Interventions to increase influenza vaccination among healthcare workers in hospitals

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    Interventions to increase influenza vaccination among healthcare workers in hospitals


    A systematic review of studies aimed at increasing uptake of influenza vaccination among hospital healthcare workers (HCW) was recently published by Hollmeyer et al (1).

    Studies included in the review involved HCW from acute care hospitals, describing all the activities that were implemented and that had a control group so the effect of the intervention could be compared. Twenty five studies conducted in eight countries using a wide variety of intervention strategies were included in the final review. The selected studies were grouped into four categories according to the study design and duration of interventions, to allow for comparability. In general, studies that implemented a larger number of intervention components achieved higher vaccination coverage rates.

    The provision of free vaccines was a crucial part of all interventions.

    The most effective intervention, however, was a mandatory vaccination policy for all HCW and the three programs that used this strategy had almost universal coverage. Not surprisingly, implementation of mandatory vaccination was met with occasional resistance and caused controversy among HCW as their freedom of choice conflicted with the HCW mandate to do no harm and to act in their patient’s best interests (2,3).

    All studies that introduced mandatory vaccination allowed medical or religious reasons exemptions. Successful programs also made substantial efforts in education and organizational culture towards vaccination before starting the mandatory program. Other notable factors in the success of programs included sustained vaccination efforts, strong leadership and commitment by hospital management, flexible work-site delivery, assignment of dedicated staff and provision of targeted educational materials.

    Pre-intervention surveys to understand the knowledge and attitudes of HCW to tailor programs accordingly were also linked with an increase in vaccine uptake. The authors of this review noted limitations such as publication bias and that intervention components were not mutually exclusive, so standardization and comparison between programs was difficult. Overall, the literature suggests that a comprehensive, multi-pronged approach towards influenza vaccination of HCW demonstrated the best outcomes.

    Annual influenza vaccination rates among hospital HCW remain almost universally low despite recommendations from public health bodies and governments worldwide. Influenza infections in hospital HCW have been shown to lead to nosocomial outbreaks (4,5) particularly in immunocompromised or elderly patients, an important observation as vaccine efficacy tends to be lower in these groups compared to younger healthy adults (6,7). Influenza vaccination has also been shown to be effective in reducing absenteeism among HCW during influenza seasons (8). Other studies have noted that the main reasons for vaccine rejection among HCW were concerns over vaccine safety, side effects and efficacy, as well as a lack of education about influenza infection (9,10).

    Targeting educational programs to address these findings is important to increase vaccination acceptability and uptake. The WHO, in accordance with the SAGE recommendations on immunization, recommends seasonal influenza vaccination of HCW to provide protection against the individual as well as reducing the spread of influenza to vulnerable patient groups (11).

    1) Hollmeyer HG, Hayden F, Mounts A, Buchholz U. Review: Interventions to increase influenza vaccination among healthcare workers in hospitals. Influenza and Other Respiratory Viruses 2012. DOI: 10.1111/irv.12002.

    2) Anikeeva O, Braunack-Mayer A, Rogers W. Requiring influenza vaccination for health care workers. Am J Public Health 2009; 99:24–29.

    3) Rea E, Upshur R. Semmelweis revisited: the ethics of infection prevention among health care workers. CMAJ 2001; 164:1447–1448.

    4) Voirin N, Barret B, Metzger MH, Vanhems P. Hospital-acquiredinfluenza: a synthesis using the Outbreak Reports and InterventionStudies of Nosocomial Infection (ORION) statement. J Hosp Infect 2009; 71:1-14.

    5) Salgado CD, Farr BM, Hall KK, Hayden FG. Influenza in the acutehospital setting. Lancet Infect Dis 2002; 2:145–155.

    6) Saxen H, Virtanen M. Randomised, placebo-controlled double blind study on the efficacy of influenza immunization on absenteeism of health care workers. Pediatr Infect Dis J 1999;18:779-783.

    7) Gross PA, Hermogenes AW, Sacks HS, Lau J, Levandowski RA. The efficacy of influenza vaccine in elderly persons. A meta-analysis and review of the literature. Ann Intern Med 1995; 123:518–527.

    8) Fiore AE, Shay DK, Broder K et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recomm Rep 2009; 58:1–52.

    9) Aguilar-Diaz FC, Jimenez-Corona ME, Ponce-de-Leon-Rosales S. Influenza Vaccine and healthcare workers. Archives of Medical Research 2011;42:652-657.

    10) Hollmeyer HG, Hayden F, Poland G, Buchholz U. Influenza vaccination of health care workers in hospitals – A review of studies on attitudes and predictors. Vaccine. 2009;27:3935-3944.

    11) Meeting of the Strategic Advisory Group of Experts on immunization, April 2012- conclusions and recommendations, WER, 2012, No. 21, 87,201-216

    Further Reading

    • Poland G. The 2009-2010 influenza pandemic: effects on pandemic and seasonal vaccine uptake and lessons learned for seasonal vaccination campaigns. Vaccine. 2010;285: D3-D13.

    • Dolan GP, Harris RC, Clarkson M, Sokal R, Morgan G, Mukaigawara M, Horiuchi H, Hale R, Stormont L, Béchard-Evans L, Chao YS, Eremin S, Martins S, Tam JS, Peñalver J, Zanuzadana A, Nguyen-Van-Tam JS. Vaccination of health care workers to protect patients at increased risk for acute respiratory disease. Emerg Infect Dis. 2012 Aug;18(8):1225-34.
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