Vaccine 29 (2011) 2840–2845 Contents lists available at ScienceDirect Vaccine journal homepage: www.elsevier.com/locate/vaccine Short communication Effectiveness of age-based strategies to increase influenza vaccination coverage among high risk subjects in Madrid (Spain) Rodrigo Jiménez-García a,* , Cristina Rodríguez-Rieiro a , Valentín Hernández-Barrera a , Ana Lopez de Andres a , Agustin Rivero Cuadrado a , Angel Rodriguez Laso b , Pilar Carrasco-Garrido a a Preventive Medicine Unit, Rey Juan Carlos University, Avda. de Atenas s/n, Alcorcón 28402 Madrid, Spain b Subdirección de Promoción de la Salud y Prevención, Consejería de Sanidad de Madrid Julián Camarillo, 4B, 28037 Madrid, Spain article info Article history: Received 29 October 2010 Received in revised form 4 January 2011 Accepted 4 February 2011 Available online 18 February 2011 Keywords: Influenza Vaccine Coverage Adherence Strategies abstract We aim to assess the effectiveness of age-based strategies to increase influenza vaccination coverage among high risk subjects. To do so, we describe and compare the influenza vaccination coverage in the 2006/2007 campaign between the Autonomous Community of Madrid (ACM), where in year 2005 the recommendation was extended by 5 years to cover all those aged 60 and over, and other regions of Spain where the universally recommended age was 65 years and above. We used individualized secondary data provided by two surveys carried out in 2007 in ACM and in the rest of Spain. The total number of subjects included in the study was 21,948. For the 60–64 years age group influenza vaccination coverage was significantly higher 40.1% (CI 95% 36.4–43.8) in ACM residents than among residents in the Rest of Spain 29.1% (CI 95% 24.5–33.7). The difference in vaccine uptake was even greater, 59% (CI 95% 51.8–66.2) vs. 43.5%(CI 95% 34.3–52.7), when we compared subjects who suffered a chronic condition, which represents an indication for the anti-influenza vaccination. The results of the multivariate analysis show that the probability of a subject aged 60–64 living in ACM of being vaccinated was almost two times higher (OR 1.95 CI 95% 1.46–2.61) than a person of the same age who lived in a region of Spain where the universal recommendation for influenza vaccine started at 65 years. In conclusion, the available evidence indicates the effectiveness of age-based strategies to increase influenza vaccination coverage among high risk subjects aged 60–64 years in our population. © 2011 Elsevier Ltd. All rights reserved. 1. Introduction Every year considerable mortality and morbidity is associated with influenza infections and this result in a huge annual finan- cial burden [1–4]. The risks of complications, hospitalizations, and deaths from seasonal influenza are higher among adults aged 65 years and older; children aged under 5 years, and persons of any age suffering from chronic underlying conditions that place them at increased risk of complications from influenza [1–6]. Influenza vaccine is effective in preventing a substantial – although annually variable – proportion of infections, and in miti- gating influenza-related complications, hospitalizations and deaths among subjects aged 65 years and older and/or those presenting with underlying medical disorders [7–9]. In Spain, the responsibility for establishing guidelines for use of the influenza vaccine lies with the Ministry for Health working in * Corresponding author at: Unidad Medicina Preventiva, Facultad de Ciencias de la Salud, Avda. de Atenas s/n, 28922 Alcorcón, Madrid, Spain. Tel.: +34 91 4888853; fax: +34 91 4888848. E-mail address: rodrigo.jimenez@urjc.es (R. Jiménez-García). liaison with the Autonomous Regions. Since 1992 the recommen- dations issued have included all subjects over the age of 64 years, younger persons who suffer medical disorders and are at increased risk of severe complications from influenza, subjects who have immunosuppression, health care workers and residents of nursing homes and other chronic-care facilities [10]. In all such cases vac- cination is administered free of charge [10]. In 2005, the age range for anti-influenza vaccination in “the Autonomous Community of Madrid” (ACM) was extended by 5 years to cover all those aged 60 and over [11]. This modification aimed to increase vaccination coverage in persons with chronic conditions and was in line with some countries, notably the USA, where public health authorities have gradually extended recommendations for influenza vaccina- tion to lower ages [4,12]. The evidence for this change in ACM was the limited success of previous prevention policies to improve cov- erage among high risk groups of persons less than 65 years and that several studies have shown that an age-based vaccination strategy is more effective than one based on diagnosis or clinical character- istics [12–15]. This study therefore sets out to assess the effectiveness of age- based strategies to increase influenza vaccination coverage among high risk subjects. To do so, we describe and compare the influenza 0264-410X/$ – see front matter © 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.vaccine.2011.02.004