Patient Willingness to Skip Flu Shots May Be Issue for COVID Vaccines

A considerable number of people with Parkinson’s disease living at home missed every flu vaccination given over five years despite being at higher risk of preventable respiratory infections, a single-site U.S. study of homebound and ambulatory patients found.

Nearly 25% of these patients also expressed hesitancy about vaccines, and nearly 32% were unsure of their doctor’s recommendations regarding vaccinations. These findings, from a small 2016–17 study, underscore the need to communicate well vaccine importance during the COVID-19 pandemic, its New York University researchers noted.

“Our study suggests that targeted education and interventions may be necessary to address and overcome concerns about COVID-19 vaccines … Effective communication strategies between the neurologist, the person with PD [Parkinson’s disease], and their household members may reduce vaccine hesitancy and increase uptake,” they wrote.

The study, “Barriers to vaccination among people with Parkinson’s disease and implications for COVID-19,” was published in the Journal of Parkinson’s Disease.

The “rollout” of vaccines against COVID-19 has brought into sharp focus patients’ use of, and opinions toward, vaccinations in general — and their ease of access to them.

In the U.S., more than one-third of people 65 and older are reported to not get vaccinated for common respiratory disease-causing bacteria or viruses (pathogens), the study noted.

The issue is particularly relevant for specific patient populations, such as those with Parkinson’s disease. These people are typically older and “may be at higher risk of contracting and suffering complications of respiratory pathogens, with conflicting data on whether this applies to becoming infected with COVID-19,” the researchers wrote.

To understand what might prevent people with Parkinson’s from adhering to vaccination, researchers with New York University Langone Medical Center conducted a study of patients attending their clinic between September 2016 and May 2017.

The study included 143 patients with idiopathic (of unknown cause) Parkinson’s, with a mean age of 75.2; almost half (48.3%) were women.

Among them, 102 people were ambulatory — defined by the study as reasonably independent in leaving the house — and 41 were homebound, defined as movement outside the home being considerably difficult and requiring an assistive device, special transportation, or personal assistance.

Homebound patients were older (mean of 80.2 years) than ambulatory patients ( mean age, 73.0) and had longer disease duration (mean of 12.5 vs. 8.1 years). They were also more likely to live alone than ambulatory patients (35.0% vs. 24.5%).

Through questions, the researchers aimed to find out how often these Parkinson’s patients missed vaccinations.

Results showed that in the five years prior to the study, 9.8% of them had missed all vaccinations against the influenza virus, with no significant differences between ambulatory or homebound groups. About two-thirds (67.8%) had received any of the age-appropriate pneumococcal vaccinations, which protect against infections caused by the bacterium Streptococcus pneumoniae. Again, no significant differences between homebound and ambulatory patients were observed.

However, when the researchers looked at the vaccination records that could be obtained for 20 of the 41 homebound participants, they found the number of vaccinations were, for the most part, over-reported — both for influenza and pneumococcal vaccinations.

“Only two individuals had concordance between self-report and verification,” the researchers wrote.

A questionnaire, the SAGE Core Vaccine Hesitancy Survey, was given to assess patients’ attitudes and concerns with vaccines.

Overall, 3.5% of the 143 patients did not believe that “vaccines protect people from serious disease,” and 10.5% expressed a similar doubt.

Almost one-quarter — 24.5% — felt hesitant about taking a vaccine, and that 13.3% had previously refused a vaccine. Another 13.3% said people in their house were also not fully vaccinated.

Guidance from healthcare providers as to vaccine importance was not clear, the study found, with 2.6% of patients thinking their doctors did not favor vaccinations, while 31.5% were unsure of their doctor’s vaccine recommendations.

Distance to clinic sites and difficulties in travel were noted as barriers vaccination, but only by small numbers of patients. Distance was a barrier for two (4.9%) homebound patient and no ambulatory patients, while difficulty of traveling to a clinic was noted as a barrier by five of 41 homebound patients (12.2%), and one (1%) of 102 ambulatory patients.

“This perceived barrier may be exacerbated during the COVID-19 pandemic as visitor restrictions for healthcare appointments introduce additional challenges to attending in-person visits,” the researchers wrote.

Over the year before this study, these patients made a mean of 3.1 visits to their primary care provider. Homebound patients had more frequent emergency department visits (31.7% vs. 9.8%) and hospitalizations (14.6% vs. 2.9%) than ambulatory patients.

These visits to clinics and emergency rooms suggest there was no link between clinic use and vaccinations, with vaccines missed  “despite ample healthcare utilization,” the researchers wrote.

Throughout the COVID-19 pandemic, “now is the time to advocate for preventive care and improve vaccine trust and uptake in our patients and their care partners,” the researchers concluded.