Human Vaccines & Immunotherapeutics
ISSN: 2164-5515 (Print) 2164-554X (Online) Journal homepage: http://www.tandfonline.com/loi/khvi20
Factors associated with pneumococcal vaccination among an urban elderly population in China Shijun Liu, Erping Xu, Yan Liu, Yuyang Xu, Jun Wang, Jian Du, Xiaoping Zhang, Xinren Che & Wenwen Gu To cite this article: Shijun Liu, Erping Xu, Yan Liu, Yuyang Xu, Jun Wang, Jian Du, Xiaoping Zhang, Xinren Che & Wenwen Gu (2014) Factors associated with pneumococcal vaccination among an urban elderly population in China, Human Vaccines & Immunotherapeutics, 10:10, 2994-2999, DOI: 10.4161/21645515.2014.972155 To link to this article: http://dx.doi.org/10.4161/21645515.2014.972155
Accepted online: 31 Oct 2014.
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Date: 20 September 2015, At: 20:08
RESEARCH PAPER Human Vaccines & Immunotherapeutics 10:10, 2994--2999; October 2014; © 2014 Taylor & Francis Group, LLC
Factors associated with pneumococcal vaccination among an urban elderly population in China Shijun Liuy, Erping Xu*, Yan Liu, Yuyang Xu, Jun Wang, Jian Du, Xiaoping Zhang, Xinren Che, and Wenwen Gu Hangzhou Center for Disease Control and Prevention; Hangzhou, China y Present address: Jianggan District; Hangzhou, China
Keywords: 23-valent pneumococcal polysaccharide vaccine, cross-sectional study, elderly population, immunization, pneumococcal vaccination
Downloaded by [University of Windsor] at 20:08 20 September 2015
Abbreviations: 23-PPV, 23-valent pneumococcal polysaccharide vaccine; OR, odds ratios; CI, confidence interval; CHC, community health center; IPD, invasive pneumococcal disease; HR, health record
Objectives: To investigate the coverage of the 23-valent pneumococcal polysaccharide vaccine (23-PPV) in the Chinese urban elderly population and to understand the attitudes, knowledge and beliefs of this population toward the 23-PPV vaccination. Methods: A cross-sectional approach was employed to survey the willingness of this population to receive the 23-PPV vaccination. Two thousand 9 hundred 2 six subjects over the age of 60 y were enrolled via a multistage random sampling method from the urban community population in Hangzhou, China. The relationships between the variables and the willingness to receive the 23-PPV vaccination were computed as odds ratios (ORs) by multivariate analysis. Results Of the participants, 21.77% were willing to undergo 23-PPV vaccination, and 61.65% of the subjects agreed that pneumonia is a serious disease among elderly people. The rate of reasonable perceptions about vaccination, including the perception about vaccine efficacy and safety, among the subjects was below 50%. Only 1.23% of subjects had been vaccinated with 23-PPV, and a similarly low rate was observed for the seasonal influenza vaccine (4.17%). The factors that were independently related to the willingness to receive the 23-PPV vaccine included consensus with the hazards of pneumonia (OR D 1.67, 95% CI: 1.28 – 2.17), the safety of vaccination (OR D 2.00, 95% CI: 1.54 – 2.59), advice about the 23-PPV vaccination from family members (OR D 2.37, 95% CI: 1.39 – 4.40), influenza vaccination history (OR D 2.57, 95% CI: 1.66 – 3.98) and pneumococcal vaccination history (OR D 7.48, 95% CI: 2.4– 22.92). Conclusion: The administration of the 23-PPV vaccine among the urban elderly population is not optimistic in China. Emphasis on persuasion from families and the improvement of knowledge about vaccination might encourage elderly people to get the 23-PPV vaccination. Suggestions from physicians did not affect the participants’ willingness to get the 23-PPV vaccination in multivariate analysis, but elderly people typically visited the Community Health Center (CHC) in their residential districts, and thus, systematic encouragement from healthcare physicians might be the key to increasing 23-PPV vaccination.
Introduction Pneumococcal pneumonia remains a major cause of morbidity and mortality, particularity among the elderly population.1 In China, the epidemiology of pneumococcal pneumonia in the elderly had not been well documented. Previous research has suggested that the burden of pneumonia in adults is most likely significantly underestimated.2 With the aging of the population, the burden caused by pneumococcal pneumonia will be exacerbated and will be particularly reinforced by influence of chronic disease. Moreover, antimicrobial resistance continues to present a threat in clinical treatment.3 The current 23-valent pneumococcal polysaccharide vaccine (23-PPV) covers 23 of the more than 90
pneumococcal serotypes that are responsible for 88% of bacteremia infections and has been recommended for the elderly population to prevent invasive pneumococcal disease (IPD) for years.4,5 A recent systemic review strongly supported the efficacy of the 23-PPV vaccine in the prevention of IPD.6 A program called the Healthy People 2010 was proposed by the United States Public Health Service with the aim of immunizing 90% of the elderly over the age of 65 y and 60% of younger high-risk individuals against pneumococcal diseases.7 Approximately 60% of people over the age of 65 y and 30% of adults between the ages of 50 and 65 who are “at risk” have received one dose of 23-PPV.8 In China, coverage for payments for the 23-PPV vaccine has been recommended since the 1990s,
*Correspondence to: Erping Xu; Email: [email protected] Submitted: 03/05/2014; Revised: 07/16/2014; Accepted: 07/26/2014 http://dx.doi.org/10.4161/21645515.2014.972155
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Volume 10 Issue 10
Table 1. Frequency distributions, means and standard deviations of the subjects’ characteristics according to willingness to get the 23-PPV vaccination
Downloaded by [University of Windsor] at 20:08 20 September 2015
Willingness to get the 23-PPV vaccination
N (%) Age (year) Sex (%) Male Female Education (%) Less than primary school Junior to senior school Higher than college Smoking (%) No Current Ever Drinking (%) No Current Ever Children at home (%) Living without children Living with children
Yes
No or not sure
2926 70.36 § 8 .26
637 (21.77) 70.64 § 8 .37
2289 (78.23) 69.37 § 7 .77
40.19 59.81
40.66 59.34
40.06 59.94
57.73 38.40 3.87
61.70 34.85 3.45
56.63 39.39 3.98
0.07
77.09 15.18 7.73
75.20 18.05 6.75
77.62 14.38 8.00
0.05
71.27 21.92 6.81
67.66 24.65 7.69
72.28 21.16 6.56
0.07
66.20 33.80
60.28 39.72
67.84 32.16
but the extent of vaccination has not reached satisfactory levels in recent years. The proportion of persons over the age of 60 y suggests that the society of China is aging. Recently, campaigns in cities, such as Beijing and Shanghai, have persuaded the government to pay for vaccinations for aged people, and this typically includes 23-PPV and the seasonal influenza vaccine. However, investigations of the potential barriers to the acceptance of 23PPV among the elderly are rare, and the reported 23-PPV coverage rates of based on community surveys are still unclear. A Chinese publication revealed that 19.6% of participants aged over 60 y know that this vaccination can prevent pneumonia, only 2.1% of these participants had a pneumonia vaccination history.9 This survey was performed in 3 communities in Beijing but lacked a description of the representation achieved with the sampling method. The present study aimed to report on the 23-PPV vaccination coverage and to elucidate the knowledge, attitudes and beliefs of the elderly in China toward the 23-PPV vaccination.
Results General characteristics of the subjects The descriptive characteristics of the subjects are shown in Table 1. The average age of the participants was 70.36 § 8 .26 y Six hundred 3 seven subjects (21.77%) exhibited positive attitudes toward 23-PPV vaccination, and these subjects were older than those with “no or uncertain” opinions about 23-PPV (P < 0.01). Furthermore, no significance differences were found across districts. Of the elderly people, 33.80% were living with children, and the proportions of participants who expressed a willingness to get the 23-PPV vaccination were significantly different between those living with and without children. The frequency distributions for the other variables, including sex,
www.landesbioscience.com
P-value
Total
＜0.01 0.78
＜0.01
education and smoking and drinking habits, between these 2 groups were not significantly different (P > 0.05). Health information for the subjects by willingness to get the 23-PPV vaccination The individuals were asked to self-report their health conditions. Of the subjects, 13.21% reported poor health conditions, and the attitudes toward 23-PPV vaccination were significantly different between those who reported poor health conditions and those who did not (P < 0.05). Among our subjects, 14.37% had never been to a professional health worker for health information, and 4.82% (p D 0.95) had histories of pneumonia, and 3.18% had histories of pneumonia in their families (p D 0.75). Among the subjects, 13.19% had been hospitalized at least once within the past year, and this rate among their families was 9.98% (p D 0.79); 65.21% of the subjects had chronic disease histories according to the survey, but no significant differences in attitudes toward 23-PPV vaccination according to these factors were found (Table 2). Examination of the medical institution visits by the elderly revealed that 82.54% of the subjects typically visited CHCs for professional suggestions. The visiting rates for other health care institutions were 12.58% to provincial and municipal hospitals, 2.72% to county hospitals, 1.12% to private clinics and 1.04% to other medical institutions (Fig. 1). Knowledge, attitudes and beliefs toward pneumonia and vaccination according to willingness to get the 23-PPV vaccination Our investigation revealed that 52.04% of the subjects agreed that elderly persons are susceptible to pneumonia, and 61.65% of the subjects believed that pneumonia is a serious disease. Regarding vaccination, 43.38% of the subjects believed that vaccination could protect them from disease, but a greater
Human Vaccines & Immunotherapeutics
2995
Table 2. Health information of the subjects by willingness to get the 23-PPV vaccination
Downloaded by [University of Windsor] at 20:08 20 September 2015
Willingness to get the 23-PPV vaccination
Health status (%) Poor General Good Consult professional worker for health information (%) Never Occasionally Usually History of pneumonia (%) No Yes History of pneumonia for families (%) No Yes Hospitalization in the past year (%) No Yes Hospitalization in the past year for families (%) No Yes Chronic disease (%) No Yes
Total
Yes
No or not sure
P-value
13.21 62.16 24.63
13.03 58.56 28.41
13.25 63.17 23.58
0.04
14.37 73.80 11.83
16.33 71.11 12.56
13.82 74.55 11.63
0.19
95.18 4.82
95.13 4.87
95.19 4.81
0.95
96.82 3.18
97.02 2.98
96.77 3.23
0.75
86.81 13.19
86.50 13.50
86.89 13.11
0.79
90.02 9.98
90.11 9.89
90.00 10.00
0.93
34.79 65.21
34.86 65.46
34.54 65.14
0.88
proportion of individuals (58.27%) were worried about the side effects of vaccination. Few subjects had received suggestions from physicians (7.73%) and families (4.65%), and 1.23% of the subjects had previously received the 23-PPV vaccination. Regarding the seasonal influenza vaccine, 4.17% of subjects had received this vaccination. All of these variables were significantly different between the 2 groups by the willingness of 23-PPV vaccination (Table 3).
rated to the willingness to get the 23-PPV vaccination after adjustments. However, the perception of the effectiveness of the vaccine and suggestions from physicians had ORs of 0.86 (0.66 – 1.13) and 0.86 (0.55 – 1.33; Table 3), respectively, and thus did not contribute to the willingness to get the 23-PPV vaccination in the adjusted analysis.
Discussion Factors associated with the subjects’ willingness to get the 23-PPV vaccination In Model 1, all of the knowledge and attitude factors were significantly correlated with the willingness to get the 23-PPV vaccination without adjustment. However, 23-PPV vaccination history was the most influential factor with an OR D 30.21 (10.64–85.77). In Model 2, the admission that pneumonia is a severe disease, agreement with the safety of vaccination, having received suggestions about the 23-PPV vaccine from families, seasonal flu vaccination and 23-PPV vaccination history were
Figure 1. The level of medical institution for the elderly visiting usually
2996
The present survey confirmed that the coverage rate of the 23PPV vaccine among elderly Chinese people was low. The geriatric population not only possessed inaccurate knowledge and beliefs about the vaccination but also exhibited a low level of willingness to get the 23-PPV vaccination. Approximately 2-thirds of the subjects reported chronic disease histories, more than half of the individuals agreed that pneumonia is a serious disease and most of the subjects had experience with physician consultations; however, only 21.77% of the participants exhibited a willingness to get the 23-PPV vaccination. Agreement with the seriousness of pneumonia and the safety of vaccination, experience with the seasonal influenza and 23-PPV vaccinations and the receipt of persuasion regarding the 23-PPV vaccination from family were significantly associated with the willingness to get the 23-PPV vaccination among the elderly people. In China, children are persuaded to follow a vaccination schedule by the National CDC. Elderly people living with children typically have improved access to information about vaccinations and were more likely to accept the 23-PPV vaccination. However, 33.80% of these subjects in the current survey did not express a willingness to get the 23-PPV vaccination, which was not different
Human Vaccines & Immunotherapeutics
Volume 10 Issue 10
Table 3. Attitudes, knowledge, and beliefs about pneumonia and vaccinations according to the subjects’ willingness to get the 23-PPV vaccination Willingness to get the 23-PPV vaccination Total
No and not sure Yes No and not sure Yes No and not sure Yes
Downloaded by [University of Windsor] at 20:08 20 September 2015
No and not sure Yes No Yes No Yes No Yes No Yes
Yes
No or not sure
Odds Ratio (95%CI) P-value
Model 1
Elderly people are susceptible to pneumonia (%) 51.75
ISSN: 2164-5515 (Print) 2164-554X (Online) Journal homepage: http://www.tandfonline.com/loi/khvi20
Factors associated with pneumococcal vaccination among an urban elderly population in China Shijun Liu, Erping Xu, Yan Liu, Yuyang Xu, Jun Wang, Jian Du, Xiaoping Zhang, Xinren Che & Wenwen Gu To cite this article: Shijun Liu, Erping Xu, Yan Liu, Yuyang Xu, Jun Wang, Jian Du, Xiaoping Zhang, Xinren Che & Wenwen Gu (2014) Factors associated with pneumococcal vaccination among an urban elderly population in China, Human Vaccines & Immunotherapeutics, 10:10, 2994-2999, DOI: 10.4161/21645515.2014.972155 To link to this article: http://dx.doi.org/10.4161/21645515.2014.972155
Accepted online: 31 Oct 2014.
Submit your article to this journal
Article views: 24
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=khvi20 Download by: [University of Windsor]
Date: 20 September 2015, At: 20:08
RESEARCH PAPER Human Vaccines & Immunotherapeutics 10:10, 2994--2999; October 2014; © 2014 Taylor & Francis Group, LLC
Factors associated with pneumococcal vaccination among an urban elderly population in China Shijun Liuy, Erping Xu*, Yan Liu, Yuyang Xu, Jun Wang, Jian Du, Xiaoping Zhang, Xinren Che, and Wenwen Gu Hangzhou Center for Disease Control and Prevention; Hangzhou, China y Present address: Jianggan District; Hangzhou, China
Keywords: 23-valent pneumococcal polysaccharide vaccine, cross-sectional study, elderly population, immunization, pneumococcal vaccination
Downloaded by [University of Windsor] at 20:08 20 September 2015
Abbreviations: 23-PPV, 23-valent pneumococcal polysaccharide vaccine; OR, odds ratios; CI, confidence interval; CHC, community health center; IPD, invasive pneumococcal disease; HR, health record
Objectives: To investigate the coverage of the 23-valent pneumococcal polysaccharide vaccine (23-PPV) in the Chinese urban elderly population and to understand the attitudes, knowledge and beliefs of this population toward the 23-PPV vaccination. Methods: A cross-sectional approach was employed to survey the willingness of this population to receive the 23-PPV vaccination. Two thousand 9 hundred 2 six subjects over the age of 60 y were enrolled via a multistage random sampling method from the urban community population in Hangzhou, China. The relationships between the variables and the willingness to receive the 23-PPV vaccination were computed as odds ratios (ORs) by multivariate analysis. Results Of the participants, 21.77% were willing to undergo 23-PPV vaccination, and 61.65% of the subjects agreed that pneumonia is a serious disease among elderly people. The rate of reasonable perceptions about vaccination, including the perception about vaccine efficacy and safety, among the subjects was below 50%. Only 1.23% of subjects had been vaccinated with 23-PPV, and a similarly low rate was observed for the seasonal influenza vaccine (4.17%). The factors that were independently related to the willingness to receive the 23-PPV vaccine included consensus with the hazards of pneumonia (OR D 1.67, 95% CI: 1.28 – 2.17), the safety of vaccination (OR D 2.00, 95% CI: 1.54 – 2.59), advice about the 23-PPV vaccination from family members (OR D 2.37, 95% CI: 1.39 – 4.40), influenza vaccination history (OR D 2.57, 95% CI: 1.66 – 3.98) and pneumococcal vaccination history (OR D 7.48, 95% CI: 2.4– 22.92). Conclusion: The administration of the 23-PPV vaccine among the urban elderly population is not optimistic in China. Emphasis on persuasion from families and the improvement of knowledge about vaccination might encourage elderly people to get the 23-PPV vaccination. Suggestions from physicians did not affect the participants’ willingness to get the 23-PPV vaccination in multivariate analysis, but elderly people typically visited the Community Health Center (CHC) in their residential districts, and thus, systematic encouragement from healthcare physicians might be the key to increasing 23-PPV vaccination.
Introduction Pneumococcal pneumonia remains a major cause of morbidity and mortality, particularity among the elderly population.1 In China, the epidemiology of pneumococcal pneumonia in the elderly had not been well documented. Previous research has suggested that the burden of pneumonia in adults is most likely significantly underestimated.2 With the aging of the population, the burden caused by pneumococcal pneumonia will be exacerbated and will be particularly reinforced by influence of chronic disease. Moreover, antimicrobial resistance continues to present a threat in clinical treatment.3 The current 23-valent pneumococcal polysaccharide vaccine (23-PPV) covers 23 of the more than 90
pneumococcal serotypes that are responsible for 88% of bacteremia infections and has been recommended for the elderly population to prevent invasive pneumococcal disease (IPD) for years.4,5 A recent systemic review strongly supported the efficacy of the 23-PPV vaccine in the prevention of IPD.6 A program called the Healthy People 2010 was proposed by the United States Public Health Service with the aim of immunizing 90% of the elderly over the age of 65 y and 60% of younger high-risk individuals against pneumococcal diseases.7 Approximately 60% of people over the age of 65 y and 30% of adults between the ages of 50 and 65 who are “at risk” have received one dose of 23-PPV.8 In China, coverage for payments for the 23-PPV vaccine has been recommended since the 1990s,
*Correspondence to: Erping Xu; Email: [email protected] Submitted: 03/05/2014; Revised: 07/16/2014; Accepted: 07/26/2014 http://dx.doi.org/10.4161/21645515.2014.972155
2994
Human Vaccines & Immunotherapeutics
Volume 10 Issue 10
Table 1. Frequency distributions, means and standard deviations of the subjects’ characteristics according to willingness to get the 23-PPV vaccination
Downloaded by [University of Windsor] at 20:08 20 September 2015
Willingness to get the 23-PPV vaccination
N (%) Age (year) Sex (%) Male Female Education (%) Less than primary school Junior to senior school Higher than college Smoking (%) No Current Ever Drinking (%) No Current Ever Children at home (%) Living without children Living with children
Yes
No or not sure
2926 70.36 § 8 .26
637 (21.77) 70.64 § 8 .37
2289 (78.23) 69.37 § 7 .77
40.19 59.81
40.66 59.34
40.06 59.94
57.73 38.40 3.87
61.70 34.85 3.45
56.63 39.39 3.98
0.07
77.09 15.18 7.73
75.20 18.05 6.75
77.62 14.38 8.00
0.05
71.27 21.92 6.81
67.66 24.65 7.69
72.28 21.16 6.56
0.07
66.20 33.80
60.28 39.72
67.84 32.16
but the extent of vaccination has not reached satisfactory levels in recent years. The proportion of persons over the age of 60 y suggests that the society of China is aging. Recently, campaigns in cities, such as Beijing and Shanghai, have persuaded the government to pay for vaccinations for aged people, and this typically includes 23-PPV and the seasonal influenza vaccine. However, investigations of the potential barriers to the acceptance of 23PPV among the elderly are rare, and the reported 23-PPV coverage rates of based on community surveys are still unclear. A Chinese publication revealed that 19.6% of participants aged over 60 y know that this vaccination can prevent pneumonia, only 2.1% of these participants had a pneumonia vaccination history.9 This survey was performed in 3 communities in Beijing but lacked a description of the representation achieved with the sampling method. The present study aimed to report on the 23-PPV vaccination coverage and to elucidate the knowledge, attitudes and beliefs of the elderly in China toward the 23-PPV vaccination.
Results General characteristics of the subjects The descriptive characteristics of the subjects are shown in Table 1. The average age of the participants was 70.36 § 8 .26 y Six hundred 3 seven subjects (21.77%) exhibited positive attitudes toward 23-PPV vaccination, and these subjects were older than those with “no or uncertain” opinions about 23-PPV (P < 0.01). Furthermore, no significance differences were found across districts. Of the elderly people, 33.80% were living with children, and the proportions of participants who expressed a willingness to get the 23-PPV vaccination were significantly different between those living with and without children. The frequency distributions for the other variables, including sex,
www.landesbioscience.com
P-value
Total
＜0.01 0.78
＜0.01
education and smoking and drinking habits, between these 2 groups were not significantly different (P > 0.05). Health information for the subjects by willingness to get the 23-PPV vaccination The individuals were asked to self-report their health conditions. Of the subjects, 13.21% reported poor health conditions, and the attitudes toward 23-PPV vaccination were significantly different between those who reported poor health conditions and those who did not (P < 0.05). Among our subjects, 14.37% had never been to a professional health worker for health information, and 4.82% (p D 0.95) had histories of pneumonia, and 3.18% had histories of pneumonia in their families (p D 0.75). Among the subjects, 13.19% had been hospitalized at least once within the past year, and this rate among their families was 9.98% (p D 0.79); 65.21% of the subjects had chronic disease histories according to the survey, but no significant differences in attitudes toward 23-PPV vaccination according to these factors were found (Table 2). Examination of the medical institution visits by the elderly revealed that 82.54% of the subjects typically visited CHCs for professional suggestions. The visiting rates for other health care institutions were 12.58% to provincial and municipal hospitals, 2.72% to county hospitals, 1.12% to private clinics and 1.04% to other medical institutions (Fig. 1). Knowledge, attitudes and beliefs toward pneumonia and vaccination according to willingness to get the 23-PPV vaccination Our investigation revealed that 52.04% of the subjects agreed that elderly persons are susceptible to pneumonia, and 61.65% of the subjects believed that pneumonia is a serious disease. Regarding vaccination, 43.38% of the subjects believed that vaccination could protect them from disease, but a greater
Human Vaccines & Immunotherapeutics
2995
Table 2. Health information of the subjects by willingness to get the 23-PPV vaccination
Downloaded by [University of Windsor] at 20:08 20 September 2015
Willingness to get the 23-PPV vaccination
Health status (%) Poor General Good Consult professional worker for health information (%) Never Occasionally Usually History of pneumonia (%) No Yes History of pneumonia for families (%) No Yes Hospitalization in the past year (%) No Yes Hospitalization in the past year for families (%) No Yes Chronic disease (%) No Yes
Total
Yes
No or not sure
P-value
13.21 62.16 24.63
13.03 58.56 28.41
13.25 63.17 23.58
0.04
14.37 73.80 11.83
16.33 71.11 12.56
13.82 74.55 11.63
0.19
95.18 4.82
95.13 4.87
95.19 4.81
0.95
96.82 3.18
97.02 2.98
96.77 3.23
0.75
86.81 13.19
86.50 13.50
86.89 13.11
0.79
90.02 9.98
90.11 9.89
90.00 10.00
0.93
34.79 65.21
34.86 65.46
34.54 65.14
0.88
proportion of individuals (58.27%) were worried about the side effects of vaccination. Few subjects had received suggestions from physicians (7.73%) and families (4.65%), and 1.23% of the subjects had previously received the 23-PPV vaccination. Regarding the seasonal influenza vaccine, 4.17% of subjects had received this vaccination. All of these variables were significantly different between the 2 groups by the willingness of 23-PPV vaccination (Table 3).
rated to the willingness to get the 23-PPV vaccination after adjustments. However, the perception of the effectiveness of the vaccine and suggestions from physicians had ORs of 0.86 (0.66 – 1.13) and 0.86 (0.55 – 1.33; Table 3), respectively, and thus did not contribute to the willingness to get the 23-PPV vaccination in the adjusted analysis.
Discussion Factors associated with the subjects’ willingness to get the 23-PPV vaccination In Model 1, all of the knowledge and attitude factors were significantly correlated with the willingness to get the 23-PPV vaccination without adjustment. However, 23-PPV vaccination history was the most influential factor with an OR D 30.21 (10.64–85.77). In Model 2, the admission that pneumonia is a severe disease, agreement with the safety of vaccination, having received suggestions about the 23-PPV vaccine from families, seasonal flu vaccination and 23-PPV vaccination history were
Figure 1. The level of medical institution for the elderly visiting usually
2996
The present survey confirmed that the coverage rate of the 23PPV vaccine among elderly Chinese people was low. The geriatric population not only possessed inaccurate knowledge and beliefs about the vaccination but also exhibited a low level of willingness to get the 23-PPV vaccination. Approximately 2-thirds of the subjects reported chronic disease histories, more than half of the individuals agreed that pneumonia is a serious disease and most of the subjects had experience with physician consultations; however, only 21.77% of the participants exhibited a willingness to get the 23-PPV vaccination. Agreement with the seriousness of pneumonia and the safety of vaccination, experience with the seasonal influenza and 23-PPV vaccinations and the receipt of persuasion regarding the 23-PPV vaccination from family were significantly associated with the willingness to get the 23-PPV vaccination among the elderly people. In China, children are persuaded to follow a vaccination schedule by the National CDC. Elderly people living with children typically have improved access to information about vaccinations and were more likely to accept the 23-PPV vaccination. However, 33.80% of these subjects in the current survey did not express a willingness to get the 23-PPV vaccination, which was not different
Human Vaccines & Immunotherapeutics
Volume 10 Issue 10
Table 3. Attitudes, knowledge, and beliefs about pneumonia and vaccinations according to the subjects’ willingness to get the 23-PPV vaccination Willingness to get the 23-PPV vaccination Total
No and not sure Yes No and not sure Yes No and not sure Yes
Downloaded by [University of Windsor] at 20:08 20 September 2015
No and not sure Yes No Yes No Yes No Yes No Yes
Yes
No or not sure
Odds Ratio (95%CI) P-value
Model 1
Elderly people are susceptible to pneumonia (%) 51.75
