Factors associated with PPSV23 coverage among older adults in Japan: a nationwide community-based survey

Abstract

ObjectivesThe 23-valent pneumococcal polysaccharide vaccine (PPSV23) was included in Japan’s national immunisation programme for older adults in 2014. While vaccination coverage has increased following the implementation of the national immunisation programme, little is known about the factors that have influenced changes in PPSV23 uptake in Japan. This study aimed to investigate the effects of municipality-level activities implemented to improve vaccine uptake during the fiscal year 2015 (April 2015–March 2016).DesignCommunity-based national survey. A postal and web-based nationwide survey was sent to all municipalities in Japan in June 2016 (n=1741). The survey included questions regarding PPSV23 coverage, out-of-pocket costs by individuals for vaccination and community-level activities implemented to improve and promote PPSV23 uptake. Municipality-level and prefecture-level variables (eg, unemployment rates, average per capita income) retrieved from published sources were also incorporated to explore the impact of social determinants on vaccine uptake.SettingJapan.ParticipantsMunicipal vaccination officers.Primary and secondary outcome measuresThe primary study outcome was PPSV23 coverage among adults aged 65 years in Japanese municipalities.ResultsA total of 1010 municipalities (58.0%) responded to the survey. The median PPSV23 coverage among responding municipalities was 41.8%. Vaccine coverage increased by 18.7% (16.7%–20.7%)%) in municipalities that sent a direct mail notification to the target population of adults compared with municipalities that did not send any notification. Vaccine coverage decreased by 3.02% (2.4%–3.6%)%) for every 1000 JPY increase in out-of-pocket costs. Municipality-level unemployment rates and average per capita income were negatively associated with PPSV23 coverage.ConclusionsThis nationwide survey provides insight into factors that may influence PPSV23 coverage in Japanese municipalities. Reduced out-of-pocket costs and direct mail notifications to the target population were associated with higher PPSV23 coverage in Japanese municipalities.

Reducing Morbidity and Mortality Rates from COVID-19, Influenza and Pneumococcal Illness in Nursing Homes and Long-Term Care Facilities by Vaccination and Comprehensive Infection Control Interventions

“…National vaccination programmes are an important stimulus to increase community pneumococcal vaccination rates [41,42], but rates still remain below national targets for seniors. Even after campaigns with subsidised vaccination in Japan, the national rate was only 74%.…”

“…Promptly notify health department for further investigation of suspected or confirmed case of SARS-CoV-2 or influenza in a resident or a healthcare person, a resident with severe respiratory infection resulting in hospitalization or death; or ≥ 3 residents or HCP with new-onset respiratory symptoms within 72 hours of each other. [42] 1741); 1010 municipalities (58.0%) responded decreased by 3.02% for every ¥ crease in out-of-pocket costs to als and coverage inversely rela nicipality unemployment rates age per capita income.…”

Pneumococcal Pneumonia and Invasive Pneumococcal Disease in Those 65 and Older: Rates of Detection, Risk Factors, Vaccine Effectiveness, Hospitalisation and Mortality

“…Median PPV23 coverage for adults aged 65 years for responding municipalities in 2016 was 41.8% and was higher by 18.7% (16.7%–20.7%) in the municipalities which sent direct mail notification to targeted adults. It decreased by 3.02% (2.4%–3.6%) for every 1000 Japanese Yen increase in out-of-pocket costs to individuals, and PPV23 coverage was inversely related to municipality unemployment rates and average per capita income [ 26 ]. In England, the coverage of PPV23 in those ≥65 was similar to Japan and was 70.1% in 2015 and 69.5% in 2018 [ 27 ].…”

Frailty is Associated with Susceptibility to and Severity of Pneumonia in Functionally-independent Community-dwelling Older Adults: A JAGES Multilevel Cross-sectional Study

“…The data were structured in three levels: the individuals were nested within their elementary or junior high school districts and the districts were further nested within the municipalities. The covariates consist of all the covariates at individual-level and the municipality dummy variable used to adjust for differences in municipalities' policies in older adult's health including preventing frailty and pneumonia at municipality-level 15,16 . The individual-level covariates were: age group, sex, educational attainment, equivalized income, household structure, marital status, smoking status, municipality population density, diabetes, respiratory disease, heart disease, kidney/prostate gland disease, hematological/immune disease, and pneumococcal vaccination.…”