Vaccine 29 (2011) 1332–1338 Contents lists available at ScienceDirect Vaccine journal homepage: www.elsevier.com/locate/vaccine Coverage and predictors of vaccination against 2009 pandemic H1N1 influenza in Madrid, Spain Cristina Rodríguez-Rieiro a , María D. Esteban-Vasallo b ,M a Felicitas Domínguez-Berjón b , Jenaro Astray-Mochales b , Domingo Iniesta-Fornies b , Dolores Barranco-Ordo ˜ nez b , Moisés Cameno-Heras b , Rodrigo Jiménez-García c,∗ a Servicio de Medicina Preventiva y Gestión de Calidad, Hospital General Universitario Gregorio Mara˜nón, C/Dr. Esquerdo, 46, 28007 Madrid, Spain b Subdirección de Promoción de la Salud y Prevención, Consejería de Sanidad, Comunidad de Madrid, C/Julián Camarillo, 4B, 28037 Madrid, Spain c Preventive Medicine Unit, Rey Juan Carlos University. Avda de Atenas s/n, Alcorcón 28402, Madrid, Spain article info Article history: Received 28 September 2010 Received in revised form 18 October 2010 Accepted 20 October 2010 Available online 21 December 2010 Keywords: Influenza A H1N1 Vaccination Chronic condition Pandemic Coverage Predictors abstract This study aimed to ascertain the coverage of vaccination against pandemic influenza in individuals aged over 6 months for whom vaccination is indicated due to a chronic health condition using as data source clinical information recorded in the primary care clinical history. Of all those for whom vaccination was indicated (1,114,632), 14.6% (162,616) finally received the vac- cine. There were statistically significance differences in coverage for sex (16.5% for men and 13.1% for women), age groups (5% for people under 30 years and 20% for those over 60), number of chronic con- ditions (11.1% for one condition, 22.5% for two conditions, and 31.3% for three or more conditions) and depending on the chronic health condition considered. The probability of being vaccinated increased with male sex, age, number of indications, type of medical card (lower among no income) and having been vaccinated against 2009 season influenza. We concluded that the coverage finally reached for those people with an indication due to chronic health condition in the H1N1 campaign was much lower than expected and wished. It is essential to investigate the different factors that could have intervened in the behavior of the population so that more efficient approaches can be adopted in future influenza pandemics. © 2010 Elsevier Ltd. All rights reserved. 1. Introduction With the emergence of the new pandemic influenza strain (H1N1) at the end of April 2009, an international public health emergency was declared. This was recently considered to have fin- ished [1]. From the emergence of the virus until June 27, 2010, at least 18 449 people have died from the disease in 214 countries [2]. In Spain, 271 deaths from H1N1 influenza were registered in 2009, i.e., 0.21 deaths per 1000 people affected [3]. Vaccination against influenza is clearly an effective measure [4]. Consequently, when the World Health Organization (WHO) declared phase 6 of the pandemic in early June 2009, it encouraged the health authorities to define a strategy with a vaccination cre- ated specifically for the circulating strain, as the virus was new and the population was not immune to it [5]. This vaccination campaign was launched along with the yearly seasonal flu campaign, and its main objectives were to directly mitigate transmission by recom- mending the vaccination for high-risk groups, ensure the general ∗ Corresponding author. Tel.: +34 91 4888853; fax: +34 91 4888955. E-mail address: rodrigo.jimenez@urjc.es (R. Jiménez-García). capacity to respond to the pandemic, and to protect the integrity of critical infrastructures [6]. The H1N1 influenza vaccination campaign began on November 16, 2009 in all Spanish Autonomous Communities. Following the indications of the Interterritorial Council of the National Health System at its meeting on October 22, 2009, vaccination was rec- ommended for the following population groups: social and health workers, people working in essential services, pregnant women, and anyone aged over 6 months whose health status placed them at high risk of complications arising from infection by H1N1 influenza. The recommendations for people with chronic conditions were the same as for seasonal influenza, except for the inclusion of morbid obesity and chronic anemia [7]. In Spain, three vaccines—Focetria ® , Pandemrix ® , and Panenza ® —have been approved for strain A/California/7/2009 (H1N1). The vaccines come in different presentations and are intended for different population groups; Focetria ® for children (6 months to 17 years) and elderly (>60 years), Pandemrix ® for adults (18–60 years), and Panenza ® for pregnant women [7]. The Ministry of Health and Social Policy purchased approximately 13 million doses. The vaccine was distributed free to public and private vaccination centers, although it was administered mainly 0264-410X/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.vaccine.2010.10.061