Delay between COVID-19 complete vaccination and SARS-CoV-2 infection among healthcare workers

ObjectivesHealthcare workers (HCWs), at increased risk of coronavirus disease 2019 (COVID-19) were among the primary targets for vaccination, which became mandatory for them on September 15th, 2021 in France. In November they were confronted to the fifth COVID-19 wave despite excellent vaccine coverage. We aimed to estimate the incidence of SARS-CoV-2 infection after complete vaccination among HCWs with different vaccination schemes, and its determinants.MethodsWe enrolled all HCWs in the university hospital of Rennes, France who had received complete vaccination (two doses of COVID-19 vaccine). The delay from last vaccination dose to SARS-CoV-2 infection was computed. Fitted mixed Cox survival model with a random effect applied to exposure risk periods to account for epidemic variation was used to estimate the determinants of SARS-CoV-2 infection after complete vaccination.ResultsOf the 6674 (82%) HCWs who received complete vaccination (36% BNT162b2, 29% mRNA-1273, and 34% mixed with ChAdOx1 nCoV-19) and were prospectively followed-up for a median of 7.0 [6.3–8.0] months, 160 (2.4%) tested positive for SARS-CoV-2 by RT-PCR. Incidence density of SARS-CoV-2 infection after complete vaccination was 3.39 [2.89–3.96] infections per 1000 person-month. Median time from vaccine completion to SARS-CoV-2 infection was 5.5 [3.2–6.6] months. Using fitted mixed Cox regression with the delay as a time-dependent variable and random effect applied to exposure risk periods, age (P < 0.001) was independently associated with the incidence of SARS-CoV-2 infection. Vaccine schemes were not associated with SARS-CoV-2 infection (P = 0.068). A period effect was significantly associated with the incidence of SARS-CoV-2 infection (P < 0.001).ConclusionsIn this real-world study, incidence of SARS-CoV-2 infection increases with time in fully vaccinated HCWs with no differences according to the vaccination scheme. The short delay between complete vaccination and incident SARS-CoV-2 infection highlights the need for sustained barrier measures even in fully vaccinated HCWs.     

Update on immunizations for healthcare personnel in the United States

Healthcare personnel (HCP) play a pivotal role in the transmission of contagious pathogens in the healthcare setting, and HCP are themselves at risk for infection with such pathogens due to the nature of their occupation. Many practices are important in order to reduce infection transmission, including HCP immunization. Unfortunately, HCP immunization rates in the United States (U.S.) have not reached recommended levels, so new strategies are being used to improve HCP coverage, including mandatory immunization and the use of immunization rates as measures of quality and safety. This article will review current practices, policies, and issues surrounding HCP immunization in the U.S.     

Association between COVID-19 vaccination status,time elapsed since the last vaccine dose,morbidity, and absenteeism among healthcare personnel: A prospective,multicenter study

AimWe assessed the impact of COVID-19 vaccination status and time elapsed since the last vaccine dose on morbidity and absenteeism among healthcare personnel (HCP) in the context of a mandatory vaccination policy.MethodsWe followed 7592 HCP from November 15, 2021 through April 17, 2022. Full COVID-19 vaccination was defined as a primary vaccination series plus a booster dose at least six months later.ResultsThere were 6496 (85.6 %) fully vaccinated, 953 (12.5 %) not fully vaccinated, and 143 (1.9 %) unvaccinated HCP. A total of 2182 absenteeism episodes occurred. Of 2088 absenteeism episodes among vaccinated HCP with known vaccination status, 1971 (94.4 %) concerned fully vaccinated and 117 (5.6 %) not fully vaccinated. Fully vaccinated HCP had 1.6 fewer days of absence compared to those not fully vaccinated (8.1 versus 9.7; p-value < 0.001). Multivariable regression analyses showed that full vaccination was associated with shorter absenteeism compared to not full vaccination (OR: 0.56; 95 % CI: 0.36–0.87; p-value = 0.01). Compared to a history of ≤ 17.1 weeks since the last dose, a history of > 17.1 weeks since the last dose was associated with longer absenteeism (OR: 1.22, 95 % CI:1.02–1.46; p-value = 0.026) and increased risk for febrile episode (OR: 1.33; 95 % CI: 1.09–1.63; p-value = 0.004), influenza-like illness (OR: 1.53, 95 % CI: 1.02–2.30; p-value = 0.038), and COVID-19 (OR: 1.72; 95 % CI: 1.24–2.39; p-value = 0.001).ConclusionsThe COVID-19 pandemic continues to impose a considerable impact on HCP. The administration of a vaccine dose in less than four months before significantly protected against COVID-19 and absenteeism duration, irrespective of COVID-19 vaccination status. Defining the optimal timing of boosters is imperative.     

Increases in vaccination coverage of healthcare personnel following institutional requirements for influenza vaccination: a national survey of U.S. hospitals

Background

Institutional requirements for influenza vaccination, ranging from policies that mandate declinations to those terminating unvaccinated healthcare personnel (HCP), are increasingly common in the US. Our objective was to determine HCP vaccine uptake following requirements for influenza vaccination at US hospitals.

Methods

Survey mailed in 2011 to a nationally representative sample of 998 acute care hospitals. An institutional requirement was defined as an institutional policy that requires receipt or declination of influenza vaccination, with or without consequences for vaccine refusal. Respondents reported institutional-level, seasonal influenza vaccination coverage, if known, during two consecutive influenza seasons: the season prior to (i.e., pre-requirement), and the first season of requirement (i.e., post-requirement). Weighted univariate and multivariate analyses accounted for sampling design and non-response.

Results

808 (81.0%) hospitals responded. Of hospitals with institutional requirements for influenza vaccination (n = 440), 228 hospitals met analytic inclusion criteria. Overall, mean reported institutional-level influenza vaccination coverage among HCP rose from 62.0% in the pre-requirement season to 76.6% in the post-requirement season, representing a single-season increase of 14.7 (95% CI: 12.6-16.7) percentage points. After adjusting for potential confounders, single-season increases in influenza vaccination uptake remained greater among hospitals that imposed consequences for vaccine refusal, and among hospitals with lower pre-requirement vaccination coverage. Institutional characteristics were not associated with vaccination increases of differential magnitude.

Conclusion

Hospitals that are unable to improve suboptimal influenza vaccination coverage through multi-faceted, voluntary vaccination campaigns may consider institutional requirements for influenza vaccination. Rapid and measurable increases in vaccination coverage followed institutional requirements at hospitals of varying demographic characteristics.     

A qualitative analysis of the impact of healthcare personnel influenza vaccination requirements in California

Objective

Using qualitative methods, we explored the implementation of California's 2007 influenza immunization requirements of hospital-based health care personnel (HCP).

Methods

We conducted nine case studies of California hospitals with different HCP vaccination rates and policies. Case studies consisted of interviewing 13 hospital representatives and analyzing relevant hospital documents, including influenza policies. We also conducted 13 semi-structured phone interviews with key state and county public health officials, union representatives, and officials of various professional healthcare organizations.

Results

Our qualitative results suggest that California's vaccination requirements likely did not increase influenza vaccination uptake among HCP. The law was not strong enough to compel hospitals with low and medium vaccination rates to improve their vaccination efforts, and hospitals with high vaccination rates were able to comply fully with the law by continuing to do what they were already doing – namely offering vaccinations to HCP, providing education about the risks of influenza and the benefits of vaccination, and obtaining signed declinations from those who refuse vaccination. Nonetheless, we found that by publicly raising the issue of influenza vaccination in the context of public safety and healthcare quality, California's law encouraged hospitals to develop and implement data systems to monitor the effectiveness of vaccination promotion efforts and prompted discussions, and, in some cases, adoption of stricter vaccination requirements at hospital or county levels.

Conclusions

Our findings generally support the literature that suggests that permissive influenza vaccination requirements, though politically feasible, provide little direct incentive for hospitals to focus efforts on increasing HCP vaccination rates.     

Reducing the rates of household transmission: The impact of COVID-19 vaccination in healthcare workers with a known household exposure

ObjectiveTo determine the impact of COVID-19 vaccination on infection rates in healthcare workers (HCWs) with a household exposure.MethodsRetrospective cohort study 8410 HCWs (400 fully vaccinated, 1645 partially vaccinated, 6365 unvaccinated), employed by a large integrated healthcare system in the southeastern United States, tested for SARS-CoV-2 between January 1 and February 26, 2021.ResultsBenefit of vaccination persisted even with household exposure, with unvaccinated HCWs being 3.7 to 7.7 times more likely to be infected than partially or fully vaccinated HCW with positive household contacts respectively (partial OR = 3.73, 95% CI 2.17 – 6.47; full OR = 7.67, CI 2.75 – 21.35). Whereas 89.4% of unvaccinated COVID-positive HCWs with known household exposures were symptomatic, 50% of fully vaccinated HCWs had symptoms, reducing risk of secondary spread from and between HCWs.ConclusionsCOVID-19 vaccination provided protection against infection even amongst healthcare workers with close household contact, and after adjusting for community prevalence.     

Reflections on the influenza vaccination of healthcare workers

Despite all that is known about the dangers of nosocomial transmission of influenza to the vulnerable patient populations in our healthcare facilities, and the benefits of the influenza vaccination, the low rates of influenza vaccination among healthcare workers (HCWs) internationally shows no sign of significant improvement. With the current voluntary 'opt-in' programmes clearly failing to adequately address this issue, the time has undoubtedly come for a new approach to vaccination to be implemented. Two different approaches to vaccination delivery have been suggested to rectify this situation, mandatory vaccination and 'opt-out' declination forms. It is suggested, however, that these two approaches are inadequate when used by themselves. In order to protect the most vulnerable patients in our healthcare facilities as best we can from serious harm or death caused by nosocomial transmission of influenza, while at the same time respecting HCWs autonomy, and in many jurisdictions, the related legal right to refuse medical treatment, it is recommended that 'op-out' declination forms should be used in conjunction with restricted mandatory vaccination. This 'combined' approach would allow any HCW to refuse the influenza vaccination, but would make the influenza vaccination a mandatory requirement for working in areas where the most vulnerable patients are cared for. Those HCWs not willing to be vaccinated should be required to work in other areas of healthcare.     

The impact of personal coaching on influenza vaccination among healthcare workers before and during COVID-19 pandemic

BackgroundWithout the implementation of mandatory vaccination, it was difficult to increase the influenza vaccination rate among healthcare workers. We described the strategy of personal coaching and assess its impact in increasing the influenza vaccination rate among healthcare workers in Hong Kong.MethodsPersonal coaching of individual staff led by the infection control officer (ICO) and senior nursing officer (SNO) from infection control team could overcome barriers and promote on-site vaccination. The influenza vaccination rates among different categories of staff in 2016/2017 (year 1, baseline), 2017/2018 (year 2, promotion using social media), and 2018/2019 to 2020/2021 (year 3–5, promotion using personal coaching) were analysed in a healthcare region with 8490 ± 206 staff during the study period.ResultsWith the implementation of personal coaching, the influenza vaccination rates increased significantly among medical (65.0% vs 57.0%, p = 0.048), nursing (30.6% vs 21.1%, p < 0.001), allied health (37.0% vs 27.4%, p < 0.001), care-related supporting staff (37.7% vs 27.3%, p < 0.001), and non-professional staff (27.3% vs 22.3%, p < 0.001) in year 3 compared with year 2, and also significantly increased among all staff in year 4 (38.0% vs 34.7%, p < 0.001) and year 5 (45.2% vs 38.0%, p < 0.001) when compared with the preceding year. The increase in vaccination rate was not apparent with social media promotion alone (26.4%, year 2 vs 25.6%, year 1, p = 0.305).ConclusionPersonal coaching led by ICO and SNO significantly increased the vaccination rates among healthcare workers in 3 consecutive years. This model could be promulgated to unit heads to establish a hospital culture conducive to vaccination.     

Immune response to one dose of BNT162b2 mRNA Covid-19 vaccine followed by SARS-CoV-2 infection: An Italian prospective observational study

IntroductionA mass vaccination campaign against SARS-CoV-2 was initiated in European countries on December 27, 2020. This study compared the antibody response in a sample of healthcare workers (HCWs) who, after the first dose of the BNT162b2 mRNA vaccine, were infected with SARS-CoV-2 (infection group) with the response in a control group of HCWs immunized with two doses (vaccine group).MethodsThis two-arm observational cohort study was carried out using routine health surveillance data obtained from HCWs at Bari Policlinico General Hospital (Italy). The antibody response was determined infection group and vaccine group.ResultsAmong the 100 HCWs, 25 (25.0%) were in the infection group and 75 (75.0%) in the full-vaccine group. At the serological evaluation, all of the HCWs tested positive, with a geometric mean titer (GMT) of 7106.8 (95 %CI = 5628.5–8973.4) and a statistically significant difference (p < 0.0001) between the infection group (GMT = 2139.7; 95 %CI = 1310.4–3493.6) and the vaccine group (GMT = 10603.6; 95 %CI = 8698.0–12926.8).DiscussionOur results shed light on the vaccine response of individuals in different risk categories. It also emphasizes the need for the continued use by HCWs of PPE and good practices during the window between the first and second anti-SARS-CoV-2 vaccinations.     

新型冠状病毒疫苗接种对成都市境外输入病例流行病学及临床特征的影响分析

目的:分析新型冠状病毒（新冠病毒）疫苗接种对成都市境外输入病例流行病学及临床特征的影响,为新型冠状病毒肺炎疫情防控提供参考依据。方法:截至2021年4月15日,经成都市入境的新冠病毒感染病例,根据新冠病毒疫苗接种史被分为疫苗接种组和疫苗未接种组。回顾性收集和分析病例的流行病学及临床特征资料。实验室检测项目包括新冠病毒核...     

Legal considerations surrounding mandatory influenza vaccination for healthcare workers in the United States

Recent years have brought increased focus on the desirability of vaccinating more healthcare workers against influenza. The concern that novel 2009 H1N1 influenza A would spark a particularly severe influenza season in 2009–2010 spurred several institutions and one state to institute mandatory vaccination policies for healthcare workers, and several new mandates have been introduced since then. Some healthcare workers, however, have voiced objections in the media and in legal proceedings. This paper reviews the characteristics of influenza and how it is transmitted in the healthcare setting; surveys possible constitutional, administrative, and common law arguments against mandates; assesses the viability of those arguments; and identifies potential new legal strategies to support influenza vaccine mandates. It is intended to assist those involved in the regulation and administration of public and private healthcare institutions who may be considering approaches to mandates but have concerns about legal challenges.     

Motivating factors for high rates of influenza vaccination among healthcare workers

Background

Recent guidance from related regulatory agencies and medical societies supports mandatory vaccination of healthcare workers (HCW) against influenza. At St. Jude Children's Research Hospital, a pediatric oncology referral center, more than 90% of HCWs receive vaccine each year without a policy mandating immunization. Factors associated with HCW uptake of influenza vaccines have not previously been evaluated in a high compliance rate setting.

Methods

A structured, anonymous, electronic questionnaire was distributed in August 2010 to employees (HCW and non-HCW). Demographics, prior receipt of influenza vaccines, reasons for acceptance or refusal of seasonal and 2009 H1N1 pandemic vaccine, and attitudes on mandatory vaccination were assessed.

Results

95.0% of 925 HCWs and 63.1% of all 3227 qualifying employees responded to the survey. 93.8% and 75.2% of HCW reported receiving seasonal and 2009 H1N1 influenza vaccines, respectively, in the 2009-2010 season. Benefits to self and/or patients were cited as the most frequent reasons for accepting seasonal (83.5% and 78.3%, respectively) and 2009 H1N1 (85.9% and 81.1%, respectively) vaccination. 36.6% of HCWs opposed mandating influenza vaccination; 88.2% and 59.9% of whom reported receiving the seasonal and 2009 H1N1 influenza vaccines, respectively. Violation of freedom of choice and personal autonomy were the most frequently reported reasons for opposition.

Conclusion

In this cohort of HCWs with a high influenza vaccination rate, realistic assessments of the potential benefits of vaccination appear to have driven the choice to accept immunization. Despite this, mandating vaccination was viewed unfavorably by a significant minority of vaccinated individuals. Employee concerns over autonomy should be addressed as institutions transition to mandatory vaccination policies.     

COVID-19 vaccine uptake and its associated factors among Palestinian healthcare workers: Expectations beaten by reality

BackgroundIn response to this extraordinary outbreak, many countries and companies rush to develop an effective vaccine, authorize, and deliver it to all people across the world. Despite these extensive efforts, curbing this pandemic relies highly upon vaccination coverage. This study aimed to determine SARS-COV-2 vaccine uptake among Palestinian healthcare workers, the factors that influence vaccination uptake, and the motivators and barriers to vaccination.MethodsA cross-sectional study was conducted using an online anonymous self-administered questionnaire during April and May 2021, after the Palestinian Ministry of Health launched the COVID-19 vaccination campaign.The questionnaire collected socio-demographic characteristics, vaccination attitude and vaccination uptake status, and motivators and barriers towards vaccination. In addition, multivariate logistic regression was performed to identify the influencing factors of vaccination uptake.ResultsThe study included 1018 participants from different professions, including 560 (55.0%) females. Of the participants, 677 (66.5%; 95% CI: 63.5–69.4%) received the vaccine. Higher uptake was observed among males (aOR = 1.5; 95 %CI: 1.1–2.1), single HCWs (aOR = 1.3; 95 %CI: 1.1–1.8), HCWs working in the non-governmental sector (aOR = 1.6; 95 %CI: 1.2–2.4), higher monthly income (aOR = 1.9; 95 %CI: 1.4–2.8) and smoking (aOR = 1.5; 95 %CI: 1.1–3.5). The lower level of negative vaccination attitudes predicted higher intake; mistrust of vaccine belief (aOR = 1.6; 95 %CI: 1.4–1.7) and worries over unforeseen future effects (aOR = 1.2; 95 %CI: 1.1–1.3).ConclusionIn conclusion, the COVID-19 vaccination uptake was comparable to other studies worldwide but still needs to be improved, especially in the context of this ongoing global pandemic. It is imperative to invest resources to promote vaccination uptake and target all the vaccine misconceptions and fears.     

Neutralizing antibody responses in healthcare personnel after three doses of mRNA BNT162b2 vaccine and association with baseline characteristics and past SARS-CoV-2 infection

AimTo estimate neutralizing antibody (NAb) immunity against SARS-CoV-2 in 739 healthcare personnel (HCP) vaccinated with three doses of BNT162b2 mRNA vaccine.MethodsSerum samples were collected at 3, 6, and 9 months after the second vaccine dose and at 7–55 days after the third dose. Samples were tested for NAbs against SARS-CoV-2 receptor binding domain.ResultsThe mean inhibition rates at 3, 6, and 9 months after the second dose were 86.33%, 73.38%, and 61.18%, and increased to 95.57% after the booster dose. Younger HCP and HCP with past SARS-CoV-2 infection had higher inhibition rates while there was an inverse correlation between NAb levels and comorbidities or tobacco use (p-values < 0.001). Increased NAb titers were also noticed in women (p-value = 0.033), especially at the end of the 9-month study period.ConclusionNAb levels increased considerably after a booster mRNA vaccine dose. Host factors and past SARS-CoV-2 infection influence NAb titers.