Vaccine uptake, associated factors and reasons for vaccination status among the South African elderly; findings and next steps

The elderly are particularly prone to complications from a number of vaccine-preventable diseases. However, there are limited data on vaccine uptake for this vulnerable population in South Africa. Consequently, this study investigated influenza, pneumococcal and shingles vaccine uptake among elderly people in South Africa; reasons for their vaccination status; and factors associated with their uptake. Cross-sectional study using an interviewer-administered questionnaire to survey 985 consenting adults aged ≥65 years in 2018. Participants were recruited from across South Africa. Bivariate analysis was used to identify socio-demographic variables associated with vaccine uptake, with multivariate logistic regression analysis used to identify key factors associated with vaccine uptake. Influenza vaccine uptake was 32.3% (318/985), with uptake highest in those aged 85-90 years. Pneumococcal and shingles vaccine uptake was 3.8% (37/985) and 0.4% (4/985) respectively, being highest among those aged >90 years. The strongest statistically significant predictors for influenza vaccination were previous influenza vaccination (OR: 8.42 [5.61-12.64]); identifying as 'Coloured' (OR: 8.39 [3.98-17.69]); and residing in Gauteng Province (OR: 5.44 [3.30-9.02]). The strongest statistically significant predictors of receiving pneumococcal vaccination included receiving influenza vaccination (OR = 10.67 [3.27-37.83]); residing in the Western Cape Province (OR: 7.34 [1.49-36.22]); identifying as 'Indian' (OR: 5.85 [2.53-13.55]); and having a university education (OR: 5.56 [1.25-24.77]). Statistically significant barriers to receiving influenza vaccination included following the Traditional African religion (OR: 0.08 [0.01-0.62]) and residing in Limpopo Province (OR: 0.16 [0.04-0.71]). The main reasons for non-vaccination were considering influenza as a mild illness (36.6%; 242/661), and lack of knowledge about the pneumococcal (93.4%; 886/948) and shingles (95.2%; 934/981) vaccines. Vaccine uptake for all vaccines was sub-optimal, with multiple non-modifiable factors predicting vaccine uptake. These pre-COVID-19 data provide a baseline for measuring the effectiveness of future interventions to increase vaccine uptake and safeguard the health of the elderly.