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Kalunga L, Bulut E, Chen Z, Li Y, Ivanek R. Increasing vaccine uptake among employees within the non-health related critical infrastructure sectors: A review. Hum Vaccin Immunother 2023; 19:2135852. [PMID: 36628470 PMCID: PMC9980543 DOI: 10.1080/21645515.2022.2135852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
This review aimed to identify barriers to employee vaccination, motivators for vaccination, and vaccine uptake strategies within the critical infrastructure sectors. We focused on non-healthcare-related sectors, including food and agriculture, manufacturing, and education where employee vaccination is rarely mandated. We conducted a search for literature published from 2012 to 2022 from MEDLINE-PubMed, PsycINFO, and Web of Science Core Collection, which resulted in 22 studies that met the inclusion criteria. We found that 1) barriers to vaccination differ by infectious disease and population; 2) common motivators for vaccination were about protecting self, family, and community; and 3) common uptake strategies for influenza (which accounted for 83% of uptake strategies in reviewed studies) addressed convenience and confidence barriers such as vaccination cost and education. Our review highlights the need for employers, policymakers, and researchers to identify infectious disease and population-specific barriers to vaccination and implement strategies aimed at addressing the identified barriers.
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Affiliation(s)
- Linda Kalunga
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA,CONTACT Linda Kalunga Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Ece Bulut
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Ziqian Chen
- College of Human Ecology, Cornell University, Ithaca, NY, USA
| | - Yihong Li
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Renata Ivanek
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
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Ledda C, Motta G, Rapisarda V, Maltezou HC. Influenza immunization of healthcare personnel in the post-COVID-19 pandemic era: Still a lot to do! Vaccine X 2023; 15:100402. [PMID: 38058792 PMCID: PMC10696103 DOI: 10.1016/j.jvacx.2023.100402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/28/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023] Open
Abstract
Healthcare-associated influenza is frequently encountered in healthcare settings with significant morbidity and mortality among vulnerable patients, absenteeism among healthcare personnel (HCP), and interruption of healthcare services. Numerous investigations indicate that nosocomial outbreaks are often traced to HCP. Despite the international and national endorsements, seasonal influenza vaccine acceptance among HCP continues suboptimal worldwide. Infection control is the major objective for healthcare risk management in order to guarantee patient safety, limit the cost of hospitalization and assurance health management in controlling influenza seasons. Vigilance and anticipation are required as globally we are moving from a reactive COVID-19 pandemic response phase to one of planning for the co-circulation of viral respiratory infections. Declining to understand HCP perception of influenza risk and acceptance of vaccination might have impact patient safety as well as healthcare services.
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Affiliation(s)
- Caterina Ledda
- Occupational Medicine Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giuseppe Motta
- Occupational Medicine Unit, “Garibaldi” Hospital of Catania, Catania, Italy
| | - Venerando Rapisarda
- Occupational Medicine Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Occupational Medicine Unit, “G. Rodolico – San Marco” University Hospital, Catania, Italy
| | - Helena C. Maltezou
- Directorate for Research, Studies and Documentation, National Public Health Organization, Athens, Greece
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3
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Malik AA, Ahmed N, Shafiq M, Elharake JA, James E, Nyhan K, Paintsil E, Melchinger HC, Team YBI, Malik FA, Omer SB. Behavioral interventions for vaccination uptake: A systematic review and meta-analysis. Health Policy 2023; 137:104894. [PMID: 37714082 PMCID: PMC10885629 DOI: 10.1016/j.healthpol.2023.104894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/22/2023] [Accepted: 08/15/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Human behavior and more specifically behavioral insight-based approaches to vaccine uptake have often been overlooked. While there have been a few narrative reviews indexed in Medline on behavioral interventions to increase vaccine uptake, to our knowledge, none have been systematic reviews and meta-analyses covering not just high but also low-and-middle income countries. METHODS We included 613 studies from the Medline database in our systematic review and meta-analysis categorizing different behavioral interventions in 9 domains: education campaigns, on-site vaccination, incentives, free vaccination, institutional recommendation, provider recommendation, reminder and recall, message framing, and vaccine champion. Additionally, considering that there is variability in the acceptance of vaccines among different populations, we assessed studies from both high-income countries (HICs) and low- to middle-income countries (LMICs), separately. FINDINGS Our results showed that behavioral interventions can considerably improve vaccine uptake in most settings. All domains that we examined improved vaccine uptake with the highest effect size associated with provider recommendation (OR: 3.4 (95%CI: 2.5-4.6); Domain: motivation) and on-site vaccination (OR: 2.9 (95%CI: 2.3-3.7); Domain: practical issues). While the number of studies conducted in LMICs was smaller, the quality of studies was similar with those conducted in HICs. Nevertheless, there were variations in the observed effect sizes. INTERPRETATION Our findings indicate that "provider recommendation" and "on-site vaccination" along with other behavioral interventions can be employed to increase vaccination rates globally.
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Affiliation(s)
- Amyn A Malik
- Yale Institute for Global Health, New Haven, CT 06510, USA; Analysis Group, Inc, Boston, MA 02199, USA
| | - Noureen Ahmed
- UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA
| | - Mehr Shafiq
- Yale Institute for Global Health, New Haven, CT 06510, USA; Columbia University School of Public Health, New York, NY 10032, USA
| | - Jad A Elharake
- Yale Institute for Global Health, New Haven, CT 06510, USA; UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA; The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Erin James
- Yale Institute for Global Health, New Haven, CT 06510, USA
| | - Kate Nyhan
- Yale University, New Haven, CT 06510, USA
| | - Elliott Paintsil
- Yale Institute for Global Health, New Haven, CT 06510, USA; Columbia University Institute of Human Nutrition, New York, NY 10032, USA
| | | | | | - Fauzia A Malik
- UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA
| | - Saad B Omer
- UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA.
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4
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Tuckerman J, Riley K, Straube S, Mohammed H, Danchin M, Marshall HS. Interventions for increasing the uptake of immunisations in healthcare workers: A systematic review. Vaccine 2023; 41:5499-5506. [PMID: 37527954 DOI: 10.1016/j.vaccine.2023.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 07/14/2023] [Accepted: 07/26/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE This systemic review aimed to evaluate the effectiveness of interventions for increasing the uptake of immunisation in healthcare workers (HCWs) compared to no or alternative interventions. METHODS A systematic review was undertaken (until March 2022) using a search strategy established a priori to capture studies that examined the effect of interventions on vaccination levels in HCWs. We included randomised controlled trials (RCT), cluster RCTs, controlled before-after (CBA) studies and interrupted time-series (ITS) studies. We described studies descriptively and synthesized results with a fixed-effect or random-effects model meta-analysis, where appropriate. The risk of bias was assessed for each study; the quality evidence per comparison was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS We identified three RCTs, six cluster RCTs and four ITS studies. There was a diverse range of interventions; many included an educational component. Based on the evidence examined the following may be effective strategies in increasing the proportion of HCWs vaccinated: policy interventions, targeted and multicomponent strategies, tailored programs directed at management, physician delivered education with a vaccine 'champion' and individual decision analysis. Limited eligible studies restricted synthesis and interpretation of findings. No studies evaluated the effectiveness of legislation. Nor did we find studies evaluating the effectiveness of incentives on their own or studies focusing solely on improving access to vaccination. We judged all the studies as either unclear or high risk of bias. CONCLUSION Few robust studies that evaluate interventions to increase vaccination in HCWs are available. A limitation of this systematic review is that interventions are diverse, poorly reported and few were sufficiently alike to combine in an evaluation. More research on the effects of interventions to increase vaccination in HCWs is required, this should address a variety of vaccines and not just influenza vaccination.
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Affiliation(s)
- Jane Tuckerman
- Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
| | - Kathryn Riley
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, North Adelaide, Australia
| | - Sebastian Straube
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Hassen Mohammed
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, North Adelaide, Australia
| | - Margie Danchin
- Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Royal Children's Hospital, Melbourne, Australia
| | - Helen S Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, North Adelaide, Australia; Adelaide Medical School, University of Adelaide, South Australia, Australia; Robinson Research Institute, University of Adelaide, South Australia, Australia
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5
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Moehring A, Collis A, Garimella K, Rahimian MA, Aral S, Eckles D. Providing normative information increases intentions to accept a COVID-19 vaccine. Nat Commun 2023; 14:126. [PMID: 36624092 PMCID: PMC9828376 DOI: 10.1038/s41467-022-35052-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/16/2022] [Indexed: 01/11/2023] Open
Abstract
Despite the availability of multiple safe vaccines, vaccine hesitancy may present a challenge to successful control of the COVID-19 pandemic. As with many human behaviors, people's vaccine acceptance may be affected by their beliefs about whether others will accept a vaccine (i.e., descriptive norms). However, information about these descriptive norms may have different effects depending on the actual descriptive norm, people's baseline beliefs, and the relative importance of conformity, social learning, and free-riding. Here, using a pre-registered, randomized experiment (N = 484,239) embedded in an international survey (23 countries), we show that accurate information about descriptive norms can increase intentions to accept a vaccine for COVID-19. We find mixed evidence that information on descriptive norms impacts mask wearing intentions and no statistically significant evidence that it impacts intentions to physically distance. The effects on vaccination intentions are largely consistent across the 23 included countries, but are concentrated among people who were otherwise uncertain about accepting a vaccine. Providing normative information in vaccine communications partially corrects individuals' underestimation of how many other people will accept a vaccine. These results suggest that presenting people with information about the widespread and growing acceptance of COVID-19 vaccines helps to increase vaccination intentions.
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Affiliation(s)
- Alex Moehring
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA.,MIT Initiative on the Digital Economy, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Avinash Collis
- McCombs School of Business, The University of Texas at Austin, Austin, TX, USA
| | - Kiran Garimella
- School of Communication and Information, Rutgers University, New Brunswick, NJ, USA
| | - M Amin Rahimian
- MIT Initiative on the Digital Economy, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sinan Aral
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA.,MIT Initiative on the Digital Economy, Massachusetts Institute of Technology, Cambridge, MA, USA.,Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Dean Eckles
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA. .,MIT Initiative on the Digital Economy, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA, USA.
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The Role of Psychological Factors and Vaccine Conspiracy Beliefs in Influenza Vaccine Hesitancy and Uptake among Jordanian Healthcare Workers during the COVID-19 Pandemic. Vaccines (Basel) 2022; 10:vaccines10081355. [PMID: 36016243 PMCID: PMC9413675 DOI: 10.3390/vaccines10081355] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 12/29/2022] Open
Abstract
Vaccination to prevent influenza virus infection and to lessen its severity is recommended among healthcare workers (HCWs). Health professionals have a higher risk of exposure to viruses and could transmit the influenza virus to vulnerable patients who are prone to severe disease and mortality. The aim of the current study was to evaluate the levels of influenza vaccine acceptance and uptake as well as its determinants, among Jordanian HCWs over the last influenza season of 2021/2022. This study was based on a self-administered electronic survey that was distributed in March 2022. Psychological determinants of influenza vaccine acceptance and vaccine conspiracy beliefs were assessed using the previously validated 5C scale questionnaire (confidence, complacency, constraints, calculation and collective responsibility) and the vaccine conspiracy beliefs scale. The study sample comprised a total of 1218 HCWs: nurses (n = 412, 33.8%), physicians (n = 367, 30.1%), medical technicians (n = 182, 14.9%), pharmacists (n = 161, 13.2%) and dentists (n = 87, 7.1%), among others. About two-thirds of the study sample expressed willingness to receive influenza vaccination if provided free of charge (n = 807, 66.3%), whereas less than one-third were willing to pay for the vaccine (n = 388, 31.9%). The self-reported uptake of the influenza vaccine in the last influenza season was 62.8%. The following factors were significantly associated with higher acceptance of influenza vaccination if provided freely, as opposed to vaccine hesitancy/rejection: male sex; physicians and dentists among HCW categories; higher confidence and collective responsibility; and lower complacency, constraints and calculation. Higher influenza vaccine uptake was significantly correlated with nurses and physicians among HCW categories, older age, a higher monthly income, higher confidence and collective responsibility, lower complacency and constraints and lower embrace of general vaccine conspiracy beliefs. The results of the current study can provide helpful clues to improve influenza vaccine coverage among HCWs in Jordan. Consequently, this can help to protect vulnerable patient groups and reserve valuable resources in healthcare settings. Psychological determinants appeared to be the most significant factors for vaccine acceptance and uptake, whereas the embrace of general vaccine conspiracy beliefs was associated with lower rates of influenza vaccine uptake, which should be considered in educational and interventional measures aiming to promote influenza vaccination.
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Huiberts A, van Cleef B, Tjon-A-Tsien A, Dijkstra F, Schreuder I, Fanoy E, van Gageldonk A, van der Hoek W, van Asten L. Influenza vaccination of school teachers: A scoping review and an impact estimation. PLoS One 2022; 17:e0272332. [PMID: 35951517 PMCID: PMC9371289 DOI: 10.1371/journal.pone.0272332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/11/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Influenza vaccination, besides protecting traditional risk groups, can protect employees and reduce illness-related absence, which is especially relevant in sectors with staff shortages. This study describes current knowledge of influenza vaccination in teachers and estimates its potential impact. Methods We conducted a scoping review of the considerations for and impact of influenza vaccination of schoolteachers (grey and scientific literature up to 2020 March, complemented with interviews). We then estimated the potential impact of teacher vaccination in the Netherlands, with different scenarios of vaccine uptake for 3 influenza seasons (2016–2019). Using published data on multiple input parameters, we calculated potentially averted absenteeism notifications, averted absenteeism duration and averted doctor visits for influenza. Results Only one scientific paper reported on impact; it showed lower absenteeism in vaccinated teachers, whereas more knowledge of vaccination impact was deemed crucial by 50% of interviewed experts. The impact for the Netherlands of a hypothetical 50% vaccine uptake was subsequently estimated: 74–293 potentially averted physician visits and 11,178–28,896 potentially averted days of influenza absenteeism (on ≈200,000 total teacher population). An estimated 12–32 vaccinations were required to prevent one teacher sick-leave notification, or 3.5–9.1 vaccinations to prevent one day of teacher absenteeism (2016–2019). Conclusion Scientific publications on influenza vaccination in teachers are few, while public interest has increased to reduce teacher shortages. However, school boards and public health experts indicate requiring knowledge of impact when considering this vaccination. Estimations of 3.5–9.1 vaccinated teachers preventing one day of influenza-related sick leave suggest a possible substantial vaccination impact on absenteeism. Financial incentives, more accessible on-site vaccinations at workplaces, or both, are expected to increase uptake, but more research is needed on teachers’ views and vaccine uptake potential and its cost-effectiveness. Piloting free on-site influenza vaccination in several schools could provide further information on teacher participation.
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Affiliation(s)
- Anne Huiberts
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- * E-mail:
| | - Brigitte van Cleef
- Department for Infectious Disease Control, Public Health Service, Amsterdam, The Netherlands
| | - Aimée Tjon-A-Tsien
- Department for Infectious Disease Control, Public Health Service, Rotterdam-Rijnmond, The Netherlands
| | - Frederika Dijkstra
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Imke Schreuder
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Ewout Fanoy
- Department for Infectious Disease Control, Public Health Service, Rotterdam-Rijnmond, The Netherlands
| | - Arianne van Gageldonk
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Wim van der Hoek
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Liselotte van Asten
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Berry SD, Goldfeld KS, McConeghy K, Gifford D, Davidson HE, Han L, Syme M, Gandhi A, Mitchell SL, Harrison J, Recker A, Johnson KS, Gravenstein S, Mor V. Evaluating the Findings of the IMPACT-C Randomized Clinical Trial to Improve COVID-19 Vaccine Coverage in Skilled Nursing Facilities. JAMA Intern Med 2022; 182:324-331. [PMID: 35099523 PMCID: PMC8804975 DOI: 10.1001/jamainternmed.2021.8067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
IMPORTANCE Identifying successful strategies to increase COVID-19 vaccination among skilled nursing facility (SNF) residents and staff is integral to preventing future outbreaks in a continually overwhelmed system. OBJECTIVE To determine whether a multicomponent vaccine campaign would increase vaccine rates among SNF residents and staff. DESIGN, SETTING, AND PARTICIPANTS This was a cluster randomized trial with a rapid timeline (December 2020-March 2021) coinciding with the Pharmacy Partnership Program (PPP). It included 133 SNFs in 4 health care systems across 16 states: 63 and 70 facilities in the intervention and control arms, respectively, and participants included 7496 long-stay residents (>100 days) and 17 963 staff. INTERVENTIONS Multicomponent interventions were introduced at the facility level that included: (1) educational material and electronic messaging for staff; (2) town hall meetings with frontline staff (nurses, nurse aides, dietary, housekeeping); (3) messaging from community leaders; (4) gifts (eg, T-shirts) with socially concerned messaging; (5) use of a specialist to facilitate consent with residents' proxies; and (6) funds for additional COVID-19 testing of staff/residents. MAIN OUTCOMES AND MEASURES The primary outcomes of this study were the proportion of residents (from electronic medical records) and staff (from facility logs) who received a COVID-19 vaccine (any), examined as 2 separate outcomes. Mixed-effects generalized linear models with a binomial distribution were used to compare outcomes between arms, using intent-to-treat approach. Race was examined as an effect modifier in the resident outcome model. RESULTS Most facilities were for-profit (95; 71.4%), and 1973 (26.3%) of residents were Black. Among residents, 82.5% (95% CI, 81.2%-83.7%) were vaccinated in the intervention arm, compared with 79.8% (95% CI, 78.5%-81.0%) in the usual care arm (marginal difference 0.8%; 95% CI, -1.9% to 3.7%). Among staff, 49.5% (95% CI, 48.4%-50.6%) were vaccinated in the intervention arm, compared with 47.9% (95% CI, 46.9%-48.9%) in usual care arm (marginal difference: -0.4%; 95% CI, -4.2% to 3.1%). There was no association of race with the outcome among residents. CONCLUSIONS AND RELEVANCE A multicomponent vaccine campaign did not have a significant effect on vaccination rates among SNF residents or staff. Among residents, vaccination rates were high. However, half the staff remained unvaccinated despite these efforts. Vaccination campaigns to target SNF staff will likely need to use additional approaches. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04732819.
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Affiliation(s)
- Sarah D Berry
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Keith S Goldfeld
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Kevin McConeghy
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, Rhode Island.,Providence Veteran's Administration Medical Center, Providence, Rhode Island
| | - David Gifford
- Center for Health Policy and Evaluation in Long-Term Care, American Health Care Association/National Center for Assisted Living, Washington, DC
| | | | - Lisa Han
- Insight Therapeutics, Norfolk, Virginia
| | - Maggie Syme
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Ashvin Gandhi
- University of California, Los Angeles Anderson School of Management, Los Angeles
| | - Susan L Mitchell
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jill Harrison
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, Rhode Island
| | - Amy Recker
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, Rhode Island
| | - Kimberly S Johnson
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Stefan Gravenstein
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, Rhode Island.,Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Vincent Mor
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, Rhode Island.,Providence Veteran's Administration Medical Center, Providence, Rhode Island
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Klompas M. New Insights into the Prevention of Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia Caused by Viruses. Semin Respir Crit Care Med 2022; 43:295-303. [PMID: 35042261 DOI: 10.1055/s-0041-1740582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A fifth or more of hospital-acquired pneumonias may be attributable to respiratory viruses. The SARS-CoV-2 pandemic has clearly demonstrated the potential morbidity and mortality of respiratory viruses and the constant threat of nosocomial transmission and hospital-based clusters. Data from before the pandemic suggest the same can be true of influenza, respiratory syncytial virus, and other respiratory viruses. The pandemic has also helped clarify the primary mechanisms and risk factors for viral transmission. Respiratory viruses are primarily transmitted by respiratory aerosols that are routinely emitted when people exhale, talk, and cough. Labored breathing and coughing increase aerosol generation to a much greater extent than intubation, extubation, positive pressure ventilation, and other so-called aerosol-generating procedures. Transmission risk is proportional to the amount of viral exposure. Most transmissions take place over short distances because respiratory emissions are densest immediately adjacent to the source but then rapidly dilute and diffuse with distance leading to less viral exposure. The primary risk factors for transmission then are high viral loads, proximity, sustained exposure, and poor ventilation as these all increase net viral exposure. Poor ventilation increases the risk of long-distance transmission by allowing aerosol-borne viruses to accumulate over time leading to higher levels of exposure throughout an enclosed space. Surgical and procedural masks reduce viral exposure but do not eradicate it and thus lower but do not eliminate transmission risk. Most hospital-based clusters have been attributed to delayed diagnoses, transmission between roommates, and staff-to-patient infections. Strategies to prevent nosocomial respiratory viral infections include testing all patients upon admission, preventing healthcare providers from working while sick, assuring adequate ventilation, universal masking, and vaccinating both patients and healthcare workers.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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10
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Cambon L, Schwarzinger M, Alla F. Increasing acceptance of a vaccination program for coronavirus disease 2019 in France: A challenge for one of the world's most vaccine-hesitant countries. Vaccine 2021; 40:178-182. [PMID: 34863619 PMCID: PMC8603000 DOI: 10.1016/j.vaccine.2021.11.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 02/08/2023]
Abstract
France is one of the most vaccine-hesitant countries in the world, including for coronavirus disease 2019 (COVID-19). After 10 months of restrictive measures and media coverage of the dangers of COVID-19, French attitudes towards a vaccine continue to deteriorate. The communication strategies of the government have not helped; in fact, they have made the situation worse. Empirical studies on the national strategy for management of the COVID-19 pandemic in France have shed light on the reasons for vaccine hesitancy. These studies have identified four pillars for the vaccination strategy: i) Communication regarding the importance of herd immunity, ii) making healthcare workers the focus of the vaccination campaign, iii) citizen mobilization and guaranteed consultations, and iv) access to free vaccines without delay. This paper discusses the evidence supporting this strategy.
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Affiliation(s)
- L Cambon
- SSMIP, CHU Bordeaux, Bordeaux, France; MeRISP, Centre Inserm U 1219, Bordeaux Population Health, Université de Bordeaux, France.
| | - M Schwarzinger
- SSMIP, CHU Bordeaux, Bordeaux, France; MeRISP, Centre Inserm U 1219, Bordeaux Population Health, Université de Bordeaux, France
| | - F Alla
- SSMIP, CHU Bordeaux, Bordeaux, France; MeRISP, Centre Inserm U 1219, Bordeaux Population Health, Université de Bordeaux, France
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11
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Silva MT, Galvao TF, Chapman E, da Silva EN, Barreto JOM. Dissemination interventions to improve healthcare workers' adherence with infection prevention and control guidelines: a systematic review and meta-analysis. Implement Sci 2021; 16:92. [PMID: 34689810 PMCID: PMC8542414 DOI: 10.1186/s13012-021-01164-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/09/2021] [Indexed: 01/04/2023] Open
Abstract
Background The COVID-19 pandemic has challenged health systems worldwide since 2020. At the frontline of the pandemic, healthcare workers are at high risk of exposure. Compliance with infection prevention and control (IPC) should be encouraged at the frontline. This systematic review aimed to assess the effects of dissemination interventions to improve healthcare workers’ adherence with IPC guidelines for respiratory infectious diseases in the workplace. Methods We searched CENTRAL, MEDLINE, Embase, and the Cochrane COVID-19 Study Register. We included randomized controlled trials (RCTs) and cluster RCTs that assessed the effect of any dissemination strategy in any healthcare settings. Certainty of evidence was assessed using the GRADE approach. We synthesized data using random-effects model meta-analysis in Stata 14.2. Results We identified 14 RCTs conducted from 2004 to 2020 with over 65,370 healthcare workers. Adherence to IPC guidelines was assessed by influenza vaccination uptake, hand hygiene compliance, and knowledge on IPC. The most assessed intervention was educational material in combined strategies (plus educational meetings, local opinion leaders, audit and feedback, reminders, tailored interventions, monitoring the performance of the delivery of health care, educational games, and/or patient-mediated interventions). Combined dissemination strategies compared to usual routine improve vaccination uptake (risk ratio [RR] 1.59, 95% confidence interval [CI] 1.54 to 1.81, moderate-certainty evidence), and may improve hand hygiene compliance (RR 1.70; 95% CI 1.03 to 2.83, moderate-certainty). When compared to single strategies, combined dissemination strategies probably had no effect on vaccination uptake (RR 1.01, 95% CI 0.95 to 1.07, low-certainty), and hand hygiene compliance (RR 1.16, 95% CI 0.99 to 1.36, low-certainty). Knowledge of healthcare workers on IPC improved when combined dissemination strategies were compared with usual activities, and the effect was uncertain in comparison to single strategy (very low-certainty evidence). Conclusions Combined dissemination strategies increased workers’ vaccination uptake, hand hygiene compliance, and knowledge on IPC in comparison to usual activities. The effect was negligible when compared to single dissemination strategies. The adoption of dissemination strategies in a planned and targeted way for healthcare workers may increase adherence to IPC guidelines and thus prevent dissemination of infectious disease in the workplace. Trial registration Protocol available at http://osf.io/aqxnp.
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Affiliation(s)
| | - Tais Freire Galvao
- Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil
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12
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Li T, Qi X, Li Q, Tang W, Su K, Jia M, Yang W, Xia Y, Xiong Y, Qi L, Feng L. A Systematic Review and Meta-Analysis of Seasonal Influenza Vaccination of Health Workers. Vaccines (Basel) 2021; 9:vaccines9101104. [PMID: 34696212 PMCID: PMC8537688 DOI: 10.3390/vaccines9101104] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/09/2021] [Accepted: 09/24/2021] [Indexed: 01/01/2023] Open
Abstract
A systematic review and meta-analysis was conducted to estimate the pooled effect of influenza vaccinations for health workers (HWs). Nine databases were screened to identify randomized clinical trials and comparative observational studies that reported the effect of influenza vaccination among HWs. The risk ratio (RR), standardized mean difference, and 95% confidence interval (CI) were employed to study the effect size using fixed/random-effect models. Subgroup analyses and sensitivity analyses were conducted accordingly. Publication bias was examined. Sixteen studies (involving 7971 HWs from nine countries) were included after a comprehensive literature search. The combined RR regarding the incidence of laboratory-confirmed influenza was 0.36 (95% CI: 0.25 to 0.54), the incidence of influenza-like illness (ILI) was 0.69 (95% CI: 0.45 to 1.06), the absenteeism rate was 0.63 (95% CI: 0.46 to 0.86), and the integrated standardized mean difference of workdays lost was −0.18 (95% CI: −0.28 to −0.07) days/person. The subgroup analysis indicated that vaccination significantly decreases the incidence of laboratory-confirmed influenza in different countries, study populations, and average-age vaccinated groups. Influenza vaccinations could effectively reduce the incidence of laboratory-confirmed influenza, absenteeism rates, and workdays lost among HWs. It is advisable, therefore, to improve the coverage and increase the influenza vaccination count among HWs, which may benefit both workers and medical institutions.
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Affiliation(s)
- Tingting Li
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing 400016, China; (T.L.); (Q.L.); (W.T.); (K.S.); (Y.X.); (Y.X.)
| | - Xiaoling Qi
- Affiliated Stomatological Hospital of Chongqing Medical University, Chongqing 400016, China;
| | - Qin Li
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing 400016, China; (T.L.); (Q.L.); (W.T.); (K.S.); (Y.X.); (Y.X.)
| | - Wenge Tang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing 400016, China; (T.L.); (Q.L.); (W.T.); (K.S.); (Y.X.); (Y.X.)
| | - Kun Su
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing 400016, China; (T.L.); (Q.L.); (W.T.); (K.S.); (Y.X.); (Y.X.)
| | - Mengmeng Jia
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, China; (M.J.); (W.Y.)
| | - Weizhong Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, China; (M.J.); (W.Y.)
| | - Yu Xia
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing 400016, China; (T.L.); (Q.L.); (W.T.); (K.S.); (Y.X.); (Y.X.)
| | - Yu Xiong
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing 400016, China; (T.L.); (Q.L.); (W.T.); (K.S.); (Y.X.); (Y.X.)
| | - Li Qi
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing 400016, China; (T.L.); (Q.L.); (W.T.); (K.S.); (Y.X.); (Y.X.)
- Correspondence: (L.Q.); (L.F.)
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, China; (M.J.); (W.Y.)
- Correspondence: (L.Q.); (L.F.)
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13
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Kitt E, Burt S, Price SM, Satchell L, Offit PA, Sammons JS, Coffin SE. Implementation of a Mandatory Influenza Vaccine Policy: A 10-Year Experience. Clin Infect Dis 2021; 73:e290-e296. [PMID: 33372217 DOI: 10.1093/cid/ciaa782] [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: 02/04/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Influenza vaccination of healthcare workers (HCWs) has been recommended for more than 30 years. In 2009, HCWs were designated as a priority group by the Centers for Disease Control and Prevention. Current HCW vaccination rates are 78% across all settings and reach approximately 92% among those employed in hospital settings. Over the last decade, it has become clear that mandatory vaccine policies result in maximal rates of HCW immunization. METHODS In this observational 10-year study, we describe the implementation of a mandatory influenza vaccination policy in a dedicated quaternary pediatric hospital setting by a multidisciplinary team. We analyzed 10 years of available data from deidentified occupational health records from 2009-2010 through the 2018-2019 influenza seasons. Descriptive statistics were performed using Stata v15 and Excel. RESULTS Sustained increases in HCW immunization rates above 99% were observed in the 10 years postimplementation, in addition to a reduction in exemption requests and healthcare-associated influenza. In the year of implementation, 145 (1.6%) HCWs were placed on temporary suspension for failure to receive the vaccine without documentation of an exemption, with 9 (0.06%) subsequently being terminated. Since then, between 0 and 3 HCWs are terminated yearly for failure to receive the vaccine. CONCLUSIONS Implementation of our mandatory influenza vaccination program succeeded in successfully increasing the proportion of immunized HCWs at a quaternary care children's hospital, reducing annual exemption requests with a small number of terminations secondary to vaccine refusal. Temporal trends suggest a positive impact on the safety of our patients.
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Affiliation(s)
- Eimear Kitt
- Division of Pediatric Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sharon Burt
- Department of Occupational Health, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Susan M Price
- Department of Occupational Health, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lauren Satchell
- Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Paul A Offit
- Division of Pediatric Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Julia S Sammons
- Division of Pediatric Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Susan E Coffin
- Division of Pediatric Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
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14
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Wang J, Zhang Y, Long S, Fu X, Zhang X, Zhao S, Xiu S, Wang X, Lu B, Jin H. Non-EPI Vaccine Hesitancy among Chinese Adults: A Cross-Sectional Study. Vaccines (Basel) 2021; 9:vaccines9070772. [PMID: 34358188 PMCID: PMC8310190 DOI: 10.3390/vaccines9070772] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/23/2021] [Accepted: 07/05/2021] [Indexed: 12/21/2022] Open
Abstract
Vaccination against coronavirus disease 2019 (COVID-19) is paramount to curtailing the pandemic. However, the impact of the Non-Expanded Program on Immunization (non-EPI) and COVID-19 vaccine hesitancy on vaccine uptake among Chinese adults remain unclear. This study was an online survey performed in Eastern, Central, and Western China between February 2021 and March 2021 using proportional sampling (n = 7381). Adults aged ≥ 18 years were included, especially younger people (aged < 65). Vaccine hesitancy was assessed using the 3C model and relative scales; logistic regression was used to explore the factors affecting vaccination uptake; structural equation modeling was used to evaluate the correlations between variables. Overall, 67.6% and 24.7% of adults reported vaccine hesitancy toward the non-EPI and COVID-19 vaccines, respectively. Participants (66.3%) reported taking the vaccine mainly based on recommendations from medical staff. Vaccine-hesitant participants (60.5%) reported a fear of side effects as the deciding factor in vaccine rejection. Vaccine hesitancy interacted negatively with confidence (β = −0.349, p < 0.001) and convenience (β = −0.232, p < 0.001), and positively with complacence (β = 0.838, p < 0.001). Nonmedical personnel, adults who had previously received the influenza vaccine, and older people had lower vaccine hesitancy than their counterparts. Most Chinese adults have non-EPI but not COVID-19 vaccine hesitancy. Vaccine safety remains a concern.
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Affiliation(s)
- Jianli Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China; (J.W.); (Y.Z.); (S.L.); (X.F.); (X.Z.); (S.Z.)
- Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Ministry of Education, Nanjing 210009, China
| | - Yan Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China; (J.W.); (Y.Z.); (S.L.); (X.F.); (X.Z.); (S.Z.)
- Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Ministry of Education, Nanjing 210009, China
| | - Sigui Long
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China; (J.W.); (Y.Z.); (S.L.); (X.F.); (X.Z.); (S.Z.)
- Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Ministry of Education, Nanjing 210009, China
| | - Xin Fu
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China; (J.W.); (Y.Z.); (S.L.); (X.F.); (X.Z.); (S.Z.)
- Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Ministry of Education, Nanjing 210009, China
| | - Xiaoxuan Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China; (J.W.); (Y.Z.); (S.L.); (X.F.); (X.Z.); (S.Z.)
- Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Ministry of Education, Nanjing 210009, China
| | - Shuangyu Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China; (J.W.); (Y.Z.); (S.L.); (X.F.); (X.Z.); (S.Z.)
- Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Ministry of Education, Nanjing 210009, China
| | - Shixin Xiu
- Wuxi Center for Disease Control and Prevention, Wuxi 214023, China; (S.X.); (X.W.); (B.L.)
| | - Xuwen Wang
- Wuxi Center for Disease Control and Prevention, Wuxi 214023, China; (S.X.); (X.W.); (B.L.)
| | - Bing Lu
- Wuxi Center for Disease Control and Prevention, Wuxi 214023, China; (S.X.); (X.W.); (B.L.)
| | - Hui Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China; (J.W.); (Y.Z.); (S.L.); (X.F.); (X.Z.); (S.Z.)
- Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Ministry of Education, Nanjing 210009, China
- Correspondence: ; Tel.: +86-025-8327-2572; Fax: +86-825-83272561
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15
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Healthcare Workers' Willingness to Receive Influenza Vaccination in the Context of the COVID-19 Pandemic: A Survey in Southern Italy. Vaccines (Basel) 2021; 9:vaccines9070766. [PMID: 34358182 PMCID: PMC8310353 DOI: 10.3390/vaccines9070766] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
This cross-sectional survey was designed to evaluate hospital healthcare workers’ (HCWs) willingness to receive the influenza vaccination during the COVID-19 pandemic and to identify the related determinants, since it is plausible that the two epidemics will coexist in future winters. Overall, 68% out of 490 participants expressed their willingness to receive influenza vaccination in the 2020/21 season, with 95% of those ever and 45.8% of those never vaccinated in the previous six influenza seasons. Belief that influenza vaccine is useful in distinguishing influenza symptoms from those of COVID-19 and that the influenza vaccine is useful to prevent influenza in hospital settings, willingness to receive COVID-19 vaccination, having no concern about influenza vaccine side effects, concern about the possibility to transmit influenza to hospitalized patients, and influenza vaccination in previous years were all predictors of willingness to receive influenza vaccination. In the context of the COVID-19 pandemic, a relevant increase in the willingness to undergo influenza vaccination was reported. Therefore, interventions focused primarily on enabling factors are needed to promote the adherence to influenza vaccination in future seasons among HCWs.
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16
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De Sarro C, Papadopoli R, Cautela V, Nobile CGA, Pileggi C, Pavia M. Vaccination coverage among health-care workers: pre-post intervention study to assess impact of an on-site vaccination-dedicated clinic. Expert Rev Vaccines 2021; 20:753-759. [PMID: 33896347 DOI: 10.1080/14760584.2021.1915776] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Several studies have revealed low vaccinations coverage among health-care workers (HCWs) for all vaccinations. The aim of our study was to evaluate the impact of the implementation of an on-site vaccination-dedicated clinic on the vaccination coverage rates of HCWs. RESEARCH DESIGN AND METHODS A quasi-experimental pre-post intervention study was carried out among undergraduate and postgraduate students attending medical and health-care professions schools. RESULTS We enrolled 804 students, 404 in the control and 400 in the experimental group. A significantly higher increase of vaccination coverage in the experimental group than in the control group for all the investigated vaccinations (p < 0.001) was found. The odds of adherence to vaccinations in the experimental group, compared to the control group, ranged from 6.9-fold (95% CI 3.51-13.44) to 18.9-fold (95% CI 10.85-32.96). The increase in the coverage rate in the control group was between 2.5% and 3.5%, whereas in the experimental group, higher increases were found, ranging from 34.8% to 71%. CONCLUSIONS The extraordinary increase in the adherence to HCWs recommended vaccinations found in the study seems to indicate a significant role of enabling factors in the complex process of decision-making and implementation of health-related behaviors.
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Affiliation(s)
- Caterina De Sarro
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro (Italy)
| | - Rosa Papadopoli
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro (Italy)
| | - Vincenza Cautela
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro (Italy)
| | | | - Claudia Pileggi
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro (Italy)
| | - Maria Pavia
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples (Italy)
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17
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Hamilton RA, Krockow EM, Vekria P. Attitudes towards influenza and uptake of the flu vaccine: A survey of pharmacy staff working in English hospitals. Vaccine 2021; 39:2636-2642. [PMID: 33846044 DOI: 10.1016/j.vaccine.2021.03.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/12/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Pharmacy staff working in hospitals are at risk of contracting and disseminating influenza. Previous research focuses on community pharmacists' attitudes towards influenza and vaccination. This survey investigates the beliefs and attitudes of pharmacists and other pharmacy staff working in English Hospitals regarding influenza and the vaccine and how this relates to vaccine uptake. METHODS A self-administered survey was provided to pharmacy staff at three hospitals in the East Midlands of England. Job role, age and vaccination status (vaccinated, intended to be vaccinated, and not vaccinated) were collected alongside ratings of agreement with 20 statements regarding influenza and vaccination using a Likert scale. RESULTS 170 pharmacy staff responded; 50.6% had been vaccinated, 17.1% intended to be vaccinated and 32.4% were not vaccinated. Increasing age showed a significant (p = 0.017) positive correlation with increased vaccine uptake as did the beliefs that vaccination protects the individual from influenza (p = 0.049) and that vaccination should be mandatory for NHS staff (p = 0.006). Fear of needles and believing their immune system is strong enough to protect against influenza were negatively correlated with vaccine uptake (p = 0.016 and p = 0.010, respectively). Job role was also strongly correlated with vaccine uptake (p = 0.001), with those holding a pharmacy degree more likely to report being vaccinated or intending to be vaccinated compared to all other pharmacy staff groups. CONCLUSIONS This is the first survey to focus on vaccine behaviours of all pharmacy staff groups working in hospitals. Current uptake of the influenza vaccine may be increased through engagement of senior pharmacy colleagues and providing education on influenza, vaccines, and vaccination. Similar studies should be undertaken on a larger scale to fully interrogate the differences between pharmacy staff groups.
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Affiliation(s)
- Ryan A Hamilton
- Leicester School of Pharmacy, De Montfort University, Leicester LE1 9BH, United Kingdom; Pharmacy Department, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, United Kingdom.
| | - Eva M Krockow
- Department of Neuroscience, Psychology & Behaviour University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Priya Vekria
- Pharmacy Department, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, United Kingdom
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18
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Li Y, Wang LL, Xie LL, Hou WL, Liu XY, Yin S. The epidemiological and clinical characteristics of the hospital-acquired influenza infections: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25142. [PMID: 33725996 PMCID: PMC7982188 DOI: 10.1097/md.0000000000025142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/21/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The hospital-acquired influenza (HAI) were usually contributed to severe outcomes among the inpatients. Here, we performed a meta-analysis to summarize and quantify the epidemiological and clinical characteristics of HAI. METHODS We performed a literature search thorough PubMed, Web of Science, Cochrane Library, Embase, Scopus and China National Knowledge Infrastructure (CNKI), and Wanfang databases for observational studies. Random/fix-effects models were used to obtain pooled proportion, odds ratio (OR), and weighted mean difference (WMD). RESULTS A total of 14 studies involving 1483 HAI and 71849 non-hospital-acquired influenza infections (NHAI) cases were included.The proportion of the HAI among the influenza cases was 11.38% (95% confidence interval [CI]: 5.19%-19.55%) and it was increased after 2012 (6.15% vs 12.72%). The HAI cases were significantly older (WMD = 9.51, 95% CI: 0.04-18.98) and the patients with chronic medical diseases were at increased risk of HAI (OR = 1.85, 95% CI: 1.57-2.19). Among them, metabolic disorders (OR = 8.10, 95% CI: 2.46-26.64) ranked the highest danger, followed by malignancy (OR = 3.18, 95% CI: 2.12-4.76), any chronic diseases (OR = 2.81, 95% CI: 1.08-9.31), immunosuppression (OR = 2.13, 95% CI: 1.25-3.64), renal diseases (OR = 1.72, 95% CI:1.40-2.10), heart diseases (OR = 1.52, 95% CI: 1.03-1.44), and diabetes (OR = 1.22, 95% CI: 1.03-1.44). The HAI cases were more likely to experience longer hospital stay (WMD = 10.23, 95% CI: 4.60-15.85) and longer intensive care unit (ICU) stay (WMD = 2.99, 95% CI: 1.50-4.48). In the outcomes within 30 days, those population was still more likely to receive hospitalization (OR = 6.55, 95% CI: 5.19-8.27), death in hospital (OR = 1.99, 95% CI: 1.65-2.40) but less likely to discharged (OR = 0.20, 95% CI: 0.16-0.24). CONCLUSION The proportion of the HAI among the influenza cases was relatively high. Reinforcement of the surveillance systems and vaccination of the high-risk patients and their contacts are necessary for the HAI control.
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Affiliation(s)
- Yi Li
- Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China
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19
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Bakhuys Roozeboom MC, Wiezer NM, Boot CRL, Bongers PM, Schelvis RMC. Use of Intervention Mapping for Occupational Risk Prevention and Health Promotion: A Systematic Review of Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041775. [PMID: 33670376 PMCID: PMC7918071 DOI: 10.3390/ijerph18041775] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/19/2022]
Abstract
Aim: Intervention mapping (IM) is a method to systematically design interventions that is applied regularly within the public health domain. This study investigates whether IM is effectively used within the occupational safety and health domain as well. Specifically, this study explores the relation between the fidelity regarding the use of the IM protocol for intervention development, the implementation process and the effectiveness of the occupational risk prevention and health promotion interventions. Methods: A systematic review was conducted including articles on development, implementation, and effects of occupational risk prevention and health promotion interventions that were developed according to the IM-protocol. By means of a checklist, two authors reviewed the articles and rated them on several indicators regarding the fidelity of the IM-protocol, the implementation process, and the intervention effect. Results: A literature search resulted in a total of 12 interventions as described in 38 articles. The fidelity to the IM-protocol was relatively low for participation throughout the development process and implementation planning. No relationship was found between fidelity of the IM-protocol and the intervention effect. A theory-based approach (as one of the core elements of IM) appears to be positively related to a successful implementation process. Conclusion: Results of the review suggest that organizing a participative approach and implementation planning is difficult in practice. In addition, results imply that conducting matrices of change objectives as part of the intervention development, although challenging and time-consuming, may ultimately pay off, resulting in a tailored intervention that matches the target group.
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Affiliation(s)
- Maartje C. Bakhuys Roozeboom
- Department of Healthy Living, Netherlands Organisation for Applied Scientific Research (TNO), Schipholweg 77, 2316 ZL Leiden, The Netherlands; (N.M.W.); (P.M.B.)
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University, Amsterdam UMC, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands;
- Correspondence:
| | - Noortje M. Wiezer
- Department of Healthy Living, Netherlands Organisation for Applied Scientific Research (TNO), Schipholweg 77, 2316 ZL Leiden, The Netherlands; (N.M.W.); (P.M.B.)
| | - Cécile R. L. Boot
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University, Amsterdam UMC, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands;
| | - Paulien M. Bongers
- Department of Healthy Living, Netherlands Organisation for Applied Scientific Research (TNO), Schipholweg 77, 2316 ZL Leiden, The Netherlands; (N.M.W.); (P.M.B.)
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University, Amsterdam UMC, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands;
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20
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Chevallier C, Hacquin AS, Mercier H. COVID-19 Vaccine Hesitancy: Shortening the Last Mile. Trends Cogn Sci 2021; 25:331-333. [PMID: 33618982 PMCID: PMC7871796 DOI: 10.1016/j.tics.2021.02.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 01/14/2023]
Abstract
We offer three recommendations to increase coronavirus disease 2019 (COVID-19) vaccination rates. First, use communication campaigns leveraging evidence-based levers and argumentation tools with experts. Second, use behavioral insights to make vaccination more accessible. Third, help early adopters communicate about their decision to be vaccinated to accelerate the emergence of pro-vaccination norms.
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Affiliation(s)
- Coralie Chevallier
- Laboratoire de Neurosciences Cognitives et Computationnelles (LNC2), Département d'Études Cognitives, INSERM U960, École Normale Supérieure, PSL Research University, F-75005 Paris, France.
| | - Anne-Sophie Hacquin
- Institut Jean-Nicod, Département d'Études Cognitives, CNRS UMR8129, École Normale Supérieure, PSL Research University, F-75005 Paris, France
| | - Hugo Mercier
- Institut Jean-Nicod, Département d'Études Cognitives, CNRS UMR8129, École Normale Supérieure, PSL Research University, F-75005 Paris, France.
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21
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Tarca AJ, Lau GT, Mascaro F, Clifford P, Campbell AJ, Taylor E. Pre- and post-intervention study examining immunisation rates, documentation, catch-up delivery and the impact of a dedicated immunisation service at a tertiary paediatric hospital. J Paediatr Child Health 2021; 57:263-267. [PMID: 33053600 DOI: 10.1111/jpc.15217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/06/2020] [Accepted: 09/21/2020] [Indexed: 12/01/2022]
Abstract
AIM To explore immunisation rates and catch-up delivery to children admitted to hospital before and after an immunisation service was commenced. METHODS This pre- and post-intervention study examined 300 admissions prior to (cohort 1) and 300 following (cohort 2) the introduction of an immunisation service. Immunisation rates, documentation, catch-up delivery and accuracy of the Australian Immunisation Register (AIR) were examined. RESULTS On admission, 75% (cohort 1) and 89% (cohort 2) were up-to-date with immunisations. Immunisation history was documented in the medical record in 78% and requirement for catch-up documented in 10%. AIR was incorrect in one-third of cases. By 3 months following discharge, 28% (cohort 1) and 64% (cohort 2) of patients were immunised. CONCLUSIONS Children admitted to hospital have lower immunisation rates than the national average. Documentation was poor, opportunities for catch-up were missed and AIR is error-prone. Catch-up rates increased following the introduction of an immunisation service.
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Affiliation(s)
- Adrian J Tarca
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Cardiology Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Gloria Ty Lau
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Filomena Mascaro
- Immunisation Services, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Patricia Clifford
- Immunisation Services, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Anita J Campbell
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Telethon Kids Institute, Wesfarmers Centre of Vaccines and Infectious Diseases, Nedlands, Western Australia, Australia
| | - Ellen Taylor
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
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22
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Determinants of Vaccination Uptake in Risk Populations: A Comprehensive Literature Review. Vaccines (Basel) 2020; 8:vaccines8030480. [PMID: 32867126 PMCID: PMC7563537 DOI: 10.3390/vaccines8030480] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/13/2020] [Accepted: 08/19/2020] [Indexed: 12/14/2022] Open
Abstract
Vaccination uptake has decreased globally in recent years, with a subsequent rise of vaccine-preventable diseases. Travellers, immunocompromised patients (ICP), and healthcare workers (HCW) are groups at increased risk for (severe) infectious diseases due to their behaviour, health, or occupation, respectively. While targeted vaccination guidelines are available, vaccination uptake seems low. In this review, we give a comprehensive overview of determinants-based on the integrated change model-predicting vaccination uptake in these groups. In travellers, low perceived risk of infection and low awareness of vaccination recommendations contributed to low uptake. Additionally, ICP were often unaware of the recommended vaccinations. A physician's recommendation is strongly correlated with higher uptake. Furthermore, ICP appeared to be mainly concerned about the risks of vaccination and fear of deterioration of their underlying disease. For HCW, perceived risk of (the severity of) infection for themselves and for their patients together with perceived benefits of vaccination contribute most to their vaccination behaviour. As the determinants that affect uptake are numerous and diverse, we argue that future studies and interventions should be based on multifactorial health behaviour models, especially for travellers and ICP as only a limited number of such studies is available yet.
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23
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Saunier F, Berthelot P, Mottet-Auselo B, Pelissier C, Fontana L, Botelho-Nevers E, Gagneux-Brunon A. Impact of a decision-aid tool on influenza vaccine coverage among HCW in two French hospitals: A cluster-randomized trial. Vaccine 2020; 38:5759-5763. [PMID: 32684500 DOI: 10.1016/j.vaccine.2020.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/29/2020] [Accepted: 07/07/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Nosocomial outbreaks of seasonal influenza are frequent, and vaccination is largely recommended for healthcare workers (HCWs). Vaccine coverage in French HCWs does not exceed 20%. Decision-aids (DA) are potential useful interventions to increase vaccine coverage (VC). Our aim was to evaluate the impact of a DA on HCWs influenza vaccine coverage. MATERIAL AND METHODS Prospective cluster-randomized trial conducted in 83 departments in two public hospitals (a teaching and a non-teaching hospital) during the 2018-2019 flu season. Distribution of the DA and of questionnaire about decisional conflict and knowledge in the departments randomized in the intervention group. RESULTS A total number of 3 547 HCWs were concerned by the study (1 953 in the intervention group, 1 594 in the control group). Global VC was 35.6% during the 2018-2019 season, instead of 23.6% in the 2017-2018 season (p < 0.005). During the 2018-2019 season, VC was 31% (95% CI 28.7-33.3) in the control group and 38.7% (95% CI 36.5-40.9) in the intervention group (p < 0.005). Among the 158 HCWs exposed to the DA who answered the survey, 51.3% had no decisional conflict. HCWs without decisional conflict were more prone to get vaccinated before flu season. CONCLUSION The use of the DA was associated with a 25% relative increase in VC among HCWs against seasonal influenza. This modest increase remained far from the WHO 75% target, but may have reduced the number of nosocomial. Multi-component interventions are needed to increase VC in HCWs.
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Affiliation(s)
- Florian Saunier
- Department of Infectious Diseases, and Infection Control Unit, University Hospital of Saint-Etienne, France
| | - Philippe Berthelot
- Department of Infectious Diseases, and Infection Control Unit, University Hospital of Saint-Etienne, France; Groupe Immunité des Muqueuses et Agents Pathogènes, Centre International de Recherche en Infectiologie, Université Jean Monnet, Université de Lyon, Saint-Etienne, France; Institut de Recherche PRESAGE, Chaire vaccination, Prévention et Contrôle de l'Infection, Université de Lyon Saint-Etienne, France
| | | | - Carole Pelissier
- Department of occupational medicine, University Hospital of Saint-Etienne, France
| | - Luc Fontana
- Department of occupational medicine, University Hospital of Saint-Etienne, France
| | - Elisabeth Botelho-Nevers
- Department of Infectious Diseases, and Infection Control Unit, University Hospital of Saint-Etienne, France; Groupe Immunité des Muqueuses et Agents Pathogènes, Centre International de Recherche en Infectiologie, Université Jean Monnet, Université de Lyon, Saint-Etienne, France; Institut de Recherche PRESAGE, Chaire vaccination, Prévention et Contrôle de l'Infection, Université de Lyon Saint-Etienne, France
| | - Amandine Gagneux-Brunon
- Department of Infectious Diseases, and Infection Control Unit, University Hospital of Saint-Etienne, France; Groupe Immunité des Muqueuses et Agents Pathogènes, Centre International de Recherche en Infectiologie, Université Jean Monnet, Université de Lyon, Saint-Etienne, France; Institut de Recherche PRESAGE, Chaire vaccination, Prévention et Contrôle de l'Infection, Université de Lyon Saint-Etienne, France.
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Diomidous M, Isaakidou M. Factors Influencing the Implementation of Flu Vaccination in Healthcare Professionals: Pros and Cons. Mater Sociomed 2020; 32:307-314. [PMID: 33628135 PMCID: PMC7879438 DOI: 10.5455/msm.2020.32.307-314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Vaccination is the best method for microbial and viral infections prevention. Especially for health professionals, flu vaccination is the best method to protect them, and the same applies for the patients and the general population from being infected. One of the most important preventive measure is vaccination and the main types of vaccines available, the limitations and side effects are briefly presented. Aim: The aim of this paper is to present the necessity of the healthcare professionals to conceptualize the importance of flu vaccination ifor themselves and the general population. Healthcare professionals are influenced by their knowledge, attitudes, and beliefs. Epidemiological surveys on this issue are presented for Greece, European Union, and the USA. Methods: A broad scope literature review was conducted based on a strict selection process of articles referring to the general population and the healthcare professionals with emphasis on the time period from the fall of 2018 until the spring of 2020 across Greece. The method used in this research obtained information through bibliographical references throughout Europe, USA, and relevant studies in Greece. Results: The results of this research indicated that influenza vaccination among healthcare professionals in Greece in the time period 2018-2019 was higher in primary health centers (PHCs) with a percentage of 43.8% than in Hospitals which was 30.6%. In addition, in the time period 2019-2020 flu vaccination among health professionals was higher in PHCs with a percentage of 57.9% rather than in Hospitals with a percentage of 38.8%. Specifically, flu vaccination rate which took place in hospitals was higher among physicians than in other healthcare personnel. Furthermore, the fundamental reasons for recommending flu vaccination in healthcare professionals are presented, and issues related to denial or acceptance of it are highlighted. Measures and strategies are proposed in order to increase flu vaccination coverage in healthcare facilities in Greece. Conclusions: Based on this research review healthcare professionals (HCPs) especially the ones working in ICUs, in ICUs for newborn children, in Departments for acute care infections, in Departments caring of persons with immunodeficiency or Units for transplantation, Oncology and Haematology Departments, and finally, in Emergency Care Units need directly to be vaccinated for the flu virus. Different measures have been undertaken to promote flu vaccination and the percentage of implementation has been highlighted.
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Affiliation(s)
- Marianna Diomidous
- Department of Public Health, Faculty of Nursing, National and Kapodistrian University of Athens, Greece
| | - Marianna Isaakidou
- Department of Public Health, Faculty of Nursing, National and Kapodistrian University of Athens, Greece
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25
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Jenkin DC, Mahgoub H, Morales KF, Lambach P, Nguyen-Van-Tam JS. A rapid evidence appraisal of influenza vaccination in health workers: An important policy in an area of imperfect evidence. Vaccine X 2019; 2:100036. [PMID: 31384750 PMCID: PMC6668237 DOI: 10.1016/j.jvacx.2019.100036] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The World Health Organization recommends vaccination of health workers (HWs) against influenza, but low uptake is intransigent.We conducted a Rapid Evidence Appraisal on: the risk of influenza in HWs, transmission risk from HWs to patients, the benefit of HW vaccination, and strategies for improving uptake. We aimed to capture a 'whole-of-system' perspective to consider possible benefits for HWs, employers and patients. METHODS We executed a comprehensive search of the available literature published from 2006 to 2018 in the English language. We developed search terms for seven separate questions following the PICO framework (population, intervention, comparators, outcomes) and queried nine databases. RESULTS Of 3784 publications identified, 52 met inclusion criteria. Seven addressed HW influenza risk, of which four found increased risk; 15 addressed influenza vaccine benefit to HWs or their employers, of which 10 found benefit; 11 addressed influenza transmission from HWs to patients, of which 6 found evidence for transmission; 12 unique studies addressed whether vaccinating HWs produced patient benefit, of which 9 concluded benefits accrued. Regarding the number of HWs needed to vaccinate (NNV) to deliver patient benefit, NNV estimates ranged from 3 to 36,000 but were in significant disagreement. Fourteen studies provided insights on strategies to improve uptake; the strongest evidence was for mandatory vaccination. CONCLUSIONS The evidence on most questions related to influenza vaccination in HWs is mixed and often of low-quality. Substantial heterogeneity exists in terms of study designs and settings, making comparison between studies difficult. Notwithstanding these limitations, a majority of studies suggests that influenza vaccination benefit HWs and their employers; and HWs are implicated in transmission events. The effects of vaccinating HWs on patient morbidity and mortality may include reductions in all-cause mortality and influenza-like illness (ILI). Taken together, the evidence suggests that HW vaccination is an important policy for HWs themselves, their employers, and their patients.
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Key Words
- GAVI, the global alliance for vaccines and immunization
- HW, health workers
- Health worker
- Healthcare
- ILI, influenza like illness
- Influenza
- LTCF, long-term care facility(ies)
- NNV, number needed to vaccinate
- OR, odds ratio
- Policy
- RCTs, randomised controlled trials
- RR, relative risk
- Transmission
- Vaccine
- WHO, World Health organization
- cRCTs, clustered randomised controlled trials
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Affiliation(s)
- Dawn C. Jenkin
- Health Protection and Influenza Research Group (WHO Collaborating Centre), University of Nottingham School of Medicine, United Kingdom
| | - Hamid Mahgoub
- East of England Health Protection Team, Public Health England, United Kingdom
| | | | | | - Jonathan S. Nguyen-Van-Tam
- Health Protection and Influenza Research Group (WHO Collaborating Centre), University of Nottingham School of Medicine, United Kingdom
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26
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Edmond MB. Mandatory Flu Vaccine for Healthcare Workers: Not Worthwhile. Open Forum Infect Dis 2019; 6:ofy214. [PMID: 31011587 PMCID: PMC6468124 DOI: 10.1093/ofid/ofy214] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/22/2018] [Indexed: 11/26/2022] Open
Abstract
In 2010, the Society for Healthcare Epidemiology published a recommendation that annual influenza vaccination of healthcare workers be made a condition of employment despite no high-level evidence to support this recommendation. A better strategy for reducing the transmission of respiratory viruses in the healthcare setting would be to encourage vaccination and reduce presenteeism, which is very common among healthcare workers with influenza-like illness. In a hospital with a baseline vaccination compliance of 70%, reducing presenteeism by 2% has the equivalent impact of mandating vaccination in terms of the number of healthcare workers with influenza-like illness at work. Expectations for compliance with interventions to improve the quality of care should be correlated tightly to the underlying evidence to support the intervention, reserving mandates for interventions with very high quality supporting evidence.
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27
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Perl TM, Talbot TR. Universal Influenza Vaccination Among Healthcare Personnel: Yes We Should. Open Forum Infect Dis 2019; 6:ofz096. [PMID: 31012441 PMCID: PMC6468130 DOI: 10.1093/ofid/ofz096] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/22/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Trish M Perl
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Thomas R Talbot
- Departments of Medicine and Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
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28
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Meijboom MJ, Riphagen-Dalhuisen J, Hak E. The potential economic value of influenza vaccination for healthcare workers in The Netherlands. Influenza Other Respir Viruses 2018; 12:457-464. [PMID: 29624882 PMCID: PMC6005606 DOI: 10.1111/irv.12558] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2018] [Indexed: 12/01/2022] Open
Abstract
Background Despite the clinical evidence, influenza vaccination coverage of healthcare workers remains low. To assess the health economic value of implementing an influenza immunization program among healthcare workers (HCW) in University Medical Centers (UMCs) in the Netherlands, a cost‐benefit model was developed using a societal perspective. Methods/Patients The model was based on a trial performed among all UMCs in the Netherlands that included both hospital staff and patients admitted to the pediatrics and internal medicine departments. The model structure and parameters estimates were based on the trial and complemented with literature research, and the impact of uncertainty explored with sensitivity analyses. Results In a base‐case scenario without vaccine coverage, influenza‐related annual costs were estimated at € 410 815 for an average UMC with 8000 HCWs and an average occupancy during the influenza period of 6000 hospitalized patients. Of these costs, 82% attributed to the HCWs and 18% were patient‐related. With a vaccination coverage of 15.47%, the societal program’s savings were € 2861 which corresponds to a saving of € 270.53 per extended hospitalization. Univariate sensitivity analyses show that the results are most sensitive to changes in the model parameters vaccine effectiveness in reducing influenza‐like illness (ILI) and the vaccination‐related costs. Conclusion In addition to the decreased burden of patient morbidity among hospitalized patients, the effects of the hospital immunization program slightly outweigh the economic investments. These outcomes may support healthcare policymakers’ recommendations about the influenza vaccination program for healthcare workers.
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Affiliation(s)
- Marjan J Meijboom
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Josien Riphagen-Dalhuisen
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
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29
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Volling C, Coleman BL, Katz K, Simor AE, Muller M, Powis J, McElhaney J, McGeer A. Immunogenicity and reactogenicity of high- vs. standard-dose trivalent inactivated influenza vaccine in healthcare workers: a pilot randomized controlled trial. Clin Microbiol Infect 2018; 25:217-224. [PMID: 29783025 DOI: 10.1016/j.cmi.2018.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/30/2018] [Accepted: 05/01/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare immunogenicity, reactogenicity and acceptability of high- and standard-dose trivalent inactivated influenza vaccine (HDTIV, SDTIV) in 18- to 64-year-olds. METHODS We randomized 18- to 64-year-olds to HDTIV or SDTIV in two consecutive years. We collected serum on days 0 and 21, measured haemagglutination inhibition geometric mean titres (GMT) and compared seroconversion, day 21 titres, seroprotection, reactogenicity and acceptability. RESULTS Immunogenicity was evaluable in 42 of 47 2014 participants, all 33 both-year participants and 87 of 90 2015-only participants. First-dose HDTIV recipients experienced seroconversion more frequently than SDTIV recipients to A(H3N2) in 2014 (13/21, 62% vs. 4/21, 19%, p 0.01) and to all vaccine strains in 2015: (A(H1N1): 24/42, 57% vs. 15/59, 25%; A(H3N2): 42/42, 100% vs. 47/59, 80%; B: 25/42, 60% vs. 13/59, 22%; all p <0.01). Day 21 haemagglutination inhibition GMT were higher in first and two sequential-year HDTIV vs. SDTIV recipients: A(H1N1): GMT 749 and 768 vs. 384 (p <0.0001, p 0.002); A(H3N2): 1238 and 956 vs. 633 (p 0.0003, p 0.1); and B: 1113 and 1086 vs. 556 (p 0.0005, p 0.02). HDTIV was more reactogenic (local pain score 3 vs. 1 of 10 on day 0/1, p 0.0003), but recipients were equally willing to be revaccinated (HDTIV: 76/83 (92%); SDTIV: 76/80 (95%), p 0.54). The ratios of day 21 GMT in SDTIV recipients vaccinated in 0 to 4 prior years to those in SDTIV and HDTIV recipients vaccinated in 15 or more prior years were A(H1N1): 3.73 and 1.38; A(H3N2) 3.07 and 1.16; and B: 2.01 and 1.21. CONCLUSIONS HDTIV is more immunogenic and reactogenic and as acceptable as SDTIV in 18- to 64-year-olds.
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Affiliation(s)
- C Volling
- Mount Sinai Hospital, Toronto, Canada; University of Toronto, Toronto, Canada.
| | - B L Coleman
- Mount Sinai Hospital, Toronto, Canada; University of Toronto, Toronto, Canada
| | - K Katz
- University of Toronto, Toronto, Canada; North York General Hospital, North York, Canada
| | - A E Simor
- University of Toronto, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - M Muller
- University of Toronto, Toronto, Canada; St. Michael's Hospital, Toronto, Canada
| | - J Powis
- University of Toronto, Toronto, Canada; Michael Garron Hospital, East York, Canada
| | - J McElhaney
- Health Sciences North Research Institute, Sudbury, Canada
| | - A McGeer
- Mount Sinai Hospital, Toronto, Canada; University of Toronto, Toronto, Canada
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30
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Boey L, Bral C, Roelants M, De Schryver A, Godderis L, Hoppenbrouwers K, Vandermeulen C. Attitudes, believes, determinants and organisational barriers behind the low seasonal influenza vaccination uptake in healthcare workers - A cross-sectional survey. Vaccine 2018; 36:3351-3358. [PMID: 29716777 DOI: 10.1016/j.vaccine.2018.04.044] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Seasonal influenza threatens hospitalised patients and residents of nursing homes annually. Due to age and chronic disease their protection following immunisation is diminished. Additional immunisation of direct contacts and in particular healthcare workers (HCWs) has proven added value. As vaccination coverage in HCWs remains low, we aimed to gain insight in the factors behind the demotivation for influenza vaccination. METHODS Attitudes and believes towards influenza vaccination and socio-demographic and professional determinants were surveyed in 5141 Belgian HCWs from 13 hospitals and 14 nursing homes. Additionally, influenza campaign coordinators of the participating healthcare institutions were interviewed about the factors of success/failure in their campaigns. RESULTS The mean vaccination coverage registered by the participating healthcare institutions was 40.4% in the hospitals and 45.3% in the nursing homes. Overall, up to 90% of HCWs found it important not to infect their patients. However, only 20% of non-vaccinated HCWs considered influenza vaccination a duty to not harm their patients. Up to 40% of unvaccinated staff believed they could get influenza after vaccination and that vaccination weakens their immune system. Also, only about 20% of unvaccinated staff thought to have a high chance of getting influenza. Reasons for unvaccinated staff to get vaccinated in the future are self-protection and protection of family members. Factors that positively influenced vaccination coverage are encouragement by supervisors (OR, hospitals: 7.1, p < 0.001; nursing homes: 7.5, p < 0.001) and well-organized vaccination campaigns with on-site vaccination. Factors that negatively affected vaccination coverage are misconceptions about influenza and its vaccine (OR, range 0.1-0.7, p < 0.001 for most misconceptions) and underestimation of the risk of contracting influenza by patients or HCWs (OR of perceived susceptibility, range 2.1-5.1, p < 0.001 for most factors). CONCLUSION There is a need for guidance for the organization of seasonal influenza campaigns, in which education, communication and easy accessible vaccination are promoted.
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Affiliation(s)
- Lise Boey
- Leuven University Vaccinology Center, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium.
| | - Charlotte Bral
- Leuven University Vaccinology Center, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Mathieu Roelants
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Antoon De Schryver
- Department of Epidemiology and Social Medicine, University of Antwerp, Belgium; IDEWE Occupational Health Services, Heverlee-Leuven, Belgium
| | - Lode Godderis
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, Belgium; IDEWE Occupational Health Services, Heverlee-Leuven, Belgium
| | - Karel Hoppenbrouwers
- Leuven University Vaccinology Center, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium; Environment and Health, Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Corinne Vandermeulen
- Leuven University Vaccinology Center, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
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31
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Brewer NT, Chapman GB, Rothman AJ, Leask J, Kempe A. Increasing Vaccination: Putting Psychological Science Into Action. Psychol Sci Public Interest 2018; 18:149-207. [DOI: 10.1177/1529100618760521] [Citation(s) in RCA: 483] [Impact Index Per Article: 80.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Vaccination is one of the great achievements of the 20th century, yet persistent public-health problems include inadequate, delayed, and unstable vaccination uptake. Psychology offers three general propositions for understanding and intervening to increase uptake where vaccines are available and affordable. The first proposition is that thoughts and feelings can motivate getting vaccinated. Hundreds of studies have shown that risk beliefs and anticipated regret about infectious disease correlate reliably with getting vaccinated; low confidence in vaccine effectiveness and concern about safety correlate reliably with not getting vaccinated. We were surprised to find that few randomized trials have successfully changed what people think and feel about vaccines, and those few that succeeded were minimally effective in increasing uptake. The second proposition is that social processes can motivate getting vaccinated. Substantial research has shown that social norms are associated with vaccination, but few interventions examined whether normative messages increase vaccination uptake. Many experimental studies have relied on hypothetical scenarios to demonstrate that altruism and free riding (i.e., taking advantage of the protection provided by others) can affect intended behavior, but few randomized trials have tested strategies to change social processes to increase vaccination uptake. The third proposition is that interventions can facilitate vaccination directly by leveraging, but not trying to change, what people think and feel. These interventions are by far the most plentiful and effective in the literature. To increase vaccine uptake, these interventions build on existing favorable intentions by facilitating action (through reminders, prompts, and primes) and reducing barriers (through logistics and healthy defaults); these interventions also shape behavior (through incentives, sanctions, and requirements). Although identification of principles for changing thoughts and feelings to motivate vaccination is a work in progress, psychological principles can now inform the design of systems and policies to directly facilitate action.
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Affiliation(s)
- Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina
| | | | | | - Julie Leask
- Faculty of Nursing and Midwifery, University of Sydney
- Faculty of Medicine, University of Sydney
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine
- Department of Pediatrics, University of Colorado Anschutz Medical Campus
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, Colorado
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32
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Rashid H, Yin JK, Ward K, King C, Seale H, Booy R. Assessing Interventions To Improve Influenza Vaccine Uptake Among Health Care Workers. Health Aff (Millwood) 2017; 35:284-92. [PMID: 26858382 DOI: 10.1377/hlthaff.2015.1087] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite official recommendations for health care workers to receive the influenza vaccine, uptake remains low. This systematic review of randomized controlled trials was conducted to understand the evidence about interventions to improve influenza vaccine uptake among health care workers. We identified twelve randomized controlled trials that, collectively, assessed six major categories of interventions involving 193,924 health care workers in high-income countries. The categories were educational materials and training sessions, improved access to the vaccine, rewards following vaccination, organized efforts to raise vaccine awareness, reminders to get vaccinated, and the use of lead advocates for vaccination. Only one of the four studies that evaluated the effect of a single intervention in isolation demonstrated a significantly higher vaccine uptake rate in the intervention group, compared to controls. However, five of the eight studies that evaluated a combination of strategies showed significantly higher vaccine uptake. Despite the low quality of the studies identified, the data suggest that combined interventions can moderately increase vaccine uptake among health care workers. Further methodologically appropriate trials of combined interventions tailored to individual health care settings and incorporating less-studied strategies would enhance the evidence about interventions to improve immunization uptake among health care workers.
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Affiliation(s)
- Harunor Rashid
- Harunor Rashid is an epidemiologist in the National Centre for Immunisation Resarch and Surveillance of Vaccine Preventable Diseases (NCIRS), Kids Research Institute, Children's Hospital at Westmead, New South Wales, Australia
| | - Jiehui Kevin Yin
- Jiehui Kevin Yin is a conjoint lecturer at the Sydney School of Public Health, Faculty of Medicine, University of Sydney, in New South Wales
| | - Kirsten Ward
- Kirsten Ward is a monitoring and evaluation officer at the NCIRS, Kids Research Institute, Children's Hospital at Westmead
| | - Catherine King
- Catherine King is a medical librarian at the NCIRS, Kids Research Institute, Children's Hospital at Westmead
| | - Holly Seale
- Holly Seale is a senior lecturer in the School of Public Health and Community Medicine, University of New South Wales, in Sydney
| | - Robert Booy
- Robert Booy is head of clinical research at the NCIRS, Kids Research Institute, Children's Hospital at Westmead
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De Serres G, Skowronski DM, Ward BJ, Gardam M, Lemieux C, Yassi A, Patrick DM, Krajden M, Loeb M, Collignon P, Carrat F. Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement. PLoS One 2017; 12:e0163586. [PMID: 28129360 PMCID: PMC5271324 DOI: 10.1371/journal.pone.0163586] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 08/27/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Four cluster randomized controlled trials (cRCTs) conducted in long-term care facilities (LTCFs) have reported reductions in patient risk through increased healthcare worker (HCW) influenza vaccination. This evidence has led to expansive policies of enforcement that include all staff of acute care hospitals and other healthcare settings beyond LTCFs. We critique and quantify the cRCT evidence for indirect patient benefit underpinning policies of mandatory HCW influenza vaccination. METHODS Plausibility of the four cRCT findings attributing indirect patient benefits to HCW influenza vaccination was assessed by comparing percentage reductions in patient risk reported by the cRCTs to predicted values. Plausibly predicted values were derived according to the basic mathematical principle of dilution, taking into account HCW influenza vaccine coverage and the specificity of patient outcomes for influenza. Accordingly, predicted values were calculated as a function of relevant compound probabilities including vaccine efficacy (ranging 40-60% in HCWs and favourably assuming the same indirect protection conferred through them to patients) × change in proportionate HCW influenza vaccine coverage (as reported by each cRCT) × percentage of a given patient outcome (e.g. influenza-like illness (ILI) or all-cause mortality) plausibly due to influenza virus. The number needed to vaccinate (NNV) for HCWs to indirectly prevent patient death was recalibrated based on real patient data of hospital-acquired influenza, with adjustment for potential under-detection (5.2-fold), and using favourable assumptions of HCW-attributable risk (ranging 60-80%). RESULTS In attributing patient benefit to increased HCW influenza vaccine coverage, each cRCT was found to violate the basic mathematical principle of dilution by reporting greater percentage reductions with less influenza-specific patient outcomes (i.e., all-cause mortality > ILI > laboratory-confirmed influenza) and/or patient mortality reductions exceeding even favourably-derived predicted values by at least 6- to 15-fold. If extrapolated to all LTCF and hospital staff in the United States, the prior cRCT-claimed NNV of 8 would implausibly mean >200,000 and >675,000 patient deaths, respectively, could be prevented annually by HCW influenza vaccination, inconceivably exceeding total US population mortality estimates due to seasonal influenza each year, or during the 1918 pandemic, respectively. More realistic recalibration based on actual patient data instead shows that at least 6000 to 32,000 hospital workers would need to be vaccinated before a single patient death could potentially be averted. CONCLUSIONS The four cRCTs underpinning policies of enforced HCW influenza vaccination attribute implausibly large reductions in patient risk to HCW vaccination, casting serious doubts on their validity. The impression that unvaccinated HCWs place their patients at great influenza peril is exaggerated. Instead, the HCW-attributable risk and vaccine-preventable fraction both remain unknown and the NNV to achieve patient benefit still requires better understanding. Although current scientific data are inadequate to support the ethical implementation of enforced HCW influenza vaccination, they do not refute approaches to support voluntary vaccination or other more broadly protective practices, such as staying home or masking when acutely ill.
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Affiliation(s)
- Gaston De Serres
- Institut national de santé publique du Québec, Quebec City, Quebec, Canada
- Laval University, Quebec City, Quebec, Canada
| | - Danuta M. Skowronski
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian J. Ward
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael Gardam
- University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Camille Lemieux
- University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Annalee Yassi
- University of British Columbia, Vancouver, British Columbia, Canada
| | - David M. Patrick
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Loeb
- McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Peter Collignon
- Australian National University, Acton, Australia
- Canberra Hospital, Garran, ACT, Australia
| | - Fabrice Carrat
- Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Sorbonne Universités, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Unité de Santé Publique, Paris, France
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Haviari S, Bénet T, Saadatian-Elahi M, André P, Loulergue P, Vanhems P. Vaccination of healthcare workers: A review. Hum Vaccin Immunother 2016; 11:2522-37. [PMID: 26291642 DOI: 10.1080/21645515.2015.1082014] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Vaccine-preventable diseases are a significant cause of morbidity and mortality. As new vaccines are proving to be effective and as the incidence of some infections decreases, vaccination practices are changing. Healthcare workers (HCWs) are particularly exposed to and play a role in nosocomial transmission, which makes them an important target group for vaccination. Most vaccine-preventable diseases still carry a significant risk of resurgence and have caused outbreaks in recent years. While many professional societies favor vaccination of HCWs as well as the general population, recommendations differ from country to country. In turn, vaccination coverage varies widely for each microorganism and for each country, making hospitals and clinics vulnerable to outbreaks. Vaccine mandates and non-mandatory strategies are the subject of ongoing research and controversies. Optimal approaches to increase coverage and turn the healthcare workforce into an efficient barrier against infectious diseases are still being debated.
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Affiliation(s)
- Skerdi Haviari
- a Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon ; Lyon , France
| | - Thomas Bénet
- a Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon ; Lyon , France.,b Equipe Epidémiologie et Santé Publique, Université de Lyon, Université Lyon 1 ; Lyon , France.,c Institut National de la Santé et de la Recherche Médicale (INSERM), French Clinical Research Investigation Network (F-CRIN), Innovative Clinical Research Network in Vaccinology (I-REIVAC) ; Lyon , France
| | - Mitra Saadatian-Elahi
- a Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon ; Lyon , France
| | - Philippe André
- a Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon ; Lyon , France
| | - Pierre Loulergue
- c Institut National de la Santé et de la Recherche Médicale (INSERM), French Clinical Research Investigation Network (F-CRIN), Innovative Clinical Research Network in Vaccinology (I-REIVAC) ; Lyon , France.,d Université Paris Descartes, Sorbonne Paris Cité, INSERM, CIC 1417, Assistance Publique Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Broca Hôtel Dieu, CIC Cochin-Pasteur ; Paris , France.,e INSERM, F-CRIN, I-REIVAC, Cochin Center ; Paris , France
| | - Philippe Vanhems
- a Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon ; Lyon , France.,b Equipe Epidémiologie et Santé Publique, Université de Lyon, Université Lyon 1 ; Lyon , France.,c Institut National de la Santé et de la Recherche Médicale (INSERM), French Clinical Research Investigation Network (F-CRIN), Innovative Clinical Research Network in Vaccinology (I-REIVAC) ; Lyon , France
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Thomas RE, Jefferson T, Lasserson TJ. Influenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions. Cochrane Database Syst Rev 2016; 2016:CD005187. [PMID: 27251461 PMCID: PMC8504984 DOI: 10.1002/14651858.cd005187.pub5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A systematic review found that 3% of working adults who had received influenza vaccine and 5% of those who were unvaccinated had laboratory-proven influenza per season; in healthcare workers (HCWs) these percentages were 5% and 8% respectively. Healthcare workers may transmit influenza to patients. OBJECTIVES To identify all randomised controlled trials (RCTs) and non-RCTs assessing the effects of vaccinating healthcare workers on the incidence of laboratory-proven influenza, pneumonia, death from pneumonia and admission to hospital for respiratory illness in those aged 60 years or older resident in long-term care institutions (LTCIs). SEARCH METHODS We searched CENTRAL (2015, Issue 9), MEDLINE (1966 to October week 3, 2015), EMBASE (1974 to October 2015) and Web of Science (2006 to October 2015), but Biological Abstracts only from 1969 to March 2013 and Science Citation Index-Expanded from 1974 to March 2013 due to lack of institutional access in 2015. SELECTION CRITERIA Randomised controlled trials (RCTs) and non-RCTs of influenza vaccination of healthcare workers caring for individuals aged 60 years or older in LTCIs and the incidence of laboratory-proven influenza and its complications (lower respiratory tract infection, or hospitalisation or death due to lower respiratory tract infection) in individuals aged 60 years or older in LTCIs. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed risk of bias. Effects on dichotomous outcomes were measured as risk differences (RDs) with 95% confidence intervals (CIs). We assessed the quality of evidence with GRADE. MAIN RESULTS We identified four cluster-RCTs and one cohort study (n = 12,742) of influenza vaccination for HCWs caring for individuals ≥ 60 years in LTCIs. Four cluster RCTs (5896 residents) provided outcome data that addressed the objectives of our review. The studies were comparable in their study populations, intervention and outcome measures. The studies did not report adverse events. The principal sources of bias in the studies related to attrition, lack of blinding, contamination in the control groups and low rates of vaccination coverage in the intervention arms, leading us to downgrade the quality of evidence for all outcomes due to serious risk of bias.Offering influenza vaccination to HCWs based in long term care homes may have little or no effect on the number of residents who develop laboratory-proven influenza compared with those living in care homes where no vaccination is offered (RD 0 (95% CI -0.03 to 0.03), two studies with samples taken from 752 participants; low quality evidence). HCW vaccination probably leads to a reduction in lower respiratory tract infection in residents from 6% to 4% (RD -0.02 (95% CI -0.04 to 0.01), one study of 3400 people; moderate quality evidence). HCW vaccination programmes may have little or no effect on the number of residents admitted to hospital for respiratory illness (RD 0 (95% CI -0.02 to 0.02, one study of 1059 people; low quality evidence). We decided not to combine data on deaths from lower respiratory tract infection (two studies of 4459 people) or all cause deaths (four studies of 8468 people). The direction and size of difference in risk varied between the studies. We are uncertain as to the effect of vaccination on these outcomes due to the very low quality of evidence. Adjusted analyses, which took into account the cluster design, did not differ substantively from the pooled analysis with unadjusted data. AUTHORS' CONCLUSIONS Our review findings have not identified conclusive evidence of benefit of HCW vaccination programmes on specific outcomes of laboratory-proven influenza, its complications (lower respiratory tract infection, hospitalisation or death due to lower respiratory tract illness), or all cause mortality in people over the age of 60 who live in care institutions. This review did not find information on co-interventions with healthcare worker vaccination: hand-washing, face masks, early detection of laboratory-proven influenza, quarantine, avoiding admissions, antivirals and asking healthcare workers with influenza or influenza-like illness (ILI) not to work. This review does not provide reasonable evidence to support the vaccination of healthcare workers to prevent influenza in those aged 60 years or older resident in LTCIs. High quality RCTs are required to avoid the risks of bias in methodology and conduct identified by this review and to test further these interventions in combination.
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Affiliation(s)
- Roger E Thomas
- University of CalgaryDepartment of Family Medicine, Faculty of MedicineHealth Sciences Centre3330 Hospital Drive NWCalgaryABCanadaT2N 4N1
| | | | - Toby J Lasserson
- Cochrane Central ExecutiveCochrane Editorial UnitSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
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Jarrett C, Wilson R, O'Leary M, Eckersberger E, Larson HJ. Strategies for addressing vaccine hesitancy - A systematic review. Vaccine 2015; 33:4180-90. [PMID: 25896377 DOI: 10.1016/j.vaccine.2015.04.040] [Citation(s) in RCA: 612] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED The purpose of this systematic review is to identify, describe and assess the potential effectiveness of strategies to respond to issues of vaccine hesitancy that have been implemented and evaluated across diverse global contexts. METHODS A systematic review of peer reviewed (January 2007-October 2013) and grey literature (up to October 2013) was conducted using a broad search strategy, built to capture multiple dimensions of public trust, confidence and hesitancy concerning vaccines. This search strategy was applied and adapted across several databases and organizational websites. Descriptive analyses were undertaken for 166 (peer reviewed) and 15 (grey literature) evaluation studies. In addition, the quality of evidence relating to a series of PICO (population, intervention, comparison/control, outcomes) questions defined by the SAGE Working Group on Vaccine Hesitancy (WG) was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria; data were analyzed using Review Manager. RESULTS Across the literature, few strategies to address vaccine hesitancy were found to have been evaluated for impact on either vaccination uptake and/or changes in knowledge, awareness or attitude (only 14% of peer reviewed and 25% of grey literature). The majority of evaluation studies were based in the Americas and primarily focused on influenza, human papillomavirus (HPV) and childhood vaccines. In low- and middle-income regions, the focus was on diphtheria, tetanus and pertussis, and polio. Across all regions, most interventions were multi-component and the majority of strategies focused on raising knowledge and awareness. Thirteen relevant studies were used for the GRADE assessment that indicated evidence of moderate quality for the use of social mobilization, mass media, communication tool-based training for health-care workers, non-financial incentives and reminder/recall-based interventions. Overall, our results showed that multicomponent and dialogue-based interventions were most effective. However, given the complexity of vaccine hesitancy and the limited evidence available on how it can be addressed, identified strategies should be carefully tailored according to the target population, their reasons for hesitancy, and the specific context.
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Affiliation(s)
- Caitlin Jarrett
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rose Wilson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Maureen O'Leary
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Elisabeth Eckersberger
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Heidi J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.
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Nowrouzi-Kia B, McGeer A. External cues to action and influenza vaccination among post-graduate trainee physicians in Toronto, Canada. Vaccine 2014; 32:3830-4. [PMID: 24837775 DOI: 10.1016/j.vaccine.2014.04.067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 03/31/2014] [Accepted: 04/21/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Understanding factors affecting trainee physician choices about vaccination may permit the design of more effective vaccination programmes. METHODS To identify factors associated with seasonal and pandemic influenza vaccination, an online questionnaire based on the health belief model was sent to trainee physicians registered at the post-graduate medical education office at the University of Toronto in September 2011. RESULTS 963 complete responses were received from 1884 trainee physicians (51%); 28 (2.9%) reported an allergy to vaccine components and were excluded from further analysis. Reported seasonal influenza vaccination rates in 2008, 2009 and 2010 were 69% (648/935), 75% (708/935) and 76% (703/935), respectively; 788 (84%) reported receiving the A(H1N1)pdm09 vaccine. In multivariable analysis, number of years of post-graduate training (OR for 4+ versus 1-3 post-graduate years 2.2 (95% CL 1.3, 3.8)) was associated with receipt of the 2009 pandemic vaccine, as were four components of the health belief model: odds ratios were 4.7 (95% CL 3.0, 7.5) for perceived severity, 1.9 (95% CL 1.2, 2.9) for perceived benefits, .35 (95% CL .21, .59) for perceived barriers, and 5.8 (95% CLI 3.6, 9.1) for external cues to action. Both vaccinated and unvaccinated respondents reported that their decisions were significantly influenced by encouragement from their colleagues, families and employers. CONCLUSION Self-reported vaccination coverage among trainee physicians was high. External cues to action appear to be particularly important in trainee physician vaccination decisions: active institutional promotion may increase influenza vaccination rates in trainees.
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Affiliation(s)
| | - Allison McGeer
- Dalla Lana School of Public Health, University of Toronto, Canada; Department of Microbiology, Mount Sinai Hospital, Toronto, Canada.
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38
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Hooper CR, Breathnach A, Iqbal R. Is there a case for mandating influenza vaccination in healthcare workers? Anaesthesia 2014; 69:95-100. [PMID: 24443849 DOI: 10.1111/anae.12561] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C R Hooper
- St George's, University of London, London, UK.
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Panning M, Huzly D, Hengel H, V. Kern W, Dettenkofer M. The crucial role of molecular diagnostics. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:10. [PMID: 24565272 PMCID: PMC3948014 DOI: 10.3238/arztebl.2014.0010a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Marcus Panning
- *Institut für Virologie, Department für Medizinische Mikrobiologie und Hygiene Universitätsklinikum Freiburg
| | | | | | - Winfried V. Kern
- **Abteilung Infektiologie, Department Innere Medizin Universitätsklinikum Freiburg
| | - Markus Dettenkofer
- *** Institut für Umweltmedizin und Krankenhaushygiene Universitätsklinikum Freiburg
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Ahmed F, Lindley MC, Allred N, Weinbaum CM, Grohskopf L. Effect of influenza vaccination of healthcare personnel on morbidity and mortality among patients: systematic review and grading of evidence. Clin Infect Dis 2013; 58:50-7. [PMID: 24046301 DOI: 10.1093/cid/cit580] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Influenza vaccination of healthcare personnel (HCP) is recommended in >40 countries. However, there is controversy surrounding the evidence that HCP vaccination reduces morbidity and mortality among patients. Key factors for developing evidence-based recommendations include quality of evidence, balance of benefits and harms, and values and preferences. METHODS We conducted a systematic review of randomized trials, cohort studies, and case-control studies published through June 2012 to evaluate the effect of HCP influenza vaccination on mortality, hospitalization, and influenza cases in patients of healthcare facilities. We pooled trial results using meta-analysis and assessed evidence quality using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS We identified 4 cluster randomized trials and 4 observational studies conducted in long-term care or hospital settings. Pooled risk ratios across trials for all-cause mortality and influenza-like illness were 0.71 (95% confidence interval [CI], .59-.85) and 0.58 (95% CI, .46-.73), respectively; pooled estimates for all-cause hospitalization and laboratory-confirmed influenza were not statistically significant. The cohort and case-control studies indicated significant protective associations for influenza-like illness and laboratory-confirmed influenza. No studies reported harms to patients. Using GRADE, the quality of the evidence for the effect of HCP vaccination on mortality and influenza cases in patients was moderate and low, respectively. The evidence quality for the effect of HCP vaccination on patient hospitalization was low. The overall evidence quality was moderate. CONCLUSIONS The quality of evidence is higher for mortality than for other outcomes. HCP influenza vaccination can enhance patient safety.
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Affiliation(s)
- Faruque Ahmed
- Immunization Services Division, National Center for Immunization and Respiratory Diseases
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