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Lymon H, Meng L, Reses HE, Barbre K, Dubendris H, Shafi S, Wiegand R, Reddy GRTY, Woods A, Kuhar DT, Stuckey MJ, Lindley MC, Haas L, Qureshi I, Wong E, Benin A, Bell JM. Declines in Influenza Vaccination Coverage Among Health Care Personnel in Acute Care Hospitals During the COVID-19 Pandemic - United States, 2017-2023. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:1244-1247. [PMID: 37943698 PMCID: PMC10651322 DOI: 10.15585/mmwr.mm7245a6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Health care personnel (HCP) are recommended to receive annual vaccination against influenza to reduce influenza-related morbidity and mortality. Every year, acute care hospitals report receipt of influenza vaccination among HCP to CDC's National Healthcare Safety Network (NHSN). This analysis used NHSN data to describe changes in influenza vaccination coverage among HCP in acute care hospitals before and during the COVID-19 pandemic. Influenza vaccination among HCP increased during the prepandemic period from 88.6% during 2017-18 to 90.7% during 2019-20. During the COVID-19 pandemic, the percentage of HCP vaccinated against influenza decreased to 85.9% in 2020-21 and 81.1% in 2022-23. Additional efforts are needed to implement evidence-based strategies to increase vaccination coverage among HCP and to identify factors associated with recent declines in influenza vaccination coverage.
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Rubenstein BL, Amiel PJ, Ternier A, Helmy H, Lim S, Chokshi DA, Zucker JR. Increases In COVID-19 Vaccination Among NYC Municipal Employees After Implementation Of Vaccination Requirements. Health Aff (Millwood) 2023; 42:357-365. [PMID: 36877900 PMCID: PMC10917388 DOI: 10.1377/hlthaff.2022.00809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
In July 2021 New York City (NYC) instituted a requirement for all municipal employees to be vaccinated against COVID-19 or undergo weekly testing. The city eliminated the testing option November 1 of that year. We used general linear regression to compare changes in weekly primary vaccination series completion among NYC municipal employees ages 18-64 living in the city and a comparison group of all other NYC residents in this age group during May-December 2021. The rate of change in vaccination prevalence among NYC municipal employees was greater than that of the comparison group only after the testing option was eliminated (employee slope = 12.0; comparison slope = 5.3). Among racial and ethnic groups, the rate of change in vaccination prevalence among municipal employees was higher than the comparison group for Black and White people. The requirements were associated with narrowing the gap in vaccination prevalence between municipal employees and the comparison group overall and between Black municipal employees and employees from other racial and ethnic groups. Workplace requirements are a promising strategy for increasing vaccination among adults and reducing racial and ethnic disparities in vaccination uptake.
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Affiliation(s)
- Beth L Rubenstein
- Beth L. Rubenstein , New York City Department of Health and Mental Hygiene, Queens, New York; and Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pierre J Amiel
- Pierre J. Amiel, NYC Department of Health and Mental Hygiene; and CDC Foundation, Atlanta, Georgia
| | | | - Hannah Helmy
- Hannah Helmy, NYC Department of Health and Mental Hygiene
| | - Sungwoo Lim
- Sungwoo Lim, NYC Department of Health and Mental Hygiene
| | - Dave A Chokshi
- Dave A. Chokshi, City University of New York and New York University, New York, New York
| | - Jane R Zucker
- Jane R. Zucker, NYC Department of Health and Mental Hygiene; and CDC
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Lee JT, Sean Hu S, Zhou T, Bonner KE, Kriss JL, Wilhelm E, Carter RJ, Holmes C, de Perio MA, Lu PJ, Nguyen KH, Brewer NT, Singleton JA. Employer requirements and COVID-19 vaccination and attitudes among healthcare personnel in the U.S.: Findings from National Immunization Survey Adult COVID Module, August - September 2021. Vaccine 2022; 40:7476-7482. [PMID: 35941037 PMCID: PMC9234000 DOI: 10.1016/j.vaccine.2022.06.069] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/07/2022] [Accepted: 06/15/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Employer vaccination requirements have been used to increase vaccination uptake among healthcare personnel (HCP). In summer 2021, HCP were the group most likely to have employer requirements for COVID-19 vaccinations as healthcare facilities led the implementation of such requirements. This study examined the association between employer requirements and HCP's COVID-19 vaccination status and attitudes about the vaccine. METHODS Participants were a national representative sample of United States (US) adults who completed the National Immunization Survey Adult COVID Module (NIS-ACM) during August-September 2021. Respondents were asked about COVID-19 vaccination and intent, requirements for vaccination, place of work, attitudes surrounding vaccinations, and sociodemographic variables. This analysis focused on HCP respondents. We first calculated the weighted proportion reporting COVID-19 vaccination for HCP by sociodemographic variables. Then we computed unadjusted and adjusted prevalence ratios for vaccination coverage and key indicators on vaccine attitudes, comparing HCP based on individual self-report of vaccination requirements. RESULTS Of 12,875 HCP respondents, 41.5% reported COVID-19 vaccination employer requirements. Among HCP with vaccination requirements, 90.5% had been vaccinated against COVID-19, as compared to 73.3% of HCP without vaccination requirements-a pattern consistent across sociodemographic groups. Notably, the greatest differences in uptake between HCP with and without employee requirements were seen in sociodemographic subgroups with the lowest vaccination uptake, e.g., HCP aged 18-29 years, HCP with high school or less education, HCP living below poverty, and uninsured HCP. In every sociodemographic subgroup examined, vaccine uptake was more equitable among HCP with vaccination requirements than in HCP without. Finally, HCP with vaccination requirements were also more likely to express confidence in the vaccine's safety (68.3% vs. 60.1%) and importance (89.6% vs 79.6%). CONCLUSION In a large national US sample, employer requirements were associated with higher and more equitable HCP vaccination uptake across all sociodemographic groups examined. Our findings suggest that employer requirements can contribute to improving COVID-19 vaccination coverage, similar to patterns seen for other vaccines.
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Affiliation(s)
- James T. Lee
- CDC COVID-19 Response, 1600 Clifton Road NE, Atlanta, GA 30333, USA,Corresponding author
| | - S. Sean Hu
- CDC COVID-19 Response, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - Tianyi Zhou
- CDC COVID-19 Response, 1600 Clifton Road NE, Atlanta, GA 30333, USA,Leidos Inc, 2295 Parklake Dr NE Suite 300, Atlanta, GA 30345, USA
| | - Kimberly E. Bonner
- CDC COVID-19 Response, 1600 Clifton Road NE, Atlanta, GA 30333, USA,Epidemic Intelligence Service, CDC, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | | | | | | | - Carissa Holmes
- CDC COVID-19 Response, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | | | - Peng-jun Lu
- CDC COVID-19 Response, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | | | - Noel T. Brewer
- UNC Gillings School of Global Public Health, 325 Rosenau Hall CB #7440 Chapel Hill, NC 27599, USA
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Flu Vaccination Coverage and Predictors of Non-Vaccination in Military Health Corps Personnel 2016-2017 and 2019-2021. Vaccines (Basel) 2022; 10:vaccines10030460. [PMID: 35335092 PMCID: PMC8953286 DOI: 10.3390/vaccines10030460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
(1) Background: Vaccination is the most effective intervention to control seasonal influenza morbidity and mortality. The present study aimed to determine the influenza vaccination coverage in the Military Health Corps personnel in the 2020−2021 season, as well as the time trend and the possible influence of the pandemic on coverage, in order to study the reasons that led to the non-vaccination of health professionals and to analyze adverse drug reactions (ADRs). (2) Methods: A descriptive, cross-sectional study was conducted from February to May 2021. All FAS CMS personnel were included. A self-administered questionnaire was sent by e-mail to the selected personnel. (3) Results: Vaccination coverage in the 2016−2017 season was 15.8% (n = 276), in the 2019−2020 season it was 17.41% (n = 424), and in the 2020−2021 season it was 24.22% (n = 590). The percentage of vaccinated men was higher than the percentage of women. In 2019 and 2020 the most vaccinated group was 31−40 years old. Lieutenants had the highest vaccination uptake in 2019 and 2020. The personnel with the highest uptake of vaccines were those in the specialty of nursing in each of 2016, 2019 and 2020, with >30 years of time worked in 2016. In terms of factors leading to refusal of vaccination, the most reported was “not considered a risk group” (23.0%), and the least reported was “avoidance of vaccine administration” (2.2%). Eighty individuals presented adverse reactions after vaccine administration (9.6%). (4) Conclusions: The rate of influenza vaccination among healthcare professionals was lower during the 2020 season compared to the previous season, but was expected to increase in the upcoming 2021 season.
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McConeghy KW, Huang SS, Miller LG, McKinnell JA, Shireman TI, Mor V, Gravenstein S. Hospital Influenza Admissions as a Harbinger for Nursing Home Influenza Cases. J Am Med Dir Assoc 2019; 21:121-126. [PMID: 31445924 DOI: 10.1016/j.jamda.2019.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 03/22/2019] [Accepted: 06/24/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine temporal associations of local measures of influenza morbidity and mortality by the Centers for Disease Control and Prevention (CDC) with influenza hospitalizations in nursing home residents. DESIGN Retrospective, longitudinal panel study. SETTING AND PARTICIPANTS Long-stay nursing home residents, aged 65 years or older in 823 nursing homes from 2011 to 2015. MEASURES CDC-reported rates of influenza and pneumonia mortality and laboratory-confirmed influenza hospitalizations. We compared the CDC measures to nursing home resident hospitalizations due to (1) all-cause, (2) a primary diagnosis of respiratory or circulatory illness, and (3) a primary diagnosis of pneumonia or influenza based on Medicare Part A Claims data. RESULTS Our final sample included 273,743 unique residents in 819 nursing homes in 108 cities. National laboratory-confirmed influenza-associated hospitalizations for the group aged 65 and older occurred 0 to 1 week prior to nursing home resident influenza-related hospitalizations (Spearman ρ = 0.54). CDC-reported influenza hospitalizations occurred 3 weeks prior to CDC-reported influenza deaths (ρ = 0.59). Nursing home resident influenza hospitalizations occurred 2 weeks before local CDC-reported pneumonia and influenza deaths occurred (ρ = 0.44). CONCLUSIONS/IMPLICATIONS Publicly reported CDC measures correlate well with nursing home hospitalizations for pneumonia and influenza. Rates of laboratory-confirmed influenza hospitalizations (as reported by the CDC) may be a useful surrogate for nursing home influenza outbreaks but should be considered along with local indicators of disease outbreaks. Early community signals could be clinically leveraged as a trigger for increased infection control measures in nursing homes.
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Affiliation(s)
- Kevin W McConeghy
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI; Center of Innovation-Long-Term Services and Supports, Providence VA Medical Center, Providence, RI.
| | - Susan S Huang
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA
| | - Loren G Miller
- Infectious Disease Clinical Outcomes Research Unit (ID-CORE), Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA
| | - James A McKinnell
- Infectious Disease Clinical Outcomes Research Unit (ID-CORE), Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA
| | - Theresa I Shireman
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI; Center of Innovation-Long-Term Services and Supports, Providence VA Medical Center, Providence, RI
| | - Vincent Mor
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI; Center of Innovation-Long-Term Services and Supports, Providence VA Medical Center, Providence, RI
| | - Stefan Gravenstein
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI; Center of Innovation-Long-Term Services and Supports, Providence VA Medical Center, Providence, RI; Department of Medicine, Warren-Alpert School of Medicine, Brown University, Providence, RI
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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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Agreement with employer influenza vaccination requirements among us healthcare personnel during the 2016–2017 season. Infect Control Hosp Epidemiol 2018; 39:1019-1020. [DOI: 10.1017/ice.2018.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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McPherson CM, Halperin DM, Henry B, Di Castri AM, Kwong JC. Examination of the British Columbia influenza prevention policy for healthcare workers: Phase 1 qualitative case study. Hum Vaccin Immunother 2018; 14:1883-1889. [PMID: 29617181 PMCID: PMC6149879 DOI: 10.1080/21645515.2018.1460296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
In August 2012, British Columbia became the first Canadian province to implement a province-wide Influenza Prevention Policy requiring all healthcare workers (HCWs) in residential and acute care facilities to either be immunized against influenza, or wear masks in patient care areas during the influenza season. This qualitative case study sought to understand the key facilitators and barriers involved in developing and implementing British Columbia's Influenza Prevention Policy. An explanatory qualitative case study approach was selected for this project. Data were collected through the review of 110 documents (policy and planning documents, implementation tools, press releases, communication materials, etc.), and through 7 focus groups with policy implementation team members (n = 48). Focus group interview transcripts were analyzed using Framework Analysis methods, and Prior's approach guided document analysis. Four themes were identified: (1) Clashing paradigms, (2) Policy implementation gaps, (3) Pathways of power, and (4) Personal impacts. Issues embedded in macro-, meso-, and micro-level contexts, and planning across the province, were identified as critical to policy implementation. A province-wide approach with senior-level engagement and dedicated resources is critical in a province-wide influenza prevention policy for HCW. Recommendations to improve large-scale implementation of condition-of-service influenza policies include: engaging stakeholders early, considering the complexity of political contexts, allotting time to plan appropriately, developing 'enforcement' plans, and providing education and skills to frontline providers.
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Affiliation(s)
- Charmaine M McPherson
- a Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and the Nova Scotia Health Authority , Halifax , NS , Canada.,b School of Nursing, St. Francis Xavier University , Antigonish , NS , Canada.,c Risk Mitigation - Primary and Acute Care Branch, System Strategy and Performance Division , Department of Health and Wellness , Province of Nova Scotia, Halifax , NS , Canada
| | - Donna M Halperin
- a Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and the Nova Scotia Health Authority , Halifax , NS , Canada.,b School of Nursing, St. Francis Xavier University , Antigonish , NS , Canada
| | - Bonnie Henry
- d School of Population and Public Health, Faculty of Medicine, University of British Columbia, and Office of the Provincial Health Officer, Ministry of Health , BC , Canada
| | - Antonia M Di Castri
- a Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and the Nova Scotia Health Authority , Halifax , NS , Canada
| | - Jeffrey C Kwong
- e Institute for Clinical Evaluative Sciences , Toronto , ON , Canada.,f Public Health Ontario , Toronto , ON , Canada.,g Department of Family & Community Medicine , University of Toronto , Toronto , ON , Canada.,h Dalla Lana School of Public Health, University of Toronto , Toronto , ON , Canada.,i University Health Network , Toronto , ON , Canada
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Anderson LJ, Shekelle P, Keeler E, Uscher-Pines L, Shanman R, Morton S, Aliyev G, Nuckols TK. The Cost of Interventions to Increase Influenza Vaccination: A Systematic Review. Am J Prev Med 2018; 54:299-315. [PMID: 29362167 PMCID: PMC5788040 DOI: 10.1016/j.amepre.2017.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/28/2017] [Accepted: 11/20/2017] [Indexed: 12/15/2022]
Abstract
CONTEXT Influenza vaccination rates remain below Healthy People 2020 goals. This project sought to systematically review economic evaluations of healthcare-based quality improvement interventions for improving influenza vaccination uptake among general populations and healthcare workers. EVIDENCE ACQUISITION The databases MEDLINE, Econlit, Centre for Reviews & Dissemination, Greylit, and Worldcat were searched in July 2016 for papers published from January 2004 to July 2016. Eligible studies evaluated efforts by bodies within the healthcare system to encourage influenza vaccination by means of an organizational or structural change. For each study, program costs per enrollee and per additional enrollee vaccinated were derived (excluding vaccine costs, standardized to 2017 U.S. dollars). Complete economic evaluations were examined when available. EVIDENCE SYNTHESIS Of 2,350 records, 18 articles were eligible and described 29 unique interventions. Most interventions improved vaccine uptake. Among 23 interventions in general populations, the median program cost was $3.27 (interquartile range, $0.82-$11.53) per enrollee and $50.78 (interquartile range, $27.85-$124.84) per additional enrollee vaccinated. Among ten complete economic evaluations in general populations, three studies reported net cost savings, four reported costs <$50,000 per quality-adjusted life year, and three reported costs <$60,000 per life saved. Among six interventions in healthcare workers, the median program cost was $8.09 (interquartile range, $5.03-$10.31) per worker enrolled and $125.24 (interquartile range, $96.06-$171.38) per additional worker vaccinated (there were no complete economic analyses). CONCLUSIONS Quality improvement interventions for influenza vaccination involve per-enrollee costs that are similar to the cost of the vaccine itself ($11.78-$36.08/dose). Based on limited available evidence in general populations, quality improvement interventions may be cost saving to cost effective for the health system.
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Affiliation(s)
- Laura J Anderson
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; Department of Epidemiology, UCLA Jonathan and Karin Fielding School of Public Health, University of California-Los Angeles, Los Angeles, California.
| | - Paul Shekelle
- Evidence-based Synthesis Program, West Los Angeles VA Medical Center, Los Angeles, California; Rand Health, RAND Corporation, Santa Monica, California
| | - Emmett Keeler
- Rand Health, RAND Corporation, Santa Monica, California
| | | | | | - Sally Morton
- Department of Statistics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Gursel Aliyev
- Rand Health, RAND Corporation, Santa Monica, California
| | - Teryl K Nuckols
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; Rand Health, RAND Corporation, Santa Monica, California
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Public health masking mandates improve hospital healthcare personnel vaccination rates. Am J Infect Control 2017. [PMID: 28647050 DOI: 10.1016/j.ajic.2017.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Toledo D, Soldevila N, Guayta-Escolies R, Lozano P, Rius P, Gascón P, Domínguez A. Knowledge of and Attitudes to Influenza Vaccination among Community Pharmacists in Catalonia (Spain). 2013-2014 Season: A Cross Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070756. [PMID: 28696401 PMCID: PMC5551194 DOI: 10.3390/ijerph14070756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/30/2017] [Accepted: 07/06/2017] [Indexed: 11/25/2022]
Abstract
Annual recommendations on influenza seasonal vaccination include community pharmacists, who have low vaccination coverage. The aim of this study was to investigate the relationship between influenza vaccination in community pharmacists and their knowledge of and attitudes to vaccination. An online cross-sectional survey of community pharmacists in Catalonia, Spain, was conducted between September and November 2014. Sociodemographic, professional and clinical variables, the history of influenza vaccination and knowledge of and attitudes to influenza and seasonal influenza vaccination were collected. The survey response rate was 7.33% (506 out of 6906); responses from 463 community pharmacists were included in the final analyses. Analyses were performed using multivariable logistic regression models and stepwise backward selection method for variable selection. The influenza vaccination coverage in season 2013–2014 was 25.1%. There was an association between vaccination and correct knowledge of the virus responsible for epidemics (adjusted Odds Ratio (aOR) = 1.74; 95% CI 1.03–2.95), recommending vaccination in the postpartum (aOR = 3.63; 95% CI 2.01–6.55) and concern about infecting their clients (aOR = 5.27; 95% CI 1.88–14.76). In conclusion, community pharmacists have a very low influenza vaccination coverage, are not very willing to recommend vaccination to all their customers but they are concerned about infecting their clients.
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Affiliation(s)
- Diana Toledo
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
- Departament de Medicina, Universitat de Barcelona, 08036 Barcelona, Spain.
| | - Núria Soldevila
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
- Departament de Medicina, Universitat de Barcelona, 08036 Barcelona, Spain.
| | - Rafel Guayta-Escolies
- Unitat de Projectes i Recerca, Consell de Col·legis Farmacèutics de Catalunya, 08009 Barcelona, Spain.
| | - Pau Lozano
- Unitat de Projectes i Recerca, Consell de Col·legis Farmacèutics de Catalunya, 08009 Barcelona, Spain.
| | - Pilar Rius
- Unitat de Projectes i Recerca, Consell de Col·legis Farmacèutics de Catalunya, 08009 Barcelona, Spain.
| | - Pilar Gascón
- Unitat de Projectes i Recerca, Consell de Col·legis Farmacèutics de Catalunya, 08009 Barcelona, Spain.
| | - Angela Domínguez
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
- Departament de Medicina, Universitat de Barcelona, 08036 Barcelona, Spain.
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Pless A, Shaw D, McLennan S, Elger BS. Nurses' attitudes towards enforced measures to increase influenza vaccination: A qualitative study. Influenza Other Respir Viruses 2017; 11:247-253. [PMID: 27943585 PMCID: PMC5410727 DOI: 10.1111/irv.12441] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Despite studies demonstrating that the annual influenza vaccination of healthcare workers reduces morbidity and mortality among vulnerable patients, vaccination rates remain very low, particularly in nursing staff. Educational programmes have failed to improve rates, which has led to a diverse range of enforced approaches being advocated and implemented. OBJECTIVES To examine the attitudes of non-vaccinated nursing staff towards various enforced measures aimed at increasing rates of influenza vaccination. METHODS Semi-structured qualitative interviews with a purposive sample of 18 non-vaccinated nurses, working in units with high-risk patients at two hospitals in Switzerland. Analysis of interviews was done using conventional content analysis. RESULTS Nurses were critical of enforced measures. However, measures that include an element of choice were perceived as more acceptable. Declination forms and mandatory vaccinations as part of the employment requirements were found to be the most accepted measures. CONCLUSION The perception of choice is crucial to the acceptance of a measure. Respect for choice and autonomy has a positive effect on behavioural change. Mandatory influenza vaccination as a condition of new (and perhaps ongoing) employment could be a feasible, effective and ethical measure to increase vaccination rates among nurses who oppose vaccination.
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Affiliation(s)
- Anina Pless
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - David Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Stuart McLennan
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.,Institute for History, Ethics and Philosophy of Medicine, Medizinische Hochschule Hannover, Hannover, Germany
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.,Center for Legal Medicine, University of Geneva, Geneva, Switzerland
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Influenza Vaccination Requirements for Healthcare Personnel in U.S. Hospitals: Results of a National Survey. Infect Control Hosp Epidemiol 2017; 37:485-7. [PMID: 26996061 DOI: 10.1017/ice.2015.277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lu PJ, O'Halloran AC, Ding H, Williams WW, Black CL. Influenza Vaccination of Healthcare Personnel by Work Setting and Occupation-U.S., 2014. Am J Prev Med 2016; 51:1015-1026. [PMID: 27866594 PMCID: PMC5831180 DOI: 10.1016/j.amepre.2016.08.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 08/19/2016] [Accepted: 09/09/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Routine influenza vaccination of healthcare personnel (HCP) can reduce influenza-related illness and its potentially serious consequences among HCP and their patients. Influenza vaccination has been routinely recommended for HCP since 1984. METHODS Data from the 2013 and 2014 National Health Interview Survey were analyzed in 2015. Kaplan-Meier survival estimated the cumulative proportion of HCP reporting 2013-2014 season influenza vaccination. Vaccination coverage by work setting and occupation were assessed. Multivariable logistic regression and predictive marginal analyses identified factors independently associated with vaccination among HCP. RESULTS Influenza vaccination coverage was 64.9% among HCP aged ≥18 years (95% CI=60.5%, 69.3%), which was significantly higher compared with non-HCP among the same age group (41.0%, 95% CI=39.8%, 42.1%) (p<0.05). Vaccination coverage was higher among physicians (82.3%) and nurses (77.5%) than other types of HCP (range, 50.2%-65.6%). Coverage was higher among HCP working in hospitals (76.9%) versus other settings (range, 53.9%-60.2%). Characteristics independently associated with an increased likelihood of vaccination among HCP were older age, higher education, having more physician contacts, and having health insurance. Having never been married was independently associated with decreased likelihood of vaccination among HCP. CONCLUSIONS Influenza vaccination coverage was higher among HCP than non-HCP, but still below the national target of 90%. Vaccination coverage varied widely by occupation type, work settings, and demographic characteristics. Evidence-based interventions, such as making vaccine available at no cost in the workplace and active promotion of vaccination, are needed to increase influenza vaccination among HCP in all healthcare settings.
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Affiliation(s)
- Peng-Jun Lu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Alissa C O'Halloran
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Helen Ding
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Walter W Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carla L Black
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Martini L, Presley D, Klieger S, Burris S. A Scan of CDC-Authored Articles on Legal Epidemiology, 2011-2015. Public Health Rep 2016; 131:809-815. [PMID: 28123227 DOI: 10.1177/0033354916669497] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The Centers for Disease Control and Prevention (CDC) conducts research on legal epidemiology, the scientific study of law as a factor in the cause, distribution, and prevention of disease. This study describes a scan of articles written by CDC staff members to characterize the frequency and key features of legal epidemiology articles and their distribution across CDC departments and divisions. METHODS CDC librarians searched an internal repository for journal articles by CDC staff published from January 1, 2011, to May 31, 2015. Researchers reviewed and coded the abstracts to produce data on key features of the articles. RESULTS Researchers identified 158 CDC-authored legal epidemiology articles published in 83 journals, most frequently in Preventing Chronic Disease (14 publications), Journal of Public Health Management Practice (10 publications), and Morbidity and Mortality Weekly Report (9 publications). Most articles concerned the use and impact of law as a deliberate tool of intervention. Thirteen articles addressed the legal infrastructure of public health, and 3 assessed the incidental or unintended effects of nonhealth laws. CDC-authored articles encompassed policy making, implementation, and impact. Literature reviews and studies mapping laws across multiple jurisdictions constituted one-quarter of all publications. Studies addressed laws at the international, national, state, local, and organizational levels. CONCLUSION Results of the scan can be used to identify opportunities for the agency to better support research, professional development, networking, publication, and tracking of publication in this emerging field.
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Affiliation(s)
- Leila Martini
- Center for Public Health Law Research, Temple University Beasley School of Law, Philadelphia, PA, USA
| | - David Presley
- Center for Public Health Law Research, Temple University Beasley School of Law, Philadelphia, PA, USA
| | - Sarah Klieger
- Center for Public Health Law Research, Temple University Beasley School of Law, Philadelphia, PA, USA
| | - Scott Burris
- Center for Public Health Law Research, Temple University Beasley School of Law, Philadelphia, PA, USA
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Buchan SA, Kwong JC. Influenza immunization among Canadian health care personnel: a cross-sectional study. CMAJ Open 2016; 4:E479-E488. [PMID: 27730112 PMCID: PMC5047845 DOI: 10.9778/cmajo.20160018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Influenza immunization coverage among Canadian health care personnel remains below national targets. Targeting this group is of particular importance given their elevated risk of influenza infection, role in transmission and influence on patients' immunization status. We examined influenza immunization coverage in health care personnel in Canada, reasons for not being immunized and the impact of "vaccinate-or-mask" influenza prevention policies. METHODS In this national cross-sectional study, we pooled data from the 2007 to 2014 cycles of the Canadian Community Health Survey and restricted it to respondents who reported a health care occupation. Using bootstrapped survey weights, we examined immunization coverage by occupation and by presence of vaccinate-or-mask policies, and reasons for not being immunized. We used modified Poisson regression to estimate the prevalence ratio (PR) of influenza immunization for health care occupations compared with the general working population. RESULTS For all survey cycles combined, 50% of 18 446 health care personnel reported receiving seasonal influenza immunization during the previous 12 months, although this varied by occupation type (range 4%-72%). Compared with the general working population, family physicians and general practitioners were most likely to be immunized (PR 3.15, 95% confidence interval [CI] 2.76-3.59), whereas chiropractors, midwives and practitioners of natural healing were least likely (PR 0.17, 95% CI 0.10-0.30). Among those who were not immunized, the most frequently cited reason was the belief that influenza immunization is unnecessary. Introduction of vaccinate-or-mask policies was associated with increased influenza immunization among health care personnel. INTERPRETATION Health care personnel are more likely to be immunized against influenza than the general working population, but coverage remains suboptimal overall, and we observed wide variation by occupation type. More efforts are needed to target specific health care occupations with low immunization coverage.
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Affiliation(s)
- Sarah A Buchan
- Dalla Lana School of Public Health (Buchan, Kwong), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; Institute for Clinical Evaluative Sciences (Kwong), Toronto, Ont
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health (Buchan, Kwong), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; Institute for Clinical Evaluative Sciences (Kwong), Toronto, Ont
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Block L, Pitts S, Perl TM. Barriers and Facilitators of Implementation of a Mandate for Influenza Vaccination among Healthcare Personnel. Infect Control Hosp Epidemiol 2016; 35:724-7. [DOI: 10.1086/676434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Mandatory influenza vaccination is associated with improved healthcare personnel vaccination rates, but institutional barriers to implementation and enforcement are reported. We explored barriers and facilitators to mandatory vaccination among a national sample of hospital administrators. Support from employees and administration were cited as key to the success of a mandate.Infect Control Hosp Epidemiol 2014;35(6):724-727
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Lin CJ, Nowalk MP, Raymund M, Sweeney PM, Zimmerman RK. Association of State Laws and Healthcare Workers’ Influenza Vaccination Rates. J Natl Med Assoc 2016; 108:99-102. [DOI: 10.1016/j.jnma.2015.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
The purpose of this statement is to reaffirm the American Academy of Pediatrics' support for a mandatory influenza immunization policy for all health care personnel. With an increasing number of organizations requiring influenza vaccination, coverage among health care personnel has risen to 75% in the 2013 to 2014 influenza season but still remains below the Healthy People 2020 objective of 90%. Mandatory influenza immunization for all health care personnel is ethical, just, and necessary to improve patient safety. It is a crucial step in efforts to reduce health care-associated influenza infections.
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Abstract
With all the new vaccines and strategies for prevention, the most important challenge that one continues to talk about globally and at home is the one presented by ongoing transmission of diseases for which excellent vaccines already exist. As pediatricians, this presents a constant reminder to keep the conversation about the importance of vaccine-preventable diseases with the patients and their families going at every possible opportunity possible. One needs to constantly remind oneself that every case of a vaccine-preventable disease is a missed opportunity for prevention. One must also have a broader perspective for global eradication of vaccine-preventable disease and advocate for availability of vaccines globally at affordable cost and encourage local vaccine development.
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Affiliation(s)
- Ayesha Mirza
- Department of Pediatrics, University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES), 653-1 West 8th Street, Jacksonville, FL 32209, USA; Pediatric Infectious Diseases and Immunology, Wolfson Children's Hospital, 800 Prudential Drive, Jacksonville, FL 32207, USA
| | - Mobeen H Rathore
- Department of Pediatrics, University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES), 653-1 West 8th Street, Jacksonville, FL 32209, USA; Pediatric Infectious Diseases and Immunology, Wolfson Children's Hospital, 800 Prudential Drive, Jacksonville, FL 32207, USA.
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Ojha RP, Stallings-Smith S, Flynn PM, Adderson EE, Offutt-Powell TN, Gaur AH. The Impact of Vaccine Concerns on Racial/Ethnic Disparities in Influenza Vaccine Uptake Among Health Care Workers. Am J Public Health 2015; 105:e35-41. [PMID: 26180953 DOI: 10.2105/ajph.2015.302736] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We explored whether collective concerns about the safety, effectiveness, and necessity of influenza vaccines mediate racial/ethnic disparities in vaccine uptake among health care workers (HCWs). METHODS We used a self-administered Web-based survey to assess race/ethnicity (exposure), concerns about influenza vaccination (mediator; categorized through latent class analysis), and influenza vaccine uptake (outcome) for the 2012 to 2013 influenza season among HCWs at St. Jude Children's Research Hospital in Memphis, Tennessee. We used mediation analysis to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the total, direct, and indirect effects of race/ethnicity on influenza vaccine uptake. RESULTS Non-Hispanic Blacks had lower influenza vaccine uptake than non-Hispanic Whites (total effect: PR = 0.87; 95% CI = 0.75, 0.99), largely mediated by high concern about influenza vaccines (natural indirect effect: PR = 0.89; 95% CI = 0.84, 0.94; controlled direct effect: PR = 0.98; 95% CI = 0.85, 1.1). Hispanic and Asian HCWs had modestly lower uptake than non-Hispanic Whites, also mediated by high concern about influenza vaccines. CONCLUSIONS Racial/ethnic disparities among HCWs could be attenuated if concerns about the safety, effectiveness, and necessity of influenza vaccines were reduced.
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Affiliation(s)
- Rohit P Ojha
- Rohit P. Ojha and Sericea Stallings-Smith are with the Department of Epidemiology and Cancer Control, and Patricia M. Flynn, Elisabeth E. Adderson, and Aditya H. Gaur are with the Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN. Tabatha N. Offutt-Powell is with the Data and Informatics Section, Division of Public Health, Delaware State Health Services, Dover
| | - Sericea Stallings-Smith
- Rohit P. Ojha and Sericea Stallings-Smith are with the Department of Epidemiology and Cancer Control, and Patricia M. Flynn, Elisabeth E. Adderson, and Aditya H. Gaur are with the Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN. Tabatha N. Offutt-Powell is with the Data and Informatics Section, Division of Public Health, Delaware State Health Services, Dover
| | - Patricia M Flynn
- Rohit P. Ojha and Sericea Stallings-Smith are with the Department of Epidemiology and Cancer Control, and Patricia M. Flynn, Elisabeth E. Adderson, and Aditya H. Gaur are with the Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN. Tabatha N. Offutt-Powell is with the Data and Informatics Section, Division of Public Health, Delaware State Health Services, Dover
| | - Elisabeth E Adderson
- Rohit P. Ojha and Sericea Stallings-Smith are with the Department of Epidemiology and Cancer Control, and Patricia M. Flynn, Elisabeth E. Adderson, and Aditya H. Gaur are with the Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN. Tabatha N. Offutt-Powell is with the Data and Informatics Section, Division of Public Health, Delaware State Health Services, Dover
| | - Tabatha N Offutt-Powell
- Rohit P. Ojha and Sericea Stallings-Smith are with the Department of Epidemiology and Cancer Control, and Patricia M. Flynn, Elisabeth E. Adderson, and Aditya H. Gaur are with the Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN. Tabatha N. Offutt-Powell is with the Data and Informatics Section, Division of Public Health, Delaware State Health Services, Dover
| | - Aditya H Gaur
- Rohit P. Ojha and Sericea Stallings-Smith are with the Department of Epidemiology and Cancer Control, and Patricia M. Flynn, Elisabeth E. Adderson, and Aditya H. Gaur are with the Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN. Tabatha N. Offutt-Powell is with the Data and Informatics Section, Division of Public Health, Delaware State Health Services, Dover
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Lei Y, Pereira JA, Quach S, Bettinger JA, Kwong JC, Corace K, Garber G, Feinberg Y, Guay M. Examining Perceptions about Mandatory Influenza Vaccination of Healthcare Workers through Online Comments on News Stories. PLoS One 2015; 10:e0129993. [PMID: 26086194 PMCID: PMC4473076 DOI: 10.1371/journal.pone.0129993] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/16/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of this study was to understand online public perceptions of the debate surrounding the choice of annual influenza vaccinations or wearing masks as a condition of employment for healthcare workers, such as the one enacted in British Columbia in August 2012. METHODS Four national and 82 local (British Columbia) Canadian online news sites were searched for articles posted between August 2012 and May 2013 containing the words "healthcare workers" and "mandatory influenza vaccinations/immunizations" or "mandatory flu shots and healthcare workers." We included articles from sources that predominantly concerned our topic of interest and that generated reader comments. Two researchers coded the unedited comments using thematic analysis, categorizing codes to allow themes to emerge. In addition to themes, the comments were categorized by: 1) sentiment towards influenza vaccines; 2) support for mandatory vaccination policies; 3) citing of reference materials or statistics; 4) self-identified health-care worker status; and 5) sharing of a personal story. RESULTS 1163 comments made by 648 commenters responding to 36 articles were analyzed. Popular themes included concerns about freedom of choice, vaccine effectiveness, patient safety, and distrust in government, public health, and the pharmaceutical industry. Almost half (48%) of commenters expressed a negative sentiment toward the influenza vaccine, 28% were positive, 20% were neutral, and 4% expressed mixed sentiment. Of those who commented on the policy, 75% did not support the condition to work policy, while 25% were in favour. Of the commenters, 11% self-identified as healthcare workers, 13% shared personal stories, and 18% cited a reference or statistic. INTERPRETATION The perception of the influenza vaccine in the comment sections of online news sites is fairly poor. Public health agencies should consider including online forums, comment sections, and social media sites as part of their communication channels to correct misinformation regarding the benefits of HCW influenza immunization and the effectiveness of the vaccine.
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Affiliation(s)
- Yang Lei
- Public Health Ontario, Toronto, ON, Canada
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | | | | | - Julie A. Bettinger
- Vaccine Evaluation Center, Vancouver, BC, Canada
- BC Children’s Hospital, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | - Jeffrey C. Kwong
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Kimberly Corace
- The Ottawa Hospital, Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Gary Garber
- Public Health Ontario, Toronto, ON, Canada
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - Yael Feinberg
- Public Health Ontario, Toronto, ON, Canada
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Maryse Guay
- Département des sciences de la santé communautaire, Université de Sherbrooke, Longueuil, QC, Canada
- Institut national de santé publique du Québec, Longueuil, QC, Canada
- Centre de recherche de l’Hôpital Charles LeMoyne, Longueuil, QC, Canada
- Agence de la santé et des services sociaux de la Montérégie, Longueuil, QC, Canada
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Kim H, Lindley MC, Dube D, Kalayil EJ, Paiva KA, Raymond P. Evaluation of the impact of the 2012 Rhode Island health care worker influenza vaccination regulations: implementation process and vaccination coverage. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2015; 21:E1-9. [PMID: 25105280 PMCID: PMC4736136 DOI: 10.1097/phh.0000000000000128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT In October 2012, the Rhode Island Department of Health (HEALTH) amended its health care worker (HCW) vaccination regulations to require all HCWs to receive annual influenza vaccination or wear a surgical mask during direct patient contact when influenza is widespread. Unvaccinated HCWs failing to wear a mask are subject to a fine and disciplinary action. OBJECTIVE To describe the implementation of the 2012 Rhode Island HCW influenza vaccination regulations and examine their impact on vaccination coverage. DESIGN Two data sources were used: (1) a survey of all health care facilities subject to the HCW regulations and (2) HCW influenza vaccination coverage data reported to HEALTH by health care facilities. Descriptive statistics and paired t tests were performed using SAS Release 9.2. SETTING AND PARTICIPANTS For the 2012-2013 influenza season, 271 inpatient and outpatient health care facilities in Rhode Island were subject to the HCW regulations. MAIN OUTCOME MEASURE Increase in HCW influenza vaccination coverage. RESULTS Of the 271 facilities, 117 facilities completed the survey (43.2%) and 160 facilities reported vaccination data to HEALTH (59.0%). Between the 2011-2012 and 2012-2013 influenza seasons, the proportion of facilities having a masking policy, as required by the revised regulations, increased from 9.4% to 94.0% (P < .001). However, the proportion of facilities implementing Advisory Committee on Immunization Practices-recommended strategies to promote HCW influenza vaccination did not increase. The majority of facilities perceived benefits to collecting HCW influenza vaccination data, including strengthening infection prevention efforts (83.2%) and improving patient and coworker safety (75.2%). Concurrent with the new regulations, influenza vaccination coverage among employee HCWs in Rhode Island increased from 69.7% in the 2011-2012 influenza season to 87.2% in the 2012-2013 season. CONCLUSION Rhode Island's experience demonstrates that statewide HCW influenza vaccination requirements incorporating mask wearing and moderate penalties for noncompliance can be effective in improving influenza vaccination coverage among HCWs.
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Affiliation(s)
- Hanna Kim
- Division of Community, Family Health, and Equity, Rhode Island Department of Health, Providence (Dr Kim and Mss Paiva and Raymond); Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island (Dr Kim); National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Lindley); Independent Healthcare Consultant, Providence, Rhode Island (Ms Dube); and Carter Consulting, Inc, Atlanta, Georgia (Ms Kalayil)
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Jarrett C, Wilson R, O'Leary M, Eckersberger E, Larson HJ. Strategies for addressing vaccine hesitancy - A systematic review. Vaccine 2015; 33:4180-90. [PMID: 25896377 DOI: 10.1016/j.vaccine.2015.04.040] [Citation(s) in RCA: 612] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED The purpose of this systematic review is to identify, describe and assess the potential effectiveness of strategies to respond to issues of vaccine hesitancy that have been implemented and evaluated across diverse global contexts. METHODS A systematic review of peer reviewed (January 2007-October 2013) and grey literature (up to October 2013) was conducted using a broad search strategy, built to capture multiple dimensions of public trust, confidence and hesitancy concerning vaccines. This search strategy was applied and adapted across several databases and organizational websites. Descriptive analyses were undertaken for 166 (peer reviewed) and 15 (grey literature) evaluation studies. In addition, the quality of evidence relating to a series of PICO (population, intervention, comparison/control, outcomes) questions defined by the SAGE Working Group on Vaccine Hesitancy (WG) was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria; data were analyzed using Review Manager. RESULTS Across the literature, few strategies to address vaccine hesitancy were found to have been evaluated for impact on either vaccination uptake and/or changes in knowledge, awareness or attitude (only 14% of peer reviewed and 25% of grey literature). The majority of evaluation studies were based in the Americas and primarily focused on influenza, human papillomavirus (HPV) and childhood vaccines. In low- and middle-income regions, the focus was on diphtheria, tetanus and pertussis, and polio. Across all regions, most interventions were multi-component and the majority of strategies focused on raising knowledge and awareness. Thirteen relevant studies were used for the GRADE assessment that indicated evidence of moderate quality for the use of social mobilization, mass media, communication tool-based training for health-care workers, non-financial incentives and reminder/recall-based interventions. Overall, our results showed that multicomponent and dialogue-based interventions were most effective. However, given the complexity of vaccine hesitancy and the limited evidence available on how it can be addressed, identified strategies should be carefully tailored according to the target population, their reasons for hesitancy, and the specific context.
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Affiliation(s)
- Caitlin Jarrett
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rose Wilson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Maureen O'Leary
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Elisabeth Eckersberger
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Heidi J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.
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A new approach to improving healthcare personnel influenza immunization programs: a randomized controlled trial. PLoS One 2015; 10:e0118368. [PMID: 25781888 PMCID: PMC4363667 DOI: 10.1371/journal.pone.0118368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 01/11/2015] [Indexed: 11/19/2022] Open
Abstract
Background Healthcare personnel influenza immunization rates remain sub-optimal. Following multiple studies and expert consultations, the “Successful Influenza Immunization Programs for Healthcare Personnel: A Guide for Program Planners” was produced. This trial assessed the impact of the Guide with facilitation in improving healthcare personnel influenza immunization rates in Canadian healthcare organizations. Methods A sample of 26 healthcare organizations across six Canadian provinces (ON, MB, NS, BC, SK, NL) was randomized to Intervention (n=13) or Control groups (n=13). Baseline influenza immunization rates were obtained for 2008–2009; the study groups were followed over two subsequent influenza seasons. The Intervention group received the Guide, facilitation support through workshops for managers and ongoing support. The Control groups conducted programs as usual. The Groups were compared using their reported influenza healthcare personnel influenza immunization rates and scores from a program assessment questionnaire. Findings Twenty-six organizations agreed to participate. 35% (9/26) of sites were acute care hospitals, 19% (5/26) continuing care, long-term care organizations or nursing homes, and 46% (12/26) were mixed acute care hospitals and long-term care or regional health authorities. The median rate of influenza immunization among healthcare personnel for the Intervention group was 43%, 44%, and 51% at three points in time respectively, and in the Control group: 62%, 57%, and 55% respectively. No significant differences were observed between the groups at the three points in time. However, there was a 7% increase in the median rates between the Baseline Year and Year Two in the Intervention group, and a 6% decrease in the Control group over the same time period, which was statistically significant (0.071 versus -0.058, p < 0.001). Interpretation This pragmatic randomized trial of the Guide with facilitation of its implementation improved healthcare personnel immunization rates, but these rates continued to be sub-optimal and below rates achievable in programs requiring personnel to be immunized. Trial Registration ClinicalTrials.gov NCT01207518
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Workplace-based influenza vaccination promotion practices among large employers in the United States. J Occup Environ Med 2014; 56:397-402. [PMID: 24492538 DOI: 10.1097/jom.0000000000000115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Influenza vaccination levels in the working-age population are low. Workplace promotion practices can increase employee vaccination levels, but the extent of employers' use of these practices is unknown. We aimed to estimate the prevalence of employers' use of evidence-based practices for promoting influenza vaccination in the workplace. METHODS We conducted a telephone survey of large employers across the United States regarding their use of evidence-based practices to promote vaccination. RESULTS Eighty-four percent of 583 employers surveyed offered on-site vaccination. Use of four promotion practices was high (75% or more), but the remaining four practices were used by only a minority of employers. There is particular room for improvement in the use of practices that increase physical access to vaccination. CONCLUSIONS Employers are highly engaged in basic influenza vaccination promotion practices, but there is potential to increase levels of use.
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Gruben V, Siemieniuk RA, McGeer A. Health care workers, mandatory influenza vaccination policies and the law. CMAJ 2014; 186:1076-80. [PMID: 24863919 PMCID: PMC4188651 DOI: 10.1503/cmaj.140035] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Vanessa Gruben
- Faculty of Common Law (Gruben), University of Ottawa, Ottawa, Ont.; Department of Internal Medicine (Siemieniuk), University of Toronto; Department of Laboratory Medicine and Pathobiology and the Dalla Lana School of Public Health (McGeer), University of Toronto, Toronto, Ont
| | - Reed A Siemieniuk
- Faculty of Common Law (Gruben), University of Ottawa, Ottawa, Ont.; Department of Internal Medicine (Siemieniuk), University of Toronto; Department of Laboratory Medicine and Pathobiology and the Dalla Lana School of Public Health (McGeer), University of Toronto, Toronto, Ont
| | - Allison McGeer
- Faculty of Common Law (Gruben), University of Ottawa, Ottawa, Ont.; Department of Internal Medicine (Siemieniuk), University of Toronto; Department of Laboratory Medicine and Pathobiology and the Dalla Lana School of Public Health (McGeer), University of Toronto, Toronto, Ont.
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A systematic review of mandatory influenza vaccination in healthcare personnel. Am J Prev Med 2014; 47:330-40. [PMID: 25145618 DOI: 10.1016/j.amepre.2014.05.035] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 04/12/2014] [Accepted: 05/29/2014] [Indexed: 11/20/2022]
Abstract
CONTEXT Influenza is a major cause of patient morbidity. Mandatory influenza vaccination of healthcare personnel (HCP) is increasingly common yet has uncertain clinical impact. This study systematically examines published evidence of the benefits and harm of influenza vaccine mandates. EVIDENCE ACQUISITION MEDLINE, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Science Citation Index Expanded, and Conference Proceedings Citations Index were searched and analyzed in 2013. Studies must have assessed the effect of a requirement of influenza vaccination among HCP for continued employment or clinical practice. Studies were not limited by comparison group, outcome, language, or study design. Two reviewers independently abstracted data and assessed bias risk. EVIDENCE SYNTHESIS Twelve observational studies were included in the study from 778 citations. Following implementation of a vaccine mandate, vaccination rates increased in all eight studies reporting this outcome, exceeding 94%. Three studies documented increased vaccination rates in hospitals with mandates compared to those without (p<0.001 for all comparisons). Two single-institution studies reported limited, inconclusive results on absenteeism among HCP. No studies reported on clinical outcomes among patients. Medical and religious exemptions and terminations or voluntary resignations were rare. CONCLUSIONS Evidence from observational studies suggests that a vaccine mandate increases vaccination rates, but evidence on clinical outcomes is lacking. Although challenging, large healthcare employers planning to implement a mandate should develop a strategy to evaluate HCP and patient outcomes. Further studies documenting the impact of HCP influenza vaccination on clinical outcomes would inform decisions on the use of mandatory vaccine policies in HCP.
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Wicker S, Maltezou HC. Vaccine-preventable diseases in Europe: where do we stand? Expert Rev Vaccines 2014; 13:979-87. [DOI: 10.1586/14760584.2014.933077] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kao CM, Schneyer RJ, Bocchini JA. Child and adolescent immunizations: selected review of recent US recommendations and literature. Curr Opin Pediatr 2014; 26:383-95. [PMID: 24722457 DOI: 10.1097/mop.0000000000000093] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To provide a clinically relevant summary of the latest research and recommendations regarding childhood and adolescent immunizations. RECENT FINDINGS Childhood vaccination has dramatically reduced pediatric morbidity and mortality in the United States. Recent research on childhood and adolescent immunizations has focused on expanding the use of current vaccines for additional subpopulations as well as the development of new vaccines. In particular, data confirming the safety and immunogenicity of vaccines in various groups of children have shaped national guidelines. Furthermore, studies on vaccine uptake, cost-effectiveness, and impact of vaccination have reinforced the importance of adhering to these guidelines. More work needs to be done by providers and parents to increase vaccination coverage rates to better protect children and adolescents from these serious diseases. In this article, selected recent publications and recommendations on the following vaccines are reviewed: influenza, meningococcal conjugate, childhood and adolescent/adult formulations of diphtheria and tetanus toxoids and acellular pertussis, pneumococcal conjugate, and human papillomavirus. SUMMARY Research on childhood and adolescent vaccinations continues to shape future guidelines. Through this work, we can learn how to optimize the protection of all children and adolescents against vaccine-preventable diseases.
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Affiliation(s)
- Carol M Kao
- aDivision of General Pediatrics, Steven and Alexandra Cohen Children's Medical Center, North Shore-Long Island Jewish Health System, New Hyde Park, New York bDepartment of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
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Khodyakov D, Uscher-Pines L, Lorick SA, Lindley MC, Shier V, Harris K. A qualitative analysis of the impact of healthcare personnel influenza vaccination requirements in California. Vaccine 2014; 32:3082-7. [PMID: 23845810 PMCID: PMC5763491 DOI: 10.1016/j.vaccine.2013.06.077] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 05/15/2013] [Accepted: 06/20/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Using qualitative methods, we explored the implementation of California's 2007 influenza immunization requirements of hospital-based health care personnel (HCP). METHODS We conducted nine case studies of California hospitals with different HCP vaccination rates and policies. Case studies consisted of interviewing 13 hospital representatives and analyzing relevant hospital documents, including influenza policies. We also conducted 13 semi-structured phone interviews with key state and county public health officials, union representatives, and officials of various professional healthcare organizations. RESULTS Our qualitative results suggest that California's vaccination requirements likely did not increase influenza vaccination uptake among HCP. The law was not strong enough to compel hospitals with low and medium vaccination rates to improve their vaccination efforts, and hospitals with high vaccination rates were able to comply fully with the law by continuing to do what they were already doing - namely offering vaccinations to HCP, providing education about the risks of influenza and the benefits of vaccination, and obtaining signed declinations from those who refuse vaccination. Nonetheless, we found that by publicly raising the issue of influenza vaccination in the context of public safety and healthcare quality, California's law encouraged hospitals to develop and implement data systems to monitor the effectiveness of vaccination promotion efforts and prompted discussions, and, in some cases, adoption of stricter vaccination requirements at hospital or county levels. CONCLUSIONS Our findings generally support the literature that suggests that permissive influenza vaccination requirements, though politically feasible, provide little direct incentive for hospitals to focus efforts on increasing HCP vaccination rates.
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Affiliation(s)
| | | | | | - Megan C Lindley
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Harris KM, Uscher-Pines L, Han B, Lindley MC, Lorick SA. The impact of influenza vaccination requirements for hospital personnel in California: knowledge, attitudes, and vaccine uptake. Am J Infect Control 2014; 42:288-93. [PMID: 24581018 DOI: 10.1016/j.ajic.2013.09.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/26/2013] [Accepted: 09/30/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND Seasonal influenza infections are a leading cause of illness, death, and lost productivity. Vaccinating health care personnel (HCP) can reduce transmission of influenza virus to patients and reduce influenza-related absenteeism, enabling the health care system to meet elevated demand for care during influenza outbreaks. OBJECTIVES We evaluated the impact of California's 2006 influenza vaccination requirement for hospital workers (requiring vaccination or signed declinations) on uptake and vaccination-related attitudes, beliefs, and knowledge among hospital HCP. METHODS We used a causal difference-in-differences approach to compare changes over the prior 10 years in the self-reported frequency of influenza vaccination for California hospital HCP and those from other states without similar laws using data from a stratified sample (N = 3,529) of HCP drawn from online survey panels. We also examined cross-sectional differences in awareness of vaccination policies, promotion efforts, and attitudes toward influenza vaccination. All analyses used propensity score weighting to balance the observable characteristics of the 2 samples. RESULTS We found that compared with their counterparts in other states, California hospital HCP were (1) more likely to report working under a formal written policy for influenza vaccination, (2) no more likely to be vaccinated, and (3) less likely to report working for an employer who provided financial incentives for vaccination or rewarded or recognized employees for being vaccinated. CONCLUSION Our results suggest that state-level vaccination requirements such as those enacted by California, may not be sufficient to increase uptake among hospital HCP.
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Affiliation(s)
| | | | - Bing Han
- RAND Corporation, Santa Monica, CA
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Tetanus, diphtheria and acellular pertussis (Tdap) vaccination among healthcare personnel-United States, 2011. Vaccine 2013; 32:572-8. [PMID: 24308960 DOI: 10.1016/j.vaccine.2013.11.077] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 11/13/2013] [Accepted: 11/21/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Health-care personnel (HCP) are at risk for exposure to and possible transmission of vaccine-preventable diseases. Receiving recommended vaccines is an essential prevention practice for HCP to protect themselves and their patients. The tetanus, diphtheria and acellular pertussis vaccine (Tdap) was recommended by the Advisory Committee on Immunization Practices (ACIP) for HCP in 2006 for protection against pertussis. We assessed the recent compliance of U.S. HCP in receiving Tdap vaccination. METHODS To estimate Tdap vaccination coverage among HCP, we analyzed data from the 2011 National Health Interview Survey (NHIS). Multivariable logistic regression and predictive marginal models were performed to identify factors independently associated with vaccination among HCP. RESULTS Overall, Tdap vaccination coverage was 26.9% among HCP aged 18-64 years (95% confidence interval (CI)=24.3%, 29.7%), which was significantly higher compared with non-HCP among the same age group (11.1%; 10.5-11.8%). Overall, vaccination coverage was significantly higher among physicians (41.5%) compared with nurses (36.5%) and other types of HCP (range 11.7-29.9%). Vaccination coverage was significantly higher among HCP aged 18-49 years compared with those 50-64 years (30.0% vs. 19.2%, respectively). Characteristics independently associated with an increased likelihood of Tdap vaccination among HCP were: younger age, higher education, living in the western United States, being hospitalized within past year, having a place for routine health care in clinic or health center, and receipt of influenza vaccination in the previous year. Marital status of widowed, divorced, or separated was independently associated with a decreased likelihood of Tdap vaccination among HCP. CONCLUSIONS By 2011, Tdap vaccination coverage was only 26.9% among HCP. Vaccination coverage varied widely by types of HCP and demographic characteristics. Emphasizing the benefits of HCP vaccination for staff and patients, providing vaccinations in the workplace and other non-traditional settings, and providing Tdap at no charge may help increase Tdap vaccination among HCP in all health-care settings.
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Domínguez A, Godoy P, Castilla J, Soldevila N, Toledo D, Astray J, Mayoral JM, Tamames S, García-Gutiérrez S, González-Candelas F, Martín V, Díaz J, Torner N. Knowledge of and attitudes to influenza vaccination in healthy primary healthcare workers in Spain, 2011-2012. PLoS One 2013; 8:e81200. [PMID: 24260560 PMCID: PMC3832596 DOI: 10.1371/journal.pone.0081200] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 10/09/2013] [Indexed: 01/08/2023] Open
Abstract
Annual influenza vaccination is recommended for healthcare workers, but many do not follow the recommendation. The objective of this study was to investigate the factors associated with seasonal influenza vaccination in the 2011–2012 season. We carried out an anonymous web survey of Spanish primary healthcare workers in 2012. Information on vaccination, and knowledge and attitudes about the influenza vaccine was collected. Workers with medical conditions that contraindicated vaccination and those with high risk conditions were excluded. Multivariate analysis was performed using unconditional logistic regression. We included 1,749 workers. The overall vaccination coverage was 50.7% and was higher in workers aged ≥ 55 years (55.7%), males (57.4%) and paediatricians (63.1%). Factors associated with vaccination were concern about infection at work (aOR 4.93; 95% CI 3.72–6.53), considering that vaccination of heathcare workers is important (aOR 2.62; 95%CI 1.83–3.75) and that vaccination is effective in preventing influenza and its complications (aOR 2.40; 95% CI 1.56–3.67). No association was found between vaccination and knowledge of influenza or the vaccine characteristics. Educational programs should aim to remove the misconceptions and attitudes that limit compliance with recommendations about influenza vaccination in primary healthcare workers rather than only increasing knowledge about influenza and the characteristics of the vaccine.
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Affiliation(s)
- Angela Domínguez
- Departamento de Salud Pública, Universidad de Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- * E-mail:
| | - Pere Godoy
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Agencia de Salud Pública de Cataluña, Barcelona, Spain
| | - Jesús Castilla
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Instituto de Salud Pública de Navarra, Pamplona, Spain
| | - Núria Soldevila
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Diana Toledo
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Servicio de Epidemiología, Agencia de Salud Pública de Barcelona, Barcelona, Spain
| | - Jenaro Astray
- Área de Epidemiología, Comunidad de Madrid, Madrid, Spain
| | | | - Sonia Tamames
- Dirección General de Salud Pública, Investigación, Desarrollo e Innovación, Junta de Castilla y León, León, Spain
| | | | | | - Vicente Martín
- Instituto de Biomedicina, Universidad de León, León, Spain
| | - José Díaz
- Servicio Andaluz de Salud, Sevilla, Spain
| | - Nuria Torner
- Departamento de Salud Pública, Universidad de Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Agencia de Salud Pública de Cataluña, Barcelona, Spain
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Byrd KK, Lu PJ, Murphy TV. Hepatitis B vaccination coverage among health-care personnel in the United States. Public Health Rep 2013; 128:498-509. [PMID: 24179261 PMCID: PMC3804093 DOI: 10.1177/003335491312800609] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES We compared self-reported hepatitis B (HepB) vaccine coverage among health-care personnel (HCP) with HepB vaccine coverage among the general population and determined trends in vaccination coverage among HCP. METHODS We used the 2010 National Health Interview Survey (NHIS) to determine the weighted proportion of self-reported ≥ 1- and ≥ 3-dose HepB vaccine coverage among HCP aged ≥ 18 years. We used logistic regression to determine independent predictors of vaccination and performed a trend analysis to determine changes in coverage from 2004 to 2010 using data from the 2004-2010 NHIS. RESULTS Overall, 69.5% (95% confidence interval [CI] 67.2, 71.8) and 63.4% (95% CI 60.8, 65.9) of HCP reported receiving ≥ 1 and ≥ 3 doses of HepB vaccine, respectively, compared with 27.1% (95% CI 26.1, 28.1%) and 23.0% (95% CI 22.1, 24.0) among non-HCP. Among HCP with direct patient contact, 80.7% (95% CI 78.2, 83.1) and 74.0% (95% CI 71.2, 76.8) received ≥ 1 and ≥ 3 HepB vaccine doses, respectively. Independent predictors of vaccination included direct patient contact, having more than a high school education, influenza vaccination in the past year, and ever having been tested for HIV. There was no significant change in reported coverage from 2004 through 2010. CONCLUSION The 2010 HepB vaccine coverage estimate among HCP remained well below the Healthy People 2010 goal of 90%. Efforts to target unvaccinated HCP for preexposure HepB protection should be encouraged.
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Affiliation(s)
- Kathy K. Byrd
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Viral Hepatitis, Atlanta, GA
| | - Peng-jun Lu
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division, Atlanta, GA
| | - Trudy V. Murphy
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Viral Hepatitis, Atlanta, GA
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Quach S, Pereira JA, Kwong JC, Quan S, Crowe L, Guay M, Bettinger JA. Immunizing health care workers against influenza: a glimpse into the challenges with voluntary programs and considerations for mandatory policies. Am J Infect Control 2013; 41:1017-23. [PMID: 23973425 DOI: 10.1016/j.ajic.2013.05.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 05/15/2013] [Accepted: 05/15/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Vaccination of health care workers (HCWs) is an important patient safety initiative. It prevents influenza infection among patients and reduces staff illness and absenteeism. Despite these benefits, HCW influenza immunization uptake is low. Therefore, strategies to achieve high immunization coverage in HCWs, barriers to uptake, and perceptions of mandatory influenza immunization policies were discussed in key informant interviews with influenza immunization program planners. METHODS We conducted telephone interviews with 23 influenza immunization program planners from 21 organizations (7 acute care hospitals, 6 continuing care facilities, and 8 public health organizations) across Canada. We used content analysis to identify themes from the interviews. RESULTS Participants used a variety of promotional and educational activities, and many vaccine delivery approaches, to support HCW immunization programs. Barriers to achieving high coverage in HCWs included misconceptions about the safety and effectiveness of the influenza vaccine, negative personal experiences associated with the vaccine, and antivaccine sentiments. Participants mentioned mandatory influenza immunizations as a solution to low coverage. However, they identified challenges with this approach such as obtaining support from stakeholders, enforcement, and limiting personal autonomy. CONCLUSION Participants believed immunization coverage in health care organizations will continue to be suboptimal using existing program strategies. Although participants discussed mandatory immunization as a way to improve uptake, potential obstacles will need to be addressed for this to be implemented successfully.
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Affiliation(s)
- Susan Quach
- Surveillance and Epidemiology, Public Health Ontario, Toronto, Canada
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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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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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Paris B, Arahood T, Asche C, Amundson G. Voluntary reporting of health care personnel seasonal influenza vaccination rates and the impact of universal policies in Illinois hospitals. Vaccine 2013. [PMID: 23176977 DOI: 10.1016/j.vaccine.2012.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE In 2009, voluntary public reporting of hospital health care personnel (HCP) vaccination rates began in Illinois. We describe our experience over 3 influenza seasons and examine the impact universal policies have had on performance. METHODS A secure website was used to report monthly HCP vaccination rates by each participating hospital. Overall and individual hospital performance was publicly reported each month. RESULTS In the first two seasons, there were 11 hospitals reporting with an average end of season rate of 76% (2009-2010) and 81% (2010-2011). In the 2011-2012 season, there were 22 hospitals reporting, 9 of which had a new universal policy for HCP influenza vaccination. The average 2011-2012 end of season rate was 72% for hospitals with a voluntary program and 95% for hospitals with a universal policy. HCP were also vaccinated earlier in the influenza season when a universal policy was in place, providing greater benefit over time. CONCLUSION Public reporting of HCP influenza vaccination rates may contribute to implementation of universal employee vaccination policies. Hospitals with universal policies have higher vaccination rates than those with voluntary vaccination programs.
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Affiliation(s)
- Bonnie Paris
- Quality Quest for Health of Illinois, Peoria, IL 61602, USA.
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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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Estudio de actitudes y conocimientos sobre la vacunación antigripal en personal sanitario de atención primaria. Temporada 2011-2012. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.vacun.2013.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Correlates of seasonal flu vaccination among U.S. home health aides. Vaccine 2012; 31:287-90. [PMID: 23146678 DOI: 10.1016/j.vaccine.2012.10.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Revised: 10/29/2012] [Accepted: 10/30/2012] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Home health aides (HAs) receive limited training and reach many older patient populations highly susceptible to influenza virus. We sought to examine socio-demographic correlates of seasonal flu vaccination receipt among HAs. METHODS We analyzed data from the 2007 U.S. National Home Health Aide Survey, a nationally representative sample of HAs reporting on occupational status, job and demographic characteristics and receipt of seasonal flu vaccine (n=3377). RESULTS Seasonal flu vaccine receipt was low among all types of HAs (43.9%). After adjustment for socio-demographic indicators (i.e. age, gender, race and health insurance), home health, home care, hospice and personal care attendants were significantly less likely to report receiving seasonal flu vaccine as compared to licensed nursing assistants (adjusted odds ratio, AOR=0.42, 95% CI [0.20-0.85]; 0.41, [0.17-0.99]; 0.50, [0.26-0.97], and 0.53, [0.26-0.99], respectively). CONCLUSION Targeted effective vaccination campaigns are needed to improve vaccination rates among home health aides.
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Bryce E, Embree J, Evans G, Johnston L, Katz K, McGeer A, Moore D, Roth V, Simor A, Suh K, Vearncombe M. AMMI Canada position paper: 2012 Mandatory influenza immunization of health care workers. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2012; 23:e93-5. [PMID: 24294284 PMCID: PMC3597405 DOI: 10.1155/2012/756824] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Elizabeth Bryce
- Infection Prevention and Control, Vancouver Coastal Health, Vancouver, British Columbia
| | - Joanne Embree
- Department of Medical Microbiology and Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| | - Gerald Evans
- Infection Prevention & Control Kingston General Hospital/Hotel Dieu Hospital, and Departments of Medicine, Biomedical & Molecular Sciences and Pathology & Molecular Medicine, Queen’s University, Kingston, Ontario
| | - Lynn Johnston
- Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia
| | - Kevin Katz
- Infection Prevention and Control Program, North York General Hospital, Toronto, Ontario
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario
| | - Allison McGeer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario
- Infection Control, Mount Sinai Hospital, Toronto, Ontario
| | - Dorothy Moore
- Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec
| | - Virginia Roth
- Infection Prevention and Control Program, Division of Infectious Diseases, The Ottawa Hospital, and the Department of Medicine, University of Ottawa, Ottawa, Ontario
| | - Andrew Simor
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario
- Department of Microbiology, Sunnybrook Health Sciences Centre, Toronto, Ontario
- Infection Prevention and Control, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Kathryn Suh
- Infection Prevention and Control Program, Division of Infectious Diseases, The Ottawa Hospital, and the Department of Medicine, University of Ottawa, Ottawa, Ontario
| | - Mary Vearncombe
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario
- Department of Microbiology, Sunnybrook Health Sciences Centre, Toronto, Ontario
- Infection Prevention and Control, Sunnybrook Health Sciences Centre, Toronto, Ontario
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