Influenza Vaccine Recommendations Research Articles

Improving Influenza Vaccination Coverage in Patients with Cancer: A Position Paper from a Multidisciplinary Expert Group.

Patients with cancer can be immunocompromised because of their disease and/or due to anticancer therapy. In this population, severe influenza virus infections are associated with an elevated risk of morbidity and mortality. Influenza vaccination is therefore highly recommended in cancer patients, including those receiving anticancer therapy. However, vaccination coverage remains far below the recommended target for vulnerable subjects. Six specialists in oncology, hematology, immunology, and public health/vaccinology convened with the objective of developing strategies, based on evidence and clinical experience, for improving influenza vaccination coverage in cancer patients. This viewpoint provides an overview of current influenza vaccination recommendations in cancer patients, discusses barriers to vaccination coverage, and presents strategies for overcoming said barriers. New immunization issues raised by the COVID-19 pandemic are also addressed. Future directions include improving public education on influenza vaccination, providing the media with accurate information, improving knowledge among healthcare professionals, improving access to vaccines for cancer patients, co-administration of the influenza and COVID-19 vaccines, increased collaboration between oncologists and other health professionals, increased accessibility of digital vaccination registries to specialists, shared information platforms, and promoting immunization campaigns by healthcare systems with the support of scientific societies.

Impact of vaccination education in cardiac rehabilitation on attitudes and knowledge.

Clinical guidelines recommend influenza vaccination for cardiac patients, and COVID-19 vaccination is also beneficial given their increased risk. Patient education regarding vaccination was developed for cardiac rehabilitation (CR); impact on knowledge and attitudes were evaluated. A single-group pre-post design was applied at a Spanish CR program in early 2022. After baseline assessment, a nurse delivered the 40-minute group education. Knowledge and attitudes were re-assessed. Sixty-one (72%) of the 85 participants were vaccinated for influenza, and 40 (47%) for pneumococcus. Most participants perceived vaccines were important, and that the COVID-19 vaccine specifically was important, with three-quarters not influenced by vaccine myths/misinformation. The education intervention resulted in significant improvements in perceptions of the importance of vaccines (Hake's index 69%), understanding of myths (48%), knowledge of the different types of COVID vaccines (92%), and when they should be vaccinated. Vaccination rates are low despite their importance; while further research is needed, education in the CR setting could promote greater uptake.

Influenza vaccine during pregnancy, recommendations from healthcare providers, and race/ethnicity in the United States.

We examined racial/ethnic differences in the association between influenza vaccine recommendations from healthcare providers and maternal vaccination uptake. This cross-sectional study examined data from the Pregnancy Risk Assessment Monitoring System. We categorized respondents as non-Hispanic (NH) Whites, NH-Blacks, NH-Asians, American Indians/Alaska Natives, NH Other non-Whites, and Hispanics. We conducted multivariable logistical regression models to evaluate adjusted odds ratios (AOR) and 95% confidence intervals (CI). Covariates included maternal age, marital status, education, insurance status before pregnancy, the number of previous live births, the number of prenatal care visits, and smoking status during pregnancy. The prevalences of receiving influenza vaccine recommendations from healthcare providers and maternal vaccine were 80.01% and 50.42%, respectively. NH-Blacks are less likely to receive provider recommendations (AOR = 0.82; 95%CI 0.77-0.87) and be vaccinated (AOR = 0.76; 95%CI 0.72-0.80) than NH-Whites. Receiving provider recommendations was significantly associated with increased maternal influenza vaccine uptake (AOR = 15.50; 95% CI 14.51-16.55). The associations were significant for all racial/ethnic groups, with the highest among NH-Asians (AOR = 22.04; 95% CI 17.88-27.16) and the lowest among NH Other non-Whites (AOR = 11.07; 95% CI 8.25-14.86). Within NH-Asians, effectiveness among Chinese was highest (AOR = 29.39; 95% CI 18.10-47.71). Racial/ethnic disparities in maternal influenza vaccine uptake and receiving vaccine recommendations from healthcare providers persisted. Further studies on the racial/ethnic disparities in maternal vaccination were warranted and tailored strategies are required to reduce this health disparity.

Influenza in Pregnancy: Prevention and Treatment: ACOG Committee Statement No. 7.

Pregnant and postpartum individuals are at significantly higher risk of serious complications related to seasonal and pandemic influenza infections compared with nonpregnant people. The Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists (ACOG) recommend that all adults receive an annual influenza vaccine and that individuals who are or will be pregnant during influenza season receive an inactivated or recombinant influenza vaccine as soon as it is available. Although the influenza vaccine significantly lowers the risk of severe disease, it will not prevent all infections. Obstetrician-gynecologists and other obstetric health care professionals should consider both influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for pregnant individuals who present with symptoms of respiratory illness. Antiviral treatment should not be delayed while awaiting respiratory infection test results, and a patient's vaccination status should not affect the decision to treat. Obstetrician-gynecologists and other obstetric care professionals can help reduce disparities in influenza vaccination rates as well as severe outcomes related to influenza infection by strongly recommending influenza vaccination to all patients.

Assessing interventions to encourage primary care health workers to recommend influenza vaccination and the impact on vaccination uptake for persons with Non-Communicable diseases in China

BackgroundInfluenza vaccination coverage is low among persons with non-communicable diseases (NCDs) in China. Chinese health workers (HWs) do not routinely recommend influenza vaccination despite evidence that recommendations increase vaccine uptake. This study aims to assess whether interventions increased primary care HWs’ recommendation for influenza vaccination and measure their impact on influenza vaccine uptake in persons with NCDs. MethodsWe conducted a cluster randomized controlled study in public primary healthcare clinics in Hubei from November 2018 through April 2019. In the intervention clinics, primary care HWs received training on the benefits of influenza vaccination and were asked to recommend influenza vaccine in routine primary healthcare for persons with NCDs. In the control clinics, primary care HWs did not receive training and provided standard services. We conducted questionnaire surveys before and after the intervention to collect information about recommendations made and receipt of influenza vaccines. ResultsA total of 896 primary care HWs and 4552 persons with NCDs were included. After intervention, a higher percentage of HWs recommended influenza vaccines in intervention clinics compared to control clinics. Vaccinated primary care HWs were more likely to recommend vaccination. Persons with NCDs reported higher influenza vaccination coverage in intervention than control clinics, and primary care HWs’ recommendation increased vaccination uptake among persons with NCDs. ConclusionsVaccinated primary care HWs were more likely to recommend influenza vaccination than unvaccinated HWs. Promoting primary care HWs’ vaccination and encouraging them to recommend influenza vaccination during routine primary healthcare could increase influenza vaccine receipt among persons with NCDs.Registration number ChiCTR2200067140.

Understanding the gap between guidelines and influenza vaccination coverage in people with diabetes: a scoping review.

Diabetes affects millions of people worldwide, making them more vulnerable to infections, including seasonal influenza. It is therefore particularly important for those suffering from diabetes to be vaccinated against influenza each year. However, influenza vaccination coverage remains low in this population. This review primarily aims to identify the determinants of influenza vaccination in people with diabetes (T1D or T2D). Secondly, it aims to assess main recommendations for influenza vaccination, vaccine effectiveness, vaccination coverage, and how education and pharmacists can encourage uptake of the vaccine in the diabetic population. A scoping review was conducted in January 2022 to systematically review evidence on influenza vaccination in people with diabetes using data from PubMed, Science Direct, and EM Premium with terms such as "Diabetes mellitus," "Immunization Programs," "Vaccination," and "Influenza Vaccines." Quality assessment and data extraction were independently conducted by two authors. Disagreements between the authors were resolved through discussion and consensus, and if necessary, by consulting a third author. Of the 333 records identified, 55 studies met the eligibility criteria for inclusion in this review. Influenza vaccination was recommended for people ≥6 months. Despite effectiveness evidence showing a reduction in mortality and hospitalizations in people with diabetes vaccinated vs. non-vaccinated ones, very few studies reported a coverage rate ≥ 75%, which is WHO's target objective. Determinants such as advanced age, presence of comorbidities and healthcare givers' advice were associated with increased vaccination uptake. On the contrary, fear of adverse reactions and concerns about vaccine effectiveness were significant barriers. Finally, education and pharmacists' intervention played a key role in promoting vaccination and increasing vaccination uptake. Influenza vaccination coverage in people with diabetes remains low despite recommendations and evidence on vaccine effectiveness. Motivators and barriers as well as several socio-demographic and clinical factors have been identified to explain this trend. Efforts are now needed to increase the number of diabetics vaccinated against influenza, mainly through education and the involvement of healthcare givers.

Knowledge, attitudes, beliefs and practices of pregnant women towards the influenza vaccine in Trinidad.

Pregnant women and their babies are at increased risk of influenza-related complications. The World Health Organisation recommends influenza vaccination to this high-risk population as the highest priority. A knowledge, attitudes,beliefs, and practices (KAP) of pregnant women towards the influenza vaccine in Trinidad. It was disseminated to 480 pregnant women attending the clinic and completed by 146 yielding a response rate of 30%. Women who received the vaccine in a past pregnancy were nine times more likely to consider taking the vaccine in the current pregnancy. There was a statistically significant difference in vaccine uptake based on the source of information received by participants about the influenza vaccine (χ2 (3) = 9.864, P = 0.020), with the highest mean score for uptake shown in women who received information from a health care provider. A moderate, positive correlation was found between knowledge and vaccine uptake (rs (143) =0.430, P < 0.01), a weak, positive correlation between perceived susceptibility and vaccine uptake (rs (143) = 0.264, P < 0.01), and a weak, positive correlation between knowledge and perceived susceptibility (rs (143) = 0.229, P < 0.01). The study findings highlight that the source of information significantly influences vaccine uptake, with health care providers being the most influential source. This underscores the role of primary care physicians in providing accurate and up-to-date information about influenza vaccination to pregnant women. There is a need for accurate information and recommendations to be given to pregnant women by all health care workers including primary care physicians in order to increase vaccine uptake and reduce maternal and neonatal morbidity and mortality.

Summary of the National Advisory Committee on Immunization (NACI) Seasonal Influenza Vaccine Statement for 2023-2024.

The National Advisory Committee on Immunization (NACI) reviews the evolving evidence on influenza immunization and provides annual recommendations regarding the use of seasonal influenza vaccines. The NACI Statement on Seasonal Influenza Vaccine for 2023-2024 updates the 2022-2023 NACI recommendations. To summarize the 2023-2024 NACI seasonal influenza vaccine recommendations and to highlight new and updated information. In the preparation of the Statement on Seasonal Influenza Vaccine for 2023-2024, the NACI Influenza Working Group applied the NACI evidence-based process to critically appraise the available evidence and to propose recommendations. The recommendations were then considered and approved by NACI in light of the available evidence. Key changes for the 2023-2024 season include: 1) incorporation of updated information/guidance on influenza vaccination in the context of the coronavirus disease 2019 (COVID-19); 2) new recommendations for Flucelvax® Quad and Influvac® Tetra, the two quadrivalent inactivated influenza vaccines with expanded paediatric age indications; and 3) an update to the format of the Statement. Overall, NACI continues to recommend that an age-appropriate influenza vaccine should be offered annually to all individuals aged six months and older who do not have a contraindication to the vaccine, with particular focus on the groups for whom influenza vaccination is particularly recommended.

Peri-Pandemic Acceptance of Influenza and COVID-19 Vaccination by Swiss Healthcare Workers in Primary Care 2020/21: A Cross-Sectional Study.

Objectives: To assess and compare influenza and COVID-19 vaccination uptake of Swiss healthcare workers (HCWs) in primary care 2020/21. Methods: Influenza and COVID-19 vaccination uptake and recommendation behaviours of HCWs in the primary care were assessed using an online semi-structured questionnaire. Associations between vaccination rates and age, language, gender, profession, vaccination history, vaccination training and recommendation behaviours were evaluated using descriptive and multivariable logistic regression analyses. Results: Vaccinated against COVID-19 in 2020/21 were 91.8% of the 1,237 participating HCWs, while 60.1% were vaccinated against influenza. Physicians and pharmacists presented the highest influenza vaccination rates (87.3%, 73.7%, respectively) compared to nurses (45.8%) and medical practice assistants (52.5%) while COVID-19 vaccination rates were high across all professions. Influenza and COVID-19 vaccination rates were significantly associated with age, profession, vaccination history, vaccination training and recommendation behaviours. Conclusion: Acceptance for influenza vaccination has increased during the pandemic but is lower than that for COVID-19 among the HCWs. Demographics, vaccination status and vaccination training impact the vaccination behaviour among HCWs and should be considered in future campaigns to increase vaccination uptake.

Optimal timing of influenza vaccination among patients with acute myocardial infarction – Findings from the IAMI trial

Influenza vaccination reduces the risk of adverse cardiovascular events.The IAMI trial randomly assigned 2571 patients with acute myocardial infarction (AMI) to receive influenza vaccine or saline placebo during their index hospital admission. It was conducted at 30 centers in 8 countries from October 1, 2016 to March 1, 2020. In this post-hoc exploratory sub-study, we compare the trial outcomes in patients receiving early season vaccination (n = 1188) and late season vaccination (n = 1344).The primary endpoint wasthe composite of all-cause death, myocardial infarction (MI), or stent thrombosis at 12 months. Thecumulative incidence of the primary and key secondary endpoints by randomized treatment and early or late vaccination was estimated using the Kaplan-Meier method. In the early vaccinated group, the primary composite endpoint occurred in 36 participants (6.0%) assigned to influenza vaccine and 49 (8.4%) assigned to placebo (HR 0.69; 95% CI 0.45 to 1.07), compared to 31 participants (4.7%) assigned to influenza vaccine and 42 (6.2%) assigned to placebo (HR 0.74; 95% CI 0.47 to 1.18) in the late vaccinated group (P = 0.848 for interaction on HR scale at 1 year). We observed similar estimates for the key secondary endpoints of all-cause death and CV death. There was no statistically significant difference in vaccine effectiveness against adverse cardiovascular events by timing of vaccination. The effect of vaccination on all-cause death at one year was more pronounced in the group receiving early vaccination (HR 0.50; 95% CI, 0.29 to 0.86) compared late vaccination group (HR 0.75; 35% CI, 0.40 to 1.40) but there was no statistically significant difference between these groups (Interaction P = 0.335). In conclusion,there is insufficient evidence from the trial to establish whether there is a difference in efficacy between early and late vaccinationbut regardless of vaccination timing we strongly recommend influenza vaccination in all patients with cardiovascular diseases.

The critical factors for COVID-19 vaccination uptake are perceived ‎vaccine effectiveness and the desire to protect others

ABSTRACT The proportion of the population vaccinated in Israel against COVID-19 in 2021 was significantly higher than that of the annual uptake rates of the influenza vaccine over time. Understanding the reasons behind the high vaccination rate may facilitate maintaining these rates if annual COVID-19 vaccination is required. Using a mixed-methods design, we characterized the individuals who were vaccinated and studied their attitudes toward vaccines and motivators for the COVID-19 vaccine. The first part was a cross-sectional study of adults aged 65 and over who were vaccinated against COVID-19. We stratified them according to their annual influenza vaccination patterns, and compared variables such as age, gender, health status, and timing of COVID-19 vaccination. The second part consisted of a questionnaire administered to a subsample of the above population, inquiring about vaccine hesitancy, motivators for vaccination, and intention to be vaccinated in the future. We found that motivating factors for COVID-19 vaccination are similar between those who regularly vaccinate against influenza and those who don’t. Internal motivators such as perceived vaccine effectiveness and the desire to protect others were stronger than external rewards or sanctions. High adherence to annual influenza vaccine recommendations was associated with earlier COVID-19 vaccine uptake. Respondents with lower adherence to influenza vaccines were more likely to demonstrate higher levels of vaccine hesitancy. These factors should be addressed in future vaccination campaigns.

Recommendations for Prevention and Control of Influenza in Children, 2023-2024.

This technical report accompanies the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccine and antiviral medications in the prevention and treatment of influenza in children during the 2023-2024 season. The rationale for the American Academy of Pediatrics recommendation for annual influenza vaccination of all children without medical contraindications starting at 6 months of age is provided. Influenza vaccination is an important strategy for protecting children and the broader community against influenza. This technical report summarizes recent influenza seasons, morbidity and mortality in children, vaccine effectiveness, and vaccination coverage, and provides detailed guidance on vaccine storage, administration, and implementation. The report also provides a brief background on inactivated and live-attenuated influenza vaccines, available vaccines this season, vaccination during pregnancy and breastfeeding, diagnostic testing for influenza, and antiviral medications for treatment and chemoprophylaxis. Strategies to promote vaccine uptake are emphasized.

Influenza Vaccination during Pregnancy: A Descriptive Study of the Knowledge, Beliefs, and Practices of Mexican Gynecologists and Family Physicians.

Influenza in pregnancy is associated with elevated morbidity and mortality. Influenza vaccines are safe and effective in pregnancy. There are no Mexican surveys of physicians on knowledge, beliefs, and practices towards influenza and influenza immunization during pregnancy. A 32-question descriptive survey was conducted, addressing the general knowledge of influenza as well as beliefs and practices regarding influenza vaccination during pregnancy among Mexican physicians responsible for prenatal care, traditionally Obstetricians (OBGYNs) and Family Physicians (FPs). A total of 206 surveys were available, 98 (47.6%) from OBGYNs and 108 (52.4%) from FPs, representing an estimated 2472 daily pregnancy consultations. In total, 54 of the 206 respondents (26.2%) were not aware that influenza is more severe during pregnancy, 106 of the 206 respondents (51.5%) ignored the potential side effects of influenza infection on the fetus, and 56.8% did not know when to vaccinate pregnant women. Pregnancy as a risk factor for developing influenza complications was only known by 99 of the 206 respondents (48.1%), and 6.1% believed that vaccination does not confer protection to the fetus. The current beliefs of Mexican OBGYNs and FPs for both influenza morbidity and mortality, and the importance of influenza vaccination during pregnancy are suboptimal. The drivers of these beliefs should be assessed to improve influenza vaccination recommendations, as knowledge alone is not sufficient.

Association of Provider Recommendation and Receipt of Influenza Vaccine Among Pregnant Women by Race and Ethnicity.

Background: All pregnant women and those who may become pregnant are recommended by the Advisory Committee on Immunization Practices to receive the flu vaccine to prevent severe illness in the woman and infant. Despite the increased risk for complications in this population, flu vaccine uptake in pregnant women was 68.1% in the 2020-2021 flu season, with disparities by race and ethnicity. We sought to describe associations between provider recommendation with flu vaccine uptake by race and ethnicity in Tennessee women with a recent live birth. Materials and Methods: Weighted analysis used data from the 2016 to 2020 Tennessee Pregnancy Risk Assessment Monitoring System complex survey analysis procedures. Uptake was measured as receipt of flu vaccine in the 12 months before the most recent live birth, and positive recall of receiving provider advice to get the shot was the independent variable; for both we estimated 5-year averages stratified by race/ethnicity. Differences were assessed using chi-square tests. We modeled receipt of flu vaccine and estimated marginal predicted prevalence ratios (PRs); stratified models by race/ethnicity were constructed to estimate unadjusted and adjusted PRs. Results: The 5-year average for vaccine uptake before or during pregnancy was 56.7% but varied by race and ethnicity. Stratified bivariate analyses yielded different magnitudes of association by race/ethnicity between provider recommendation and flu vaccine receipt. After adjustment for payment source at delivery, marital status, age group, urbanicity, and maternal education, receiving a provider recommendation was strongly associated with flu vaccine uptake for all stratified models of pregnant women included in the study. The effect size was of a larger magnitude among non-Hispanic black women, a population with a lower vaccine uptake. Conclusions: Given the association between provider recommendation and vaccine uptake in all groups, attention should be focused on increasing rates of provider recommendation.

Influenza-associated respiratory illness among five cohorts of pregnant women and their young infants (0-6months), Bangladesh, 2013-2017.

Pregnant women with their infants are considered at higher risk for influenza-associated complications, and the World Health Organization (WHO) recommends influenza vaccination during pregnancy to protect them, including their infants (0-6months). There are limited data on the influenza burden among pregnant women and their infants (0-6months), and there are no routine influenza vaccinations in Bangladesh. Five annual cohorts (2013-2017) of pregnant women were enrolled from the eight sub-districts of Bangladesh before the influenza season (May-September); they were contacted weekly to identify new onset of influenza-like illness (ILI) (subjective or measured fever and cough) and acute respiratory illness (ARI) (at least two of these symptoms: cough, rhinorrhea, or difficulty in breathing) among their infants from birth to 6 months of age. We collected nasopharyngeal swabs from ILI and ARI cases, tested by real-time reverse transcription polymerase chain reaction (rRT-PCR) for influenza virus (including types and subtypes) and estimated influenza incidence (95% CI)/10000 pregnant women-months or infant-months, respectively. We enrolled 9020 pregnant women, followed for 26,709 pregnancy-months, and detected 1241 ILI episodes. We also followed 8963 infants for 51,518 infant-months and identified 5116 ARI episodes. Influenza positivity was 23% for ILI and 3% for ARI cases. The overall incidence (2013-2017) of influenza among pregnant women was 158.5/10000 pregnant women-months (95% CI: 141.4-177.6) and that among infants was 21.9/10000 infant-months (95% CI: 18.2-26.5). Although the data was collected more than 5 years ago, as the only baseline data, our findings illustrate evidence of influenza burden among pregnant women and infants (0-6months), which may support preventive policy decisions in Bangladesh.

Cost-effectiveness of routine annual influenza vaccination by age and risk status

BackgroundThe epidemiology of circulating seasonal influenza strains changed following the 2009 pandemic influenza A(H1N1). A universal influenza vaccination recommendation has been implemented and new vaccine types have become available post-2009. The objective of this study was to evaluate the cost-effectiveness of routine annual influenza vaccination in the context of this new evidence. MethodsA state transition simulation model was constructed to estimate the health and economic outcomes of influenza vaccination compared to no vaccination for hypothetical US cohorts stratified by age and risk status. Model input parameters were derived from multiple sources, including post-2009 vaccine effectiveness data from the US Flu Vaccine Effectiveness Network. The analysis used societal and healthcare sector perspectives and a one-year time horizon, except permanent outcomes were also included. The primary outcome was the incremental cost-effectiveness ratio (ICER) in dollars per quality-adjusted life years (QALYs) gained. ResultsCompared to no vaccination, vaccination yielded ICERs lower than $95,000/QALY for all age and risk groups, except for non-high-risk adults 18–49 years ($194,000/QALY). Vaccination was cost-saving for adults ≥50 years at higher risk for influenza-related complications. Results were most sensitive to changes in the probability of influenza illness. Performing the analysis from the healthcare sector perspective, excluding vaccination time costs, delivering vaccinations in lower-cost settings, and including productivity losses improved the cost-effectiveness of vaccination. Sensitivity analysis revealed that vaccination remains below $100,000/QALY for older persons ≥65 years at vaccine effectiveness estimates as low as 4 %. ConclusionsCost-effectiveness of influenza vaccination varied by age and risk status and was less than $95,000/QALY for all subgroups, except for non-high-risk working-age adults. Results were sensitive to the probability of influenza illness and vaccination was more favorable under certain scenarios. Vaccination for higher risk subgroups resulted in ICERs below $100,000/QALY even at low levels of vaccine effectiveness or circulating virus.

The Influence of Recommendation of Medical and Non-Medical Authorities on the Decision to Vaccinate against Influenza from a Social Vaccinology Perspective: Cross-Sectional, Representative Study of Polish Society.

Vaccination against seasonal flu is crucial to prevention of illness in modern societies. The level of influenza vaccination in Poland is low and, for many years, has hovered around a few percent of the general population. For this reason, it is crucial to understand the reasons for such a low level of vaccination and to assess the influence of medical and social authorities on the decision to vaccinate against influenza from the perspective of social vaccinology. For this purpose, a representative survey was conducted in 2022 among adult Poles (N = 805), orchestrated with the CAWI technique based on the author's questionnaire. The most significant authority in the context of influenza vaccination is held by physicians, especially among the oldest part of the population, over 65 years of age-in this group, 50.4% of respondents declare a very high level of respect for physicians on the issue of recommended influenza vaccination (p < 0.001), and the second-highest authority group for which seniors have respect in the aspect of influenza vaccination is pharmacists (p = 0.011). It was also shown that pharmacists have more authority on the issue of influenza vaccination than nurses, especially in the group that declared themselves opponents of vaccination (p < 0.001). The survey indicates the need to strengthen the authority of physicians and pharmacists regarding influenza vaccination, and, in the case of pharmacists, the need for changing the law to allow them to qualify for influenza vaccination.

Immunization status of patients with spinal muscular atrophy receiving nusinersen therapy

BackgroundChildren with chronic neurological diseases, including spinal muscular atrophy (SMA), are particularly susceptible to vaccine-preventable infections. We aimed to evaluate the age-appropriate immunization status and its relationship with nusinersen therapy in pediatric patients with SMA. MethodsChildren with SMA who received nusinersen treatment were included in this cross-sectional prospective study. Data were collected on SMA characteristics, nusinersen therapy, vaccination status according to the National Immunization Program (NIP), administration, and influenza vaccination recommendation. ResultsA total of 32 patients were enrolled. In patients with SMA type 1, the frequency of under-vaccination of hepatitis B, BCG, DTaP-IPV-HiB, OPV, and MMR was statistically higher than in patients with SMA type 2–3 (p<0.001). The influenza vaccine was administered to only 9.3% of patients and was never recommended to 13 (40.6%) parents. The frequency of under-vaccination of hepatitis B, BCG, DTaP-IPV-HiB, OPV, and MMR was statistically higher in patients receiving nusinersen maintenance therapy than in those with loading doses (p<0.001). Physician recommendations for influenza and pneumococcal vaccines were significantly higher in the nusinersen maintenance group (p = 0.029). There was no statistical significance between the groups in terms of administration of influenza and pneumococcal vaccines (p = 0.470). ConclusionChildren with SMA had lower immunization rates and poor compliance with immunization programs. Clinicians should ensure that children with SMA receive the same preventive health measures as healthy children, including vaccinations.

Acceptance or rejection of vaccination against influenza and SARS-CoV2 viruses among primary care professionals in Central Catalonia. A cross-sectional study

BackgroundWith the outbreak of the SARS-CoV-2 pandemic, the uncertainty about the real impact of coinfection with other viruses, and the increased risk of mortality in the case of coinfection with the influenza virus, health authorities recommended an increase in influenza vaccination coverage among at-risk groups to minimize the possible impact on individuals and the healthcare system. Recommendations for influenza vaccination during the 2020–2021 campaign in Catalonia were focused on increasing vaccination coverage, especially for social and healthcare workers, elderly people and at-risk individuals of any age. The objectives for the 2020–2021 season in Catalonia were to reach 75 % for the elderly and for social and healthcare workers, and 60 % for pregnant women and at-risk groups. In the case of healthcare professionals and those over 65 years of age, the target was not met. Vaccination coverage reached 65.58 % and 66.44 %, respectively (in the 2019–2020 campaign it was 39.08 %).Analysing and following up on the background and context in which health professionals accept influenza vaccination will help develop strategies for long-term influenza vaccination campaigns. The present study looks at healthcare professionals in a specific territory where the reasons for acceptance or refusal of the influenza vaccine during the 2021–2022 vaccination campaign, as well as the reasons for acceptance or refusal of the COVID-19 vaccine, were analysed by means of an online survey. MethodsCalculations suggested that a random sample of 290 individuals would be sufficient to estimate, with 95% confidence and a precision of +/- 5 percentage units, a population percentage that was expected to be around 30%. The required replacement rate was 10%.The R statistical software (version 3.6.3) was used for the statistical analysis. Confidence intervals were 95 % and contrasts with a p-value of < 0.05 were considered significant. FindingsOf the 1921 professionals to whom the survey was sent, 586 (30.5%) responded to all the questions. 95.2% of respondents were vaccinated against COVID-19 and 66.2% against influenza.It was observed that the relationship between sociodemographic characteristics and the decision to get vaccinated was different for influenza and COVID-19. The reasons for accepting the COVID-19 vaccine with the highest percentage were firstly protecting family (82.2%), self-protection (74.9%) and also protecting patients (57.8%). Otherwise, other reasons not described in the survey (50%) and mistrust (42.3%) were the reasons for rejecting the COVID-19 vaccine.Regarding influenza, the most relevant reasons for which professionals got vaccinated were self-protection (70.7%), protecting family (69.7%) and protecting patients (58.4%). Reasons for refusing the influenza vaccine were reasons not mentioned in the survey (29.1%) and the low probability of suffering complications (27.4%). InterpretationAnalysing the context, territory, sector, and the reasons for both accepting and refusing a vaccine will help develop effective strategies. Although vaccination coverage against COVID-19 was very high throughout Spain, a marked increase in influenza vaccination in the context of COVID-19 was observed among healthcare professionals in the Central Catalonia region compared to the previous pre-pandemic campaign.

Inclusion of vaccination into clinical pathways for COPD and asthma: current challenges and future perspectives in Italy

to describe the importance given to vaccination as a preventive measure in the clinical pathways (CPWs) of patients affected by chronic obstructive pulmonary disease (COPD) and asthma in the Italian regional healthcare services. a comparative analysis was conducted to assess the presence/absence of vaccination recommendations among the available regional CPWs for the management of COPD and asthma. all the regional CPWs for COPD and asthma available in the "Fondazione ReS" database between 2008 and 2019 have been analysed. the role attributed to vaccination was assessed in terms of type of recommended vaccinations, management step indicated for administration, vaccination schedules, healthcare professionals involved in the vaccination pathway, potential contraindications, use of indicators for the monitoring of the offer. thirteen CPWs for COPD and only 3 for asthma were published between 2008 and 2019. Twelve of the CPWs for COPD included recommendation for influenza vaccination, 11 of which including also pneumococcal vaccination. The most recent CPW also contained recommendations for measles-mumps-rubella, varicella, Herpes Zoster, and tetanus-diphtheria-acellular pertussis vaccinations. Two of the CPWs related to asthma in adults recommended influenza vaccination. All CPWs provided for the vaccination recommendations during the patient follow-up step. Italian CPWs still pay little attention to the topic of vaccinations in patients with COPD and asthma. CPWs are required to be updated in the future being compliant with the national immunization schedule recommendations.