Determinants of tetanus, pneumococcal and influenza vaccination in the elderly: a representative cross-sectional study on knowledge, attitude and practice (KAP).

Carolina J Klett-Tammen,Linda Seefeld,Jördis J Ott,Gérard Krause

doi:10.1186/s12889-016-2784-8

Abstract

BackgroundSeverity and incidence of vaccine-preventable infections with influenza viruses, s. pneumoniae and c. tetani increase with age. Furthermore, vaccine coverage in the elderly is often insufficient. The aim of this study is to identify socio-economic and knowledge-, attitude- and practice- (KAP)-related determinants of vaccination against influenza, pneumococcal disease and tetanus in the older German population.MethodsWe analysed data from a German nationally representative questionnaire-based KAP-survey on infection prevention and hygiene behavior in the elderly (n = 1223). We used logistic regressions to assess impacts of socio-demographic- and KAP-related variables on vaccine uptake in general and on tetanus-, influenza- and pneumococcal vaccination. To generate KAP-scores, we applied factor analyses and analysed scores as predictors of specific vaccinations.ResultsA low rated personal health status was associated with a higher uptake of influenza vaccine whereas place of residence within Germany strongly impacted on pneumococcal vaccination. For tetanus and influenza vaccination, the strongest single vaccination predictor was attitude-related, i.e., the perceived importance of the vaccine (OR = 18.1, 95 % CI = 4.5–71.8; OR = 23.0, 95 % CI = 14.9–35.3, respectively). Pneumococcal vaccination was mostly knowledge-associated, i.e., knowing the recommendation predicted uptake (OR = 17.1, 95 % CI = 9.5–30.7). Regarding the generated KAP-scores, the practice-score reflecting vaccine related behavior such as having a vaccination record, was predictive for all vaccines considered. The knowledge-score was associated with influenza (OR = 1.3, 95 % CI = 1.0–1.6) and pneumococcal vaccination (OR = 1.2, 95 % CI = 1.0–1.5). Uniquely for influenza vaccination, the attitude-score was linked to vaccine uptake (OR = 1.1, 95 % CI = 1.0–1.1).ConclusionsOur results indicate that predictors of vaccination uptake in the elderly strongly depend on vaccine type and that scores of KAP are useful and valid to condense information from numerous individual KAP-variables. While awareness for vaccinations against influenza and tetanus is fairly high already it might have to be increased for vaccinations against pneumocoocal infections.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2784-8) contains supplementary material, which is available to authorized users.

Highlights

Severity and incidence of vaccine-preventable infections with influenza viruses, s. pneumoniae and c. tetani increase with age
[3] Severe disease outcomes from S. pneumoniae include invasive pneumococcal diseases (IPD) [4], as sepsis, pneumonia [5], and meningitis [6], whereas influenza virus infection is characterized by high fever, aching muscles, headache, cough, sore throat and rhinitis
Reviewing the existing evidence from 69 international publications on determinants of vaccine-usage in the elderly, we found the following to be most frequently significantly associated with vaccine uptake: socio-demographic determinants such as living arrangement [14], low awareness of the vaccine recommendation [15, 16], attitudes like the perceived low severity of the corresponding disease [17, 18], and practices including previous uptake of vaccinations [19]

Summary

Introduction

Severity and incidence of vaccine-preventable infections with influenza viruses, s. pneumoniae and c. tetani increase with age. Severity and incidence of vaccine-preventable infections with influenza viruses, s. The aim of this study is to identify socio-economic and knowledge-, attitude- and practice- (KAP)-related determinants of vaccination against influenza, pneumococcal disease and tetanus in the older German population. Older age is strongly associated with disease severity and case fatality resulting from Streptococcus pneumoniae In Germany, reported incidence of IPD and influenza infection in 2014 was 1.35/100.000 and 5.92/100.000, respectively in the age group 60 years and older. Vaccines against all three diseases are available and German vaccine recommendations for adults aged ≥60 years include the 10 year interval tetanus and diphtheria vaccination, the annual influenza vaccination and a singular pneumococcal vaccination, using the 23-valent PPV dose, while PCV is licensed [10]. While a national campaign promotes influenza vaccination [12], no comparable strategies are in place for pneumococcal or tetanus vaccination, focusing on the elderly

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