Gavazzi Gaëtan, Wazieres Benoit, Lejeune Benoist, Rothan-Tondeur Monique
Département de Médicine Gériatrique et Communautaire, Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
Gerontology. 2007;53(6):382-7. doi: 10.1159/000105166. Epub 2007 Jul 5.
Annual immunization with influenza vaccine is effective in preventing influenza-associated mortality and morbidity in the elderly. Pneumococcal vaccination is also considered as an effective strategy to decrease pneumococcal-associated diseases and mortality, particularly in the geriatric health care setting. However, in France, influenza and pneumococcal vaccination coverage in senior citizens living in long-term care facilities has not been comprehensively evaluated.
A prospective multicenter study was conducted to measure influenza and pneumococcal vaccine coverage and to assess the existence of local recommendations and the reasons for reluctance to immunize patients in geriatric health care settings in France. Two questionnaires were developed: the initial questionnaire to record the demographic characteristics of patients in health care facilities and to note influenza and pneumococcal vaccine coverage, and a second questionnaire, sent to all responders in June 2003, to record the number and causes of death (December 2002 to April 2003). Questions about the reasons for non-vaccination were added to all settings which had pneumococcal or influenza vaccination coverages below the median levels in the first query.
105 health care facilities measuring vaccine coverage in 7,882 elderly patients participated in the study. Of 105 units, 9 were acute care units (n = 203 patients), 22 rehabilitation care units (n = 923), 68 long-term care facilities (n = 6,458), and 6 nursing homes (n = 315). The median and mean age of patients was 83 (SD 3.5) years. Influenza and pneumococcal vaccine rates were 87.7% (median 90%, range 0-100%) and 21.9% (median 2.8%, range 0-100%), respectively. There were significant differences between the type of setting and wide variability. There was no correlation between vaccine coverage and local recommendations. Mortality was 15.2% and was negatively correlated with influenza vaccine. The reasons for non-vaccination evaluated in 20 units differed for influenza and pneumococcal vaccine.
Influenza vaccine coverage is high in long-term care settings but not in other settings. Pneumococcal vaccine coverage is very low in most settings, in part because of the lack of positive recommendations in France. Annual vaccination records are needed and should be a goal for the National Health Care Department. In addition, reasons for failure to administer both vaccines should be precisely evaluated on large populations to improve vaccination coverage.
每年接种流感疫苗可有效预防老年人中与流感相关的死亡率和发病率。肺炎球菌疫苗接种也被视为降低肺炎球菌相关疾病和死亡率的有效策略，尤其是在老年保健机构中。然而，在法国，长期护理机构中老年人的流感和肺炎球菌疫苗接种覆盖率尚未得到全面评估。
开展一项前瞻性多中心研究，以测量流感和肺炎球菌疫苗接种覆盖率，并评估法国老年保健机构中是否存在当地建议以及患者不愿接种疫苗的原因。设计了两份问卷：初始问卷用于记录医疗机构中患者的人口统计学特征，并记录流感和肺炎球菌疫苗接种覆盖率；第二份问卷于2003年6月发送给所有应答者，用于记录死亡人数和死亡原因（2002年12月至2003年4月）。在首次调查中，肺炎球菌或流感疫苗接种覆盖率低于中位数水平的所有机构中，均增加了关于未接种疫苗原因的问题。
105家测量7882名老年患者疫苗接种覆盖率的医疗机构参与了该研究。在105个机构中，9个是急性护理机构（n = 203名患者），22个康复护理机构（n = 923），68个长期护理机构（n = 6458），以及6个养老院（n = 315）。患者的年龄中位数和平均值为83（标准差3.5）岁。流感和肺炎球菌疫苗接种率分别为87.7%（中位数90%，范围0 - 100%）和21.9%（中位数2.8%，范围0 - 100%）。不同机构类型之间存在显著差异且差异很大。疫苗接种覆盖率与当地建议之间无相关性。死亡率为15.2%，且与流感疫苗呈负相关。在20个机构中评估的未接种疫苗原因，流感疫苗和肺炎球菌疫苗有所不同。
长期护理机构中的流感疫苗接种覆盖率较高，但其他机构并非如此。大多数机构中的肺炎球菌疫苗接种覆盖率非常低，部分原因是法国缺乏积极的建议。需要年度接种记录，这应该是国家卫生保健部门的一个目标。此外，应在大量人群中精确评估两种疫苗未接种的原因，以提高接种覆盖率。
