RRH Library Newsletter, December 2012

Newsletter sections include: Adult Vaccination; Coming Soon! HUBNET; Library New

Improving Vaccination Rates in Adults with Type II Diabetes in a Family Practice Setting: An Evidence-based Quality Improvement Project

The purpose of this evidenced-based quality improvement project is to implement processes to facilitate providers’ adherence to the American Diabetes Association (2017), American Association of Clinical Endocrinologist (2015), and American College of Endocrinology (2015) immunization guidelines for adults with type II diabetes. Presently, diabetes is the 7th leading cause of death in the United States contributing to serious complications throughout the body as a result of poor glucose control. Adults with diabetes are at increased susceptibility to infectious disease because of hyperglycemia, poor glucose control, and decreased immunity. A protocol was created using The Four Pillars Transformation Program ™ to align provider practices at a family practice clinic with recommended guidelines. Interventions aimed at improving recommended vaccination rates in adults with type II diabetes mellitus include standing orders for all immunizations, a vaccine clinic that operates simultaneously during office hours, vaccine needs screening, patient education, flyers, electronic medical record alerts, an appointed immunization champion, and quality improvement meetings. At project completion 62% of eligible patients had been screened for vaccine need and 62% received education. Ten weeks post project implementation, 64% of the eligible patients had been vaccinated with pneumococcal polysaccharide vaccine 23, 86% pneumococcal conjugate vaccine, 89% tetanus, and 54% herpes zoster. Thirty-seven out of 49 (76%) eligible patients who received education received all recommended vaccines indicating a need for continued work on staff and patient education that will facilitate patient consent for recommended vaccines

Using primary care records to evaluate the National Herpes Zoster Immunisation Program in Australia

Background: The National Herpes Zoster Immunisation Program using the one-dose live-attenuated zoster vaccine commenced in Australia in November 2016 for 70-year-olds with a catch-up program for 71–79-year-olds. As surveillance data to monitor the program effects was limited, this thesis presents four studies examining aspects of program evaluation including vaccine coverage, the impact of vaccination on zoster incidence, and vaccine effectiveness. Methods: MedicineInsight consists of de-identified electronic medical records extracted from participating general practices across Australia. Vaccination data from MedicineInsight records to December 2018 was used to estimate vaccine coverage and factors associated with vaccine receipt using a logistic regression model. The additional effects of a structured older persons health assessment and co-administration of seasonal influenza vaccines on zoster vaccination uptake were analysed using generalized estimating equations. An interrupted time-series model was used to investigate the impact of the program on zoster incidence and Cox proportional hazards models were used to estimate real-world vaccine effectiveness. Results: Twenty-six months following commencement of the national program, 46.9% (25,791/55,034) of those aged 70–79 years old had received a zoster vaccine. Factors associated with vaccine receipt included female sex, area of residence, and socioeconomic status. Both the structured older persons health assessment and co-administration of seasonal influenza vaccines were associated with higher zoster vaccine uptake (adjusted OR = 3.0 for both). The program was also significantly associated with reduced zoster incidence in those aged 70–79 years old, with an estimated annual decrease of 2.3 (95% CI: 1.3–3.2) per 1000 persons in the two years after the program was launched; an estimated 7000 zoster cases were prevented through the program. In the first year of the program, vaccine effectiveness against incident zoster was 63.5% (95% CI: 47.5–74.6) but this fell to 48.2% (95% CI: 30.0–61.7) in the second year. Conclusions: This thesis uses electronic general practice records in Australia to provide estimates of zoster vaccine coverage and adds to the evidence on the impact of vaccination on zoster disease and vaccine effectiveness. I found moderate levels of coverage and a level of effectiveness and reductions in disease consistent with international data

Shingrix Education for Providers

Shingles is a prevalent disease within the overall population, and incidence in North America continues to increase. Shingles is commonly found in older adults 60 years of age and older and can recur two or three times. Shingrix was released in 2017 as a recombinant vaccine for prevention of shingles. Despite its benefits, this vaccine has not been recommended by many prescribing providers. Research has shown that an effective education program improves attitudes and misconceptions related to vaccines and can increase prescribing rates. An education program was created to share with prescribing providers to improve overall knowledge and recommendation rates for the vaccine. This formal education program was designed for prescribing providers for review in a 30-minute seminar. To determine overall effectiveness, the program was piloted in a primary care office setting in Central Virginia. The program was found to increase overall knowledge and appeared to increase the likelihood of recommendation. This evidence-based practice project was consistent with established research indicating that when a prescribing provider is informed about a vaccine, he or she is more likely to discuss it with patients. Patients consider their prescribing provider’s opinion seriously when making decisions about vaccines, including Shingrix

Le fardeau de la varicelle et du zona à la suite de l'introduction du programme de vaccination à une puis à deux doses

Le but de l'étude a été d'évaluer le fardeau associé à la varicelle et au zona au Québec à la suite de l'introduction du programme public de vaccination contre la varicelle à une puis à deux doses. La première dose contre la varicelle a été introduite dans le programme régulier d'immunisation québécois en 2006 et la deuxième dose a été mise en place en 2016. La revue de littérature a démontré que l'ajout d'une deuxième dose de vaccin pouvait permettre de réduire davantage les consultations, les hospitalisations et les décès liés à la varicelle et au zona (chez les 0-9 ans). Cette étude a utilisé un devis de recherche quantitatif à visée descriptive afin de dresser le portrait de la varicelle et du zona au Québec de 1996 à 2018. Elle a utilisé des données clinico-administratives de la Régie de l'assurance maladie du Québec (RAMQ), les données Maintenance et exploitation des données pour l'étude de la clientèle hospitalière (MED-ECHO), la Banque de données communes des urgences (BDCU) ainsi que le registre de décès de l'Institut de la statistique du Québec (ISQ) pour mesurer le fardeau de la varicelle et du zona au Québec. Entre la période pré-vaccinale (1996-2000) et la période de vaccination à une dose contre la varicelle (2006-2015), une baisse du taux de consultation pour varicelle de 93 % a été enregistrée. Il y a eu une réduction de 83 % du taux d'hospitalisation pour la varicelle entre la période vaccinale à deux doses (2017-2018) et la période vaccinale dans le secteur privé (2001-2005). Il y a eu une diminution de 76 % du taux d'hospitalisation pour le zona chez les 0-9 ans entre la période 2017-2018 et la période 2001-2005. Une poursuite de la surveillance est nécessaire pour mieux cerner l'impact de la deuxième dose.The purpose of this study was to assess the burden associated with varicella and herpes zoster in Quebec following the introduction of the one and two-dose public varicella vaccination programs. The first dose of the varicella vaccine was introduced as part of the regular immunization program in 2006, and the second dose was introduced in 2016. A review of the literature conducted outside Quebec demonstrated that the addition of a second dose of vaccine could further reduce consultations, hospitalizations and deaths related to varicella and shingles (0-9 years old). This study used a quantitative, descriptive research design in order to evaluate the burden of varicella and shingles in Quebec from 1996 to 2018. It used clinico-administrative data from the Régie de l'assurance maladie du Québec (RAMQ), the Maintenance et exploitation des données pour l'étude de la clientèle hospitalière (MED-ECHO), the Banque de données communes des urgences (BDCU), and the Institut de la statistique du Québec (ISQ) death registry to measure the burden of varicella and herpes zoster in Quebec. Between the pre-vaccination era (1996-2000) and the one-dose varicella vaccination era (2006-2015), a 93 % decrease in the rate of varicella consultations was recorded. There was an 83% reduction in the hospitalization rate for varicella between the two-dose vaccine period (2017-2018) and the pre-vaccine period (1996-2000). There was a 76 % decrease in the hospitalization rate for shingles in 0-9 years olds between 2017-2018 and the private sector vaccine period (2001-2005). Continued surveillance is necessary in order to measure the impact of the second dose

The association between vitamin D deficiency and the risk of herpes zoster and COVID-19

BACKGROUND: Acute viral infections or reactivations, such as Coronavirus Disease 2019 (COVID-19) and herpes zoster (HZ), can cause high morbidity and mortality among older adults. Although vitamin D has immunomodulatory effects, the association between vitamin D status and COVID-19 and HZ is unclear. In this thesis, I investigated the association between vitamin D deficiency and HZ and COVID-19. METHODS: This thesis comprises four parts: one systematic review and three analytic studies using UK Biobank. First, I systematically reviewed studies about vitamin D and human herpesviruses infection or reactivation. Second, I conducted a cross-sectional study which described the distribution of vitamin D status and identified demographic risk factors for vitamin D deficiency and insufficiency in UK Biobank. In the third part, I undertook a cohort study to explore the association between vitamin D status, supplementation, and prescriptions and the risk of incident HZ. Finally, I assessed the association between vitamin D status and COVID-19 diagnosis, hospitalisation, and mortality. RESULTS: My systematic review and meta-analysis (Chapter 3) included ten studies, and the results demonstrated that vitamin D deficiency was not associated with cytomegalovirus (CMV) diseases in transplant patients, but vitamin D supplementation was associated with a lower risk of HZ in individuals receiving haemodialysis. All included studies were hospital-based and conducted among immunosuppressed people. In my cross-sectional study (Chapter 5) of 449,943 participants aged 40 to 69 years with vitamin D records, I found that the winter and spring seasons, northern regions, male sex, abnormal body mass index (BMI), non-white ethnic backgrounds, smoking, and socioeconomic deprivation were associated with vitamin D deficiency and insufficiency. My cohort study of vitamin D and HZ (Chapter 6) included 177,572 participants with linked clinical records. I found no association between vitamin D deficiency and incident HZ (deficient: adjusted hazard ratio (HR) = 0.99, 95% confidence interval (CI) = 0.90–1.10). Vitamin D supplementation or prescriptions were not associated with incident HZ. Finally, in the cohort study of vitamin D and COVID-19 (Chapter 7), including 307,512 people with linked COVID-19 clinical records, I found an inconsistent association between vitamin D deficiency and COVID-19 diagnosis during different follow-up periods (during British summertime (BST) months: HR=0.86, 95% CI=0.77–0.95; during non-BST months: HR=1.14, 95%CI=1.01– 1.30). I found no evidence that vitamin D deficiency or insufficiency was associated with either hospitalisation or mortality due to COVID-19 in any time stratum. CONCLUSION: In summary, I found no association between vitamin D status, supplementation, or prescriptions and the risk of HZ or COVID-19. According to currently available evidence, extra vitamin D supplementation should not be recommended to prevent HZ or COVID- 19

Use of Information and Communication Technology Strategies to Increase Vaccination Coverage in Older Adults: A Systematic Review

Background: Coverage rates of routinely recommended vaccines in older adults still fall below the targets established by international and national advisory committees. As a result, related diseases still have a high incidence, morbidity, and mortality. Information and Communication Technologies (ICT) could provide useful tools to improve immunization rates by bringing information directly to the target user at a relatively low cost. The present research aims to systematically review recent literature on interventions applying ICT to improve the uptake of influenza, pneumococcal, COVID-19 and herpes zoster immunization rates among older adults. Methods: Studies published in English between 1 January 2000 and 10 November 2022 were identified by searching electronic medical databases (PubMed, Scopus) and were independently reviewed by two different authors. A total of 22 studies were included in this review. Findings: Interventions applied the following ICT tools: phone calls, text messages, messages sent via personal electronic medical records, automated phone calls, remote patient monitoring in a home telehealth program and emails. In terms of the vaccines promoted, 11 studies prompted the influenza vaccine, four prompted the influenza and pneumococcal vaccines, three the pneumococcal vaccine, two the herpes zoster vaccine, one the COVID-19 vaccine and one both the pneumococcal and herpes zoster vaccines. Overall, more than half of the studies (n = 12) found some level of effectiveness of these ICT strategies in increasing vaccination rates among older adults, while five studies were partially effective (for specific vaccines or population subgroups), and five reported no significant effect. Conclusions: Prevention programs using ICT tools could be effective in promoting immunizations among older adults