Healthcare workers and their attitudes to influenza vaccination

Despite Department of Health recommendations that healthcare workers (HCWs) receive influenza vaccination, uptake is low. Influenza vaccination has been promoted to reduce nosocomial transmission and staff absenteeism during the winter period. Our study aimed to investigate factors associated with uptake, and non-uptake, of influenza vaccination. In March 2001 we undertook a questionnaire-based cross-sectional survey of 604 hospital HCWs in Leicester and 11 occupational health nurses. Following multivariate analysis, uptake was associated with previous influenza vaccination (OR: Odds ratio 1000, 95% CI 20-3,333), age > 45 years (OR 4.45, 95% CI 1.66-11.9), and belief that influenza is a serious illness (OR 3.8, 95% CI 1.3-10.6). HCWs receive vaccination predominantly as a benefit for themselves. Campaigns should improve accessibility, target younger staff and stress the consequences of influenza infection. Simply raising awareness may not translate into increased uptake. Absenteeism was attributed to vaccine-related adverse effects by 11/83 (13%) vaccinees, resulting in 0.46 workdays lost per dose administered.     

Parental perspectives on influenza vaccination among children with asthma

OBJECTIVES: The objectives of this study were to: (1) identify modifiable factors influencing receipt of influenza vaccination among children with asthma, and (2) to evaluate the effect of heightened media attention on vaccination rates. METHODS: During November and December 2003, we interviewed parents of children with asthma about their experiences with and beliefs about influenza vaccination. We randomly selected 500 children from a study population of 2,140 children identified with asthma in a managed care organization in Massachusetts. We obtained data on influenza vaccination status from computerized medical records and determined significant factors influencing receipt of influenza vaccination. RESULTS: Children were more likely to be vaccinated if their parent recalled a physician recommendation (odds ratio [OR] 2.6; 95% confidence interval [CI] 1.5, 4.5), believed the vaccine worked well (OR 2.0; 95% CI 1.4, 2.8), or expressed little worry about vaccine adverse effects (OR 1.3; 95% CI 1.0, 1.6), or if the child was younger (OR 1.1 per year of age; 95% CI 1.0, 1.2). During the study period, there was heightened media attention about influenza illness and the vaccine. The influenza vaccination rate for children with asthma was 43% in 2003-04 compared with 27% in 2002-03. Comparison of weekly influenza vaccination rates in 2003-04 and 2002-03 suggested that the media attention was associated with the increase in vaccination rates. CONCLUSIONS: Physician recommendations and parental education about influenza vaccine availability, effectiveness, and adverse effects are potentially important influences on influenza vaccination. Our findings suggest that media coverage of the risks of influenza was associated with a significant increase in vaccination rates.     

Factors associated with tuberculin reactivity in two general hospitals in Mexico.

OBJECTIVE: To identify risk factors associated with tuberculin reactivity in healthcare workers (HCWs). DESIGN: Cross-sectional survey of tuberculin reactivity (2 TU of purified protein derivative (PPD) RT23, using the Mantoux two-step test). SETTING: Two general hospitals located in a region with a high prevalence of tuberculosis and high bacille Calmette-Guerin (BCG) coverage. PARTICIPANTS: Volunteer sample of HCWs. RESULTS: 605 HCWs were recruited: 71.2% female; mean age, 36.4 (standard deviation [SD], 8.2) years; 48.9% nurses, 10.4% physicians, 26.8% administrative personnel; mean time of employment, 10.9 (SD, 6.7) years. PPD reactivity (> or =10 mm) was found in 390 (64.5%). Multivariate analysis revealed an association of tuberculin reactivity with occupational exposure in the hospital: participation in autopsies (odds ratio [OR], 9.3; 95% confidence interval [CI95], 2.1-40.5; P=.003.), more than 1 year of employment (OR, 2.4; CI95, 1.1-5.0; P=.02), work in the emergency or radiology departments (OR, 2.0; CI95, 1.03-3.81; P=.04), being physicians or nurses (OR, 1.5; CI95, 1.04-2.11; P=.03), age (OR, 1.04; CI95, 1.02-1.07 per year of age; P<.001), and BCG scar (OR, 2.1; CI95, 1.2-3.4; P=.005). CONCLUSIONS: Although the studied population has a high baseline prevalence of tuberculosis infection and high coverage of BCG vaccination, nosocomial risk factors associated with PPD reactivity were identified as professional risks; strict early preventive measures must be implemented accordingly.     

Seasonal influenza vaccination coverage and barriers among healthcare workers in an Egyptian Province

Background:Influenza vaccination uptake by Egyptian healthcare workers remains sub-optimal despite local initiatives and infection control programs to increase it.Objective:To assess vaccination coverage and investigate health care workers’ barriers and also motivators toward seasonal influenza vaccination.Methods:An interview questionnaire survey and focus group sessions were conducted to measure uptake and assess barriers to seasonal influenza vaccination among HCWs in main hospitals and primary care centers in Ismailia city.Results:There were 980 participants, of whom 131 (13.4%) reported having received influenza vaccination in last season 2018/2019. Females were 76.8% of participants, and nurses were the main occupational category of study sample (80.4%). The most commonly reported motivator (97.7%) was “protection of oneself and family members” among the vaccinated participants. The top barriers among non-vaccinated ranked by their Relative Importance Index (RII), included lack of instruction by supervisors RII=0.82, lack of awareness about vaccine benefits RII=0.79 and lack of awareness from where to get the vaccine RII=0.71. Predictors of non-vaccination included belief that the vaccine itself may induce influenza (OR: 1.9 p<0.05, CI, 1.3-2.8) and the perception that vaccination is ineffective (OR: 2.8 p<0.05, CI, 1.5-5.2), and lack of knowledge about the vaccinations recommended for health care workers (OR: 1.9 p<0.05, CI, 1.2-2.8).Conclusions:Addressing specific barriers to influenza vaccination uptake among healthcare workers may improve vaccination rate. Targeted evidence-based promotion campaigns and programs should be established to overcome identified barriers.Key words: Seasonal influenza vaccination, health care workers, barriers     

Seasonal and Pandemic A (H1N1) 2009 influenza vaccination coverage and attitudes among health-care workers in a Spanish University Hospital

Influenza vaccination coverage among health-care workers (HCWs) remains the lowest compared with other priority groups for immunization. Little is known about the acceptability and compliance with the pandemic (H1N1) 2009 influenza vaccine among HCWs during the current campaign. Between 23 December 2009 and 13 January 2010, once the workplace vaccination program was over, we conducted a cross-sectional, questionnaire-based survey at the University Hospital 12 de Octubre (Madrid, Spain). Five hundred twenty-seven HCWs were asked about their influenza immunization history during the 2009–2010 season, as well as the reasons for accepting or declining either the seasonal or pandemic vaccines. Multiple logistic-regression analysis was preformed to identify variables associated with immunization acceptance. A total of 262 HCWs (49.7%) reported having received the seasonal vaccine, while only 87 (16.5%) affirmed having received the pandemic influenza (H1N1) 2009 vaccine. “Self-protection” and “protection of the patient” were the most frequently adduced reasons for acceptance of the pandemic vaccination, whereas the existence of “doubts about vaccine efficacy” and “fear of adverse reactions” were the main arguments for refusal. Simultaneous receipt of the seasonal vaccine (odds ratio [OR]: 0.27; 95% confidence interval [95% CI]: 0.14–0.52) and being a staff (OR: 0.08; 95% CI: 0.04–0.19) or a resident physician (OR: 0.16; 95% CI: 0.05–0.50) emerged as independent predictors for pandemic vaccine acceptance, whereas self-reported membership of a priority group was associated with refusal (OR: 5.98; 95% CI: 1.35–26.5). The pandemic (H1N1) 2009 influenza vaccination coverage among the HCWs in our institution was very low (16.5%), suggesting the role of specific attitudinal barriers and misconceptions about immunization in a global pandemic scenario.     

Risk perception and attitudes towards HIV in Serbian health care workers

BACKGROUND: Health care workers (HCWs) are at risk of occupational exposure to human immunodeficiency virus (HIV). AIM: To investigate the perception of professional risk from, and the knowledge, attitudes and practice of HCWs to HIV and AIDS in Serbia. METHODS: Cross-sectional study of 1,559 Serbian HCWs using self-administered anonymous questionnaires. Chi-square testing and multiple logistic regression analysis were applied. RESULTS: Eighty-nine per cent of HCWs believed that they were at risk of acquiring HIV through occupational exposure. The perception of professional risk was higher among HCWs frequently exposed to patients' blood and body fluids (OR 7.9, 95% CI 4.4-14.5), who used additional personal protection if the HIV status of patient was known (OR 2.6, 95% CI 1.5-4.6), who had experienced sharp injuries within the last year (OR 1.9, 95% CI 1.0-3.8) or who had been tested for HIV (OR 2.1, 95% CI 1.2-3.5), and among HCWs who had treated HIV-positive patients (OR 1.7, 95% CI 1.1-2.8). The majority of respondents had deficient knowledge about modes of HIV transmission. Attitudes towards HIV-positive patients were significantly different by occupation. Seventy per cent of HCWs used appropriate protection during their daily work with patients. CONCLUSIONS: HCWs require specific educational programmes and training protocols to ensure that they are adequately protected when carrying out high quality care.     

Risk of tuberculous infection among healthcare workers in a tertiary-care hospital in Ankara, Turkey.

OBJECTIVE: To determine risk factors for tuberculin skin test (TST) positivity among healthcare workers (HCWs). DESIGN: Two-step TST was performed in 2002. SETTING: Tertiary-care hospital in Ankara, Turkey. PARTICIPANTS: A sample of 491 hospital HCWs were included. Information related to demographics, profession, work duration, department, and individual and family history of tuberculosis (TB) was obtained by a structured questionnaire. RESULTS: Four hundred eight (83%) had two-step TST positivity. On multivariate analysis, male physicians (relative risk [RR], 1.5; 95% confidence interval [CI95], 1.23-1.69; P = .001), nurses (RR, 1.5; CI95, 1.29-1.66; P = .005), radiology technicians (RR, 1.7; CI95, 1.35-1.73; P = .002), laboratory technicians (RR, 1.6; CI95, 1.3-1.74; P = .007), and male housekeepers (RR, 1.6; (HCWs). CI95, 1.38-1.7; P < .001) had a higher risk than did female physicians. Among laboratory technicians, radiology technicians had the highest TST positivity (85%). HCWs working for less than 1 year (RR, 0.8; CI95, 0.72-0.98; P = .027) had a lower risk of infection. The HCWs having bacille Calmette-Guerin vaccination (RR, 1.12; CI95, 1.08-1.45) had higher TST positivity. CONCLUSION: Male physicians, nurses, and laboratory technicians had increased risk of Mycobacterium tuberculosis infection in this setting, but community exposure likely accounted for most infections.     

青岛市医务人员流感疫苗接种及影响因素分析

目的 了解山东省青岛市医务人员流感疫苗接种情况, 探索影响医务人员接种流感疫苗的主要因素。方法 采用整群分层抽样方法对青岛市6家不同级别医疗机构的1 301名医务人员进行调查。对流感及流感疫苗认知现状进行描述性分析, 用logistic回归模型对疫苗接种率的影响因素进行单因素和多因素分析。结果 2013—2014年流感季流感疫苗接种率为4.8%(63/1 301), 未接种的主要原因是担心出现疫苗不良反应, 占43.4%(412/950)。多因素分析结果显示, 社区乡镇卫生院(OR=8.23, 95%CI=3.78~17.93)、二级医院(OR=2.27, 95%CI=1.02~5.06)、之前3年不连续接种(OR=2.01, 95%CI=1.08~3.77)或每年均接种流感疫苗(OR=3.49, 95%CI=1.23~9.92)、担心流感季节患流感(OR=2.72, 95%CI=1.46~5.05)、认同不接种流感疫苗, 容易得流感(OR=2.49, 95%CI=1.26~4.91)和得流感会后悔(OR=3.03, 95%CI=1.29~7.08)、季前接种意愿为有可能(OR=2.73, 95%CI=1.42~5.26)、可能性大(OR=6.44, 95%CI=2.55~16.26)的医务人员更容易接种流感疫苗。结论 医务人员流感疫苗接种率很低, 担心疫苗安全性是阻碍接种的首要原因;医院层级、流感疫苗接种史、季前接种意愿和态度心理等因素是医务人员季节性流感疫苗接种影响因素。     

Knowledge and attitude of Kenyan healthcare workers towards pandemic influenza disease and vaccination: 9 years after the last influenza pandemic

BackgroundHealthcare workers (HCWs) are at high risk of exposure and transmission of infectious respiratory pathogens like influenza. Despite the potential benefits, safety and efficacy of influenza vaccination, vaccines are still underutilized in Africa, including among HCWs.MethodFrom May-June 2018, we conducted a cross-sectional, self-administered, written survey among HCWs from seven counties in Kenya and assessed their knowledge attitudes and perceptions towards pandemic influenza disease and vaccination. Using regression models, we assessed factors that were associated with the HCW’s knowledge of pandemic influenza and vaccination.ResultsA total of 2,035 HCWs, representing 49% of the targeted respondents from 35 health facilities, completed the question. Sixty eight percent of the HCWs had ever heard of pandemic influenza, and 80.0% of these were willing to receive pandemic influenza vaccine if it was available. On average, Kenyan HCWs correctly answered 55.0% (95% CI 54.0–55.9) of the questions about pandemic influenza and vaccination. Physicians (65.6%, 95% CI 62.5–68.7) and pharmacists (61.7%, 95% CI 57.9–65.5) scored higher compared to nurses (53.1%, 95% CI 51.7–54.5). HCWs with 5 or more years of work experience (55.8, 95% CI 54.5–57.0) had marginally higher knowledge scores compared to those with less experience (53.9%, 95% CI 52.5–55.3). Most participants who were willing to receive pandemic influenza vaccine did so to protect their relatives (88.7%) or patients (85.9%).ConclusionOur findings suggest moderate knowledge of pandemic influenza and vaccination by HCWs in Kenya, which varied by cadre and years of work experience. These findings highlight the need for continued in-service health education to increase the HCW’s awareness and knowledge of pandemic influenza to increase acceptance of influenza vaccination in the case of a pandemic.     

Occupation and the risk of laryngeal cancer in Turkey

OBJECTIVES: A hospital-based case-referent study was conducted in Turkey to provide further information on occupational risk factors and laryngeal cancer. METHODS: Among 7631 cancer cases seen at an oncology treatment center between 1979 and 1984, 958 laryngeal cancer cases were identified among men. Occupational history, tobacco and alcohol use, and demographic data were obtained from patients with a standardized questionnaire. Special 7-digit standard occupational and industrial codes were created to classify the job and industrial titles of the subjects. After exclusions, 940 laryngeal cancer cases and 1519 referents were available for study. Age-, smoking- and alcohol-adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. RESULTS: Excess laryngeal cancer occurred among guards (OR 1.5, 95% CI 1.1-2.1), production supervisors (OR 1.8, 95% CI 1.1-3.1), textile workers (OR 1.9, 95% CI 1.2-3.3), drivers (OR 1.7, 95% CI 1.1-2.4), construction workers (OR 1.7, 95% Cl 1.2-2.6), and workers in grain mills (OR 3.1, 95% CI: 1.3-7.6), trade unions (OR 3.6, 95% CI: 1.1-11.7) and local government services (OR 4.7, 95% CI 1.7-12.5). Supraglottic cancer was excessive among the textile workers, construction workers, and local government laborers, all with potential dust exposure. The risks of the general managers, electricians, and workers from industries such as pharmaceutical production, industrial machinery production, electric utilities, and retail services were lower than expected. CONCLUSIONS: The risk of laryngeal cancer was associated with several occupations, and supraglottic larynx cancer appears to be more common among workers in dusty occupations and industries.     

Influenza vaccination of future healthcare workers: A cross-sectional study of uptake,knowledge and attitudes

Promotional campaigns recommend immunisation against influenza in healthcare workers (HCWs) but the uptake in this group remains low. We conducted a survey study during the 2008–2009 influenza vaccination period amongst future HCWs to quantify uptake and identify barriers to immunisation. Overall uptake was 8.0% (95% CI 5.9–10.8%), which is lower than the uptake amongst current HCWs (13.4%) and short of current government targets (75%). Knowledge about influenza was good but insufficient to encourage HCWs to get vaccinated. Promotional campaigns are needed that emphasise the role of vaccination in personal and patient protection.     

The impact of socioeconomic level on influenza vaccination among Italian adults and elderly: a cross-sectional study

OBJECTIVE: To assess the predictive factors of influenza vaccination among Italian adults, focusing on socioeconomic differences. METHODS: A cross-sectional study was carried out using interview and self-reported data on 102,095 subjects aged 25-89 years from the national survey "health conditions and health care services use" conducted in Italy in 1999-2000. Analyses were stratified by age and multiple logistic regression models were used to estimate odds ratios (OR) of influenza vaccination. RESULTS: Approximately one in six individuals (17.3%) received an influenza vaccine in the previous 12 months. Older age, poor health status and former smoking were all positively associated with influenza vaccination (P-value<0.05). Lower educated individuals and subjects with manual occupations were less likely to be vaccinated than those better off, with an OR ranging from 0.65 (95% CI 0.55, 0.77) to 0.82 (95% CI 0.71, 0.93). Among individuals aged 65-89 there was no apparent influence of both variables on the likelihood of receiving the influenza vaccine. CONCLUSIONS: Socioeconomic inequalities in influenza vaccine uptake were present among the adults but not among the elderly. Because in Italy the National Health Service provides influenza vaccination to the elderly free of charge, it is possible that this policy attenuated the socioeconomic differential.     

Laryngeal and hypopharyngeal cancer and occupation: results of a case control-study.

OBJECTIONS: To ascertain whether certain occupations are associated with laryngeal or hypopharyngeal cancer. METHODS: A hospital based case-control study was carried out in 15 hospitals in France. It included 528 male cases diagnosed between January 1989 and April 1991, and 305 male controls with various other types of cancer. Interviews were carried out to obtain lifetime job histories and information on potential confounders. Logistic regression was used to compute the odds ratios (OR) for each of about 80 occupations and industries. RESULTS: There was an excess risk of laryngeal and hypopharyngeal cancer among service workers (OR 2.2, 95% confidence interval (95% CI) 1.3 to 3.9), agricultural and animal husbandry workers (OR 1.6, 95% CI 0.9 to 2.8), miners and quarrymen (OR 2.0, 95% CI 0.9 to 4.3), plumbers and pipe fitters (OR 2.6, 95% CI 0.8 to 8.1), glass formers and potters (OR 4.3, 95% CI 1.0 to 18) transport equipment operators (OR 1.5, 95% CI 1.0 to 2.5), and unskilled workers (OR 1.7, 95% CI 1.0 to 2.9). Analysis by industrial branch showed an excess risk for coal mining (OR 2.1, 95% CI 1.1 to 4.1), manufacture of metal products (OR 1.9, 95% CI 1.0 to 3.3), and administration and sanitary services (OR 1.7, 95% CI 1.1 to 2.5). CONCLUSION: These results suggest that occupational exposure might have a role in generating laryngeal and hypopharyngeal cancer, and indicate the need for further evaluation of these findings, an for the identification of the carcinogens which might account for the excess risks found for certain occupations.     

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

BackgroundSeasonal 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.MethodsAttitudes 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.ResultsThe 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).ConclusionThere is a need for guidance for the organization of seasonal influenza campaigns, in which education, communication and easy accessible vaccination are promoted.     

Knowledge,attitudes and vaccination coverage of healthcare workers regarding occupational vaccinations

Objectives

Immunization of healthcare workers (HCWs) is a major issue for infection control in healthcare facilities. The aim of this study was to evaluate knowledge regarding occupational vaccinations, HBV, varicella and influenza vaccination rates and attitudes towards influenza vaccine among HCWs.

Design and setting

A cross-sectional survey was conducted in two wards (Medicine and Paediatrics) of a 1182-bed teaching hospital in Paris, France.

Methods

A standardized, anonymous, self-administered questionnaire was used.

Results

Of 580 HCWs, 395 (68%) completed the questionnaire. Knowledge about the occupational vaccinations of HCWs was low. HBV (69%), tuberculosis (54%) and influenza (52%) were the most cited vaccinations. Paediatric staff was more aware of influenza and pertussis immunizations (p < .05). HBV vaccination rate was 93%, among whom 65% were aware of their immune status. Influenza vaccination rate for 2006–2007 was 30% overall, ranging from 50% among physicians to 20% among paramedical staff (p < .05). Physicians based their refusal on doubts about vaccine efficacy, although paramedics feared side effects. Influenza vaccination was associated with knowledge of vaccine recommendations [OR = 1.75, 95% CI: 1.13–2.57] and contact with patients [OR = 3.05, 95% CI: 1.50–5.91].

Conclusions

Knowledge of recommended occupational vaccinations is insufficient in HCWs, except for HBV and influenza. Although the HBV vaccine coverage of HCWs is satisfactory, a large proportion of them is unaware of immune status. Influenza vaccine coverage remains low, especially among paramedical staff because of fear of side effects. As vaccine coverage is associated with knowledge, educational campaigns should be strengthened to increase the adhesion of HCWs to vaccinations.     

Knowledge and attitudes towards influenza vaccination of health care workers in emergency services

Annual vaccination rates among French health care workers (HCWs) are in decline even in Emergency Services to which patients at highest risk of influenza complications are admitted, and in which HCWs have the greatest risk of exposure to influenza from patients. We aimed here to identify knowledge and attitudes towards influenza vaccination of HCWs in Emergency Services. We collected 344 self-administered questionnaires of 1060 HCWs. Only 18% of HCWs were vaccinated against influenza. Physicians were vaccinated more often (55%) than nurses (16%) or aid nurses (11%). The most important barriers to vaccination were reported as being a lack of time (33%), lack of safety of the vaccine (31%), fear of contracting influenza due to vaccination (29%), and lack of effectiveness (23%). Being vaccinated was significantly related to a higher knowledge score based on epidemiological influenza items (OR (95% CI)) (1.63 (1.08–2.46)) and vaccine features items (2.36 (1.36–4.10)).     

Hepatitis B vaccination coverage in healthcare workers in Gauteng Province, South Africa

Hepatitis B (HB) virus (HBV) is highly endemic and HBV infection is a major public health problem in sub-Saharan Africa. Percutaneous/parenteral transmission is an important mode of spread of HBV in the healthcare setting, thus healthcare workers (HCWs) and their patients are at risk for acquiring HBV infections. This study was conducted on three HCW populations in Gauteng Province during 2009, in order to (1) determine HB vaccination coverage of HCWs, and (2) investigate demographic predictors of vaccination uptake. Being a doctor was a statistically significant predictor of vaccination uptake (odds ratio [OR]: 3.2; 95% confidence interval [CI]: 1.48-6.72; p-value: 0.003), while working in the private sector was also statistically significantly associated with vaccination uptake (OR: 1.73; 95% CI: 1.01-2.98; chi-square p-value: 0.035). The majority (67.9% [491/723]) of HCWs had received at least 1 dose of vaccine, but where data on number of doses was available, only 19.9% (94/472) were fully vaccinated. In conclusion, there is a need to increase HB vaccination uptake in Gauteng HCWs through a policy that is properly implemented and routinely monitored and evaluated, and this policy must ensure that all three doses of vaccine are administered.     

Prevalence of tuberculin skin test positivity and conversions among healthcare workers in New York City during 1994 to 2001.

OBJECTIVE: To determine the prevalence of and risk factors for tuberculin skin test positivity and conversion among New York City Department of Health and Mental Hygiene employees. DESIGN: Point-prevalence survey and prospective cohort analysis. Sentinel surveillance was conducted from March 1, 1994, to December 31, 2001. PARTICIPANTS: HCWs in high-risk and low-risk settings for occupational TB exposure. RESULTS: Baseline tuberculin positivity was 36.2% (600 of 1,658), 15.5% (143 of 922) among HCWs born in the United States, and 48.5% (182 of 375) among HCWs not born in the United States. There were 36 tuberculin conversions during 2,754 observation-years (rate, 1.3 per 100 person-years). For HCWs born in the United States, the risk for tuberculin conversion was greater in high-risk occupational settings compared with low-risk settings (OR, 5.7; CI95, 1.7-19.2; P < .01). HCWs not born in the United States and those employed at the Office of the Chief Medical Examiner (OCME) were at high risk for baseline tuberculin positivity (OR, 3.2; CI95, 1.7-5.8; P < .001); OCME HCWs (OR, 4.7; CI95, 2.3-9.4; P < .001), those of Asian ethnicity (OR, 4.3; CI95, 1.4-13.5; P < .01), and older HCWs (OR, 1.0; CI95, 1.0-1.1; P < .05) were at a higher risk for conversion. CONCLUSIONS: Although the prevalence of tuberculin positivity decreased after the peak of the recent TB epidemic in New York City, the conversion rate among HCWs in high-risk occupational settings for TB exposure was still greater than that among HCWs in low-risk settings. Continued surveillance of occupational TB infection is needed, especially among high-risk HCWs.     

Healthcare workers and H1N1 vaccination: does having a chronic disease make a difference?

Introduction

A novel H1N1 vaccine was manufactured in response to the pandemic in 2009. This study describes the willingness to be vaccinated for H1N1 among healthcare workers (HCWs) in primary healthcare clinics with and without chronic medical conditions, their reasons for refusing vaccination and whether they sought additional information to make an informed decision for the vaccination.

Materials and methods

An anonymous survey was conducted in November 2009 among all medical, nursing, allied health and operations HCWs in nine primary care clinics in Singapore. Participants were asked if they had any chronic medical conditions associated with influenza-related complications (example: asthma, stroke, heart disease, cancer, diabetes mellitus, renal disease), their perception towards vaccination for H1N1 and against seasonal influenza within the preceding 2 years.

Results

The initial response rate was 80%, of which 711 (54.7%) of the completed surveys were analysed. Among the 711 respondents, 16.6% reported having at least 1 chronic disease. Asthma (10.8%), hypertension (10.4%) and dyslipidaemia (9.8%) were the main chronic conditions. Only 39.4% of respondents were willing to be vaccinated against H1N1. Males were 2.07 (95% CI 1.19-3.62) times more likely than females to receive the H1N1 vaccination; the 45-54 and 55+ years old were 2.12 (95% CI 1.06-4.24) and 2.44 (95% CI 1.13-5.27) times more willing than those below 25 years old; and those who considered accepting the seasonal influenza vaccine were 7.0 times more likely than those who did not (95%CI 4.48-10.92). The 2 principal barriers were “fear of side effects” and “unsure of vaccine's effectiveness”. Although 78% attended some H1N1-related talks, only 7% of all HCWs felt that they had sufficient information. Most wanted more information about the vaccine's safety profile and contraindications.

Conclusion

Fewer than 40% of HCWs expressed willingness to receive the H1N1 vaccination, lower than past rates of influenza vaccine. HCWs in primary care clinics who had a chronic condition did not perceive themselves to be at higher risk of developing H1N1-related complications and were not more willing than the rest of the HCWs to accept H1N1 vaccination. Vaccine's side effects and effectiveness were the main concerns. Uptake of H1N1 vaccine may improve with targeted health information covering the vaccine's safety profile.     

Parental perspectives on influenza immunization of children aged 6 to 23 months

BACKGROUND: For the first time, in 2002, the Advisory Committee on Immunization Practices encouraged the vaccination of healthy children 6 to 23 months against influenza, whenever feasible. Participating inner-city health centers designed interventions to introduce influenza vaccination among this group of children. The study was designed to assess parents' attitudes toward the vaccine. METHODS: Following the 2002-2003 influenza vaccination season, parents were surveyed to identify barriers to and facilitators of influenza vaccination. A low-literacy level, 19-question survey was mailed to parents in three waves, 4 weeks apart. A subset of children had medical record data available to confirm vaccination status. Measures of validity were calculated. This paper focused only on the children whose parent-reported vaccination status was concordant with that reported in medical records (n = 193). Associations of responses to vaccination status were calculated in 2004, using chi-square and logistic regression procedures. RESULTS: Sensitivity was 85.7% and specificity was 66% (kappa = 0.50), assessing the ability of parents to recall receipt or nonreceipt of influenza vaccine. The most important factors related to immunization of healthy infants were perceived doctor's recommendation (odds ratio [OR] = 5.5; 95% confidence interval [CI] = 2.4-12.3; p < 0.001) and belief that getting an influenza shot is a smart idea (OR = 3.5; 95% CI = 1.3-8.9; p < 0.01) for those with medical record-confirmed vaccination status. CONCLUSIONS: A clear message that the doctor recommends influenza vaccination for a child is an important factor for ensuring vaccination, and may foster the idea that vaccination is "smart."