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8 Influenza Vaccination

 

Description | Specific Indicators | Corresponding OPHS Outcomes | Corresponding Indicators from Other Sources | Data Sources |  Alternative Data Sources | ICD Codes | Analysis Check List | Method of Calculation |  Basic Categories | Indicator Comments | Cross-References to Other Sections | References | Acknowledgements | Changes Made
  
 
Description
  • Proportion of people who have had an influenza vaccine for the current influenza season.

Specific Indicators
  • Influenza vaccination coverage for those 65 years and older with no chronic condition
  • Influenza vaccination coverage for those 65 years and older with a chronic condition
  • Influenza vaccination coverage for those 12-64 years with a chronic condition
  • Influenza vaccination coverage in the general population (12 years and older)


Corresponding Outcomes from the Ontario Public Health Standards (OPHS)

The Ontario Public Health Standards (OPHS) establish requirements for the fundamental public health programs and services carried out by boards of health, which include assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. The OPHS consist of one Foundational Standard and 13 Program Standards that articulate broad societal goals that result from the activities undertaken by boards of health and many others, including community partners, non-governmental organizations, and governmental bodies. These results have been expressed in terms of two levels of outcomes: societal outcomes and board of health outcomes. Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices and result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population. Board of health outcomes are the results of endeavours by boards of health and often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. Boards of health are accountable for these outcomes. The standards also outline the requirements that boards of health must implement to achieve the stated results.  Outcomes Related to this Indicator
  • Societal Outcomes (Vaccine Preventable Diseases): Target coverage rates for vaccine preventable diseases are achieved; There is improved effectiveness of publicly funded immunization programs.
  • Board of Health Outcomes (Vaccine Preventable Diseases): Target coverage rates for provincially funded immunizations are achieved;


Corresponding Health Indicator(s) from Statistics Canada and CIHI

  • Influenza immunization: Population aged 12 and over (aged 65 and over for data from the National Population Health Survey) who reported when they had their last influenza immunization (flu shot).
    http://www5.statcan.gc.ca/bsolc/olc-cel/olc-cel?catno=82-221-X&lang=eng
    Click on "view" beside "Free", "Latest issue".
    Click on "Data tables and maps" on the left side menu.
    Click on the indicator "Influenza immunization" under Health system performance, Accessibility.

Corresponding Indicators from Other Sources

Comparable health indicators: (Select "View" under latest issue then "Data tables")
http://www5.statcan.gc.ca/bsolc/olc-cel/olc-cel?catno=82-401-x&lang=eng

  • Immunization for influenza for 65 and over ("flu shot")

 

Data Sources

Numerator & Denominator: 1996/97 Ontario Health Survey (OHS)
Original source: Statistics Canada
Distributed by: Ontario MOHLTC
Suggested citation (see Data Citation Notes):
Ontario Health Survey 1996/97, Statistics Canada, Share File, Ontario MOHLTC

Numerator & Denominator:
Canadian Community Health Survey (CCHS)
Original source: Statistics Canada
Distributed by: Ontario MOHLTC
Suggested citation (see Data Citation Notes):
Canadian Community Health Survey [year], Statistics Canada, Share File, Ontario MOHLTC 


Survey Questions
Ontario Health Survey
1996/97 Questions:
ACC-Q50: Have you ever had a flu shot?
ACC-Q52: When did you have your last flu shot?

Canadian Community Health Survey 2000/01, 2003, & 2005 Questions:
FS_Q160: Have you ever had a flu shot?
FS_Q162: When did you have your last flu shot?
CCC_Q031: Do you have asthma?
CCC_Q091A: Do you have chronic bronchitis?
CCCE_91E: Do you have emphysema?
CCCE_91F: Do you have chronic obstructive pulmonary disease (COPD)?
CCCE_101: Do you have diabetes?
CCCE_121: Do you have heart disease?
CCCE_131: Do you have cancer?
CCCE_151: Do you suffer from the effects of a stroke?
 

Alternative Data Sources
Rapid Risk Factor Surveillance System (RRFSS)

  • RRFSS Questions as of June 2008:
    I1A: Since September 2007, have you had a flu shot?

    Chronic Disease Questions from RRFSS related to the definition of high-risk:
    Have you ever been told by a doctor or other health care professional that you have any of the following disorders:
    Cd1b: Asthma?
    Cd1d: Diabetes?
    Any other chronic disease or disorder such as heart disease, cancer, or thyroid disorder?
    Cd3: blood disorder (8); cancer (1); heart disease/problem (4); immune disorder (9); kidney disease/problem (3); lung disease/problem (5)

Analysis Check List

  • Before releasing and/or publishing these data, users should first determine the number of sampled respondents who contributed to the calculation of the estimate. If this unweighted number is less than 30, the weighted estimate should not be released regardless of the estimate's coefficient of variation (C.V.). For unweighted estimates of 30 or more, users should determine the C.V. of the rounded weighted estimate and follow the guidelines below: 
    • Acceptable (C.V. of 0.0 - 16.5) Weighted estimates can be considered for general unrestricted release. Requires no special notation.
    • Marginal (C.V. of 16.6 - 33.3) Weighted estimates can be considered for general unrestricted release but should be accompanied by a warning cautioning of high sampling variability.
    • Unacceptable (C.V. greater than 33.3) Statistics Canada recommends not releasing estimates of unacceptable quality. However, if the user chooses to do so then estimates should be flagged and the following warning should accompany the estimates: "The user is advised that . . .(specify the data) . . . do not meet Statistics Canada's quality standards for this statistical program. Conclusions based on these data will be unreliable and most likely invalid". These data and any consequent findings should not be published. If the user chooses to publish these data or findings, then this disclaimer must be published with the data.
  • For RRFSS analysis, questions may be asked seasonally and weights may need to be recalculated to reflect this.



Method of Calculation
 

Weighted number of people aged 65 years and older with no chronic condition who had a flu shot in past year

    x 100

Weighted total number aged 65 years and older

 
 

Weighted number of people aged 65 years and older with a chronic condition who had a flu shot in past year

    x 100

Weighted total number aged 65 years and older 

 
 

Weighted number of people aged 12-64 years with a chronic condition who had a flu shot in past year

    x 100

Weighted total number aged 12-64 years

 
 

Weighted number of people who had a flu shot in past year

    x 100

Weighted total number aged 12+


 
Basic Categories

  • Sex: male, female
  • Geographic areas: Canadian Community Health Survey: 37 health areas

  
Indicator Comments

  • Vaccination against influenza is an annual event.
  • In October 2000, the influenza vaccine became publicly funded in Ontario and available free of charge for all residents.
  • The Mandatory Health Programs and Services Guidelines recommended influenza vaccination for those aged 65 and older and those in high risk groups. 
  • According to NACI, people at high risk for influenza-related complications include:
    • Adults and children with selected chronic health conditions. These include cardiac or pulmonary disorders (including bronchopulmonary dysplasia, cystic fibrosis and asthma), diabetes mellitus and other metabolic diseases, cancer, immunodeficiency, immunosuppression (due to underlying disease and/or therapy), renal disease, anemia and hemoglobinopathy, conditions that compromise the management of respiratory secretions and are associated with an increased risk of aspiration, and conditions treated for long periods with acetylsalicylic acid.
    • People of any age who are residents of nursing homes and other chronic care facilities
    • People 65 years of age and older
    • Healthy children aged 6-23 months
  • CCHS does not include questions about immunodeficiency, immunosuppression, renal disease, cystic fibrosis, blood disorders, conditions that compromise the management of respiratory secretions, and conditions treated with acetylsalicylic acid. Reporting influenza vaccination coverage for persons with high risk chronic conditions is limited only to those chronic conditions included in the CCHS


Cross-References to Other Sections

  • None


References

  • Evans AS, Brachman PS. Bacterial Infections in Humans: Epidemiology and Control. Springer, 1998.
  • Heymann DL. Control of Communicable Diseases Manual. American Public Health Association, 2004.
  • Pohani G. Summary Report of the 2000/2001 Ontario Influenza Season. PHERO, Volume 12(11), December 22, 2001; 330-340.
  • Pohani G, Henry B, Nsubuga J. Summary Report of the 1999/2000 Ontario Influenza Season. PHERO, Volume 11(7), July and August 2000;136-149.
  • National Advisory Committee on Immunization. Canadian Immunization Guide, Seventh Edition, 2006. Ottawa, ON: Public Health Agency of Canada, 2006. Available at http://www.phac-aspc.gc.ca/publicat/cig-gci/index-eng.php
  • Public Health Agency of Canada. CCDR 2006;32S3:1-44. Canadian National Report on Immunization, 2006. Available at: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/06vol32/32s3/index.html
  • Public Health Agency of Canada. Final Report of Outcomes from the National Consensus Conference for Vaccine-Preventable Diseases in Canada. CCDR 2007;33S3:1-56. Available at: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/08vol34/34s2/index-eng.php

Acknowledgements

Lead Author(s)

Katherine Haimes , Ottawa Public Health
Stephanie Wolfe, Simcoe Muskoka District Health Unit

Contributing Author(s)

Core Indicators Infectious Disease Subgroup

CIWG Reviewers

Core Indicators Infectious Disease Subgroup

External Reviewers

Effie Gournis, Toronto Public Health
Rachel Savage, Ontario Agency for Health Protection and Promotion
Ameeta Mathur, Toronto Public Health

 

Changes Made

Date

Type of Review

(Formal or Adhoc)

Changes made by

Changes

June 13, 2008

Formal

Infectious Disease subgroup

  • Added related outcomes from draft Ontario Public Health Standards 
  • Updated indicator comments including adding more details on definition of chronic conditions
  • Updated references
January 2009

Formal

Infectious Disease subgroup

  • Incorporated reviewer comments.
January 31, 2012 Ad hocSherri Deamond on behalf of CIWG
  • Added "Acknowledgements" and "Changes Made" sections

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