Vaccination contre la grippe: résultats d'une enquête sur la couverture vaccinale du personnel hospitalier à l'hôpital de la Croix-Rousse (hôpitaux de Lyon)

Quantifying preferences around vaccination against frequent, mild disease with risk for vulnerable persons: A discrete choice experiment among French hospital health care workers

The individual determinants of vaccine acceptance among health workers (HCWs) have been described in the literature, but there is little evidence regarding the impact of vaccine characteristics and contextual factors (e.g., incentives, communication) on vaccination intentions. We developed a single profile discrete choice experiment (DCE) to assess the impact of seven attributes on stated vaccination intention against an unnamed disease, described as frequent with rapid clinical evolution and epidemic potential (similar to influenza or pertussis). Attributes evaluated vaccine characteristics (effectiveness, security profile), inter-individual aspects (epidemic risk, controversy, potential for indirect protection, vaccine coverage) and incentives (e.g., badge, hierarchical injunction). A total of 1214 French hospital-based HCWs, recruited through professional organizations, completed the online DCE questionnaire. The relative impact of each attribute was estimated using random effects logit models on the whole sample and among specific subgroups. Overall, 52% of included HCWs were vaccinated against influenza during 2017-18 and the average vaccination acceptance rate across all scenarios was 58%. Aside from the management stance, all attributes' levels had significant impact on vaccination decisions. Poor vaccine safety had the most detrimental impact on stated acceptance (OR 0.04 for the level controversy around vaccine safety). The most motivating factor was protection of family (OR 2.41) and contribution to disease control (OR 2.34). Other motivating factors included improved vaccine effectiveness (OR 2.22), high uptake among colleagues (OR 1.89) and epidemic risk declared by health authorities (OR 1.76). Social incentives (e.g., a badge I'm vaccinated) were dissuasive (OR 0.47). Compared to HCWs previously vaccinated against influenza, unvaccinated HCWs who were favorable to vaccination in general were most sensitive towards improved vaccine effectiveness. Our study suggests that vaccine safety considerations dominate vaccine decision-making among French HCWs, while adapted communication on indirect protection and social conformism can contribute to increase vaccination acceptance.

Flu Vaccination Attitudes, Behaviours, and Knowledge among Health Workers

The aim of this work is to evaluate the attitudes, behaviours, and knowledge of health workers employed at an Italian University Hospital on the topic of vaccinations and in regard to flu vaccination. To this end, the study provided for the articulation of a computerised questionnaire on the digital platform EUSurvey which was administered online via e-mail to a sample of 457 health workers, in the period between November 2018 and March 2019. The data were subjected to descriptive and inferential statistical analysis. In particular, a logistic regression analysis was carried out in order to evaluate the relationship between the variables collected and the dichotomous outcome (vaccinated/unvaccinated subjects in the 2018–2019 season). The results, in line with what has been reported by the literature, highlighted that vaccine hesitancy is prevalent also among health workers. Furthermore, according to our study, only 30.6% of the health care workers had the flu vaccination. The survey points out the need to plan educational and informative interventions aimed at changing the attitudes, behaviours, and knowledge of health workers in the field of flu vaccination, for the purpose of protecting the health of healthcare personnel and their patients.

[Influenza vaccination and cystic fibrosis. Impact of an incentivisation campaign about influenza vaccination for patients attending the Dunkerque cystic fibrosis treatment centre and their health care workers]

INTRODUCTION

The main aim of this study is to evaluate the effectiveness of preventive actions regarding influenza in the studied populations. The secondary objective is to analyze and understand the mechanisms which bring about a behavioural change regarding influenza vaccination.

METHODS

The interventional and prospective study was undertaken in the form of an anonymous questionnaire about influenza vaccination coverage and about the reasons for vaccinating or not vaccinating. The studied populations were patients followed for cystic fibrosis (n=67) in the Dunkerque cystic fibrosis treatment centre and their health care workers (n=117), before (April 2014) and after (April 2015) an information campaign and primary prevention actions (vaccination in the workplace with expanded time slots) in collaboration with the department of occupational medicine.

RESULTS

In 2015, the vaccination coverage rate of health care workers rose to 65.63%, that is to say 2.38 times more than in 2014 (27.55%). This difference is significant (χ²[1]=29.17, P<0.0001). However, no significant difference between 2014 and 2015 was observed among patients (children and adults) (χ²[1]=0.24, NS) whose vaccination coverage was already optimal before the study.

CONCLUSIONS

Raising awareness among health care workers about vaccination against influenza increases the coverage rate and decreases outbreaks of virus infection in the care services and among patients at risk. Three main levers were identified: the necessity of providing information on influenza vaccination to health care workers, the ease of vaccination access and the attitude towards vaccination of supervisory staff (health executives/doctors).

[The seasonal flu vaccination among caregivers in geriatric units: Up-to-date]

BACKGROUND

Flu vaccinations for healthcare professionals seems to be one of the most effective preventive actions in the face of a disease that carries a high risk of a potentially serious nosocomial epidemic in a geriatric environment. The aim of this study was to take stock of the flu vaccination status among caregivers in the geriatric units and to understand the reasons for their reluctance to be vaccinated, in order to put forward proposals to improve vaccination coverage.

METHOD

A literature search of articles published since 2000 in the area of geriatrics, infectious diseases or pneumology was mainly conducted on PubMed using the keywords "caregivers", "elderly", "flu", "influenza", "nosocomial" and "vaccination". After reading all abstracts in English or French and ruling out irrelevant articles, only 64 relevant articles have been listed in bibliography section.

RESULTS

Despite official recommendations, the literature reveals insufficient vaccination coverage of healthcare personnel at both the national and international level. Vaccination coverage seems to be lower among younger female non-medical staff. The factors that determine the likelihood of vaccination are the wish to protect one's self, one's family and patients/residents, as well as the experience of earlier bouts of flu. Factors that oppose vaccination are complex and related to the fear of side effects, the use of other preventive measures, the feeling that vaccination is ineffective, poor understanding of the disease and the vaccine, forgetfulness and problems of organization. Campaigns to promote vaccination that target healthcare professionals must be multidimensional and very incentive. The pedagogical message must be centered on the benefits to the individual and adjusted to socio-professional categories. Mobile strategies in the different departments to encourage staff are a pragmatic solution to this challenge. The referring doctor has an essential role to play, as does the occupational doctor in association with the hospital hygiene services.

CONCLUSION

Flu vaccinations must be included in the education and training of caregivers.

Vaccination coverage against hepatitis A and B viruses, Streptococcus pneumoniae, seasonal flu, and A(H1N1)2009 pandemic influenza in HIV-infected patients

BACKGROUND

Several vaccines are recommended in HIV-infected patients due to an increased risk of vaccine-preventable infections, severe forms of the disease, or shared transmission routes. Few data are available regarding vaccination coverage and its determinants in this population.

METHODS

A cross-sectional study was performed in HIV-infected patients included in a hospital-based cohort in 2011. Vaccination coverage against hepatitis A virus (HAV), hepatitis B virus (HBV), seasonal and A(H1N1)2009 pandemic influenza, and invasive pneumococcal diseases (IPD) were recorded. Factors associated with vaccination were assessed by multivariate logistic regression.

RESULTS

2467 patients were included (median age: 47 years; male gender 71.5%; men having sex with men (MSM): 43.9%; CDC stage C: 24.3%; HBV and/or hepatitis C virus co-infection: 14.4%). Median duration of HIV infection was 10 years and 93.1% of patients received combination antiretroviral therapy. At baseline, the median CD4 count was 527 cells/mm(3) and HIV viral load was <50 copies/mL in 83.3% of cases. Vaccination coverage for HBV, HAV, seasonal influenza, A(H1N1)2009 pandemic influenza, and IPD were 61.9%, 47.4%, 30.9, 48.3%, and 64.6%, respectively. Factors independently associated with vaccination were a younger (HBV) or an older age (influenza), male gender (HBV, HAV), MSM (HBV), CD4 count >200/mm(3) and HIV-RNA <50 copies/mL (IPD, influenza), longer duration of HIV infection (IPD, influenza), and follow-up by an experienced physician (HBV, IPD).

CONCLUSIONS

Vaccination coverage remained insufficient for all vaccine-preventable infections investigated in this study. Determinants for vaccination were largely not evidence-based, and efforts should be focused on improving physicians' knowledge about guidelines.

[Impact of the A influenza pandemic on anti-seasonal influenza vaccination of French general practitioners: A cohort follow-up 2007-2010]

BACKGROUND

Our objective was to assess the impact of the A influenza pandemic on the anti-seasonal influenza vaccination of French general practitioners.

METHODS

A survey was conducted in 2007 in a random sample of general practitioners. A second survey conducted in 2010 included all general practitioners who had not been vaccinated in 2007 and one-third of those who had been.

RESULTS

Responses were obtained from 1010 general practitioners in 2007. The coverage rate of anti-seasonal influenza vaccination reached 73%. In 2010, the coverage was 73.5% and rate of anti-A influenza vaccination was 59% (weighted numbers). Between the two surveys, 130 family physicians (15.5%) changed their behavior. Analysis showed that the A influenza pandemic had a slight positive impact on anti-seasonal influenza vaccination.

CONCLUSION

This first cohort of French general practitioners concerning influenza vaccination found the same anti-seasonal influenza vaccination rates widely reported in the literature and showed that the A influenza pandemic had slight impact on it.

Routes of transmission during a nosocomial influenza A(H3N2) outbreak among geriatric patients and healthcare workers

BACKGROUND

Influenza presents a life-threatening infection for hospitalized geriatric patients, who might be nosocomially infected via healthcare workers (HCWs), other patients or visitors. In the 2011/2012 influenza season an influenza A(H3N2) outbreak occurred in the geriatric department at the Hôpital Edouard Herriot, Lyon.

AIM

To clarify the transmission chain for this influenza A(H3N2) outbreak by sequence analysis and to identify preventive measures.

METHODS

Laboratory testing of patients with influenza-like illness in the acute care geriatric department revealed 22 cases of influenza between 19th February and 15th March 2012. Incidences for patients and HCWs were calculated and possible epidemiological links were analysed using a questionnaire. Neuraminidase and haemagglutinin genes of culture-positive samples and community influenza samples were sequenced and clustered to detect patients with identical viral strains.

FINDINGS

Sixteen patients and six HCWs were affected, resulting in an attack rate of 24% and 11% respectively. Six nosocomial infections were recorded. The sequence analysis confirmed three independent influenza clusters on three different sections of the geriatric ward. For at least two clusters, an HCW source was determined.

CONCLUSION

Epidemiological and microbiological results confirm influenza transmission from HCWs to patients. A higher vaccination rate, isolation measures and better hand hygiene are recommended in order to prevent outbreaks in future influenza seasons.

Pandemic A(H1N1)2009 influenza vaccination in Lyon University Hospitals, France: perception and attitudes of hospital workers

Health-care authorities encouraged A(H1N1)2009 influenza vaccination for all hospital workers because of their high risk of contracting and transmitting the virus. Six months after the vaccination campaign began, an electronic anonymous questionnaire was completed by 1630 among 14,000 hospital workers (11.6%). Vaccination rate was 54.3%. Independent predictors for vaccination acceptance were advanced age (OR=1.61-2.19), being a physician (OR=5.07), working in gynaecology-obstetrics or podiatry (OR=1.62), and having been informed about vaccination (OR=2.78). The main reasons for getting vaccinated were to avoid flu for relatives (82.4%), themselves (65.8%) and patients (57.1%). Arguments against vaccination were lack of sufficient studies of the vaccine (75.7%) and the perception of A(H1N1)2009 influenza as a benign disease (51.5%). Vaccination coverage would be insufficient to keep the health-care system operating at maximum capacity during a severe pandemic disease, and to avoid nosocomial transmission of influenza. These results suggest a better-targeted vaccination campaign.

Review: interventions to increase influenza vaccination among healthcare workers in hospitals

Please cite this paper as: Hollmeyer et al. (2012) Review: interventions to increase influenza vaccination among healthcare workers in hospitals. Influenza and Other Respiratory Viruses 7(4), 604–621.

Annual influenza vaccination rates among hospital healthcare workers (HCW) are almost universally low despite recommendations from WHO and public health authorities in many countries. To assist in the development of successful vaccination programmes, we reviewed studies where interventions aimed to increase the uptake of influenza vaccination among hospital HCW. We searched PUBMED from 1990 up to December 2011 for publications with predetermined search strategies and of pre‐defined criteria for inclusion or exclusion. We evaluated a large number of ‘intervention programmes’ each employing one or more ‘intervention components’ or strategies, such as easy access to vaccine or educational activities, with the goal to raise influenza vaccine uptake rates in hospital HCW during one influenza season. Included studies reported results of intervention programmes and compared the uptake with the season prior to the intervention (historical control) or to another intervention programme within the same season that started from the same set of baseline activities. Twenty‐five studies performed in eight countries met our selection criteria and described 45 distinct intervention programmes. Most studies used their own facility as historical control and evaluated only one season. The following elements were used in intervention programmes that increased vaccine uptake: provision of free vaccine, easy access to the vaccine (e.g. through mobile carts or on‐site vaccination), knowledge and behaviour modification through educational activities and/or reminders and/or incentives, management or organizational changes, such as the assignment of personnel dedicated to the intervention programme, long‐term implementation of the strategy, requiring active declination and mandatory immunization policies. The number of these components applied appeared to be proportional to the increase in uptake. If influenza uptake in hospital HCW is to be increased on sustained basis, hospital managers need to be committed to conduct a well‐designed long‐term intervention programme that includes a variety of co‐ordinated managerial and organizational elements.

Vaccination coverage of health care personnel working in health care facilities in France: results of a national survey, 2009

We conducted a national cross-sectional survey to investigate vaccination coverage (VC) in health care personnel (HCP) working in clinics and hospitals in France. We used a two-stage stratified random sampling design to select 1127 persons from 35 health care settings. Data were collected by face-to-face interviews and completed using information gathered from the occupational health doctor. A total of 183 physicians, 110 nurses, 58 nurse-assistants and 101 midwives were included. VC for compulsory vaccinations was 91.7% for hepatitis B, 95.5% for the booster dose of diphtheria-tetanus-polio (DTP), 94.9% for BCG. For non-compulsory vaccinations, coverage was 11.4% for the 10 year booster of the DTP pertussis containing vaccine, 49.7% for at least one dose of measles, 29.9% for varicella and 25.6% for influenza. Hepatitis B VC did not differ neither between HCP working in surgery and HCP in other sectors, nor in surgeons and anaesthesiologists compared to physicians working in medicine. Young HCP were better vaccinated for pertussis and measles (p<0.01), and those working in an obstetric or a paediatric ward were better vaccinated for influenza and pertussis (p<0.01). HCP are overall well covered by compulsory vaccinations, whereas VC for non-compulsory vaccinations is very insufficient. The vaccination policy regarding these latter vaccinations should be reinforced in France.

[Influenza A H1N1 in neonatal intensive care unit: analysis and lessons]

Since WHO announced the flu-like pandemic H1N1v in autumn 2009, data on clinical presentation and treatment of H1N1v infection in preterm infants with oseltamivir remain scarce. We cared for four infected preterm infants and ordered prophylactic treatment with oseltamivir in 13 additional contact preterm infants. A number of lessons can be drawn from this experience. The first two cases in twins were revealed by an increase in the number of apnea and one infant required mechanical ventilation. Cough was the major symptom in the two other infected infants. No digestive intolerance was observed among the 17 preterm infants during oseltamivir treatment. Polymerase chain reaction (PCR) quickly determined whether an infant was infected, making it helpful in deciding on initial containment. PCR remained positive, whereas culture became negative. Therefore, culture appeared to be more relevant in deciding on the end of containment. Follow-up of the four infected infants showed their ability to develop immunity against H1N1v.

Randomised active programs on healthcare workers' flu vaccination in geriatric health care settings in France: the VESTA study

BACKGROUND

Because of a lack of efficacy of influenza vaccination in elderly population, there are still numerous outbreaks in geriatric health care settings. The health care workers (HCW) flu vaccination is known to get herd immunity and decrease the impact of influenza in elderly population living in geriatric health care settings. However, the rates of vaccinated HCWs are still low in France. The French Geriatric Infection Risk Institute (ORIG) performed the VESTA study, a three-phase multicentre to identify factors limiting vaccination in HCWs, and to develop and implement active programs promoting HCWs influenza vaccination.

OBJECTIVES

To implement multicenter programs to enhance HCW influenza vaccination.

DESIGN

It was a cluster randomised interventional studies.

SETTING

43 geriatric health care settings (GHCSs), long term care and rehabilitation care settings in France.

PARTICIPANTS

1814 Health care workers from 20 GHCSs in the interventional group and 2,435 health care workers in 23 GHCSs in the control group.

INTERVENTION

After the failure of a first educational program giving scientific information and. tested during the 2005-06 flu season in 43 HCSs, a second program was designed with the help of marketing experts, one year after Program 1. The objectives were to involve HCWs in the creation of "safety zones", and to give personal satisfaction. Program 2 was tested during the 2006-07 season. 20 of the 24 HCSs from the Program 1 cluster were included in the Program 2 cluster (1,814 HCWs), and 16 of the 19 HCSs from the Control 1 cluster, plus 7 new HCSs with interest in participating, were included in the Control 2 cluster (23 HCSs; 2,435 HCWs).

MEASUREMENTS

The efficacy of each program was assessed by calculating and comparing the percentage of vaccinated HCWs, from all HCSs taken together, in the program and control clusters.

RESULTS

Program 1 failed to increase the HCW vaccination coverage rate (VCR) (Program 1: 34%; Control 1: 32%; p > 0.05),). Program 2 increased the VCR in HCWs (Program 2: 44%; Control 2: 27%; Chi2 test, p < 0.001) regardless their occupational group but only in the non previous vaccinated subgroup.

CONCLUSIONS

In geriatric health care centres in France, an active multicenter program giving personal satisfaction and taking into account the profile of non-vaccinated HCWs was more effective in promoting flu vaccination than a scientifically factual information program. HCW involvement is required in program implementation in order to avoid rejection of top-down information.

Assessment of healthcare worker influenza vaccination program in French geriatric wards: a cluster-randomized controlled trial

BACKGROUND AND AIMS

The French institute for study of geriatric infection risk (ORIG) has run a multiphase multicenter study (VESTA) to develop and implement active programs promoting healthcare worker (HCW) influenza vaccination. The present article reports results after implementation of the first active program.

METHOD

A cluster-randomized controlled trial was conducted from December 1 to December 15, 2005, and a total of 43 geriatric wards (3646 HCWs) were randomly assigned to two clusters. The program cluster (24 wards; 1918 HCWs) received the active program whereas no action was taken in the control cluster (19 wards; 1728 HCWs). The program was educational; its objective was to convince HCWs to be vaccinated by giving them topdown scientific information and developing a sense of altruism. Data from 1201 HCWs (63%) from the program cluster and 1144 HCWs (66%) from the control cluster were collected.

RESULTS

The program failed to increase the HCW influenza vaccination rate (program: 34%; control: 32%; p>0.05), but won the faithfulness of vaccinated HCWs (5% vs 8% HCWs quitted vaccination; p<0.05).

CONCLUSIONS

Resistance to active influenza vaccination programs was found. Future active programs will have to restore a climate of confidence between sources of knowledge and HCWs and promote "self-protection" in contrast with the protection of elderly people.

Acceptance of the 2009 A(H1N1) influenza vaccine among hospital workers in two French cancer centers

The aim of the study was to determine predictive factors influencing the acceptance of the 2009 A(H1N1) influenza vaccination among hospital workers (HW) in two French cancer centers. A standardized, anonymous, self-administered questionnaire was sent to HW of two cancer centers. The survey response rate was 26.2% (n=506). Main reasons for A(H1N1) vaccination acceptance were "to protect my relatives" (30.3%), "to protect myself" (30.3%). Main reasons for A(H1N1) vaccination refusal were the fear of side effects (43.1%), doubt about the vaccine's efficacy (25.8%). Vaccinated HW were more influenced by the institutional campaign (p<0.001) or colleagues' advice (p<0.001) whereas non-vaccinated HW were influenced by their family physician's advice (p=0.03), personal conviction (p<0.001) or the media (p<0.001). A multivariate analysis revealed age (>35 vs ≤ 35), prior seasonal influenza vaccination, professional category and source of information to be predictive factors of vaccination. Future vaccination campaigns will need to focus on young HW (≤ 35-year old), with no prior influenza vaccination and HW who are in contact with patients and who reported low seasonal influenza vaccination rates.

[Analysis of motivations for antiflu vaccination of the Clermont-Ferrand University Hospital staff]

OBJECTIVE

The vaccination of hospital staff decreases patient mortality and disorganization of services due to sick leave. The main aim of our study was to determine the Clermont-Ferrand University hospital (CHU) personnel's motivations for or against antiflu vaccination to increase the effectiveness of prevention campaigns.

DESIGN

An autoquestionnaire with multiple choices was given to the 7601 CHU staff in May 2005. It documented socioprofessional characteristics, vaccinal status, and reasons for vaccination, nonvaccination, or stopping antiflu vaccination.

RESULTS

The answer rate was 26.5% (2011 autoquestionnaires returned) and representative of the CHU staff. The rate of vaccination in 2004 was 36.35% with a strong correlation between vaccination and former influenza infection (p<0.001). Five of the six principal reasons for vaccination were altruistic including the first two: avoiding transmission to patients (61.8%) and his family (59.8%). The main reason for stopping was the lack of time. The reasons for nonvaccination were linked to a feeling of invulnerability: conviction of not being at risk, of being too young, or in good health.

CONCLUSIONS

The Haute Autorité de santé's objective of vaccinal coverage against influenza for 75% of the health professionals requires their active compliance. The effectiveness of future campaigns could aim at improving knowledge by insisting particularly on the young age of the risk populations. The lack of time can be compensated by offering on-site vaccination, including at night and by proposing larger schedules for vaccination.