The relationship of health beliefs and a postcard reminder to influenza vaccination.

The relationship of certain health beliefs to influenza vaccination and the effect of a postcard reminder on vaccination rates was studied among 232 high-risk patients. In agreement with the Health Belief Model tested, the patients vaccinated believed influenza to be more serious, believed they were more susceptible to influenza, and believed the vaccine to be more efficacious than did patients not vaccinated. Those not vaccinated were less satisfied with their medical care and felt the vaccine was more expensive than those vaccinated. A postcard reminding patients of influenza vaccination was an effective way to increase the vaccination rate. Patients receiving the card had a 59.7 percent vaccination rate compared to a 30.0 percent rate among those not receiving the postcard. This study suggests that a reminder postcard is an effective means to promote influenza vaccination and that these beliefs are important determinants of vaccination behavior.     

Use of a pandemic preparedness drill to increase rates of influenza vaccination among healthcare workers.

OBJECTIVE: To determine the effect of a pandemic influenza preparedness drill on the rate of influenza vaccination among healthcare workers (HCWs). DESIGN: Before-after intervention trial. SETTING: The University of Iowa Hospitals and Clinics (UIHC), a large, academic medical center, during 2005. SUBJECTS: Staff members at UIHC. METHODS: UIHC conducted a pandemic influenza preparedness drill that included a goal of vaccinating a large number of HCWs in 6 days without disrupting patient care. Peer vaccination and mobile vaccination teams were used to vaccinate HCWs, educational tools were distributed to encourage HCWs to be vaccinated, and resources were allocated on the basis of daily vaccination reports. Logit models were used to compare vaccination rates achieved during the 2005 vaccination drill with the vaccination rates achieved during the 2003 vaccination campaign. RESULTS: UIHC vaccinated 54% of HCWs (2,934 of 5,467) who provided direct patient care in 6 days. In 2 additional weeks, this rate increased to 66% (3,625 of 5,467). Overall, 66% of resident physicians (311 of 470) and 63% of nursing staff (1,429 of 2,255) were vaccinated. Vaccination rates in 2005 were significantly higher than the hospitalwide rate of 41% (5,741 of 14,086) in 2003. CONCLUSIONS: UIHC dramatically increased the influenza vaccination rate among HCWs by conducting a pandemic influenza preparedness drill. Additionally, the drill allowed us to conduct a bioemergency drill in a realistic scenario, use innovative methods for vaccine delivery, and secure administrative support for future influenza vaccination campaigns. Our study demonstrates how a drill can be used to improve vaccination rates significantly.     

Effectiveness of a brief intervention for acceptance of influenza vaccine in reluctant primary care patients

ObjectiveTo determine the effectiveness of a brief intervention in increasing influenza vaccination coverage compared with the usual advice in people who refuse it, and to record the main reasons for refusing to be vaccinated.MethodA cluster randomized clinical trial was conducted in which the study population was individuals with high risk factors who initially had refused to be vaccinated against influenza. Professionals (doctors and nurses) who voluntarily accepted to participate were assigned randomly to the intervention group (brief intervention) and the control group (usual advice).Results57 professionals recruited 524 people who had previously declined the influenza vaccination (271 in the control group and 253 in the intervention group). Brief intervention showed its effectiveness with an odds ratio of 2.48 (1.61-3.82; p < 0.001), in individuals aged 60 or over, both healthy or with risk factors. The most frequent reasons for rejection of vaccination were the belief that there was no risk of getting sick (53.0%) and the fear of the side effects (33.3%).ConclusionsBrief intervention is an effective tool in improving vaccination coverage in people who have initially rejected it.     

Enhancing influenza immunization. Postcard and telephone reminders and the challenge of immunization site shift

OBJECTIVE: To determine if postcard and telephone reminders increased the rate of influenza immunization of Medicare beneficiaries. DESIGN: Before and after trial (postcard reminders) with systematically allocated control group (telephone reminder intervention). SETTING: A semirural family practice residency program. PATIENTS AND OTHER PARTICIPANTS: All 475 noninstitutionalized persons older than 65 years who had received at least 1 office service in the previous 2 years. INTERVENTION: In September 1996, each of 475 patients received a postcard urging prompt influenza immunization. Those not responding within 1 month were systematically allocated either to a group receiving further telephone contact or to a control group. At the time of telephone contact, any offered information about influenza immunization received outside the Smoky Hill Family Practice Center, Salina, Kan, was recorded. MAIN OUTCOME MEASURES: We measured the percentage of change in practice-administered influenza immunizations compared with the baseline rate of the preceding 2 years; the difference in immunization rates between the telephone intervention group and controls; and the number of patients contacted by telephone who reported receiving influenza immunization at a site other than the Family Practice Center. RESULTS: Twenty-eight percent of patients who received a postcard obtained office influenza immunizations within 1 month, but no additional immunizations could be attributed to the telephone intervention. Thirty-five percent of patients contacted by telephone reported receiving influenza immunization at a site other than the Family Practice Center. CONCLUSIONS: The postcard intervention was associated with a significant increase in the office immunization rate. This increase may have been confounded by "site shift" in which individuals came to the office for an immunization that they might otherwise have received at other community sites.     

Improving influenza vaccination performance in an HMO setting: the use of computer-generated reminders and peer comparison feedback.

We evaluated a program for improving influenza immunization performance in a health maintenance organization (HMO). The HMO implemented several interventions successively from 1984-87: a postcard reminder to members at high risk for complications of influenza, a computer-generated reminder to the physician at the time of any primary care visit by high-risk patients, performance feedback to chiefs of service, and, finally, retrospective feedback to each physician comparing his/her performance with that of the other physicians. We examined immunization rates for a group of members older than age 65, a high-risk group under age 65, and a group of diabetic members who had not been subject to the reminders (vs a group who had been covered by the program). Vaccination rates were increased in those diabetic members who received reminders. Nevertheless, among members younger and older than age 65 whose experience was observed over three flu seasons, a significant increase in vaccination rates was not achieved until physician feedback was added to the program. We conclude that each element of the reminder and feedback program has contributed to the overall increase in vaccination rates at the HMO and that effective ongoing influenza immunization programs can be implemented in practice settings with appropriate systems support.     

Randomized Trial of a Program to Increase Staff Influenza Vaccination in Primary Care Clinics

PURPOSE Although vaccination of health care workers against influenza is widely recommended, vaccination uptake is low. Data on interventions to increase staff immunization in primary care are lacking. We examine the effect of a promotional and educational intervention program, not addressing vaccine availability, to raise the influenza vaccination rate among staff in primary care clinics.METHODS The study included all 344 staff members with direct patient contact (physicians, nurses, pharmacists, and administrative and ancillary staff) in 27 primary care community clinics in the Jerusalem area during the 2007–2008 influenza season. Thirteen clinics were randomly selected for an intervention that consisted of a lecture session given by a family physician, e-mail-distributed literature and reminders, and a key figure from the local staff who personally approached each staff member.RESULTS Influenza immunization rate was 52.8% (86 of 163) in the intervention group compared with 26.5% (48 of 181) in the control group (P<.001). When compared with the rate of immunization for the previous season, the absolute increase in immunization rate was 25.8% in the intervention clinics and 6.6% in the control clinics. Multivariate analysis showed a highly significant (P<.001) independent association between intervention and immunization, with an odds ratio of 3.51 (95% confidence interval, 2.03–6.09).CONCLUSION We have developed an effective intervention program to increase previously low vaccination rates among primary health care workers. This simple intervention could be reproduced easily in other clinics and organizations with an expected substantial increase in influenza immunization rates.     

The efficacy and problems with influenza vaccination among hospital workers

PURPOSE: The purposes of this study were: (1) to assess the therapeutic and side effects of influenza vaccination during a winter season by comparison of vaccinated and non-vaccinated subjects; and (2) to survey their willingness to receive vaccination in the future based on their experience with the present vaccination. METHOD: The subjects were 185 vaccinated hospital workers and 450 unvaccinated city office workers. We explained to the first group the desirability of receiving vaccination for the purpose of preventing in-hospital infections and received informed consent before administering influenza vaccinations. There were five subjects who did not receive any vaccination due to strong side effects from previous vaccinations or who did not give consent. We then examined the therapeutic and side effects of the vaccination with the vaccinated subjects. A questionnaire was also filled out by both groups of subjects regarding their physical condition and whether they wished to receive vaccination in the future. In this study, the criterion for influenza was a fever of 38.5 degrees C or higher while common cold was concluded with a fever under 38.5 degrees C. RESULTS AND DISCUSSION: The percentage of subjects who subsequently developed influenza symptoms was 13.2% for the vaccinated group whereas that for the unvaccinated group was 33.2%. The difference was significant (P < 0.01). There was no significant difference in the frequency of common cold symptoms between the two groups. According to the vaccinated group's self-report (through the questionnaire; n = 159), 16 subjects (10%) suffered some kind of side effects after the vaccination. In terms of their desire to receive vaccination the following year, in the vaccinated group, 25% of those who reported side effects wanted vaccination the following year whereas 86% of those who did not report side effects wanted vaccination. The difference was significant (P < 0.01). CONCLUSION: The significantly lower percentage of vaccinated subjects with influenza symptoms may have been due to the vaccination effect. The prevalence of side effects (10%) was rather low. Although a relatively high percentage of the vaccinated subjects wished to receive vaccination in the following year, the breakdown indicated that only a small number of those with side effects wanted furture vaccination. Even among those with no side effect, there were some (9.1%) who did not desire vaccination in the future. Thus, there seems to be a need for further education regarding the importance of preventing influenza through vaccination.     

Brief education to promote maternal influenza vaccine uptake: A randomized controlled trial

BackgroundAlthough pregnant women are the highest priority group for seasonal influenza vaccination, maternal influenza vaccination rates remain suboptimal. The purpose of this study was to evaluate the effect of a brief education intervention on maternal influenza vaccine uptake.MethodsDuring the 2013–14 and 2014–15 influenza seasons, we recruited 321 pregnant women from the antenatal clinics of 4 out of 8 public hospitals in Hong Kong with obstetric services. Hospitals were geographically dispersed and provided services to pregnant women with variable socioeconomic backgrounds. Participants were randomized to receive either standard antenatal care or brief one-to-one education. Participants received telephone follow-up at 2 weeks postpartum. The primary study outcome was self-reported receipt of influenza vaccination during pregnancy. The secondary outcomes were the proportion of participants who initiated discussion about influenza vaccination with a health care professional and the proportion of participants who attempted to get vaccinated.ResultsCompared with participants who received standard care, the vaccination rate was higher among participants who received brief education (21.1% vs. 10%; p = 0.006). More participants in the education group initiated discussion about influenza vaccination with their HCP (19.9% vs. 13.1%; p = 0.10), but the difference was not statistically significant. Of participants who did not receive the influenza vaccine (n = 271), 45 attempted to get vaccinated. A significantly higher proportion of participants who attempted to get vaccinated were in the intervention group (82.2% vs. 17.8%; p < 0.001). If participants who had attempted vaccination had received the vaccine, vaccination rates would have been substantially higher (44.1% vs. 15%; p < 0.001). Twenty-six participants were advised against influenza vaccination by a healthcare professional, including general practitioners, obstetricians, and nurses.ConclusionAlthough brief education was effective in improving vaccination uptake among pregnant women, overall vaccination rates remain suboptimal. Multicomponent approaches, including positive vaccination recommendations by healthcare professionals, are needed to promote maternal influenza vaccination.Clinical Trial Registration: www.clinicaltrials.gov (NCT01772901).     

Determinants of influenza vaccination in hard-to-reach urban populations

OBJECTIVE: Influenza vaccination rates among disadvantaged minority and hard-to-reach populations are lower than in other groups. We assessed the barriers to influenza vaccination in disadvantaged urban areas. METHODS: We conducted a cross-sectional study, using venue-based sampling, collecting data on residents of eight neighborhoods throughout East Harlem and the Bronx, New York City. RESULTS: Of 760 total respondents, 461 (61.6%) had received influenza vaccination at some point in their life. In multivariable models, having access to routine medical care, receipt of health or social services, having tested positive for HIV, and current interest in receiving influenza vaccination were significantly associated with having received influenza vaccination in the previous year. Of participants surveyed, 79.6% were interested in receiving an influenza vaccination at the time of survey. Among participants who had never previously received influenza vaccination in the past, 73.4% were interested in being vaccinated; factors significantly associated with an interest in being vaccinated were minority race, lower annual income, history of being homeless, being uninsured/underinsured, and not having access to routine medical care. CONCLUSIONS: Participants who are unconnected to health or social services or government health insurance are less likely to have been vaccinated in the past although these persons are willing to receive vaccine if it were available.     

Improving influenza vaccination in chronically ill children using a tertiary-care based vaccination clinic: Is there a role for the live-attenuated influenza vaccine (LAIV)?

BackgroundChildren with underlying medical conditions should receive influenza vaccine (IV) yearly; yet this remains sub-optimal. We aimed to describe our experience with a tertiary-care hospital-based influenza vaccination clinic for this at-risk population.MethodsFrom October to December 2012, 2013, and 2014, we ran an influenza vaccination clinic at the Montreal Children's Hospital, where children with high-risk conditions come for their follow-up. Both injectable IV (IIV) and live-attenuated IV (LAIV) were offered free of charge to patients and their household contacts. Upon vaccination, parents were asked to fill a pre-piloted questionnaire.ResultsWe vaccinated a total of 2640 high-risk children and 1912 household members during the three influenza vaccination seasons. In 2012 and 2013, 631 and 630 patients with chronic illnesses were vaccinated, compared to 1379 in 2014. Caregivers preferred LAIV primarily because no needle was involved (49.0%) and because it was perceived as less painful (46.9%). LAIV was administered to 69% (2012), 55% (2013) and 47% (2014) of high-risk children. The main reason for not receiving LAIV was because it was contra-indicated. A small fraction of children previously vaccinated with LAIV who did not present any contraindication to LAIV opted for IIV: 12/101 (11.8%) in 2013 and 16/272 (5.9%) in 2014. In 2014, this was mainly due to a previous negative experience with LAIV (11/16).ConclusionHaving an influenza vaccination clinic on site at a tertiary care hospital, where children come for their scheduled visits, facilitates yearly influenza vaccination in children with chronic illnesses. LAIV is preferred by caregivers and patients, when not contraindicated.     

A prospective study of influenza vaccination and time to pregnancy

BackgroundAlthough pregnancy planners are a priority group for influenza vaccination in the United States, little is known about the extent to which influenza vaccination affects fecundability.MethodsWe analyzed data from Pregnancy Study Online (PRESTO), an ongoing preconception cohort study of North American pregnancy planners. During June 2013 to August 2019, 8654 female participants and 2137 of their male partners completed a baseline questionnaire and were followed until reported pregnancy, fertility treatment initiation, loss to follow-up, or 12 menstrual cycles of attempt time, whichever came first. At baseline, male and female participants reported whether they received an influenza vaccination in the past year and the date of vaccination. We used proportional probabilities regression models to estimate fecundability ratios (FR) and 95% confidence intervals (CI) comparing those who did and did not report influenza vaccination, adjusting for demographics, anthropometrics, behavioral factors, and medical history.ResultsInfluenza vaccination in the past year was more common among female participants than male participants (47% vs. 37%). FRs were 1.04 (95% CI: 0.98–1.10) for female vaccination and 1.03 (95% CI: 0.93–1.14) for male vaccination. Among the 2137 couples with complete data on both partners, for 40% neither partner was vaccinated, 23% had female-only vaccination, 9% had male-only vaccination, and in 28% both partners were vaccinated. Compared with couples in which neither participant was vaccinated, FRs were 1.13 for female-only vaccination (95% CI: 0.99–1.29), 0.94 for male-only vaccination (95% CI: 0.78–1.12), and 1.07 when both partners were vaccinated (95% CI: 0.94–1.21). When restricted to recent vaccination before peak influenza season, results were similar.ConclusionsOur data indicate no adverse effect of influenza vaccination on fecundability.     

In a prospective observational study, influenza vaccination prevented hospitalization among older home care patients

OBJECTIVE: The aim of the study is (1) to describe the prevalence of vaccination against influenza in older home care patients and (2) to investigate the protective effect of influenza vaccination for hospitalization events. STUDY DESIGN AND SETTING: This is an observational study conducted in four large cohorts of elderly patients in home care during the 1998-1999, 1999-2000, 2000-2001, and 2001-2002 influenza seasons. We analyzed data from the Italian Silver Network Home Care project. A total of 2,201 patients were enrolled in the present study. The main outcome measures were prevalence of vaccination against influenza and the rate of hospitalization according to vaccination status and influenza season. RESULTS: The rate of influenza vaccination was around 48% of the studied sample. During the follow-up including the peak of influenza and the total influenza season, 412 subjects (40%) were hospitalized among vaccinated compared to 610 subjects (59%) among not vaccinated (P<0.001). After adjusting for age, gender, location of home care program, and all the variables significantly different between vaccinated and not-vaccinated subjects, vaccinated subjects were less likely to be hospitalized compared to not-vaccinated subjects (OR, 0.73; 95% CI 0.60-0.90). CONCLUSIONS: Vaccination against influenza has an important prognostic implication for frail geriatric patients living in the community.     

Influenza vaccination rates and motivators among healthcare worker groups.

BACKGROUND: The rate of influenza vaccination among healthcare workers (HCWs) is approximately 40%. Differences in vaccination rates among HCW groups and reasons for accepting or rejecting vaccination are poorly understood. OBJECTIVES: To determine vaccination rates and motivators among different HCW groups during the 2004-2005 influenza season. DESIGN: Cross-sectional survey conducted between July 10 and September 30, 2005. SETTING: Two tertiary care teaching hospitals in an urban center. PARTICIPANTS: Physicians, nurses, nursing aides, and other staff. Surveys were collected from 1,042 HCWs (response rate, 42%). RESULTS: Sixty-nine percent of physicians (n=282) and 63% of medical students (n=145) were vaccinated, compared with 46% of nurses (n=336), 42% of nursing aides (n=135), and 29% of administrative personnel (n=144). Physicians and medical students were significantly more likely to be vaccinated than all other groups (P<.0001). Pediatricians (84%) were more likely than internists (69%) and surgeons (43%) to be vaccinated (P<.0001). Among the HCWs who were vaccinated, 33.4% received the live attenuated influenza vaccine (LAIV) and 66.6% received trivalent inactivated influenza vaccine (TIV). Vaccinated HCWs were less likely than unvaccinated HCWs to report an influenza-like illness (P=.03). Vaccination with LAIV resulted in fewer episodes of influenza-like illness than did receiving no vaccine (P=.03). The most common reason for rejecting vaccination was a concern about availability. Understanding that HCWs may transmit the virus to patients correlated with vaccine acceptance (P=.0004). CONCLUSIONS: Significant differences in vaccination exist among physician specialties and employee groups, and there are inadequate vaccination rates among those with the greatest amount of patient contact, potentially providing a basis for group-specific interventions.     

Acceptance of a post-partum influenza vaccination (cocooning) strategy for neonates in Greece

Young infants are at increased risk for influenza-associated serious illness, onset of complications, utilization of health-care services, and hospitalization. We investigated the feasibility and acceptance of an influenza vaccination (cocooning) strategy by household contacts implemented in a maternity hospital and the neonatal unit of a pediatric hospital in Athens. A total of 224 mothers (mean age: 30.2 years) who gave birth to 242 neonates were studied. Of them, 165 (73.7%) mothers were vaccinated. Multiple logistic regression revealed that statistically significant factors associated with increased vaccination rates among mothers were: being of Roma origin (p-value=0.002), being an immigrant (p-value=0.025), giving birth to a neonate with birth weight <2500g (p-value=0.012), and residing in a family with ≥4 family members (p-value=0.017). Of the 224 fathers, 125 (55.8%) received the influenza vaccine. Fathers of neonates whose mothers were vaccinated had 6-fold higher vaccination rates compared to fathers of neonates whose mothers refused vaccination (p-value<0.001). Overall, influenza vaccine was administered to 348 (46.9%) of a total of 742 household contacts of the 242 neonates. Upon entering the 2011-2012 influenza season, 51 (22.7%) of 224 families had all household contacts vaccinated against influenza (complete cocoon). Among parents, the statement "I do not want to receive the vaccine" was the prevalent reason for declining influenza vaccination, followed by the misconception "I am not at risk for contacting influenza" (41.1% and 38.2%, respectively).     

Interventions over 2 years to increase influenza vaccination of children aged 6-23 months in inner-city family health centers

The purposes of this study were to test the ability of tailored interventions to raise influenza immunization rates and assess the effect on timely receipt of other vaccines. We conducted a before/after trial over 2 years to increase influenza vaccination rates of patients 6-23 months old in five inner-city family health centers serving low-income children with a sixth site as a concurrent control. Influenza vaccination rates improved significantly from a baseline of 4.7-24.7% in the first year and 36.6% in the second year, P < 0.001. The increase in rates was greater in intervention sites than the control site (31.9% versus 25.7%, P = 0.02). In regression analyses of influenza vaccination, intervention year was associated with an odds ratio (OR) of 9.4 (95% confidence interval (CI) = 4.4-20.0) for the first intervention year and OR = 13.4 (95% CI = 6.5-28.0) for the second intervention year. Children vaccinated against influenza were more likely to have received DTaP 3 and MMR within 2 months of the recommended age than children not vaccinated against influenza (P < 0.001).     

Are medical residents a "core group" for future improvement of influenza vaccination coverage in health-care workers? A study among medical residents at the University Hospital of Palermo (Sicily)

Despite international recommendations, vaccination coverage among European healthcare workers, including physicians, is widely recognized as unsatisfactory. In order to plan tailored vaccination campaigns and increase future coverage, we investigated reasons for refusing vaccination and determinants associated with influenza vaccine uptake among young health care workers.A survey was carried out during September and October 2010 on medical residents attending post-graduate Schools of the Medical Faculty at the University of Palermo (Italy). Each participant completed an anonymous web-based questionnaire including items on demographic and occupational characteristics, knowledge, attitudes and behaviours with regard to influenza and influenza vaccination, and main sources of information.A total of 202 (66.9%) out of 302 medical residents participated in the survey. During the 2009-2010 influenza vaccine campaign, 44 residents (21.8%) were vaccinated against seasonal influenza and 84 (41.6%) against pandemic influenza A (H1N1) 2009. For the impending 2010-2011 influenza season, 45 (22.3%) stated their intention to get vaccinated against seasonal influenza, 40 (19.8%) were uncertain and 117 (57.9%) were opposed. Considering themselves to be a high risk group for developing influenza was significantly associated with vaccination against both 2009-2010 seasonal (adj-OR = 1.46; 95% CI = 1.05-2.04) and pandemic A (H1N1) influenza (adj-OR 1.38; 95% CI = 1.08-1.75). Intention to get vaccinated against 2010-2011 seasonal influenza was significantly more frequent in participants who had a high perception of efficacy/safety (adj-OR = 1.49; 95% CI = 1.05-2.12). After adjusting for confounding, vaccinations against seasonal 2009-2010 influenza, pandemic influenza A (H1N1) 2009 and seasonal 2010-2011 influenza were significantly more frequent in residents who were vaccinated against influenza at least once in the previous five influenza seasons.Influenza vaccination among medical residents appears to be habitual, with little comprehension of the rationale and logic for vaccination, including the need to be vaccinated to protect patients from nosocomial influenza infection. Our study suggests the importance of prioritizing residents for vaccination campaigns, as they represent “the future” and include a core group that habitually accepts vaccination.     

Assessment of efficacy and economic impact of an influenza vaccination campaign in the personnel of a health care setting

INTRODUCTION: Although vaccination against influenza is a well-established practice among the elderly in rest homes, in community-dwelling elderly people and in persons with underlying medical conditions associated with a high risk of complications, vaccination of workers is not always considered cost-effective, even though influenza is high on the list of diseases of public health importance. The aim of this study was to evaluate the efficacy and the cost-benefit ratio of an influenza vaccination campaign in health care workers (HCW) of a teaching hospital. METHODS: A group of 423 HCW vaccinated against influenza during the 2002-2003 winter season was compared with a group of subjects not vaccinated, matched for sex and working area. The following outcomes were considered: (i) prevalence of influenza-like illness (ILI); (ii) days of absence from work due to ILL The cost-benefit ratio was calculated with a model using the following indices. indirect benefits (IB), indirect non medical costs (IC) and direct costs (DC). RESULTS: The prevalence of ILI in the non vaccinated group (102 cases out of 423 subjects, 24%) was significantly increased (p < 0.001) compared with vaccinated subjects (64 cases out of 423, 15%). Working days lost for ILI were 516 in the non-vaccinated group versus 315 reported in the vaccinated group. Economic impact evaluation showed a cost of Euro 35,786.88 in vaccinees and of Euro 57,759.52 in the non-vaccinees. The resulting IB was Euro 21,078.64. The DC and IC for vaccination were Euro 2,463.29 and Euro 2,172.53 respectively. The overall cost-benefit ratio (IB/DC+IC) was 4.5. DISCUSSION: The study shows that the influenza vaccination campaign was effective in preventing the influenza syndrome in HCW The economic impact assessment shows a cost-saving with an important cost-benefit ratio. This study suggests that a continuous effort should be recommended to increase the compliance of HCW with vaccination practice both to reduce their chance of becoming infected and for the economic benefits for healthy working adults.     

Improvement in attitudes toward influenza vaccination in medical students following an integrated curricular intervention

Introduction

Vaccination of health care workers (HCW) reduces transmission of influenza among patients, yet uptake of vaccination remains low. If vaccination education is integrated into the early medical school curriculum, will student attitudes toward the vaccine change? The objectives of the study were to: (1) Determine influenza vaccination rates among entering medical students; (2) Assess the attitudes toward influenza vaccination; (3) Evaluate the effects of a multifaceted educational intervention on attitudes to vaccination.

Methods

Entering medical students were surveyed before and after an intervention at the beginning of the influenza season. This intervention provided by an inter-professional team, included education about influenza, importance of vaccination for HCWs, followed by vaccination administration practice, and ended with students vaccinating consenting classmates.

Results

The pre-intervention surveys and intervention were completed by 124 of 125 (99%) students. Pre-intervention survey revealed 60 (48%) of students had been previously vaccinated. Of the vaccinated students 91% had been recommended vaccination by their healthcare provider compared to 43% of non-vaccinated students. More positive attitudes were noted in the vaccinated students compared to non-vaccinated students: importance of vaccination (p < 0.01); HCWs should be vaccinated (p < 0.01); recommendation of vaccine to family and friends (p < 0.01). 97 (78%) students completed post-intervention surveys. Significant improvement in these attitudes was noted post-intervention compared to pre-intervention: importance of vaccination 93% versus 71% (p < 0.01); HCWs should be vaccinated 95% versus 83% (p < 0.01); recommendation to family and friends 93% versus 73% (p < 0.01); comfort with vaccine counseling 92% versus 41%; comfort with vaccine administration 84% versus 22% (p < 0.01).

Conclusion

Educating medical students and promoting the importance of vaccination early in a medical student's career using such an intervention is relatively simple and easily integrated into the curriculum. This intervention was successful in vaccinating all students, and demonstrated a marked positive shift in attitudes toward influenza vaccination.     

Telephone survey assessment of household patterns of influenza vaccination, Twin Cities seven county metro area, 2008-2009

Major national surveys do not collect the influenza vaccination status of all household members, thus limiting current understanding of household influenza vaccination patterns. In an early 2009 telephone survey of 800 households in the metropolitan Minneapolis-St Paul area, household respondents reported the age, gender, and 2008-2009 seasonal influenza vaccination status of all household members. After poststratification to adjust for nonresponse, the full household influenza vaccination rate for multiperson households is 35.2%, partial household influenza vaccination rate is 39.9% and the rate of complete household nonvaccination is 24.9%. Full household influenza vaccination is more common in households with an elderly resident, intermediate in households with a child under 5 years of age, and less common in the remaining households. No household members are vaccinated in approximately 10% of multiperson households with either an elderly adult or young child; the corresponding rate in other households is 32.8%. An estimated 51.4% of households with children over 1 year of age have all children vaccinated against influenza; 43.5% of households with children had no children vaccinated against influenza. Households with younger children are more likely to have all children vaccinated and less likely to have no children vaccinated. We believe this is the first study to describe the prevalence of household influenza vaccination patterns. Continued efforts to monitor and increase household vaccination may be a valuable strategy to protect individuals and communities from influenza.     

Influenza vaccination coverage among health-care personnel --- United States, 2010-11 influenza season

The Advisory Committee on Immunization Practices (ACIP) and the Healthcare Infection Control Practices Advisory Committee recommend that all U.S. health-care personnel (HCP) be vaccinated annually against influenza. Nonetheless, influenza vaccination coverage among HCP in the United States has increased slowly over the past decade; during the 2009-10 influenza season, 61.9% of HCP received seasonal influenza vaccination. To update data with estimates from the 2010-11 influenza season, CDC conducted an Internet-based survey of 1,931 HCP who participated in three online survey panels. This report summarizes the results of that survey, which indicated that overall influenza vaccination coverage among HCP was 63.5% during the 2010--11 influenza season, similar to coverage for the 2009-10 season. Among HCP who reported working at a facility where vaccination was required by their employer, 98.1% were vaccinated. Among HCP without such an employer requirement but who were offered vaccination onsite, greater coverage was associated with a personal reminder from the employer to get vaccinated (69.9%), vaccination availability at no cost (67.9%), and vaccination availability for >1 day (68.8%). Influenza vaccination of HCP is needed to protect patients from HCP-transmitted disease. Maximizing influenza vaccination for all HCP is an important part of any comprehensive infection-control program.