Influenza vaccination of staff in aged care facilities in the ACT: how can we improve the uptake of influenza vaccine?

A systematic review of barriers and enablers associated with uptake of influenza vaccine among care home staff

Barriers and enablers to vaccination of care home (CH) staff should be identified in order to develop interventions to address them that increase uptake and protect residents. We aimed to synthesis the evidence describing the barriers and enablers that affect the influenza vaccination uptake of care home (CH) staff.

METHOD

We searched PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, AMED, IBSS, SCOPUS to identify quantitative, qualitative or mixed-method studies. Data related to health or social care workers in CHs reported barriers or enablers were extracted and mapped to the Theoretical Domains Framework (TDF); the data within each domain were grouped and categorized into key factors affecting influenza vaccine uptake among CH staff.

RESULTS

We screened 4025 studies; 42 studies met our inclusion criteria. Thirty-four (81 %) were surveys. Five theoretical domains were frequently reported as mediators of influenza vaccine uptake: Beliefs about consequences (32 studies), Environmental context and resources (30 studies), Emotions (26 studies), Social influences (25 studies), Knowledge (22 studies). The low acceptance rate of the influenza vaccine among CH staff can be attributed to multiple factors, including insufficient understanding of the vaccine, its efficacy, or misconceptions about the vaccine (knowledge), perceiving the vaccine as ineffective and unsafe (beliefs about consequences), fear of influenza vaccine and its side effects (emotions), and experiencing limited accessibility to the vaccine (environmental context and resources).

CONCLUSION

Interventions aimed at increasing influenza vaccine uptake among CH staff should focus on addressing the barriers identified in this review. These interventions should include components such as enhancing knowledge by providing accurate information about vaccine benefits and safety, addressing negative beliefs by challenging misconceptions, managing concerns and fears through open communication, and improving accessibility to the vaccine through convenient on-site options. This review provides a foundation for the development of tailored Interventions to improve influenza vaccine uptake among CH staff.

Are We Prepared for the Next Pandemic? Management, Systematic Evaluation and Lessons Learned from an In-Hospital COVID-19 Vaccination Centre for Healthcare Workers

BACKGROUND

the organisation of a COVID-19 vaccination campaign for healthcare workers (HCWs) within a university hospital presents a challenge of a particularly large scale and urgency. Here, we evaluate the in-hospital vaccination process and centre for HCWs at LMU University Hospital in Munich, Germany.

METHODS

We executed a mixed-method process evaluation of the vaccination centre at LMU University Hospital during the first COVID-19 vaccination campaign. In a programme monitoring, we continuously assessed the implementation of the centre's operational management including personnel resources. In evaluating the outreach to and satisfaction of the target group with the centre and process, we executed two anonymous surveys aimed at the HCWs vaccinated at the in-hospital centre (1) as well as centre staff members (2).

RESULTS

staff numbers and process time per person were reduced several times during the first vaccination campaign. Lessons concerning appointment scheduling were learned. HCWs vaccinated at the in-hospital centre were satisfied with the process. A longer waiting time between admission and inoculation, perceived dissatisfying accessibility as well as an increased frequency of observed adverse events were linked to a reduced satisfaction. Comparatively subpar willingness to adhere to non-pharmaceutical measures was observed. Centre staff reported high satisfaction and a workload relatively equal to that of their regular jobs. Our outcomes provide references for the implementation of an in-hospital vaccination centre in similar settings.

Factors associated with repeated influenza vaccine uptake among aged care staff in an Australian sample from 2017 to 2019

BACKGROUND/AIM

Influenza vaccination is strongly recommended every year for aged care staff to protect themselves and minimise risk of transmission to residents. This study aimed to determine the factors associated with repeated annual influenza vaccine uptake among Australian aged care staff from 2017 to 2019.

METHODS

Demographic, medical and vaccination data collected from the staff, who participated in an observational study from nine aged care facilities under a single provider in Sydney Australia, were analysed retrospectively. Based on the pattern of repeated influenza vaccination from 2017 to 2019, three groups were identified: (1) unvaccinated all three years; (2) vaccinated occasionally(once or twice) over three years; and (3)vaccinated all threeyears. Multinomial logistic regression analysis was performed to better understand the factors associated with the pattern of repeated influenza vaccination.

RESULTS

From a total of 138 staff, between 2017 and 2019, 28.9 % (n = 40) never had a vaccination, while 44.2 % (n = 61) had vaccination occasionally and 26.8 % (n = 37) had vaccination all three years. In the multinomial logistic regression model, those who were<40 years old (OR = 0.57, 95 % CI: 0.19-0.90, p < 0.05) and those who were current smokers (OR = 0.20; 95 % CI: 0.03-0.76, p < 0.05) were less likely to have repeated vaccination for all three years compared to the unvaccinated group. Those who were<40 years old (OR = 0.61; 95 % CI: 0.22-0.68, p < 0.05) and those who were born overseas (OR = 0.50; 95 % CI:0.27-0.69, p < 0.05) were more likely to be vaccinated occasionally compared to the unvaccinated group.

CONCLUSION

The significant predictors of repeated vaccine uptake across the three-year study period among aged care staff were age, smoking status and country of birth (Other vs Australia). Targeted interventions towards the younger age group (<40 years old), smokers and those who were born overseas could improve repeated influenza vaccination uptake in the aged care workforce.

Influenza cases in nine aged care facilities in Sydney, Australia over a three-year surveillance period, 2018-2020

BACKGROUND

Influenza outbreaks in aged care facilities are a major public health concern. In response to the severe 2017 influenza season in Australia, enhanced influenza vaccines were introduced from 2018 onwards for those over 65 and more emphasis was placed on improving vaccination rates among aged care staff. During the COVID-19 pandemic, these efforts were then further escalated to reduce the additional burden that influenza could pose to facilities.

METHODS

An observational epidemiological study was conducted from 2018 to 2020 in nine Sydney (Australia) aged care facilities of the same provider. De-identified vaccination data and physical layout data were collected from participating facility managers from 2018 to 2020. Active surveillance of influenza-like illness was carried out from 2018 to 2020 influenza seasons. Correlation and Poisson regression analyses were carried out to explore the relationship between physical layout variables to occurrence of influenza cases.

RESULTS

Influenza cases were low in 2018 and 2019, and there were no confirmed influenza cases identified in 2020. Vaccination rates increased among staff by 50.5% and residents by 16.8% over the three-year period of surveillance from 2018 to 2020. For each unit increase in total number of beds, common areas, single rooms, all types of rooms (including double occupancy rooms), the influenza cases increased by 1.02 (95% confidence interval:1.018-1.025), 1.04 (95% confidence interval: 1.019-1.073), 1.03 (95% confidence interval: 1.016-1 0.038) and 1.02 (95% confidence interval:1.005-1.026) times which were found to be statistically significant. For each unit increase in the proportion of shared rooms, influenza cases increased by 1.004 (95% confidence interval:1.0001-1.207) which was found to be statistically significant.

CONCLUSIONS

There is a relationship between influenza case counts and aspects of the physical layout such as facility size, and this should be considered in assessing risk of outbreaks in aged care facilities. Increased vaccination rates in staff and COVID-19 prevention and control measures may have eliminated influenza in the studied facilities in 2020.

Facilitators to vaccination among hesitant adopters

To end the COVID-19 pandemic, it is essential to increase vaccine coverage in the United States (U.S.). In this study, we examine the facilitators that helped hesitant adopters - those who are both vaccinated and report some degree of hesitancy - overcome barriers to vaccination. Drawing on a sample of 867 hesitant adopters in Arkansas, we find social networks, individual actions, health care organizations and professionals, employers, religious communities and leaders, and the media all play a role in helping the vaccine hesitant overcome barriers to vaccination. Our findings demonstrate vaccine hesitancy and uptake occur simultaneously, and overcoming hesitancy in the U.S. population requires multifaceted strategies from multiple entities. We provide recommendations for overcoming barriers, including hesitancy, based on our findings.

Mapping of the Covid-19 Vaccine Uptake Determinants From Mining Twitter Data

Opinion polls on vaccine uptake clearly show that Covid-19 vaccine hesitancy is increasing worldwide. Thus, reaching herd immunity not only depends on the efficacy of the vaccine itself, but also on overcoming this hesitancy of uptake in the population. In this study, we revealed the determinants regarding vaccination directly from people's opinions on Twitter, based on the framework of the 6As taxonomy. Covid-19 vaccine acceptance depends mostly on the characteristics of new vaccines (i.e. their safety, side effects, effectiveness, etc.), and the national vaccination strategy (i.e. immunization schedules, quantities of vaccination points and their localization, etc.), which should focus on increasing citizens' awareness, among various other factors. The results of this study point to areas for potentially improving mass campaigns of Covid-19 immunization to increase vaccine uptake and its coverage and also provide insight into possible directions of future research.

Epidemiology of 2017 influenza outbreaks in nine Australian Aged care facilities

Background

The 2017 A/H3N2 influenza season was the most severe season since the 2009 influenza pandemic. There were over 591 influenza outbreaks in institutions across the state of New South Wales (NSW) in Australia.

Aim

To describe the epidemiology of influenza outbreaks in nine Sydney aged care facilities in 2017.

Methods

Study data were collected from nine Sydney aged care facilities for 2017 influenza season. Descriptive epidemiological analysis was conducted.

Results

From the nine sites included, with a total of 716 residents, four sites reported laboratory‐confirmed influenza outbreaks during the study period, with an attack rate in residents ranging from 6% to 29%. The outbreaks resulted in lockdowns in two facilities and hospitalisation of seven residents. No deaths were reported as a result of influenza infection. Influenza A was the most common influenza type reported across the facilities. The duration of outbreak lasted for 1‐4 weeks varied by site.

Conclusion

The 2017 season was a severe influenza season recorded in Australia. About half of the facilities studied experienced outbreaks of influenza, with a high attack rate among residents. Infection prevention and control measures and outbreak management plans are crucial for aged care facilities, including vaccination of staff and visitors to prevent outbreaks among the vulnerable residents.

Utility of Healthcare System-Based Interventions in Improving the Uptake of Influenza Vaccination in Healthcare Workers at Long-Term Care Facilities: A Systematic Review

Healthcare workers (HCWs) in long-term care facilities (LTCFs) can represent a source of influenza infection for the elderly. While flu vaccination coverage (VC) is satisfactory in the elderly, HCWs are less likely to be vaccinated. There is no definitive evidence on which types of healthcare system-based interventions at LTCFs would be more useful in improving the vaccination uptake among HCWs. We performed a systematic review in different databases (Pubmed, Cochrane Database of Systematic Reviews, Health Evidence, Web of Science, Cinahl) to provide a synthesis of the available studies on this topic. Among the 1177 articles screened by their titles and abstracts, 27 were included in this review. Most of the studies reported multiple interventions addressed to improve access to vaccination, eliminate individual barriers, or introduce policy interventions. As expected, mandatory vaccinations seem to be the most useful intervention to increase the vaccination uptake in HCWs. However, our study suggests that better results in the vaccination uptake in HCWs were obtained by combining interventions in different areas. Educational campaigns alone could not have an impact on vaccination coverage. LTCFs represent an ideal setting to perform preventive multi-approach interventions for the epidemiological transition toward aging and chronicity.

Influenza vaccine coverage and predictors of vaccination among aged care workers in Sydney Australia

Aged care facilities (ACFs) are residential communities with a concentration of vulnerable individuals with increased risk of severe influenza infection and complications such as outbreaks, hospitalisations and deaths. Aged care workers (ACW) are potential sources of influenza introduction and transmission in ACFs. Little is known about vaccine uptake among ACW. This study aimed to measure the vaccine uptake rate among Australian ACW and evaluate the demographic determinants of uptake during the influenza season of 2018. 146 ACWs were recruited from 7 facilities of a multisite aged care provider in Sydney. ACWs completed a questionnaire regarding their demographic, occupational and vaccination status. Vaccine coverage was calculated and variables were examined against their 2018 influenza vaccination status in statistical analysis. ACWs in our study were predominantly from a non-health occupational background with a large proportion of migrant workers (56%, 75/134). Vaccine coverage in 2018 was 48% (65/135). The strongest determinants of vaccine uptake were previous year vaccination history (Odds Ratio [OR] 10.49, 95% CI 3.33-33.10), workplace immunisation programs for employees (OR 7.87, 95% CI 2.47-25.10), casual work as employment status (OR 0.14, 95% CI 0.02-0.77), and presence of comorbidities (OR 4.04, 95% CI 1.23-13.32). ACW are a unique and understudied group who are critical to infection control in ACFs. Few ACWs have formal health training, and many are migrants who may lack access to subsidised health care and face out of pocket costs for vaccination. Vaccine coverage among ACW were below recommended levels. Provision of influenza vaccine for staff in workplaces is highly effective in raising vaccine coverage amongst ACWs. More research on the aged care sector workforce is needed in order to evaluate the determinants of vaccine uptake among Australian ACWs.

Factors associated with adverse outcomes during influenza outbreaks in aged care facilities

OBJECTIVE

To explore factors associated with adverse outcomes during influenza outbreaks in residential aged care facilities.

METHODS

A retrospective cohort study of all outbreaks reported to three Sydney metropolitan Public Health Units during 2017.

RESULTS

A total of 123 outbreaks affected 1,787 residents and 543 staff. Early notification to a Public Health Unit was associated with shorter outbreak duration (p<0.001; B=0.674). Resident attack rates and resident mortality rates were lower in outbreaks notified early, on univariate analysis (p=0.034 and p=0.048 respectively) but not on an adjusted model. Staff attack rates were significantly associated with resident attack rates (p=0.001; B=0.736). Data on staff vaccination rates was incomplete and reported coverage rates were low (median 39%). Resident vaccination coverage ≥95% was associated with shorter outbreak duration in univariate testing but not on an adjusted model.

CONCLUSIONS

Early public health notification is associated with improved outbreak parameters; sick staff may pose a risk to residents, yet vaccination rates are low. Resident vaccination may also be valuable. Implications for public health: Measures that facilitate early PHU involvement in influenza outbreaks should be implemented, such as compulsory reporting requirements and processes that permit easier notification through technology. Actions that enhance staff and resident vaccination coverage should also be undertaken.

Prevalence and predictors of influenza vaccination among residents of long-term care facilities

Influenza is a respiratory illness which results in significant morbidity and mortality, especially in the older population. Older people living in Long-Term Care Facilities (LTCFs) have a significantly higher risk of infection and complications from influenza. Influenza vaccine is considered the best strategy to prevent infection in high-risk populations. In Australia, the Communicable Diseases Network Australia (CNDA) suggests a vaccination coverage rate of 95% in both staff and residents¹. This study aims to measure the vaccination coverage rates for residents in LTCFs and identify predictors of vaccination uptake for these individuals. This study was conducted in nine LTCFs in four sites from March to September 2018. This was done via medical record reviews for residents over 65 years old in these LTCFs, collecting information such as vaccination status, age, gender, ethnicity and occupation. Simple and multivariable logistic regression was used to calculate the Odds Ratio (OR) to determine significant predictors of influenza vaccination uptake. The overall vaccination rate among LTCF residents was 83.6%. Significant predictors of vaccination were LTCF location, ethnicity and previous year vaccination status. Residents in LTCF Site D were less likely to be vaccinated compared to Site A (OR 0.11, 95% CI 0.02-0.61), non-Caucasians were less likely to get vaccinated (OR 0.09, 95% CI 0.01-0.67), and residents who refused the 2017 vaccine were less likely to be vaccinated (OR 0.04, 95% CI 0.01-0.15). Compared with previous Australian studies on LTCF vaccination rates, the overall vaccination rate was high in these LTCFs (83.6% versus 66-84%), but it varied across different sites. Reasons for varying vaccination rates should be explored further - for example, lower rates in non-Caucasians with diverse cultural backgrounds. Better understanding the causes of under-vaccination can help improve vaccination programs in LTCFs.

The fear of needles: A systematic review and meta-analysis

AIMS

The aim of this study was to evaluate the prevalence of needle fear and summarize the characteristics of individuals who exhibit this fear.

BACKGROUND

Injections are among the most common medical procedures, yet fear of needles can result in avoidance of preventive measures and treatment.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE (1966-2017), Embase (1947-2017), PsycINFO (1967-2017), and CINAHL (1961-2017) were searched, with no restrictions by age, gender, race, language, or country.

REVIEW METHODS

The prevalence of needle fear was calculated and restricted maximum likelihood random effects models were used for meta-analysis and meta-regression.

RESULTS

The search yielded 119 original research articles which are included in this review, of which 35 contained sufficient information for meta-analysis. The majority of children exhibited needle fear, while prevalence estimates for needle fear ranged from 20-50% in adolescents and 20-30% in young adults. In general, needle fear decreased with increasing age. Both needle fear and needle phobia were more prevalent in females than males. Avoidance of influenza vaccination because of needle fear occurred in 16% of adult patients, 27% of hospital employees, 18% of workers at long-term care facilities, and 8% of healthcare workers at hospitals. Needle fear was common when undergoing venipuncture, blood donation, and in those with chronic conditions requiring injection.

CONCLUSIONS

Fear of needles is common in patients requiring preventive care and in those undergoing treatment. Greater attention should be directed to interventions which alleviate fear in high-risk groups.

Interventions to increase influenza vaccination rates of those 60 years and older in the community

BACKGROUND

The effectiveness of interventions to increase influenza vaccination uptake in people aged 60 years and older varies by country and participant characteristics. This review updates versions published in 2010 and 2014.

OBJECTIVES

To assess access, provider, system, and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community.

SEARCH METHODS

We searched CENTRAL, which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE, Embase, CINAHL, and ERIC for this update, as well as WHO ICTRP and ClinicalTrials.gov for ongoing studies to 7 December 2017. We also searched the reference lists of included studies.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and cluster-randomised trials of interventions to increase influenza vaccination in people aged 60 years or older in the community.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures as specified by Cochrane.

MAIN RESULTS

We included three new RCTs for this update (total 61 RCTs; 1,055,337 participants). Trials involved people aged 60 years and older living in the community in high-income countries. Heterogeneity limited some meta-analyses. We assessed studies as at low risk of bias for randomisation (38%), allocation concealment (11%), blinding (44%), and selective reporting (100%). Half (51%) had missing data. We assessed the evidence as low-quality. We identified three levels of intervention intensity: low (e.g. postcards), medium (e.g. personalised phone calls), and high (e.g. home visits, facilitators).Increasing community demand (12 strategies, 41 trials, 53 study arms, 767,460 participants)One successful intervention that could be meta-analysed was client reminders or recalls by letter plus leaflet or postcard compared to reminder (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.07 to 1.15; 3 studies; 64,200 participants). Successful interventions tested by single studies were patient outreach by retired teachers (OR 3.33, 95% CI 1.79 to 6.22); invitations by clinic receptionists (OR 2.72, 95% CI 1.55 to 4.76); nurses or pharmacists educating and nurses vaccinating patients (OR 152.95, 95% CI 9.39 to 2490.67); medical students counselling patients (OR 1.62, 95% CI 1.11 to 2.35); and multiple recall questionnaires (OR 1.13, 95% CI 1.03 to 1.24).Some interventions could not be meta-analysed due to significant heterogeneity: 17 studies tested simple reminders (11 with 95% CI entirely above unity); 16 tested personalised reminders (12 with 95% CI entirely above unity); two investigated customised compared to form letters (both 95% CI above unity); and four studies examined the impact of health risk appraisals (all had 95% CI above unity). One study of a lottery for free groceries was not effective.Enhancing vaccination access (6 strategies, 8 trials, 10 arms, 9353 participants)We meta-analysed results from two studies of home visits (OR 1.30, 95% CI 1.05 to 1.61) and two studies that tested free vaccine compared to patient payment for vaccine (OR 2.36, 95% CI 1.98 to 2.82). We were unable to conduct meta-analyses of two studies of home visits by nurses plus a physician care plan (both with 95% CI above unity) and two studies of free vaccine compared to no intervention (both with 95% CI above unity). One study of group visits (OR 27.2, 95% CI 1.60 to 463.3) was effective, and one study of home visits compared to safety interventions was not.Provider- or system-based interventions (11 strategies, 15 trials, 17 arms, 278,524 participants)One successful intervention that could be meta-analysed focused on payments to physicians (OR 2.22, 95% CI 1.77 to 2.77). Successful interventions tested by individual studies were: reminding physicians to vaccinate all patients (OR 2.47, 95% CI 1.53 to 3.99); posters in clinics presenting vaccination rates and encouraging competition between doctors (OR 2.03, 95% CI 1.86 to 2.22); and chart reviews and benchmarking to the rates achieved by the top 10% of physicians (OR 3.43, 95% CI 2.37 to 4.97).We were unable to meta-analyse four studies that looked at physician reminders (three studies with 95% CI above unity) and three studies of facilitator encouragement of vaccination (two studies with 95% CI above unity). Interventions that were not effective were: comparing letters on discharge from hospital to letters to general practitioners; posters plus postcards versus posters alone; educational reminders, academic detailing, and peer comparisons compared to mailed educational materials; educational outreach plus feedback to teams versus written feedback; and an intervention to increase staff vaccination rates.Interventions at the societal levelNo studies reported on societal-level interventions.Study funding sourcesStudies were funded by government health organisations (n = 33), foundations (n = 9), organisations that provided healthcare services in the studies (n = 3), and a pharmaceutical company offering free vaccines (n = 1). Fifteen studies did not report study funding sources.

AUTHORS' CONCLUSIONS

We identified interventions that demonstrated significant positive effects of low (postcards), medium (personalised phone calls), and high (home visits, facilitators) intensity that increase community demand for vaccination, enhance access, and improve provider/system response. The overall GRADE assessment of the evidence was moderate quality. Conclusions are unchanged from the 2014 review.

Feasibility of Integrating Residential Care Pharmacists into Aged Care Homes to Improve Quality Use of Medicines: Study Protocol for a Non-Randomised Controlled Pilot Trial

Older adults are particularly susceptible to iatrogenic disease and communicable diseases, such as influenza. Prescribing in the residential aged care population is complex, and requires ongoing review to prevent medication misadventure. Pharmacist-led medication review is effective in reducing medication-related problems; however, current funding arrangements specifically exclude pharmacists from routinely participating in resident care. Integrating an on-site clinical pharmacist into residential care teams is an unexplored opportunity to improve quality use of medicines in this setting. The primary objective of this pilot study is to investigate the feasibility of integrating a residential care pharmacist into the existing care team. Secondary outcomes include incidence of pharmacist-led medication review, and incidence of potential medication problems based on validated prescribing measures. This is a cross-sectional, non-randomised controlled trial with a residential care pharmacist trialled at a single facility, and a parallel control site receiving usual care and services only. The results of this hypothesis-generating pilot study will be used to identify clinical outcomes and direct future larger scale investigations into the implementation of the novel residential care pharmacist model to optimise quality use of medicines in a population at high risk of medication misadventure.

Understanding motivators and barriers of hospital-based obstetric and pediatric health care worker influenza vaccination programs in Australia

Understanding motivators and barriers of health care worker (HCW) vaccination programs is important for determining strategies to improve uptake. The aim of this study was to explore key drivers and HCW decision making related to recommended vaccines and seasonal influenza vaccination programs. We used a qualitative approach with semi-structured one-to-one interviews with 22 HCWs working at a tertiary pediatric and obstetric hospital in South Australia. A thematic analysis and coding were used to examine data. Key motivators that emerged included: sense of responsibility, convenience and ease of access, rotating trolleys, the influenza vaccine being free, basic knowledge about influenza and influenza vaccination, peer pressure, personal values and family culture, as well as the culture of support for the program. Personal decisions were the major barrier to HCWs receiving the influenza vaccine which were predominantly self-protection related or due to previous experience or fear of adverse reactions. Other barriers that emerged were misconceptions about the influenza vaccine, needle phobia and privacy concerns. This study identified both attitudinal and structural barriers that could be addressed to improve uptake of the seasonal influenza vaccine.

The 5As: A practical taxonomy for the determinants of vaccine uptake

Suboptimal vaccine uptake in both childhood and adult immunisation programs limits their full potential impact on global health. A recent progress review of the Global Vaccine Action Plan stated that "countries should urgently identify barriers and bottlenecks and implement targeted approaches to increase and sustain coverage". However, vaccination coverage may be determined by a complex mix of demographic, structural, social and behavioral factors. To develop a practical taxonomy to organise the myriad possible root causes of a gap in vaccination coverage rates, we performed a narrative review of the literature and tested whether all non-socio-demographic determinants of coverage could be organised into 4 dimensions: Access, Affordability, Awareness and Acceptance. Forty-three studies were reviewed, from which we identified 23 primary determinants of vaccination uptake. We identified a fifth domain, Activation, which captured interventions such as SMS reminders which effectively nudge people towards getting vaccinated. The 5As taxonomy captured all identified determinants of vaccine uptake. This intuitive taxonomy has already facilitated mutual understanding of the primary determinants of suboptimal coverage within inter-sectorial working groups, a first step towards them developing targeted and effective solutions.

Influenza Vaccination Among Registered Nurses: Information Receipt, Knowledge, and Decision-Making at an Institution With a Multifaceted Educational Program

Objective.

To evaluate the receipt of information and knowledge about influenza and vaccination, as well as influenza vaccination status and reasons for declining vaccination, among registered nurses.

Design.

Cross-sectional survey of registered nurses (RNs).

Setting.

A large tertiary medical center with a long-standing, multifaceted influenza vaccination program and relatively high vaccination rates among employees overall (76.5%).

Participants.

Randomly selected group of 990 RNs employed as inpatient staff nurses at the institution.

Results.

The survey was completed by 513 (51.8%) of 990 RNs. Most RNs (86.7%) had received an influenza vaccination in the past, and 331 (64.5%) intended to receive vaccination during the 2005-2006 influenza season. More than 90% of RNs acknowledged exposure to educational bulletins, and most had received information about influenza severity (383 [74.7%]), transmission (398 [77.6%]), vaccine safety (416 [81.1%]), and the time and location of free vaccination (460 [89.7%]). A majority (436 [85.0%]) felt they had received all the information they needed to make good decisions about vaccination. However, only 49 RNs (9.6%) gave correct answers to more than 85% of the knowledge questions on the survey. The reasons most frequently reported for declining vaccination were doubts about the risk of influenza and the need for vaccination, concerns about vaccine effectiveness and side effects, and dislike of injections.

Conclusions.

RNs exposed to a longstanding, multifaceted educational program had received information about influenza vaccination, but misconceptions were common and only 331 (64.5%) intended to receive vaccination. Strategies other than educational interventions are needed to increase influenza vaccination rates and thereby to ensure healthcare worker and patient safety.

Factors affecting uptake of recommended immunizations among health care workers in South Australia

Despite the benefits of vaccination for health care workers (HCWs), uptake of recommended vaccinations is low, particularly for seasonal influenza and pertussis. In addition, there is variation in uptake within hospitals. While all vaccinations recommended for HCWs are important, vaccination against influenza and pertussis are particularly imperative, given HCWs are at risk of occupationally acquired influenza and pertussis, and may be asymptomatic, acting as a reservoir to vulnerable patients in their care. This study aimed to determine predictors of uptake of these vaccinations and explore the reasons for variation in uptake by HCWs working in different hospital wards. HCWs from wards with high and low influenza vaccine uptake in a tertiary pediatric and obstetric hospital completed a questionnaire to assess knowledge of HCW recommended immunizations. Multiple logistic regression was used to determine predictors of influenza and pertussis vaccination uptake. Of 92 HCWs who responded, 9.8% were able to identify correctly the vaccines recommended for HCWs. Overall 80% of respondents reported they had previously received influenza vaccine and 50.5% had received pertussis vaccine. Independent predictors of pertussis vaccination included length of time employed in health sector (P < 0.001), previously receiving hepatitis B/MMR (measles, mumps, rubella) vaccine (P < 0.001), and a respondent being aware influenza infections could be severe in infants (p = 0.023). Independent predictors of seasonal influenza vaccination included younger age (P < 0.001), English as first language (P < 0.001), considering it important to be vaccinated to protect themselves (P < 0.001), protect patients (p = 0.012) or awareness influenza could be serious in immunocompromised patients (p = 0.030). Independent predictors for receiving both influenza and pertussis vaccinations included younger age (P < 0.001), time in area of work (P = 0.020), previously receiving hepatitis B vaccine (P = 0.006) and awareness influenza could be severe in infants (P < 0.001). A knowledge gap exists around HCW awareness of vaccination recommendations. Assessment of the risk/benefit value for HCWs and their patients, determines uptake of HCW immunization programs and should be considered in promotional HCW vaccination programs.

Interventions to increase influenza vaccination rates of those 60 years and older in the community

BACKGROUND

The effectiveness of interventions to increase the uptake of influenza vaccination in people aged 60 and older is uncertain.

OBJECTIVES

To assess access, provider, system and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community.

SEARCH METHODS

We searched CENTRAL (2014, Issue 5), MEDLINE (January 1950 to May week 3 2014), EMBASE (1980 to June 2014), AgeLine (1978 to 4 June 2014), ERIC (1965 to June 2014) and CINAHL (1982 to June 2014).

SELECTION CRITERIA

Randomised controlled trials (RCTs) of interventions to increase influenza vaccination uptake in people aged 60 and older.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed study quality and extracted influenza vaccine uptake data.

MAIN RESULTS

This update identified 13 new RCTs; the review now includes a total of 57 RCTs with 896,531 participants. The trials included community-dwelling seniors in high-income countries. Heterogeneity limited meta-analysis. The percentage of trials with low risk of bias for each domain was as follows: randomisation (33%); allocation concealment (11%); blinding (44%); missing data (49%) and selective reporting (100%). Increasing community demand (32 trials, 10 strategies)The interventions with a statistically significant result were: three trials (n = 64,200) of letter plus leaflet/postcard compared to letter (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.07 to 1.15); two trials (n = 614) of nurses/pharmacists educating plus vaccinating patients (OR 3.29, 95% CI 1.91 to 5.66); single trials of a phone call from a senior (n = 193) (OR 3.33, 95% CI 1.79 to 6.22), a telephone invitation versus clinic drop-in (n = 243) (OR 2.72, 95% CI 1.55 to 4.76), a free groceries lottery (n = 291) (OR 1.04, 95% CI 0.62 to 1.76) and nurses educating and vaccinating patients (n = 485) (OR 152.95, 95% CI 9.39 to 2490.67).We did not pool the following trials due to considerable heterogeneity: postcard/letter/pamphlets (16 trials, n = 592,165); tailored communications (16 trials, n = 388,164); customised letter/phone-call (four trials, n = 82,465) and client-based appraisals (three trials, n = 4016), although several trials showed the interventions were effective. Enhancing vaccination access (10 trials, six strategies)The interventions with a statistically significant result were: two trials (n = 2112) of home visits compared to clinic invitation (OR 1.30, 95% CI 1.05 to 1.61); two trials (n = 2251) of free vaccine (OR 2.36, 95% CI 1.98 to 2.82) and one trial (n = 321) of patient group visits (OR 24.85, 95% CI 1.45 to 425.32). One trial (n = 350) of a home visit plus vaccine encouragement compared to a home visit plus safety advice was non-significant.We did not pool the following trials due to considerable heterogeneity: nurse home visits (two trials, n = 2069) and free vaccine compared to no intervention (two trials, n = 2250). Provider- or system-based interventions (17 trials, 11 strategies)The interventions with a statistically significant result were: two trials (n = 2815) of paying physicians (OR 2.22, 95% CI 1.77 to 2.77); one trial (n = 316) of reminding physicians about all their patients (OR 2.47, 95% CI 1.53 to 3.99); one trial (n = 8376) of posters plus postcards (OR 2.03, 95% CI 1.86 to 2.22); one trial (n = 1360) of chart review/feedback (OR 3.43, 95% CI 2.37 to 4.97) and one trial (n = 27,580) of educational outreach/feedback (OR 0.77, 95% CI 0.72 to 0.81).Trials of posters plus postcards versus posters (n = 5753), academic detailing (n = 1400) and increasing staff vaccination rates (n = 26,432) were non-significant.We did not pool the following trials due to considerable heterogeneity: reminding physicians (four trials, n = 202,264) and practice facilitators (three trials, n = 2183), although several trials showed the interventions were effective. Interventions at the societal level We identified no RCTs of interventions at the societal level.

AUTHORS' CONCLUSIONS

There are interventions that are effective for increasing community demand for vaccination, enhancing access and improving provider/system response. Heterogeneity limited pooling of trials.

Influenza vaccination among health care personnel in California: 2010-2011 influenza season

BACKGROUND

Influenza vaccination among health care personnel (HCP) is a key measure to prevent influenza infection and transmission in health care settings. This study described influenza vaccination coverage among employees in various health care settings in California and examined factors associated with HCP influenza vaccination.

METHODS

This study analyzed data from 111 facilities recruited through statewide invitation. Data on facility characteristics, vaccination programs, and vaccination receipt within and outside facilities were collected using Web-based questionnaires. Employees were defined as all persons in the facility payroll system regardless of patient contact. Facility-level employee vaccination coverage was calculated for 91 facilities.

RESULTS

The mean employee influenza vaccination coverage was 60.7% overall: 64.0% for acute care hospitals (n = 30), 54.7% for long-term care facilities (n = 22), 59.4% for ambulatory surgery centers (n = 8), 58.6% for dialysis centers (n = 25), and 77.2% for physician practices (n = 6). Vaccination promotion methods such as risk-benefit education, personal reminders, and vaccination data tracking and feedback were significantly associated with increased vaccination coverage.

CONCLUSION

The study findings suggest some variations in HCP vaccination coverage by type of health care setting as well as substantial challenges in reaching the Healthy People 2020 goal of 90%. Health care facilities need to use comprehensive promotion methods to improve HCP influenza vaccinations.

Influenza A/H1N1/2009 outbreak in a neonatal intensive care unit

BACKGROUND

Outbreaks of influenza A/H1N1/2009 in neonatal intensive care units (NICUs) have been reported only rarely. Annual vaccination of all healthcare workers (HCWs) against seasonal influenza is recommended but compliance is low and exposure to infected staff as the source of nosocomial outbreaks has been described.

AIM

To report an outbreak of influenza A/H1N1/2009 in a tertiary level NICU that resulted in considerable morbidity.

METHODS

When the first influenza case was identified, a prospective study was conducted and control measures were implemented to reduce the spread of infection throughout the NICU. Neonates who developed influenza were treated with oseltamivir, and exposed neonates were given prophylaxis with oseltamivir.

FINDINGS

Two infected infants who were immature by gestational age and birth weight developed pneumonitis requiring respiratory support, and a third full-term neonate had a mild uncomplicated illness. No significant adverse effects were noted during antiviral treatment or prophylaxis. The investigation identified infected HCWs as the likely source of the outbreak. There was a very low influenza vaccination rate of 15% among nursing staff.

CONCLUSION

Nosocomial influenza can cause considerable morbidity, especially in high risk neonates, and is readily transmissible in the NICU setting by unvaccinated staff members who contract influenza. To prevent outbreaks, in addition to infection control measures, the implementation of HCW vaccination is very important. Oseltamivir treatment was well-tolerated even among premature infants and appeared to be effective, because neonates with influenza had complete recovery and only one of those who received prophylaxis developed the infection.

Characteristics of an educational publication sourced from deaths investigated by the Coroner that is reported to have promoted practice change

Objective. The purpose of this study was to investigate the characteristics of the Residential Aged Care Coronial Communiqué that have promoted previously reported professional practice change, and to explore the circumstances of these changes. Methods. This was an exploratory, qualitative study for which data was collected through semi-structured interview of 15 subscribers to the Residential Aged Care Coronial Communiqué. Results. The Residential Aged Care Coronial Communiqué was reported to promote self-reported practice change though the inclusion of case studies, by being associated with the Coroner, and by providing evidence to justify change. The combination of existing concerns about risk and staff awareness, in conjunction with reading the Residential Aged Care Coronial Communiqué was also reported to promote practice change, as was having the support of senior staff and the authority to implement change. Conclusions. The combination of narrative case studies in the context of an educational publication associated with the Coroner’s Office has been reported to provided evidence and incentive to promote professional practice change in an aged care setting. However the relative influence of the Residential Aged Care Coronial Communiqué, and other background circumstance and facilitating factors on practice change cannot be determined from this study. What is known about the topic? Passive dissemination of written educational material has little or no impact on altering clinical practice. What does this paper add? Exploratory research findings published in this paper provide insight into characteristics of an electronic, educational publication for a health professional audience reported to have promoted practice change in a residential aged care setting. What are the implications for practitioners? The inclusion of short, clearly written case studies that describe real situations that have been investigated by the Coroner, in the context of a publication associated with the Coroner’s Office, has been reported to motivate staff to change professional practice to improve safety in a residential aged care setting.

Annual influenza vaccination: coverage and attitudes of primary care staff in Australia

Please cite this paper as: Ward et al. (2011) Annual influenza vaccination: coverage and attitudes of primary care staff in Australia. Influenza and Other Respiratory Viruses 5(2), 135–141.

Background  Annual influenza vaccination is recommended for all Australian health care workers (HCWs) including those working in primary health care. There is limited published data on coverage, workplace provision, attitudes and personal barriers to influenza vaccination amongst primary health care staff. The aim of this study was to contribute to the limited literature base in this important area by investigating these issues in the primary health care setting in New South Wales (NSW), Australia.

Methods  A postal survey was sent to general practitioners (GPs) and practice nurses (PNs) from inner city, semi‐urban and rural areas of NSW, Australia. There were 139 responses in total (response rate 36%) from 79 GPs (response rate 30%) and 60 PNs (response rate 46%).

Results  Reported influenza vaccination coverage in both 2007 and 2008 was greater than 70%, with GPs reporting higher coverage than PNs in both years. The main barriers identified were lack of awareness of vaccination recommendations for general practice staff and concern about adverse effects from the vaccine.

Conclusions  Rates of influenza vaccination coverage reported in this study were higher than in previous studies of hospital and institutional HCWs, though it is possible that the study design may have contributed to these higher results. Nevertheless, these findings highlight that more needs to be done to understand barriers to vaccination in this group, to inform the development of appropriate strategies to increase vaccination coverage in primary health care staff, with a special focus on PNs.

Interventions to increase influenza vaccination rates of those 60 years and older in the community

BACKGROUND

Although the evidence to support influenza vaccination is poor, it is promoted by many health authorities. There is uncertainty about the effectiveness of interventions to increase influenza vaccination rates in those 60 years or older.

OBJECTIVES

To assess effects of interventions to increase influenza vaccination rates in those 60 or older.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2010, issue 3), containing the Cochrane Acute Respiratory Infections Group's Specialized Register, MEDLINE (January 1950 to July 2010), PubMed (January 1950 to July 2010), EMBASE (1980 to 2010 Week 28), AgeLine (1978 to July 2010), ERIC (1965 to July 2010) and CINAHL (1982 to July 2010).

SELECTION CRITERIA

Randomized controlled trials (RCTs) to increase influenza vaccination rates in those aged 60 years and older, recording influenza vaccination status either through clinic records, billing data or local/national vaccination registers.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed study quality and extracted data.

MAIN RESULTS

Forty-four RCTs were included. All included RCTs studied seniors in the community and in high-income countries. No RCTs of society-level interventions were included. Heterogeneity was marked and meta-analysis was limited. Only five RCTs were graded at low and six at moderate risk of bias. They included three of 13 personalized postcard interventions (all three with the 95% confidence interval (CI) above unity), two of the four home visit interventions (both with 95% CI above unity, but one a small study), three of the four reminder to physicians interventions (none with 95% CI above unity) and three of the four facilitator interventions (one with 95% CI above unity, and one P < 0.01). The other 33 RCTs were at high risk of bias and no recommendations for practice can be drawn.

AUTHORS' CONCLUSIONS

Personalized postcards or phone calls are effective, and home visits, and facilitators, may be effective. Reminders to physicians are not. There is insufficient good evidence for other interventions.

Influenza vaccination for healthcare workers: from a simple concept to a resistant issue?

Different strategies for the management of influenza epidemics are particularly important in elderly population. High morbidity and mortality rates are associated with influenza in the elderly, and annual vaccination against flu is considered to be the best cost-effective strategy. However, its efficiency is reduced in older adults and only half of them are protected. Several studies show that vaccinating healthcare workers is an efficient way of decreasing mortality rates in nursing home residents within influenza season. National and international public health authorities recommend therefore healthcare worker vaccinations for up to 5 years. However, influenza healthcare worker vaccination coverages are still low. Here we summarize data regarding the justification of healthcare worker vaccination, the efficiency of this strategy, the reasons of the reluctance of vaccination, the means and results of interventional programs and, then, focus on the debate of a mandatory healthcare worker influenza vaccination. Because several interventional programs are efficient but still need high financial and human support, only a strong political-will can improve this chosen strategy.

Requiring influenza vaccination for health care workers

Annual influenza vaccination for health care workers has the potential to benefit health care professionals, their patients, and their families by reducing the transmission of influenza in the health care setting. Furthermore, staff vaccination programs are cost-effective for health care institutions because of reduced staff illness and absenteeism. Despite international recommendations and strong ethical arguments for annual influenza immunization for health care professionals, staff utilization of vaccination remains low. We have analyzed the ethical implications of a variety of efforts to increase vaccination rates, including mandatory influenza vaccination. A program of incentives and sanctions may increase health care worker compliance with fewer ethical impediments than mandatory vaccination.

Attitudes and knowledge regarding influenza vaccination among hospital health workers caring for women and children

This cross-sectional study of 340 obstetrics/gynecology, 123 neonatology, and 244 pediatric health care workers (HCWs) was designed to evaluate compliance with recommendations concerning the use of influenza vaccine during pregnancy and among pediatric subjects. The results clearly show that only a marginal number of the HCWs in all three fields currently recommend vaccine use for pregnant women and healthy young children. Moreover, all of the HCWs were seriously deficient in terms of their general knowledge of influenza prevention and their own personal vaccination coverage was low. Extensive and sustained efforts to overcome cultural limitations concerning influenza and its prevention are urgently required among HCWs caring for women and children in order to ensure effective compliance with the current recommendations.

Whooping cough: are health-care workers putting children at risk?

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.

Influenza vaccine coverage for healthcare workers in geriatric settings in France

BACKGROUND AND AIMS

Because of a relative lack of efficiency of influenza vaccine in the elderly population, influenza outbreaks in geriatric healthcare settings are probable, despite high influenza vaccination rates in patients. Nosocomial influenza outbreaks, more probably related to healthcare workers, have also been reported. Therefore, vaccination of healthcare workers is considered to be an important preventive policy, to decrease the in-hospital influenza burden during the viral circulation period.

METHODS

This multicenter study measured influenza vaccine coverage of Health Care Worker in 102 geriatric healthcare settings (acute care, rehabilitation care, long-term care) by a first questionnaire. A second questionnaire assessed main factors associated with vaccine acceptance.

RESULTS

102 geriatric healthcare settings (20%) answered the first questionnaire. Vaccine coverage for physicians (n=187), nurses (n=631) and nurse assistants (n=1487) were 48.4%, 30.5% and 27.9%, respectively. Vaccination rates were correlated between occupational categories according to healthcare settings. Vaccination rates were significantly lower in acute care settings compared with rehabilitation and long-term care settings. Local recommendations was reported for 29.9%, but was not correlated with vaccine coverage. The second questionnaire showed that lack of motivation and knowledge, and organizational problems were the three main reasons for reluctance to be vaccinated.

CONCLUSIONS

In French geriatric settings, influenza vaccine coverage of healthcare workers is low and highly variable, according to the type of healthcare setting. A group effect was found between occupational categories. However, the reasons for non-acceptance need further evaluation to improve HCW influenza vaccine coverage.

La vaccination antigrippale du personnel hospitalier. Enquête de prévalence au CHU de Besançon, hiver 2003–2004

BACKGROUND

Influenza vaccination reduces the mortality of the patients when the vaccination rates of healthcare workers is important. PURPOSE AND METHOD OF THE STUDY: To investigate the vaccination rates at the Universitary Hospital of Besançon by anonymous questionnaire.

RESULTS

Three thousand hundred seventy-seven answers were analyzed (228 men and 1145 women). Two hundred seventy-seven persons declared receiving the vaccine (20.1%) corresponding to sixty-three men (27.6%) and two hundred thirteen women (18.6%) (P = 0.001). The average age of the healthcare workers vaccined was of 38.9+/-11 years. Among most than 50 years, 34% was vaccined. Among the doctors, 40.5% were vaccined against 20.6% of the nurses. In the services of geriatrics, 78.5% of the staff was vaccined.

CONCLUSIONS

Our results indicate a weak rate of influenza vaccination in our establishment and a misunderstanding of the character nosocomial of the influenza among the nurse.

"I hate needles" and other factors impacting on travel vaccine uptake

Travel vaccines comprise an essential component of pretravel health advice; however, many travelers do not take advantage of this preventive health strategy to decrease their risk of travel-related illness. Factors that impact on a traveler's decision on whether or not to be vaccinated are related to the knowledge, attitudes and beliefs of the traveler regarding travel vaccines, vaccine-preventable diseases, and other factors. Further research is required to increase travelers' awareness of the need for pretravel vaccination and then to translate that awareness into positive attitudes leading to increased travel vaccine uptake.