Key points

• Influenza vaccine uptake for those aged 65 years and older during the 2015/16 season decreased to 55.4%, a decrease of 8% compared to the previous season and remained below the EU and WHO target of 75% uptake. In addition uptake rates are one of the lowest since the 2004/2005 influenza season.
• In Ireland, influenza vaccination uptake rates among medical cardholders and GP visit cardholders aged 65 years and older show regional variation with HSE-SE area having the highest uptake rate and HSE-NW the lowest rate. The regional differences are the same year after year with HSE -SE consistently having highest uptake rates.
• Influenza vaccine uptake rates among medical cardholders and GP visit cardholders show age group variation with those aged 75 years and older having the highest uptake and those aged 65-69 years the lowest rate.
• Low influenza vaccine uptake in the 65-69 year age group needs to be addressed. It is important to note that current available influenza vaccine uptake data for this age group includes only 50.6% of the population of this age group.
• The inclusion of pharmacy claims increased influenza vaccine uptake during the 2015/2016 influenza season by 2.8% among people aged 65 years and older.
• Initiatives need to be developed to promote influenza vaccination uptake among risk groups including those aged 65 years and older as recommended by the European Centre for Disease Prevention and Control (ECDC).

In Ireland, seasonal influenza vaccination is recommended for persons aged 65 years and older (1). Influenza vaccination (both vaccine and administration) is free for all medical cardholders and GP visit cardholders in Ireland. This report analyses data obtained from the Primary Care Reimbursement Service (PCRS), HSE- Finance Shared Services on the number of registered medical and GP visit cardholders aged 65 years and older vaccinated with influenza vaccine (by age group, HSE and CHO Area), at GP clinics and pharmacies for the 2015/2016 influenza season.

The number of patients vaccinated with influenza vaccine detailed in this report refers to GP and pharmacy ‘Paid Claims' for influenza vaccine reimbursement reported by the PCRS, for the period September 2015 to August 2016, inclusive. ‘Paid claims’ refer to claims for payment from GPs/pharmacies for influenza vaccination of patients with medical cards/GP visit cards. These claims have passed validation at PCRS and PCRS will pay/has paid the relevant GPs/pharmacies. Data from pharmacies are only available since the 2012/13 influenza season when administration of influenza vaccine by pharmacists commenced.

Between September and December 2015 the median number of medical or GP visit card holders among people aged 65 years and older was 505,859 (83.5% of the total population of that age group). During the same period, only 50.6% of people aged between 65-69 years had a medical or GP visit card.

 
Methods

Influenza uptake rates in those aged 65 years and older were calculated based on the proportion of registered patients with medical cards and GP visit cards who were vaccinated during the period September 2015 to August 2016. This period of time was used as it represents the time during which the majority of influenza vaccinations were administered. Definitions of the number vaccinated and the number of patients with medical cards/GP visit cards used in the calculation of influenza vaccine uptake are outlined below:

1. The number of patients aged 65 years and older vaccinated with the 2015/2016 influenza vaccine refers to the number of GP and pharmacy paid claims (see table 1 for definitions of claim types) for influenza vaccination reported from the PCRS for the period September 2015 to August 2016, inclusive.
2. The median number of registered medical and GP visit cardholders aged 65 years and older were calculated for the period September – December 2015, which is the period of time when the majority of influenza vaccinations were administered. 

To assess variations reported by age group and region, uptake was analysed by various age groups (aged 65 years and older) and also by HSE and CHO Area. 

Table 1: Type of claim and description of claim type reported from Primary Care Reimbursement Service (PCRS), HSE-Finance Shared Services

 

Results

The average influenza vaccine uptake nationally in medical and GP visit card holders aged 65 years and older attending GP clinics and pharmacies for vaccination was 55.4%, during the period September 2015 to August 2016. This uptake rate is a decrease compared to that reported for the 2014/15 season (60.2%) and the 2013/14 season (59.4%) and remains well below the highest uptake recorded during the 2008/09 season (70.1%). In addition, the uptake rate is one of the lowest recorded since 2004/2005 (table 2). Variation in vaccination coverage was observed between age groups, with the highest uptake (60.6%) in those aged 75 years and older and the lowest uptake in those aged 65-69 years (45.5%) (table 3).

Table 2: Percentage seasonal influenza vaccine uptake in Medical Card and GP Visit Card Holders* aged 65 years and older by season (September 2015 – August 2016), attending GP clinics and pharmacies

*The number of medical card and GP visit card holders represents the median number of card holders for the period September – December 2015, which is the period of time when the majority of influenza vaccinations were administered.

Table 3: Seasonal influenza vaccine uptake in Medical Card and GP Visit Card Holders by age group (in years) in those aged 65 years or older, attending GP clinics and pharmacies, 2015/16

 

Slight variation in vaccination coverage was also observed between HSE areas, ranging from 48.6% in HSE-NW to 59.2% in HSE-SE (figure 1). In addition, figure 2 shows that HSE-SE has the highest vaccination coverage for all ages while HSE-NW presents the lowest coverage across all ages. Vaccination coverage by CHO areas nationally presented in figures 1a & 2a.

Figure 1:  Percentage seasonal influenza vaccine uptake in medical and GP visit card holders aged 65 years and older, by HSE-Area for patients attending GPs and pharmacies for influenza vaccination, 2015/16

 
Figure 1a:  Percentage seasonal influenza vaccine uptake in medical and GP visit card holders aged 65 years and older, by CHO-Area for patients attending GPs and pharmacies for influenza vaccination, 2015/16

Figure 2:  Percentage seasonal influenza vaccine uptake in medical and GP visit card holders by age group, by HSE-Area for patients attending GPs and pharmacies for influenza vaccination, 2015/16

Figure 2a:  Percentage seasonal influenza vaccine uptake in medical and GP visit card holders by age group, by CHO-Area for patients attending GPs and pharmacies for influenza vaccination, 2015/16 

Table 4 includes data on the total number of GP and pharmacy claims by claim type (including data on unpaid claims) for influenza vaccination reported from the PCRS (see table 1 for definitions). Pharmacy claims only accounted for 5.2% (n=14,487) of all paid influenza vaccine claims in those aged 65 years and older for the period September 2015 to August 2016, with GP claims accounting for 94.8% (n=265,559). For both GPs and pharmacies, the paid claims were in the majority compared to unpaid claims and vaccine records (97.5% for GPs and 76.1% for pharmacies) (table 4).

Table 4: Number and percentage of influenza vaccination claims for those aged 65 years and older from GPs and Pharmacies reported from PCRS, by claim type, for the period September 2015 to August 2016 

Discussion

The seasonal vaccine uptake rate (55.4%) among medical cardholders and GP visit cardholders aged 65 years of age and older decreased for the 2015/2016 season compared to the previous season 2014/2015 (60.2%). The uptake is well below the recommended vaccine coverage for all EU Member States (75%) and one of the lowest recorded since the 2004/2005 season. This decrease might be related to the fact that from 5th August 2015 everyone aged 70 or over, ordinarily resident in Ireland, was eligible for free GP care regardless of income. All people aged 70 or over who did not have a Medical Card or GP Visit card were able to register to access this service, consequently the number of eligible individuals for vaccination increased.

There are limitations to the dataset analysed in this report. The limitations are primarily based on the eligibility criteria for medical/GP visit cards, for the period of time the report covers (table 1). From mid-2001 to the end of 2008, all individuals aged 70 years and older were eligible for a medical card. Between 2009 and 2015, automatic entitlement to a medical card for those aged 70 years and older no longer applied. During this latter time period all those aged 70 years and older who applied for a medical card were subject to a means test based on income. There were different guidelines for the means test dependent on age, with three age categories: under 66 years, 66-69 years and 70 years and older. GP visit cards have been available since mid-2006 and up to 2015 were also subject to a means test based on income and age. Further information on eligibility for medical/GP cards is available here. The proportion of the Irish population with medical cards and GP visit cards aged 65 years and older was 83.5% for the 2015/2016 season and higher if compared with the same period in time in 2014/15 (75.6%) (2).

It should be noted that unpaid claims may include duplicates and were therefore excluded from the influenza vaccine uptake analysis in this report. Unpaid claims only accounted for 0.7% of all claims for all ages reported from PCRS for the period September 2015 to August 2016. 

 
Jolita Mereckiene, Lisa Domegan, Joan O’Donnell, Suzanne Cotter, HPSC

 Acknowledgements

The authors would like to thank the Primary Care Reimbursement Service (HSE-Finance Shared Services) for data provided for this study.

Bibliography

1. National Immunisation Advisory Committee. Immunisation Guidelines for Ireland. Influenza. Chapter 11. Updated September 2016. Royal College of Physicians of Ireland. http://www.hse.ie/eng/health/immunisation/hcpinfo/guidelines/chapter11.pdf. 2016.
2. Domegan L, O’Donnell J, Cotter S, Mereckiene J, O’Flanagan D. Seasonal influenza vaccine uptake in older people improving, but remains below target. Epi-Insight. 2015;16(11).