ReviewInfluenza vaccination of health care workers in hospitals—A review of studies on attitudes and predictors☆
Introduction
Influenza infections among hospitalized patients can have much more serious consequences than among the general population because an increasing proportion of hospital patients are elderly and/or immunocompromised. Several outbreaks of health care facility-acquired influenza involving older patients as well as adults and children with immunosuppression have been documented in the infection control literature [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]. Although these patients belong to risk groups that should be vaccinated against influenza, vaccination rates in these groups vary widely among countries. Even if vaccinated, the efficacy of influenza vaccine is lower in the elderly and immunocompromised than in younger adults [13], [14], [15], [16], [17], [18] necessitating indirect protection through vaccination of health care workers (HCW).
Influenza vaccination of HCW reduces the risk for infection, influenza-like-illness, absenteeism and presenteeism1 among staff [19], [20], [21], [22] and appears to prevent nosocomial infections and associated morbidity and mortality among their patients [21], [23], [24], [25]. The World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC) and immunization guidelines of many countries recommend influenza vaccination of HCW, or at least in those who are in regular, frequent contact with high-risk persons, to prevent transmission of influenza from HCW to patients [26], [27], [28], [29]. However, the same countries report a low uptake of influenza vaccine in HCW [30], [31], [32], [33], [34], [35].
Understanding the barriers to and facilitators of influenza vaccine uptake by HCW is essential to overcome low compliance with recommendations. To aid public health officials responsible for infection control programs as well as hospital and infection control managers in their efforts to design effective interventions to raise rates of influenza vaccination (among HCW), we undertook a review of published studies with the following objectives: (1) to identify self-reported reasons among HCW for vaccine acceptance or non-acceptance and (2) to identify predictive factors2 that are statistically associated with influenza vaccine acceptance.
Section snippets
Selection and analysis of literature
Published articles were obtained using PUBMED computerized databases from 1980 to 2008 searching the following words: influenza, influenza vaccine3, vaccination, immunization, health care worker(s), health care personnel, nurse(s), physician(s), knowledge, attitudes, behavior,
Reasons for refusing influenza vaccine
We included 21 studies from nine different countries; 9 (43%) of the 21 publications originated in the USA [22], [33], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50]. For this review, many studies had to be discarded from analysis because their study populations did not include HCW from hospitals. All but 5 of the eligible studies [41], [47], [50], [51], [52] were conducted in single hospitals. The largest study comprised all 132 public hospitals in
Discussion
Our findings indicate that if HCW get immunized against influenza, they do so more often for their own benefit than for the benefit of their patients. A typical HCW vaccine recipient trusted the vaccine's effectiveness, was older than those who were not vaccinated, and usually received immunization every year. We identified two major reasons for non-receipt of influenza vaccine by HCW. The first was a wide range of misconceptions or lack of knowledge about influenza infection and its risks for
Acknowledgements
Special thanks for their scientific support goes to Alex Greninger, David Scales, Klaus Stöhr and the Swiss Federal Office of Public Health.
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The first author is a staff member of the World Health Organization. The author alone is responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of the World Health Organization.