, the Netherlands uses computerised medical records to estimate uptake among risk groups.  Ireland does not have information systems with which to routinely identify those at risk for vaccination and to monitor uptake among this group. 

The most recent data on seasonal influenza vaccination uptake among Health Care workers (HCWs) is available from HPSC.  Overall in 2012 - 2013 the percentage uptake among HCWs as reported by participating hospitals was 17.4% (range 10.1% - 27.8%), a slight decrease from 18.0% reported in 2011 - 2012).  However, data from the National Telephone Survey 2013 found that self-reported vaccine uptake among HCW participants of 29.5%, suggesting that the data provided by hospitals may be incomplete and not accurately reflect uptake among HCWs, some of whom may obtain vaccination outside the occupational health care department (and therefore not reported by occupational health statistics).   

During the current 2013 - 2014 influenza season HSE is working to improve uptake among HCWs in the hospitals and other health care settings.  Based on provisional data from HPSC (for October 2013 - January 2014) the estimated uptake among hospital HCWs is 18.1%, and among HCWs in long term care facilities is 22.8%.  The slight increase reported in this current season most likely reflects the increased attention and promotion to vaccination within the HSE health care facilities (hospitals and long term care facilities).  The data for the complete season will be available following the final request for uptake figures made at the end of the season (May 2014). 

Internationally, achieving high influenza vaccine uptake among HCWs is seen as challenging.  Within Europe recent data (VENICE II survey, 2011 - 2012 influenza season) reported a wide inter-country variation of influenza vaccine coverage among HCWs, range 6.4% (Poland) to 54.4% (Romania).