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Home Eurosurveillance Monthly Release  1998: Volume 3/ Issue 3 Article 5 Printer friendly version
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Eurosurveillance, Volume 3, Issue 3, 01 March 1998
Surveillance report
Monitoring the introduction of universal influenza vaccination for the elderly people in the Netherlands

Citation style for this article: van Essen GA. Monitoring the introduction of universal influenza vaccination for the elderly people in the Netherlands. Euro Surveill. 1998;3(3):pii=92. Available online:
G.A. van Essen
Department of General Practice, Utrecht University, The Netherlands

For many years, influenza vaccination in the Netherlands has been administered by general practitioners (GPs), with whom every person is registered. Nine out of ten practices use one of six approved general practice information systems (GPIS). The exponential growth in use of computerised medical records in countries such as the Netherlands and the United Kingdom (UK) may be considered one of the major advances in recent years with regard to population-based disease prevention. The patient list and automation make systematic prevention in general practice feasible.

In 1995, the Dutch Minister of Health financed a prevention project - "tailor-made prevention”, managed by the professional organisations for GPs - that focused initially on influenza vaccination and Pap smear screening. In all 23 districts of the National Association of General Practitioners a practice facilitator and a coordinating GP were employed, to support GPs in organising the influenza vaccination in their practices. Special software for the GPIS was developed, to facilitate the selection of “at risk” groups and to minimise the amount of paperwork associated with the vaccination. Guidelines on influenza vaccination from the Dutch College of General Practitioners were distributed. Support was offered to all practices.

The project's outcome was evaluated by the Department of General Practice of Utrecht University, by means of a questionnaire to a random sample of one in three general practices. The organisation of influenza vaccination improved considerably: 66% of the practices sent postcard invitations in 1996 compared with 40% in 1994, and 76% used special tags in their GPIS in 1996 compared with 58% in 1994.

The influenza vaccination rate in high risk groups in the Netherlands has improved considerably in recent years. Each year the Health Council of the Netherlands publishes guidelines for influenza vaccination. In 1996 in the light of recent research (1-4) vaccination for all people over 64 years of age was recommended in the national guidelines for the first time, along with the usual at risk groups of heart, lung, and diabetes patients.

Influenza vaccination is recommended for about 19% of the population. In 1996, the change in policy was published just before the vaccination season, at the end of October. Despite this late notification the vaccination rate in at risk groups rose from 52% in 1995 to 63% in 1996. The vaccination rate in " healthy " over 64s - without any other risk factor was 58%. A total of 15% of the population was immunised.

In 1997 a new distribution system for influenza vaccines was developed. In May, all practices ordered the needed vaccines, postcards, and information slips they needed from a single centre. The call/recall system was stimulated by the national prevention project. In October the vaccines were distributed to practices, making a visit to the pharmacy to collect your own dose of vaccine no longer necessary.

The vaccination is paid for by the National Health System, so there are no financial barriers for at risk groups. The GP sends the bill for vaccination of at risk patients to a central administration office. The goal for the vaccination coverage in 1997 was 75% of all risk groups, including the healthy over 64s, but the amount of ordered vaccines would enable 80% to be vaccinated.

  1. Nichol KL, Margolis KL, Wuorenma J, Sternberg T von. The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. N Engl J Med 1994; 331: 778-84.
  2. Ohmit SE, Monto AS. Influenza vaccine effectiveness in preventing hospitalization among the elderly during influenza type A and type C seasons. Int J Epidemiol 1995; 24: 1240-8.
  3. Ahmed AEH, Nicholson KG, Nguyen-Van-Tam JS. Reduction in mortality associated with influenza vaccine during 1989-90 epidemic. Lancet 1995; 346: 591-5.
  4. Gross PA, Hermogenes AW, Sacks AS, Lau J, Levandowski RA. The efficacy of influenza vaccine in elderly persons. A meta-analysis and review of the literature. Ann Int Med 1995; 123: 518-27.

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