Willingness of European healthcare workers to undergo vaccination against seasonal influenza: current situation and suggestions for improvement

Knowledge, attitudes and practices of health care workers in a cardiology department on influenza vaccination

BACKGROUND

Evidence has accrued that influenza vaccination may be effective in preventing myocardial infarction (MI). However, vaccination rates in both adults and health care workers (HCW) are low, and hospitalisation is often a missed opportunity for vaccination. We hypothesised that knowledge, attitude and practices of health care workers regarding vaccination impacts vaccine uptake in hospitals. The cardiac ward admits high-risk patients, many of whom are indicated for influenza vaccine, especially those caring for patients with acute MI.

AIM

To understand the knowledge, attitudes, and practices of HCW in cardiology ward within a tertiary institution, on influenza vaccination.

METHODS

We used focus group discussions with HCW caring for AMI patients in an acute cardiology ward, to explore the knowledge, attitudes, and practices of HCW regarding influenza vaccination for patients under their care. Discussions were recorded, transcribed, and thematically analysed using NVivo software. In addition, participants completed a survey on their knowledge and attitudes towards the uptake of influenza vaccination.

RESULTS

A lack of awareness regarding the associations between influenza, vaccination and cardiovascular health was identified amongst HCW. Participants did not routinely discuss the benefits of influenza vaccination or recommend influenza vaccinations to patients under their care; this may be due to a combination of a lack of awareness, not seeing it as part of their job and workload issues. We also highlighted difficulties in access to vaccination, and concerns of adverse reactions to the vaccine.

CONCLUSION

There is limited awareness among HCW of the role of influenza on cardiovascular health and the benefits of influenza vaccine in the prevention of cardiovascular events. Improved vaccination of at-risk patients in hospital may need active engagement of HCW. Improving the health literacy of HCW regarding the benefits of vaccination as a preventative strategy may result in better health care outcomes for cardiac patients.

Low influenza vaccine uptake by healthcare workers caring for the elderly in South African old age homes and primary healthcare facilities

BACKGROUND

The elderly bear the highest burden of South Africa's estimated annual > 10 million influenza cases and > 11,000 influenza-related deaths. Unvaccinated healthcare workers (HCWs) are at high occupational risk of contracting influenza, and may transmit influenza to elderly patients in their care. Thus, the South African National Department of Health recommends that HCWs receive annual influenza vaccination. This study aimed to determine influenza vaccination coverage among HCWs; identify reasons for their vaccination status; and investigate if HCWs recommend vaccination to their elderly patients.

METHODS

A descriptive study was conducted in 18 community health centres and 44 private sector and non-governmental organisation managed old age homes across South Africa, using a self-administered structured questionnaire, which was distributed to 360 HCWs present on the day of data collection. Data were captured using Microsoft Excel® and imported to Epi Info™ 7 (Centers for Disease Control and Prevention, USA) for descriptive statistical analysis. Ethics approval (SMUREC/P/36/2018: PG) and permission to conduct the study at the facilities were obtained. All participants provided informed consent.

RESULTS

The response rate was 76.7% (276/360). Most participants were female (90.9% [251/276]), nursing professionals (81.2% [224/276]) with a mean age of 41.1 ± 11.7 years. Although 62.7% of participants indicated having ever received at least one dose of the influenza vaccine, influenza vaccine uptake for 2017 and 2018 was 24.36% (41/276) and 33.3% (92/276) respectively. The main reasons given for never being vaccinated against influenza were related to the unavailability of the vaccine (70.9%) and vaccine hesitancy (27.2%). Most participants (67.8% [187/276]) recommended vaccines to elderly patients in their care.

CONCLUSION

The main reasons behind low influenza vaccine uptake by HCWs in South Africa who care for the elderly were related to unavailability of the vaccine and vaccine hesitancy. Strategies to educate HCWs on the importance of influenza vaccination, while concurrently increasing sustained and easy access to the vaccine by HCWs are needed to preserve public health.

Perceptions of the safety of vaccines and vaccine associated knowledge levels in Europe: A 2019 cross-sectional study in 28 countries

Vaccination has saved millions of lives. Vaccine hesitancy was recently declared a major threat to health by the World Health Organisation. Sociodemographic variables and knowledge level about vaccines have been suggested previously to affect vaccine uptake. This study aimed to investigate how levels of vaccination knowledge and concerns around safety of vaccines varied across sociodemographic factors in the European Union and United Kingdom. Levels and sources of knowledge and vaccine attitude patterns were examined across different areas of Europe. Data from the March 2019 Eurobarometer survey was used in this study which had 27,524 participants across the European Union and the United Kingdom. Two-level logistic and linear regressions were used to look for associations between sociodemographic variables, vaccine attitudes and knowledge level. Those who trusted information from healthcare workers and healthcare authorities were most likely to have positive vaccine attitudes; those trusting internet sources the most were the least likely. Those with greater vaccine related knowledge were more likely to report positive vaccination attitudes. Healthcare workers are key to dissemination of vaccination advice however many are becoming hesitant themselves. An increasing number of people are seeking online sources for vaccination information, and this has implications with information accuracy and vaccine hesitancy. A considerable proportion of the adult population in the European Union and the United Kingdom was concerned about the safety or side effects of vaccines. Continued efforts to increase trust in vaccines both in whole populations and specific groups are needed.

Attitudes, beliefs and practice of Egyptian healthcare workers towards seasonal influenza vaccination

BACKGROUND

Seasonal influenza vaccination is highly recommended for healthcare workers (HCWs) every year to protect them and reduce the risk of disease transmission at workplaces. Relatively few studies addressed influenza vaccination in the Eastern Mediterranean Region.

OBJECTIVES

The main objective of this study was to explore the attitudes, beliefs and practice of Egyptian HCWs towards seasonal influenza vaccine.

METHODS

This is a nationwide cross-sectional study. Data were collected through self-administered structured questionnaire. A sample of 3534 HCWs (physicians and nurses) was collected from different levels of healthcare facilities.

RESULTS

The proportion of seasonal influenza vaccine uptake during the last season was 30.7% while the percentage of ever vaccinated was 46.8%. The most identified reason for non-compliance was lack of trust about vaccine efficacy and its adverse events. Around 80% of participants expressed positive attitude towards influenza vaccine and the vast majority (98%) agreed to uptake the vaccine during pandemic. There was significant positive association between attitude score and influenza vaccine uptake. Raising awareness about vaccine and ensuring vaccine availability were the main suggestions by HCWs to improve vaccine uptake.

CONCLUSIONS

Although there was positive attitude towards influenza vaccine, yet vaccination coverage was suboptimal particularly among those working in university hospitals. Educational messages and operational strategies addressing motivators and barriers that emerged from this study are needed to optimize vaccine uptake.

To Be or Not to Be Vaccinated? The Ethical Aspects of Influenza Vaccination among Healthcare Workers

Influenza is a highly contagious airborne disease with a significant morbidity and mortality burden. Seasonal influenza (SI) vaccination has been recommended for healthcare workers (HCWs) for many years. Despite many efforts to encourage HCWs to be immunized against influenza, vaccination uptake remains suboptimal. Sometimes there is a significant sign of improvement, only if numerous measures are taken. Is 'the evidence' and 'rationale' sufficient enough to support mandatory influenza vaccination policies? Most voluntary policies to increase vaccination rates among HCWs have not been very effective. How to close the gap between desired and current vaccination rates? Whether (semi)mandatory policies are justified is an ethical issue. By means of a MEDLINE search, we synthesized the most relevant publications to try to answer these questions. Neither the 'clinical' Hippocratic ethics (the Georgetown Mantra: autonomy, beneficence, non-maleficence, and justice), nor the 'public health' ethics frameworks resolve the question completely. Therefore, recently the 'components of justice' framework was added to the ethical debate. Most options to increase the uptake arouse little ethical controversy, except mandatory policies. The success of vaccination will largely depend upon the way the ethical challenges like professional duty and ethics (deontology), self-determination, vaccine hesitance, and refusal ('conscientious objector') are dealt with.

Low tetanus-diphtheria-acellular pertussis (Tdap) vaccine coverage among healthcare workers in a quaternary university hospital in São Paulo, Brazil: need for continuous surveillance and implementation of active strategies

Introduction

Vaccination with tetanus-diphtheria-acellular pertussis (Tdap) has been recommended for healthcare workers (HCWs) by Brazilian Ministry of Health since November 2014.

Objective

To describe the strategies implemented to improve Tdap uptake, cumulative vaccine coverage after each intervention, variables associated to Tdap vaccination, and reasons for non-vaccination among HCWs of the main building of a quaternary hospital attached to the Sao Paulo University Medical School.

Methods

A list of HCWs eligible for pertussis vaccination was generated. From April to December 2015, the following interventions were implemented: note on intern journal reminding the importance of pertussis vaccination; email to the head nurses strengthening vaccine recommendations; lectures on pertussis and Tdap for physicians of Obstetrics and Neonatology Clinics; on-site vaccination by mobile teams at the Obstetrics, Neonatology, and Anesthesiology Clinics. Vaccine coverage was accessed at the end of each month. Multivariate Poisson regression model with a robust error variance was used to evaluate variables associated with Tdap vaccination. Reasons for non-vaccination were evaluated from January to May 2017 through phone calls for HCWs who had not received Tdap.

Results

The study included 456 HCWs. After the interventions, Tdap coverage raised from 2.8% to 41.2%. In the multivariate analysis, occupation (physician), working place (obstetrics or anesthesiology) and influenza vaccination in 2015 were independently associated to Tdap vaccination. The main reason for non-vaccination was unawareness of Tdap recommendations.

Conclusions

Tdap uptake among HCWs was low in our hospital. Providing vaccination at convenient places/times for HCW seems to be the most efficient strategy to increase vaccine uptake.

A systematic review of adult tetanus-diphtheria-acellular (Tdap) coverage among healthcare workers

During the last decades pertussis incidence raised globally. Several vaccination strategies targeting adults to reduce pertussis among young infants have been proposed, including vaccination of healthcare workers (HCWs). The aim of this study was to analyse, by performing a systematic review of literature, published papers that evaluated Tdap coverage among HCWs, variables associated with vaccine uptake and efforts implemented to raise vaccination rates. We searched the MedLine, Embase, SCOPUS, LILACS, Web of Science and Cochrane for full-text studies that evaluated Tdap coverage in HCW. Two independent reviewers screened the articles and extracted the data.Twenty-eight studies published from 2009 to 2018 were reviewed. Most studies were conducted in the USA. Initial Tdap coverage varied from 6.1% to 63.9%. USA and France are the only two countries with studies evaluating Tdap coverage within HCWs using national data. In the USA, Tdap coverage in HCWs raised from 6.1% to 45.1% from 2007 to 2015. In the analysis of French national data, a Tdap coverage of 63.9% was observed. Five studies used interventions to raise Tdap coverage in HCWs. Two intervention studies implemented mandatory vaccination and three used educational strategies. All of them achieved coverages over 86%. Only eleven studies analysed the association of Tdap vaccination with variables of interest. Previous immunization with other vaccines recommended for HCWs (like influenza, hepatitis B and MMR) was positively associated with Tdap uptake in four studies. In conclusion, overall Tdap coverage among HCWs is low, but seems to increase over the years after the vaccine introduction and with implementation of interventions to increase coverage.

Attitudes, believes, determinants and organisational barriers behind the low seasonal influenza vaccination uptake in healthcare workers - A cross-sectional survey

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.

Influenza vaccination coverage of health care workers: a cross-sectional study based on data from a Swiss gynaecological hospital

Background: Pregnancy is a risk factor for severe influenza and related complications. The vaccination has been recommended in healthcare workers as a strategy for preventing influenza in risk patients. The aim of this study was to analyze the influenza vaccination rate of the department of obstetrics and gynaecology of the Cantonal hospital St. Gallen in Switzerland.

Methods: A cross-sectional study was carried out to investigate the influenza vaccination rates of all staff members of the Department of obstetrics and gynaecology (n=259). The vaccination coverage was compared according to sociodemographic variables using Chi-squared test. Associations were determined using a logistic regression model. Possible reasons for and against vaccination coverage were then investigated.

Results: 200 questionnaires were included (valid response rate 77%). 15% reported being vaccinated against influenza (n=29). Reasons to be vaccinated are the belief of protection of patients (82%), oneself (75%) or family (61%). Reasons not to get vaccinated, including beliefs regarding the vaccine is not important (49%) and its ineffectiveness (44%). In the logistic regression analysis, the vaccination coverage among doctors (61% vaccinated) and nurses/midwives (4% vaccinated) is different from the vaccination coverage among the non-medical staff reference category (16% vaccinated; p=0.004, p=0.027), after controlling for the effect of other variables sex (p=0.807), age (p=0.438) and full time employment (p=0.298).

Discussion: This study showed that doctors have a higher vaccination rate compared to other job roles, whereas the nurses and midwives had very low vaccination rates, which indicate a significant public health communication gap that needs to be addressed.

Healthcare Professionals' Knowledge of Influenza and Influenza Vaccination: Results of a National Survey in Poland

In Poland, the seasonal influenza vaccination rate is just barely 3% which may be related to the unsatisfactory knowledge of influenza among healthcare professionals, poor recognition of the benefits of influenza immunization and the fear of side effects. To address these issues, we surveyed healthcare professionals through an online questionnaire consisting of 18 closed-ended items. The questionnaire was completed by 495 healthcare professionals, mostly physicians (83%). The results revealed gaps in the knowledge concerning influenza diagnosis, complications, risk groups, and prognostic factors. On average, respondents only answered 4.8 of the 18 questions correctly (27%). Only 10% of respondents passed the threshold of 50% correct answers. The knowledge of contraindications to vaccination far outweighed the knowledge of indications for vaccination. Poor knowledge with a focus on the adverse effects of immunization may be a significant factor responsible for the low vaccination rate in Poland. To increase vaccination rate, healthcare professionals need to be educated about influenza-related risks and benefits of vaccination.

Influenza vaccination motivators among healthcare personnel in a large acute care hospital in Israel

BACKGROUND

Vaccinating healthcare personnel (HCP) against influenza is important to prevent transmission and morbidity among patients and staff.

METHODS

We conducted an online survey assessing knowledge, perceptions and attitudes concerning influenza vaccination among HCP. Multivariate logistic regression was performed to identify independent predictors of vaccination.

RESULTS

The survey was completed by 468 HCP representing all categories of staff. Doctors believed that vaccination was the best way to prevent influenza and perceived the vaccine less harmful as compared to nurses and allied health professionals. Getting vaccinated was associated with a greater likelihood of recommending vaccination to patients: 86 % vs. 54 % in vaccinated and unvaccinated HCP, respectively. Reasons for vaccine refusal were fear of needles (19 %); fear of side effects (66 %) and lack of time (16 %). In the multivariate analysis, survey items that were independently associated with vaccination were beliefs that: vaccine effectively prevents influenza (OR 4.07 95 % CI 2.51, 6.58); HCP are at increased risk of influenza (OR 2.82 95 % CI 1.56, 5.13); vaccine can cause influenza (OR 0.41 95 % CI 0.25, 0.65); contracting influenza is likely in the absence of vaccination (OR 1.96 95 % CI 1.12, 3.42); and that HCP might transmit influenza to their family (OR 4.54 95 % CI 1.38, 14.97). The belief that HCP might transmit influenza to patients was not independently associated with vaccine uptake.

CONCLUSION

Our study revealed misconceptions and knowledge gaps concerning the risk of influenza and the influenza vaccine. There were significant differences in knowledge and attitudes between healthcare professions. HCP decline vaccination because they do not perceive a personal risk of influenza infection and are concerned about side effects. Thus, in order to increase vaccination rates it is important to educate HCP to correct misconceptions concerning vaccine efficacy and safety, while promoting the benefit of getting vaccinated in order to protect themselves and their families.

Influenza vaccination: key facts for general practitioners in Europe-a synthesis by European experts based on national guidelines and best practices in the United Kingdom and the Netherlands

Currently there is no influenza vaccination guidance for European general practitioners. Furthermore, although the European Council recommends a target seasonal influenza vaccination rate of 75% in the elderly (65 years and above) and in anyone aged >6 months with a chronic medical condition, there remain wide discrepancies throughout Europe. A harmonised guideline regarding not only vaccination strategy but also for the consistent diagnosis of influenza across Europe is essential to support a common approach for the implementation of seasonal influenza vaccination across Europe. This document is based on pre-existing guidelines available in the UK and Netherlands and has been approved by a group of European experts for use throughout Europe. As well as providing a standardised influenza diagnosis, it also reviews the current recommendations for influenza vaccination, the types of vaccine available, the contraindications, vaccine use in special populations (in pregnancy, children, and in those with egg allergy), and concomitant administration with other vaccines. The effectiveness, safety, and timing of the seasonal influenza vaccine are also reviewed. A second section provides practical guidance for general practitioners for the implementation of a seasonal influenza vaccination program, including the selection and notification of those eligible for vaccination, as well as suggestions for the organisation of a vaccination programme. Finally, suggested responses to common patient misconceptions and frequently asked questions are included. The aim of this article is to harmonise the diagnosis of seasonal influenza and the approach of European general practitioners to seasonal influenza vaccination in order to better identify influenza outbreaks and to move towards reaching the target vaccination rate of 75% throughout Europe.

Using behavior change frameworks to improve healthcare worker influenza vaccination rates: A systematic review

BACKGROUND

Influenza vaccination of healthcare workers (HCW) is important for protecting staff and patients, yet vaccine coverage among HCW remains below recommended targets. Psychological theories of behavior change may help guide interventions to improve vaccine uptake. Our objectives were to: (1) review the effectiveness of interventions based on psychological theories of behavior change to improve HCW influenza vaccination rates, and (2) determine which psychological theories have been used to predict HCW influenza vaccination uptake.

METHODS

MEDLINE, EMBASE, CINAHL, PsycINFO, The Joanna Briggs Institute, SocINDEX, and Cochrane Database of Systematic Reviews were searched for studies that applied psychological theories of behavior change to improve and/or predict influenza vaccination uptake among HCW.

RESULTS

The literature search yielded a total of 1810 publications; 10 articles met eligibility criteria. All studies used behavior change theories to predict HCW vaccination behavior; none evaluated interventions based on these theories. The Health Belief Model was the most frequently employed theory to predict influenza vaccination uptake among HCW. The remaining predictive studies employed the Theory of Planned Behavior, the Risk Perception Attitude, and the Triandis Model of Interpersonal Behavior. The behavior change framework constructs were successful in differentiating between vaccinated and non-vaccinated HCW. Key constructs identified included: attitudes regarding the efficacy and safety of influenza vaccination, perceptions of risk and benefit to self and others, self-efficacy, cues to action, and social-professional norms. The behavior change frameworks, along with sociodemographic variables, successfully predicted 85-95% of HCW influenza vaccination uptake.

CONCLUSION

Vaccination is a complex behavior. Our results suggest that psychological theories of behavior change are promising tools to increase HCW influenza vaccination uptake. Future studies are needed to develop and evaluate novel interventions based on behavior change theories, which may help achieve recommended HCW vaccination targets.