Elsevier

Public Health

Volume 120, Issue 11, November 2006, Pages 1074-1080
Public Health

Original Research
Influenza vaccination coverage rates in the UK: A comparison of two monitoring methods during the 2002–2003 and 2003–2004 seasons

https://doi.org/10.1016/j.puhe.2006.05.026Get rights and content

Summary

Objectives

To assess the feasibility of measuring influenza vaccination coverage during 2002–2003 and 2003–2004 seasons using a telephone survey; to compare these findings with routine vaccine uptake monitoring based on data provided by general practitioners.

Study design

Telephone-based survey.

Methods

We interviewed a random sample of non-institutionalized individuals representative of the population aged 16 years and over. Four target groups were determined for analysis: (1) people aged 65 years and over; (2) healthcare workers; (3) people under 65 years with chronic illnesses, which placed them at risk for influenza; and (4) a group composed of all three previous groups combined.

Results

The overall sample consisted of 4054 people (about 2000 per season). Population influenza vaccine coverage in the UK increased from 22.3% in 2002–2003 to 24.2% in 2003–2004. Vaccine uptake was strongly age dependent, even in people aged 65 years and over (the ages at which all people are routinely targeted). In both seasons, the estimates of vaccine uptake in people aged 65 years and over were remarkably consistent with those obtained through routine monitoring. Vaccine uptake in healthcare workers was markedly suboptimal.

Conclusions

In the UK, a telephone-based system of monitoring influenza vaccine uptake seems robust enough to generate data that are comparable with routine vaccine monitoring undertaken using data provided by general practitioners. Although such a system cannot easily contribute towards monitoring of vaccination at local and regional levels, it offers a validated method of estimating vaccine uptake that is independent of healthcare workers’ time. This may be especially important for a pandemic vaccination programme, especially in countries in which healthcare resources are scarce, or where the configuration of healthcare services is less conducive to internal monitoring than is the case in the UK.

Introduction

Although influenza is often perceived as a self-limiting and generally problem-free disease in healthy adults, it places a relatively high burden on patients and is of considerable socio-economic relevance to society.1 In addition, elderly and other high-risk people are vulnerable to the serious complications of influenza. Every year in the UK, an average of 16,000 excess hospital admissions and 12,500 deaths (up to 28,000 in epidemics) occur as a result of influenza and its complications, mostly involving people aged 65 years and over.2, 3

Vaccination is an effective means of reducing mortality and morbidity from influenza in elderly and high-risk people.4 In the UK, vaccination has repeatedly been shown to reduce mortality.5, 6 In a recent cohort study, the pooled effectiveness of vaccine against deaths due to respiratory disease was 12% (95% confidence interval [CI], 8–16%). A greater proportionate reduction was seen among people without medical disorders, but absolute rate reduction was higher in individuals with medical disorders, compared with individuals without such disorders (6.14 deaths due to respiratory disease/100,000 person-weeks vs. 3.12 deaths due to respiratory disease/100,000 person-weeks).7

In the UK, government policy is to vaccinate all people aged 65 years and over (age-related policy introduced in 2000–2001); individuals aged 6 months and over who fall into a clinically defined risk group (chronic respiratory disease, including asthma, chronic heart disease, chronic renal disease, diabetes and immunosuppression); and individuals living in long-stay, residential-care institutions. Health and social-care workers involved in direct care are also recommended for vaccination.8 Vaccination is conducted almost exclusively in primary care. To support official policy, each year a target is set for vaccination uptake among people aged 65 years and over, rewarded by a financial incentive to general practitioners.8 Between 1999–2000 and 2003–2004, the target threshold has risen gradually. The current target for vaccine coverage in people aged 65 years and over is 70%, but it began at 60% in 2000–2001. In general, routine population-based monitoring of influenza vaccination coverage does not exist in most countries. This was the case in the UK during the 1990s when information came from a number of ad hoc surveys based on high-risk groups (age-based vaccination of elderly people was not official policy at that time).9, 10, 11, 12, 13 However, with effect from 2000 to 2001, an official programme of vaccination uptake monitoring has existed in England. This has been made possible because virtually all primary-care services in the UK are provided under the auspices of the National Health Service. Individual general practitioners, Primary Care Trusts and Strategic Health Authorities participate in the scheme, which is managed by the Health Protection Agency on behalf of the Department of Health in England.14 Similar schemes exist in the devolved administrations of Northern Ireland, Scotland and Wales. The existence of such a scheme has provided an opportunity to test the validity of a rapid telephone-based patient survey of vaccination, which may be the preferred method during a pandemic when health services are hard pressed providing acute medical care.

Section snippets

Objectives

The objectives of this study were to (1) identify the level of influenza vaccination coverage in the 2002–2003 and 2003–2004 seasons in the UK, and to compare this with estimates obtained from official monitoring sources; (2) to describe vaccine uptake according to demographic parameters; (3) and to determine the validity of a telephone-based patient survey as a means of monitoring uptake of a future pandemic vaccine programme.

Methods

A population-based telephone survey was carried out during two influenza seasons, 2002–2003 and 2003–2004, in the UK. A random sample of 70,000 (35,000 per season) telephone numbers was purchased from an external sample supplier (SSI Inc.), who provides random digit dial (RDD) numbers with an area postcode appended. The numbers supplied by SSI were pre-cleaned to delete dead lines and business numbers. As only the telephone number was supplied, the first adult in the household who picked up the

Results

In the 2002–2003 and 2003–2004 seasons, telephone calls were made to randomly selected individuals until 2028 and 2026 interviews, respectively, had been completed.

Discussion

This survey was carried out internationally (France, Italy, Spain and Germany) as well as in the UK, for two consecutive seasons: 2002–2003 and 2003–2004. The data from outside the UK are presented elsewhere. By conducting the study in the UK, where there is already a well-established, robust and successful programme of influenza vaccine uptake monitoring now in place, it has been possible to determine the validity of results obtained from a ‘cold-calling’ telephone-based survey with those

Acknowledgements

This study was made possible by an unrestricted research grant from Aventis-Pasteur MSD (now Sanofi Pasteur MSD), Lyon, France. Dr Van-Tam first became involved with this work when he was employed by Aventis Pasteur MSD in the UK. He has subsequently moved to the Health Protection Agency, from where he has helped to complete the work.

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