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Lee HR, Kim SR, Cho MH, Kim DE, Jang SY, Lee JE, Jeong HR, Kang HJ, Song JY, Chun BC. Incidence and risk factors of COVID-19 in a tertiary hospital and the effectiveness of booster vaccination among health care workers: A retrospective cohort study, January 2020 to June 2022. Am J Infect Control 2024; 52:688-695. [PMID: 38246494 DOI: 10.1016/j.ajic.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Health care workers (HCWs) face a higher risk of infection and may transmit pathogens to patients during a pandemic. This study aims to evaluate infection-control measures by analyzing the incidence and risk factors of COVID-19 and estimating vaccine effectiveness (VE) at a tertiary hospital in Seoul, Republic of Korea. METHODS This study included 2,516 HCWs from January 1, 2020, to June 30, 2022. Data were analyzed to determine the incidence density and cumulative incidence; the results were compared by the age- and gender-specific standardized incidence ratios (SIR). VE was estimated with multivariate Cox proportional-hazard models as 1-adjusted hazard ratio × 100%. RESULTS SIR indicated a lower COVID-19 risk in the hospital population than in the general Korean population (SIR, 0.81; 95% confidence interval [CI]: 0.76-0.87). Multivariate Cox analysis indicated that, compared to doctors, nonmedical service supporters and other HCWs (excluding doctors and nurses) were high-risk groups (adjusted hazard ratio [95% CI], 1.72 [1.04-2.83] and 1.76 [1.20-2.58], respectively). Compared to the outpatient unit, the emergency department was a high-risk department (1.70 [1.16-2.50]). The VE of the booster dose was 55.47%, compared to no or incomplete vaccination (95% CI: 22.63-74.37). CONCLUSIONS Besides encouraging HCWs vaccination, effective infection-control measures should target high-risk groups and departments.
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Affiliation(s)
- Hae Ry Lee
- Infection Control Team, Korea University Guro Hospital, Seoul, South Korea; Department of Epidemiology and Health Informatics, Graduate School of Public Health, Korea University, Seoul, South Korea
| | - Sung Ran Kim
- Infection Control Team, Korea University Guro Hospital, Seoul, South Korea
| | - Min Hee Cho
- Infection Control Team, Korea University Guro Hospital, Seoul, South Korea
| | - Da Eun Kim
- Infection Control Team, Korea University Guro Hospital, Seoul, South Korea
| | - Su Yeon Jang
- Infection Control Team, Korea University Guro Hospital, Seoul, South Korea
| | - Jae Eun Lee
- Infection Control Team, Korea University Guro Hospital, Seoul, South Korea
| | - Hye Rin Jeong
- Infection Control Team, Korea University Guro Hospital, Seoul, South Korea
| | - Hyeon Jeong Kang
- Infection Control Team, Korea University Guro Hospital, Seoul, South Korea
| | - Joon Young Song
- Infection Control Team, Korea University Guro Hospital, Seoul, South Korea; Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Byung Chul Chun
- Department of Epidemiology and Health Informatics, Graduate School of Public Health, Korea University, Seoul, South Korea; Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea.
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Kaddour O, Ben Mabrouk A, Arfa S, Lassoued N, Berriche O, Chelli J. Knowledge and attitudes of healthcare workers about influenza vaccination. Infect Dis Health 2024:S2468-0451(24)00027-0. [PMID: 38679564 DOI: 10.1016/j.idh.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/01/2024]
Abstract
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.
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Affiliation(s)
- Oussama Kaddour
- Internal Medicine and Endocrinology Department, Taher Sfar Hospital, Mahdia, Tunisia
| | - Asma Ben Mabrouk
- Internal Medicine and Endocrinology Department, Taher Sfar Hospital, Mahdia, Tunisia.
| | - Sondess Arfa
- Internal Medicine and Endocrinology Department, Taher Sfar Hospital, Mahdia, Tunisia
| | - Najoua Lassoued
- Internal Medicine and Endocrinology Department, Taher Sfar Hospital, Mahdia, Tunisia
| | - Olfa Berriche
- Internal Medicine and Endocrinology Department, Taher Sfar Hospital, Mahdia, Tunisia
| | - Jihene Chelli
- Internal Medicine and Endocrinology Department, Taher Sfar Hospital, Mahdia, Tunisia
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Gur-Arie R, Katz MA, Hirsch A, Greenberg D, Malosh R, Newes-Adeyi G, Davidovitch N, Rosenthal A. "You Have to Die Not to Come to Work": A Mixed Methods Study of Attitudes and Behaviors regarding Presenteeism, Absenteeism and Influenza Vaccination among Healthcare Personnel with Respiratory Illness in Israel, 2016-2019. Vaccine 2021; 39:2366-2374. [PMID: 33789798 DOI: 10.1016/j.vaccine.2021.03.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/23/2021] [Accepted: 03/17/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Healthcare personnel (HCP) have an increased risk of exposure to influenza and other respiratory pathogens. Increased presenteeism, decreased absenteeism, and low uptake of the influenza vaccine can contribute to the spread of influenza among HCP in healthcare settings. We used a mixed methods approach to investigate attitudes and behaviors of HCP in Israel towards influenza vaccination, presenteeism, and absenteeism. METHODS The study took place over three influenza seasons (2016-2017, 2017-2018, 2018-2019) at the largest hospital in southern Israel. We administered a Knowledge, Attitudes and Practices (KAP) questionnaire and conducted semi-structured interviews with HCP who had been recently ill with respiratory symptoms. The KAP questionnaire included closed-ended questions about attitudes and behaviors regarding influenza, working while sick, and influenza vaccination. The interviews investigated HCP's perceptions of influenza infection and attitudes about absenteeism, presenteeism, and the influenza vaccine. RESULTS We conducted 74 semi-structured interviews over three influenza seasons. Four HCP were interviewed twice, in separate seasons for different illness episodes. The 70 individuals interviewed included 16 physicians, 45 nurses or technicians, and 9 administrative staff. The median age was 42.5 years (range: 25-60), and most (79%) were female. Half (50%) got vaccinated against influenza before their illness episode. In interviews, most HCP said they come to work while sick (presenteeism) due to a strong personal work ethic and an institutional culture that discourages taking sick leave (absenteeism). HCP expressed skepticism about the effectiveness of the influenza vaccine as well as concern that the influenza vaccine causes severe illness. DISCUSSION Over three influenza seasons in Israel, HCP cited a number of reasons for working while sick, and doubted the usefulness of influenza vaccine. Addressing reasons for presenteeism and vaccine hesitancy among HCP is crucial to protect HCP and patients from influenza virus infection and other viral respiratory illnesses, such as COVID-19.
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Affiliation(s)
- Rachel Gur-Arie
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA; Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Mark A Katz
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel; School of Public Health, Medical School for International Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Avital Hirsch
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - David Greenberg
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Ryan Malosh
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Nadav Davidovitch
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Anat Rosenthal
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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Gafner M, Korlander H, Zimlichman R, Ziv-Baran T, Zimlichman E. Influenza Vaccination Rate and Factors Associated With Compliance Among Health Care Employees in Large and Medium Acute Care Hospitals. Am J Med Qual 2021; 36:115-121. [PMID: 32486936 DOI: 10.1177/1062860620929423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Annual influenza epidemics are associated with high morbidity and mortality worldwide, with vaccinations being the main preventive intervention; however, the compliance rate of health care employees remains low. Study aims were to examine vaccination rates among physicians and nurses in surgical and medicine wards, compare between medium and large tertiary hospitals, and identify factors associated with increased vaccination rates. Structured questionnaires were distributed. A total of 238/339 (70.2%) were vaccinated. In multivariate analysis, respiratory illness during precedent winter (odds ratio [OR] 3.146, P = .007), working in a medium hospital (OR 2.4, P = .003), and an attending resident with an infectious diseases subspecialty (OR 20.473, P = .007) were associated with a higher vaccination rate. Institutional email or portal messages were associated with decreased vaccination rates (OR = 0.259, P = .007). The leading reason for vaccination was "to stay healthy" (73.5%). Recruiting experts in the field, providing up-to-date information, and increasing management's involvement could encourage vaccination among health care employees.
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Affiliation(s)
- Michal Gafner
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel Medicine and Hypertension Institute, Wolfson Medical center, Holon, Israel Department of Clinical Affairs, Quality and Patient Safety, Sheba Medical Center, Ramat-Gan, Israel
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Van Hooste WLC, Bekaert M. To Be or Not to Be Vaccinated? The Ethical Aspects of Influenza Vaccination among Healthcare Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203981. [PMID: 31635299 PMCID: PMC6844122 DOI: 10.3390/ijerph16203981] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/12/2019] [Accepted: 10/16/2019] [Indexed: 11/16/2022]
Abstract
Influenza is a highly contagious airborne disease with a significant morbidity and mortality burden. Seasonal influenza (SI) vaccination has been recommended for healthcare workers (HCWs) for many years. Despite many efforts to encourage HCWs to be immunized against influenza, vaccination uptake remains suboptimal. Sometimes there is a significant sign of improvement, only if numerous measures are taken. Is 'the evidence' and 'rationale' sufficient enough to support mandatory influenza vaccination policies? Most voluntary policies to increase vaccination rates among HCWs have not been very effective. How to close the gap between desired and current vaccination rates? Whether (semi)mandatory policies are justified is an ethical issue. By means of a MEDLINE search, we synthesized the most relevant publications to try to answer these questions. Neither the 'clinical' Hippocratic ethics (the Georgetown Mantra: autonomy, beneficence, non-maleficence, and justice), nor the 'public health' ethics frameworks resolve the question completely. Therefore, recently the 'components of justice' framework was added to the ethical debate. Most options to increase the uptake arouse little ethical controversy, except mandatory policies. The success of vaccination will largely depend upon the way the ethical challenges like professional duty and ethics (deontology), self-determination, vaccine hesitance, and refusal ('conscientious objector') are dealt with.
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Affiliation(s)
- Wim Leo Celina Van Hooste
- Occupational Health Services-External Service for Prevention and Protection at Work, Opvoedingstraat 143, B-9000 Gent, Belgium.
| | - Micheline Bekaert
- Occupational Health Services-External Service for Prevention and Protection at Work, Opvoedingstraat 143, B-9000 Gent, Belgium.
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Gur-Arie R. Maximizing influenza vaccination uptake among healthcare personnel in Israel: lessons learned from mandatory vaccination policy in the United States. Isr J Health Policy Res 2019; 8:60. [PMID: 31522682 PMCID: PMC6745778 DOI: 10.1186/s13584-019-0326-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 06/11/2019] [Indexed: 11/17/2022] Open
Abstract
Background Maximizing vaccination uptake is crucial in generating herd immunity and preventing infection incidence (Quach et al., Am J Infect Control 11:1017–23, 2013). Vaccination of healthcare personnel (HCP) against influenza is vital to influenza infection control in healthcare settings, given the consistent exposure of HCP to high-risk patients like: those with compromised immune systems, children, and the elderly (Johnson & Talbot, Curr Opin Infect Dis 24: 363–369, 2011). Influenza vaccination uptake among HCP remains suboptimal: in 2017–18, 47.6% of HCP who worked in settings where influenza vaccination was not mandatory were vaccinated against influenza in United States (Black et al., Morb Mortal Wkly Rep 67: 1050, 2018). Mandatory vaccination policies result in HCP influenza vaccination uptake rates substantially higher than opt-in influenza vaccination campaigns (94.8% vs. 47.6%) (Black et al., Morb Mortal Wkly Rep 67: 1050, 2018). Goals The Israel Journal of Health Policy Research has published articles focused on the issues of influenza vaccination (Yamin et al., Isr J Health Policy Res 3: 13, 2014), improving influenza vaccination coverage of HCP (Weber et al., Isr J Health Policy Res 5: 1–5, 2016), influenza vaccination motivators among HCP (Nutman and Yoeli, Isr J Health Policy Res 5: 52, 2016), legal imposition of vaccination (Kamin-Friedman, Isr J Health Policy Res 6:58, 2017), and mandatory vaccination (Gostin, Cell Biosci 8: 1-4, 2018). Each article explores factors influencing disease prevention from different angles within an Israeli context. This article attempts to fuse these topics by investigating how to apply aspects of American mandatory influenza vaccination policy targeted at HCP in an Israeli context. Methods Critical document analysis was conducted on relevant literature and policy discussing influenza prevention interventions among HCP within the United States. Mandatory vaccination policies were highlighted. A discussion of the professional responsibility of HCP to vaccinate against influenza serves as background. Case studies of hospitals in the United States that implemented mandatory vaccination policies for their employees are analyzed. The article concludes with analysis exploring how qualities of mandatory influenza vaccination policy of HCP could take shape in Israel, giving contextual limitations, urging Israeli health policy makers to reflect on lessons learned from the American case study. Main findings and conclusion Mandatory HCP influenza vaccination policies in comparison to non-mandatory interventions are most effective in obtaining maximum influenza vaccination uptake among HCP (Black et al., Morb Mortal Wkly Rep 67: 1050, 2018). Many HCP cite individual objections to influenza vaccination rooted in personal doubts and ethical concerns. The ethical responsibility of HCP to their patients and work environments to prevent and lower influenza infection incidence arguably overrules such individual objections. Mandatory HCP influenza vaccination policies are an effective method of maximizing HCP influenza vaccine uptake and minimizing the spread of the influenza virus within healthcare settings. Still, cultural, social and political sensitivity must be taken into consideration when implementing both full-on mandatory HCP influenza vaccination policies and/or aspects of mandatory policies, especially within an Israeli context.
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Affiliation(s)
- Rachel Gur-Arie
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.
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Alshammari TM, Yusuff KB, Aziz MM, Subaie GM. Healthcare professionals' knowledge, attitude and acceptance of influenza vaccination in Saudi Arabia: a multicenter cross-sectional study. BMC Health Serv Res 2019; 19:229. [PMID: 30992004 PMCID: PMC6469139 DOI: 10.1186/s12913-019-4054-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/31/2019] [Indexed: 01/30/2023] Open
Abstract
Background All healthcare professionals (HCPs) are at high risk of influenza infection. Therefore, immunization is recommended for all HCPs. Due to safety and effectiveness concerns, HCPs have a low vaccination rate. This study was designed to explore the attitude, awareness and knowledge of HCPs toward vaccination for influenza. Method A cross-sectional study was performed during October–November 2016. A total of 405 questionnaires were distributed in 8 major hospitals in Saudi Arabia. A validated questionnaire consisting of 31 questions and 5 sections was administered. Statistical Analysis Software (SAS®) version 9.2 was used to analyze the data. Results A total of 364 HCPs responded to the study survey, which is a response rate of 90%. A large proportion (61.8%) of participants were female. The majority of the participants were nurses (60.4%). More than half of the respondents (57.7%) were working in government-run hospitals. Among all the participants, approximately 67.6% of HCPs were vaccinated. The majority (84.1%) of HCPs believed that influenza vaccine prevents the flu. Furthermore, approximately 75% of participants believed that HCPs can be more susceptible to influenza infections than other people. The majority of participants (89.6%) knew the proper signs and symptoms of influenza. HCPs’ belief that vaccination prevents influenza infection (OR = 3.93, 95% CI = 1.97–7.82), their awareness of the Scientific Committee for Influenza and Pneumococcal Vaccination (SCIPV)‘s guidelines (OR = 2. 13, 95% CI = 1.16–3.90) and the presence of the standing orders regarding influenza vaccine (OR = 1.57, 95% CI = 1.01–3.21), were the predictors for receipt of influenza vaccine by HCPs. Many (58.0%) respondents believed that vaccine safety concerns is a major barrier to the vaccination of HCPs. Some misconceptions, such as influenza infection due to vaccination (42.3%) and incorrect perceptions about the symptoms of influenza in adults (50.5%), were found. Conclusion The acceptance of and participation in influenza vaccination by HCPs in Saudi Arabia appears to have markedly increased in the 2016 season. Continuing evaluation of vaccination practices is necessary, and more training programs are needed in the future. Electronic supplementary material The online version of this article (10.1186/s12913-019-4054-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thamir M Alshammari
- College of Pharmacy, University of Hail, P.O. Box 6166, Hail City, zip code 81442, Saudi Arabia. .,Saudi Food and Drug Authority, Riyadh, Saudi Arabia. .,Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia.
| | - Kazeem B Yusuff
- College of Clinical Pharmacy, King Faisal University, Al-ahsa, Saudi Arabia
| | | | - Gehad M Subaie
- College of Pharmacy, University of Hail, P.O. Box 6166, Hail City, zip code 81442, Saudi Arabia
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Hoffmann A, Dumke C, Hanschmann KMO, Wicker S. Local thermal reaction after influenza vaccination: Quantification by infrared imaging and biometric considerations. Vaccine 2018; 36:2783-2787. [PMID: 29653847 DOI: 10.1016/j.vaccine.2018.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 03/28/2018] [Accepted: 04/02/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extensive clinical investigations are mandatory to evaluate the safety and reactogenicity of vaccines. The recording of common adverse events like injection site soreness or general discomfort derives from individual subjective perceptions. Thermal imaging at the injection site possibly provides a non-subjective and a non-invasive approach to supplement this evaluation. RESULTS A protocol for quantified injection-site infrared imaging included 86 participants during a flu vaccine campaign, 40% of whom had a thermal reaction of 1 °C; 25-30% had no thermal response. There was little subjective pain reporting and no clinical correlations were observed except with post-vaccination erythema. Higher responses were linked with advanced age and multiple previous vaccinations. CONCLUSION Evan if influenza vaccine was only moderately reactogenic, a thermal response was detectable in about 70% of vaccinees, though no relationship to reactogenicity was seen. Infrared imaging might however be a prospective tool for individual studies of vaccine-induced vascular responses.
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Affiliation(s)
- Andreas Hoffmann
- Paul-Ehrlich-Institute, Federal Institute for Vaccines and Biomedicines, 63225 Langen, Germany.
| | - Claudia Dumke
- Paul-Ehrlich-Institute, Federal Institute for Vaccines and Biomedicines, 63225 Langen, Germany
| | | | - Sabine Wicker
- University Hospital Frankfurt, Goethe University, Occupational Health Service, 60590 Frankfurt am Main, Germany
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Surtees TC, Teh BW, Slavin MA, Worth LJ. Factors contributing to declination of annual influenza vaccination by healthcare workers caring for cancer patients: An Australian experience. Vaccine 2018; 36:1804-1807. [PMID: 29503114 DOI: 10.1016/j.vaccine.2018.02.098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/16/2018] [Accepted: 02/22/2018] [Indexed: 10/17/2022]
Abstract
Healthcare workers (HCWs) at an Australian cancer centre were evaluated using a voluntary declination form program to determine factors contributing to declination of annual influenza vaccination. Overall, 1835/2041 HCWs (89.9%) completed a consent or declination form; 1783 were vaccinated and 52 declined. Staff roles with minimal patient contact were significantly associated with lower vaccine uptake (adjusted odds ratio 0.48, 95% confidence interval 0.23-0.99). Reasons for vaccine refusal included personal choice (41%), previous side-effect/s (23.1%), and medical reasons (23.1%). Of these, a large proportion may not be amenable to intervention, and this must be considered in setting threshold targets for future campaigns.
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Affiliation(s)
- T C Surtees
- Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
| | - B W Teh
- Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; National Centre for Infections in Cancer, National Health and Medical Research Council Centre for Research Excellence, The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - M A Slavin
- Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; National Centre for Infections in Cancer, National Health and Medical Research Council Centre for Research Excellence, The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - L J Worth
- Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; National Centre for Infections in Cancer, National Health and Medical Research Council Centre for Research Excellence, The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Victorian Healthcare Associated Infection Surveillance System (VICNISS), Doherty Institute, Melbourne, VIC, Australia
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Mandatory influenza vaccination for all healthcare personnel: a review on justification, implementation and effectiveness. Curr Opin Pediatr 2017; 29:606-615. [PMID: 28700416 DOI: 10.1097/mop.0000000000000527] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW As healthcare-associated influenza is a serious public health concern, this review examines legal and ethical arguments supporting mandatory influenza vaccination policies for healthcare personnel, implementation issues and evidence of effectiveness. RECENT FINDINGS Spread of influenza from healthcare personnel to patients can result in severe harm or death. Although most healthcare personnel believe that they should be vaccinated against seasonal influenza, the Centers for Disease Control and Prevention (CDC) report that only 79% of personnel were vaccinated during the 2015-2016 season. Vaccination rates were as low as 44.9% in institutions that did not promote or offer the vaccine, compared with rates of more than 90% in institutions with mandatory vaccination policies. Policies that mandate influenza vaccination for healthcare personnel have legal and ethical justifications. Implementing such policies require multipronged approaches that include education efforts, easy access to vaccines, vaccine promotion, leadership support and consistent communication emphasizing patient safety. SUMMARY Mandatory influenza vaccination for healthcare personnel is a necessary step in protecting patients. Patients who interact with healthcare personnel are often at an elevated risk of complications from influenza. Vaccination is the best available strategy for protecting against influenza and evidence shows that institutional policies and state laws can effectively increase healthcare personnel vaccination rates, decreasing the risk of transmission in healthcare settings. There are legal and ethical precedents for institutional mandatory influenza policies and state laws, although successful implementation requires addressing both administrative and attitudinal barriers.
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Luz PM, Johnson RE, Brown HE. Workplace availability, risk group and perceived barriers predictive of 2016-17 influenza vaccine uptake in the United States: A cross-sectional study. Vaccine 2017; 35:5890-5896. [PMID: 28890192 DOI: 10.1016/j.vaccine.2017.08.078] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Seasonal influenza, though mostly self-limited in the healthy adult, may lead to severe disease and/or complications in subpopulations. Annual influenza vaccination is available in many countries with coverage goals rarely being met. We conducted a cross-sectional study of influenza vaccine uptake and explored socio-demographic, economic, and psychological factors that explained vaccine uptake. METHODS The survey was administered via Amazon Mechanical Turk (MTurk) to United States residents in January 2017, using the Qualtrics platform. Using principal axis factor analysis, we reduced the 25 items theory-based psychological determinants into the primary constructs they measure if/when internal consistency was sufficient (Cronbach's alpha >0.60). Logistic regression models were used to quantify the association of socio-demographic, economic, and psychological factors with reported vaccine behavior in the 2016-17 flu season. RESULTS 1007 participants completed the survey, sex distribution was even, 67% had 25-44years of age, and 61% annual household income of $30-99 thousand United States dollars. About 25% had the flu shot offered at their workplace and 20% reported belonging to a group for whom the flu shot is recommended. Vaccine uptake was 31.5%. Eight predictors remained in the final adjusted model (R2=0.489), having the vaccine offered at the workplace, belonging to a group for whom the vaccine is recommended, and higher perceived barriers were the strongest predictors of vaccine uptake, increasing (and decreasing in the case of barriers) the odds by >3-fold. Additionally, higher household income, higher perceived susceptibility and higher perceived benefits also independently predicted vaccine uptake. DISCUSSION We found evidence that perceived barriers significantly impaired vaccine uptake to the same extent that having the vaccine offered at the workplace or belonging to a group for whom the vaccine is recommended facilitated uptake. Ideally, a better understanding of drivers of vaccine hesitancy will result in improved interventions to increase vaccine uptake.
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Affiliation(s)
- Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, Brazil.
| | - Riley E Johnson
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, 1295 N Martin Ave, University of Arizona, Tucson, AZ, United States
| | - Heidi E Brown
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, 1295 N Martin Ave, University of Arizona, Tucson, AZ, United States
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Asma S, Akan H, Uysal Y, Poçan AG, Sucaklı MH, Yengil E, Gereklioğlu Ç, Korur A, Başhan İ, Erdogan AF, Özşahin AK, Kut A. Factors effecting influenza vaccination uptake among health care workers: a multi-center cross-sectional study. BMC Infect Dis 2016; 16:192. [PMID: 27142774 PMCID: PMC4855819 DOI: 10.1186/s12879-016-1528-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 04/28/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The present study aimed to identify factors affecting vaccination against influenza among health professionals. METHODS We used a multi-centre cross-sectional design to conduct an online self-administered questionnaire with physicians and nurses at state and foundation university hospitals in the south-east of Turkey, between 1 January 2015 and 1 February 2015. The five participating hospitals provided staff email address lists filtered for physicians and nurses. The questionnaire comprised multiple choice questions covering demographic data, knowledge sources, and Likert-type items on factors affecting vaccination against influenza. The target response rate was 20 %. RESULTS In total, 642 (22 %) of 2870 health professionals (1220 physicians and 1650 nurses) responded to the questionnaire. Participants' mean age was 29.6 ± 9.2 years (range 17-62 years); 177 (28.2 %) were physicians and 448 (71.3 %) were nurses. The rate of regular vaccination was 9.2 % (15.2 % for physicians and 8.2 % for nurses). Increasing age, longer work duration in health services, being male, being a physician, working in an internal medicine department, having a chronic disease, and living with a person over 65 years old significantly increased vaccination compliance (p < 0.05). We found differences between vaccine compliant and non-compliant groups for expected benefit from vaccination, social influences, and personal efficacy (p < 0.05). Univariate analysis showed differences between the groups in perceptions of personal risks, side effects, and efficacy of the vaccine (p < 0.05). Multivariate analysis found that important factors influencing vaccination behavior were work place, colleagues' opinions, having a chronic disease, belief that vaccination was effective, and belief that flu can be prevented by natural ways. CONCLUSION Numerous factors influence health professionals' decisions about influenza vaccination. Strategies to increase the ratio of vaccination among physicians and nurses should consider all of these factors to increase the likelihood of success.
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Affiliation(s)
- Süheyl Asma
- Department of Family Medicine, Başkent University Faculty of Medicine, Bağlıca Kampüsü Eskişehir Yolu 20. km Bağlıca, Ankara, 06810, Turkey.
| | - Hülya Akan
- Department of Family Medicine, Yeditepe University Faculty of Medicine, İnönü Mahallesi, Kayışdağı Cad., 26 Ağustos Yerleşimi, Kadıköy, İstanbul, 34755, Turkey
| | - Yücel Uysal
- Department of Family Medicine, Mersin University Faculty of Medicine, Çiftlikköy Kampusu, Mersin, 33343, Turkey
| | - A Gürhan Poçan
- Department of Family Medicine, Başkent University Faculty of Medicine, Bağlıca Kampüsü Eskişehir Yolu 20. km Bağlıca, Ankara, 06810, Turkey
| | - Mustafa Haki Sucaklı
- Department of Family Medicine Sütçü İmam University Faculty of Medicine, Avşar Kampüsü, Kahramanmaraş, 46100, Turkey
| | - Erhan Yengil
- Department of Family Medicine, Mustafa Kemal University Faculty of Medicine, Ürgen Paşa Mh, Hatay, 31030, Turkey
| | - Çiğdem Gereklioğlu
- Department of Family Medicine, Başkent University Faculty of Medicine, Bağlıca Kampüsü Eskişehir Yolu 20. km Bağlıca, Ankara, 06810, Turkey
| | - Aslı Korur
- Department of Family Medicine, Başkent University Faculty of Medicine, Bağlıca Kampüsü Eskişehir Yolu 20. km Bağlıca, Ankara, 06810, Turkey
| | - İbrahim Başhan
- Department of Family Medicine, Mersin University Faculty of Medicine, Çiftlikköy Kampusu, Mersin, 33343, Turkey
| | - A Ferit Erdogan
- Department of Family Medicine, Başkent University Faculty of Medicine, Bağlıca Kampüsü Eskişehir Yolu 20. km Bağlıca, Ankara, 06810, Turkey
| | - A Kürşat Özşahin
- Department of Family Medicine, Başkent University Faculty of Medicine, Bağlıca Kampüsü Eskişehir Yolu 20. km Bağlıca, Ankara, 06810, Turkey
| | - Altuğ Kut
- Department of Family Medicine, Başkent University Faculty of Medicine, Bağlıca Kampüsü Eskişehir Yolu 20. km Bağlıca, Ankara, 06810, Turkey
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Santacruz-Hamer V, Porras-Povedano M, Oliva-Reina I. [Perception and attitudes of health professionals from a health area regarding influenza vaccination]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2016; 31:159-167. [PMID: 26749105 DOI: 10.1016/j.cali.2015.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/28/2015] [Accepted: 10/19/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Influenza is an infectious, acute and highly contagious disease, and vaccination remains the most effective prevention measure. Health professionals are considered at risk because of their daily exposure with patients. Vaccine coverage among health professionals in Spain is relatively low. The aim of this paper is to describe and analyse the perception and attitudes about influenza vaccination among health professionals from a health care area. METHOD A descriptive cross-sectional study was conducted using a web application method (EUSurvey). Data were analysed using descriptive, bivariate, and multivariate (logistic regression) analysis using R-project statistical software. RESULTS A total of 161 professionals (17.9%) responded to the online survey, 54.0% women (n=87) and 45.9% men (n=74). Influenza vaccination rate coverage among health professionals was 34.7%. The main reason reported by health professionals for getting vaccinated was to protect themselves (98.1%), to protect their family (72.6%), and to protect their patients (65.4%). On the other hand, the reasons for health professionals that reported not getting vaccinated was because of the lack of information about it (37.4%), fear of adverse reactions (22.2%), not having had time (14.1%), and considering that the vaccine does not work (14.1%). Multivariate analysis showed that the main factors for not getting vaccinated was to be female, type of service (administrative, medical-surgical and surgical), lack of information, and not been vaccinated before. CONCLUSIONS In order to increase vaccine uptake among health care personnel, information on the benefits of influenza vaccinations must be increased. Vaccination strategies should be targeted at those groups with lower coverage and are at high risk.
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Affiliation(s)
| | - M Porras-Povedano
- Unidad de Gestión Clínica Prevención, Promoción y Vigilancia de la Salud, Hospital de Riotinto, Área de Gestión Sanitaria Norte de Huelva, Minas de Riotinto, Huelva, España.
| | - I Oliva-Reina
- Unidad de Gestión Clínica Prevención, Promoción y Vigilancia de la Salud, Hospital de Riotinto, Área de Gestión Sanitaria Norte de Huelva, Minas de Riotinto, Huelva, España
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Rebmann T, Turner JA, Kunerth AK. Presenteeism Attitudes and Behavior Among Missouri Kindergarten to Twelfth Grade (K-12) School Nurses. J Sch Nurs 2016; 32:407-415. [PMID: 27026665 DOI: 10.1177/1059840516637651] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Working while ill (presenteeism) with symptoms of influenza-like illness can contribute to outbreaks, but little is known about school nurse presenteeism. Missouri Association of School Nurses members (N = 396) were sent a survey in 2013/2014. A chi square test was conducted to compare having a school culture that encourages presenteeism versus actual sick leave policies. Multivariate logistic regression was conducted to delineate factors associated with presenteeism. In total, 133 school nurses participated (33.6% response rate). Almost half (42.1%, n = 56) reported presenteeism. Nurses were more likely to feel pressure to engage in presenteeism than reported punitive sick leave policies (14.3% vs. 3.8%, χ2 = 18.3, p < .001). Presenteeism was associated with perceived pressure, odds ratio (OR) = 4.8, confidence interval (CI) = [1.5, 15.8], p < .01, and having a mild illness, OR = 3.6, CI = [1.4, 9.7], p = .01. Many school nurses engage in presenteeism, and this appears to be associated with organizational cultural norms rather than established sick leave policies.
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Affiliation(s)
- Terri Rebmann
- Institute for Biosecurity, Saint Louis University, College for Public Health & Social Justice, St. Louis, MO, USA .,Department of Environmental and Occupational Health, Saint Louis University, College for Public Health & Social Justice, St. Louis, MO, USA
| | - James Austin Turner
- Institute for Biosecurity, Saint Louis University, College for Public Health & Social Justice, St. Louis, MO, USA.,Department of Medical Imaging and Radiation Therapeutics, Edward and Margaret Doisy College of Health Sciences, Saint Louis University, St. Louis, MO, USA
| | - Allison K Kunerth
- Institute for Biosecurity, Saint Louis University, College for Public Health & Social Justice, St. Louis, MO, USA
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Akan H, Yavuz E, Yayla M, Külbay H, Kaspar E, Zahmacıoğlu O, Badur S. Factors affecting uptake of influenza vaccination among family physicians. Vaccine 2016; 34:1712-8. [DOI: 10.1016/j.vaccine.2016.01.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 12/14/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
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Attitudes toward influenza vaccination improvement strategies in Veterans Affairs health care workers providing care for patients with spinal cord injuries and disorders: Acceptability of a declination form program. Vaccine 2015. [DOI: 10.1016/j.vaccine.2015.06.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wicker S, Marckmann G. Vaccination of health care workers against influenza: Is it time to think about a mandatory policy in Europe? Vaccine 2014; 32:4844-8. [DOI: 10.1016/j.vaccine.2013.09.062] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 08/25/2013] [Accepted: 09/26/2013] [Indexed: 01/05/2023]
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Winston L, Wagner S, Chan S. Healthcare workers under a mandated H1N1 vaccination policy with employment termination penalty: a survey to assess employee perception. Vaccine 2014; 32:4786-90. [PMID: 24996124 DOI: 10.1016/j.vaccine.2014.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 04/21/2014] [Accepted: 06/02/2014] [Indexed: 11/26/2022]
Abstract
The ethical debate over mandatory healthcare worker (HCW) influenza vaccination is a heated one. Our study hospital instituted a mandatory employee influenza vaccination policy for the 2009-2010 influenza season during the highly publicized pandemic of the H1N1 "Swine Flu." Under this mandate there was no informed declination option, and termination of employment was the consequence for noncompliance. Our objective was to examine HCW perceptions of the H1N1 influenza virus, the vaccine, and the strict mandated vaccination policy. A survey was designed, distributed, and anonymously collected. In total, 202 completed questionnaires were obtained via accidental sampling by the investigators achieving a 100% response rate. Data analysis showed that 31.7% of surveyed HCWs felt the mandate was an infringement on their rights and 3.5% of HCWs would electively seek employment elsewhere. Significantly more nurses and clerks/technicians were opposed to the mandate compared to other types of employees. 96% felt that the mandating hospital should be liable should a significant adverse effect occur from receiving the vaccine. While the mandate helped to increase HCW influenza vaccination rates dramatically, the strict consequence of employment termination created negative feelings of coercion. Adopting a policy that includes a declination option with mandatory masking during influenza season might be a more widely acceptable and still adequate approach.
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Affiliation(s)
- Lori Winston
- CEP America, Kaweah Delta Health Care District, Visalia, CA, United States; University of California at Irvine and American University of Antigua, United States.
| | - Stephanie Wagner
- Infinity Healthcare, Sacred Heart Hospital Eau Claire, WI, United States
| | - Shu Chan
- Presence Resurrection Medical Center, Chicago, IL, United States; University of Illinois at Chicago, United States
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Lehmann BA, Ruiter RAC, Wicker S, van Dam D, Kok G. "I don't see an added value for myself": a qualitative study exploring the social cognitive variables associated with influenza vaccination of Belgian, Dutch and German healthcare personnel. BMC Public Health 2014; 14:407. [PMID: 24775096 PMCID: PMC4021212 DOI: 10.1186/1471-2458-14-407] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health Authorities recommend influenza vaccination of healthcare personnel (HCP) to decrease the transmission of influenza to vulnerable patients. Recent studies have almost exclusively used quantitative questionnaires in order to identify determinants of vaccination behaviour. Interviews enable HCP to express freely why they think they are (not) willing to get vaccinated against influenza. METHODS By means of semi-structured one-on-one interviews with 123 Belgian, Dutch and German HCP, reasons for and against vaccination, experiences with influenza vaccination, intention to get vaccinated and possible barriers, as well as willingness to advice influenza vaccination to patients were investigated. Data were processed with QSR NVivo 8.0 and analysed using a combination of a deductive and a general inductive approach. RESULTS Across countries, self-protection, patient protection, and protection of family members were reported as most important reasons to get vaccinated against influenza. Reasons to not get vaccinated against influenza were fear of side effects caused by the vaccine, a low risk-perception, the disbelief in the effectiveness of influenza vaccination, organizational barriers, misconceptions, and undefined negative emotions. CONCLUSIONS The social cognitive variables underlying the decision of HCP to get vaccinated against influenza (or not) seem to be similar in Belgium, Germany, and the Netherlands, even though some differences surfaced. A quantitative investigation of those social cognitive variables is needed in order to determine the importance of the social cognitive variables in explaining the intention to get vaccinated and the importance of the similarities and differences between countries that have been found in this study.
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Affiliation(s)
- Birthe A Lehmann
- Department of Work & Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
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Zimmerman RK. Ethical analyses of institutional measures to increase health care worker influenza vaccination rates. Vaccine 2013; 31:6172-6. [PMID: 24188752 DOI: 10.1016/j.vaccine.2013.10.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/18/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
Abstract
Health care worker (HCW) influenza vaccination rates are modest. This paper provides a detailed ethical analysis of the major options to increase HCW vaccination rates, comparing how major ethical theories would address the options. The main categories of interventions to raise rates include education, incentives, easy access, competition with rewards, assessment and feedback, declination, mandates with alternative infection control measures, and mandates with administrative action as consequences. The aforementioned interventions, except mandates, arouse little ethical controversy. However, these efforts are time and work intensive and rarely achieve vaccination rates higher than about 70%. The primary concerns voiced about mandates are loss of autonomy, injustice, lack of due process, and subsuming the individual for institutional ends. Proponents of mandates argue that they are ethical based on beneficence, non-maleficence, and duty. A number of professional associations support mandates. Arguments by analogy can be made by mandates for HCW vaccination against other diseases. The ethical systems used in the analyses include evolutionary ethics, utilitarianism, principalism (autonomy, beneficence, non-maleficence, and justice), Kantism, and altruism. Across these systems, the most commonly preferred options are easy access, assessment and feedback, declinations, and mandates with infection control measures as consequences for non-compliance. Given the ethical imperatives of non-maleficence and beneficence, the limited success of lower intensive interventions, and the need for putting patient safety ahead of HCW convenience, mandates with additional infection control measures as consequences for non-compliance are preferred. For those who opt out of vaccination due to conscience concerns, such mandates provide a means to remain employed but not put patient safety at risk.
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Affiliation(s)
- Richard K Zimmerman
- Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh, 3518 Fifth Avenue, Pittsburgh, PA 15261, United States.
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Wicker S, Rabenau HF, von Gierke L, François G, Hambach R, De Schryver A. Hepatitis B and influenza vaccines: Important occupational vaccines differently perceived among medical students. Vaccine 2013; 31:5111-7. [DOI: 10.1016/j.vaccine.2013.08.070] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 07/23/2013] [Accepted: 08/07/2013] [Indexed: 10/26/2022]
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Nowalk MP, Lin CJ, Raymund M, Bialor J, Zimmerman RK. Impact of hospital policies on health care workers' influenza vaccination rates. Am J Infect Control 2013; 41:697-701. [PMID: 23422232 DOI: 10.1016/j.ajic.2012.11.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 11/02/2012] [Accepted: 11/02/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Overall annual influenza vaccination rate has slowly increased among health care workers but still remains below the national goal of 90%. METHODS To compare hospitals that mandate annual health care worker (HCW) influenza vaccination with and without consequences for noncompliance, a 34-item survey was mailed to an infection control professional in 964 hospitals across the United States in 4 waves. Respondents were grouped by presence of a hospital policy that required annual influenza vaccination of HCWs with and without consequences for noncompliance. Combined with hospital characteristics from the American Hospital Association, data were analyzed using χ(2) or Fisher exact tests for categorical variables and t tests for continuous variables. RESULTS One hundred fifty hospitals required influenza vaccination, 84 with consequences (wear a mask, termination, education, restriction from patient care duties, unpaid leave) and 66 without consequences for noncompliance. Hospitals whose mandates have consequences for noncompliance included a broader range of personnel, were less likely to allow personal belief exemptions, or to require formal declination. The change in vaccination rates in hospitals with mandates with consequences (19.5%) was nearly double that of the hospitals with mandates without consequences (11%; P=.002). Presence of a state law regulating HCW influenza vaccination was associated with an increase in rates for mandates with consequences nearly 3 times the increase for mandates without consequences. CONCLUSION Hospital mandates for HCW influenza vaccination with consequences for noncompliance are associated with larger increases in HCW influenza vaccination rates than mandates without such consequences.
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Schmidt S, Saulle R, Di Thiene D, Boccia A, La Torre G. Do the quality of the trials and the year of publication affect the efficacy of intervention to improve seasonal influenza vaccination among healthcare workers?: Results of a systematic review. Hum Vaccin Immunother 2013; 9:349-61. [PMID: 23291943 DOI: 10.4161/hv.22736] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Despite longstanding recommendations by public-health authorities vaccination coverage in health care workers worldwide are poor. The aim of this study is to conduct a systematic review of the trials conducted to increase seasonal influenza vaccination rates among health care workers. RESULTS Ten articles met the pre-determined criteria. For all article the score calculation was performed. DISCUSSION The combination of an educational and a promotional element appared the most effective in augmenting the influenza vaccination coverage among health care workers. But some cases, the intervention did not contribute to increasing the vaccination rates among health care workers. In any case, the quality of controlled trials plays an important role in the results obtained by carrying out a specific intervention and contributed to obtaining this debatable results. MATERIALS AND METHODS Research was conducted using Scopus and PubMed database. We selected all clinical trials to perform the meta-analyses.
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Affiliation(s)
- Silvia Schmidt
- Department of Public Health and Infectious Diseases; Sapienza University of Rome; Rome, Italy; 2 University of Amsterdam; Amsterdam, the Netherlands
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Orenstein WA, Gellin BG, Buck T, Jackson LA, LaRussa PS, Mason JO, McCormick M, Morita J, Mouton C, Nevin-Woods C, Pisani A, Tan L(LJ, Torres C, Stenvig TE, Viswanath K, Hetherington S, Lewin C. Strategies to Achieve the Healthy People 2020 Annual Influenza Vaccine Coverage Goal for Health-Care Personnel: Recommendations from the National Vaccine Advisory Committee. Public Health Rep 2013. [DOI: 10.1177/003335491312800103] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - Bruce G. Gellin
- Director, National Vaccine Program Office, U.S. Department of Health and Human Services, Washington, DC Public Members
| | | | - Lisa A. Jackson
- Center for Health Studies, Group Health Cooperative, Seattle, WA
| | | | | | - Marie McCormick
- Harvard School of Public Health, Department of Society, Human Development, and Health, Boston, MA
| | - Julia Morita
- Chicago Department of Public Health, Chicago, IL
| | - Charles Mouton
- Meharry Medical College, Dean School of Medicine, Nashville, TN
| | | | | | | | - Catherine Torres
- State of New Mexico, Cabinet Secretary of Health for New Mexico, Santa Fe, NM
| | | | - Kasisomayajula Viswanath
- Harvard School of Public Health, Department of Society, Human Development, and Health, Boston, MA
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Landelle C, Vanhems P, Saadatian-Elahi M, Voirin N. Influenza vaccination coverage among patients and healthcare workers in a university hospital during the 2006-2007 influenza season. Vaccine 2012; 31:23-6. [PMID: 23116695 DOI: 10.1016/j.vaccine.2012.10.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 10/01/2012] [Accepted: 10/17/2012] [Indexed: 11/15/2022]
Abstract
Despite years of public health effort to increase vaccine uptake among populations recommended for influenza vaccination, immunization rates remain low among patients and healthcare workers (HCWs). The objective of this study was to report on influenza vaccination coverage of patients and HCWs for the same time period in 4 wards of a university hospital. A prospective cross-sectional study was conducted among patients and HCWs between December 11, 2006 and April 15, 2007 and individual factors associated with being vaccinated against influenza were assessed. Results indicated that older patients were significantly more vaccinated than younger patients. Physicians and residents were more likely to be vaccinated that the rest of staff, with possible differences between wards. Immunization of HCWs is a major issue in infection control in hospitals and long-term care facilities. However, the impact of influenza vaccination among HCWs in reducing hospital-acquired influenza and patient morbidity needs to be explored further.
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Affiliation(s)
- Caroline Landelle
- Hospices Civils de Lyon, Service d'Hygiène, Epidémiologie et Prévention, Unité Epidémiologie et Biomarqueurs de l'Infection, Lyon F-69437, France
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Hollmeyer H, Hayden F, Mounts A, Buchholz U. Review: interventions to increase influenza vaccination among healthcare workers in hospitals. Influenza Other Respir Viruses 2012; 7:604-21. [PMID: 22984794 PMCID: PMC5781006 DOI: 10.1111/irv.12002] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Helge Hollmeyer
- International Health Regulations Coordination Department, World Health Organization, Geneva, Switzerland.
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Nienhaus A, Kesavachandran C, Wendeler D, Haamann F, Dulon M. Infectious diseases in healthcare workers - an analysis of the standardised data set of a German compensation board. J Occup Med Toxicol 2012; 7:8. [PMID: 22553942 PMCID: PMC3474162 DOI: 10.1186/1745-6673-7-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 05/03/2012] [Indexed: 01/25/2023] Open
Abstract
Introduction Healthcare workers (HCW) are exposed to infectious agents. Disease surveillance is therefore needed in order to foster prevention. Methods The data of the compensation board that covers HCWs of non-governmental healthcare providers in Germany was analysed for a five-year period. For hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, the period analysed was extended to the last 15 years. The annual rate of occupational infectious diseases (OIDs) per 100,000 employees was calculated. For needlestick injuries (NSI) a rate per 1,000 employees was calculated. Results Within the five years from 2005 to 2009 a total of 384 HCV infections were recognised as OIDs (1.5/100,000 employees). Active TB was the second most frequent cause of an OID. While the numbers of HBV and HCV infections decreased, the numbers for active TB did not follow a clear pattern. Needlestick injuries (NSIs) were reported especially often at hospitals (29.9/1,000 versus 7.4/1,000 employees for all other HCWs). Conclusion Although they are declining, HCV infections remain frequent in HCWs, as do NSIs. Whether the reinforcement of the recommendations for the use of safety devices in Germany will prevent NSIs and therefore HCV infections should be closely observed.
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Affiliation(s)
- Albert Nienhaus
- Institute for Health Services Research in Dermatology and Nursing, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Wicker S, Rabenau HF, Betz W, Lauer HC. Attitudes of dental healthcare workers towards the influenza vaccination. Int J Hyg Environ Health 2012; 215:482-6. [DOI: 10.1016/j.ijheh.2011.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 08/05/2011] [Accepted: 08/16/2011] [Indexed: 10/17/2022]
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Schaetti C, Chaignat CL, Hutubessy R, Khatib AM, Ali SM, Schindler C, Weiss MG. Social and cultural determinants of anticipated acceptance of an oral cholera vaccine prior to a mass vaccination campaign in Zanzibar. HUMAN VACCINES 2011; 7:1299-308. [PMID: 22108036 DOI: 10.4161/hv.7.12.18012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Despite improvements in sanitation and water supply, cholera remains a serious public health burden. Vaccination is included among recommendations for cholera control. Cultural concepts of illness are likely to affect vaccine acceptance. This study examined social and cultural determinants of anticipated acceptance of an oral cholera vaccine (OCV) prior to a mass vaccination campaign in Zanzibar. Using a cultural epidemiological approach, 356 unaffected adult residents were studied with vignette-based semi-structured interviews. Anticipated acceptance was high for a free OCV (94%), but declined with increasing price. Logistic regression models examined social and cultural determinants of anticipated acceptance at low (USD 0.9), medium (USD 4.5) and high (USD 9) price. Models including somatic symptoms (low and high price), social impact (low and medium) and perceived causes (medium and high) explained anticipated OCV acceptance better than models containing only socio-demographic characteristics. Identifying thirst with cholera was positively associated with anticipated acceptance of the low-priced OCV, but acknowledging the value of home-based rehydration was negatively associated. Concern about spreading the infection to others was positively associated at low price among rural respondents. Confidence in the health system response to cholera outbreaks was negatively associated at medium price among peri-urban respondents. Identifying witchcraft as cause of cholera was negatively associated at medium and high price. Anticipated acceptance of free OCVs is nearly universal in cholera-endemic areas of Zanzibar; pre-intervention assessments of community demand for OCV should not only consider the social epidemiology, but also examine local socio-cultural features of cholera-like illness that explain vaccine acceptance.
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Affiliation(s)
- Christian Schaetti
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
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Abstract
PURPOSE OF REVIEW Vaccination of healthcare workers (HCWs) against influenza is an important component of infection control in healthcare settings but HCW vaccination rates remain low. Here we review current and emerging strategies for influenza vaccination of HCWs. RECENT FINDINGS Professional organizations have recommended annual influenza vaccination for HCWs since 1984, but HCW vaccination rates have improved minimally. Recent studies indicate that comprehensive influenza vaccination programs have failed to achieve adequate influenza vaccination rates for HCWs in spite of allocating substantial resources to HCW vaccination programs. Mandatory HCW influenza vaccination programs have been introduced and clearly outperform traditional comprehensive vaccination programs. Some argue that mandatory vaccination programs infringe on HCW autonomy, and introduction of mandatory vaccination programs can be controversial. Public reporting of institutional HCW influenza vaccination rates is another strategy to achieve high vaccination rates, as HCW influenza vaccination may be used in the future as a quality and safety metric. SUMMARY HCW influenza vaccination in the setting of a comprehensive infection control program is a core patient-safety practice. Mandatory HCW influenza vaccination and public reporting of HCW vaccination rates will complement one another in achieving substantial gains for HCW influenza vaccination programs.
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Kok G, van Essen GA, Wicker S, Llupià A, Mena G, Correia R, Ruiter RAC. Planning for influenza vaccination in health care workers: an Intervention Mapping approach. Vaccine 2011; 29:8512-9. [PMID: 21939722 DOI: 10.1016/j.vaccine.2011.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Revised: 08/26/2011] [Accepted: 09/06/2011] [Indexed: 11/30/2022]
Abstract
Influenza vaccination uptake by health care workers (HCWs) decreases the transmission of influenza to vulnerable patients and prevents influenza-related absenteeism. Vaccination is effective, easy, and generally without serious side-effects. However, vaccination rates of HCWs are too low. This paper's objective is to apply Intervention Mapping (IM), a planning process for the systematic theory- and evidence-based development of health promotion interventions, to the development of voluntary educational interventions to promote influenza vaccination in HCWs. IM consists of the following six steps: needs assessment, program objectives, methods and applications, program development, planning for program implementation, and planning for program evaluation. Examples are provided to illustrate the activities associated with these steps. It is concluded that applying IM in the (influenza) vaccination field may help the development of effective behavior change interventions.
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Affiliation(s)
- Gerjo Kok
- Work & Social Psychology, Maastricht University, the Netherlands.
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Chen SC, Hawkins G, Aspinall E, Patel N. Factors influencing uptake of influenza A (H1N1) vaccine amongst healthcare workers in a regional pediatric centre: lessons for improving vaccination rates. Vaccine 2011; 30:493-7. [PMID: 21527302 DOI: 10.1016/j.vaccine.2011.04.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 03/29/2011] [Accepted: 04/09/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Influenza A (H1N1) vaccination has been recommended for all frontline healthcare workers (HCWs) in the UK since October 2009, to protect individuals and their patients from infection. Understanding the factors influencing vaccine uptake by HCW may improve future vaccination programmes in current and subsequent years. AIMS To assess the uptake of influenza A (H1N1) vaccine, and factors affecting vaccine uptake, in frontline healthcare workers in a large pediatric hospital. METHOD A cross-sectional questionnaire survey conducted in a regional Pediatric Hospital in Scotland incorporating intensive care and ECMO services. One page, anonymised questionnaires were distributed to all frontline HCW in high risk departments of the hospital. RESULTS 260 questionnaires were completed, capturing an estimated 52% of all staff. Vaccination rate was 49.6%, and was significantly higher amongst doctors (OR 2.4, 95% CI 1.3-4.5, P=0.005). Commonest reasons for vaccine uptake were high risk of contact with H1N1 (88%) and responsibility to protect patients (71%). Uncertainty about vaccine side-effects (47%), concern about vaccine safety (33%) and being too busy to attend the vaccine clinic (22%) were the commonest reasons for non-vaccination. Reasons for vaccination varied between staff grouping and department. 36% of non-vaccinated staff would accept the vaccine if offered. CONCLUSIONS Vaccine uptake may be increased by addressing HCW knowledge and attitudes and access to vaccine. Future vaccination programmes should include targeted education and vaccine delivery, at the convenience of staff, and in their own department.
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Affiliation(s)
- Suet Ching Chen
- Royal Hospital for Sick Children, Dalnair Street, Yorkhill, Glasgow G3 8SJ, United Kingdom.
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Niedrige Influenzaimpfquoten bei Mitarbeitern im Gesundheitswesen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 53:1298-303. [DOI: 10.1007/s00103-010-1176-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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