Cost-Benefit Analysis of Vaccination Against Influenza of Employees from an Academic Medical Centre

Objective: To determine whether vaccination against influenza in the Academic Medical Centre (AMC) of the University of Amsterdam, The Netherlands, may lead to an economic benefit by avoiding the loss in productivity associated with an outbreak of influenza illness among its employees. Design: A newly developed cost-benefit model from an employer’s perspective was applied and several scenario and sensitivity analyses were performed. Methods: The model inputs were vaccination-, personnel- and influenza-related elements, which were obtained from data specific to the AMC where possible, otherwise these were based on published literature. The output (net benefit) was defined as the difference between the benefits of vaccination due to reducing workplace absenteeism (productivity) of employees and the costs of vaccination, excluding campaign and administration costs. The net benefits of baseline, vaccination promotion and influenza-persistent scenarios were assessed and sensitivity analysis was performed. Results: The net benefits for all the scenarios was positive, being 120 000 Euros (EUR), EUR460 000 and EUR180 000 (2000 values) for the baseline, vaccination promotion and influenza-persistent scenarios, respectively. The vaccination compliance rate appeared to be the element with greatest impact on the net benefits. Conclusion: An influenza vaccination program in an institution with the characteristics of the AMC can be performed with an economic benefit for the organization. Our results suggest that vaccination of medical residents provides greater economic benefits than vaccination of other personnel.     

The Economics of Hepatitis B Virus Vaccination

Objective: To assess and compare the costs and effectiveness of different vaccination strategies against hepatitis B in Switzerland. Design: A birth cohort of 85 000 individuals was followed over their lifetime, using a decision-tree analysis. Published data were used to simulate the risk of hepatitis B virus (HBV) infection in the cohort, the consecutive clinical outcomes and the associated costs. Five new vaccination scenarios were assessed and compared with a baseline strategy of vaccination of high-risk groups. The 5 new vaccination scenarios were: (i) systematic prenatal screening and vaccination of newborns at risk; (ii) universal vaccination of infants; (iii) universal vaccination of school children; (iv) universal vaccination of infants and school children; and (v) universal vaccination of infants, school children and adolescents. Results: The incremental cost per year of life saved for systematic prenatal screening and vaccination of newborns at risk compared with the baseline scenario was estimated to be 23 350 Swiss francs (SwF; 1996 values). The 4 universal vaccination scenarios had a much larger impact on the number of chronic infections and deaths prevented. The incremental cost per year of life saved for universal vaccination compared with systematic prenatal screening and vaccination of newborns at risk ranged from SwF6120 (infant vaccination strategy) to SwF10 200 (school children vaccination strategy). In the sensitivity analysis, prevalence, vaccine price and discount rate were key elements. Conclusions: Incremental cost-effectiveness ratios are lower with universal vaccination strategies than with selective vaccination. Furthermore, with universal vaccination strategies, increasingly ambitious strategies result in higher costs but also in more incremental years of life saved.     

A report on the status of vaccination in Europe

Vaccine policy, decision processes and outcomes vary widely across Europe. The objective was to map these factors across 16 European countries by assessing (A) national vaccination strategy and implementation, (B) attributes of healthcare vaccination systems, and (C) outcomes of universal mass vaccination (UMV) as a measure of how successful the vaccination policy is.

• A.Eleven countries use standardised assessment frameworks to inform vaccine recommendations. Only Sweden horizon scans new technologies, uses standard assessments, systematic literature and health economic reviews, and publishes its decision rationale. Time from European marketing authorisation to UMV implementation varies despite these standard frameworks. Paediatric UMV recommendations (generally government-funded) are relatively comparable, however only influenza vaccine is widely recommended for adults.
• B.Fourteen countries aim to report annually on national vaccine coverage rates (VCRs), as well as have target VCRs per vaccine across different age groups. Ten countries use either electronic immunisation records or a centralised registry for childhood vaccinations, and seven for other age group vaccinations.
• C.National VCRs for infant (primary diphtheria tetanus pertussis (DTP)), adolescent (human papillomavirus (HPV)) and older adult (seasonal influenza) UMV programmes found ranges of: 89.1% to 98.2% for DTP-containing vaccines, 5% to 85.9% for HPV vaccination, and 4.3% to 71.6% for influenza vaccine. Regarding reported disease incidence, a wide range was found across countries for measles, mumps and rubella (in children), and hepatitis B and invasive pneumococcal disease (in all ages).

These findings reflect an individual approach to vaccination by country. High VCRs can be achieved, particularly for paediatric vaccinations, despite different approaches, targets and reporting systems; these are not replicated in vaccines for other age groups in the same country. Additional measures to improve VCRs across all age groups are needed and could benefit from greater harmonisation in target setting, vaccination data collection and sharing across EU countries.     

A Surveillance System for the Real-Time Reporting of Influenza Activity

Background: Effective influenza surveillance and communication of influenza activity are crucial for the management of influenza outbreaks. The accuracy of clinical diagnoses can be enhanced if the influenza virus is known to be circulating in the community. Objective: To report on the development of a new influenza surveillance system in Germany (2001–2002) based on consultation rates and near patient test results using the Influenza A/B Rapid Test (IRT) and RealFlu? Surveillance methodology. Methods: This is the first internationally standardized, rapid influenza surveillance system providing harmonized influenza-specific information. RealFlu? Surveillance is unique in its approach by generating two baselines: one with morbidity rates and one with specific influenza activity based on near patient test results. The baselines are set independently for each participating country and its constituent regions, thereby allowing monitoring of national as well as regional influenza activity. The system is highly specific and sensitive to influenza and differentiates between three levels of the RealFlu? Surveillance influenza activity: (i) no/sporadic activity; (ii) moderate activity; and (iii) high activity. Weekly activity is presented in graphs, maps, and data tables with daily updates and comments. In this report, data collected during the influenza season 2001–2002 in Germany are presented. Results: The RealFlu? Surveillance system has been running for four consecutive influenza seasons since 1999. The first increase in influenza circulation was seen from week 2 (from year start) to week 4. In week 5, a steep increase in influenza positives was observed. A significant amount of excess morbidity was seen from week 7, peaking in week 11. The season started in western regions of Germany and ended in eastern regions of Germany. Regional outbreaks were detected also when the aggregated country data did not indicate any significant increase in influenza activity. Conclusion: By providing specific, real-time monitoring of regional and national influenza outbreaks, the RealFlu? Surveillance system complements existing schemes and presents a practical surveillance methodology for countries where influenza surveillance does not exist.     

Influenza immunisation: attitudes and beliefs of UK healthcare workers

Aim

To explore attitudes to influenza immunisation and rates of uptake among staff working in acute hospitals in the UK.

Method

A cross‐sectional survey of 11 670 healthcare workers in six UK hospitals was carried out using a postal questionnaire.

Results

Among 6302 responders (54% of those mailed), 19% had taken up influenza immunisation during winter 2002/3. Vaccination was well tolerated, with a low prevalence of side effects (13%) and associated time off work (2%). The majority of subjects who accepted vaccination (66%) were most strongly influenced by the personal benefits of protection against influenza. Prevention of sickness absence and protection of patients were the prime motivation for only 10% and 7% of subjects, respectively. Among 3967 who declined vaccination, the most common primary demotivators were concern about safety (31%) and efficacy (29%). 22% were most strongly deterred by lack of time to attend for vaccination. Free text answers indicated that 37% declined because of a perceived low ratio of personal benefits to adverse effects. Subjects said they would be persuaded to take up vaccination in future by easier access (36%), more information about personal benefit and risk (34%) and more information about effects on staff absence (24%).

Conclusions

These findings indicate that the uptake of influenza immunisation among UK healthcare workers remains low. There is some scope for increasing uptake by improving accessibility and encouragement from professional peers. However, the results suggest that perception of small personal benefit in relation to risk mitigates, importantly, against higher uptake of routine annual influenza vaccination. Thus, resource might better be allocated to ensuring efficient management in epidemic years. The effect of publicity about pandemic influenza on risk perception and vaccine uptake among healthcare workers during winter 2005/6 warrants further study.Since the late 1960s annual influenza immunisation has been recommended for people in the UK general population who are at high risk of serious illness from influenza. In 2000, UK national policy was extended to include those aged ⩾65 years,¹ and since then vaccine uptake in vulnerable groups has been high.² In 2000 the Chief Medical Officer also recommended that influenza vaccine should be offered annually to all healthcare workers, irrespective of age or personal medical indications. However, in contrast to the successful public health campaign, uptake among healthy National Health Service (NHS) employees has been low.^3,4,5,6,7If low vaccine acceptance among healthcare workers is to be addressed, it is important to understand the beliefs that influence uptake. However, most studies of influenza immunisation in UK healthcare workers pre‐date the Chief Medical Officer''s guidance, or were undertaken soon after the change in policy. Since then, NHS occupational health departments (OHDs) have promoted influenza immunisation intensively, and it is possible that the barriers to uptake have changed. Moreover, most previous work on reasons for non‐uptake is derived from small studies,^4,6,7 which might be influenced by regional factors (eg, cultural influences on illness behaviour, the tendency to take sickness absence and the opinions of local professional peer leaders). Therefore, to guide national policy on influenza immunisation in healthcare workers, we undertook a large multicentre cross‐sectional survey of attitudes in acute NHS hospitals.     

Comparative Studies of Metal Air Pollution by Atomic Spectrometry Techniques and Biomonitoring with Moss and Lichens

Our study was dedicated to the analysis of air pollution level with metals in Dambovita County, Romania; maps of the concentration distributions for air pollutants were drawn; statistical analysis includes calculation of the background concentrations and the contamination factors. The highest values of the contamination factor CF is 63.1 ± 6.63 for mosses samples and 33.12 ± 3.96 for lichens and it indicates extreme contaminations in the surroundings of steel works and an electric plant. The comparison of the distribution maps for Cr, Cu, Fe, Ni, Pb and Zn concentrations enables the identification of the pollution sources, the limits of areas with very high levels of pollution, the comparison of the concentration gradients in some areas and the influence of woodlands on the spread of pollutants through the air.     

The Development of a Tool to Assess Quality of Cost Estimates

Objective: To develop and implement a quality assessment instrument to evaluate cost estimates in economic evaluation studies. Design and setting: The assessment instrument was devised through a consensus process. The instrument was developed in the process of estimating a national set of provincial standard costs for healthcare services in Canada. Participants: All healthcare providers for a variety of services including public health, inpatient acute care, ambulatory care, physicians, pharmaceuticals, blood and ambulance services, and workers’ lost productivity. Main outcome measures: An assessment form which evaluated estimates for the full cost of resources; the appropriate inclusion of resources and resource prices; the degree of detail in the unit of measurement; basis of evidence; and the sample of providers from which cost estimates were generated. Results: When applied to existing cost estimates, a wide variation in quality was observed between service categories and provinces. Inpatient hospital, physician services, and drugs had high quality estimates; public health, nursing home, and home care had lower quality estimates. Conclusions: This quality assessment instrument can be used to target deficiencies in cost estimates and to identify administrative units which are leaders in the field, and hence which can serve as role models for further development of these data.     

The determinants of 2009 pandemic A/H1N1 influenza vaccination: a systematic review

Background

Pandemic A/H1N1 influenza vaccine coverage varied widely across countries. To understand the factors influencing pandemic influenza vaccination and to guide the development of successful vaccination programs for future influenza pandemics, we identified and summarized studies examining the determinants of vaccination during the 2009 influenza pandemic.

Methods

We performed a systematic literature review using the PubMED electronic database from June 2009 to February 2011. We included studies examining an association between a possible predictive variable and actual receipt of the pandemic A/H1N1 influenza vaccine. We excluded studies examining intention or willingness to receive the vaccine.

Results

Twenty-seven studies were identified from twelve countries. Pandemic influenza vaccine coverage varied from 4.8% to 92%. Coverage varied by population sub-group, country, and assessment method used. Most studies used questionnaires to estimate vaccine coverage, however seven (26%) used a vaccination registry. Factors that positively influenced pandemic influenza vaccination were: male sex, younger age, higher education, being a doctor, being in a priority group for which vaccination was recommended, receiving a prior seasonal influenza vaccination, believing the vaccine to be safe and/or effective, and obtaining information from official medical sources.

Conclusions

Vaccine coverage during the pandemic varied widely across countries and population sub-groups. We identified some consistent determinants of this variation that can be targeted to increase vaccination during future influenza pandemics.     

H5 N-terminal β sheet promotes oligomerization of H7-HA1 that induces better antibody affinity maturation and enhanced protection against H7N7 and H7N9 viruses compared to inactivated influenza vaccine

Initiation of mass vaccination is critical in response to influenza pandemic. There is an urgent need of a simple, rapid method for production of influenza vaccine that is more effective than current traditional influenza vaccines. Recent H7N9 transmissions to humans in China with high morbidity/mortality initiated extensive vaccine evaluation. We produced the HA1 domains (amino acids 1-320) from H7N9 and H7N7 strains in E. coli. Both were found to contain primarily monomers/trimers with low oligomeric content. However, when residues from the N-terminal β sheet (first 8 amino acid) of H7 HA1 domains were swapped with the corresponding amino acids from H5N1, functional oligomeric H7 HA1 were produced (HA1-DS), demonstrating strong receptor binding and hemagglutination. In rabbits, the HA1-DS from either H7N9 or H7N7 generated high neutralization titers against both homologous and heterologous H7 strains, superior to the unmodified H7 HA1 proteins. In ferrets, HA1-DS from H7N7 elicited higher (and faster) HI titers, better protected ferrets from lethality, weight loss, and reduced viral loads following challenge with wild-type highly pathogenic H7N7 virus compared with inactivated H7N7 subunit vaccine. HA1-DS vaccinated ferrets were also better protected from weight loss after challenge with the heterologous H7N9 virus compared with inactivated H7N7 subunit vaccine. Importantly, the H7N7 HA1-DS vaccine induced antibody affinity maturation far superior to the inactivated H7N7 subunit vaccine, which strongly correlated with control of viral loads in the nasal washes after challenge with either H7N7 or H7N9 strains. We conclude that N-terminus β sheet domain-swap can be used to produce stable functional oligomeric forms of better recombinant HA1 vaccines in simple, inexpensive bacterial system for rapid response to emerging pandemic threat for the global population.     

Analysis of Asthma-Related Costs and Patterns of Resource Utilization in a Managed-Care Population

Objectives: To identify the asthma prevalence rate, the total healthcare and asthma-related treatment costs, and the medical and pharmacy costs associated with different asthma medication usage patterns in a managed-care organisation (MCO). Study design and participants: The medical and pharmacy claims databases from a 400 000 member MCO were used. The medical claims database was searched from 1994 to 1996 for patients having at least one asthma medical claim in either the first or second diagnosis field of the medical claims, and the total healthcare and asthma-related costs were determined. A subpopulation with a more restrictive asthma definition was identified and their costs were also determined. In addition, the patterns of drug treatment were identified. Study perspective: MCO perspective. Results: The mean total healthcare cost of caring for patients with asthma was significant and approximately twice the mean cost of all patients enrolled in the MCO. Using a broad definition of asthma, the mean (± standard deviation) annual total per patient healthcare cost was $US2511 ± 7314 and the annual asthma-related cost was $US679 ± 2247 (1996 values). Using a more restrictive definition of asthma, the mean annual total per patient healthcare cost was $US2653 ± 5268 and the asthma-related cost was $1026 ± 2447. There appeared to be a low overall use of asthma medications, especially anti-inflammatory formulations; <3% of patients with asthma were high users of anti-inflammatory inhalers. Conclusions: Patients with asthma are costly to managed-care organizations. Asthma-related costs constitute a minority (<30%) of the costs of caring for these patients, and under utilization of anti-inflammatory products by patients is widespread. Further research is needed to assess the cost impact of different asthma treatment patterns.     

Optimising the introduction of multiple childhood vaccines in Japan: A model proposing the introduction sequence achieving the highest health gains

Background

Many countries struggle with the prioritisation of introducing new vaccines because of budget limitations and lack of focus on public health goals. A model has been developed that defines how specific health goals can be optimised through immunisation within vaccination budget constraints.

Influenza vaccination in healthy working adults in Russia

Background

All age groups are affected by influenza infection, resulting in significant medical and economic burden. Influenza infection of healthy working adults can have a marked effect on companies due to lost work days and reduced productivity. Studies in corporate settings have shown that vaccination programmes reduce this burden, although there is a lack of data in Eastern European countries.

Objectives

To determine the effectiveness of influenza vaccination in healthy working adults in Russia and the economic benefits of such a programme from an employer’s perspective.

Methods

In a prospective, non-randomized, non-placebo-controlled, observational study, healthy vaccinated and unvaccinated adults employed at the Russian Railways Public Corporation were followed for 8 months during the 2005–6 influenza season using questionnaires. A first questionnaire was administered at inclusion to collect general employee information; a second questionnaire was administered to collect data on post-vaccination adverse events; and monthly questionnaires were used to gather data on influenza-like illness (ILI). Effectiveness calculations and cost analyses were performed to evaluate the impact of the influenza vaccination programme on employee productivity and costs for the employer. The study vaccine used was the trivalent, inactivated, split vaccine Vaxigrip® (sanofi pasteur, France).

Results

A total of 1331 employees volunteered for the study: 701 were vaccinated and 630 were not. The vaccine effectiveness was 70.4% against ILI events and 80.8% against sick leave days. Assuming that employees working with ILI symptoms had a reduced level of productivity (30–70% of normal), cost savings per vaccinated employee ranged from ?.13 to ?.43.

Conclusions

This study showed that an influenza vaccination programme significantly reduced ILI episodes and absenteeism, and may provide a positive return on investment for the employer.     

Treatment of Pneumonias in a Managed-Care Organisation

Objective: To evaluate a pneumonia disease management programme in a naturalistic setting. Design and Setting: A 300 000 member managed-care organisation introduced an antibacterial treatment guideline designed to change antibacterial prescribing by physicians. A relational database was created to measure changes in healthcare resources, use of antibacterials and health event profiles. One year of data before and after promoting the treatment guideline was compared. Intervention: The primary disease management intervention was the promotion of the guideline through mailings and face-to-face interventions by 2 disease management specialists. Participants: All patients with pneumonia diagnoses on the medical claims database were included in the analysis. Results: The study demonstrated that medical costs increased by 5 to 10% after the treatment guideline was implemented. Health event analysis demonstrated changes in antibacterial prescribing and average cost per antibacterial selected. In both years, the highest success rate was with the amoxicillin group. Although there were fewer patients, doxycycline also had success rates of at least 70%. The econometric model demonstrated that holding other variables constant, including patient age and the presence of any comorbidities, treatment with amoxicillin was associated with a statistically significant reduction in health event costs. Conclusions: The study identified the need for validating treatment guidelines with results from actual practice. The data also demonstrate the use and importance of measuring clinical and economic outcomes from disease management interventions by using databases readily available within most managed-care organisations. In addition, the econometric model was useful in comparing different drug groups with these retrospective data.     

An evaluation of the emerging vaccines against influenza in children

Background

Influenza is an under-appreciated cause of acute lower respiratory infections (ALRI) in children. It is estimated to cause approximately 20 million new episodes of ALRI in children annually, 97% of these occurring in developing countries. It is also estimated to result in 28000 to 112000 deaths annually in young children. Apart from hospitalisations and deaths, influenza has significant economic consequences. The current egg-based inactivated influenza vaccines have several limitations: annual vaccination, high production costs, and cannot respond adequately to meet the demand during pandemics.

Methods

We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging cross-protective vaccines against influenza relevant to several criteria of interest: answerability; cost of development, production and implementation; efficacy and effectiveness; deliverability, affordability and sustainability; maximum potential impact on disease burden reduction; acceptability to the end users and health workers; and effect on equity. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). They answered questions from the CHNRI framework and their “collective optimism” towards each criterion was documented on a scale from 0 to 100%.

Results

The experts expressed very high level of optimism for deliverability, impact on equity, and acceptability to health workers and end users. However, they expressed concerns over the criteria of answerability, low development cost, low product cost, low implementation cost, affordability and, to a lesser extent sustainability. In addition they felt that the vaccine would have higher efficacy and impact on disease burden reduction on overall influenza-associated disease rather than specifically influenza-associated pneumonia.

Conclusion

Although the landscape of emerging influenza vaccines shows several promising candidates, it is unlikely that the advancements in the newer vaccine technologies will be able to progress through to large scale production in the near future. The combined effects of continued investments in researching new vaccines and improvements of available vaccines will hopefully shorten the time needed to the development of an effective seasonal and pandemic influenza vaccine suitable for large scale production.

     

An Integrated Model for the Management of Co-Occurring Psychiatric and Substance Disorders in Managed-Care Systems

Objective: To use the System of Objectified Judgement Analysis (SOJA) method for the rational selection of Helicobacter pylori eradication therapies for formulary inclusion. Design: Drug selection for the eradication therapy of H. pylori is made by means of the SOJA method. In this formulary decision-making model, selection criteria for a given class of drugs are prospectively defined and weighted by a panel of experts. The following criteria (relative weight) were used: variability of pharmacokinetics; drug interactions; resistance to antibacterials; efficacy; general adverse effects; complexity of the regimen; acquisition cost and clinical documentation. Only published studies with at least 30 evaluable patients were considered, at least 3 studies had to be available per treatment regimen and efficacy had to be assessed on an intent-to-treat basis. Main outcome measures and results: The regimens containing clarithromycin and an imidazole antibacterial in combination with omeprazole or ranitidine bismutrex showed the highest scores for eradication of H. pylori. The combinations amoxicillin/clarithromycin and omeprazole or lansoprazole showed slightly lower eradication rates and were more costly. The eradication rates obtained with 2-drug regimens were low, resulting in a low overall SOJA score. No quadruple regimens could be included, as none of the regimens fulfilled the inclusion criteria. This was also true for the classical triple therapy with bismuth/metronidazole/tetracycline. Conclusion: The present score is specific for the Netherlands, as Dutch acquisition costs and data on resistance were used. In other countries, with different degrees of imidazole and clarithromycin resistance, other regimens may be more appropriate. The SOJA score will be regularly updated through the internet to include relevant new studies or new successful eradication regimens. The interactive program offers groups of physicians the opportunity to discuss the optimal H. pylori eradication regimen, based on their weighting of the criteria.     

Standardized Telephonic Case Management in a Hispanic Heart Failure Population

Background: Heart failure (HF) is as common in Hispanic as it is in non-Hispanic populations. However, there do not appear to be any published reports of HF disease management programs which include Hispanic populations. Objective:To test the effectiveness of a standardized telephonic disease management intervention, Pfizer Inc.’s At Home With Heart Failure?, in decreasing acute care resource use and cost in Hispanic patients with HF. Participants and methods: A factorial design was used to analyze data obtained in a randomized controlled clinical trial. Patients with HF were enrolled in the trial when admitted to hospital, randomized to the intervention or usual care control groups, and followed for 6 months. Of the 358 participants, 93 (26%) were Hispanic (35 in the intervention group, 58 in the usual care group). Data were analyzed to determine if comparable decreases in acute care resource use were evident in Hispanic and non-Hispanic intervention group patients. Intervention: Registered nurses telephoned patients after hospital discharge to provide advice, solve problems, encourage adherence, and facilitate access to needed services. Results: Acute care resource use was lowered as effectively in the Hispanic patients as in the non-Hispanic patients, despite significant between-group differences in education, income, and living situations. When a fully crossed (language by group) analysis was conducted, no significant differences were found between the Hispanic and non-Hispanic intervention groups. However, in most categories there was a trend towards lower resource use in the Hispanic intervention group. The cost of inpatient care was more than $US1000 (2000 values) less in the Hispanic than the non-Hispanic intervention group. Conclusion: The results of this study suggest that Hispanic patients with HF are receptive of, and responsive to, a case management intervention provided in a culturally competent manner, despite differences in cultural views on chronic illness and self-care as discussed in the literature.     

Factors affecting nurses’ decision to get the flu vaccine

The objective of this study was to identify factors that influence the decision whether or not to get the influenza (flu) vaccine among nurses in Israel by using the health belief model (HBM). A questionnaire distributed among 299 nurses in Israel in winter 2005/2006 included (1) socio-demographic information; (2) variables based on the HBM, including susceptibility, seriousness, benefits, barriers and cues to action; and (3) knowledge about influenza and the vaccine, and health motivation. A probit model was used to analyze the data. In Israel, the significant HBM categories affecting nurses’ decision to get a flu shot are the perceived benefits from vaccination and cues to action. In addition, nurses who are vaccinated have higher levels of (1) knowledge regarding the vaccine and influenza, (2) perceived seriousness of the illness, (3) perceived susceptibility, and (4) health motivation than do those who do not get the vaccine. Immunization of healthcare workers may reduce the risk of flu outbreaks in all types of healthcare facilities and reduce morbidity and mortality among high-risk patients. In order to increase vaccination rates among nurses, efforts should be made to educate them regarding the benefits of vaccination and the potential health consequences of influenza for their patients, and themselves.

Implementation of mandatory immunisation of healthcare workers: observations from New South Wales, Australia

Objective

To identify factors influencing implementation of a state-wide mandatory immunisation policy for healthcare workers (HCWs) in New South Wales (NSW), Australia, in 2007. Vaccines included were measles, mumps, rubella, varicella, hepatitis B, diphtheria, tetanus and pertussis, but not influenza.

Methods

We evaluated the first 2 years of this policy directive in 2009. A qualitative study was conducted among 4 stakeholder groups (the central health department, hospitals, health professional associations, and universities). 58 participants were identified using maximum variation sampling and data were analysed using a hierarchical thematic framework. Quantitative data on policy compliance were reviewed at the regional level.

Results

Success in policy implementation was associated with effective communication, including support of clinical leaders, provision of free vaccine, access to occupational health services which included immunisation, and appropriate data collection and reporting systems. Achieving high vaccine uptake was more challenging with existing employees and with smaller institutions.

Conclusion

These findings may apply to other jurisdictions in Australia or internationally considering mandatory approaches to HCW vaccination.