Dataset Information

Influenza vaccination, inverse care and homelessness: cross-sectional survey of eligibility and uptake during the 2011/12 season in London.

ABSTRACT:

Background

Influenza vaccination eligibility and uptake among homeless adults has not been previously assessed in the UK. This cross-sectional survey aimed to measure the proportion of homeless people visited by an NHS outreach service (Find and Treat) who were eligible for and had received vaccination during 2011/12.

Methods

A cross-sectional survey was carried out in 27 separate homeless hostels, day centres and drug services in London between July and August in 2012. Eligibility for the survey was by virtue of being in attendance at one of 27 venues visited by Find and Treat. No specific exclusion criteria were used.

Results

455 clients took part in the survey out of 592 approached (76.9%). A total of 190 homeless people (41.8%; 95% CI: 34.5,50.5) were eligible for influenza vaccination. In those aged 16-64, eligibility due to clinical risk factors was 38.9% (95% CI: 31.5,48.2). Uptake of vaccination in homeless 16-64 year olds with a clinical risk factor during the 2011/12 influenza season was 23.7% (95% CI: 19.8,28.3) compared to national levels of 53.2% (excluding pregnant women). In those aged over 65, uptake was 42.9% (95% CI: 16.7,100.0) compared with 74.0% nationally.

Conclusions

This study demonstrates that the homeless population have high levels of chronic health problems predisposing them to severe complications of influenza, but vaccine uptake levels that are less than half those seen among eligible GP patient groups in England. It provides a clear example of the health inequalities and inverse care law that impact this population. The results of this study provide strong justification for intensifying efforts to ensure homeless people have access to influenza vaccination.

SUBMITTER: Story A

PROVIDER: S-EPMC3906096 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThere are few estimates of vaccination-averted influenza-associated illnesses in China.MethodsWe used a mathematical model and Monte Carlo algorithm to estimate numbers and 95% confidence intervals (CI) of influenza-associated outcomes (hospitalization, illness, and medically-attended (MA) illness) averted by vaccination among children aged 6-59 months in Suzhou from October 2011-September 2016. Influenza illnesses included non-hospitalized MA influenza illnesses and non-MA influenza illnesses. The numbers of influenza-associated outcomes averted by vaccination were the difference between the expected burden if there were no vaccination given and the observed burden with vaccination. The model incorporated the disease burden estimated based on surveillance data from Suzhou University Affiliated Children's Hospital (SCH) and data from health utilization surveys conducted in the catchment area of SCH, age-specific estimates of influenza vaccination coverage in Suzhou from the Expanded Program on Immunization database, and influenza vaccine effectiveness estimates from previous publications. Averted influenza estimations were presented as absolute numbers and in terms of the prevented fraction (PF). A hypothetical scenario with 50% coverage (but identical vaccine effectiveness) over the study period was also modeled.ResultsIn ~250,000 children, influenza vaccination prevented an estimated 731 (CI: 549-960) influenza hospitalizations (PF: 6.2% of expected, CI: 5.8-6.6%) and 10,024 (7593-12,937) influenza illnesses (PF: 6.5%, 6.4-6.7%), of which 8342 (6338-10,768) were MA (PF: 6.6%, 6.4-6.7%) from 2011 to 2016. The PFs declined each year along with decreasing influenza vaccination coverage. If 50% of the study population had been vaccinated over time, the estimated numbers of averted cases during the study period would have been 4059 (3120-5762) influenza hospitalizations (PF: 27.2%, 26.4-27.9%) and 56,215 (42,925-78,849) influenza illnesses (PF: 28.5%, 28.3-28.7%), of which 46,596 (35,662-65,234) would be MA (PF: 28.5%, 28.3-28.7%).ConclusionInfluenza vaccination is estimated to have averted influenza-associated illness outcomes even with low coverage in children aged 6-59 months in Suzhou. Increasing influenza vaccination coverage in this population could further reduce illnesses and hospitalizations.