Klett-Tammen Carolina J, Krause Gérard, Seefeld Linda, Ott Jördis J
Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, 38124, Braunschweig, Germany.
Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
BMC Public Health. 2016 Feb 4;16:121. doi: 10.1186/s12889-016-2784-8.
Severity 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.
We 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.
A 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).
Our 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.
流感病毒、肺炎链球菌和破伤风杆菌引起的可通过疫苗预防的感染的严重程度和发病率随年龄增长而增加。此外，老年人的疫苗接种覆盖率往往不足。本研究的目的是确定德国老年人群中与流感、肺炎球菌疾病和破伤风疫苗接种相关的社会经济因素以及知识、态度和行为（KAP）相关因素。
我们分析了一项基于问卷调查的德国全国代表性KAP调查的数据，该调查涉及老年人的感染预防和卫生行为（n = 1223）。我们使用逻辑回归来评估社会人口统计学和KAP相关变量对总体疫苗接种以及破伤风、流感和肺炎球菌疫苗接种的影响。为了生成KAP分数，我们应用了因子分析，并将分数作为特定疫苗接种的预测指标进行分析。
个人健康状况评分较低与流感疫苗接种率较高相关，而在德国境内的居住地点对肺炎球菌疫苗接种有很大影响。对于破伤风和流感疫苗接种，最强的单一疫苗接种预测因素与态度相关，即疫苗的感知重要性（OR = 18.1，95%CI = 4.5 - 71.8；OR = 23.0，95%CI = 14.9 - 35.3）。肺炎球菌疫苗接种主要与知识相关，即了解推荐意见可预测接种情况（OR = 17.1，95%CI = 9.5 - 30.7）。关于生成的KAP分数，反映疫苗相关行为（如有疫苗接种记录）的行为分数可预测所有考虑的疫苗接种情况。知识分数与流感疫苗接种（OR = 1.3，95%CI = 1.0 - 1.6）和肺炎球菌疫苗接种（OR = 1.2，95%CI = 1.0 - 1.5）相关。对于流感疫苗接种而言，独特的是态度分数与疫苗接种情况相关（OR = 1.1，95%CI = 1.0 - 1.1）。
我们的结果表明，老年人疫苗接种的预测因素很大程度上取决于疫苗类型，并且KAP分数对于汇总众多个体KAP变量的信息是有用且有效的。虽然对流感和破伤风疫苗接种的认识已经相当高，但对于肺炎球菌感染疫苗接种的认识可能还需要提高。
