Vaccine history, gender and influenza vaccination in a household context

Background

Few studies have investigated the effect of the history of vaccination on the current influenza vaccine uptake. The objective of this paper is to study the effects of vaccine history, for each sex separately, on the likelihood of vaccine uptake among single-head households and two-person households, controlling not only for the respondents’ own prior vaccination history but also the history of vaccination among possible co-residents.

Materials and methods

We used logistic regression and data from a nationally representative telephone survey of the non-institutionalized Norwegian population aged ≥65 years to estimate our models (N = 354). The survey was carried out in November 2008.

Results

The lowest vaccine uptake was found among those who live alone with no prior history of vaccination and among those who live in two-person households where both members had no prior history of vaccination (10-22%). Those who live in two-person households where both members had previously been vaccinated had the highest vaccine uptake (86%). While a man who has previously been vaccinated has a higher likelihood of continued vaccination if his wife also has a prior history of vaccination, a woman with a prior history of vaccination is not dependent on her husband's prior practice with respect to the probability of continued vaccination. Of those who have no history of vaccination, more women than men are vaccinated for the first time when they have a spouse who has a history of vaccination.

Conclusion

Our study shows that the history of vaccination of a co-resident/spouse has an effect above and beyond the respondent's own vaccination history. The results indicate that there are gender differences in the willingness to encourage family members to be vaccinated or to embark upon a familial vaccination regime in order to protect the individual's own personal health and that of other family members from influenza. To the best of our knowledge such gender differences have never been shown before in research on influenza vaccine uptake. However, the finding is in accordance with a number of studies on the role of gender and the positive effect on health and mortality of social support and social control in marriage.     

Determinants of A (H1N1) vaccination: cross-sectional study in a population of pregnant women in Quebec

Background

Because of the risk of complication, pregnant women were a priority target for vaccination during the A (H1N1) pandemic influenza. In Quebec, 63% of pregnant women were vaccinated, which is a higher rate than vaccination against seasonal influenza. However, the behaviour of pregnant women relative to the vaccination during the H1N1 pandemic is unknown. The present study was aimed at identifying factors influencing the decision-making of pregnant women regarding H1N1 vaccination.

Methods

A cross-sectional survey was conducted in February 2010 in pregnant women or in early postpartum at the Sherbrooke University Hospital Centre using a self-administered questionnaire based on the Health Belief Model (HBM). Data items collected were: socio-demographic data, vaccination status, information sources consulted, knowledge on vaccination, and the HBM dimensions: effectiveness and risks of vaccination, severity and vulnerability towards the influenza. The associations between questionnaire variables and vaccination status were assessed by univariate and multivariate analysis.

Results

Of the 250 women interviewed, 95% knew that the vaccination was recommended, but only 76% received the vaccine. Variables positively associated with vaccination were late vaccination during pregnancy (OR = 7.3, 95% CI 2.1-25.3), belief in the efficacy of the vaccine (OR = 7, 95% CI 2-23.4), and consultation of the Pandémie-Québec website (OR = 4.5, 95% CI 1.5-13.4). However, the belief that the vaccine had not been adequately tested (OR = 0.08, 95% CI 0.02-0.35) and consultation of mainstream websites (OR = 0.22, 95% CI 0.06-0.81) were associated with lower vaccination rates.

Conclusions

The vast majority of pregnant women were aware of the recommendations relative to A (H1N1) vaccination. Internet media played an important role in their decision to get vaccinated. Better information on the safety of the vaccine must be prepared for future pandemics.     

Factors associated with uptake of vaccination against pandemic influenza: a systematic review

Background

In June 2009 a global influenza pandemic was declared by the World Health Organisation. A vaccination programme against H1N1 influenza was introduced in many countries from September 2009, but there was low uptake in both the general population and health professionals in many, though not all, countries.

Purpose

To examine the psychological and demographic factors associated with uptake of vaccination during the 2009 pandemic.

Method

A systematic literature review searching Web of Science and PubMed databases up to 24 January 2011.

Results

37 articles met the study inclusion criteria. Using the framework of Protection Motivation Theory the review found that both the degree of threat experienced in the 2009 pandemic influenza outbreak and perceptions of vaccination as an effective coping strategy were associated with stronger intentions and higher uptake of vaccination. Appraisal of threat resulted from both believing oneself to be at risk from developing H1N1 influenza and concern and worry about the disease. Appraisal of coping resulted from concerns about the safety of the vaccine and its side effects. There was evidence of an influence of social pressure in that people who thought that others wanted them to be vaccinated were more likely to do so and people getting their information about vaccination from official health sources being more likely to be vaccinated than those relying on unofficial sources. There was also a strong influence of past behaviour, with those having been vaccinated in the past against seasonal influenza being more likely to be vaccinated against pandemic influenza. Demographic factors associated with higher intentions and uptake of vaccination were: older age, male gender, being from an ethnic minority and, for health professionals, being a doctor.

Discussion

Interventions designed to increase vaccination rates could be developed and implemented in advance of a pandemic. Strategies to improve uptake of vaccination include interventions which highlight the risk posed by pandemic influenza while simultaneously offering tactics to ameliorate this risk (e.g. vaccination). Perceived concerns about vaccination can be tackled by reducing the omission bias (a perception that harm caused by action is worse than harm caused by inaction). In addition, interventions to increase seasonal influenza vaccination in advance of a future pandemic may be an effective strategy.     

Behavioral change with influenza vaccination: factors influencing increased uptake of the pandemic H1N1 versus seasonal influenza vaccine in health care personnel

Background

Many health care personnel (HCP) choose not to get vaccinated against influenza despite recommendations to do so. The pH1N1 epidemic gave a unique opportunity to evaluate the attitudes to influenza vaccination of a group of HCP who routinely choose not to get vaccinated, but accepted the pH1N1 vaccine.

Methods

HCP employed at a tertiary care hospital in Winnipeg, Canada who received the pH1N1 vaccine were invited to participate in an online survey asking about attitudes and experiences regarding seasonal and pH1N1 influenza and vaccination. Those eligible included primarily nurses, other clinical staff, and support staff, as few physicians work as employees.

Results

Of the 684 respondents (29% return rate), 504 reported routinely getting vaccinated (RV) for seasonal influenza and 180 reported routinely not getting vaccinated (NRV). These two groups had different attitude towards the two strains of influenza, with markedly lower level of concern about seasonal influenza than pH1N1 for the NRV group. The contrast was especially notable regarding the NRV's view of the seriousness of the illness, their sense of exposure risk, and their confidence in the vaccine effectiveness (for all, seasonal < pH1N1, p < 0.001). The most common motivators for getting vaccinated for both NRV and RV groups related to concerns about personal or family safety, while the choice to decline seasonal vaccination related primarily to lack concern about the illness and concerns about vaccine effectiveness and safety. Coworkers were influential in the decision to get the pH1N1 vaccine for the NRV group.

Conclusion

For HCP who do not routinely get the seasonal vaccination, perception of risk outweighing side effect concerns appeared to be a major influence in going ahead with the pH1N1 vaccine. Educational campaigns that focus on personal benefit, engage peer champions, and address concerns about the vaccine may improve influenza vaccine uptake among health care personnel.     

Health care professionals’ awareness of,knowledge about and attitude to influenza vaccination

Objectives

Influenza vaccination is recommended to all health care professionals (HCPs). However, vaccination rate among HCPs is low and may be due to uncertainty about the effectiveness of the vaccine and fear of its adverse effects. Therefore, this study aimed to investigate the awareness, knowledge, and attitude of HCPs towards influenza vaccination and we ascertain reasons for not getting vaccinated.

Method

A cross-sectional conducted in 6 major hospitals in Saudi Arabia. 245 anonymous questionnaires were distributed to a convenient sample of staff during the 2012–2013 influenza season. The validated questionnaire consists of five sections that collect information about: demographics, attitude towards influenza vaccination, knowledge about influenza virus and vaccination, current practice and awareness of published guidelines.

Results

242 completed questionnaires were received, a response rate of 98%. 38% of HCPs reported getting vaccinated. The most common reasons given by HCPs for not getting vaccinated were: fear of contracting illness (16%), belief that they are not at risk from influenza because they are young and healthy (13%) and being unaware of vaccine availability (13%). Non-availability of vaccine (43%) was the highest barrier for not providing vaccine for patients and HCPs followed by safety concerns for the patients (35%) and the respondents (33%). Almost 75% of HCPs were not aware of the influenza immunization guidelines published by the Advisory Committee on Immunization Practices and Centre for Disease Control.

Conclusion

Despite the recommendations, only low percentage of HCPs in Saudi Arabian hospitals is vaccinated against influenza. The attention of health policy makers is needed to improve compliance of HCPs with guidelines on influenza vaccination.     

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.     

The expected emotional benefits of influenza vaccination strongly affect pre-season intentions and subsequent vaccination among healthcare personnel

Background

The relative importance of different attitudes in predicting vaccination among healthcare personnel (HCP) is unclear. We hypothesized that HCP who feel at risk without vaccination or say they would regret not getting vaccinated would be more likely to get vaccinated than HCP who do not expect these emotional benefits.

Methods

A prospective cohort of 1544 HCP with direct patient care was enrolled from September 18 to December 18, 2010 at Scott &; White Healthcare in Texas and Kaiser Permanente Northwest in Oregon and Washington. An Internet-based questionnaire assessed pre-season intention to be vaccinated and included 12 questions on attitudes about vaccination: single-item measures of perceived susceptibility and vaccine effectiveness, 5 items that were summed to form a concerns about vaccine scale, and 5 items summed to form an emotional benefits of vaccination scale. Influenza vaccination status for the 2010–2011 season and for 5 prior seasons was confirmed by medical record extraction.

Results

There were significant differences between vaccinated and unvaccinated HCP on all attitude items; 72% of vaccinated HCP agreed that they “worry less about getting the flu” if vaccinated, compared to only 26% of the unvaccinated (odds ratio = 7.4, 95% confidence interval = 5.8–9.5). In a multivariate model, the emotional benefits scale was the strongest predictor of 2010–2011 seasonal influenza vaccination, after adjusting for other attitude measures, prior vaccination history, and pre-season intention to be vaccinated. The predictive value of the emotional benefits scale was strongest for HCP with low pre-season intention to be vaccinated, where HCP vaccine receipt was 15% versus 83% for those with low versus high scores on the emotional benefits scale.

Conclusions

The expected emotional benefits of vaccination strongly affect seasonal influenza vaccination among HCP, even after taking into account other attitudes, pre-season intentions, and prior vaccination history. These attitudes are promising targets for future vaccination campaigns.     

Factors influencing uptake of influenza A (H1N1) vaccine amongst healthcare workers in a regional pediatric centre: lessons for improving vaccination rates

Background

Influenza A (H1N1) vaccination has been recommended for all frontline healthcare workers (HCWs) in the UK since October 2009, to protect individuals and their patients from infection. Understanding the factors influencing vaccine uptake by HCW may improve future vaccination programmes in current and subsequent years.

Aims

To assess the uptake of influenza A (H1N1) vaccine, and factors affecting vaccine uptake, in frontline healthcare workers in a large pediatric hospital.

Method

A cross-sectional questionnaire survey conducted in a regional Pediatric Hospital in Scotland incorporating intensive care and ECMO services. One page, anonymised questionnaires were distributed to all frontline HCW in high risk departments of the hospital.

Results

260 questionnaires were completed, capturing an estimated 52% of all staff. Vaccination rate was 49.6%, and was significantly higher amongst doctors (OR 2.4, 95% CI 1.3-4.5, P = 0.005). Commonest reasons for vaccine uptake were high risk of contact with H1N1 (88%) and responsibility to protect patients (71%). Uncertainty about vaccine side-effects (47%), concern about vaccine safety (33%) and being too busy to attend the vaccine clinic (22%) were the commonest reasons for non-vaccination. Reasons for vaccination varied between staff grouping and department. 36% of non-vaccinated staff would accept the vaccine if offered.

Conclusions

Vaccine uptake may be increased by addressing HCW knowledge and attitudes and access to vaccine. Future vaccination programmes should include targeted education and vaccine delivery, at the convenience of staff, and in their own department.     

Influenza vaccination motivators among healthcare personnel in a large acute care hospital in Israel

Background

Vaccinating healthcare personnel (HCP) against influenza is important to prevent transmission and morbidity among patients and staff.

Methods

We conducted an online survey assessing knowledge, perceptions and attitudes concerning influenza vaccination among HCP. Multivariate logistic regression was performed to identify independent predictors of vaccination.

Results

The survey was completed by 468 HCP representing all categories of staff. Doctors believed that vaccination was the best way to prevent influenza and perceived the vaccine less harmful as compared to nurses and allied health professionals. Getting vaccinated was associated with a greater likelihood of recommending vaccination to patients: 86 % vs. 54 % in vaccinated and unvaccinated HCP, respectively. Reasons for vaccine refusal were fear of needles (19 %); fear of side effects (66 %) and lack of time (16 %). In the multivariate analysis, survey items that were independently associated with vaccination were beliefs that: vaccine effectively prevents influenza (OR 4.07 95 % CI 2.51, 6.58); HCP are at increased risk of influenza (OR 2.82 95 % CI 1.56, 5.13); vaccine can cause influenza (OR 0.41 95 % CI 0.25, 0.65); contracting influenza is likely in the absence of vaccination (OR 1.96 95 % CI 1.12, 3.42); and that HCP might transmit influenza to their family (OR 4.54 95 % CI 1.38, 14.97). The belief that HCP might transmit influenza to patients was not independently associated with vaccine uptake.

Conclusion

Our study revealed misconceptions and knowledge gaps concerning the risk of influenza and the influenza vaccine. There were significant differences in knowledge and attitudes between healthcare professions. HCP decline vaccination because they do not perceive a personal risk of influenza infection and are concerned about side effects. Thus, in order to increase vaccination rates it is important to educate HCP to correct misconceptions concerning vaccine efficacy and safety, while promoting the benefit of getting vaccinated in order to protect themselves and their families.

     

Factors associated with continued adherence to influenza vaccination in the elderly

Objective

We aimed to analyze the factors influencing continued adherence to influenza vaccination in elderly persons vaccinated in the preceding season.

Methods

Using a population-based vaccination registry, we evaluated the proportion of persons vaccinated against influenza in Navarre, Spain, in the 2010-11 season among non-institutionalized persons aged 65 years or over who had been vaccinated in the 2009-10 season. Logistic regression was used to analyze the influence of sociodemographic, clinical and health care factors.

Results

Of the 64,245 persons vaccinated against influenza in the 2009-10 season, 87% were vaccinated in the 2010-11 season. Continued adherence to vaccination increased with the number of physician visits per year. It was lower in women, in the 65-69 and ≥ 95 year age-groups, in those hospitalized or diagnosed with any major chronic condition in the previous year, and in persons with hematological cancer or dementia. Health districts and physicians with higher coverage in the previous season continued to have higher adherence in the following season.

Conclusions

People vaccinated against influenza in one season tend to be vaccinated in the following one. Sociodemographic, clinical and health care factors have a moderate effect on the continuity of vaccination, with the most important factor being the treating physician.     

Knowledge and intention to participate in cervical cancer screening after the human papillomavirus vaccine

Background

If women who receive the human papillomavirus (HPV) vaccine are unduly reassured about the cancer prevention benefits of vaccination, they may choose not to participate in screening, thereby increasing their risk for cervical cancer. This study assesses adult women's knowledge of the need to continue cervical cancer screening after HPV vaccination, describes Pap test intentions of vaccinated young adult women, and evaluates whether knowledge and intentions differ across groups at greatest risk for cervical cancer.

Methods

Data were from the 2008 Health Information National Trends Survey (HINTS) and the 2008 National Health Interview Survey (NHIS), which initiated data collection approximately 18 months after the first FDA approval of an HPV vaccine. We calculated associations between independent variables and the outcomes using chi-square tests.

Results

Of 1586 female HINTS respondents ages 18 through 74, 95.6% knew that HPV-vaccinated women should continue to receive Pap tests. This knowledge did not vary significantly by race/ethnicity, education, income, or healthcare access. Among 1101 female NHIS respondents ages 18-26 who had ever received a Pap test, the proportion (12.7%; n = 139) who reported receipt of the HPV vaccine were more likely than those not vaccinated to plan to receive a Pap test within three years (98.1% vs. 92.5%, p < 0.001).

Conclusions

US adult women possess high knowledge and intention to participate in Pap testing after HPV vaccination. The vast majority of young adult women who received the HPV vaccine within its first two years on the market intend to participate in cervical cancer screening in the near future. Future studies are needed to examine whether those vaccinated in adolescence will become aware of, and adhere to, screening guidelines as they become eligible.     

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

Background

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

Methods

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

Results

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

Conclusion

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

Characteristics associated with the uptake of influenza vaccination among adults in the United States

Objective

Existing data suggest that influenza vaccination rates among adults in the United States fall far short of the Healthy People 2010 goals and the updated Healthy People 2020 targets. We identified characteristics associated with influenza vaccination that might inform strategies for increasing coverage.

Methods

We used data from the 2009 Behavioral Risk Factor Surveillance System to estimate adjusted prevalence ratios for receiving the influenza vaccine in the past 12 months.

Results

Among 134,101 adults aged ≥ 65 years, the influenza vaccination coverage level was 68.9%. Among 286,867 younger adults aged 18-64 years, coverage was markedly lower: 31.8%. Having health care coverage was the strongest predictor of vaccination in both age groups, after accounting for other sociodemographic characteristics, health behaviors, and health status. Those reporting older age, white race, higher education, non-smoking status, being physically active, or having poor physical health or a personal history of various chronic conditions were also more likely to report having received the influenza vaccine.

Conclusion

Our results show clearly that vaccine uptake in the United States is related to social position as well as other health behaviors. These findings call for renewed attention to vaccination strategies to meet the updated Healthy People 2020 goals.     

Efficacy of dual vaccination of pandemic H1N1 2009 influenza and seasonal influenza on institutionalized elderly: a one-year prospective cohort study

Background

The influenza A (H1N1) 2009 pandemic was declared by the WHO in April 2009. In Hong Kong, the vaccination program began in December 2009 in addition to the annual seasonal trivalent influenza vaccination program. The clinical efficacy of dual vaccination was unknown.

Method

From December 2009 to November 2010, a prospective 12-month cohort study on institutionalized elderly of nine nursing homes was conducted. Elderly persons who were followed up by the Hong Kong West Community Geriatric Assessment Team and had been vaccinated by the Department of Health were included. Outcome measures included all cause mortality, all cause hospitalization, hospitalization for fever on admission and hospitalization for pneumonia based on ICD-9-CM.

Results

711 elderly persons were included. 274 received both seasonal influenza vaccine and (H1N1) 2009 vaccine (H1N1-TIV), 368 received seasonal influenza vaccine only (TIV alone) and 69 received no vaccination (unvaccinated). Baseline characteristics were well matched between the groups, except there were fewer females in the TIV alone. The 12-month mortality rates of the H1N1-TIV, TIV alone and unvaccinated were 10.6%, 19.8% and 29%, respectively. Multivariate analysis demonstrated that dual vaccination in the institutionalized elderly significantly reduced all cause mortality by 54% (Hazard Ratio [HR] 0.46; 95% confidence interval [CI] 0.29-0.72; p < 0.001) and 74% (HR 0.26; CI 0.13-0.49; p < 0.001), compared with vaccination of seasonal vaccination alone and no vaccination, respectively. Dual vaccination also reduced all cause hospitalization, hospitalization for fever on admission and hospitalization for pneumonia compared with seasonal vaccination alone and the unvaccinated group.

Conclusion

Dual vaccination with both H1N1 and seasonal vaccinations provided additional protection to institutionalized elderly in reducing mortality and hospitalization.     

Seasonal influenza vaccination in adults: practice and attitudes about collaborative delivery with community vaccinators

Background

Less than half of adults for whom seasonal influenza vaccine is recommended receive the vaccine. Little is known about physician willingness to collaborate with community vaccinators to improve delivery of vaccine.

Objectives

To assess among general internists and family medicine physicians: (1) seasonal influenza vaccination practices, (2) willingness to collaborate with community vaccinators, (3) barriers to collaboration, and (4) characteristics associated with unwillingness to refer patients to community sites for vaccination.

Design

Mail and Internet-based survey.

Setting

National survey conducted during July-October 2009.

Participants

General internists and family medicine physicians.

Measurements

Survey responses on vaccination practices, willingness to collaborate to deliver vaccine and barriers to collaboration.

Results

Response rates were 78% (337/432 general internists) and 70% (298/424 family medicine physicians). Ninety-eight percent of physicians reported giving influenza vaccine in their practice during the 2008-2009 season. Most physicians reported willingness to refer certain patients to other community vaccinators such as public clinics or pharmacies (79%); to collaborate with public health entities in holding community vaccination clinics (76%); and set up vaccination clinics with other practices (69%). The most frequently reported barriers to collaboration included concerns about record transfer (24%) and the time and effort collaboration would take (21%). Reporting loss of income (RR 1.40, 95% CI 1.03-1.89) and losing opportunities to provide important medical services to patients with chronic medical conditions (RR 1.77, 95% CI 1.25-2.78) were associated with unwillingness to refer patients outside of the practice for vaccination.

Limitations

Surveyed physicians may not be representative of all physicians.

Conclusions

The majority of physicians report willingness to collaborate with other community vaccinators to increase influenza vaccination rates although some will need assurance that collaboration will be financially feasible and will not compromise care. Successful collaboration will require reliable record transfer and must not be time consuming.     

Determinantes de la vacunación antigripal en personal sanitario, temporada 2009-2010

Objectives

To determine vaccination coverage against seasonal influenza and the new A (H1N1) influenza virus among healthcare personnel during the 2009-2010 season and to identify its determining factors.

Methods

We performed a cross-sectional study among healthcare staff at the General University Hospital in Alicante (Spain) during the 2008-2009 and 2009-2010 influenza vaccination campaigns. The 2009-2010 vaccination campaign was subdivided into two phases. In the first phase, from 1st October to 19th November, 2009, the seasonal influenza vaccine was administered; in the second phase, from 16th November to 30th December, 2009, vaccination against the new A (H1N1) influenza virus was performed. Each of the vaccine programs was preceded by a specific vaccination promotion campaign. Healthcare staff were asked to complete a brief self-administered questionnaire containing a list of reasons for being vaccinated. Coverage during both vaccination campaigns was calculated, and the results, both overall and for each profession, were then compared using a Chi-square test.

Results

Coverage against seasonal influenza was 31% and that against the new A (H1N1) influenza virus was 22.2% (p < 0.05); these percentages were 36% and 34% respectively in medical personnel (NS), 33% and 24% respectively in nursing personnel (p < 0.001), and 21% and 12% respectively in nursing assistants (p < 0.001). The main reason given for being vaccinated was self-protection.

Conclusions

The low coverage achieved is a public health problem. Specific intervention programs should be implemented.     

Contact and communication with healthcare providers regarding influenza vaccination during the 2009-2010 H1N1 pandemic

Objective

The existence of two vaccines—seasonal and pandemic—created the potential for confusion and misinformation among consumers during the 2009-2010 vaccination season. We measured the frequency and nature of influenza vaccination communication between healthcare providers and adults for both seasonal and 2009 influenza A(H1N1) vaccination and quantified its association with uptake of the two vaccines.

Methods

We analyzed data from 4040 U.S. adult members of a nationally representative online panel surveyed between March 4th and March 24th, 2010. We estimated prevalence rates and adjusted associations between vaccine uptake and vaccination-related communication between patients and healthcare providers using bivariate probit models.

Results

64.1% (95%-CI: 61.5%-66.6%) of adults did not receive any provider-issued influenza vaccination recommendation. Adults who received a provider-issued vaccination recommendation were 14.1 (95%-CI: − 2.4 to 30.6) to 32.1 (95%-CI: 24.3-39.8) percentage points more likely to be vaccinated for influenza than adults without a provider recommendation, after adjusting for other characteristics associated with vaccination.

Conclusions

Influenza vaccination communication between healthcare providers and adults was relatively uncommon during the 2009-2010 pandemic. Increased communication could significantly enhance influenza vaccination rates.     

Acute disseminated encephalomyelitis following influenza vaccination

Introduction

Approximately 5% of cases of acute disseminated encephalomyelitis are preceded by vaccination within 1 month prior to symptom onset. This occurs rarely following influenza immunization.

Methods

Case presentation and literature review.

Results

A 75-year-old woman developed acute disseminated encephalomyelitis within 3 weeks of receiving the seasonal influenza vaccine. The patient subsequently passed away, despite treatment with methylprednisolone and plasma exchange therapy.

Conclusions

The literature on post-influenza vaccination encephalomyelitis is limited. The majority of published cases had favourable outcomes following treatment with intravenous methylprednisolone. Given the limited number of cases, no incidence estimates have been published.