Acceptance of yellow fever vaccine in the older traveller: a cohort study Yellow fever vaccination in elderly: adherence and challenges

Main Article Content

Pietro Ferrara
Cristina Masuet-Aumatell
Josep Maria Ramon-Torrell

Keywords

adherence; older traveller; yellow fever vaccine; safety

Abstract

Background and aim: Current demographic changes and improvement of quality of life of elderly population have direct consequences on international travelling. The older traveller demands for specific care and precautions to be observed, as for the yellow fever (YF) vaccination, due to the increased incidence rate of adverse events following immunization (AEFI) in people aged 60 years or over. The aim of our study was to determine the adherence to YF vaccine and travel behaviours in a sample of elderly travellers moving to YF endemic areas.


Methods: Participants in this cohort study were offered YF vaccine, and informed about the increased risk of AEFIs and the unavoidable risk of acquiring YF at the destination. The research was planned on survey-based design, using pre- and post-travel questionnaires.


Results: In 2018, 239 travellers aged 60 years or older attended our travel clinic, of whom 36.8% (n = 88) planned to travel to YF endemic areas and 23.0% (n = 55) for the first time. Of these, 63.6% accepted and 36.4% rejected the vaccination, with 15 travellers moving to endemic areas without immunization, including one patient who presented contraindications to YF vaccine.


Conclusions: The presence of more than a third of elderly travellers who travelled without vaccination is a substantial public health problem and, since the number of older travellers continues to increase, it becomes necessary to implement robust actions to improve YF vaccine advocacy and adherence.

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References

1. Garske T, Van Kerkhove MD, Yactayo S, et al. Yellow Fever in Africa: Estimating the Burden of Disease and Impact of Mass Vaccination from Outbreak and Serological Data. PLoS Med. 2014; 11(5): e1001638. doi: 10.1371/journal.pmed.1001638
2. Centers for Disease Control and Prevention. CDC Yellow Book 2018: Health Information for International Travel. New York: Oxford University Press; 2017.
3. Tomori O. Yellow fever: the recurring plague. Crit Rev Clin Lab Sci 2004;41(4):391-427. doi: 10.1080/10408360490497474
4. World Health Organization. Vaccines and vaccination against yellow fever. WHO Position Paper. Weekly Epidemiological Record 2013; 88:269-84
5. World Health Organization. Addendum to Vaccines and vaccination against yellow fever WHO: Position Paper – June 2013. Weekly epidemiological record 2017; 92:345-56
6. Plotkin S, Orenstein W, Offit P, Edwards KM. Plotkin's Vaccines (Seventh Edition). Elsevier 2018. Monath T et al. Yellow Fever Vaccines: 1181–265.e20.
7. Lamson D, Ramani R, Kleabonas M, Metcalfe M, Humphrey C, St. George K. Anunusual case of influenza-like illness after yellow fever vaccination. J Clin Virol2014, pii:S1386-6532(14)00040-7.
8. Seligman SJ, Casanova JL. Yellow fever vaccine: worthy friend or stealthy foe? Expert Review of Vaccines 2016; 15: 681-91. doi: 10.1080/14760584.2016.1180250
9. Lindsey NP, Rabe IB, Miller ER, Fischer M, Staples JE. Averse event reports following yellow fever vaccination, 2007-13. Journal of Travel Medicine 2016; 23(5): pii:taw045. doi: 10.1093/jtm/taw045
10. Vaccine Adverse Event Reporting System (VAERS) database. https://vaers.hhs.gov/data.html
11. World Health Organization. Detection and investigation of serious adverse events following yellow fever vaccination. 2008
12. United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Ageing 2015 (ST/ESA/SER.A/390).
13. Wo´s M, Korzeniewski K. The older traveller. Int Marit Health 2018;69:285–96.
14. Del Prete V, Mateo-Urdiales A, Bueno-Cavanillas A, Ferrara P. Malaria prevention in the older traveller: a systematic review. Journal of Travel Medicine 2019;26(7):taz067. doi: 10.1093/jtm/taz067
15. Gianfredi V, Albano L, Basnyat B, Ferrara P. Does age have an impact on acute mountain sickness? A systematic review. Journal of Travel Medicine 2020;27(6):taz104. doi: 10.1093/jtm/taz104
16. Rafferty E, Duclos P, Yactayo S, Schuster M. Risk of yellow fever vaccine-associated viscerotropic disease among the elderly: A systematic review. Vaccine. 2013; 31: 5798-805. doi: 10.1016/j.vaccine.2013.09.030
17. Tanizaki R, Ujiie M, Hori N, et al. Comparative study of adverse events after yellow fever vaccination between elderly and non-elderly travellers: questionnaire survey in Japan over a 1-year period. Journal of Travel Medicine 2016; 23(3): pii:taw012. doi: 10.1093/jtm/taw012
18. MHRA, PHE, NaTHNaC, HPS Yellow fever vaccine: stronger precautions in people with weakened immunity and those aged 60 years or older November 21, 2019.
19. Electronic Medical Records system (HC3) of the Catalan Health Service (CatSalut). At: web.gencat.cat/en/actualitat/detall/20140901_Historia-clinica-compartida-HC3
20. Centers for Disease Control and Prevention Yellow Fever Maps. Source: https://www.cdc.gov/yellowfever/maps/index.html
21. Dubé E, Bettinger JA, Fisher WA, Naus M, Mahmud SM, Hilderman T. Vaccine acceptance, hesitancy and refusal in Canada: Challenges and potential approaches. Can Comm Dis Rep. 2016;42(12):246-51.
22. Hosmer DW Jr, Lemeshow S, Sturdivant RX. Applied Logistic Regression. 3rd ed. New York, NY: Wiley; 2013.
23. Mehta CR, Patel N. Exact Logistic Regression: Theory and Examples. Statistics in Medicine 1995;14(19):2143-60
24. StataCorp. 2013. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP
25. Jentes ES, Han P, Gershman MD, et al. Travel characteristics and yellow fever vaccine usage among US Global TravEpiNet. Travelers visiting countries with risk of yellow fever virus transmission, 2009–2011. Am. J. Trop. Med. Hyg 2013;88(5):954-61. doi:10.4269/ajtmh.12-0463
26. Ferrara P, Masuet-Aumatell C, Ramon-Torrell JM. Pre-travel health care attendance among migrant travellers visiting friends and relatives (VFR): a 10-year retrospective analysis. BMC Public Health 2019;19:1397. doi: 10.1186/s12889-019-7722-0
27. Shady I, Gaafer M, Bassiony L. Travel risk behaviors as a determinants of receiving pre-travel health consultation and prevention. Tropical Diseases, Travel Medicine and Vaccines 2015; 1(3) doi: 10.1186/s40794-015-0003-8
28. Zuckerman JN, Hoet B. Hepatitis B immunisation in travellers: Poor risk perception and inadequate protection. Travel Medicine and Infectious Disease 2008; 6(5): 315-20. doi: 10.1016/j.tmaid.2008.05.001
29. Zuckerman JN, Steffen R. Risks of hepatitis B in travelers as compared to immunization status. Journal of Travel Medicine 2000;7(4):170-4. doi: 10.2310/7060.2000.00054
30. Ferrara P, Masuet-Aumatell C, Agüero F, Ramon-Torrell JM. Stand-by emergency treatment (SBET) of malaria in Spanish travellers: a cohort study. Malar J 17, 134 (2018). https://doi.org/10.1186/s12936-018-2304-7
31. Schilthuis H, Goossens I, Ligthelm R, de Vlas S, Varkevisser C, Richardus J. Factors determining use of pre-travel preventive health services by West African immigrants in The Netherlands. Trop Med Int Health 2007; 12: 990-8.
32. Hamer D, Connor B. Travel health knowledge, attitudes and practices among United States travelers. J Travel Med 2004;11:23-6. doi: 10.2310/7060.2004.13600
33. Baker, Brink GK, Lipschitz S, Marcolongo T. The older traveller: A guide for the health professional. South African Society of Travel Medicine (SASTM) Publications; 2016
34. Lee TK, Hutter JN, Masel J, Joya C, Whitman TJ. Guidelines for the prevention of travel-associated illness in older adults. Tropical Diseases, Travel Medicine and Vaccines, 2017; 3(10). doi: 10.1186/s40794-017-0054-0
35. Miyaji KT, Luiz AM, Lara AN, et al. Active assessment of adverse events following yellow fever vaccination of persons aged 60 years and more. Human Vaccines & Immunotherapeutics 2013; 9(2): 277-82. doi 10.4161/hv.22714

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