Perception of mandatory infant vaccines and trust in vaccination among first-year healthcare students: An opportunity window for the training of future healthcare workers

IntroductionA high level of vaccine hesitancy is observed in France; to maintain a high level of vaccine coverage, a policy of mandatory vaccines has been applied since January 2019. As vaccine hesitancy has been described among healthcare workers, we aimed to assess the adhesion to vaccination in students enrolled in the first common year of healthcare studies (PACES), and their perceptions regarding the mandatory vaccine policy.MethodsWe elaborated an anonymous online questionnaire and asked the 35 French universities offering PACES studies to diffuse it to their students; 26 accepted.ResultsOverall, 4326 participants completed the questionnaire (age 18.7 ± 1.5 years, female 76.1%). They evaluated vaccine usefulness and harmfulness at a median of 90 [IQT:80–100] and 25 [IQT:10–50], respectively; on the same scale, their median trust in vaccines was 82 [IQT:70–94]. Among the five main age classes (17 to 21 years), the positive perceptions of vaccination declined with age. A majority declared that making vaccines mandatory was morally and scientifically justified (65.7% and 84.7%, respectively); in response to the questionnaire showing a blatant anti-mandatory vaccine billboard, 52.3% and 28.6%, respectively, strongly disagreed or rather disagreed with it. Again, these proportions declined between 17 and 21 years. Participants were asked whether the mandatory vaccine policy would improve their perceptions of vaccination; those with poorer perceptions were less likely to answer this question positively.ConclusionThe perceptions of vaccination and the recent mandatory vaccine policy are positive in first-year students but better in younger ones, thus suggesting that vaccination should be taught early, during this study year. The mandatory vaccine policy may not improve the perceptions of those with a high level of vaccine hesitancy.     

Vaccination policies for healthcare workers in Europe

Health-care workers (HCWs) are at increased risk for acquisition of vaccine-preventable diseases (VPDs) and vaccination is justified in order to protect them from occupational exposure and to prevent the spread of VPDs that pose a threat to susceptible patients. Review of European vaccination policies for HCWs revealed significant differences between countries in terms of recommended vaccines, implementation frame (mandatory or recommendation), target HCW groups and health-care settings. Further, the few published studies available identified indicate significant immunity gaps among HCWs against VPDs in Europe. In order to achieve higher vaccination coverage against VPDs stronger recommendations are needed. The issue of mandatory vaccination should be considered for diseases that can be transmitted to susceptible patients (influenza, measles, mumps, rubella, hepatitis B, pertussis, varicella). The acceptance of vaccinations and of mandatory vaccinations by HCWs is a challenge and appears to be VPD-specific.     

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.     

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.     

The views of key stakeholders around mandatory influenza vaccination of hospital and aged care staff: Examining the current climate in Australia

Background

Healthcare worker (HCW) vaccination against seasonal influenza is considered a key preventative measure within hospitals and aged-care facilities (ACFs) to reduce the risk of transmission and related disease. Despite this, many facilities experience persistently low vaccination coverage rates and mandatory vaccination has been explored as a potential strategy to improve coverage. This study explored the current climate around staff vaccination in Australia from the perspective of opinion leaders and key stakeholders.

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.     

Self-reported immunity and opinions on vaccination of hospital personnel among paediatric healthcare workers in Denmark

BackgroundDenmark has no general recommendations for vaccination of healthcare workers (HCWs). We explored the self-reported immunity to varicella, measles, mumps, and rubella, reasons for receiving the influenza vaccine or not, and opinions on vaccination of HCWs against varicella, MMR, pertussis, diphtheria, and influenza among staff from departments with a high risk of exposure to infectious agents.MethodsFrom May 2019 to August 2019, a structured questionnaire was distributed to clinical and non-clinical HCWs at a tertiary and a general paediatric department in Denmark. Self-reported immunity was defined as either previous infection or vaccination against the disease.ResultsOf 619 employed HCWs, 555 (90%) were included. A large proportion were unsure of or denied previous vaccination or infection with measles (20.1%), mumps (30.2%), rubella (21.4%), varicella (12.1%), pertussis (44.1%), and diphtheria (32.1%). Non-clinical personnel and employees born in 1974–1983 had the lowest level of self-reported immunity. Mandatory vaccination of non-immune HCWs was approved by 54–68.9% of participants, and any kind of vaccination (mandatory or as an offer at hospitals) was approved of up to 95.3% of all participants depending on the disease. During the season 2018/19, 214 (38.6%) HCWs received the influenza vaccine, including 20.3% of non-clinical staff, 34.8% of nurses and 56.5% of doctors (P < 0.001). Reasons for lack of vaccine uptake were mainly employees considering themselves rarely sick, the vaccine was not regarded as necessary, forgetfulness or lack of time. Only 37.8% was in favour of mandatory influenza vaccination.ConclusionsA large proportion of paediatric HCWs were not aware of their immune status against important vaccine-preventable diseases. >90% supported vaccination of HCWs, with two out of three supporting mandatory MMR, pertussis and diphtheria vaccination. Better information and an official immunisation policy of non-immune HCWs in Denmark is warranted.     

Seroprevalence of pertussis among healthcare workers: A cross-sectional study from Tunisia

This cross-sectional study aimed to assess pertussis seroprevalence among healthy healthcare workers (HCW) of the Children’s Hospital of Tunis, Tunisia. During the study period, 236 blood samples were obtained to determine HCW exposure to pertussis. Concentrations of immunoglobulin G (IgG) to pertussis toxin (PT) were measured using a commercial enzyme-linked immunosorbent assay. Cut-offs values used were 40 and 100?IU/ml, respectively indicative of an infection within the last year and a current/recent infection. Overall, seropositivity rate was 11.4% (95% CI 7.4–15.5) and 2.5% (95% CI 0.5–4.6) of ELISA results were indicative of a current infection. Seroprevalence was significantly most important in nurses (p?=?0.03) and in participants aged 21–31y (p?=?0.009). Our study confirmed that pertussis is circulating in hospital settings and affecting Tunisian HCW, in close contact with infants. Therefore, a booster dose of acellular pertussis vaccine needs to be considered.     

Attitudes of junior healthcare professionals towards mandatory vaccination

Vaccination of healthcare professionals (HCPs) is a key measure to prevent infections in healthcare facilities, but uptake rates often remain low. Mandatory vaccination policies have been occasionally implemented to increase compliance among HCPs, but this remains an issue of controversy. The purpose of this survey was to assess the attitudes and beliefs of trainee HCPs towards mandatory occupational vaccination and further explore the factors that determine their decision. In this cross-sectional survey, trainees consisted of medical residents and medical and nursing students undergoing their clinical clerkship. An anonymous questionnaire was distributed following pilot testing. In total, 410 trainees participated (response rate: 90.1%), of whom 194 (47.3%) were residents, 154 (37.6%) medical and 62 (15.1%) nursing students. Most participants (320/410, 78%) supported mandatory occupational vaccination, stating that it should be applied to promote public welfare and benefit (294/320, 91.9%) or should be a prerequisite for employment (271/320, 84.7%). Only 22/410 (5.4%) of HCPs opposed to mandatory occupational vaccination. The primary reasons for a negative attitude were the belief that personal rights outweigh public benefit (10/22, 45.5%) and the fear of side effects (9/22, 40.9%). Univariate analysis revealed that HCPs that have been informed by vaccination campaigns or had higher knowledge scores, were more likely to support mandatory occupational vaccination (OR 1.7, 95% CI: 1.1–2.7, p 0.038 and OR 1.7, 95% CI: 1.02– 2.7. p 0.044, respectively). In conclusion, most medical and nursing trainees in this study supported mandatory vaccination for HCPs. Focusing on continuing professional education on vaccines is important to positively determine HCPs’ attitudes towards occupational vaccination and increase their vaccination uptake rates.     

Examining the views of key stakeholders regarding the provision of occupational influenza vaccination for healthcare workers in Australia

Annual vaccination of hospital healthcare workers (HCWs) may be an effective measure to reduce the transmission of healthcare associated influenza. However, vaccine coverage rates among HCWs in most public Australian hospitals are below satisfactory for a number of reasons. This study aimed to examine the opinions of key health stakeholders on current issues regarding HCW influenza vaccination.     

Anti-SARS-CoV immunoglobulin G in healthcare workers, Guangzhou, China

To determine the prevalence of inapparent infection with severe acute respiratory syndrome (SARS) among healthcare workers, we performed a serosurvey to test for immunoglobulin (Ig) G antibodies to the SARS coronavirus (SARS-CoV) among 1,147 healthcare workers in 3 hospitals that admitted SARS patients in mid-May 2003. Among them were 90 healthcare workers with SARS. As a reference group, 709 healthcare workers who worked in 2 hospitals that never admitted any SARS patients were similarly tested. The seroprevalence rate was 88.9% (80/90) for healthcare workers with SARS and 1.4% (15/1,057) for healthcare workers who were apparently healthy. The seroprevalence in the reference group was 0.4% (3/709). These findings suggest that inapparent infection is uncommon. Low level of immunity among unaffected healthcare workers reinforces the need for adequate personal protection and other infection control measures in hospitals to prevent future epidemics.     

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.     

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.     

Effectiveness of seasonal influenza vaccination in healthcare workers: a systematic review

Vaccination is considered a key measure to protect vulnerable groups against influenza infection. The objectives of this review are to determine the effect of influenza vaccinations in reducing laboratory-confirmed influenza infections, influenza-like illnesses (ILIs), working days lost among vaccinated HCWs, and associated adverse effects after vaccination. Twenty-two healthcare-related databases and internet resources, as well as reference lists, and the bibliographies of all of the retrieved articles were examined. All randomized controlled trials (RCTs) comparing the effectiveness of any kind of influenza vaccine among all groups of HCWs with a placebo/vaccine other than the influenza vaccine/no intervention were included in the review. Only three RCTs matched the inclusion criteria. There is a limited amount of evidence suggesting that receiving influenza vaccination reduces laboratory-confirmed influenza infections in HCWs. No evidence can be found of influenza vaccinations significantly reducing the incidence of influenza, number of ILI episodes, days with ILI symptoms, or amount of sick leave taken among vaccinated HCWs. There is insufficient data to assess the adverse effects after vaccination. There is no definitive conclusion on the effectiveness of influenza vaccinations in HCWs because of the limited number of related trials. Further research is necessary to evaluate whether annual vaccination is a key measure to protect HCWs against influenza infection and thus increase their confidence in the vaccine. In the mean time, the direction of promoting influenza vaccination to HCWs can be shifted from staff protection to patient protection, with accurate information to address concerns and misconceptions.     

Vaccine hesitancy among healthcare workers in Europe: A qualitative study

Healthcare workers (HCWs) are often referred to as the most trusted source of vaccine-related information for their patients. However, the evidence suggests that a number of HCWs are vaccine-hesitant. This study consists of 65 semi-structured interviews with vaccine providers in Croatia, France, Greece, and Romania to investigate concerns HCWs might have about vaccination. The results revealed that vaccine hesitancy is present in all four countries among vaccine providers. The most important concern across all countries was the fear of vaccine side effects. New vaccines were singled out due to perceived lack of testing for vaccine safety and efficacy. Furthermore, while high trust in health authorities was expressed by HCWs, there was also strong mistrust of pharmaceutical companies due to perceived financial interests and lack of communication about side effects. The notion that it is a doctor’s responsibility to respond to hesitant patients was reported in all countries. Concerns were also seen to be country- and context-specific. Strategies to improve confidence in vaccines should be adapted to the specific political, social, cultural and economic context of countries. Furthermore, while most interventions focus on education and improving information about vaccine safety, effectiveness, or the need for vaccines, concerns raised in this study identify other determinants of hesitancy that need addressing. The representativeness of the views of the interviewed HCWs must be interpreted with caution. This a qualitative study with a small sample size that included geographical areas where vaccination uptake was lower or where hesitancy was more prevalent and it reflects individual participants’ beliefs and attitudes toward the topic. As HCWs have the potential of influencing patient vaccination uptake, it is crucial to improve their confidence in vaccination and engage them in activities targeting vaccine hesitancy among their patients.     

Hepatitis B vaccination in women healthcare workers: A seroepidemiological survey

Objective To assess the concentration and kinetics of antibody response after hepatitis B vaccination among women healthcare workers. Design. Longitudinal retrospective seroepidemiological survey among women vaccinated against hepatitis B working in a university hospital and followed-up in an occupational health department. A structured form was used to collect socio-demographic characteristics, clinical data, age at vaccination, vaccination schedule, measurement of antibodies to hepatitis B surface antigen (anti-HBs antibody). Subjects were considered seronegative against hepatitis B when anti-HBs antibody concentration was less than 10 mIU/ml. Setting. A 1260-bed general hospital in Paris, France. Participants. All women healthcare workers visiting the occupational health department between January 1997 1st and December 2000 31st and who had a measurement of anti-HBs antibody. Results Irrespective of the age at the primary vaccination, 810 (92%) women were seropositive (anti-HBs antibody ≥ 10 mIU/ml). Only 22 women (4.5%) vaccinated before 26 years of age were seronegative, against 46 (13.2%) vaccinated after 25 years of age (p < 0.001). Seven years after vaccination, 78% of women were still seropositive. An inadequate vaccination schedule (adjusted hazard ratio (HR), 3.0; 95% confidence interval [CI], 1.6–5.5) and an age greater than 25 years at primary vaccination (HR, 2.6; 95% CI, 1.5–4.4) were associated with being seronegative against hepatitis B. Conclusions. Despite vaccination, some women healthcare workers were seronegative against hepatitis B virus. Vaccinating early in the career of a health-care worker using an adequate schedule seems key-elements to guarantee an anti-HBs measurement ≥10 mIU/ml.