Self-reported influenza vaccination rates and attitudes towards vaccination among health care workers: results of a survey in a German university hospital

Knowledge and attitudes of healthcare workers about influenza vaccination

BACKGROUND

Influenza infection is a highly contagious viral disease. It may cause several nosocomial outbreaks. This study aimed to evaluate the knowledge and attitudes of healthcare workers (HCWs) about influenza vaccination and to identify factors associated with the uptake of influenza vaccination.

METHODS

We conducted a cross-sectional study over 5 months between November 2021 and March 2022. Data was collected using an anonymous self-administered questionnaire. We included all HCWs at Taher Sfar University Hospital who were willing to participate in the study.

RESULTS

A total of 395 HCWs were included. They were mainly women (78.7%) with an average age of 27 years. The medical personnel was the largest group (67.8%). Most respondents considered the vaccination to be optional and knew that it should be renewed every year, but 97.5% of them judged the efficacy of the vaccine to be low. The influenza vaccination uptake was only 20.2%. The main reasons for accepting vaccination were to protect patients and families. However, misconceptions about the severity and the risk of influenza and the belief that barrier measures were sufficient to prevent infection were the main causes of avoiding vaccination. The factors associated with adherence to vaccination were being a medical professional, old age, longer professional experience, and considering vaccination to be mandatory for HCWs.

CONCLUSION

Our study showed a low adherence to influenza vaccination with misconceptions about vaccine efficacy and safety. More efforts are needed to improve the knowledge of HCW about the vaccine and boost the adherence rates.

Drivers and barriers of seasonal influenza vaccination 2015/16 & 2019/20 to 2022/23 - a survey on why most Norwegians don't get the flu vaccine

BACKGROUND

This study aimed to explore the reasons adults in the general population, influenza risk groups (RGs) and health care workers (HCWs) in Norway give for their vaccination choices and whether these reasons vary between groups or over time in order to further improve influenza vaccination coverage.

METHODS

Respondents of a nationally representative telephone survey conducted by Statistics Norway were asked "What was the most important reason why you did/did not get vaccinated?". The question on influenza non-vaccination was included in 2016 and in 2020 to 2023 and the question on influenza vaccination in 2021 to 2023.

RESULTS

The study included 9 705 individuals aged 18-79 years. Influenza vaccination coverage in the RGs increased from 20.6% in 2016 to 63.1% in 2022, before a reduction to 58.3% in 2023. Common reasons for non-vaccination were similar in all groups. The most cited reasons were "no need" for the vaccine and "no specific reason", followed by "not recommended/offered the vaccine", "worry about side effects" and "vaccine refusal". The most frequent reasons for vaccination among the general population and RGs were protection against influenza and belonging to a RG, while the most frequent responses among HCWs were being offered the vaccine at work/work in health care, followed by a desire for protection against influenza. Receiving a vaccine recommendation from a health professional was mentioned in all groups. We also observed that the proportion reporting "no need" for the vaccine decreased over time, especially among HCWs, and that the proportions reporting vaccine refusal and worry about side effects as reasons for non-vaccination were temporarily reduced during the COVID-19 pandemic.

CONCLUSIONS

The general population and RGs cite protection against influenza as their primary incentive for vaccination, while HCWs mainly refer to their professional role or workplace vaccination. For non-vaccination we see a similar pattern in all groups, with "no need" and "no specific reason" as the main reasons. Of note, worry about side effects and vaccine refusal is as frequent among HCWs as in other groups. Continued efforts to maintain and increase vaccine confidence are needed.

Mapping trends and hotspots in research on global influenza vaccine hesitancy: A bibliometric analysis

Background and Aims

Influenza is one of the most widespread respiratory infections and poses a huge burden on health care worldwide. Vaccination is key to preventing and controlling influenza. Influenza vaccine hesitancy is an important reason for the low vaccination rate. In 2019, Vaccine hesitancy was identified as one of the top 10 threats to global health by the World Health Organization. However, there remains a glaring scarcity of bibliometric research in that regard. This study sought to identify research hotspots and future development trends on influenza vaccine hesitation and provide a new perspective and reference for future research.

Methods

We retrieved publications on global influenza vaccine hesitancy from the Web of Science Core Collection database, Scopus, and PubMed databases from inception to 2022. This study used VOSviewer and CiteSpace for visualization analysis.

Results

Influenza vaccine hesitancy-related publications increased rapidly from 2012 and peaked in 2022. One hundred and nine countries contributed to influenza vaccine hesitation research, and the United States ranked first with 541 articles and 7161 citations. Vaccines-Basel was the journal with the largest number of published studies on influenza vaccine hesitations. MacDonald was the most frequently cited author. The most popular research topics on influenza vaccine hesitancy were (1) determinants of influenza vaccination in specific populations, such as healthcare workers, children, pregnant women, and so on; (2) influenza and COVID-19 vaccine hesitancy during the COVID-19 pandemic.

Conclusions

The trend in the number of annual publications related to influenza vaccine hesitancy indicating the COVID-19 pandemic will prompt researchers to increase their attention to influenza vaccine hesitancy. With healthcare workers as the key, reducing vaccine hesitancy and improving vaccine acceptance in high-risk groups will be the research direction in the next few years.

Influenza vaccination rates among healthcare workers: a systematic review and meta-analysis investigating influencing factors

Introduction

Healthcare workers risk of exposure to the influenza virus in their work, is a high-risk group for flu infections. Thus WHO recommends prioritizing flu vaccination for them-an approach adopted by >40 countries and/or regions worldwide.

Methods

Cross-sectional studies on influenza vaccination rates among healthcare workers were collected from PubMed, EMBASE, CNKI, and CBM databases from inception to February 26, 2023. Influenza vaccination rates and relevant data for multiple logistic regression analysis, such as odds ratios (OR) and 95% confidence intervals (CI), were extracted.

Results

A total of 92 studies comprising 125 vaccination data points from 26 countries were included in the analysis. The meta-analysis revealed that the overall vaccination rate among healthcare workers was 41.7%. Further analysis indicated that the vaccination rate was 46.9% or 35.6% in low income or high income countries. Vaccination rates in the Americas, the Middle East, Oceania, Europe, Asia, and Africa were 67.1, 51.3, 48.7, 42.5, 28.5, and 6.5%, respectively. Influencing factors were age, length of service, education, department, occupation, awareness of the risk of influenza, and/or vaccines.

Conclusion

The global influenza vaccination rate among healthcare workers is low, and comprehensive measures are needed to promote influenza vaccination among this population.

Systematic review registration

www.inplysy.com, identifier: 202350051.

Vaccination coverage and predictors of influenza, pneumococcal, herpes zoster, tetanus, measles, and hepatitis B vaccine uptake among adults in Greece

OBJECTIVES

Insufficient adult vaccination coverage rates remain an international challenge. This nationwide study aimed at exploring vaccination coverage and predictors of influenza, pneumococcal, herpes zoster, tetanus, measles, and hepatitis B vaccine uptake, following the recommendations of the National Immunization Program for adults.

STUDY DESIGN

This was a multicenter, mixed-methods study conducted at 23 primary care units in six different regions of Greece.

METHODS

A pretested questionnaire was administered to three randomly selected adults who visited each practice daily for 30 consecutive working days.

RESULTS

Among the 1571 participants, vaccination coverage for influenza in the high-risk groups was 55%, 36% for pneumococcal disease, 12% for herpes zoster (HZ), 21% for tetanus, 33% for measles, and 11% for hepatitis B. Perception of low susceptibility to disease due to good health status, concerns about side-effects and vaccines' efficacy, and mistrust in pharmaceutical companies were among common factors associated with the vaccines uptake. The strongest factor associated with the participants' vaccination status was their doctor's recommendation (odds ratio [95% confidence interval] influenza: 6.06 [4.52-8.14], pneumococcal disease: 15.73 [10.98-22.52], HZ: 17.01 [9.05-31.96], tetanus: 23.93 [16.20-35.35], measles: 33.47 [16.85-66.47], and hepatitis B: 73.92 [17.47-312.74]). Being well-informed about each vaccine was also a predictor of its uptake.

CONCLUSIONS

Vaccination coverage was suboptimal and especially low in tetanus, HZ, and hepatitis B immunization. Person-centered approach, with provision of appropriate information about vaccines' safety and efficacy, responding to each patient's needs, as well as physicians' strong recommendation for vaccination are considered crucial to advocate against the spread of vaccine misinformation and increase vaccination coverage.

Vaccine Hesitancy among Healthcare Workers in Europe: A Systematic Review

This study analyzes vaccine hesitancy (VH) among healthcare workers (HCWs) in 15 European countries. We have undertaken a systematic review by synthesizing data from 46 articles (between 2015 and 2022) encompassing 55,612 subjects. Despite the heterogeneity of the methods in the various studies, we found that physicians had consistently higher vaccination rates than nurses across different countries and different vaccines. Physicians' average vaccination rate was 79% across a selection of vaccines, while that of nurses was 62%. Concerns regarding vaccine safety, information gaps, and the responsibility of healthcare authorities in managing VH are highlighted by qualitative insights. This research contributes to our comprehension of the ways in which VH among HCWs is impacted by healthcare roles, vaccine types, and regional disparities. The insights gleaned from this analysis can serve as a guide for targeted interventions aimed at increasing vaccine acceptance and coverage in Europe, ultimately strengthening public health.

Flu and COVID-19 Vaccination: What Happens to the Flu Shot When the Campaigns Overlap? Experience from a Large Italian Research Hospital

Influenza represents a threat to global health and health care workers (HCWs) have an increased risk of contracting the influenza virus in the workplace. The COVID-19 pandemic has brought back the importance of influenza vaccination, as the influenza virus can circulate together with SARS-CoV-2. The aim of this report is to describe the actual flu vaccination coverage among healthcare workers of a research hospital and the trend changes, with respect to the past flu vaccination campaigns, in light of the present pandemic and COVID-19 vaccination. A Pearson’s χ2 test was used to test the correlation of flu vaccination coverage, across all professional categories, between the last two years. A linear regression model was adopted to predict the total vaccination coverage of this year. A statistically significant decrease (p < 0.01) was observed in vaccination coverage among all the professional categories with a 50% reduction in vaccination trends between the last two years. Analyzing the data from the previous six flu vaccination campaigns, the expected value, according to the linear regression model, was estimated to be 38.5% while the observed value was 24%. The decrease in vaccination coverage may be due to the fear of the pandemic situation and especially to the uncertainty related to the consequences of a concurrent administration which may overload the immune system or may be more reactogenic. The COVID-19 pandemic represents an opportunity to promote and support large-scale influenza vaccination among HCWs through structured programs, adequate funding, and tailored communication strategies.

Incidence of Influenza Virus Infection among Wroclaw's Healthcare Workers in Pre-COVID-19 2019-2020 Influenza Season Using Novel Flu SensDx Device

Background: Healthcare workers (HCWs) are more exposed to influenza infection, and the influenza vaccination is recommended each year, to reduce the risk of influenza infection and prevent influenza transmission. This study is a cross-sectional study and the objectives were to determine the rate of influenza virus infection among HCWs in the 2019−2020 influenza season. Methods: Between January and March 2020, a survey was carried out in 2 hospitals and 15 primary health-care settings (PHCS) in Wroclaw (Poland). The novel point-of-care testing Flu SensDx device was used, which detects the M1 protein of the influenza virus using electrochemical impedance spectroscopy from biological material (throat/nasal swabs). Results: A total of 150 samples were collected. The majority of participating HCWs by profession were 83 physicians (55.3%) and half (51.3%) of the participating HCWs worked in PHCS. Influenza vaccination coverage was 61.3% in 2019−2020 and 46.0% in the 2018−2019 season for all participants. Of the participating HCWs, 44.0% were positive tested by the Flu SensDx device. There were no statistically significant differences among the positive tested HCWs, their influenza immunization history, and the presence of symptoms of influenza-like illness (p > 0.05). Conclusion: Although the results of the present study suggest that influenza vaccination does not reduce the frequency of influenza virus detection by Flu SensDx testing in the HCWs participants, larger studies are needed to estimate the incidence of influenza virus infection among HCWs to understand the underlying mechanism and fine-tune policies aimed at reducing nosocomial infections.

Influenza Vaccination Coverage, Motivators for, and Barriers to Influenza Vaccination among Healthcare Workers in Wroclaw, Poland

Background: Influenza vaccination, as a key element of control activities intended to prevent nosocomial influenza transmission, is recommended each year for all healthcare workers (HCWs). The objectives were to determine the rate of influenza vaccination and to identify reasons for receiving or declining the influenza vaccine among HCWs in the 2018/19 and 2019/20 influenza seasons. Methods: This study is a cross-sectional observational study carried out between January and March 2020, in 2 hospitals and 15 primary health-care settings (PHCS) in Wroclaw (Poland). Results: A total of 165 questionnaires were completed. The majority of participating HCWs were female—137 (83.0%), and, by profession, the majority were physicians 92 (55.8%). Influenza vaccination coverage was 61.2% in 2019/20, and 47.9% in the 2018/19 season for all participants. Participants who were male, physicians and personnel from PHCS were more frequently vaccinated in both seasons. According to the statistical analysis, physicians were more likely to receive vaccinations than nurses (p < 0.01), as were HCWs who had been vaccinated in the previous season (p < 0.001). Conclusion: The identified barriers were mainly caused by misconceptions (fear of vaccine adverse effects and perception of not being at risk/no need to get vaccinated) and an organizational barriers (lack of time). These findings may prove useful for designing immunization campaigns to tailor strategies to reach specific groups.

Health care provider trust in vaccination: a systematic review and qualitative meta-synthesis

BACKGROUND

Vaccine hesitancy is a growing issue globally amongst various populations, including health care providers. This study explores the factors that influence vaccine hesitancy amongst nurses and physicians.

METHODS

We performed a qualitative meta-synthesis of 22 qualitative and mixed-method studies exploring the factors that may contribute to vaccine hesitancy amongst nurses and physicians. We included all articles that mentioned any aspect of trust concerning vaccination, including how trust may influence or contribute to vaccine hesitancy in nurses and physicians.

RESULTS

Our findings revealed that vaccine hesitancy amongst nurses stemmed predominantly from two factors: distrust in health authorities and their employers, and distrust in vaccine efficacy and safety. Both nurses and physicians had a precarious relationship with health authorities. Nurses felt that their employers and health authorities did not prioritize their health over patients' health, provided inaccurate and inconsistent vaccine information, and were mistrustful of pharmaceutical company motives. Like nurses, physicians were also skeptical of pharmaceutical company motives when it came to vaccination. Additionally, physicians also held doubts regarding vaccine efficacy and safety.

CONCLUSIONS

The relationship health care providers or their patients have with health authorities and other providers regarding vaccination serves as unsystematic clinical experiences that may bolster vaccine hesitancy. Providing accurate and tangible information to emphasize the safety and efficacy of vaccines to health care providers may help address their specific concerns that may ultimately increase vaccine uptake.

Contracting Out National Immunization Program Does Not Improve Vaccination Rate Nor Socioeconomic Inequality: A Case Study of Seasonal Influenza Vaccination in South Korea

The objective of the present study was to investigate if the policy for contracting out the Korean influenza National Immunization Program (NIP) for individuals aged ≥ 65 years affects a reduction in vaccination inequality based on gender and socioeconomic position (SEP). In South Korea, initially only public health centers provided influenza vaccination for free; however, starting from the fall of 2015, the program was expanded to include private medical institutions. The policy was expected to improve overall vaccination rate and reduce its inequality, through improving access to vaccination. The present study analyzed how the gap in the vaccination rate changed between before and after contracting out. A multivariate logistic regression model stratified by gender and SEP of individuals aged ≥ 65 years was used. The study also analyzed changes in the unvaccinated rates between before and after contracting out based on an interrupted time series model. The gap in the unvaccinated rate based on SEP present prior to contracting out of the NIP for individuals aged ≥ 65 years did not decrease afterwards. In particular, the step changes were 0.94% (95% confidence interval [CI]: 0.00, 1.89) and 1.34% (95% CI: 1.17, 1.52) in men and women, respectively. In the pre-policy period, among women, the unvaccinated rate of the medical aid beneficiaries group was 1.22-fold higher (95% CI: 1.12, 1.32) than that of the health insurance beneficiaries, and the difference was not reduced post-policy implementation (odds ratio: 1.27, 95% CI: 1.20, 1.36). The findings of the study were that contracting out of the NIP was not effective in improving vaccination rate nor resolving vaccination inequality. Future studies should focus on identifying the mechanism of vaccination inequality and exploring measures for resolving such inequality.

Barriers for vaccination of healthcare workers

Outbreaks of vaccine preventable diseases (VPDs) in hospital settings remain a challenge even in countries with established (childhood-) vaccination programs. Healthcare workers (HCWs) with an updated vaccination card play an important role in reducing the risk of nosocomial spread of VPDs. Yet, in many places, HCWs report their immunization status to be unknown or not updated. In times of a global pandemic, the debate on vaccination of HCWs is as hot as ever; do HCWs have an increased responsibility to get vaccinated against VPDs? If so, how do we increase vaccination uptake rates among HCWs? Mandatory vaccination against VPDs for HCWs has been introduced in some countries, but it may cause ethical dilemmas and not be culturally acceptable everywhere. We looked at vaccination policies and HCWs' attitudes toward immunization against VPDs. We found that missing vaccine policies and lack of knowledge of VPDs, vaccination benefits, as well as inadequate organization around HCWs' immunizations were important barriers to have a complete vaccination record. A systematic approach to employees providing information of VPDs and vaccinations, going through their vaccination cards and offering antibody testing where appropriate or a shot of a missing vaccine could support staff to adhere to vaccination schemes.

Healthcare Workers' Willingness to Receive Influenza Vaccination in the Context of the COVID-19 Pandemic: A Survey in Southern Italy

This cross-sectional survey was designed to evaluate hospital healthcare workers’ (HCWs) willingness to receive the influenza vaccination during the COVID-19 pandemic and to identify the related determinants, since it is plausible that the two epidemics will coexist in future winters. Overall, 68% out of 490 participants expressed their willingness to receive influenza vaccination in the 2020/21 season, with 95% of those ever and 45.8% of those never vaccinated in the previous six influenza seasons. Belief that influenza vaccine is useful in distinguishing influenza symptoms from those of COVID-19 and that the influenza vaccine is useful to prevent influenza in hospital settings, willingness to receive COVID-19 vaccination, having no concern about influenza vaccine side effects, concern about the possibility to transmit influenza to hospitalized patients, and influenza vaccination in previous years were all predictors of willingness to receive influenza vaccination. In the context of the COVID-19 pandemic, a relevant increase in the willingness to undergo influenza vaccination was reported. Therefore, interventions focused primarily on enabling factors are needed to promote the adherence to influenza vaccination in future seasons among HCWs.

Improved influenza vaccination coverage among health-care workers: evidence from a web-based survey in China, 2019/2020 season

To understand influenza vaccination and its correlates among health-careworkers (HCWs) during the 2019/2020 season in China, we used a self-administeredelectronic questionnaire to collect information on demographics, occupational characteristics, influenza vaccination status and access to free vaccination on the "Breath Circles", a Chinese media platform for respiratory medical professionals. The reported influenza vaccine coverage among HCWs during this season was 67%, with more HCWs in a workplace with free vaccination than those with no free vaccination (79% vs.34%,p < .001). The influenza vaccine coverage among HCWs who were required or encouraged to get vaccinated by the workplace was significantly higher than that without any intervention measures (80% & 70 vs.39%,p < .001). The vaccine coverage in the workplaces with free and required vaccination simultaneously was highest compared to that with neither free vaccination nor any intervention measures (OR = 14.86, 95% CI: 10.93-20.20). The influenza vaccination coverage of HCWs in high-riskdepartments was significantly higher than that of other departments (70% vs.58%,p =.023). HCWs' vaccine coverage was related to personal opinions and attitudes toward influenza or influenza vaccines, as well as other constraints such as availability of influenza vaccines, workplace regulations, and access to free vaccines.

A qualitative meta-synthesis on how autonomy promotes vaccine rejection or delay among health care providers

In spite of the overwhelming evidence that highlights the effectiveness of routine vaccination, an increasing number of people are refusing to follow recommended vaccination schedules. While the majority of research in this area has focussed on vaccine hesitancy in parents, there is little research on the factors that promote vaccine hesitancy in health care providers (HCPs). Identifying factors that promote vaccine hesitancy in HCPs is essential because it may help broaden our understanding of vaccine hesitancy in patients. Therefore, the goal of this investigation was to review 21 studies and examine how professional autonomy and risk perception may promote vaccine acceptance, rejection and delay in physicians and nurses. We found that vaccine hesitant nurses and physicians shared similar views towards vaccines; both groups believed that their decision to vaccinate was separate from their role as an HCP. This belief comprised of three themes: decisional autonomy, personal risk perception and alternatives to vaccination. Both groups believed that mandatory vaccine policies reduced their ability to decide whether vaccination was in their best interests. We argue that decisional autonomy may weaken risk perception of disease, which in turn may encourage beliefs and behaviours that reinforce a 'hero persona' that reduces appropriate preventive and hygiene measures. We employ the Health Belief Model to discuss the crucial role that risk perceptions may play in reinforcing autonomy in vaccine hesitant physician and nurses. We conclude this paper by providing a set of recommendations that aim to improve the decision-making process surrounding mandatory vaccinations for HCPs.

Characteristics of Healthcare Workers Vaccinated against Influenza in the Era of COVID-19

Understanding the potential impact of COVID-19 on receiving influenza vaccination among healthcare workers (HCWs) is of utmost importance. The purposes of the present cross-sectional study were to describe the characteristics and to explore the predictors of receiving influenza vaccination among a large cohort of Italian HCWs in hospital settings. Information was collected through an anonymous questionnaire from December 2020 through January 2021. General and practice characteristics, perceived risk of seasonal influenza, attitudes towards efficacy and safety of influenza vaccination, and reasons behind the decision to be vaccinated against influenza were explored. Fewer than half (46.2%) of HCWs agreed that influenza is a serious illness and perceived the risk of getting infected with influenza, and concerns about the safety of the vaccination were significant positive predictors. Fewer than half of the respondents were not concerned at all about the efficacy (48.6%) and safety (49.8%) of influenza vaccination, and 51.9% reported that they have not received a seasonal influenza vaccine during the previous season. The most mentioned reason for receiving the influenza vaccine in the current season was that influenza and COVID-19 share some similar symptoms. Study results will aid policymakers in developing vaccination education programs, promotion of trust to address negative misconceptions, and to achieve future high coverage among this high-risk group.

Free flu shots vs herd immunity in flu vaccination advertising: the interaction of attribute type and message sidedness on flu vaccination judgment

Purpose

This study aims to examine how the relative importance of a search versus a credence attribute, strategically addressed in a flu vaccination advertisement, varies as a function of message sidedness. A search attribute was designed to highlight the affordability of flu shots, and a credence attribute addressed the potential health benefits of flu vaccination.

Design/methodology/approach

Two experiments were designed to explore how the relative persuasiveness of search versus credence attributes varies as a function of message sidedness in the context of flu vaccination advertising. In Experiment 1, the search–credence attribute type was manipulated by addressing either the affordability (e.g. “Get free flu shots”) or indirect health benefits of flu vaccines (e.g. “Improve herd immunity/community health”). In Experiment 2, an individual-level credence attribute (e.g. “Strengthen your immune system”) was created and compared to the other two attribute conditions used in Experiment 1: a search versus a societal credence versus an individual credence attribute.

Findings

Experiment 1 (N = 114) revealed the relative advantage of a search attribute (free flu shots) in the two-sided persuasion. Experiment 2 (N = 193) indicated that the persuasive impact of a societal credence attribute (herd immunity/community health) was greater in the two-sided message condition (vs one-sided message condition).

Originality/value

Relatively little research has examined how consumers respond to strategic flu prevention and vaccination messages promoting either credence or search attributes. Motivated by the need to investigate the relative effectiveness of stressing “herd immunity” versus “free flu shots” in flu vaccination advertising, this study examines how the effects of these distinct attributes on flu vaccination judgments differ between two-sided (e.g. “No vaccine is 100% effective”) and one-sided persuasion.

Knowledge, Attitudes, and Sources of Information on Vaccines in Spanish Nursing Students: A Cross-Sectional Study

Health professionals are the most influential and main sources of information about vaccines for the general population, as they are regarded as role models by patients and society. The objective of the present study was to determine the knowledge and attitudes of a group of university Nursing students about vaccines, as well as their sources of information and their education needs. A cross-sectional study was performed through a questionnaire (55 items) provided to Nursing students at two Spanish universities. A total of 1122 students participated in the study. The mean score obtained for knowledge about vaccines was 44.6 ± 4.3, and for attitudes towards vaccines, it was 37.2 ± 3.9. Hepatitis B (94.7%) and the Flu (89%) are the two main vaccines they should receive as health workers. The main source of information was the family environment (65.6%). Most of them considered that post-graduate education about vaccines should be provided by academic entities (universities, 62.7%). Among the health professionals, Nurses (85.5%) must be better educated and trained on the subject of vaccines. It is therefore necessary to delve into and complete the nurses’ training on vaccines, to educate them about the risks at the individual level, and their decisive role as promoters of the vaccination strategy for the general population. Universities must become the leaders in vaccine education and training.

Factors Associated with COVID-19 Vaccine Hesitancy

It is critical to develop tailored strategies to increase acceptability of the COVID-19 vaccine and decrease hesitancy. Hence, this study aims to assess and identify factors associated with COVID-19 vaccine hesitancy in Portugal. We used data from a community-based survey, "COVID-19 Barometer: Social Opinion", which includes data regarding intention to take COVID-19 vaccines, health status, and risk perception in Portugal from September 2020 to January 2021. We used multinomial regression to identify factors associated with intention to delay or refuse to take COVID-19 vaccines. COVID-19 vaccine hesitancy in Portugal was high: 56% would wait and 9% refuse. Several factors were associated with both refusal and delay: being younger, loss of income during the pandemic, no intention of taking the flu vaccine, low confidence in the COVID-19 vaccine and the health service response during the pandemic, worse perception of government measures, perception of the information provided as inconsistent and contradictory, and answering the questionnaire before the release of information regarding the safety and efficacy of COVID-19 vaccines. It is crucial to build confidence in the COVID-19 vaccine as its perceived safety and efficacy were strongly associated with intention to take the vaccine. Governments and health authorities should improve communication and increase trust.

Factors Associated with COVID-19 Vaccine Hesitancy

It is critical to develop tailored strategies to increase acceptability of the COVID-19 vaccine and decrease hesitancy. Hence, this study aims to assess and identify factors associated with COVID-19 vaccine hesitancy in Portugal. We used data from a community-based survey, "COVID-19 Barometer: Social Opinion", which includes data regarding intention to take COVID-19 vaccines, health status, and risk perception in Portugal from September 2020 to January 2021. We used multinomial regression to identify factors associated with intention to delay or refuse to take COVID-19 vaccines. COVID-19 vaccine hesitancy in Portugal was high: 56% would wait and 9% refuse. Several factors were associated with both refusal and delay: being younger, loss of income during the pandemic, no intention of taking the flu vaccine, low confidence in the COVID-19 vaccine and the health service response during the pandemic, worse perception of government measures, perception of the information provided as inconsistent and contradictory, and answering the questionnaire before the release of information regarding the safety and efficacy of COVID-19 vaccines. It is crucial to build confidence in the COVID-19 vaccine as its perceived safety and efficacy were strongly associated with intention to take the vaccine. Governments and health authorities should improve communication and increase trust.

Monitoring influenza vaccination coverage and acceptance among health-care workers in German hospitals - results from three seasons

Health-care workers are an important vaccination target group, they are more frequently exposed to infectious diseases and can contribute to nosocomial infections. We established a country-wide online monitoring system to estimate influenza vaccine uptake and its determinants among German hospital staff (OKaPII). The online questionnaire included items on vaccination behavior and reasons for and against influenza vaccination. After a pilot phase in 2016, a country-wide roll-out was performed in 2017. Questions on measles (2018) and hepatitis B (2019) vaccination status were added in subsequent years. In 2017, 2018 and 2019 in total 52, 125 and 171 hospitals with 5 808, 17 891 and 27 163 employees participated, respectively. Influenza vaccination coverage in season 2016/17 and 2017/18 was similar (39.5% and 39.3%) while it increased by 12% in 2018/19 (52.3%). Uptake was higher for physicians than for nurses. Self-protection was the most common reason for influenza vaccination. While physicians mainly identified constraints as reasons for being unvaccinated, nurses mainly referred to a lack of vaccine confidence. Of the hospital staff, 87.0% were vaccinated against measles, 6.3% claimed to be protected due to natural infection; 97.7% were vaccinated against hepatitis B. OKaPII shows that influenza vaccination coverage among German hospital staff is low. Occupational group-specific differences should be considered: physicians might benefit from easier access; information campaigns might increase nurses' vaccine confidence. OKaPII serves as a platform to monitor the uptake of influenza and other vaccines; it also contributes to a better understanding of vaccination behavior and planning of targeted interventions.

Vaccine Hesitancy among Master's Degree Students in Nursing and Midwifery: Attitude and Knowledge about Influenza Vaccination

Influenza vaccination among healthcare workers may reduce morbidity and protect fragile patients. Most of the evidence concerning the vaccine hesitancy of healthcare workers reported lack of knowledge and wrong attitude. The aims of this study were to explore the knowledge and attitudes about influenza vaccination among master's degree students in Nursing and Midwifery, and to evaluate the effectiveness of their involvement in the hospital vaccination campaign in order to increase intention to receive immunization. The students of nurses and midwives were involved in the vaccination sessions of the 2018-19 hospital campaign. They were recruited to complete an online survey. Students of the 2nd year (involved in the vaccination campaign) and the 1st year (not involved) were compared. Descriptive and inferential statistics were performed for data analysis. Students who intend to receive influenza vaccination in the following year registered a percentage of 83.6% and showed an overall attitude of 66.8%. The involvement of the students in the vaccination campaign led to a significant increase in their positive vaccination attitude (80.9% vs. 87.0%) and in their intention to receive flu vaccination in the following year (67.7% vs. 100%). A positive attitude towards vaccinations was observed by nurses and midwives. Their involvement in the planning and activities during the vaccination campaign could positively influence their opinions and intention to receive vaccination.

Reasons for the low influenza vaccination rate among nurses in Slovenia

AIM

This study aimed to identify nurses' views on influenza vaccination and factors that might explain why they do not receive influenza vaccinations, and to examine any ethical issues encountered in the vaccination process.

BACKGROUND

All 27 European Union member states and 2 other European countries recommended influenza vaccinations for healthcare workers in 2014-15. Data show that the influenza vaccination rate among nurses in Slovenia is even lower than in other European countries. Slovenian study showed that 41.7% of the respondents had received both the pandemic and the seasonal vaccine. Doctors had the highest level of vaccine coverage, with 44.1%, followed by registered nurses at 23.4%, whereas the lowest level was found among nursing assistants and nursing technicians (17%) at a Ljubljana health clinic.

METHODS

A qualitative study was carried out. Nineteen nurses who did not receive influenza vaccination took part in the study. Thematic interviews were conducted in December 2018. Interview transcripts were read, coded, reviewed and labelled by three independent researchers. The collected material was processed using qualitative content analysis.

FINDINGS

Thirteen categories and four themes were identified and coded, which enabled an understanding of the nurses' views regarding influenza vaccination. Most of their experiences were positive in one way: they recognised the importance of vaccination and people's awareness of it. However, they did not obtain the influenza vaccine themselves. The main barriers to vaccination were doubt regarding the vaccine's effectiveness, the potential for side effects, the belief that young healthcare professionals are well protected and not at high risk, an overrated trust in their own immune systems, and the belief that pharmaceutical industry marketing was targeting them. The nurses suggested several ways that vaccination could be promoted and improved vaccination coverage achieved. These findings call attention to the importance of recognising both the need for targeted information for the nurses and the need for different approaches to healthcare provision.

Determinants of Vaccination Uptake in Risk Populations: A Comprehensive Literature Review

Vaccination uptake has decreased globally in recent years, with a subsequent rise of vaccine-preventable diseases. Travellers, immunocompromised patients (ICP), and healthcare workers (HCW) are groups at increased risk for (severe) infectious diseases due to their behaviour, health, or occupation, respectively. While targeted vaccination guidelines are available, vaccination uptake seems low. In this review, we give a comprehensive overview of determinants-based on the integrated change model-predicting vaccination uptake in these groups. In travellers, low perceived risk of infection and low awareness of vaccination recommendations contributed to low uptake. Additionally, ICP were often unaware of the recommended vaccinations. A physician's recommendation is strongly correlated with higher uptake. Furthermore, ICP appeared to be mainly concerned about the risks of vaccination and fear of deterioration of their underlying disease. For HCW, perceived risk of (the severity of) infection for themselves and for their patients together with perceived benefits of vaccination contribute most to their vaccination behaviour. As the determinants that affect uptake are numerous and diverse, we argue that future studies and interventions should be based on multifactorial health behaviour models, especially for travellers and ICP as only a limited number of such studies is available yet.

Self-reported immunity and opinions on vaccination of hospital personnel among paediatric healthcare workers in Denmark

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Vaccination of healthcare workers prevents the spread of infections in hospitals.

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A forth of healthcare workers reported to be non-immune to vaccine-preventable diseases.

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Nine out of 10 employees supported vaccination of non-immune healthcare workers.

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National recommendations for vaccination of healthcare workers in Denmark are needed.

Background

Denmark has no general recommendations for vaccination of healthcare workers (HCWs). We explored the self-reported immunity to varicella, measles, mumps, and rubella, reasons for receiving the influenza vaccine or not, and opinions on vaccination of HCWs against varicella, MMR, pertussis, diphtheria, and influenza among staff from departments with a high risk of exposure to infectious agents.

Methods

From May 2019 to August 2019, a structured questionnaire was distributed to clinical and non-clinical HCWs at a tertiary and a general paediatric department in Denmark. Self-reported immunity was defined as either previous infection or vaccination against the disease.

Results

Of 619 employed HCWs, 555 (90%) were included. A large proportion were unsure of or denied previous vaccination or infection with measles (20.1%), mumps (30.2%), rubella (21.4%), varicella (12.1%), pertussis (44.1%), and diphtheria (32.1%). Non-clinical personnel and employees born in 1974–1983 had the lowest level of self-reported immunity. Mandatory vaccination of non-immune HCWs was approved by 54–68.9% of participants, and any kind of vaccination (mandatory or as an offer at hospitals) was approved of up to 95.3% of all participants depending on the disease. During the season 2018/19, 214 (38.6%) HCWs received the influenza vaccine, including 20.3% of non-clinical staff, 34.8% of nurses and 56.5% of doctors (P < 0.001). Reasons for lack of vaccine uptake were mainly employees considering themselves rarely sick, the vaccine was not regarded as necessary, forgetfulness or lack of time. Only 37.8% was in favour of mandatory influenza vaccination.

Conclusions

A large proportion of paediatric HCWs were not aware of their immune status against important vaccine-preventable diseases. >90% supported vaccination of HCWs, with two out of three supporting mandatory MMR, pertussis and diphtheria vaccination. Better information and an official immunisation policy of non-immune HCWs in Denmark is warranted.

A new strategy to promote flu vaccination among health care workers: Molinette Hospital's experience

RATIONALE, AIMS, AND OBJECTIVES

Seasonal flu represents a major public health issue, especially for health care workers (HCWs). WHO highlights the need of higher awareness and flu vaccine coverage among HCWs. In Europe the coverage is less than 30-40%. Italy reports some of the lowest rates. The paper aims to illustrate the 2017/2018 flu vaccination campaign within Molinette, the third Italian hospital for dimensions, to provide inputs about strategies for increasing HCWs coverage. The campaign objective was to increase the administered doses at least of 30%.

METHODS

The intervention included informational material, direct educational sessions for workers, extension of the access time to Occupational Medicine Service, elimination of the reservation requirement, composition of "moving vaccination units" (MVUs), and organisation of vaccination sessions within departments.

RESULTS

In 2017/2018, 593 doses were administered. The doses percentage change between 2017/2018 and 2016/2017 vaccination seasons was +46.06%, while it was +84.74% compared with the previous 5-year period mean. The majority was administered by Occupational Medicine Service, while 6.75% by MVUs. Among the total doses, 72.68% were administered to workers, 13.49% to residents, 6.75% to students, and 7.08% to "other". So, 7.68% of total workforce was vaccinated. Only 0.3% of vaccinated people presented mild adverse reactions.

CONCLUSIONS

A combined campaign, that includes actions for education, increase of awareness, improved access to facilities and active offers to workers has potentiality but there is still work to do. The vaccination increase was determined mostly by the re-organization of the occupational medicine, while the MVUs were useful to HCWs of detached offices.

Influenza Vaccination in Italian Healthcare Workers (2018-2019 Season): Strengths and Weaknesses. Results of a Cohort Study in Two Large Italian Hospitals

BACKGROUND

Annual vaccination is the most effective way to combat influenza. As influenza viruses evolve, seasonal vaccines are updated annually. Within the European project Development of Robust and Innovative Vaccine Effectiveness (DRIVE), a cohort study involving Italian healthcare workers (HCWs) was carried out during the 2018-2019 season. Two aims were defined: to measure influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza cases and to conduct an awareness-raising campaign to increase vaccination coverage.

METHODS

Each subject enrolled was followed up from enrollment to the end of the study. Each HCW who developed ILI was swabbed for laboratory confirmation of influenza. Influenza viruses were identified by molecular assays. A Cox regression analysis, crude and adjusted for confounding variables, was performed to estimate the IVE.

RESULTS

Among the 4483 HCWs enrolled, vaccination coverage was 32.5%, and 308 ILI cases were collected: 23.4% were positive for influenza (54.2% A(H1N1) pdm09; 45.8% A(H3N2)). No influenza B viruses were detected. No overall IVE was observed. Analyzing the subtypes of influenza A viruses, the IVE was estimated as 45% (95% CI: -59 to 81) for A(H1N1) pdm09.

CONCLUSIONS

Vaccination coverage among HCWs increased. Study difficulties and the circulation of drifted variants of A(H3N2) could partly explain the observed IVE.

Influenza Vaccination Coverage among Registered Nurses in China during 2017-2018: An Internet Panel Survey

Influenza vaccination is recommended for nurses in China but is not mandatory or offered free of charge. The main objective of this study was to determine influenza vaccination coverage and the principal factors influencing influenza vaccination among nurses in China. During 22 March-1 April 2018, we conducted an opt-in internet panel survey among registered nurses in China. Respondents were recruited from an internet-based training platform for nurses. Among 22,888 nurses invited to participate, 4706 responded, and 4153 were valid respondents. Overall, 257 (6%) nurses reported receiving the seasonal influenza vaccine during the 2017/2018 season. Vaccination coverage was highest among nurses working in Beijing (10%, p < 0.001) and nurses working in primary care (12%, p = 0.023). The top three reasons for not being vaccinated were lack of time (28%), not knowing where and when to get vaccinated (14%), and lack of confidence in the vaccine's effectiveness (12%). Overall, 41% of nurses reported experiencing at least one episode of influenza-like illness (ILI) during the 2017/2018 season; 87% of nurses kept working while sick, and 25% of nurses reported ever recommending influenza vaccination to patients. Compared with nurses who did not receive influenza vaccination in the 2017/2018 season, nurses who received influenza vaccination were more likely to recommend influenza vaccination to patients (67% vs. 22%, p < 0.001). Influenza vaccination coverage among nurses was low, and only a small proportion recommended influenza vaccine to patients. Our findings highlight the need for a multipronged strategy to increase influenza vaccination among nurses in China.

[Management of seasonal influenza in 2017/2018 at a German tertiary-care hospital]

BACKGROUND

There are only few structured reports on inpatient management of a seasonal influenza epidemic.

OBJECTIVES

A systematic description of a seasonal influenza patient population at a German university hospital to improve risk stratification and clinical care.

METHODS

In this monocentric, retrospective observational study of the 2017/2018 influenza season at the University Medical Center Hamburg-Eppendorf, patients with confirmed influenza infection were included.

RESULTS

Of all influenza swabs performed in the emergency department, 24% (n = 162/676) were positive. A total of 255 patients (median age 66 years) had an influenza infection (influenza A n = 79, influenza B n = 176); 27 (15.3%) were nosocomial infections. Of the 179 (70.2%) patients that were hospitalized, 51 (20%) received intensive medical care. Patients with subsequent need for intensive care had an elevated CRP level (69.5 mg/dl [SD 62.8] vs. 141.7 [SD 127.2] mg/dl) at the time of influenza diagnosis and more frequent infiltrates in X‑ray/CT of the thorax (n = 43 [33.6%] vs. n = 43 [84.3%]). Antiviral therapy with oseltamivir was administered for 74 (29.0%) patients and 11 (6.1%) patients were treated with extracorporeal membrane oxygenation (ECMO). Of the 23 (9.0%) patients who died, only four of them had been vaccinated (trivalent). Those four had an influenza B infection.

CONCLUSION

The structured use of diagnostic tests (influenza PCR, X‑ray/CT chest and CRP) and antiviral therapy (oseltamivir) as well as targeted management of admission, intensive care capacities, and an increase in vaccination rates are important for improving patient care and optimizing the use of resources during seasonal influenza epidemics.

Clinical nurses' awareness and caring experiences for patients with cervical cancer: A qualitative study

To determine the degree to which nurses are aware of cervical cancer and to describe nurses' experiences of caring for patients with cervical cancer. To promote quality of nursing care of cervical cancer, we need to explore their perceptions and nursing experience in doing cervical-cancer care. This study was a qualitative descriptive design. Interviews were conducted with 14 registered nurses. The interviews were audiotaped, transcribed and analyzed. Content analysis was performed. Fourteen nurses who had been working at wards and cancer education centers were recruited in this study. Nine key themes emerged from three categories such as nurses' awareness of cervical cancer, awareness of cervical cancer patient and caring experience. Nurses expressed fear of cervical cancer and helplessness in the face of a life-threatening prognosis. Nurses stated that they might have prejudice about cervical cancer, since it is caused by a sexually transmitted disease. They also recalled that patients with cervical cancer were more sensitive and demanding. Our findings provide a comprehensive and in-depth perspective in understanding the experience of caring for cervical cancer patients. Clinical nurses showed complex emotional reactions to cervical cancer, and expressed prejudice against the sex life of cervical-cancer patients. More education is required to ensure that clinical nurses can provide a nurse-led intervention with patients by managing nurses' fear, prejudice, and the care burden.

Non-familial paid caregivers as potential flu carriers and cause of spread: the primary prevention of flu measured through their adhesion to flu vaccination campaigns-A Florentine experience

Introduction: Influenza vaccination is recommended for caregivers of elderly people. In a study aimed at assessing the level of health literacy (HL) in a sample non-familial caregivers in the Florence Health District (Tuscany), data were collected regarding access and adherence to the flu vaccination campaigns.

Methods: The sample consists of 47 non-familial paid caregivers.

We collected information regarding socio-demographic characteristics, services provided and daily work time, whether or not influenza vaccination was administered for the 2016/2017 season and in the previous three years. The level of HL was assessed through the Newest Vital Sign.

Results: 63.8% of non-familial caregivers have not joined the flu campaigns over the last four years, 14.9% have been vaccinated only sometimes (in some epidemic seasons), and 21.3% have received a flu shot in all the seasons investigated. Most of the non-familial caregivers who do not get vaccinated (27.7%) do not perceive that they are in direct contact with a person at-risk; those who get the vaccine regularly (12.8%) reported they want to protect the assisted person as motivation for vaccine uptake. Vaccination was not associated with HL.

Conclusion: Adhesion to anti-flu vaccination campaigns for these homecare workers has been resulted rather poor. Coverage does not seem to be related with HL level. It seems appropriate to promote extensively flu vaccination among family carers by actively offering the vaccination in appropriate forms, places and times, to avoid serious consequences on elderly people with higher risk of comorbidity and frailty.

Attitudes, believes, determinants and organisational barriers behind the low seasonal influenza vaccination uptake in healthcare workers - A cross-sectional survey

BACKGROUND

Seasonal influenza threatens hospitalised patients and residents of nursing homes annually. Due to age and chronic disease their protection following immunisation is diminished. Additional immunisation of direct contacts and in particular healthcare workers (HCWs) has proven added value. As vaccination coverage in HCWs remains low, we aimed to gain insight in the factors behind the demotivation for influenza vaccination.

METHODS

Attitudes and believes towards influenza vaccination and socio-demographic and professional determinants were surveyed in 5141 Belgian HCWs from 13 hospitals and 14 nursing homes. Additionally, influenza campaign coordinators of the participating healthcare institutions were interviewed about the factors of success/failure in their campaigns.

RESULTS

The mean vaccination coverage registered by the participating healthcare institutions was 40.4% in the hospitals and 45.3% in the nursing homes. Overall, up to 90% of HCWs found it important not to infect their patients. However, only 20% of non-vaccinated HCWs considered influenza vaccination a duty to not harm their patients. Up to 40% of unvaccinated staff believed they could get influenza after vaccination and that vaccination weakens their immune system. Also, only about 20% of unvaccinated staff thought to have a high chance of getting influenza. Reasons for unvaccinated staff to get vaccinated in the future are self-protection and protection of family members. Factors that positively influenced vaccination coverage are encouragement by supervisors (OR, hospitals: 7.1, p < 0.001; nursing homes: 7.5, p < 0.001) and well-organized vaccination campaigns with on-site vaccination. Factors that negatively affected vaccination coverage are misconceptions about influenza and its vaccine (OR, range 0.1-0.7, p < 0.001 for most misconceptions) and underestimation of the risk of contracting influenza by patients or HCWs (OR of perceived susceptibility, range 2.1-5.1, p < 0.001 for most factors).

CONCLUSION

There is a need for guidance for the organization of seasonal influenza campaigns, in which education, communication and easy accessible vaccination are promoted.