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Barosa M, Ioannidis JPA, Prasad V. Evidence base for yearly respiratory virus vaccines: Current status and proposed improved strategies. Eur J Clin Invest 2024:e14286. [PMID: 39078026 DOI: 10.1111/eci.14286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/22/2024] [Indexed: 07/31/2024]
Abstract
Annual vaccination is widely recommended for influenza and SARS-CoV-2. In this essay, we analyse and question the prevailing policymaking approach to these respiratory virus vaccines, especially in the United States. Every year, licensed influenza vaccines are reformulated to include specific strains expected to dominate in the season ahead. Updated vaccines are rapidly manufactured and approved without further regulatory requirement of clinical data. Novel vaccines (i.e. new products) typically undergo clinical trials, though generally powered for clinically unimportant outcomes (e.g. lab-confirmed infections, regardless of symptomatology or antibody levels). Eventually, the current and future efficacy of influenza and COVID-19 vaccines against hospitalization or death carries considerable uncertainty. The emergence of highly transmissible SARS-CoV-2 variants and waning vaccine-induced immunity led to plummeting vaccine effectiveness, at least against symptomatic infection, and booster doses have since been widely recommended. No further randomized trials were performed for clinically important outcomes for licensed updated boosters. In both cases, annual vaccine effectiveness estimates are generated by observational research, but observational studies are particularly susceptible to confounding and bias. Well-conducted experimental studies, particularly randomized trials, are necessary to address persistent uncertainties about influenza and COVID-19 vaccines. We propose a new research framework which would render results relevant to the current or future respiratory viral seasons. We demonstrate that experimental studies are feasible by adopting a more pragmatic approach and provide strategies on how to do so. When it comes to implementing policies that seriously impact people's lives, require substantial public resources and/or rely on widespread public acceptance, high evidence standards are desirable.
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Affiliation(s)
- Mariana Barosa
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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Shope TR, Walker BH, Aird L, Southward L, Martin JM. Influenza Vaccine Requirements in United States Child Care Centers. J Pediatric Infect Dis Soc 2020; 9:566-572. [PMID: 31828319 DOI: 10.1093/jpids/piz078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/18/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Influenza vaccine is the most effective means to prevent influenza for the high-risk population of child care attendees. This national survey assessed child care center directors' reports of seasonal influenza vaccine requirements for children and adult caregivers. METHODS This was a 2016 telephone-based survey of child care center directors randomly selected from a national database of licensed United States child care centers and queried about influenza vaccine requirements. Conceptually related items were grouped into 4 indexes: general infection control, use of health consultants, quality of child care, and pandemic influenza preparedness. These indexes, along with other center and director characteristics, were used to predict director-reported influenza vaccine requirements. RESULTS Of 518 child care center directors, only 24.5% and 13.1% reported an influenza vaccine requirement for children and adult caregivers, respectively. Center and director characteristics and the indexes were not associated with a director-reported influenza vaccine requirement. After adjusting for covariates, only having a state influenza vaccine law for children and an adult influenza vaccine requirement predicted having a child influenza vaccine requirement. Only having a child influenza vaccine requirement predicted having an adult vaccine requirement. CONCLUSIONS Director-reported influenza vaccine requirements for children and adult caregivers were influenced primarily by state influenza vaccine laws. Given the high risk of children in child care and low director-reported influenza vaccine requirements, more states should pass laws requiring influenza vaccine for children and adult caregivers at child care programs.
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Affiliation(s)
- Timothy R Shope
- Division of General Academic Pediatrics, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Benjamin H Walker
- Social Science Research Center, Mississippi State University, Starkville, Mississippi, USA
| | - Laura Aird
- Department of Healthy, Resilient Children, Youth, and Families, American Academy of Pediatrics, Itasca, Illinois, USA
| | - Linda Southward
- Social Science Research Center, Mississippi State University, Starkville, Mississippi, USA
| | - Judith M Martin
- Division of General Academic Pediatrics, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Slaunwhite JM, Smith SM, Halperin BA, Langley JM, Halperin SA. The role of healthcare provider attitudes in increasing willingness to accept seasonal influenza vaccine policy changes. Vaccine 2016; 34:5704-5707. [PMID: 27665353 DOI: 10.1016/j.vaccine.2016.08.083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/25/2016] [Accepted: 08/29/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND This research explored the role of attitudes in acceptance of organizational change initiatives. METHODS A survey assessed factors associated with health care provider (HCP) likelihood to accept seasonal influenza vaccine policy changes. We evaluated the impact of knowledge and individual attitudes on this outcome measure. RESULTS Knowledge of seasonal influenza vaccine and influenza recommendations was a significant predictor of HCP's attitudes toward vaccine at the individual (p<0.001), organizational (p<0.05), and legislative level (p<0.05). Mixed results were obtained when investigating the impact of knowledge on actual willingness to accept vaccine, suggesting that knowledge was only a significant predictor at the organizational (p<0.05) and legislative levels (p<0.05). Attitudes fully mediated the impact of knowledge at both the organizational and legislative levels. INTERPRETATION Knowledge of seasonal influenza and vaccine recommendations is an important, but insufficient predictor of willingness to accept policy change.
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Affiliation(s)
- Jason M Slaunwhite
- Department of Psychology, Saint Mary's University, Halifax, Nova Scotia, Canada; Canadian Center for Vaccinology, The IWK Health Centre, Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Steven M Smith
- Department of Psychology, Saint Mary's University, Halifax, Nova Scotia, Canada; Canadian Center for Vaccinology, The IWK Health Centre, Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Beth A Halperin
- Canadian Center for Vaccinology, The IWK Health Centre, Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada; School of Nursing, The IWK Health Centre, Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Pediatrics, The IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joanne M Langley
- Canadian Center for Vaccinology, The IWK Health Centre, Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Pediatrics, The IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Community Health and Epidemiology, The IWK Health Centre, Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, The IWK Health Centre, Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Pediatrics, The IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
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To KW, Lai A, Lee KCK, Koh D, Lee SS. Increasing the coverage of influenza vaccination in healthcare workers: review of challenges and solutions. J Hosp Infect 2016; 94:133-42. [PMID: 27546456 DOI: 10.1016/j.jhin.2016.07.003] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
Seasonal influenza vaccine uptake rate of healthcare workers (HCWs) varies widely from <5% to >90% worldwide. Perception of vaccine efficacy and side-effects are conventional factors affecting the uptake rates. These factors may operate on a personal and social level, impacting the attitudes and behaviours of HCWs. Vaccination rates were also under the influence of the occurrence of other non-seasonal influenza pandemics such as avian influenza. Different strategies have been implemented to improve vaccine uptake, with important ones including the enforcement of the local authority's recommendations, promulgation of practice guidelines, and mandatory vaccination polices. Practised in some regions in North America, mandatory policies have led to higher vaccination rate, but are not problem-free. The effects of conventional educational programmes and campaigns are in general of modest impact only. Availability of convenient vaccination facilities, such as mobile vaccination cart, and role models of senior HCWs receiving vaccination are among some strategies which have been observed to improve vaccination uptake rate. A multi-faceted approach is thus necessary to persuade HCWs to participate in a vaccination programme, especially in areas with low uptake rate.
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Affiliation(s)
- K W To
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - A Lai
- Occupational Health Division, Ministry of Health, Negara Brunei Darussalam
| | - K C K Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - D Koh
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Negara Brunei Darussalam; SSH School of Public Health, National University of Singapore, Singapore
| | - S S Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
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Workplace-based influenza vaccination promotion practices among large employers in the United States. J Occup Environ Med 2014; 56:397-402. [PMID: 24492538 DOI: 10.1097/jom.0000000000000115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Influenza vaccination levels in the working-age population are low. Workplace promotion practices can increase employee vaccination levels, but the extent of employers' use of these practices is unknown. We aimed to estimate the prevalence of employers' use of evidence-based practices for promoting influenza vaccination in the workplace. METHODS We conducted a telephone survey of large employers across the United States regarding their use of evidence-based practices to promote vaccination. RESULTS Eighty-four percent of 583 employers surveyed offered on-site vaccination. Use of four promotion practices was high (75% or more), but the remaining four practices were used by only a minority of employers. There is particular room for improvement in the use of practices that increase physical access to vaccination. CONCLUSIONS Employers are highly engaged in basic influenza vaccination promotion practices, but there is potential to increase levels of use.
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Bentele H, Bergsaker MR, Hauge SH, Bjørnholt JV. Vaccination coverage for seasonal influenza among residents and health care workers in Norwegian nursing homes during the 2012/13 season, a cross-sectional study. BMC Public Health 2014; 14:434. [PMID: 24885662 PMCID: PMC4049507 DOI: 10.1186/1471-2458-14-434] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 04/30/2014] [Indexed: 02/03/2023] Open
Abstract
Background WHO has set a goal of 75% vaccination coverage (VC) for seasonal influenza for residents and also recommends immunization for all healthcare workers (HCWs) in nursing homes (NHs). We conducted a cross-sectional study to estimate the VC for seasonal influenza vaccination in Norwegian NHs in 2012/2013 since the VC in NHs and HCWs is unknown. Methods We gathered information from NHs concerning VC for residents and HCWs, and vaccination costs for HCWs, using a web-based questionnaire. We calculated VC among NH residents by dividing the number of residents vaccinated by the total number of residents for each NH. VC among HCWs was similarly calculated by dividing the number of HCWs vaccinated by the total number of HCWs for each NH. The association between VC and possible demographic variables were explored. Results Of 910 NHs, 354 (38.9%) responded. Median VC per NH was 71.7% (range 0-100) among residents and 0% (range 0-100) among HCWs, with 214 (60%) NHs reporting that none of their HCWs was vaccinated. Median VC for HCWs in NHs with an annual vaccination campaign was 0% (range 0-53), compared to when they did not have an annual vaccination campaign 0% (range 0-12); the distributions in the two groups differed significantly (Mann–Whitney U, P = 0.006 two tailed). Conclusion Median influenza VC in Norwegian NHs was marginally lower than recommended among residents and exceptionally low among HCWs. The VC in HCWs was significantly higher when NHs had an annual vaccination campaign. We recommend that NHs implement measures to increase VC among residents and HCWs, including vaccination campaigns and studies to identify potential barriers to vaccination.
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Affiliation(s)
- Horst Bentele
- Department of Infection Control Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
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