Elsevier

Vaccine

Volume 26, Issue 20, 12 May 2008, Pages 2482-2489
Vaccine

Influenza vaccination among primary healthcare workers

https://doi.org/10.1016/j.vaccine.2008.03.011Get rights and content

Summary

Influenza vaccination of health care workers (HCW) is widely recommended, but immunization rates are low. In order to assess performance among primary HCW and identify barriers, we conducted a survey among the staff of 27 primary care community clinics in Jerusalem. The low rate of vaccination (30.2%) was in contrast with the large proportion of HCW who considered it desirable to immunize primary health clinic staff (72.1%). Physicians reported having been immunized significantly more (p = 0.008) than the rest of the staff. They also had better knowledge and more favorable attitude towards immunization. Also associated (independently of profession) with performance of immunization were age (p < 0.001), knowledge (that immunization can not cause influenza, p = 0.051), attitude (the belief that it is desirable to immunize primary HCW, p < 0.001), previous years’ performance of immunization (p < 0.001) and a physician's recommendation (p = 0.042). A media scare which occurred during the vaccination period was reported to have influenced the decision not to get immunized of 34.1% of HCW who had not been immunized. The study results raise hope of prospective increase in vaccination through educational and technical interventions and by increasing physician involvement.

Introduction

Influenza is a known major cause of morbidity and mortality, especially among the very young, the elderly and the chronically ill [1], [2]. The benefit of immunization against influenza is well documented [3]. Health care workers (HCW), because of their close proximity to patients, are especially exposed to infections and are also potential sources of infection to their patients. Influenza vaccination of HCW has been shown to be effective in protecting their patients [4], [5], [6] and themselves from influenza infection and to reduce their absenteeism during the influenza season [7], [8]. Many health authorities and organizations recommend routine vaccination of HCW [9], [10]. However, in contrast to the relatively successful implementation of immunization programs among the elderly and other high risk groups, uptake among HCW has been low [11].

In an attempt to better understand this low compliance among HCW, a number of studies have examined HCW knowledge and attitude and reasons for taking or for not taking the vaccination. These previous studies were conducted mainly in hospitals and long term institutions. Our study, conducted in the primary care setting, addresses these issues in the context of the community. In this context, staff immunization may have a smaller effect on direct infectivity from and to patients, but a larger effect on patient immunization behavior. Physicians who receive immunization are more likely to recommend it more strongly to their patients [12], [13].

The influenza season of 2006–2007, after which we conducted our survey, was notable for the effect of prominent media reporting of a number of deaths which occurred in people who had been immunized against influenza. Though there was no connection found between these events and the immunization, the scare caused a significant reduction in public compliance with immunization recommendations [14]. We, therefore, also examined the effect of these reports on HCW.

The work settings of the HCW in our study were primary care community clinics incorporating physician, nursing, pharmacy and office services. All sites offered the staff free immunization on site.

Section snippets

Methods

A self-administered questionnaire was distributed in 2007, after the influenza season, among the staff of 27 primary care community clinics in the Jerusalem area. The self-administered questionnaire, addressing issues of performance of influenza immunization and knowledge and attitudes concerning it, was distributed on site to all primary care physicians, nurses, pharmacists and administrative and ancillary workers, all working with direct patient contact. The survey included questions about

Results

A total of 275 workers, 71.8% of the staff (of 383), returned the questionnaire. The response rate was relatively low among the pharmacists (53.5%), but otherwise there were no apparent statistically significant differences between responders and non-responders (examined for age, sex and chronic disease). We also compared influenza immunization rates among responders and non-responders based on institutional data (these data may be less accurate but the comparison would detect major selection

Discussion

The reported low HCW influenza immunization rates of 30.2% and 41.2% for the last and previous seasons illustrate the dismal compliance with recommendations. However, they also present opportunity for investigation and improvement. These low compliance rates are in accord with reports on HCW immunization in other countries [11], [16], [17]. The large proportion of HCW who considered it desirable to immunize primary health clinic staff (72.1%, including 88.3% of physicians) is in contrast with

Acknowledgements

We would like to thank Dr. Ohad Avni and Dr. Ian Miskin for initiating the effort to increase primary HCW influenza immunization, of which this study is the first step. We would also like to thank the administrative data assistants for their technical help with the questionnaires.

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