Seasonal influenza epidemics yearly affects 5-15% of the world’s population, resulting in 3-5 million serious cases and up to 650,000 deaths. Elderly, pregnant women and individuals with underlying chronic conditions are considered at increased risk of complications. Immunization against influenza is an essential cost-effective strategy. According to the Italian National Immunization Prevention Plan 2017-2019, these categories benefit from free vaccination. Influenza coverage rate in Italy does not reach the minimum recommended threshold of 75%. Rising evidence suggests that influenza can trigger adverse cardiovascular events, so the American Heart Association, the American College of Cardiology and the European Society of Cardiology recommend vaccination for secondary prevention of cardiovascular diseases. The study investigated the coverage rate for five consecutive influenza seasons (from 2010/2011 to 2014/2015) in the population of the Local Health Unit (LHU) of Ferrara and, in particular, in subjects with exemption from paying healthcare costs for chronic heart disease. Coverage rates in the elderly living in the Municipality of Ferrara according to a local socioeconomic and healthcare deprivation index were also evaluated. The amount of delivered immunisations was not constant with a decreasing trend. An increase in coverage with increasing age was observed, but the 75% target of over-65 years old individuals immunised was never achieved. The number of delivered doses and coverage rates decreased, while the percentage of immunisations delivered by the General Practitioners (GPs) increased. The District with the lowest vaccination coverage in all age groups and in all influenza seasons was the Western District. The higher levels of immunisation were observed in South-Eastern District, with a statistically significant difference compared to North-Central and Western District, in the pediatric age (0-14 years old), in North-Central District, with a statistically significant difference compared to South-Eastern and Western District, in the 15-64 years old age group. In over 65 years old age group, coverage rates in South-Eastern and North-Central District were higher with a statistically significant difference compared to Western District. Coverage rates of elderly people living in the Municipality of Ferrara were on average below 60%, showing a decreasing trend with lowering deprivation, in general population and in males, but not in females. The coverage rates in individuals with exemption from paying healthcare costs for chronic heart disease were decreasing from 50.3% in season 2011/2012 to 43.1% in season 2014/2015, but, when considering only subjects younger than 65 years old, coverage levels fell to values below 30%. No statistically significant difference was observed between genders. The logistic regression analysis showed that the influenza coverage levels were statistically significant different according to age, District of residence, category of cardiovascular disease and duration of the exemption. The trend in immunisation coverage in the LHU of Ferrara was similar to regional and national data, conditioned in the 2014/2015 season by the spreading of worrying news, although unfounded, on the safety of the vaccine. The GPs were essential in ensuring vaccine uptake, growing the percentage of delivered doses and effectively achieving elderly immunisation. The recommendation of influenza immunisation was weakly followed in individuals with chronic cardiovascular diseases. A collaboration between cardiologists, GPs, scientific societies and patient associations could successfully support influenza vaccine uptake.

Ogni anno, l’influenza colpisce il 5-15% della popolazione mondiale, provocando 3-5 milioni di casi gravi e fino a 650.000 decessi. Anziani, donne in gravidanza, persone con patologie croniche sono considerati a rischio di sviluppare le complicanze dell’infezione. La vaccinazione rappresenta una strategia costo-efficace fondamentale. Secondo il Piano Nazionale per la Prevenzione Vaccinale 2017-2019, queste categorie beneficiano della vaccinazione gratuita. La copertura tuttavia non raggiunge il valore minimo perseguibile del 75%. Evidenze scientifiche indicano che l’influenza è in grado di provocare eventi cardiovascolari acuti. L’American Heart Association, l’American College of Cardiology e l’European Society of Cardiology raccomandano la vaccinazione per la prevenzione secondaria delle patologie cardiovascolari. Lo studio ha valutato la copertura in cinque stagioni vaccinali consecutive (dalla 2010/11 alla 2014/15) nella popolazione dell’Azienda Unità Sanitaria Locale (AUSL) di Ferrara e, in particolare, negli individui con esenzione dalla compartecipazione alla spesa sanitaria per patologie croniche cardiovascolari. Sono state valutate le coperture negli anziani residenti nel Comune di Ferrara in relazione ad uno specifico indice di deprivazione socioeconomica e sanitaria. La quota di dosi erogate non è stata costante ed ha evidenziato un andamento in diminuzione. I livelli di immunizzazione hanno assunto un trend crescente all’aumentare dell’età, tuttavia l’obiettivo del 75% di ultrasessantacinquenni vaccinati non è stato raggiunto in nessuna stagione vaccinale. Nonostante la diminuzione del numero di dosi erogate e delle coperture vaccinali, si è assistito ad un costante aumento della percentuale di vaccinazioni somministrate dai Medici di Medicina Generale (MMG). Il Distretto con coperture vaccinali più basse in tutte le fasce d’età ed in tutte le stagioni vaccinali è stato il Distretto Ovest. I livelli di vaccinazione più elevati sono stati osservati nel Distretto Sud-Est, con una differenza statisticamente significativa rispetto ai Distretti Centro-Nord e Ovest, in età pediatrica (0-14 anni); nel Distretto Centro-Nord, con una differenza statisticamente significativa rispetto ai Distretti Sud-Est e Ovest, nella fascia d’età 15-64 anni. Negli ultrasessantacinquenni, le maggiori coperture sono state registrate nei Distretti Sud-Est e Centro-Nord con una differenza statisticamente significativa rispetto al Distretto Ovest. Il livello medio di copertura antinfluenzale negli anziani del Comune di Ferrara era inferiore al 60%, con un andamento decrescente al diminuire della deprivazione nella popolazione in generale e nei maschi, ma non nelle femmine. I tassi di copertura negli individui con esenzione per patologie cardiovascolari croniche sono risultati in calo dal 50,3% nella stagione vaccinale 2011/2012 al 43,1% nella stagione vaccinale 2014/2015, ma, considerando solo i soggetti fino a sessantaquattro anni, i livelli di copertura sono scesi fino a valori inferiori al 30%. Nessuna differenza statisticamente significativa è stata riscontrata tra maschi e femmine. L’analisi di regressione logistica ha evidenziato che i livelli di copertura vaccinale variavano in maniera statisticamente significativa in funzione di età, Distretto di residenza, patologia per cui si usufruisce dell’esenzione e durata dell’esenzione. Le coperture nell’AUSL di Ferrara hanno evidenziato un trend paragonabile a quello regionale e nazionale, risentendo nella stagione 2014/2015 della diffusione di notizie allarmanti sulla sicurezza del vaccino, rivelatesi infondate. I MMG sono stati fondamentali nel garantire l’adesione alla vaccinazione. La raccomandazione della vaccinazione è stata scarsamente seguita nei soggetti con patologie cardiovascolari. Una sinergia tra cardiologi, MMG, società scientifiche ed associazioni dei pazienti potrebbe incoraggiare con successo l’adesione alla vaccinazione.

Copertura vaccinale per influenza in cinque stagioni vaccinali consecutive in soggetti con condizioni di rischio: adesione nei pazienti con patologie cardiovascolari croniche e ruolo degli indici di deprivazione negli ultrasessantacinquenni

LUPI, Silvia
2020

Abstract

Seasonal influenza epidemics yearly affects 5-15% of the world’s population, resulting in 3-5 million serious cases and up to 650,000 deaths. Elderly, pregnant women and individuals with underlying chronic conditions are considered at increased risk of complications. Immunization against influenza is an essential cost-effective strategy. According to the Italian National Immunization Prevention Plan 2017-2019, these categories benefit from free vaccination. Influenza coverage rate in Italy does not reach the minimum recommended threshold of 75%. Rising evidence suggests that influenza can trigger adverse cardiovascular events, so the American Heart Association, the American College of Cardiology and the European Society of Cardiology recommend vaccination for secondary prevention of cardiovascular diseases. The study investigated the coverage rate for five consecutive influenza seasons (from 2010/2011 to 2014/2015) in the population of the Local Health Unit (LHU) of Ferrara and, in particular, in subjects with exemption from paying healthcare costs for chronic heart disease. Coverage rates in the elderly living in the Municipality of Ferrara according to a local socioeconomic and healthcare deprivation index were also evaluated. The amount of delivered immunisations was not constant with a decreasing trend. An increase in coverage with increasing age was observed, but the 75% target of over-65 years old individuals immunised was never achieved. The number of delivered doses and coverage rates decreased, while the percentage of immunisations delivered by the General Practitioners (GPs) increased. The District with the lowest vaccination coverage in all age groups and in all influenza seasons was the Western District. The higher levels of immunisation were observed in South-Eastern District, with a statistically significant difference compared to North-Central and Western District, in the pediatric age (0-14 years old), in North-Central District, with a statistically significant difference compared to South-Eastern and Western District, in the 15-64 years old age group. In over 65 years old age group, coverage rates in South-Eastern and North-Central District were higher with a statistically significant difference compared to Western District. Coverage rates of elderly people living in the Municipality of Ferrara were on average below 60%, showing a decreasing trend with lowering deprivation, in general population and in males, but not in females. The coverage rates in individuals with exemption from paying healthcare costs for chronic heart disease were decreasing from 50.3% in season 2011/2012 to 43.1% in season 2014/2015, but, when considering only subjects younger than 65 years old, coverage levels fell to values below 30%. No statistically significant difference was observed between genders. The logistic regression analysis showed that the influenza coverage levels were statistically significant different according to age, District of residence, category of cardiovascular disease and duration of the exemption. The trend in immunisation coverage in the LHU of Ferrara was similar to regional and national data, conditioned in the 2014/2015 season by the spreading of worrying news, although unfounded, on the safety of the vaccine. The GPs were essential in ensuring vaccine uptake, growing the percentage of delivered doses and effectively achieving elderly immunisation. The recommendation of influenza immunisation was weakly followed in individuals with chronic cardiovascular diseases. A collaboration between cardiologists, GPs, scientific societies and patient associations could successfully support influenza vaccine uptake.
CAMPO, Gianluca Calogero
DI VIRGILIO, Francesco
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/2478827
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