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1.
Vaccine ; 40(7): 1031-1037, 2022 02 11.
Article in English | MEDLINE | ID: covidwho-1661920

ABSTRACT

BACKGROUND: More older adults enrolled in Medicare Advantage (MA) are entering nursing homes (NHs), and MA concentration could affect vaccination rates through shifts in resident characteristics and/or payer-related influences on preventive services use. We investigated whether rates of influenza vaccination and refusal differ across NHs with varying concentrations of MA-enrolled residents. METHODS: We analyzed 2014-2015 Medicare enrollment data and Minimum Data Set clinical assessments linked to NH-level characteristics, star ratings, and county-level MA penetration rates. The independent variable was the percentage of residents enrolled in MA at admission and categorized into three equally-sized groups. We examined three NH-level outcomes including the percentages of residents assessed and appropriately considered for influenza vaccination, received influenza vaccination, and refused influenza vaccination. RESULTS: There were 936,513 long-stay residents in 12,384 NHs. Categories for the prevalence of MA enrollment in NHs were low (0% to 3.3%; n = 4131 NHs), moderate (3.4% to 18.6%; n = 4127 NHs) and high (>18.6%; n = 4126 NHs). Overall, 81.3% of long-stay residents received influenza vaccination and 14.3% refused the vaccine when offered. Adjusting for covariates, influenza vaccination rates among long-stay residents were higher in NHs with moderate (1.70 percentage points [pp], 95% confidence limits [CL]: 1.15 pp, 2.24 pp), or high (3.05 pp, 95% CL: 2.45 pp, 3.66 pp) MA versus the lowest prevalence of MA. Influenza vaccine refusal was lower in NHs with moderate (-3.10 pp, 95% CL: -3.53 pp, -2.68 pp), or high (-4.63 pp, 95% CL: -5.11 pp, -4.15 pp) MA compared with NHs with the lowest prevalence of MA. CONCLUSION: A higher concentration of long-stay NH residents enrolled in MA was associated with greater influenza vaccine receipt and lower vaccine refusal. As MA becomes a larger share of the Medicare program, and more MA beneficiaries enter NHs, decisionmakers need to consider how managed care can be leveraged to improve the delivery of preventive services like influenza vaccinations in NH settings.


Subject(s)
Influenza Vaccines , Influenza, Human , Medicare Part C , Aged , Humans , Influenza, Human/prevention & control , Nursing Homes , United States , Vaccination
2.
Infect Dis Model ; 6: 955-974, 2021.
Article in English | MEDLINE | ID: covidwho-1336464

ABSTRACT

Non-pharmaceutical interventions (NPI) were implemented all around the world in the fight against COVID-19: Social distancing, shelter-in-place, mask wearing, etc. to mitigate transmission, together with testing and contact-tracing to identify, isolate and treat the infected. The majority of countries have relied on the former measures, followed by a ramping up of their testing and tracing capabilities. We present here the cases of South Korea, Italy, Canada and the United States, as a look back to lessons that can be drawn for controlling the pandemic, specifically through the means of testing and tracing. By fitting a disease transmission model to daily case report data in each of the four countries, we first show that their combination of social-distancing and testing/tracing have had a significant impact on the evolution of their first wave of pandemic curves. We then consider the hypothetical scenario where the only NPI measures implemented past the first pandemic wave consisted of isolating individuals due to repeated, country-scale testing and contact tracing, as a mean of lifting social distancing measures without a resurgence of COVID-19. We give estimates on the average isolation rates needed to occur in each country. We find that testing and tracing each individual of a country, on average, every 4.5 days (South Korea), 5.7 days (Canada), 6 days (Italy) and 3.5 days (US), would have been sufficient to mitigate their second pandemic waves. We also considered the situation in Canada to see how a frequent large-scale asymptomatic testing and contact tracing could have been used in combination with vaccination rollout to reduce the infection in the population. This could offer an alternative approach towards preventing and controlling an outbreak when vaccine supply is limited, while testing capacity has been increasingly enhanced.

3.
Lancet Reg Health West Pac ; 10: 100140, 2021 May.
Article in English | MEDLINE | ID: covidwho-1198957

ABSTRACT

BACKGROUND: Data on COVID-19-induced disruption to routine vaccinations in the South-East Asia and Western Pacific regions (SEAR/WPR) have been sparse. This study aimed to quantify the impact of COVID-19 on routine vaccinations by country, antigen, and sector (public or private), up to 1 June 2020, and to identify the reasons for disruption and possible solutions. METHODS: Sanofi Pasteur teams from 19 countries in SEAR/WPR completed a structured questionnaire reporting on COVID-19 disruptions for 13-19 routinely delivered antigens per country, based on sales data, government reports, and regular physician interactions. Data were analysed descriptively, disruption causes ranked, and solutions evaluated using a modified public health best practices framework. FINDINGS: 95% (18/19) of countries reported vaccination disruption. When stratified by country, a median of 91% (interquartile range 77-94) of antigens were impacted. Infancy and school-entry age vaccinations were most impacted. Both public and private sector healthcare providers experienced disruptions. Vaccination rates had not recovered for 39% of impacted antigens by 1 June 2020. Fear of infection, movement/travel restrictions, and limited healthcare access were the highest-ranked reasons for disruption. Highest-scoring solutions were separating vaccination groups from unwell patients, non-traditional vaccination venues, virtual engagement, and social media campaigns. Many of these solutions were under-utilised. INTERPRETATION: COVID-19-induced disruption of routine vaccination was more widespread than previously reported. Adaptable solutions were identified which could be implemented in SEAR/WPR and elsewhere. Governments and private providers need to act urgently to improve coverage rates and plan for future waves of the pandemic, to avoid a resurgence of vaccine-preventable diseases. FUNDING: Sanofi Pasteur.

5.
Eurosurveillance ; 25(19):16, 2020.
Article in English | ProQuest Central | ID: covidwho-833282

ABSTRACT

Introduction It is unclear whether high-dose influenza vaccine (HD) is more effective at reducing mortality among seniors. Aim This study aimed to evaluate the relative vaccine effectiveness (rVE) of HD. Methods We linked electronic medical record databases in the Veterans Health Administration (VHA) and Medicare administrative files to examine the rVE of HD vs standard-dose influenza vaccines (SD) in preventing influenza/pneumonia-associated and cardiorespiratory mortality among VHA-enrolled veterans 65 years or older during the 2012/13, 2013/14 and 2014/15 influenza seasons. A multivariable Cox proportional hazards model was performed on matched recipients of HD vs SD, based on vaccination time, location, age, sex, ethnicity and VHA priority level. Results Among 569,552 person-seasons of observation, 207,574 (36%) were HD recipients and 361,978 (64%) were SD recipients, predominantly male (99%) and white (82%). Pooling findings from all three seasons, the adjusted rVE estimate of HD vs SD during the high influenza periods was 42% (95% confidence interval (CI): 24–59) against influenza/pneumonia-associated mortality and 27% (95% CI: 23–32) against cardiorespiratory mortality. Residual confounding was evident in both early and late influenza periods despite matching and multivariable adjustment. Excluding individuals with high 1-year predicted mortality at baseline reduced the residual confounding and yielded rVE of 36% (95% CI: 10–62) and 25% (95% CI: 12–38) against influenza/pneumonia-associated and cardiorespiratory mortality, respectively. These were confirmed by results from two-stage residual inclusion estimations. Discussion The HD was associated with a lower risk of influenza/pneumonia-associated and cardiorespiratory death in men during the high influenza period.

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