Revised SHEA Position Paper: Influenza Vaccination of Healthcare Personnel

Guarding the gatekeepers: a comprehensive approach to control nosocomial measles

PURPOSE

Despite substantial vaccination progress, persistent measles outbreaks challenge global elimination efforts, particularly within healthcare settings. In this paper, we critically review the factors contributing to measles outbreak and effective control measures for nosocomial transmission of measles.

METHODS

We systematically searched electronic databases for articles up to 17th May, 2023. This was performed by two independent reviewers, with any disagreements resolved by a third reviewer. We also searched governmental and international health agencies for relevant studies.

RESULTS

Forty relevant articles were systematically reviewed, revealing key factors fuelling measles outbreak in healthcare settings, including high transmissibility capability; high intensity exposure; delayed care; failure to use protective equipment and implement control measures; vaccine failure; unclear immunisation history and lack of registries; and lacking recommendation on healthcare workers' (HCWs) measles vaccination. To combat these challenges, successful control strategies were identified which include early notification of outbreak and contact tracing; triaging all cases and setting up dedicated isolation unit; strengthening protective equipment use and physical measures; improving case detection; determining immunity status of HCWs; establishing policy for measles vaccination for HCWs; management of exposed personnel; and developing a pre-incident response plan.

CONCLUSION

A coordinated and comprehensive approach is essential to promptly identify and manage measles cases within healthcare settings, necessitating multifactorial strategies tailored to individual settings. These findings provide a valuable foundation for refining strategies to achieve and maintain measles elimination status in healthcare environments.

Attitudes toward policies to encourage influenza vaccination in long-term care facilities: A national survey of US adults aged 50-80 years

In October 2017, the National Poll on Healthy Aging surveyed a nationally representative sample of 2,007 adults aged 50-80 years to assess attitudes toward influenza (flu) vaccination policies in long-term care facilities. Support for requiring vaccinations was lowest for visitors. Policy makers can use these findings to develop sustainable vaccination strategies.

Influenza vaccination coverage among health-care workers during the COVID-19 epidemic in 2020/2021 influenza season: Evidence from a web-based survey in northwestern China

Vaccinating health-care workers against influenza during the COVID-19 pandemic can effectively prevent and control influenza and reduce COVID-19 strain on health systems. This study was conducted to explore influenza vaccination coverage and determinants among health-care workers during the COVID-19 pandemic in 2020/2021 influenza season in Ningxia. This cross-sectional survey included demographic characteristics of health-care workers, influenza vaccination status, reasons for not getting vaccinated, and whether influenza vaccination was recommended for others. We found that influenza vaccine rate of health-care workers was 39.6%. A binary logistic regression analysis showed that health-care workers' vaccination coverage was higher when the individuals were aware of the effect of the influenza vaccine (OR = 0.624, 95% CI: 0.486-0.802). Health-care workers who from internal medicine (OR = 1.494, 95% CI: 1.146-1.948), pediatrics (OR = 2.091, 95% CI: 1.476-2.962), and surgery departments (OR = 1.373, 95% CI: 1.014-1.859) had a lower coverage than those who worked in vaccination and infectious disease departments. The main reasons that some stated for not getting vaccinated were that they felt it was unnecessary (52.22%). Health-care workers who were vaccinated against influenza were more likely to recommend influenza vaccination to their patients than health-care workers who had not been vaccinated. The incidence of influenza among health-care workers was higher than that of the general population in Ningxia. Under the policy of voluntary and self-pay influenza vaccination in Ningxia, the coverage rate of influenza vaccine among health-care workers was far below the vaccination requirements of influenza vaccine in influenza season even during the COVID-19 epidemic.

COVID-19 vaccination intention and activation among health care system employees: A mixed methods study

BACKGROUND

Achieving high COVID-19 vaccination rates among employees is necessary to prevent outbreaks in health care settings. The goal of the study was to produce actionable and timely evidence about factors underlying the intention and decisions to obtain the COVID-19 vaccine by employees.

METHODS

The study was conducted from December 2020 - May 2021 with employees from a VA health care system in Southeastern US. The study used a convergent mixed methods design comprising two main activities: a cross-sectional survey conducted prior to COVID-19 vaccine distribution, and semi-structured interviews conducted 4-6 months after vaccine distribution. Data were collected about participant characteristics, vaccination intention prior to distribution, vaccination decision post-distribution, determinants of vaccination intention and decision, activating factors, sources of information and intervention needs. Data from the survey and interviews were analyzed separately and integrated narratively in the discussion.

RESULTS

Prior to vaccine distribution, 77% of employees wanted to be vaccinated. Post vaccine distribution, we identified 5 distinct decision-making groups: 1) vaccine believers who actively sought vaccination and included those sometimes described as "immunization advocates", 2) go along to get along (GATGA) individuals who got vaccinated but did not actively seek it, 3) cautious acceptors who got the COVID-19 vaccine after some delay, 4) fence sitters who remained uncertain about getting vaccinated, and 5) vaccine refusers who actively rejected the COVID-19 vaccine. Participants identifying with Black or multiple races were more likely to express hesitancy in their vaccination intention.

CONCLUSION

The findings of our study highlight distinct decision-making profiles associated with COVID-19 vaccination among employees of a VA health care system, and provide tailored recommendations to reduce vaccine hesitancy in this population.

Vaccination policies for healthcare personnel: Current challenges and future perspectives

Healthcare personnel (HCP) are at occupational risk for acquisition of several vaccine-preventable diseases and transmission to patients. Vaccinations of HCP are justified to confer them immunity but also to protect susceptible patients and healthcare services from outbreaks, HCP absenteeism and presenteeism. Mandatory vaccination policies for HCP are increasingly adopted and achieve high and sustainable vaccination rates in short term. In this article we review the scientific evidence for HCP vaccination. We also address issues pertaining to vaccination policies for HCP and present the challenges of implementation of mandatory versus voluntary vaccination policies. Finally, we discuss the issue of mandatory vaccination of HCP against COVID-19.

Ethical values and principles to guide the fair allocation of resources in response to a pandemic: a rapid systematic review

Background

The coronavirus 2019 pandemic placed unprecedented pressures on healthcare services and magnified ethical dilemmas related to how resources should be allocated. These resources include, among others, personal protective equipment, personnel, life-saving equipment, and vaccines. Decision-makers have therefore sought ethical decision-making tools so that resources are distributed both swiftly and equitably. To support the development of such a decision-making tool, a systematic review of the literature on relevant ethical values and principles was undertaken. The aim of this review was to identify ethical values and principles in the literature which relate to the equitable allocation of resources in response to an acute public health threat, such as a pandemic.

Methods

A rapid systematic review was conducted using MEDLINE, EMBASE, Google Scholar, LitCOVID and relevant reference lists. The time period of the search was January 2000 to 6th April 2020, and the search was restricted to human studies. January 2000 was selected as a start date as the aim was to capture ethical values and principles within acute public health threat situations. No restrictions were made with regard to language. Ethical values and principles were extracted and examined thematically.

Results

A total of 1,618 articles were identified. After screening and application of eligibility criteria, 169 papers were included in the thematic synthesis. The most commonly mentioned ethical values and principles were: Equity, reciprocity, transparency, justice, duty to care, liberty, utility, stewardship, trust and proportionality. In some cases, ethical principles were conflicting, for example, Protection of the Public from Harm and Liberty.

Conclusions

Allocation of resources in response to acute public health threats is challenging and must be simultaneously guided by many ethical principles and values. Ethical decision-making strategies and the prioritisation of different principles and values needs to be discussed with the public in order to prepare for future public health threats. An evidence-based tool to guide decision-makers in making difficult decisions is required. The equitable allocation of resources in response to an acute public health threat is challenging, and many ethical principles may be applied simultaneously. An evidence-based tool to support difficult decisions would be helpful to guide decision-makers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12910-022-00806-8.

Effect of the 2020/21 season influenza vaccine on SARS-CoV-2 infection in a cohort of Italian healthcare workers

OBJECTIVES

Healthcare workers (HCWs) are a priority group for seasonal influenza vaccination (SIV). The 2020/21 SIV campaign was conducted during the second wave of the COVID-19 pandemic. Vaccines, including SIV, may exert non-specific protective effects on other infectious diseases which may be ascribable to the concept of trained immunity. The aim of this study was to explore the association between 2020/21 SIV and SARS-CoV-2 positivity in a cohort of Italian HCWs.

METHODS

In this observational study, a cohort of HCWs employed by a large (ca 5000 employees) referral tertiary acute-care university hospital was followed up retrospectively until the start of the COVID-19 vaccination campaign. The independent variable of interest was the 2020/21 SIV uptake. Both egg-based and cell culture-derived quadrivalent SIVs were available. The study outcome was the incidence of new SARS-CoV-2 infections, as determined by RT-PCR. Multivariable Cox regression was applied in order to discern the association of interest.

RESULTS

The final cohort consisted of 2561 HCWs who underwent ≥1 RT-PCR test and accounted for a total of 94,445 person-days of observation. SIV uptake was 35.6%. During the study period, a total of 290 new SARS-CoV-2 infections occurred. The incidence of new SARS-CoV-2 was 1.62 (95% CI: 1.22-2.10) and 3.91 (95% CI: 3.43-4.45) per 1000 person-days in vaccinated and non-vaccinated HCWs, respectively, with an adjusted non-proportional hazard ratio of 0.37 (95% CI: 0.22-0.62). E-values suggested that unmeasured confounding was unlikely to explain the association.

CONCLUSIONS

A lower risk of SARS-CoV-2 infection was observed among SIV recipients.

Influence of critically appraising exemption requests from healthcare personnel along a spectrum of influenza vaccine hesitancy

Objectives:

This study was performed to assess whether an intervention for critically appraising influenza vaccine exemption requests from healthcare personnel (HCP) affected (1) the overall rate of influenza vaccine exemption within a healthcare institution and/or (2) the rates of postintervention vaccine acceptance among those who inconsistently request exemption from annual vaccination and those who consistently request exemption from vaccination.

Design:

Retrospective, before-and-after intervention study.

Setting:

We conducted the study at a single academic medical center.

Participants:

This study included 29,663 HCP.

Methods:

Between 2010 and 2019, HCP were permitted to request an exemption from influenza vaccination without critical appraisal of exemption requests. After January 2019, medical center policy required critical appraisal of exemption requests. Of those employed 3 or more years who requested an exemption at least once during the preintervention period (n = 1,177), those with unchanging exemption reasons annually were termed “consistent exempters.” Those who changed reasons or accepted vaccination n ≥ 1 times were termed “inconsistent exempters.”

Results:

The overall exemption rate from influenza vaccine decreased from 3.8% to 1.2% (P < .001; N = 29,663) after the intervention. Of those requesting exemption at least once before the intervention, 329 (28.0%) of 1,177 were consistent exempters and 878 (72.0%) were inconsistent exempters. Of inconsistent exempters employed after the intervention, 442 (88.9%) of 497 accepted vaccine postintervention compared with 118 (59.6%) of 198 consistent exempters (P < .001). Of all exempters who changed from exemption to acceptance after the intervention, 442 (78.9%) of 560 were inconsistent exempters.

Conclusions:

Critical appraisal of HCP exemption requests promotes influenza vaccine acceptance, and acceptance by inconsistent exempters drives the effect of the intervention. Analysis of changes in annual exemption requests represents a novel objective method for describing those on the spectrum of vaccine hesitancy.

Comparing the Attitude toward the COVID-19 and the 2020/21 and 2019/20 Flu Vaccination Campaigns among Italian Healthcare Workers

BACKGROUND

While the uptake of the COVID-19 vaccine among healthcare workers (HCWs) is suboptimal, vaccine hesitancy has not been characterized in detail in this population.

OBJECTIVE

The aim of this study was to compare the prevalence of health-related conditions reported by HCWs during the COVID-19, 2020/21 flu, and 2019/20 flu vaccination campaigns, so to test the hypothesis that HCWs were more prone to report health conditions during the COVID-19 campaign.

METHODS

We analyzed vaccination questionnaires of 176 hospital-based HCWs who underwent the COVID-19 and the 2020/21 flu vaccinations; 2019/20 flu vaccination questionnaires were available for 130 of them. Outcomes included self-reported allergies, chronic diseases, and use of medications. We tested for prevalence equality, analyzed differences using the kappa statistics and concordance correlation, and explored factors associated with differences in reporting.

RESULTS

There was no difference in the proportion of HCWs reporting allergies in the three questionnaires, while chronic diseases were more frequently reported in the COVID-19 than in both 2020/21 (p = 0.04) and 2019/20 flu questionnaires (p = 0.02). Furthermore, a higher proportion of HCWs reported medications use in the COVID-19 vaccination questionnaire, compared to both the 2020/21 and the 2019/20 flu vaccination questionnaires (p < 0.001 for both). In each vaccine campaign, women reported more conditions than men, and the difference between chronic disease reports was greater for women than for men.

CONCLUSIONS

Our results show more frequent reporting of health conditions during the COVID-19 than the flu vaccination campaigns, providing quantitative evidence of hesitancy of HCWs towards the COVID-19 vaccine.

Influenza Vaccination Programs for Healthcare Personnel: Organizational Issues and Beyond

Healthcare personnel (HCP) are a high priority group for influenza vaccination aiming to protect them but also to protect vulnerable patients and healthcare services from healthcare-associated influenza and HCP absenteeism. Multi-component influenza vaccination programs targeting behavioral, organizational, and administrative barriers are critical, if influenza vaccination rates among HCP are to be raised on a sustained basis. Mandatory influenza vaccination policy is the only single intervention that can achieve high and sustainable vaccination rates in HCP in short term. In this article, we provide an overview of issues pertaining to influenza vaccination of HCP, with an emphasis on organizational issues of influenza vaccination programs.

Influenza vaccination coverage and obstacles in healthcare workers (HCWs) and the follow up of side effects: a multicenter investigation in Iran

Introduction

Seasonal influenza is an annual common occurrence in cold seasons; but the COVID-19 pandemic is also currently ongoing. These two diseases can’t be distinguished from their symptoms alone; therefore, the importance of preventing influenza by vaccination is more than ever. Due to the high exposure of hospital personnel, widespread influenza vaccination of these high-risk groups seems to be a necessity. This Study conducted to determine vaccination coverage in the personnel of four tertiary referral collegiate hospitals in 2019 and to further investigate individual obstacles for Influenza vaccination.

Methods

In this cross-sectional descriptive study, 637 personnel were selected randomly from distinctive hospitals in a list-wised. Ones vaccinated filled the side effects questionnaire and who not vaccinated filled the vaccination obstacles questionnaire. The study was approved by the ethics committee of Tehran University of Medical Sciences with this reference number: IR.TUMS.IKHC.REC.1398.218

Results

The mean vaccination coverage was 29.4% and the coverage difference among centers was not statistically significant (p = 0.192). The following items had the most impact on personnel decision: confidence about one’s immune system (p < 0.05), the experience of side effects from previous vaccinations (p = 0.011), attitude about vaccination in colleagues (p = 0.021) and work experience (p < 0.05). About 23% of vaccinated individuals reported side effects following vaccination and the most common side effect was mild cold symptoms with 12.3% prevalence.

Conclusion

The results of the current study revealed that influenza vaccination coverage among HCWs is not satisfactory in Iran. Hospital authorities and infection control units should plan to remove the obstacles of influenza vaccination.

Impact of prior vaccination on antibody response and influenza-like illness among Australian healthcare workers after influenza vaccination in 2016

BACKGROUND

Epidemiological studies suggest that influenza vaccine effectiveness decreases with repeated administration. We examined antibody responses to influenza vaccination among healthcare workers (HCWs) by prior vaccination history and determined the incidence of influenza infection.

METHODS

HCWs were vaccinated with the 2016 Southern Hemisphere quadrivalent influenza vaccine. Serum samples were collected pre-vaccination, 21-28 days and 7 months post-vaccination. Influenza antibody titres were measured at each time-point using the haemagglutination inhibition (HI) assay. Immunogenicity was compared by prior vaccination history.

RESULTS

A total of 157 HCWs completed the study. The majority were frequently vaccinated, with only 5 reporting no prior vaccinations since 2011. Rises in titres for all vaccine strains among vaccine-naïve HCWs were significantly greater than rises observed for HCWs who received between 1 and 5 prior vaccinations (p < 0.001, respectively). Post-vaccination GMTs against influenza A but not B strains decreased as the number of prior vaccinations increased from 1 to 5. There was a significant decline in GMTs post-season for both B lineages. Sixty five (41%) HCWs reported at least one influenza-like illness episode, with 6 (4%) identified as influenza positive.

CONCLUSIONS

Varying serological responses to influenza vaccination were observed among HCWs by prior vaccination history, with vaccine-naïve HCWs demonstrating greater post-vaccination responses against A(H3N2).

Use of a comprehensive program to review religious and personal seasonal influenza vaccination exemption requests by healthcare personnel

OBJECTIVE

Vanderbilt University Medical Center (VUMC) requires that all faculty and staff receive the seasonal influenza vaccine annually or receive an approved vaccine exemption, either for a medical or deeply held religious or personal belief. We sought to understand the underlying principles behind these exemption requests and their interaction with a multidisciplinary exemption review process.

DESIGN

All of the personal and religious exemption requests at VUMC for 3 consecutive influenza seasons from 2015 to 2018 were analyzed, categorizing these requests by 1 of 12 standardized employee categories and 1 of 18 unique reasons for vaccine exemption.

SETTING

Tertiary-care academic medical center.

PARTICIPANTS

Healthcare personnel (HCP).

RESULTS

Among the 3 influenza seasons, 1.1%-2.1% of all VUMC HCP requested religious or personal exemption from vaccination. The frequency of religious and personal exemption approval increased annually from 296 of 452 (65.5%) to 196 of 248 (80.2%) to 283 of 323 (87.6%) over the 3 seasons, representing a statistically significant increase each year. Of the 5 most common reasons against vaccination, 4 were explicitly religious in nature; the most common reason was that the "body is a temple or sacred." Nonclinical staff submitted the most religious and personal exemption requests of any job category, submitting approximately one-third of all requests every year.

CONCLUSIONS

These results demonstrate how detailed the personal or religious convictions behind vaccine avoidance can be among HCP and how vaccine avoidance stems from much more than simple misinformation regarding vaccination. The intersection between misinformation and personal or religious beliefs provides a unique opportunity to address HCP opinions toward vaccination in an exemption and appeals process like the one described here.

Seasonal influenza vaccination coverage and barriers among healthcare workers in an Egyptian Province

Background:

Influenza vaccination uptake by Egyptian healthcare workers remains sub-optimal despite local initiatives and infection control programs to increase it.

Objective:

To assess vaccination coverage and investigate health care workers’ barriers and also motivators toward seasonal influenza vaccination.

Methods:

An interview questionnaire survey and focus group sessions were conducted to measure uptake and assess barriers to seasonal influenza vaccination among HCWs in main hospitals and primary care centers in Ismailia city.

Results:

There were 980 participants, of whom 131 (13.4%) reported having received influenza vaccination in last season 2018/2019. Females were 76.8% of participants, and nurses were the main occupational category of study sample (80.4%). The most commonly reported motivator (97.7%) was “protection of oneself and family members” among the vaccinated participants. The top barriers among non-vaccinated ranked by their Relative Importance Index (RII), included lack of instruction by supervisors RII=0.82, lack of awareness about vaccine benefits RII=0.79 and lack of awareness from where to get the vaccine RII=0.71. Predictors of non-vaccination included belief that the vaccine itself may induce influenza (OR: 1.9 p<0.05, CI, 1.3-2.8) and the perception that vaccination is ineffective (OR: 2.8 p<0.05, CI, 1.5-5.2), and lack of knowledge about the vaccinations recommended for health care workers (OR: 1.9 p<0.05, CI, 1.2-2.8).

Conclusions:

Addressing specific barriers to influenza vaccination uptake among healthcare workers may improve vaccination rate. Targeted evidence-based promotion campaigns and programs should be established to overcome identified barriers.

Withdrawn: Vaccine hesitancy among Maltese Healthcare workers toward influenza and novel COVID-19 vaccination

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WITHDRAWN: Needed: less influenza vaccine hesitancy and less presenteeism among health care workers in the COVID-19 era

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Shoulder Injury Related to Vaccine Administration: Case Series of an Emerging Occupational Health Concern

BACKGROUND

Shoulder injury related to vaccine administration (SIRVA) is an increasingly recognized complication of improper vaccine administration. Due to the growing number of mandatory workplace vaccination programs, especially for annual influenza vaccine, it is essential that occupational health providers are aware of this condition to improve prevention and/or treatment of this condition when it arises. Therefore, we describe the clinical presentation and course of treatment of five cases of SIRVA that were seen in an employer-based Occupational Health Services Clinic (OHS) after mandatory influenza vaccine administration.

METHODS

A retrospective chart review was performed for five cases of SIRVA from 2017 to 2019.

FINDINGS

Five cases met clinical definition of SIRVA as defined by the National Vaccine Injury Compensation Program. All cases were of similar characteristics including gender, age range, and body mass index (BMI). All were treated using multiple modalities including medication, physical therapy, and modified work with eventual resolution of symptoms and full return to work.

CONCLUSIONS/APPLICATION TO PRACTICE

Awareness of SIRVA is necessary in any occupational setting where vaccines are routinely administered. Avoidance of SIRVA by adhering to proper vaccination technique is crucial, as is awareness of how to recognize and manage the condition in affected employees to limit long-term impairment.

Policy statement from the Society for Healthcare Epidemiology of America (SHEA): Only medical contraindications should be accepted as a reason for not receiving all routine immunizations as recommended by the Centers for Disease Control and Prevention

SHEA endorses adhering to the recommendations by the CDC and ACIP for immunizations of all children and adults. All persons providing clinical care should be familiar with these recommendations and should routinely assess immunization compliance of their patients and strongly recommend all routine immunizations to patients. All healthcare personnel (HCP) should be immunized against vaccine-preventable diseases as recommended by the CDC/ACIP (unless immunity is demonstrated by another recommended method). SHEA endorses the policy that immunization should be a condition of employment or functioning (students, contract workers, volunteers, etc) at a healthcare facility. Only recognized medical contraindications should be accepted for not receiving recommended immunizations.

Is flu vaccination opt-out feasible? Evidence from vaccination programme implementers and managers in the English National Health Service

BACKGROUND

In 2018/19, English NHS trusts (NHSTs) implemented an 'opt-out' policy for seasonal flu vaccination in frontline healthcare workers (HCWs). HCWs declining the vaccination were asked to sign an opt-out form and provide a reason for their decision. In addition, HCWs working in higher risk hospital environments (e.g. oncology) were asked to inform their manager about their declination decision. The policy aimed to provide greater insight into reasons for vaccination decline and information from HCWs in higher risk areas was intended for use in considering HCW redeployment. This study investigated the feasibility, acceptability, and perceived value of the policy during the 2018/19 flu vaccination season.

METHODS

We conducted semi-structured interviews across 9 NHSTs in England with different levels of HCW flu vaccination uptake in 2017/18. We interviewed 30 vaccination programme implementers and 27 managers.

FINDINGS

The purpose of the policy was poorly understood, and interviewees did not know how data on decliners was being used. Most NHSTs tried to collect the personal details of decliners and, in some instances, these were recorded in Electronic Staff Records and reported to line-managers for action. This created strain on employer-employee relationships, leading to decliners refusing to complete opt-out forms and some vaccinators not implementing the policy. None of the NHSTs had a redeployment policy for decliners, arguing that this was impractical due to strain on staffing levels.

CONCLUSION

A flu-vaccination opt-out approach for HCWs did not appear acceptable in our sampled NHSTs, due to a lack of clear messaging about its purpose and complicated implementation. To promote an opt-out approach effectively, there needs to be clear communication of its purpose, which should be to explore reasons for decline rather than identify and 'push' decliners to vaccinate, so as not to damage staff relationships. NHSTs should involve their workforce in developing flu vaccination approaches.

Recommendations for Mandatory Influenza Vaccinations for Health Care Personnel From AMDA's Infection Advisory Subcommittee

Preventing influenza infections is a national health priority, particularly among geriatric and adults with frailty who reside in post-acute and long-term care (PALTC) settings. Older adults account for more than 70% of deaths from influenza, a reflection of decreased vaccine effectiveness in that age group. Annually vaccinating health care personnel (HCP) working with these patients against influenza is critical to reducing influenza morbidity and mortality among patients. PALTC HCP have the lowest influenza vaccination rate when compared to HCP in other settings. The Advisory Committee on Immunization Practices recommends that all HCP receive an annual influenza vaccination, including those who do not have direct patient care responsibilities. Here, we discuss the importance of influenza vaccination for HCP, detail recommendations for influenza vaccination practice and procedures for PALTC settings, and offer support to PALTC settings and their staff on influenza vaccinations.

Factors and considerations for establishing and improving seasonal influenza vaccination of health workers: Report from a WHO meeting, January 16-17, Berlin, Germany

Health workers represent an important target group for seasonal influenza vaccination because of their increased risk of infection as well as the risk of transmitting infection to vulnerable patients in the health care setting. Moreover, seasonal vaccination of health workers contributes to pandemic preparedness. However, many countries, especially in Africa and Asia, do not have policies for health worker influenza vaccination. In countries where such policies exist, vaccination coverage is often low. The World Health Organization (WHO) is developing a manual to guide the introduction of seasonal influenza vaccination of health workers. An Independent External Advisory Group (IEAG) that is advising WHO on the content of the manual met to discuss issues that are relevant and often unique to health worker vaccination. This meeting report summarizes the main issues that were discussed and the outcomes of the discussion. The issues include policy considerations, including the evidence in support of health worker vaccination; categorization and prioritization of health workers; the choice of vaccination strategy; its integration into broader health worker vaccination and occupational health policies; planning and management of vaccination, particularly the approaches for communication and demand generation; and the challenges with monitoring and evaluation of health worker vaccination, especially in low and middle-income countries.

Maximizing influenza vaccination uptake among healthcare personnel in Israel: lessons learned from mandatory vaccination policy in the United States

Background

Maximizing vaccination uptake is crucial in generating herd immunity and preventing infection incidence (Quach et al., Am J Infect Control 11:1017–23, 2013). Vaccination of healthcare personnel (HCP) against influenza is vital to influenza infection control in healthcare settings, given the consistent exposure of HCP to high-risk patients like: those with compromised immune systems, children, and the elderly (Johnson & Talbot, Curr Opin Infect Dis 24: 363–369, 2011). Influenza vaccination uptake among HCP remains suboptimal: in 2017–18, 47.6% of HCP who worked in settings where influenza vaccination was not mandatory were vaccinated against influenza in United States (Black et al., Morb Mortal Wkly Rep 67: 1050, 2018). Mandatory vaccination policies result in HCP influenza vaccination uptake rates substantially higher than opt-in influenza vaccination campaigns (94.8% vs. 47.6%) (Black et al., Morb Mortal Wkly Rep 67: 1050, 2018).

Goals

The Israel Journal of Health Policy Research has published articles focused on the issues of influenza vaccination (Yamin et al., Isr J Health Policy Res 3: 13, 2014), improving influenza vaccination coverage of HCP (Weber et al., Isr J Health Policy Res 5: 1–5, 2016), influenza vaccination motivators among HCP (Nutman and Yoeli, Isr J Health Policy Res 5: 52, 2016), legal imposition of vaccination (Kamin-Friedman, Isr J Health Policy Res 6:58, 2017), and mandatory vaccination (Gostin, Cell Biosci 8: 1-4, 2018). Each article explores factors influencing disease prevention from different angles within an Israeli context. This article attempts to fuse these topics by investigating how to apply aspects of American mandatory influenza vaccination policy targeted at HCP in an Israeli context.

Methods

Critical document analysis was conducted on relevant literature and policy discussing influenza prevention interventions among HCP within the United States. Mandatory vaccination policies were highlighted. A discussion of the professional responsibility of HCP to vaccinate against influenza serves as background. Case studies of hospitals in the United States that implemented mandatory vaccination policies for their employees are analyzed. The article concludes with analysis exploring how qualities of mandatory influenza vaccination policy of HCP could take shape in Israel, giving contextual limitations, urging Israeli health policy makers to reflect on lessons learned from the American case study.

Main findings and conclusion

Mandatory HCP influenza vaccination policies in comparison to non-mandatory interventions are most effective in obtaining maximum influenza vaccination uptake among HCP (Black et al., Morb Mortal Wkly Rep 67: 1050, 2018). Many HCP cite individual objections to influenza vaccination rooted in personal doubts and ethical concerns. The ethical responsibility of HCP to their patients and work environments to prevent and lower influenza infection incidence arguably overrules such individual objections. Mandatory HCP influenza vaccination policies are an effective method of maximizing HCP influenza vaccine uptake and minimizing the spread of the influenza virus within healthcare settings. Still, cultural, social and political sensitivity must be taken into consideration when implementing both full-on mandatory HCP influenza vaccination policies and/or aspects of mandatory policies, especially within an Israeli context.

Mandatory Flu Vaccine for Healthcare Workers: Not Worthwhile

In 2010, the Society for Healthcare Epidemiology published a recommendation that annual influenza vaccination of healthcare workers be made a condition of employment despite no high-level evidence to support this recommendation. A better strategy for reducing the transmission of respiratory viruses in the healthcare setting would be to encourage vaccination and reduce presenteeism, which is very common among healthcare workers with influenza-like illness. In a hospital with a baseline vaccination compliance of 70%, reducing presenteeism by 2% has the equivalent impact of mandating vaccination in terms of the number of healthcare workers with influenza-like illness at work. Expectations for compliance with interventions to improve the quality of care should be correlated tightly to the underlying evidence to support the intervention, reserving mandates for interventions with very high quality supporting evidence.

The views of key stakeholders around mandatory influenza vaccination of hospital and aged care staff: Examining the current climate in Australia

BACKGROUND

Healthcare worker (HCW) vaccination against seasonal influenza is considered a key preventative measure within hospitals and aged-care facilities (ACFs) to reduce the risk of transmission and related disease. Despite this, many facilities experience persistently low vaccination coverage rates and mandatory vaccination has been explored as a potential strategy to improve coverage. This study explored the current climate around staff vaccination in Australia from the perspective of opinion leaders and key stakeholders.

METHODS

Qualitative semi-structured interviews were conducted between April and July 2018 with 22 individuals involved in vaccination policy and program development and implementation from a range of organisations including state health departments, hospitals and ACFs across Australia. In addition, interviews were undertaken with individuals from aged care and nursing peak bodies/colleges. Interviews were transcribed, and thematic analysis was undertaken using NVivo 12 software.

RESULTS

Major themes emerging from the interviews included a sense that attitudes around staff vaccination are changing; the persistence of administrative and resource barriers; the importance of positive workplace culture towards influenza vaccination; and the need for individualised and personal communication strategies. Perspectives were diverse on the necessity of introducing stronger policies, with participants divided in their support mandatory influenza vaccinations. Some advocated that key performance indicators should be used as an alternative to vaccine mandates.

CONCLUSIONS

This study provides policy makers with useful insights into the current Australian context around occupational vaccination policies, to inform acceptable and effective strategies to improve influenza vaccination uptake among Australian hospital and aged care staff.

Knowledge, attitudes, behaviours, and beliefs of healthcare provider students regarding mandatory influenza vaccination

Influenza infection poses the same risk to healthcare students as to practising clinicians. While there is substantial dialog about the benefits, risks, and ethics of mandatory influenza immunization policies in Canada, there has been little engagement of healthcare students. To explore the knowledge, attitudes, beliefs, and behaviours of healthcare students, we administered a web-based survey to students at Dalhousie University. Influenza vaccination status varied by program type, with 86.3% of medical students (n = 124) and 52.4% of nursing students (n = 96) self-reporting receipt of the influenza vaccine both in the previous and current seasons; pharmacy students' coverage fell between the two. Pharmacy students had higher mean knowledge scores (10.0 out of 13 questions) than medical (9.26) and nursing (8.88) students. Between 56.1% and 64.5% of students across disciplines were in support of a mandatory masking or vaccination policy, and between 72.6% and 82.3% of students would comply if such a policy were in place. A sense of duty to be immunized, desire to be taught more about influenza and influenza vaccine, belief that the hospital has a right to know vaccination status, support for declination policy, and willingness to accept consequences of noncompliance were all predictors of student support of mandatory policies. Medical and pharmacy students tended to hold more pro-influenza vaccination attitudes, had higher knowledge scores, and better vaccine coverage than nursing students. Based on the overall vaccination behaviour, knowledge, beliefs, and attitudes of students surveyed, this study demonstrates that mandatory influenza immunization policies are generally supported by the next generation of practitioners.

Vaccination of healthcare workers: is mandatory vaccination needed?

INTRODUCTION

Vaccinations of healthcare workers (HCWs) aim to directly protect them from occupational acquisition of vaccine-preventable diseases (VPDs) and to indirectly protect their patients and the essential healthcare infrastructure. However, outbreaks due to VPDs continue to challenge healthcare facilities and HCWs are frequently traced as sources of VPDs to vulnerable patients. In addition, HCWs were disproportionately affected during the current measles outbreak in Europe. Areas covered: We reviewed the recent published information about HCWs vaccinations with a focus on mandatory vaccination policies. Expert commentary: Although many countries have vaccination programs specifically for HCWs, their vaccination coverage remains suboptimal and a significant proportion of them remains susceptible to VPDs. The increasing vaccination hesitancy among HCWs is of concern, given their role as trusted sources of information about vaccines. Mandatory vaccinations for HCWs are implemented for specific VPDs in few countries. Mandatory influenza vaccination of HCWs was introduced in the United States a decade ago with excellent results. Mandatory vaccinations for VPDs that may cause significant morbidity and mortality should be considered. Issues of mistrust and misconceptions about vaccinations should also be addressed.

Should influenza vaccination be mandatory for healthcare workers?

Each year, many healthcare organizations deal with low influenza immunization rates among staff. Mandatory influenza vaccination programs may be considered in order to address this issue. These types of programs have caused controversy in the past, as staff has argued that they infringe upon their liberties and right to autonomy. However, if viewed from a public health perspective, mandatory vaccination programs are beneficial for both employees and patients and can be justified. When individuals make the decision to work in the medical field, it is assumed that their values align with those of the organization for which they work. This overrides their right to autonomy, since they are expected to put the safety of their patients ahead of their own personal interests. Although some may argue that receiving a flu shot is unsafe, evidence has demonstrated the opposite, and the minimal discomfort that may result from a vaccine is not enough to negate the responsibilities that healthcare workers have toward the patients they serve.

Knowledge, Attitude, Awareness, and Barriers Toward Influenza Vaccination Among Medical Doctors at Tertiary Care Health Settings in Peshawar, Pakistan-A Cross-Sectional Study

Objective: This study intends to evaluate the knowledge, attitude and awareness of medical doctors toward influenza vaccination and the reasons for not getting vaccinated. Methods: A cross-sectional study was carried out among medical doctors in three major tertiary care health settings in Peshawar, Khyber Pakhtunkhwa (KP), Pakistan. A web-based, pre-tested questionnaire was used for data collection. Results: A total of (n = 300) medical doctors were invited, however only (n = 215) participated in the study with a response rate of 71.7%. Among the participants, 95.3% (n = 205) were males with a mean age of 28.67 ± 3.89 years. By designation, 121(56.3%) were trainee medical officers and 40 (18.6%) were house officers. The majority 102(47.4%) had a job experience of 1-2 years. Of the total sample, 38 (17.7%) doctors reported having received some kind of vaccination, whereas only 19 (8.84%) were vaccinated against influenza. The results identified that the major barriers toward influenza vaccinations included (1) Unfamiliarity with Influenza vaccination availability (Relative Importance Index RII = 0.830), (2) Unavailability of Influenza vaccines due to lack of proper storage area in the institution (RII = 0.634), (3) Cost of vaccine (RII = 0.608), and (4) insufficient staff to administer vaccine (RII = 0.589). Additionally, 156 (72.6%) of doctors were not aware of the influenza immunization recommendation and guidelines published by the Advisory Committee on Immunization Practices (ACIP) and Centre for Disease Control and Prevention (CDC). Physicians obtained a high score (8.27 ± 1.61) of knowledge and understanding regarding influenza and its vaccination followed by medical officers (8.06 ± 1.37). Linear Regression analysis revealed that gender was significantly associated with the knowledge score with males having a higher score (8.0± 1.39) than females (6.80 ± 1.61 β = -1.254 and CI [-2.152 to -0.355], p = 0.006). Conclusion: A very low proportion of doctors were vaccinated against influenza, despite the published guidelines and recommendations. Strategies that address multiple aspects like increasing awareness and the importance of the influenza vaccine, the international recommendations and enhancing access and availability of the vaccine are needed to improve its coverage and health outcomes.

Examination of the British Columbia influenza prevention policy for healthcare workers: Phase 1 qualitative case study

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.

Protecting Healthcare Personnel in Outpatient Settings: The Influence of Mandatory Versus Nonmandatory Influenza Vaccination Policies on Workplace Absenteeism During Multiple Respiratory Virus Seasons

OBJECTIVE To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP). DESIGN Retrospective observational cohort study. SETTING This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies. PARTICIPANTS The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites. METHODS To determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012-2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models. RESULTS The proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07-0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012-2013 and 2013-2014, 0.82; 95% CI, 0.72-0.93; OR for 2014-2015, 0.81; 95% CI, 0.69-0.95). CONCLUSIONS These data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies. Infect Control Hosp Epidemiol 2018;39:452-461.

Improving Mandatory Vaccination Against Influenza: Minimizing Anxiety of Employees to Maximize Health of Patients

The objective was to describe qualitatively the attitudes among employees toward mandatory vaccination against influenza to ultimately improve such programs and prevent hospital-acquired influenza. Qualitative interviews were conducted with 21 employees at a freestanding children's hospital. Analysis of interview transcripts used grounded theory and the constant comparative method; codes were iteratively revised and refined as themes emerged. Themes emerged elucidating promoters and concerns. Promoters included a desire to protect self, family, and patients; perception of vaccination as part of professional responsibility; and free vaccination as a benefit from the organization. Concerns included negative feelings surrounding the forced nature and substantial anxiety about the physical injection. Participants expressed a strong desire for a private, compassionate, unhurried environment for the injection. Managing personal anxiety and a desire for privacy emerged as strong concerns among health care workers getting vaccinated at work. This information enabled future improvements in the mandatory vaccination campaign.

Assessment of half-mask elastomeric respirator and powered air-purifying respirator reprocessing for an influenza pandemic

BACKGROUND

Health care facilities are considering the use of reusable respiratory protective devices (RPDs) to mitigate a potential N95 filtering facepiece respirator shortage caused by an influenza pandemic. US regulators are also considering stockpiling reusable RPDs for pandemic preparedness, but limited data exist on the effectiveness of cleaning and disinfection of these devices. This study defines reprocessing protocols and evaluates their effectiveness against a pandemic influenza strain in a laboratory setting.

METHODS

Five half-mask elastomeric respirator models and 3 powered air-purifying respirator models were contaminated with influenza virus and artificial skin oil on multiple surfaces. RPDs were then manually treated with 1 of 2 methods: cleaned or cleaned and disinfected. Presence of viable influenza was determined via swab sampling and a median tissue culture infectious dose assay.

RESULTS

Across 41 RPD surfaces, a mean log reduction in viable influenza of 4.54 ± 0.97 log₁₀ median tissue culture infectious dose was achieved for all treated surfaces, which included both cleaned and cleaned and disinfected surfaces.

CONCLUSIONS

The methods defined as part of this study are effective for eliminating viable influenza in the presence of artificial skin oil on most of the RPD surfaces tested. Material type and RPD design should be considered when implementing RPD reprocessing protocols.

Improving immunization practices in United States hospitals and health systems

Purpose

Payment for healthcare services in the USA has shifted from fee for service to compensation based on value and quality. The indicators used for payments are a variety of clinical measures, including administration of vaccines to patients. The purpose of this paper is to describe the implementation of programs in health systems to improve vaccination rates and patient outcomes.

Design/methodology/approach

A search of the literature was conducted to find examples of vaccine programs in US health systems, and also to identify policies to improve immunization rates.

Findings

Successful programs for improving vaccination rates require advocacy and support of leadership, a systematic and multidisciplinary approach, and an evaluation of local resources and capacity. Numerous examples exist of medical, nursing, and pharmacy led programs that improve vaccination rates. The department in charge has relied on the support of other groups to ensure the success.

Social implications

Mandatory vaccination of healthcare personnel (HCP) in the health system has been a growing trend in the USA. Although there has been some resistance to mandatory vaccinations for HCP, the standards and requirements have resulted in improved rates in health systems, which ultimately improve efficiency and protects patients.

Originality/value

This review describes considerations for implementing a successful vaccination program in a health system and provides examples of specific strategies. An overview of mandatory vaccinations for HCP is also described.

Knowledge of and Attitudes to Influenza Vaccination among Community Pharmacists in Catalonia (Spain). 2013-2014 Season: A Cross Sectional Study

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.

Stepwise intervention including 1-on-1 counseling is highly effective in increasing influenza vaccination among health care workers

BACKGROUND

The influenza vaccination rate among health care workers (HCWs) remains suboptimal. We attempted to increase vaccine uptake in HCWs by nonmandatory measures, including 1-on-1 counseling.

METHODS

In 2015 we used a stepwise approach including (1) text messaging on the last day of the vaccination period, (2) extending the vaccination period by 3 days, (3) education for the low uptake group, and (4) 1-on-1 counseling for unvaccinated HCWs after the 3 interventions.

RESULTS

There were 1,433 HCWs included. By the end of the initial 3 days, the uptake rate was 80.0% (1,146/1,433). During an extension for a further 3 days, 33 additional HCWs received the vaccine. One month after starting the vaccination, 90.1% (1,291/1,433) of the HCWs were vaccinated, but this included only 76.1% (210/276) of the doctors (lowest among HCWs). After 3 educational presentations targeted at the unvaccinated doctors, no additional individuals were vaccinated in the following 2 weeks. After 1-on-1 counseling for unvaccinated HCWs, the overall vaccination rate increased to 94.7% (1,357/1,433) in 2015, higher than in the previous year (82.5%, P < .001). Of the unvaccinated doctors, 63.2% (43/68) were vaccinated, therefore achieving 92.4% (255/276) compliance, higher than the 56.5% in the previous year (152/269, P < .001).

CONCLUSIONS

Stepwise intervention including 1-on-1 counseling is effective in increasing influenza vaccination rates among HCWs.

Vaccinating healthcare workers: Level of implementation, barriers and proposal for evidence-based policies in Turkey

The role of healthcare workers in life-long vaccination is very important in the means of 2 sided infection, rising patient awareness and being a role model for the patients. Numerous organizations publish guidelines for vaccination of HCWs, while healthcare facilities develop vaccination policies according to the accreditation standards. Nevertheless, vaccination rates among HCWs are far below targets. The obstacles to getting vaccinated or recommending vaccination may include rather universal factors such as the vaccine paradox, however in the case of HCWs, probably a different set of factors are included. The aims of this article are to gain an overview of vaccination strategies for HCWs, to assess the coverage rates of HCWs and make in-depth analyses of the potential barriers to vaccination and potential factors to motivate HCWs for vaccination in Turkey and to compare them with the global picture to improve implementation of policies concerning vaccination of HCWs.

How to improve influenza vaccine coverage of healthcare personnel

Influenza causes substantial morbidity and mortality worldwide each year. Healthcare-associated influenza is a frequent event. Health care personnel (HCP) may be the source for infecting patients and may propagate nosocomial outbreaks. All HCP should receive a dose of influenza vaccine each year to protect themselves and others. This commentary will discuss the study recently published in the IJHPR by Nutman and Yoeli which assessed the beliefs and attitudes of HCP in an Israel hospital regarding influenza and the influenza vaccine. Unfortunately, as noted by Nutman and Yoeli in this issue many HCP in Israel choose not to receive influenza immunization and many harbor misconceptions regarding their risk for influenza as well as the benefits of influenza vaccine. We also discuss proven methods to increase acceptance by HCP for receiving an annual influenza vaccine.

The role of healthcare provider attitudes in increasing willingness to accept seasonal influenza vaccine policy changes

BACKGROUND

This research explored the role of attitudes in acceptance of organizational change initiatives.

METHODS

A survey assessed factors associated with health care provider (HCP) likelihood to accept seasonal influenza vaccine policy changes. We evaluated the impact of knowledge and individual attitudes on this outcome measure.

RESULTS

Knowledge of seasonal influenza vaccine and influenza recommendations was a significant predictor of HCP's attitudes toward vaccine at the individual (p<0.001), organizational (p<0.05), and legislative level (p<0.05). Mixed results were obtained when investigating the impact of knowledge on actual willingness to accept vaccine, suggesting that knowledge was only a significant predictor at the organizational (p<0.05) and legislative levels (p<0.05). Attitudes fully mediated the impact of knowledge at both the organizational and legislative levels.

INTERPRETATION

Knowledge of seasonal influenza and vaccine recommendations is an important, but insufficient predictor of willingness to accept policy change.

Exploring and Promoting Prosocial Vaccination: A Cross-Cultural Experiment on Vaccination of Health Care Personnel

Influenza vaccination for health care personnel (HCP) is recommended particularly because it indirectly protects patients from contracting the disease. Vaccinating can therefore be interpreted as a prosocial act. However, HCP vaccination rates are often far too low to prevent nosocomial infections. Effective interventions are needed to increase HCP's influenza vaccine uptake. Here we devise a novel tool to experimentally test interventions that aim at increasing prosocially motivated vaccine uptake under controlled conditions. We conducted a large-scale and cross-cultural experiment with participants from countries with either a collectivistic (South Korea) or an individualistic (USA) cultural background. Results showed that prosocially motivated vaccination was more likely in South Korea compared to the US, mediated by a greater perception of vaccination as a social act. However, changing the default of vaccination, such that participants had to opt out rather than to opt in, increased vaccine uptake in the US and therefore compensated for the lower level of prosocial vaccination. In sum, the present study provides both a novel method to investigate HCP influenza vaccination behavior and interventions to increase their vaccine uptake.

Association of increased influenza vaccination in health care workers with a reduction in nosocomial influenza infections in cancer patients

BACKGROUND

Vaccination of health care workers (HCWs) remains a key strategy to reduce the burden of influenza infections in cancer patients.

METHODS

In this 8-year study, we evaluated the effect of a multifaceted approach, including a mandatory influenza vaccination program, on HCW vaccination rates and its effect on nosocomial influenza infections in cancer patients.

RESULTS

The influenza vaccination rate of all employees significantly increased from 56% (8,762/15,693) in 2006-2007 to 94% (17,927/19,114) in 2013-2014 (P < .0001). The 2009 mandatory participation program increased HCW vaccination rates in the targeted groups (P < .0001), and the addition of an institutional policy in 2012 requiring influenza vaccination or surgical mask use with each patient contact further increased vaccination rates by 10%-18% for all groups in 1 year. The proportion of nosocomial influenza infections significantly decreased (P = .045) during the study period and was significantly associated with increased HCW vaccination rates in the nursing staff (P = .043) and in personnel working in high-risk areas (P = .0497).

CONCLUSIONS

Multifaceted influenza vaccination programs supported by institutional policy effectively increased HCW vaccination rates. Increased HCW vaccination rates were associated with a reduction in the proportion of nosocomial influenza infections in immunocompromised cancer patients.

Occupational Health Update: Focus on Preventing the Acquisition of Infections with Pre-exposure Prophylaxis and Postexposure Prophylaxis

Health care personnel are commonly exposed to infectious agents via sharp injuries (eg, human immunodeficiency virus, hepatitis B virus, and hepatitis C virus), direct patient care (eg, pertussis and meningococcus), and the contaminated environment (eg, Clostridium difficile). An effective occupational program is a key aspect of preventing acquisition of an infection by offering the following: (1) education of health care personnel regarding proper handling of sharps, early identification and isolation of potentially infectious patients, and hand hygiene; (2) assuring immunity to vaccine-preventable diseases; and, (3) immediate availability of a medical evaluation after a nonprotected exposure to an infectious disease.