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Grewal R, Deeks SL, Hart TA, Cox J, De Pokomandy A, Grennan T, Lambert G, Moore D, Coutlée F, Gaspar M, George C, Grace D, Jollimore J, Lachowsky NJ, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DHS, Yeung A, Burchell AN. Human papillomavirus (HPV) vaccination across a cascade of knowledge, willingness, and uptake among gay, bisexual, and other men who have sex with men in Canada's three largest cities. Hum Vaccin Immunother 2021; 17:5413-5425. [PMID: 34856869 DOI: 10.1080/21645515.2021.1979379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Some Canadian jurisdictions offer publicly funded HPV vaccine to gay, bisexual, and other men who have sex with men (GBM) aged ≤26 years. We characterized factors associated with being in different stages of HPV vaccination. METHODS Engage is a sexual health study of GBM in the three largest Canadian cities recruited via respondent driven sampling (RDS). We categorized participants as: (1) unaware of HPV vaccine, (2) undecided/unwilling to get vaccinated, (3) willing to get vaccinated, (4) vaccinated with one or more doses. Our RDS-II weighted analyses used multinomial logistic regression to identify factors associated with being in earlier stages of the cascade compared to Stage 4. RESULTS Across the cities, 26-40%, 7-14%, 33-39%, and 13-28% were in Stages 1 to 4, respectively. Compared to Stage 4, being in earlier stages of the cascade was associated with bisexual-identification (Stage 1: adjusted odds ratio[aOR] = 2.84, 95% confidence interval[CI] = 1.06-7.62; Stage 2: aOR = 3.09, 95%CI = 1.19-8.05), having immigrated to Canada (Stage 1: aOR = 1.79, 95%CI 1.07-2.99), preference to keep same-sex romantic relationships private (Stage 1: aOR = 1.25, 95% CI = 1.05-1.48; Stage 2: aOR = 1.24, 95%CI = 1.05-1.46), not receiving sexual health information (Stage 1: aOR = 0.31, 95% CI = 0.13-0.71; Stage 2: aOR = 0.27, 95%CI = 0.12-0.64), not accessing a health-care provider (Stage 2: aOR = 0.36, 95%CI = 0.15-0.83), and no past hepatitis A/B vaccination (Stage 1: aOR = 0.16, 95% CI = 0.09-0.30; Stage 2: aOR = 0.18, 95%CI = 0.09-0.35; Stage 3: aOR = 0.38, 95%CI = 0.21-0.61). DISCUSSION Interventions are needed to reduce social and financial barriers, increase sexual health knowledge, and improve GBM-competent health-care access to increase vaccine uptake among GBM.
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Affiliation(s)
- R Grewal
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - S L Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Nova Scotia Department of Health and Wellness, Halifax, Canada
| | - T A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Psychology, Ryerson University, Toronto, Canada
| | - J Cox
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Montréal, McGill University.,Direction régionale de santé publique, CIUSSS-Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - A De Pokomandy
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - T Grennan
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - G Lambert
- Direction régionale de santé publique, CIUSSS-Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - D Moore
- Department of Medicine, University of British Columbia, Vancouver, Canada.,BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - F Coutlée
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Canada.,Department of Microbiology and Immunology, Université de Montréal, Montréal, Canada
| | - M Gaspar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - C George
- Department of Exercise, Health, and Sport Sciences, University of Maine, Portland, USA
| | - D Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - J Jollimore
- Community-Based Research Centre, Vancouver, Canada
| | - N J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Community-Based Research Centre, Vancouver, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - R Nisenbaum
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Applied Health Research Centre, Unity Health Toronto, Toronto, Canada
| | - G Ogilvie
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - C Sauvageau
- Faculty of Medicine, Université Laval, Québec City, Canada.,Institut National de santé publique du Québec, Québec, Canada
| | - D H S Tan
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - A Yeung
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - A N Burchell
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada
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2
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Grewal R, Deeks SL, Hart TA, Cox J, De Pokomandy A, Grennan T, Lambert G, Moore D, Brisson M, Coutlée F, Gaspar M, George C, Grace D, Jollimore J, Lachowsky NJ, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DHS, Yeung A, Burchell AN. Human papillomavirus (HPV) vaccine uptake among a community-recruited sample of gay, bisexual, and other men who have sex with men in the three largest cities in Canada from 2017 to 2019. Vaccine 2021; 39:3756-3766. [PMID: 34074547 DOI: 10.1016/j.vaccine.2021.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/26/2021] [Accepted: 05/11/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION In 2015/2016, Canada's largest provinces implemented publicly-funded human papillomavirus (HPV) vaccination programs for gay, bisexual, and other men who have sex with men (GBM) ≤ 26 years old. We sought to describe HPV vaccine uptake among GBM and determine barriers and facilitators to vaccine initiation with a focus on healthcare access and utilization. METHODS Engage is a cohort study among GBM aged 16 + years in three Canadian cities recruited from 2017 to 2019 via respondent driven sampling (RDS). Men completed a comprehensive questionnaire at baseline. By publicly-funded vaccine eligibility (≤26 years old = eligible for vaccination, ≥27 years old = ineligible), we described HPV vaccine uptake (initiation = 1 + dose, completion = 3 doses) and explored factors associated with vaccine initiation using Poisson regression. All analyses were weighted with the RDS-II Volz-Heckathorn estimator. RESULTS Across the three cities, 26-35% and 14-21% of men ≤ 26 years and 7-26% and 2-9% of men ≥ 27 years initiated and completed HPV vaccination, respectively. Vaccine initiation was significantly associated with STI/HIV testing or visiting a HIV care specialist in the past six months (≤26: prevalence ratio[PR] = 2.15, 95% confidence interval[CI] 1.06-4.36; ≥27: PR = 2.73, 95%CI 1.14-6.51) and past hepatitis A or B vaccination (≤26: PR = 2.88, 95%CI 1.64-5.05; ≥27: PR = 2.03, 95%CI 1.07-3.86). Among men ≥ 27 years old, vaccine initiation was also positively associated with accessing PrEP, living in Vancouver or Toronto, but negatively associated with identifying as Latin American and increasing age. Vaccine initiation was twice as likely among men ≥ 27 years with private insurance versus no insurance. CONCLUSIONS Sixty-five to 74% of men eligible for publicly-funded vaccine across the three cities remained unvaccinated against HPV by 2019. High vaccine cost may partly explain even lower uptake among men ≥ 27 years old. Men seeking sexual health care were more likely to initiate vaccination; bundling vaccination with these services may help improve HPV vaccine uptake.
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Affiliation(s)
- R Grewal
- Unity Health Toronto, Canada; University of Toronto, Canada
| | - S L Deeks
- University of Toronto, Canada; Public Health Ontario, Canada
| | - T A Hart
- University of Toronto, Canada; Ryerson University, Canada
| | - J Cox
- McGill University, Canada; Direction régionale de santé publique - Montréal, Canada
| | | | - T Grennan
- BC Centre for Disease Control, Canada; University of British Columbia, Canada
| | - G Lambert
- Direction régionale de santé publique - Montréal, Canada
| | - D Moore
- University of British Columbia, Canada; BC Centre for Excellence in HIV/AIDS, Canada
| | | | - F Coutlée
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada
| | | | - C George
- University of Southern Maine, United States
| | - D Grace
- University of Toronto, Canada
| | | | - N J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Canada; Community-Based Research Centre, Canada; University of Victoria, Canada
| | - R Nisenbaum
- Unity Health Toronto, Canada; University of Toronto, Canada
| | - G Ogilvie
- BC Centre for Disease Control, Canada; University of British Columbia, Canada
| | - C Sauvageau
- Université Laval, Canada; Institut national de santé publique du Québec, Canada
| | - D H S Tan
- Unity Health Toronto, Canada; University of Toronto, Canada
| | - A Yeung
- Unity Health Toronto, Canada
| | - A N Burchell
- Unity Health Toronto, Canada; University of Toronto, Canada.
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Use of a comprehensive program to review religious and personal seasonal influenza vaccination exemption requests by healthcare personnel. Infect Control Hosp Epidemiol 2020; 42:507-512. [PMID: 33118915 DOI: 10.1017/ice.2020.1260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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4
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Grattan BJ. Should we be vaccinating our patients against influenza? Am J Emerg Med 2020; 38:966-967. [DOI: 10.1016/j.ajem.2019.12.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 10/25/2022] Open
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Smith S, Sim J, Halcomb E. Australian general practice nurse's knowledge, attitudes and practices regarding influenza vaccination: a cross-sectional survey. J Clin Nurs 2016; 25:2502-10. [DOI: 10.1111/jocn.13287] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Sarah Smith
- School of Nursing; University of Wollongong; Wollongong NSW Australia
| | - Jenny Sim
- School of Nursing; University of Wollongong; Wollongong NSW Australia
| | - Elizabeth Halcomb
- School of Nursing; University of Wollongong; Wollongong NSW Australia
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Smith S, Sim J, Halcomb E. Nurses' knowledge, attitudes and practices regarding influenza vaccination: an integrative review. J Clin Nurs 2016; 25:2730-44. [PMID: 27206347 DOI: 10.1111/jocn.13243] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 01/05/2023]
Abstract
AIMS AND OBJECTIVES To critically analyse the literature describing nurses' knowledge, attitudes and practices regarding influenza vaccination. BACKGROUND Influenza is a serious illness that has significant impacts on productivity, health outcomes and healthcare costs. Despite the recommendations for nurses to be vaccinated annually against influenza, the vaccination rates remain suboptimal. DESIGN Integrative literature review. METHODS An integrative review was conducted as described by Whittemore and Knafl (2005). A search of CINAHL, Cochrane Library, ProQuest Central, ClinicalKey, ScienceDirect, Wiley Online Library, and Informit was undertaken to identify relevant papers. Given the heterogeneity of included studies, a narrative approach was used to analyse the data. RESULTS There was limited research available on this topic area, with only 10 papers identified as meeting the inclusion criteria. Five themes were identified: the relationship between knowledge and influenza vaccination, perception of risk, motivators for influenza vaccination, barriers to influenza vaccination and impact of demographics on vaccination. CONCLUSIONS Despite the evidence for the protective effects of influenza vaccination, rates of vaccination among nurses remain sub-optimal. Nurses' influenza vaccination practices likely relate to their level of knowledge and perception of risk; the greater nurses' knowledge regarding influenza and influenza vaccination the higher their perception of risk and the more likely they are to be vaccinated. This also translates to the advice that they give patients with vaccinated nurses more inclined to recommend vaccination than those unvaccinated. RELEVANCE TO CLINICAL PRACTICE The practices of nurses related to influenza vaccination may translate to the advice that they give their patients. Understanding the knowledge levels, practices and attitudes of nurses can assist in developing strategies to enhance education of nurses.
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Affiliation(s)
- Sarah Smith
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia.
| | - Jenny Sim
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Elizabeth Halcomb
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
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7
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MacDougall D, Halperin BA, MacKinnon-Cameron D, Li L, McNeil SA, Langley JM, Halperin SA. Universal tetanus, diphtheria, acellular pertussis (Tdap) vaccination of adults: What Canadian health care providers know and need to know. Hum Vaccin Immunother 2015; 11:2167-79. [PMID: 26090861 DOI: 10.1080/21645515.2015.1046662] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The tetanus, diphtheria, and acellular pertussis vaccine (Tdap) is recommended for all adults in both Canada and the United States. There are few data on the proportion of Canadian adults vaccinated with Tdap; however, anecdotal reports indicate that uptake is low. This study aimed to explore the knowledge, attitudes, beliefs, and behaviors of Canadian health care providers (HCPs) in an attempt to identify potential barriers and facilitators to Tdap uptake. HCPs were surveyed and a geographic and practice representative sample was obtained (N =1,167). In addition, 8 focus groups and 4 interviews were conducted nationwide. Results from the survey indicate that less than half (47.5%) of all respondents reported being immunized with Tdap themselves, while 58.5% routinely offer Tdap to their adult patients. Knowledge scores were relatively low (63.2% correct answers). The best predictor of following the adult Tdap immunization guidelines was awareness of and agreement with those recommendations. Respondents who were aware of the recommendations were more likely to think that Tdap is safe and effective, that their patients are at significant risk of getting pertussis, and to feel that they have sufficient information (p < 0.0001 for each statement). Focus group data supported the survey results and indicated that there are substantial gaps in knowledge of pertussis and Tdap among Canadian HCPs. Lack of public knowledge about adult immunization, lack of immunization registries, a costing differential between Td and Tdap, workload required to deliver the vaccine, and vaccine hesitancy were identified as barriers to compliance with the national recommendations for universal adult immunization, and suggestions were provided to better translate recommendations to front-line practitioners.
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Affiliation(s)
- D MacDougall
- a Canadian Center for Vaccinology; Dalhousie University, IWK Health Centre ; and the Nova Scotia Health Authority ; Halifax , NS Canada
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Morin A, Lemaître T, Farrands A, Carrier N, Gagneur A. Maternal knowledge, attitudes and beliefs regarding gastroenteritis and rotavirus vaccine before implementing vaccination program: Which key messages in light of a new immunization program? Vaccine 2012; 30:5921-7. [DOI: 10.1016/j.vaccine.2012.07.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 07/16/2012] [Accepted: 07/23/2012] [Indexed: 11/29/2022]
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9
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Influenza vaccination among nurses in Greece. Am J Infect Control 2012; 40:276-8. [PMID: 21840087 DOI: 10.1016/j.ajic.2011.04.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Revised: 04/14/2011] [Accepted: 04/14/2011] [Indexed: 11/20/2022]
Abstract
Seasonal influenza has become a serious public health problem worldwide, and vaccination is recognized as the most effective preventative measure. However, data suggest that influenza vaccination rates are generally low among health care workers. The present study showed that the vaccination rates for influenza among nurses are 21.2%.
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10
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Toska A, Saridi M, Rekleiti M, Alonistioti A, Wozniak G, Kyriazis I, Apostolopoulou E. Hepatitis B vaccination coverage levels among nurses in Greece. Am J Infect Control 2011; 39:532. [PMID: 21601951 DOI: 10.1016/j.ajic.2010.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 09/02/2010] [Indexed: 11/17/2022]
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Johansen LJ, Stenvig T, Wey H. The decision to receive influenza vaccination among nurses in North and South Dakota. Public Health Nurs 2011; 29:116-25. [PMID: 22372448 DOI: 10.1111/j.1525-1446.2011.00966.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We examined the relationships between factors (intention, habit, facilitating conditions, and social, cognitive, and affective factors) and nurses' decisions about influenza vaccinations to understand why some get vaccinated while others do not. DESIGN AND SAMPLE In a descriptive correlational design, the Triandis model of interpersonal behavior was used to examine the decision of nurses to receive influenza vaccinations. Participants were a random sample (N=193) of registered nurses in North and South Dakota drawn from the respective state nursing licensing board lists. MEASURES Instrument construction and mail survey procedures followed Dillman's tailored design method. RESULTS The response rate exceeded 80%. The findings revealed significant, positive correlations among all model variables. Item analysis showed that false beliefs about influenza disease and vaccinations were prevalent and that there was a wide variation in employer support for nurses getting vaccinated. CONCLUSIONS Educational and social marketing strategies may improve nurse's knowledge about influenza disease and vaccine and increase vaccine uptake. Employers should be encouraged to promote and improve influenza vaccine accessibility in the workplace. Additional study is needed to understand how best to strengthen the influence of intention and habit on the decision of nurses to receive influenza vaccinations.
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Affiliation(s)
- Laurie Jo Johansen
- College of Nursing, South Dakota State University, Brookings, South Dakota 57007, USA.
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12
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Looijmans-van den Akker I, Hulscher ME, Verheij TJ, Riphagen-Dalhuisen J, van Delden JJ, Hak E. How to develop a program to increase influenza vaccine uptake among workers in health care settings? Implement Sci 2011; 6:47. [PMID: 21595877 PMCID: PMC3115899 DOI: 10.1186/1748-5908-6-47] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 05/19/2011] [Indexed: 12/02/2022] Open
Abstract
Background Apart from direct protection and reduced productivity loss during epidemics, the main reason to immunize healthcare workers (HCWs) against influenza is to provide indirect protection of frail patients through reduced transmission in healthcare settings. Because the vaccine uptake among HCWs remains far below the health objectives, systematic programs are needed to take full advantage of such vaccination. In an earlier report, we showed a mean 9% increase of vaccine uptake among HCWs in nursing homes that implemented a systematic program compared with control homes, with higher rates in those homes that implemented more program elements. Here, we report in detail the process of the development of the implementation program to enable researchers and practitioners to develop intervention programs tailored to their setting. Methods We applied the intervention mapping (IM) method to develop a theory- and evidence-based intervention program to change vaccination behaviour among HCWs in nursing homes. Results After a comprehensive needs assessment, we were able to specify proximal program objectives and selected methods and strategies for inducing behavioural change. By consensus, we decided on planning of three main program components, i.e., an outreach visit to all nursing homes, plenary information meetings, and the appointment of a program coordinator -- preferably a physician -- in each home. Finally, we planned program adoption, implementation, and evaluation. Conclusion The IM methodology resulted in a systematic, comprehensive, and transparent procedure of program development. A potentially effective intervention program to change influenza vaccination behaviour among HCWs was developed, and its impact was assessed in a clustered randomised controlled trial.
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Affiliation(s)
- Ingrid Looijmans-van den Akker
- University of Groningen, Department of Pharmacy, Pharmacoepidemiology and Pharmacoeconomy, A, Deusinglaan 1, 9713 AV, Groningen, The Netherlands
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Nikula A, Nohynek H, Puukka P, Leino-Kilpi H. Vaccination Competence of Public Health Nurses. Public Health Nurs 2011; 28:533-42. [DOI: 10.1111/j.1525-1446.2011.00943.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Toronto CE, Mullaney SM. Registered nurses and influenza vaccination. An integrative review. ACTA ACUST UNITED AC 2010; 58:463-71. [PMID: 21053796 DOI: 10.3928/08910162-20101027-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 09/24/2010] [Indexed: 11/20/2022]
Abstract
Influenza is a serious infectious disease, causing 226,000 hospitalizations and 36,000 deaths in the United States each year. Since 1981, the Centers for Disease Control and Prevention (CDC) has recommended that all health care workers receive influenza vaccination annually. Current CDC reports indicate that only 40% of health care workers receive influenza vaccination. Vaccination rates are lower among registered nurses than other health care workers. This integrative review encompasses international research published between 2003 and 2009, and explores factors that influence nurses' decision to receive or decline influenza vaccination. Findings indicated that concerns about the vaccine's safety and efficacy continue to be major barriers for registered nurses. Future efforts to improve vaccination rates should include rigorous education on vaccine efficacy and safety specific to nursing personnel.
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Affiliation(s)
- Coleen E Toronto
- Learning Laboratories, Boston College, William F. Connell School of Nursing, Chestnut Hill, MA 02467, USA.
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15
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Hidiroglu S, Ay P, Topuzoglu A, Kalafat C, Karavus M. Resistance to vaccination: The attitudes and practices of primary healthcare workers confronting the H1N1 pandemic. Vaccine 2010; 28:8120-4. [DOI: 10.1016/j.vaccine.2010.09.104] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 09/23/2010] [Accepted: 09/29/2010] [Indexed: 02/04/2023]
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Ehrenstein BP, Hanses F, Blaas S, Mandraka F, Audebert F, Salzberger B. Perceived risks of adverse effects and influenza vaccination: a survey of hospital employees. Eur J Public Health 2010; 20:495-9. [PMID: 20089677 DOI: 10.1093/eurpub/ckp227] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many hospital employees shun influenza immunization because they want to avoid adverse reactions. We surveyed hospital employees to elucidate whether the conception of the adverse effects of vaccination stems from correct or misperceived incidence rates of vaccine adverse effects. METHODS We used an anonymous self-administered paper questionnaire at a tertiary-care university hospital in Germany, in 2006. Multiple-choice questions probed respondents' knowledge about influenza, influenza vaccine and about rates of 12 possible vaccine adverse effects. We correlated overestimation of each adverse effect with failure to obtain vaccination in 2005-06, stratified by professional group. RESULTS The overall response rate was 34% (652/1898). Of the 304 respondents unvaccinated in 2005-06, 127 (42%) attributed their vaccination status mainly to concerns about adverse effects. Among physicians, failure to obtain influenza vaccination was associated with the overestimation of both non-severe and severe adverse effects. Non-vaccinated nurses were significantly more likely than the vaccinated nurses to overestimate the rates of five of six non-severe adverse effects, but differed significantly in rates of overestimation of merely one of the six severe adverse effects. Overestimation of vaccine-caused absenteeism from work was negatively associated with vaccination rates among all professionals. CONCLUSIONS Overestimation of the actual low rates of influenza vaccine adverse effects was associated with non-receipt of the vaccine among hospital employees. Due to our finding of different misconceptions about adverse effects, educational and promotional programmes should be targeted differentially for nurses and physicians.
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Affiliation(s)
- Boris P Ehrenstein
- Department of Internal Medicine I, University Medical Center Regensburg, Regensburg, Germany.
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Top KA, Halperin BA, Baxendale D, MacKinnon-Cameron D, Halperin SA. Pertussis immunization in paediatric healthcare workers: knowledge, attitudes, beliefs, and behaviour. Vaccine 2010; 28:2169-2173. [PMID: 20056190 DOI: 10.1016/j.vaccine.2009.12.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 12/09/2009] [Accepted: 12/23/2009] [Indexed: 01/05/2023]
Abstract
Healthcare workers' (HCWs) knowledge, attitudes, and beliefs regarding pertussis immunization were assessed and compared to the rate of vaccine uptake. A questionnaire was distributed to employees at a paediatric and maternity tertiary care centre. Respondents were then offered a dose of the tetanus, diphtheria, and acellular pertussis vaccine (Tdap) at a free vaccine clinic. In total, 529 out of 3051 (17%) employees completed the survey and 61 received the Tdap vaccine. Although 76% of participants were willing to be immunized, only 15% presented to the clinic. There is a widespread acceptance of pertussis immunization among paediatric HCWs. Stated intentions may be poorly predictive of behaviour. Education and institutional or public funding may improve vaccine uptake.
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Affiliation(s)
- Karina A Top
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Beth A Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Darlene Baxendale
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Scott A Halperin
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada; Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada.
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Nikula AE, Rapola SPT, Hupli MI, Leino-Kilpi HT. Factors strengthening and weakening vaccination competence. Int J Nurs Pract 2009. [DOI: 10.1111/j.1440-172x.2009.01781.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Clark SJ, Cowan AE, Wortley PM. Influenza vaccination attitudes and practices among US registered nurses. Am J Infect Control 2009; 37:551-6. [PMID: 19556035 DOI: 10.1016/j.ajic.2009.02.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 02/19/2009] [Accepted: 02/19/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND The influenza vaccination rate among US health care personnel (HCP) remains low and may vary by occupational categories. The objective of this study was to explore knowledge, attitudes, and beliefs associated with influenza vaccination in a broad population of registered nurses. METHODS The study used a cross-sectional mail survey, administered January-March 2006, of 2000 registered nurses in 4 US states. RESULTS Of the 2000 surveys sent, 1310 (72%) were returned, and 1017 (67%) were eligible for analysis. The majority of respondents (59%) reported receiving influenza vaccine during the 2005-2006 influenza season. The most common reason for being vaccinated was protecting oneself from illness (95%), and the most common reason for not being vaccinated was concern about adverse reactions (39%). Respondents who reported their patient population as high risk related to influenza were more likely to be vaccinated and to agree with statements regarding influenza disease and influenza vaccination of HCP. CONCLUSION Concerns about adverse reactions and vaccine effectiveness continue to be barriers to influenza vaccination among registered nurses. Those most knowledgeable about influenza vaccination of HCP have higher vaccination rates. Future efforts to improve vaccination rates should include data on vaccine effectiveness and adverse effects, as well as descriptions of high-risk populations.
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Affiliation(s)
- Sarah J Clark
- Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, MI 48109-5456, USA.
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Kahn JA, Ding L, Huang B, Zimet GD, Rosenthal SL, Frazier AL. Mothers' intention for their daughters and themselves to receive the human papillomavirus vaccine: a national study of nurses. Pediatrics 2009; 123:1439-45. [PMID: 19482752 DOI: 10.1542/peds.2008-1536] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aims of this study were to examine mothers' intention to vaccinate their daughters and themselves against human papillomavirus and to determine which demographic, behavioral, and attitudinal factors were associated with intention to vaccinate daughters. METHODS We surveyed 10,521 US mothers, all nurses, between June 2006 and February 2007. Multivariable logistic regression models were used to determine which of the following factors were associated with a mother's intention to vaccinate a 9- to 12-year-old daughter: demographic factors, gynecologic history, belief that one's daughter should have regular Papanicolaou testing, beliefs about Papanicolaou testing outcomes (3-item scale), and beliefs about human papillomavirus vaccines (7-item scale measuring beliefs about human papillomavirus vaccine efficacy, impact of vaccination on sexual and Papanicolaou screening behaviors, severity of and susceptibility to human papillomavirus, and anticipated clinician recommendations). RESULTS Of the 8832 mothers who completed a survey (84% response rate), 7207 had a daughter. Among mothers with a daughter, 48% intended to vaccinate a daughter if she were 9 to 12 years of age, 68% if she were 13 to 15 years of age, and 86% if she were 16 to 18 years of age. Forty-eight percent intended to receive the vaccine themselves if recommended. In multivariable regression models, variables significantly associated with intention to vaccinate a 9- to 12-year-old daughter included belief that one's daughter should have regular Papanicolaou testing and beliefs about human papillomavirus vaccines. CONCLUSIONS In this first national study of mothers' attitudes about human papillomavirus vaccines, mothers' intention to vaccinate a daughter <13 years of age was lower than intention to vaccinate an older daughter, contrasting with national recommendations to target 11- to 12-year-old girls for vaccination. Educational interventions designed to affect mothers' willingness to vaccinate daughters should focus on human papillomavirus vaccine efficacy, behavioral impact of vaccination, perceived risk of human papillomavirus, and clinician support for vaccination.
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Affiliation(s)
- Jessica A Kahn
- Division of Adolescent Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, MLC 4000, 3333 Burnet Ave, Cincinnati, OH 45229, USA.
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Which determinants should be targeted to increase influenza vaccination uptake among health care workers in nursing homes? Vaccine 2009; 27:4724-30. [PMID: 19450642 DOI: 10.1016/j.vaccine.2009.05.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 04/18/2009] [Accepted: 05/04/2009] [Indexed: 11/24/2022]
Abstract
Although health care workers (HCWs) have been recommended to be immunized against influenza, vaccine uptake remains low. So far, research on determinants of influenza vaccination among HCWs has been limited by design, population or theoretical framework. Therefore we conducted a questionnaire study in Dutch nursing homes to assess which demographical, behavioural and organisational determinants were associated with influenza vaccine uptake among HCWs. We were able to accurately predict vaccine uptake based on a 13-item prediction model including two demographical, nine behavioural and two organisational determinants developed with data from 1,125 respondents (response rate 60%). To further increase influenza vaccine uptake, implementation programs should target these determinants.
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22
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Influenza vaccination compliance among health care workers in a German university hospital. Infection 2008; 37:197-202. [PMID: 19139807 DOI: 10.1007/s15010-008-8200-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 08/06/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Since 1988, the Standing Committee on Vaccination (STIKO) at the Robert Koch-Institute, Berlin, has explicitly recommended that health-care workers (HCWs) should be vaccinated against seasonal influenza. However, acceptance of the influenza vaccination by medical personnel is low. METHODS This study analyzes factors associated with the compliance of HCWs with the seasonal influenza vaccination on the basis of three different anonymized questionnaires during two consecutive influenza seasons: 2006/2007 and 2007/2008. The questionnaires covered details of demographics, frequency of previous vaccinations, reasons for accepting or declining the vaccination, and the HCW's knowledge of the influenza vaccine and influenza itself. RESULTS Our study showed that physicians were significantly more likely to have been vaccinated than nurses (38.8% vs 17.4%; p < 0.0001). The main reasons for noncompliance included: supposition of a low risk of infection, fear of side effects, the belief that the influenza vaccine might trigger the influenza virus infection, and scepticism about the effectiveness of the influenza vaccination. CONCLUSION Our findings confirm the importance of a comprehensive approach to the vaccination, ensuring that HCWs are correctly informed about the vaccine and that it is convenient to receive it.
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Vagholkar S, Ng J, Chan RC, Bunker JM, Zwar NA. Healthcare workers and immunity to infectious diseases. Aust N Z J Public Health 2008; 32:367-71. [PMID: 18782402 DOI: 10.1111/j.1753-6405.2008.00257.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE In 2002, New South Wales (NSW) Health introduced an updated policy for occupational screening and vaccination against infectious diseases. This study describes healthcare worker (HCW) immunity to hepatitis B, measles, mumps, rubella (MMR) and varicella based on serological screening, following introduction of this policy. METHODS HCW screening serology performed at two healthcare facilities in south western Sydney (Bankstown and Fairfield) was extracted for the period September 2003 to September 2005. Immunity to hepatitis B, MMR and varicella was quantitated and cross-tabulated against age, sex and staff risk category. RESULTS A total of 1,320 HCWs were screened. Almost two thirds were immune to hepatitis B while immunity to MMR and varicella ranged from 88% to 94%. Age stratification showed lower levels of measles immunity in those born after 1965. CONCLUSIONS Despite availability of vaccination for over two decades, a significant proportion of HCWs at these two facilities were non-immune to hepatitis B. This is of concern for those non-immune staff involved in direct clinical care, who are at risk of blood and body fluid exposures. The small group of HCWs non-immune to MMR and varicella pose a risk to themselves and others in the event of an outbreak. IMPLICATIONS There is a need for improved implementation of the occupational screening and vaccination policy, including better education of HCWs about the risks of non-immunity to vaccine preventable diseases. The revised 2007 NSW Health policy may assist this process and will need evaluation to determine whether HCW immunity improves in the coming years.
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Affiliation(s)
- Sanjyot Vagholkar
- General Practice Unit, Sydney South West Area Health Service, School of Public Health & Community Medicine, University of New South Wales.
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Norton SP, Scheifele DW, Bettinger JA, West RM. Influenza vaccination in paediatric nurses: Cross-sectional study of coverage, refusal, and factors in acceptance. Vaccine 2008; 26:2942-8. [DOI: 10.1016/j.vaccine.2008.03.033] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 03/17/2008] [Accepted: 03/17/2008] [Indexed: 11/24/2022]
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Fernandez WG, Oyama L, Mitchell P, Edwards EM, St George J, Donovan J, Feldman JA. Attitudes and practices regarding influenza vaccination among emergency department personnel. J Emerg Med 2008; 36:201-6. [PMID: 18281180 DOI: 10.1016/j.jemermed.2007.07.070] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Revised: 02/26/2007] [Accepted: 07/25/2007] [Indexed: 11/29/2022]
Abstract
In the United States, infections related to influenza result in a huge burden to the health care system and emergency departments (EDs). Influenza vaccinations are a safe, cost-effective means to prevent morbidity and mortality. We sought to understand the factors that contribute to the professional and personal influenza vaccination practices of health care workers in the ED setting by assessing their knowledge, attitudes, and practices with regards to the influenza vaccine. A cross-sectional study of all full-time ED staff (nurses, emergency medicine residents, and emergency medicine faculty) at an urban academic medical center in Boston treating > 90,000 ED patients annually, was performed. We examined knowledge, attitudes, and practices regarding personal influenza vaccination and support of an ED-based influenza vaccination program using an anonymous, self-administered questionnaire. Of 130 ED staff, 126 individuals completed the survey (97% response rate). Overall, 69% of respondents reported that they were very or extremely likely to be vaccinated before the coming influenza season. Residents (94%) and attending physicians (82%) were significantly more likely than nurses (42%) to be vaccinated (p < 0.001). Respondents likely to be vaccinated this year were more likely to support a vaccination program for ED patients (80% vs. 55% of those not vaccinated,p < 0.001). Providing regular education on the efficacy of preventive vaccination therapy and dispelling misconceptions regarding adverse effects may reduce barriers to vaccination programs. An educational initiative may result in acceptance of influenza vaccination by ED providers themselves, which could result in increased support for an influenza vaccination program for ED patients.
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Affiliation(s)
- William G Fernandez
- Department of Emergency Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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Looijmans-van den Akker I, van Delden JJM, Hak E. UPTAKE OF INFLUENZA VACCINATION IN DUTCH NURSING HOME PERSONNEL FOLLOWING NATIONAL RECOMMENDATIONS. J Am Geriatr Soc 2007; 55:1486-7. [PMID: 17767701 DOI: 10.1111/j.1532-5415.2007.01277.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
AIM To explore the attitudes and knowledge of health-care workers (HCW) towards whooping cough and an adult whooping cough booster for HCW. METHODS HCW at Fairfield Health Service, who had clinical contact with infants or children, were sent a self-administered questionnaire. RESULTS Questionnaires were completed by 135 staff, giving a response rate of 74%. Thirty-five per cent were not known to be immunised against whooping cough. Fifty-nine per cent of doctors were known to be immunised, 33% of allied health staff and 28% of nurses. The rates of immunisation between the professional groups were significantly different (chi2 = 8.2 with 2 degrees of freedom; P = 0.017). Thirty-nine per cent of HCW did not know that primary immunisation did not provide lifelong protection. Twenty-seven per cent did not agree that HCW should be offered an adult whooping cough booster. Staff who felt at risk of contracting whooping cough were more likely to recommend that a booster should be offered (OR 2.71; 95% CI 1.22-6.04; P = 0.019). Doctors were less likely to recommend that a booster should be offered (OR 0.36; 95% CI 0.15-0.87; P = 0.028). CONCLUSIONS HCW have low rates of immunity to whooping cough and misconceptions about whooping cough infection and immunisation. Over a quarter of HCW did not agree that a booster should be offered. An ongoing education programme addressing the attitudes and misconceptions identified in this study is a crucial component of the campaign to increase the uptake of adult whooping cough booster immunisation by HCW.
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Affiliation(s)
- Elizabeth Peadon
- Community Paediatrics, Fairfield Health Service, Fairfield, New South Wales, Australia.
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Lugo NR. Will carrots or sticks raise influenza immunization rates of health care personnel? Am J Infect Control 2007; 35:1-6. [PMID: 17276784 DOI: 10.1016/j.ajic.2006.10.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 10/24/2006] [Accepted: 10/24/2006] [Indexed: 11/30/2022]
Abstract
New Joint Commission on the Accreditation of Healthcare Organizations standards require health care organizations to implement staff influenza immunization programs and track employee immunization rates. Although the Centers for Disease Control and Prevention have recommended influenza immunizations for health care workers since 1981, employee vaccination rates have stagnated at 30% to 40% for several years. With the recent attention on these low rates, some institutions have increased employee rates significantly with robust, multifaceted immunization programs. Others have attempted to require immunizations as a condition of employment. Declinations signed by those who refuse immunizations also have been proposed. This article examines recommendations for employee influenza immunizations and the evidence for effective strategies that increase coverage rates. With so much misunderstanding about the influenza immunization, robust interactive education, and onsite, easily accessible vaccination at no cost to employees--the carrots--may be more successful in increasing rates than are declinations and work exclusion--the sticks. Strong immunization programs may create the tipping point for making influenza immunizations as routine in health care as gloves. More robust staff immunization programs, evaluations of their effectiveness, surveillance of health care employee immunization rates, as well as further evidence of effectiveness of declinations and work exclusions should guide further policy formation and implementation.
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Affiliation(s)
- Nancy Rudner Lugo
- University of Central Florida School of Nursing; and Nancy Rudner Consulting, Inc., Orlando, Florida 32804, USA.
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Di Giuseppe G, Nobile CGA, Marinelli P, Angelillo IF. A survey of knowledge, attitudes, and behavior of Italian dentists toward immunization. Vaccine 2006; 25:1669-75. [PMID: 17129642 DOI: 10.1016/j.vaccine.2006.10.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 10/12/2006] [Accepted: 10/31/2006] [Indexed: 10/23/2022]
Abstract
This study assessed the knowledge, attitude, and compliance to immunization guidelines among dental health-care professionals in Italy. A questionnaire was mailed to a random sample of 1000 dentists on demographic and professional characteristics; knowledge regarding infectious diseases that can be acquired/transmitted by the dentist and the vaccinations recommended; attitudes regarding the vaccinations; self-assessed information about previous vaccinations. A total of 369 dentists responded. Only 44.1 and 32.4% correctly indicated all infections that can be acquired or transmitted during their activity. Half of the dentists knew that they should be vaccinated against hepatitis B and influenza and this knowledge was significantly higher in those older, who correctly indicated that hepatitis B and influenza can be acquired and transmitted during their activity, and in those with a positive attitude towards vaccinations. Those younger, involved in specialties with low blood contact, and who did not know that hepatitis B and influenza are vaccinations recommended, were more likely to believe that is important for them to receive vaccinations. A large proportion (85.7%) reported receiving the hepatitis B vaccine, but only 56.2% the three doses. Those with a lower number of years of activity, those who knew that hepatitis B can be acquired by the dentist, those who did not need information, and those who were informed from guidelines, educational courses, and dental associations were more likely to have received the three doses or to be natural immunizated. Training and educational interventions are needed to improve knowledge and immunization coverage.
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