Birte Bödeker

Cross-sectional study on factors associated with influenza vaccine uptake and pertussis vaccination status among pregnant women in Germany.

Pregnant women and their newborns are at increased risk for influenza-related complications; the latter also have an increased risk for pertussis-related complications. In Germany, seasonal influenza vaccination is recommended for pregnant women since 2010. A dose of pertussis-containing vaccine has been recommended since 2004 for women of childbearing age if they have not been vaccinated within the past 10 years. We conducted a nationwide cross-sectional survey among pregnant women in February/March 2013 to assess knowledge, attitudes, and practices related to influenza vaccination during pregnancy and to identify factors associated with their pertussis vaccination status. In total, 1025 pregnant women participated and provided information through a self-administered questionnaire. Of these, 23.2% were vaccinated against seasonal influenza during the 2012/13 season; 15.9% during their pregnancy. Major reasons for being unvaccinated (n=686 respondents) were lack of confidence in the vaccine (60.4%) and the perception that vaccination was not necessary (40.3%). Influenza vaccination during pregnancy was independently associated with having received influenza vaccine in the previous season, having received a recommendation from a physician, a high level of vaccine-related knowledge and of perceived disease severity. In contrast, knowledge of the recommendation for regular hand-washing to prevent influenza and the perception that vaccine-related side effects were likely to occur or likely to be severe were negatively associated with vaccine uptake. Receipt of a pertussis vaccine in the past 10 years was reported by 22.5% of participants. Pertussis vaccine uptake was independently associated with living in the Eastern federal states and receiving seasonal influenza vaccination annually, while a migration background was associated with a lower uptake. To enhance vaccine uptake in pregnant women and women of childbearing age, special efforts must be undertaken to improve knowledge of both recommendations and the benefits of vaccination. Gynecologists could serve as important facilitators.

Application of the screening method to monitor influenza vaccine effectiveness among the elderly in Germany

BackgroundElderly people are at increased risk for severe influenza illness and constitute therefore a major target-group for seasonal influenza vaccination in most industrialized countries. The aim of this study was to estimate influenza vaccine effectiveness (VE) among individuals aged 60+ years over three seasons and to assess if the screening method is a suitable tool to monitor influenza VE in this particular target-group in Germany.MethodsWe identified laboratory-confirmed influenza cases aged 60+ years through the national communicable disease reporting system for seasons 2010/11, 2011/12 and 2012/13. Vaccination coverage (VC) data were retrieved from a database of health insurance claims representing ~85% of the total German population. We applied the screening method to calculate influenza subtype-specific VE and compared our results with VE estimates from other observational studies in Europe.ResultsIn total, 7,156 laboratory-confirmed influenza cases were included. VE against all influenza types ranged between 49% (95% confidence interval [CI]: 39–56) in 2011/12 and 80% (95% CI: 76-83%) in 2010/11. In 2010/11 subtype-specific VE against influenza A(H1N1)pdm and B was 76% and 84%, respectively. In the following seasons, VE against influenza A(H1N1)pdm, A(H3N2) and B was 87%, -9% , 74% (2011/12), and 74%, 39%, 73% (2012/13). VE was higher among hospitalized compared to non-hospitalized influenza A cases. Seventeen observational studies from Europe reporting subtype-specific VE among the elderly were identified for the respective seasons (all applying the test-negative design) and showed comparable subtype-specific VE estimates.ConclusionsAccording to our study, influenza vaccination provided moderate protection against laboratory-confirmed influenza A(H1N1)pdm and B in individuals aged 60+ but no or only little protection against A(H3N2). Higher VE among hospitalized cases might indicate higher protection against severe influenza disease. Based on the available data, the screening method allowed us to assess subtype-specific VE in hospitalized and non-hospitalized elderly persons. Since controlling for several important confounders was not possible, the applied method only provided crude VE estimates. However, given the precise VC-data and the large number of cases, the screening method provided results being in line with VE estimates from other observational studies in Europe that applied a different study design.

Umsetzung der Influenzaimpfempfehlung in Alten- und Pflegeheimen

Residents and staff of nursing homes are important target groups for influenza vaccination in Germany. The aim of this study was to gain the first insights into whether nursing homes organize activities with respect to vaccination against influenza and whether there is a demand for further information. In the context of the national influenza immunization campaign-which is jointly carried out by the Robert Koch Institute (RKI) and the Federal Centre for Health Education (BZgA) on an annual basis-influenza information kits were sent to the management of 10,700 nursing homes in September 2013. Along with the information material, the institutions also received a questionnaire to which they were able to respond via mail, fax, or online. Data from 988 homes were included in the analysis. The majority of institutions informed both residents (88.9 %) and nursing staff (81.2 %) about influenza vaccination. However, only 64.7 % of nursing homes carried out specific immunization activities for their residents and only half (49.3 %) offered a flu shot to their staff. When asked why the institutions do not provide influenza-specific information and vaccination to their staff, the majority had the opinion that this is the responsibility of each individuals general practitioner. Overall, only 4.9 % of nursing homes assessed influenza vaccination coverage among their staff annually. A third of all surveyed institutions (33.6 %) expressed a demand for additional influenza vaccine-related information. In conclusion, improved health education is needed to raise awareness about the importance of influenza vaccination among residents and employees of nursing homes in Germany so as to prevent influenza-associated morbidity and mortality in this risk group.

[Implementation of the influenza vaccination recommendation in nursing homes in Germany : results of a survey as part of the national influenza immunization campaign].

Residents and staff of nursing homes are important target groups for influenza vaccination in Germany. The aim of this study was to gain the first insights into whether nursing homes organize activities with respect to vaccination against influenza and whether there is a demand for further information. In the context of the national influenza immunization campaign-which is jointly carried out by the Robert Koch Institute (RKI) and the Federal Centre for Health Education (BZgA) on an annual basis-influenza information kits were sent to the management of 10,700 nursing homes in September 2013. Along with the information material, the institutions also received a questionnaire to which they were able to respond via mail, fax, or online. Data from 988 homes were included in the analysis. The majority of institutions informed both residents (88.9 %) and nursing staff (81.2 %) about influenza vaccination. However, only 64.7 % of nursing homes carried out specific immunization activities for their residents and only half (49.3 %) offered a flu shot to their staff. When asked why the institutions do not provide influenza-specific information and vaccination to their staff, the majority had the opinion that this is the responsibility of each individuals general practitioner. Overall, only 4.9 % of nursing homes assessed influenza vaccination coverage among their staff annually. A third of all surveyed institutions (33.6 %) expressed a demand for additional influenza vaccine-related information. In conclusion, improved health education is needed to raise awareness about the importance of influenza vaccination among residents and employees of nursing homes in Germany so as to prevent influenza-associated morbidity and mortality in this risk group.

Implementation of seasonal influenza and human papillomavirus vaccination recommendations in gynecological practices in Germany

In Germany, seasonal influenza vaccination has been recommended for pregnant women since 2010 and human papillomavirus (HPV) vaccination for girls since 2007. Gynecologists play an important role in the communication and vaccination of these two target groups. Moreover, seasonal influenza vaccination is also recommended for healthcare workers, as well as adults aged ≥ 60 years and individuals with underlying chronic diseases. The aim of this study was to gain first insights into the acceptance and implementation of the seasonal influenza und HPV vaccination recommendations in gynecological practices. In the context of the national influenza immunization campaign-which is jointly carried out by the Robert Koch Institute (RKI) and the Federal Centre for Health Education (BZgA)-a questionnaire was sent together with influenza information kits to 7477 gynecologists in September 2014. Data from 1469 (20 %) gynecologists were included in the analysis. 72 % of respondents reported that they themselves received a seasonal influenza shot each year. The majority of gynecologists recommended seasonal influenza vaccination for pregnant women (93 %) and HPV vaccination for girls (97 %). The most commonly stated reasons against influenza vaccination were safety concerns. Those against HPV vaccination were effectiveness concerns. Additionally, for both vaccinations the provision of vaccine-related information to the patient was considered too time consuming.The high acceptance of seasonal influenza and HPV vaccination among gynecologists is discordant with the available vaccination coverage figures in Germany. Gynecologists must be reminded of their important role in the prevention of vaccine-preventable diseases in adolescents and adult women. Immunization and communication skills should be considered more strongly as an integral part of medical education and further training for gynecologists.ZusammenfassungIn Deutschland ist die Impfung gegen saisonale Influenza bei Schwangeren seit 2010 und die gegen humane Papillomaviren (HPV) bei Mädchen seit 2007 empfohlen. Niedergelassene Gynäkologinnen und Gynäkologen nehmen bei der Kommunikation und Impfung der beiden Zielgruppen eine wichtige Rolle ein. Darüber hinaus sollten auch medizinisches Personal sowie Menschen ab 60 Jahren und Personen mit chronischer Grunderkrankung die Impfung gegen saisonale Influenza erhalten. Ziel der vorliegenden Erhebung war es, einen ersten Einblick zu gewinnen, inwiefern die Influenza- und HPV-Impfempfehlungen in gynäkologischen Praxen umgesetzt werden. Im Rahmen der vom Robert Koch-Institut (RKI) und der Bundeszentrale für gesundheitliche Aufklärung (BZgA) gemeinsam durchgeführten Kampagne „Wir kommen der Grippe zuvor“ wurde im September 2014 ein Fragebogen zusätzlich zu den Medienpaketen zur Influenzaimpfaufklärung bundesweit an 7477 niedergelassene Gynäkologinnen und Gynäkologen verschickt. Es wurden Daten aus 1469 (20 %) Praxen in die Analysen einbezogen. 72 % der befragten Ärztinnen und Ärzte lassen sich jährlich gegen Influenza impfen. Die Mehrheit der Niedergelassenen empfahl Schwangeren die Impfung gegen saisonale Influenza (93 %) sowie Mädchen und jungen Frauen die HPV-Impfung (97 %). Von denjenigen, die keine Empfehlung aussprachen, wurden als Hauptgründe gegen die Influenzaimpfung Sicherheits- und gegen die HPV-Impfung Wirksamkeitsbedenken angegeben. Gegen beide Impfungen wurde zusätzlich aufgeführt, dass ein Aufklärungsgespräch zu aufwendig sei. Die in unserer Studienpopulation hohe Akzeptanz der beiden Impfungen spiegelt sich nicht in den für Deutschland verfügbaren Impfquoten wider. Gynäkologinnen und Gynäkologen müssen verstärkt auf ihre wichtige Rolle in der Impfprävention hingewiesen werden. Sowohl während der medizinischen Ausbildung als auch in weiterführenden gynäkologischen Fort- und Weiterbildungen sollte das Thema Impfen und die Kommunikation hierzu vermehrt berücksichtigt werden.AbstractIn Germany, seasonal influenza vaccination has been recommended for pregnant women since 2010 and human papillomavirus (HPV) vaccination for girls since 2007. Gynecologists play an important role in the communication and vaccination of these two target groups. Moreover, seasonal influenza vaccination is also recommended for healthcare workers, as well as adults aged ≥ 60 years and individuals with underlying chronic diseases. The aim of this study was to gain first insights into the acceptance and implementation of the seasonal influenza und HPV vaccination recommendations in gynecological practices. In the context of the national influenza immunization campaign—which is jointly carried out by the Robert Koch Institute (RKI) and the Federal Centre for Health Education (BZgA)—a questionnaire was sent together with influenza information kits to 7477 gynecologists in September 2014. Data from 1469 (20 %) gynecologists were included in the analysis. 72 % of respondents reported that they themselves received a seasonal influenza shot each year. The majority of gynecologists recommended seasonal influenza vaccination for pregnant women (93 %) and HPV vaccination for girls (97 %). The most commonly stated reasons against influenza vaccination were safety concerns. Those against HPV vaccination were effectiveness concerns. Additionally, for both vaccinations the provision of vaccine-related information to the patient was considered too time consuming.The high acceptance of seasonal influenza and HPV vaccination among gynecologists is discordant with the available vaccination coverage figures in Germany. Gynecologists must be reminded of their important role in the prevention of vaccine-preventable diseases in adolescents and adult women. Immunization and communication skills should be considered more strongly as an integral part of medical education and further training for gynecologists.

Wie werden die Impfempfehlungen gegen saisonale Influenza und gegen humane Papillomaviren in gynäkologischen Praxen umgesetzt

In Germany, seasonal influenza vaccination has been recommended for pregnant women since 2010 and human papillomavirus (HPV) vaccination for girls since 2007. Gynecologists play an important role in the communication and vaccination of these two target groups. Moreover, seasonal influenza vaccination is also recommended for healthcare workers, as well as adults aged ≥ 60 years and individuals with underlying chronic diseases. The aim of this study was to gain first insights into the acceptance and implementation of the seasonal influenza und HPV vaccination recommendations in gynecological practices. In the context of the national influenza immunization campaign-which is jointly carried out by the Robert Koch Institute (RKI) and the Federal Centre for Health Education (BZgA)-a questionnaire was sent together with influenza information kits to 7477 gynecologists in September 2014. Data from 1469 (20 %) gynecologists were included in the analysis. 72 % of respondents reported that they themselves received a seasonal influenza shot each year. The majority of gynecologists recommended seasonal influenza vaccination for pregnant women (93 %) and HPV vaccination for girls (97 %). The most commonly stated reasons against influenza vaccination were safety concerns. Those against HPV vaccination were effectiveness concerns. Additionally, for both vaccinations the provision of vaccine-related information to the patient was considered too time consuming.The high acceptance of seasonal influenza and HPV vaccination among gynecologists is discordant with the available vaccination coverage figures in Germany. Gynecologists must be reminded of their important role in the prevention of vaccine-preventable diseases in adolescents and adult women. Immunization and communication skills should be considered more strongly as an integral part of medical education and further training for gynecologists.ZusammenfassungIn Deutschland ist die Impfung gegen saisonale Influenza bei Schwangeren seit 2010 und die gegen humane Papillomaviren (HPV) bei Mädchen seit 2007 empfohlen. Niedergelassene Gynäkologinnen und Gynäkologen nehmen bei der Kommunikation und Impfung der beiden Zielgruppen eine wichtige Rolle ein. Darüber hinaus sollten auch medizinisches Personal sowie Menschen ab 60 Jahren und Personen mit chronischer Grunderkrankung die Impfung gegen saisonale Influenza erhalten. Ziel der vorliegenden Erhebung war es, einen ersten Einblick zu gewinnen, inwiefern die Influenza- und HPV-Impfempfehlungen in gynäkologischen Praxen umgesetzt werden. Im Rahmen der vom Robert Koch-Institut (RKI) und der Bundeszentrale für gesundheitliche Aufklärung (BZgA) gemeinsam durchgeführten Kampagne „Wir kommen der Grippe zuvor“ wurde im September 2014 ein Fragebogen zusätzlich zu den Medienpaketen zur Influenzaimpfaufklärung bundesweit an 7477 niedergelassene Gynäkologinnen und Gynäkologen verschickt. Es wurden Daten aus 1469 (20 %) Praxen in die Analysen einbezogen. 72 % der befragten Ärztinnen und Ärzte lassen sich jährlich gegen Influenza impfen. Die Mehrheit der Niedergelassenen empfahl Schwangeren die Impfung gegen saisonale Influenza (93 %) sowie Mädchen und jungen Frauen die HPV-Impfung (97 %). Von denjenigen, die keine Empfehlung aussprachen, wurden als Hauptgründe gegen die Influenzaimpfung Sicherheits- und gegen die HPV-Impfung Wirksamkeitsbedenken angegeben. Gegen beide Impfungen wurde zusätzlich aufgeführt, dass ein Aufklärungsgespräch zu aufwendig sei. Die in unserer Studienpopulation hohe Akzeptanz der beiden Impfungen spiegelt sich nicht in den für Deutschland verfügbaren Impfquoten wider. Gynäkologinnen und Gynäkologen müssen verstärkt auf ihre wichtige Rolle in der Impfprävention hingewiesen werden. Sowohl während der medizinischen Ausbildung als auch in weiterführenden gynäkologischen Fort- und Weiterbildungen sollte das Thema Impfen und die Kommunikation hierzu vermehrt berücksichtigt werden.AbstractIn Germany, seasonal influenza vaccination has been recommended for pregnant women since 2010 and human papillomavirus (HPV) vaccination for girls since 2007. Gynecologists play an important role in the communication and vaccination of these two target groups. Moreover, seasonal influenza vaccination is also recommended for healthcare workers, as well as adults aged ≥ 60 years and individuals with underlying chronic diseases. The aim of this study was to gain first insights into the acceptance and implementation of the seasonal influenza und HPV vaccination recommendations in gynecological practices. In the context of the national influenza immunization campaign—which is jointly carried out by the Robert Koch Institute (RKI) and the Federal Centre for Health Education (BZgA)—a questionnaire was sent together with influenza information kits to 7477 gynecologists in September 2014. Data from 1469 (20 %) gynecologists were included in the analysis. 72 % of respondents reported that they themselves received a seasonal influenza shot each year. The majority of gynecologists recommended seasonal influenza vaccination for pregnant women (93 %) and HPV vaccination for girls (97 %). The most commonly stated reasons against influenza vaccination were safety concerns. Those against HPV vaccination were effectiveness concerns. Additionally, for both vaccinations the provision of vaccine-related information to the patient was considered too time consuming.The high acceptance of seasonal influenza and HPV vaccination among gynecologists is discordant with the available vaccination coverage figures in Germany. Gynecologists must be reminded of their important role in the prevention of vaccine-preventable diseases in adolescents and adult women. Immunization and communication skills should be considered more strongly as an integral part of medical education and further training for gynecologists.

Wie werden die Impfempfehlungen gegen saisonale Influenza und gegen humane Papillomaviren in gynäkologischen Praxen umgesetzt?@@@Implementation of seasonal influenza and human papillomavirus vaccination recommendations in gynecological practices in Germany

In Germany, seasonal influenza vaccination has been recommended for pregnant women since 2010 and human papillomavirus (HPV) vaccination for girls since 2007. Gynecologists play an important role in the communication and vaccination of these two target groups. Moreover, seasonal influenza vaccination is also recommended for healthcare workers, as well as adults aged ≥ 60 years and individuals with underlying chronic diseases. The aim of this study was to gain first insights into the acceptance and implementation of the seasonal influenza und HPV vaccination recommendations in gynecological practices. In the context of the national influenza immunization campaign-which is jointly carried out by the Robert Koch Institute (RKI) and the Federal Centre for Health Education (BZgA)-a questionnaire was sent together with influenza information kits to 7477 gynecologists in September 2014. Data from 1469 (20 %) gynecologists were included in the analysis. 72 % of respondents reported that they themselves received a seasonal influenza shot each year. The majority of gynecologists recommended seasonal influenza vaccination for pregnant women (93 %) and HPV vaccination for girls (97 %). The most commonly stated reasons against influenza vaccination were safety concerns. Those against HPV vaccination were effectiveness concerns. Additionally, for both vaccinations the provision of vaccine-related information to the patient was considered too time consuming.The high acceptance of seasonal influenza and HPV vaccination among gynecologists is discordant with the available vaccination coverage figures in Germany. Gynecologists must be reminded of their important role in the prevention of vaccine-preventable diseases in adolescents and adult women. Immunization and communication skills should be considered more strongly as an integral part of medical education and further training for gynecologists.ZusammenfassungIn Deutschland ist die Impfung gegen saisonale Influenza bei Schwangeren seit 2010 und die gegen humane Papillomaviren (HPV) bei Mädchen seit 2007 empfohlen. Niedergelassene Gynäkologinnen und Gynäkologen nehmen bei der Kommunikation und Impfung der beiden Zielgruppen eine wichtige Rolle ein. Darüber hinaus sollten auch medizinisches Personal sowie Menschen ab 60 Jahren und Personen mit chronischer Grunderkrankung die Impfung gegen saisonale Influenza erhalten. Ziel der vorliegenden Erhebung war es, einen ersten Einblick zu gewinnen, inwiefern die Influenza- und HPV-Impfempfehlungen in gynäkologischen Praxen umgesetzt werden. Im Rahmen der vom Robert Koch-Institut (RKI) und der Bundeszentrale für gesundheitliche Aufklärung (BZgA) gemeinsam durchgeführten Kampagne „Wir kommen der Grippe zuvor“ wurde im September 2014 ein Fragebogen zusätzlich zu den Medienpaketen zur Influenzaimpfaufklärung bundesweit an 7477 niedergelassene Gynäkologinnen und Gynäkologen verschickt. Es wurden Daten aus 1469 (20 %) Praxen in die Analysen einbezogen. 72 % der befragten Ärztinnen und Ärzte lassen sich jährlich gegen Influenza impfen. Die Mehrheit der Niedergelassenen empfahl Schwangeren die Impfung gegen saisonale Influenza (93 %) sowie Mädchen und jungen Frauen die HPV-Impfung (97 %). Von denjenigen, die keine Empfehlung aussprachen, wurden als Hauptgründe gegen die Influenzaimpfung Sicherheits- und gegen die HPV-Impfung Wirksamkeitsbedenken angegeben. Gegen beide Impfungen wurde zusätzlich aufgeführt, dass ein Aufklärungsgespräch zu aufwendig sei. Die in unserer Studienpopulation hohe Akzeptanz der beiden Impfungen spiegelt sich nicht in den für Deutschland verfügbaren Impfquoten wider. Gynäkologinnen und Gynäkologen müssen verstärkt auf ihre wichtige Rolle in der Impfprävention hingewiesen werden. Sowohl während der medizinischen Ausbildung als auch in weiterführenden gynäkologischen Fort- und Weiterbildungen sollte das Thema Impfen und die Kommunikation hierzu vermehrt berücksichtigt werden.AbstractIn Germany, seasonal influenza vaccination has been recommended for pregnant women since 2010 and human papillomavirus (HPV) vaccination for girls since 2007. Gynecologists play an important role in the communication and vaccination of these two target groups. Moreover, seasonal influenza vaccination is also recommended for healthcare workers, as well as adults aged ≥ 60 years and individuals with underlying chronic diseases. The aim of this study was to gain first insights into the acceptance and implementation of the seasonal influenza und HPV vaccination recommendations in gynecological practices. In the context of the national influenza immunization campaign—which is jointly carried out by the Robert Koch Institute (RKI) and the Federal Centre for Health Education (BZgA)—a questionnaire was sent together with influenza information kits to 7477 gynecologists in September 2014. Data from 1469 (20 %) gynecologists were included in the analysis. 72 % of respondents reported that they themselves received a seasonal influenza shot each year. The majority of gynecologists recommended seasonal influenza vaccination for pregnant women (93 %) and HPV vaccination for girls (97 %). The most commonly stated reasons against influenza vaccination were safety concerns. Those against HPV vaccination were effectiveness concerns. Additionally, for both vaccinations the provision of vaccine-related information to the patient was considered too time consuming.The high acceptance of seasonal influenza and HPV vaccination among gynecologists is discordant with the available vaccination coverage figures in Germany. Gynecologists must be reminded of their important role in the prevention of vaccine-preventable diseases in adolescents and adult women. Immunization and communication skills should be considered more strongly as an integral part of medical education and further training for gynecologists.

Umsetzung der Influenzaimpfempfehlung in Alten- und Pflegeheimen@@@Implementation of the influenza vaccination recommendation in nursing homes in Germany: Ergebnisse einer Erhebung im Rahmen der nationalen Influenza-Impfaufklärungskampagne@@@Results of a survey as part of the national influenza immunization campaign

Residents and staff of nursing homes are important target groups for influenza vaccination in Germany. The aim of this study was to gain the first insights into whether nursing homes organize activities with respect to vaccination against influenza and whether there is a demand for further information. In the context of the national influenza immunization campaign-which is jointly carried out by the Robert Koch Institute (RKI) and the Federal Centre for Health Education (BZgA) on an annual basis-influenza information kits were sent to the management of 10,700 nursing homes in September 2013. Along with the information material, the institutions also received a questionnaire to which they were able to respond via mail, fax, or online. Data from 988 homes were included in the analysis. The majority of institutions informed both residents (88.9 %) and nursing staff (81.2 %) about influenza vaccination. However, only 64.7 % of nursing homes carried out specific immunization activities for their residents and only half (49.3 %) offered a flu shot to their staff. When asked why the institutions do not provide influenza-specific information and vaccination to their staff, the majority had the opinion that this is the responsibility of each individuals general practitioner. Overall, only 4.9 % of nursing homes assessed influenza vaccination coverage among their staff annually. A third of all surveyed institutions (33.6 %) expressed a demand for additional influenza vaccine-related information. In conclusion, improved health education is needed to raise awareness about the importance of influenza vaccination among residents and employees of nursing homes in Germany so as to prevent influenza-associated morbidity and mortality in this risk group.