Sociodemographic predictors of variation in coverage of the national shingles vaccination programme in England, 2014/15

Ward, Charlotte; Byrne, Lisa; White, Joanne; Amirthalingam, Gayatri; Tiley, Karen S.; Edelstein, Michael

doi:10.1016/j.vaccine.2017.03.042

Cited by 22 publications

(31 citation statements)

References 28 publications

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“…Uptake in the participating practices showed geographical variation, similar to that observed nationally, with ethnicity and deprivation identified as contributing factors. 14 Uptake was lower than for seasonal influenza vaccination in adults aged 65 years and older, at 73·2% for the 2013–14 season, 72·7% for the 2014–15 season, and 71·0% for the 2015–16 season. 15…”

Section: Discussionmentioning

confidence: 88%

Evaluation of the effect of the herpes zoster vaccination programme 3 years after its introduction in England: a population-based study

Amirthalingam

Andrews

Keel

et al. 2018

The Lancet Public Health

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SummaryBackgroundIn 2013, a herpes zoster vaccination programme was introduced in England for adults aged 70 years with a phased catch-up programme for those aged 71–79 years. We aimed to evaluate the effect of the first 3 years of the vaccination programme on incidence of herpes zoster and postherpetic neuralgia in this population.MethodsIn this population-based study, we extracted data from the Royal College of General Practitioners sentinel primary care network on consultations with patients aged 60–89 years for herpes zoster and postherpetic neuralgia occurring between Oct 1, 2005, and Sept 30, 2016, obtaining data from 164 practices. We identified individual data on herpes zoster vaccinations administered and consultations for herpes zoster and postherpetic neuralgia, and aggregated these data to estimate vaccine coverage and incidence of herpes zoster and postherpetic neuralgia consultations. We defined age cohorts to identify participants targeted in each year of the programme, and as part of the routine or catch-up programme. We modelled incidence according to age, region, gender, time period, and vaccine eligibility using multivariable Poisson regression with an offset for person-years.FindingsOur analysis included 3·36 million person-years of data, corresponding to an average of 310 001 patients aged 60–89 years who were registered at an RCGP practice each year. By Aug 31, 2016, uptake of the vaccine varied between 58% for the recently targeted cohorts and 72% for the first routine cohort. Across the first 3 years of vaccination for the three routine cohorts, incidence of herpes zoster fell by 35% (incidence rate ratio 0·65 [95% 0·60–0·72]) and of postherpetic neuralgia fell by 50% (0·50 [0·38–0·67]). The equivalent reduction for the four catch-up cohorts was 33% for herpes zoster (incidence rate ratio 0·67 [0·61–0·74]) and 38% for postherpetic neuralgia (0·62 [0·50–0·79]). These reductions are consistent with a vaccine effectiveness of about 62% against herpes zoster and 70–88% against postherpetic neuralgia.InterpretationThe herpes zoster vaccination programme in England has had a population impact equivalent to about 17 000 fewer episodes of herpes zoster and 3300 fewer episodes of postherpetic neuralgia among 5·5 million eligible individuals in the first 3 years of the programme. Communication of the public health impact of this programme will be important to reverse the recent trend of declining vaccine coverage.FundingPublic Health England.

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Section: Discussionmentioning

confidence: 88%

Evaluation of the effect of the herpes zoster vaccination programme 3 years after its introduction in England: a population-based study

Amirthalingam

Andrews

Keel

et al. 2018

The Lancet Public Health

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“…[ 8 ] The aggregated national zoster uptake data were also utilised in a 2017 study, which reported lower zoster vaccine uptake in deprived areas and amongst most non-White ethnic groups. [ 14 ] However in this study, deprivation was assessed as an ecological factor and individuals were assigned ethnicity and vaccination status derived from the proportions reported only at an aggregated general practice level. [ 14 ]…”

Section: Introductionmentioning

confidence: 99%

Zoster vaccination inequalities: A population based cohort study using linked data from the UK Clinical Practice Research Datalink

et al. 2018

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ObjectiveTo quantify inequalities in zoster vaccine uptake by determining its association with socio-demographic factors: age, gender, ethnicity, immigration status, deprivation (at Lower-layer Super Output Area-level), care home residence and living arrangements.MethodThis population-based cohort study utilised anonymised primary care electronic health records from England (Clinical Practice Research Datalink) linked to deprivation and hospitalisation data. Data from 35,333 individuals from 277 general practices in England and eligible for zoster vaccination during the two-year period (2013–2015) after vaccine introduction were analysed. Logistic regression was used to obtain adjusted odds ratios (aOR) for the association of socio-demographic factors with zoster vaccine uptake for adults aged 70 years (main target group) and adults aged 79 years (catch-up group).ResultsAmongst those eligible for vaccination, 52.4% (n = 18,499) received the vaccine. Socio-demographic factors independently associated with lower zoster vaccine uptake in multivariable analyses were: being older (catch-up group: aged 79 years) aOR = 0.89 (95% confidence interval (CI):0.85–0.93), care home residence (aOR = 0.64 (95%CI: 0.57–0.73)) and living alone (aOR = 0.85 (95%CI: 0.81–0.90)). Uptake decreased with increasing levels of deprivation (p-value for trend<0.0001; aOR most deprived versus least deprived areas = 0.69 (95%CI: 0.64–0.75)). Uptake was also lower amongst those of non-White ethnicities (for example, Black versus White ethnicity: aOR = 0.61 (95%CI: 0.49–0.75)) but was not lower among immigrants after adjusting for ethnicity. Lower uptake was also seen amongst females compared to men in the catch-up group.ConclusionsInequalities in zoster vaccine uptake exist in England; with lower uptake among those of non-White ethnicities, and among those living alone, in a care home and in more deprived areas. Tailored interventions to increase uptake in these social groups should assist in realising the aim of mitigating vaccination inequalities. As care home residents are also at higher risk of zoster, improving the uptake of zoster vaccination in this group will also mitigate inequalities in zoster burden.

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“…However, these practices also had lower coverage overall, particularly the two large practices in London, where coverage if childhood vaccinations is known to be lower than other areas of England. 6,9,10 Due to the level of data collected from within a busy general practice, the sample size was small. This means that the absolute costs are unlikely to be generalizable to General Practices in England more widely.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 In addition, the national averages do not reflect the significant and persistent regional variation, where coverage both in London and other large urban centers is significantly lower than other parts of the country (for example, in 2017 DTaP-IPV-Hib 12 months: England 93.4%, London 88.8%; MMR2 5 years: England 87.6%, London 79.5%), which exists alongside lower coverage in certain ethnic groups and in areas of higher deprivation. 9,10 For older adults, pneumococcal polysaccharide vaccine was introduced in 2003 and mean coverage in 2018 was 69.5%, but with significant geographic variation, ranging from 48.2% in the London Borough of Kensington and Chelsea to 78.1% in Knowsley (North West region.) 11 Vaccination against shingles was introduced in 2013 and cumulative mean coverage remains low at 41.0% 12…”

Section: Introductionmentioning

confidence: 99%

What is the cost of delivering routine vaccinations at GP practices in England? A comparative time-driven activity-based costing analysis

Crocker-Buqué

Mohan

Ramsay

et al. 2019

Human Vaccines & Immunotherapeutics

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Background: The expansion of available vaccines in recent years has increased the overall costs of the vaccine program and put pressure on providers responsible for vaccination. In England in 2016–17, GP practices responsible for vaccinating their local population were paid £227 million. However, the costs to general practice of delivering the program and the factors influencing these costs are unknown. Therefore, the aim of this study was to evaluate the costs of delivering the routine vaccination program at GP practices in England, to identify organizational factors impacting costs, and to compare these to the funding received.Methods: Time Driven Activity Based Costing was undertaken at a convenience sample of nine geographically and socio-economically diverse GP practices in 2017–2018. Cost data were gathered for the preceding year using a survey and clinical and administrative staff kept activity logs for a 2-week period.Results: The mean cost of delivering a childhood vaccination appointment was £18.20 (range £9.71-£25.97) and an adult appointment cost £14.05 (range £7.59-£20.88), of which 75% was for staff, 24% for facility costs and 1% for consumables. Organizational factors contributing to lower costs include: shorter length of allocated appointment; greater use of administrative and reception staff; lower working time for practice manager and practice nurse; and use of health-care assistants for adult vaccinations. The costs identified are lower than payments at all practices.Conclusions: Funding received for vaccination activities was higher than costs at included practices. Several organizational factors have been identified that impact on program delivery costs that could be modified.

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Sociodemographic predictors of variation in coverage of the national shingles vaccination programme in England, 2014/15

Cited by 22 publications

References 28 publications

Evaluation of the effect of the herpes zoster vaccination programme 3 years after its introduction in England: a population-based study

Evaluation of the effect of the herpes zoster vaccination programme 3 years after its introduction in England: a population-based study

Zoster vaccination inequalities: A population based cohort study using linked data from the UK Clinical Practice Research Datalink

What is the cost of delivering routine vaccinations at GP practices in England? A comparative time-driven activity-based costing analysis

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