Impact of a Catch-Up Strategy of DT-IPV Vaccination during Hospitalization on Vaccination Coverage among People Over 65 Years of Age in France: The HOSPIVAC Study (Vaccination during Hospitalization)

Sophie Blanchi,Ludovic Hery,Justine Vaux,Giorgina Barbara Piccoli,Servane Laforest,Nicolas Crochette,Jean Marc Toqué

doi:10.3390/vaccines8020292

Abstract

In France, diphtheria tetanus and inactivated polio vaccine (DT-IPV) coverage and immunization are insufficient in the elderly and decrease with age. The principal objective of this study was to assess the impact of a strategy of catch-up DT-IPV vaccination during hospitalization in people over the age of 65 years in central France (the Sarthe region). We performed a prospective, single-center, cluster-randomized study (four hospital wards). We included patients aged ≥65 years, without mental impairment, contraindication and who accepted to participate, hospitalized in the internal medicine wards in Le Mans Hospital from 28 May 2018 to 27 May 2019. The DT-IPV vaccination status of the patients was determined at inclusion and the wards were randomized (intervention and control). In the intervention group, vaccination was up-dated during hospitalization. In case of temporary contraindication, vaccination was prescribed at hospital discharge. Patients hospitalized in the control wards received oral information only. Final immunization status was determined by calling the patient’s general practitioner two months after hospital discharge. One hundred and fifty seven patients were included: 73 in the intervention and 84 in the control arm. Baseline immunization coverage was 46.5%. Vaccination coverage increased from 56.2% to 80.8% in the intervention group and from 38.1% to 40.5% in the control group (p < 0.001). Having received sufficient information from the general practitioner was the only factor associated with vaccination being up-to-date in uni- and multivariate analysis: OR = 5.07 [2.45–10.51]. In a setting of low vaccination coverage DT-IPV vaccination during hospitalization is an effective catch-up strategy.

Highlights

Vaccination has increased life expectancy and improved the health of the world population conferring both an individual and a collective benefit or “herd effect” [1], since immunization of a proportion of the population decreases the risk of infection in non-vaccinated individuals.In France, primary diphtheria tetanus and inactivated polio vaccine (DT-IPV) vaccination is compulsory in childhood
Patients was 78.1 ± 8.1 years and 81.4 ± 8 years in group A and B, From 28 May 2018 to 27 May 2019, 162 patients were included in the HOSPIVAC study
The main result of this study was that DT-IPV vaccination coverage in patients older than 65 years was low and that a hospital-based intervention was an efficient catch up strategy

Summary

Introduction

Vaccination has increased life expectancy and improved the health of the world population conferring both an individual and a collective benefit or “herd effect” [1], since immunization of a proportion of the population decreases the risk of infection in non-vaccinated individuals.In France, primary diphtheria tetanus and inactivated polio vaccine (DT-IPV) vaccination is compulsory in childhood. According to the “Health and social protection” survey carried out in 2012 by the French Institute for Documentation and Research in Health Economics (IRDES) and analyzed by the Institute of Health Surveillance (INVS), vaccination coverage varies significantly with age (p < 0.001): it increases up to 45 years of age (58%), and decreases thereafter (51% at 65 years, 47% at 70 years and 38% at 80 years) [4,5] This is observed for diphtheria tetanus pertussis and inactivated polio vaccine (DTaP-IPV) coverage [6,7,8,9]

Objectives

Methods

Results

Discussion

Conclusion