High influenza vaccination coverage among healthcare workers in acute care hospitals in Finland,seasons 2017/18, 2018/19 and 2019/20

BackgroundInfluenza vaccination is widely recommended for healthcare workers (HCWs) in European countries, but the coverage is not always satisfactory. In Finland, a new act was introduced in March 2017, according to which it is the employer’s responsibility to appoint only vaccinated HCWs for servicing vulnerable patients.AimWe determined the influenza vaccination coverage among HCWs in Finnish acute care hospitals in three influenza seasons after introduction of the act.MethodsWe analysed data collected by an internet-based survey sent annually to all Finnish acute care hospitals and described the influenza vaccination coverage among HCWs during seasons 2017/18, 2018/19 and 2019/20. We calculated mean coverage per healthcare district and season.ResultsIn season 2017/18, 38 of 39 hospitals, in 2018/19, 35 of 36 hospitals and in 2018/19 31 of 33 hospitals provided data. The mean influenza vaccination coverage was 83.7% (SD: 12.3) in season 2017/18, 90.8% (SD: 8.7) in 2018/19 and 87.6% (SD: 10.9) in season 2019/20. There was no significant increase or decrease in the mean coverage across the three seasons. The differences between districts were only significant in 2018/19 (p < 0.005).ConclusionsThe coverage of influenza-vaccinated HCWs in Finnish hospitals was high in all three seasons and the current legal situation (semi-mandatory system) in Finland seems to provide a good background for this. Data collection should be maintained and improved for further monitoring.     

Attitude et croyances du personnel soignant en Médecine Interne vis-à-vis de la vaccination antigrippale saisonnière : étude transversale descriptive

IntroductionThe rate of vaccination in HCWs in France remains low. We aimed to analyze the attitude and beliefs of HCWs toward influenza vaccination in Internal Medicine wards.MethodsWe conducted a cross-sectional survey of HCWs in the departments of Internal Medicine of two tertiary hospitals in France. An anonymous questionnaire designed for this study was used to collect demographic, health beliefs and attitudes, and medical knowledge related to the influenza and influenza vaccine. The survey started shortly prior the 2019 influenza season.ResultsThe surveys were completed by 158 (29[18–62] years-old ; 75.9% female ; 69.6% non-medical workers) of 187 (84.5%) HCWs. Overall, influenza vaccination coverage rate was 50.6% (n = 80/158). Higher vaccination coverage was found in physician and in HCWs who had a better knowledge about the virus transmission. The reason to fulfill vaccination recommendations was to protect the patients, their relatives and themselves for more than 80% of HCWs compliant to vaccination recommendation. More than a third of HCWs (n = 59/158; 37.3%) refused to be vaccinated or hesitated. Among them, 12 (12/59, 20.3%) believed that influenza vaccine could cause flu. The main reasons for reluctant HCWs to eventually accept to be vaccinated were a mandatory vaccination program and the demonstration of a better vaccine efficacy to prevent the disease.ConclusionInfluenza vaccination coverage among HCWs in Internal Medicine remains low. Education campaigns targeting in priority nurses and nurse assistants is mandatory to improve the compliance of HCWs to vaccination recommendation.     

Influenza Vaccination Coverage Rates in 5 European Countries: a Population-Based Cross-Sectional Analysis of the Seasons 02/03, 03/04 and 04/05

Abstract Introduction: Influenza continues to be a considerable health problem in Europe. Vaccination is the only preventive measure, reducing mortality and morbidity of influenza in all age groups Objectives: The objective of this survey was to assess and compare the level of influenza vaccination coverage during three consecutive influenza seasons (02/03, 03/04, 04/05) in the five European countries United Kingdom, France, Italy, Germany and Spain, understand the driving forces and barriers to vaccination now and 3 years ago and determine vaccination intentions for the following winter. Methods: We conducted a random-sampling, telephone-based household survey among non-institutionalized individuals representative of the population aged 14 and over. The surveys used the same questionnaire for all three seasons. The data were subsequently pooled. Four target groups were determined for analysis: (1) persons aged 65 and over; (2) people working in the medical field; (3) persons suffering from chronic illness and (4) a group composed of persons aged 65 and over or working in the medical field or suffering from a chronic illness. Results: The overall sample consisted of 28,021 people. The influenza vaccination coverage rate increased from 21.0% in season 02/03 to 23.6% in season 03/04 and then to 23.7% in season 04/05. The differences between the seasons are statistically significant (p = 0.01). The highest rate over all countries and seasons had Germany in season 04/05 with 26.5%, Spain had in season 02/03 with 19.3% the lowest rate totally. The coverage rate in the target group composed of person's aged 65 and over or working in the medical field or suffering from a chronic illness was 49.7% in season 02–04 and 50.0% in season 04/05. The driving forces and barriers to vaccination did not change over the years. The most frequent reasons for being vaccinated given by vaccines were: influenza, considered to be a serious illness which people wanted to avoid, having received advise from the family doctor or nurse to be vaccinated and not wanting to infect family and friends. Reasons for not being vaccinated mentioned by people who have never been vaccinated were: not expecting to catch influenza, not having considered vaccination before and not having received a recommendation from the family doctor to be vaccinated. Options encouraging influenza vaccination are: recommendation by the family doctor or nurse, more available information on the vaccine regarding efficacy and tolerance and more information available about the disease. The adjusted odds ratio of receiving influenza vaccine varied between 2.5 in Germany and 6.3 in the United Kingdom in any risk group. Conclusion: The vaccination coverage rate increased from the first season (21.0%) to the third season (23.7%) by 2.6%. The family doctor is the most important source of encouragement for people to be vaccinated against influenza. It seems that the public would be more likely to be vaccinated if they had more information on the efficacy and tolerance of the vaccine, as well as the disease. We therefore suggest that family doctors be better informed on influenza vaccine and the disease itself, so that they can actively inform their patients on these topics.     

Predictors of influenza vaccination in adults with chronic bronchitis

Influenza vaccination is recommended for people with chronic bronchitis (CB) because they have a higher risk of influenza-related complications, hospitalizations, and death during seasonal influenza epidemics.This study sought to evaluate influenza vaccination coverage among adults with CB and analyze the factors (predictors) linked to compliance with vaccination recommendations.Individual data from adults aged ≥40 years included in the Spanish Health Survey conducted in 2006 were used. Subjects were classified as chronic bronchitis sufferers if they answered affirmatively to the question: “has your doctor told you that you are currently suffering from chronic bronchitis?”. To assess influenza vaccination status we used the question, “did you have a flu shot in the latest campaign?”. Independent variables analyzed included sociodemographic, health-related variables, self-reported presence of other concomitant chronic diseases, and use of health-care services.The percentage of subjects who were reported to be suffering from CB was 6.6% (N = 1320, 95% CI 6.2–6.9%). The influenza vaccination coverage among CB sufferers was 63.6% compared with 48.6% for nonsufferers (p < 0.05). The predictors significantly associated with a higher likelihood of receiving the vaccine among adult CB sufferers were: higher age; male gender; nonsmoker or ex-smoker status; doing physical exercise; and suffering from concomitant asthma or diabetes.We conclude that influenza vaccination coverages among Spanish adults suffering from CB are below desirable levels; thereby making it necessary for strategies to be implemented aimed at improving the use of influenza vaccine among such patients.     

Impact of Vaccinating HCWs on the Ward and Possible Influence of Avian Flu Threat

Abstract Background:   The aim of the study was to evaluate the impact of a 2-year vaccination program on the compliance of healthcare workers (HCWs) employed in an acute care university hospital to influenza vaccination. Materials and Methods:   The study was carried out in October/November from 2004 to 2006 in a 286-bed acute care university hospital located in northern Italy employing 523 HCWs. The study cohort consisted of 473 HCWs continuously present in the hospital from 2004 to 2006. In 2005 and 2006, a vaccination campaign was made available in the wards that supplemented a pre-existing (2004) employee health service program. A personalized informative letter was sent to all HCWs explaining the risks and benefits of influenza vaccination for both patients and HCWs and indicating the scheduling of the additional vaccination service. Results:   The additional 2005 and 2006 campaigns produced significantly higher vaccination rates among HCWs than those achieved in previous years, from 10.4% in 2004 to 36.6% in 2005 and 23.2% in 2006. The year 2005 was characterized by an avian flu threat, which likely accounted for the highest vaccination rate of the 3-year study period. Physicians had the highest vaccination rates in the 3-year period (20.8%), while nurses in 2005 had the highest single vaccination rate (42.5%). Conclusions:   Providing easy access to vaccination in the wards is a useful approach for improving vaccination rates among HCWs, but further tailored interventions are needed because overall vaccination rates remain too low. Subgroups, such as nurses and ancillary staff, should be considered as specific targets of such vaccination programs.     

Influenza Vaccination Compliance Among Health Care Workers in a German University Hospital

Abstract Background:   Since 1988, the Standing Committee on Vaccination (STIKO) at the Robert Koch-Institute, Berlin, has explicitly recommended that health-care workers (HCWs) should be vaccinated against seasonal influenza. However, acceptance of the influenza vaccination by medical personnel is low. Methods:   This study analyzes factors associated with the compliance of HCWs with the seasonal influenza vaccination on the basis of three different anonymized questionnaires during two consecutive influenza seasons: 2006/2007 and 2007/2008. The questionnaires covered details of demographics, frequency of previous vaccinations, reasons for accepting or declining the vaccination, and the HCW’s knowledge of the influenza vaccine and influenza itself. Results:   Our study showed that physicians were significantly more likely to have been vaccinated than nurses (38.8% vs 17.4%; p < 0.0001). The main reasons for noncompliance included: supposition of a low risk of infection, fear of side effects, the belief that the influenza vaccine might trigger the influenza virus infection, and scepticism about the effectiveness of the influenza vaccination. Conclusion:   Our findings confirm the importance of a comprehensive approach to the vaccination, ensuring that HCWs are correctly informed about the vaccine and that it is convenient to receive it.     

Where adults reported receiving influenza vaccination in the United States

BACKGROUND: Influenza vaccination coverage remains unacceptably low among persons aged > or =65 years and younger high-risk adults. This study assessed locations at which US adults receive influenza (flu) vaccinations and the relative roles that traditional and nontraditional vaccination settings play in influenza vaccine delivery. METHODS: We analyzed data on types of settings at which last flu shot was received, reported by adult respondents to the 1999 Behavioral Risk Factor Surveillance System, stratified by age group and medical condition. We used multivariable logistic regression to identify factors associated with nontraditional vaccination settings. RESULTS: In 1998-1999, reported influenza vaccination coverage was 19% for persons aged 18-49 years, 36% for persons aged 50-64 years, and 67% for persons aged > or =65 years. Seventy percent of flu shots received by persons aged > or =18 years were reportedly administered in doctors' offices and other traditional settings. Vaccination in nontraditional settings (eg, workplace, stores, community centers) was more likely for young, healthy, employed, white, college-educated adults who had not had a recent routine checkup. CONCLUSION: Physicians should offer vaccination services at every opportunity. Increasing access to vaccination services in nontraditional settings should be considered as another strategy in pursuit of national vaccination coverage objectives.     

Low tetanus-diphtheria-acellular pertussis (Tdap) vaccine coverage among healthcare workers in a quaternary university hospital in São Paulo,Brazil: need for continuous surveillance and implementation of active strategies

IntroductionVaccination with tetanus-diphtheria-acellular pertussis (Tdap) has been recommended for healthcare workers (HCWs) by Brazilian Ministry of Health since November 2014.ObjectiveTo describe the strategies implemented to improve Tdap uptake, cumulative vaccine coverage after each intervention, variables associated to Tdap vaccination, and reasons for non-vaccination among HCWs of the main building of a quaternary hospital attached to the Sao Paulo University Medical School.MethodsA list of HCWs eligible for pertussis vaccination was generated. From April to December 2015, the following interventions were implemented: note on intern journal reminding the importance of pertussis vaccination; email to the head nurses strengthening vaccine recommendations; lectures on pertussis and Tdap for physicians of Obstetrics and Neonatology Clinics; on-site vaccination by mobile teams at the Obstetrics, Neonatology, and Anesthesiology Clinics. Vaccine coverage was accessed at the end of each month. Multivariate Poisson regression model with a robust error variance was used to evaluate variables associated with Tdap vaccination. Reasons for non-vaccination were evaluated from January to May 2017 through phone calls for HCWs who had not received Tdap.ResultsThe study included 456 HCWs. After the interventions, Tdap coverage raised from 2.8% to 41.2%. In the multivariate analysis, occupation (physician), working place (obstetrics or anesthesiology) and influenza vaccination in 2015 were independently associated to Tdap vaccination. The main reason for non-vaccination was unawareness of Tdap recommendations.ConclusionsTdap uptake among HCWs was low in our hospital. Providing vaccination at convenient places/times for HCW seems to be the most efficient strategy to increase vaccine uptake.     

Influenza hospitalizations in Australian children 2010–2019: The impact of medical comorbidities on outcomes,vaccine coverage,and effectiveness

BackgroundChildren with comorbidities are at greater risk of severe influenza outcomes compared with healthy children. In Australia, influenza vaccination was funded for those with comorbidities from 2010 and all children aged <5 years from 2018. Influenza vaccine coverage remains inadequate in children with and without comorbidities.MethodsChildren ≤16 years admitted with acute respiratory illness and tested for influenza at sentinel hospitals were evaluated (2010–2019). Multivariable regression was used to identify predictors of severe outcomes. Vaccine effectiveness was estimated using the modified incidence density test‐negative design.ResultsOverall, 6057 influenza‐confirmed hospitalized cases and 3974 test‐negative controls were included. Influenza A was the predominant type (68.7%). Comorbidities were present in 40.8% of cases. Children with comorbidities were at increased odds of ICU admission, respiratory support, longer hospitalizations, and mortality. Specific comorbidities including neurological and cardiac conditions increasingly predisposed children to severe outcomes. Influenza vaccine coverage in influenza negative children with and without comorbidities was low (33.5% and 17.9%, respectively). Coverage improved following introduction of universal influenza vaccine programs for children <5 years. Similar vaccine effectiveness was demonstrated in children with (55% [95% confidence interval (CI): 45; 63%]) and without comorbidities (57% [(95%CI: 44; 67%]).ConclusionsComorbidities were present in 40.8% of influenza‐confirmed admissions and were associated with more severe outcomes. Children with comorbidities were more likely experience severe influenza with ICU admission, mechanical ventilation, and in‐hospital morality. Despite demonstrated vaccine effectiveness in those with and without comorbidities, vaccine coverage was suboptimal. Interventions to increase vaccination are expected to reduce severe influenza outcomes.     

Spotlight influenza: Estimation of influenza vaccine effectiveness in elderly people with assessment of residual confounding by negative control outcomes,Finland, 2012/13 to 2019/20

BackgroundCohort studies on vaccine effectiveness are prone to confounding bias if the distribution of risk factors is unbalanced between vaccinated and unvaccinated study subjects.AimWe aimed to estimate influenza vaccine effectiveness in the elderly population in Finland by controlling for a sufficient set of confounders based on routinely available register data.MethodsFor each of the eight consecutive influenza seasons from 2012/13 through 2019/20, we conducted a cohort study comparing the hazards of laboratory-confirmed influenza in vaccinated and unvaccinated people aged 65–100 years using individual-level medical and demographic data. Vaccine effectiveness was estimated as 1 minus the hazard ratio adjusted for the confounders age, sex, vaccination history, nights hospitalised in the past and presence of underlying chronic conditions. To assess the adequacy of the selected set of confounders, we estimated hazard ratios of off-season hospitalisation for acute respiratory infection as a negative control outcome.ResultsEach analysed cohort comprised around 1 million subjects, of whom 37% to 49% were vaccinated. Vaccine effectiveness against laboratory-confirmed influenza ranged from 16% (95% confidence interval (CI): 12–19) to 48% (95% CI: 41–54). More than 80% of the laboratory-confirmed cases were hospitalised. The adjusted off-season hazard ratio estimates varied between 1.00 (95% CI: 0.94–1.05) and 1.08 (95% CI: 1.01–1.15), indicating that residual confounding was absent or negligible.ConclusionSeasonal influenza vaccination reduces the hazard of severe influenza disease in vaccinated elderly people. Data about age, sex, vaccination history and utilisation of hospital care proved sufficient to control confounding.     

Influenza vaccination of persons with cardiovascular disease in the United States

People who have cardiovascular disease are at increased risk of hospitalization or death associated with influenza infection, and are included among the high-risk groups for whom annual influenza vaccination is recommended. To measure the progress toward the national year 2000 and 2010 objectives of a 60% annual influenza vaccination of adults with high-risk conditions aged 18 to 64 years, we analyzed data from the 1997 to 2001 National Health Interview Surveys (NHIS) regarding persons with cardiovascular disease. The NHIS is an annual, cross-sectional survey representative of the U.S., noninstitutionalized, civilian population. Estimated percentages of persons with heart disease reporting influenza vaccination were relatively stable during the 1996-97 through 2000-2001 influenza seasons, with the highest levels in most groups occurring in 1999-2000: 49.2% (95% confidence interval [CI], 44.1%-54.3%) among persons aged 50 to 64 years; and 22.7% (95% CI, 18.2%-27.2%) among persons aged 18 to 49 years. Influenza vaccine coverage among adults aged 18 to 64 years with cardiovascular disease is substantially below the national objective. Multiple strategies are needed to improve vaccination coverage, such as increasing the awareness of and demand for vaccination by persons with heart disease; increasing implementation by providers of practices that have been shown to increase vaccination levels; and adopting of influenza vaccination by primary care providers and specialists as a standard of care for persons diagnosed with cardiovascular disease.     

Mask-wearing and respiratory infection in healthcare workers in Beijing,China

ObjectivesThe aim of the study was to determine rates of mask-wearing, of respiratory infection and the factors associated with mask-wearing and of respiratory infection in healthcare workers (HCWs) in Beijing during the winter of 2007/2008.MethodsWe conducted a survey of 400 HCWs working in eight hospitals in Beijing by face to face interview using a standardized questionnaire.ResultsWe found that 280/400 (70.0%) of HCWs were compliant with mask-wearing while in contact with patients. Respiratory infection occurred in 238/400 (59.5%) subjects from November, 2007 through February, 2008. Respiratory infection was higher among females (odds ratio [OR], 2.00 [95% confidence interval {CI}, 1.16-3.49]) and staff working in larger hospitals (OR, 1.72 [95% CI, 1.09-2.72]), but was lower among subjects with seasonal influenza vaccination (OR, 0.46 [95% CI, 0.28-0.76]), wearing medical masks (reference: cotton-yarn; OR, 0.60 [95% CI, 0.39-0.91]) or with good mask-wearing adherence (OR, 0.60 [95% CI, 0.37-0.98]). The risk of respiratory infection of HCWs working in low risk areas was similar to that of HCWs in high risk area.ConclusionOur data suggest that female HCWs and staffs working in larger hospitals are the focus of prevention and control of respiratory infection in Beijing hospitals. Mask-wearing and seasonal influenza vaccination are protective for respiratory infection in HCWs; the protective efficacy of medical masks is better than that of cotton yarn ones; respiratory infection of HCWs working in low risk areas should also be given attention.     

Live‐attenuated influenza vaccine effectiveness against hospitalization in children aged 2–6 years,the first three seasons of the childhood influenza vaccination program in England, 2013/14–2015/16

IntroductionIn 2013, the United Kingdom began to roll‐out a universal annual influenza vaccination program for children. An important component of any new vaccination program is measuring its effectiveness. Live‐attenuated influenza vaccines (LAIVs) have since shown mixed results with vaccine effectiveness (VE) varying across seasons and countries elsewhere. This study aims to assess the effectiveness of influenza vaccination in children against severe disease during the first three seasons of the LAIV program in England.MethodsUsing the screening method, LAIV vaccination coverage in children hospitalized with laboratory‐confirmed influenza infection was compared with vaccination coverage in 2–6‐year‐olds in the general population to estimate VE in 2013/14–2015/16.ResultsThe overall LAIV VE, adjusted for age group, week/month and geographical area, for all influenza types pooled over the three influenza seasons was 50.1% (95% confidence interval [CI] 31.2, 63.8). By age, there was evidence of protection against hospitalization from influenza vaccination in both the pre‐school (2–4‐year‐olds) (48.1%, 95% CI 27.2, 63.1) and school‐aged children (5–6‐year‐olds) (62.6%, 95% CI 2.6, 85.6) over the three seasons.ConclusionLAIV vaccination in children provided moderate annual protection against laboratory‐confirmed influenza‐related hospitalization in England over the three influenza seasons. This study contributes further to the limited literature to date on influenza VE against severe disease in children.     

Factors associated with influenza vaccination among healthcare workers in acute care hospitals in Canada

Background

Influenza vaccine coverage rates among healthcare workers (HCWs) in acute care facilities in Canada remain below national targets.

Objective

To determine factors associated with influenza vaccine uptake among HCWs.

Methods

This secondary analysis of a prospective cohort study included HCWs aged 18‐69 years, working ≥20 h/wk in a Canadian acute care hospital. Questionnaires were administered to participants in the fall of the season of participation (2011/12‐2013/14) which captured demographic/household characteristics, medical histories, occupational, behavioural and risk factors for influenza. Generalized estimating equation logistic regression was used to determine factors associated with vaccine uptake in the season of participation.

Results

The adjusted odds ratio for influenza vaccination in the current season was highest for those vaccinated in 3 of 3 previous seasons (OR 156; 95% CI 98, 248) followed by those vaccinated in 2 of 3 and 1 of 3 previous seasons when compared with those not vaccinated. Compared with nurses, physicians (OR 4.2; 95% CI 1.4, 13.2) and support services staff (OR 1.8; 95% CI 1.3, 2.4) had higher odds ratios for vaccine uptake. Conversely, HCWs identifying as Black had lower odds of uptake compared with those with European ancestry (OR 0.44, 95% CI 0.26‐0.75) when adjusted for other factors in the model.

Conclusion

Healthcare workers differ in their annual uptake of influenza vaccine based on their past vaccination history, occupation and ethnicity. These findings indicate a need to determine whether there are other vaccine‐hesitant groups within healthcare settings and learn which approaches are successful in increasing their uptake of influenza vaccines.     

The potential economic value of influenza vaccination for healthcare workers in The Netherlands

Background

Despite the clinical evidence, influenza vaccination coverage of healthcare workers remains low. To assess the health economic value of implementing an influenza immunization program among healthcare workers (HCW) in University Medical Centers (UMCs) in the Netherlands, a cost‐benefit model was developed using a societal perspective.

Methods/Patients

The model was based on a trial performed among all UMCs in the Netherlands that included both hospital staff and patients admitted to the pediatrics and internal medicine departments. The model structure and parameters estimates were based on the trial and complemented with literature research, and the impact of uncertainty explored with sensitivity analyses.

Results

In a base‐case scenario without vaccine coverage, influenza‐related annual costs were estimated at € 410 815 for an average UMC with 8000 HCWs and an average occupancy during the influenza period of 6000 hospitalized patients. Of these costs, 82% attributed to the HCWs and 18% were patient‐related. With a vaccination coverage of 15.47%, the societal program’s savings were € 2861 which corresponds to a saving of € 270.53 per extended hospitalization. Univariate sensitivity analyses show that the results are most sensitive to changes in the model parameters vaccine effectiveness in reducing influenza‐like illness (ILI) and the vaccination‐related costs.

Conclusion

In addition to the decreased burden of patient morbidity among hospitalized patients, the effects of the hospital immunization program slightly outweigh the economic investments. These outcomes may support healthcare policymakers’ recommendations about the influenza vaccination program for healthcare workers.     

Long-Term Persistence of Seroprotection by Hepatitis B Vaccination in Healthcare Workers of Southern Italy

Background

The impact of hepatitis B virus (HBV) vaccination campaigns on HBV epidemiology needs to be evaluated, in order to assess the long-term immunity offered by vaccines against HBV.

Objectives

To evaluate the current status of anti-HBV vaccine coverage among healthcare workers (HCWs) in Southern Italy, and to determine the long-term persistence of antibodies to hepatitis B surface antigens (anti-HBs) in such a cohort of subjects.

Patients and Methods

A longitudinal, retrospective seroepidemiological survey was conducted among 451 HCWs, who were working at or visiting, the Occupational Health Department of a city hospital, in Catania, Italy, between January 1976 and December 2010.

Results

At the 30-year follow-up (mean follow-up 10.15 ± 5.96 years, range 0.74-30), 261 HCWs had detectable anti-HBs titers indicating a persistence of seroprotection of 89.4% (out of 292 anti-HBs positive results, three months after vaccination). An inadequate vaccination schedule was the strongest predictor of antibody loss during follow-up (OR = 8.37 95% CI: 5.41-12.95, P < 0.001). A Kaplan-Maier survival curve revealed that the persistence of anti-HBs 30 years after vaccination, was 92.2% for high responders, while it was only 27.3% for low responders (P = 0.001).

Conclusions

A good level of seroprotection persisted in 57.9% of the subjects after 30 years. Factors related to this immunization status confirmed the importance of vaccinating HCWs early in their careers and ensuring an adequate vaccination schedule. However, with particular reference to the low rate of hepatitis B vaccine coverage among HCWs in Southern Italy, the implementation of a new educational intervention as part of an active vaccination program is needed.     

Influenza Vaccination in Patients With Congenital Heart Disease in the Pre-COVID-19 Era: Coverage Rate,Patient Characteristics,and Outcomes

BackgroundInfluenza vaccination is the most commonly recommended immune prevention strategy. However, data on influenza vaccination in patients with congenital heart disease (CHD) are scarce. In this study, our goals were to: (1) measure vaccination coverage rates (VCRs) for influenza in a large cohort of children, adolescents, and adults with CHD; (2) identify patient characteristics as predictors for vaccination; and (3) investigate the effect of influenza vaccination on hospitalization.MethodsA nationwide cohort study in Belgium included 16,778 patients, representing 134,782 vaccination years, from the Belgian Congenital Heart Disease Database Combining Administrative and Clinical Data (BELCODAC). Data over 9 vaccination years (2006-2015) were used, and patients were stratified into 5 age cohorts: 6 months to 4 years; 5-17 years; 18-49 years; 50-64 years; and 65 years and older.ResultsIn the respective age cohorts, the VCR was estimated to be 6.6%, 8.0%, 23.9%, 46.6%, and 72.8%. There was a steep increase in VCRs as of the age of 40 years. Multivariable logistic regression showed that higher anatomical complexity of CHD, older age, presence of genetic syndromes, and previous cardiac interventions were associated with significantly higher VCRs. Among adults, men had lower and pregnant women had higher VCRs. The association between influenza vaccination and all-cause hospitalization was not significant in this study.ConclusionsThe influenza VCR in people with CHD is low, especially in children and adolescents. Older patients, particularly those with complex CHD, are well covered. Our findings should inform vaccination promotion strategies in populations with CHD.     

Knowledge,attitude, and practices about the seasonal influenza vaccination among healthcare workers in Srinagar,India

Please cite this paper as: Bali NK et al. (2012) Knowledge, attitude, and practices about the seasonal influenza vaccination among healthcare workers in Srinagar, India. Influenza and Other Respiratory Viruses 7(4), 540–545. Background Healthcare workers (HCWs) universally have a poor uptake of influenza vaccination. However, no data are available from India. Objective To explore knowledge, attitudes, and practices associated with influenza vaccination in HCWs in a temperate climate area in northern India. Patients and Methods A self‐administered questionnaire was offered to all HCWs in three major hospitals of Srinagar and information sought on motivations, perceptions, preferences and practices regarding influenza vaccination. Results Of the 1750 questionnaires received, 1421 (81%) were returned. Only 62 (4·4%) HCWs had ever received influenza vaccination even as 1348 (95%) believed that influenza poses adverse potential consequences for themselves or their contacts; 1144 (81%) were aware of a vaccine against influenza and 830 (58%) of its local availability. Reasons cited by 1359 participants for not being vaccinated included ignorance about vaccine availability (435; 32%), skepticism about efficacy (248; 18%), busy schedule (166; 12%), fear of side effects (70; 4%), and a perception of not being‐at‐risk (82; 6%). Sixty‐one percent (865) believed that vaccine programs are motivated by profit. Eighty‐eight percent opined for mandatory vaccination for HCWs caring for the high‐risk patients, as a part of ‘employee health program’. Most of the participants intended to get vaccinated in the current year even as 684 (48%) held that vaccines could cause unknown illness and 444 (31%) believed their adverse effects to be underreported. Conclusion Influenza vaccination coverage among HCWs is dismally low in Srinagar; poor knowledge of vaccine availability and misperceptions about vaccine effectiveness, fear of adverse effects and obliviousness to being‐at‐risk being important barriers. Multifaceted, adaptable measures need to be invoked urgently to increase the coverage.     

COVID-19 vaccination among cirrhotics in Italy: High coverage and effectiveness of 3 doses versus 2 in preventing breakthrough infection and hospitalization

Background and AimsFew reports, all retrospective, have evaluated vaccine coverage against COVID-19 infection in cirrhotic subjects. No data are available for European Countries. We aimed to explore this topic and potential independent predictors of lack of vaccination.MethodsBetween January 1st and June 30th 2022, 1512 cirrhotic subjects of any etiology were consecutively enrolled in an observational - prospective study in 8 referral centers in Italy. Adjusted Odds Ratios (O.R.) for the association with lack of vaccination and with occurrence of breakthrough infection were evaluated by multiple logistic regression analysis.ResultsOverall vaccine coverage was 89.7% (80% among people born abroad). Among the 1358 vaccinated people, 178 (13.1%) had a breakthrough infection; of them 12 (6.7%) were hospitalized, but none died. Independent predictors associated with lack of vaccination were birth abroad, age <65 years and lower years of schooling. Child stage B/C was the only independent predictor of breakthrough infection. Occurrence of breakthrough infection was more likely reported in subjects who received 2 doses of vaccine than in those who received 3 doses (33.9% versus 9.0%; P<0.001).ConclusionHigh vaccine coverage against COVID-19 infection is observed among cirrhotic subjects in Italy. Vaccine is effective in preventing severe outcomes. Three doses are more effective than two, even in cirrhotic subjects.Lay SummaryThis large cohort study evidenced high vaccine coverage against COVID-19 infection among cirrhotic subjects in a European country and the effectiveness of vaccine in preventing severe outcomes. Three doses of vaccine are more effective than two in preventing breakthrough infection and hospitalization. Informative campaigns targeting people younger than 65 years of age and those with lower years of schooling may increase these excellent results.     

Faible taux de couverture vaccinale contre la grippe des sujets âgés hospitalisés en France

PurposeAnnual influenza epidemics is still a major cause of illness and mortality especially in the elderly. Annual vaccination is the most effective way to prevent disease and reduce hospitalizations and deaths related to influenza in the elderly population. In France, there are few data available about vaccination coverage of elderly at risk for influenza. The aim of the study was to measure the influenza vaccination coverage and assess traceability in the elderly (≥ 75 years old) admitted to hospital.MethodsIn participating French hospitals, each patient aged 75 years or more, hospitalized in acute units of internal medicine, geriatric and infectious disease, was included in a multicentric point prevalence survey.ResultsBetween April and May 2011, 63 departments of 28 hospitals participated and 903 patients were included (mean age of included patients: 85 years): 82% were previously living at home and 13% were institutionalized. Most of them had multiple diseases (77%) and 21% were admitted for a respiratory disease: 58% were vaccinated against influenza. A back-up for traceability was identified in 53% of cases. Patient refusal may be a common determinant of non-vaccination, as well as non-proposal by the attending physician. The vaccination rate did not differ according to usual living place including accommodation facilities in geriatric.ConclusionCoverage for influenza vaccination is low in hospitalized elderly patients and traceability is insufficient. This vaccine, noncompliance mostly linked to the refusal of patients, is a worrisome public health problem, on which physicians and hospital staff in charge, as well as institutions, should turn attention toward a multi-professional preventive strategy against the morbidity risk of this infectious disease.