Immunisation of healthcare workers in the Nordic countries: Variation in recommendations and practices and a lack of assessment

Healthcare workers (HCWs) are at increased risk of both exposure and transmission of infectious disease. Two European Union (EU) directives state that health services are responsible for assessing their employees’ potential exposure to infectious diseases and offering immunisation free of charge. We assessed current policy for immunisation of HCWs and the availability of vaccine coverage data in the Nordic countries by surveying national vaccination experts in Denmark, Finland, Iceland, Norway and Sweden, as well as Swedish county medical officers (CMOs). All national experts and 17 of 21 Swedish CMOs responded. All EU countries had transposed the European directives into national law, while Norway and Iceland had similar national legislation. Recommendations or guidelines were issued in Denmark, Finland, Iceland, Norway and 15 of 17 responding Swedish counties. The range of diseases covered differed by countries and Swedish counties. HCW vaccine coverage data were not systematically collected; incomplete estimates were only available for Finland and two Swedish counties. In conclusion, recommendations or guidelines exist in the Nordic countries, but their impact cannot be assessed, as vaccine uptake among HCWs is not currently measured. Systematic collection of data is a necessary step towards improving HCW immunisation policy and practice in the Nordic countries.

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A Community-Based Management of COVID-19 in a Mobile Container Unit

Vaccines ◽

10.3390/vaccines9111362 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1362

Author(s):

Elena Petrova ◽

Timothy Farinholt ◽

Tejas P. Joshi ◽

Hannah Moreno ◽

Mayar Al Mohajer ◽

...

Keyword(s):

Healthcare Workers ◽

Vaccine Coverage ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Air Filtration ◽

Clinical Environment ◽

Mobile Clinic ◽

Community Based ◽

Community Healthcare

Vaccine uptake is a multifactor measure of successful immunization outcomes that includes access to healthcare and vaccine hesitancy for both healthcare workers and communities. The present coronavirus disease (COVID-19) pandemic has highlighted the need for novel strategies to expand vaccine coverage in underserved regions. Mobile clinics hold the promise of ameliorating such inequities, although there is a paucity of studies that validate environmental infection in such facilities. Here, we describe community-based management of COVID-19 through a Smart Pod mobile clinic deployed in an underserved community area in the United States (Aldine, Harris County, TX, USA). In particular, we validate infection control and biological decontamination of the Smart Pod by testing surfaces and the air-filtration system for the COVID-19 virus and bacterial pathogens. We show the Smart Pod to be efficacious in providing a safe clinical environment for vaccine delivery. Moreover, in the Smart Pod, up-to-date education of community healthcare workers was provided to reduce vaccine hesitancy and improve COVID-19 vaccine uptake. The proposed solution has the potential to augment existing hospital capacity and combat the COVID-19 pandemic locally and globally.

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Influenza Vaccination Hesitancy among Healthcare Workers in South Al Batinah Governorate in Oman: A Cross-Sectional Study

Vaccines ◽

10.3390/vaccines8040661 ◽

2020 ◽

Vol 8 (4) ◽

pp. 661

Author(s):

Salah T. Al Awaidy ◽

Zayid K. Al Mayahi ◽

Malak Kaddoura ◽

Ozayr Mahomed ◽

Nathalie Lahoud ◽

...

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Healthcare Workers ◽

Seasonal Influenza ◽

General Medicine ◽

Knowledge Score ◽

Vaccine Uptake ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Increased Risk

Background: Seasonal influenza infections are a major cause of morbidity and mortality worldwide. Healthcare workers (HCWs) are an important target group for vaccination against influenza due to their increased risk of infection and their potential to transmit the infection to their patients, families and communities. The aim of this study was to assess the potential hesitancy and its associated factors towards influenza vaccination amongst HCWs in the South Al Batinah governorate in Oman. Methods: A cross-sectional survey of 390 HCWs with direct or indirect patient contact was conducted in May and June 2019 using a self-administered questionnaire. Associations between HCW characteristics and vaccination status were examined using bivariate and multivariate analyses to identify the likelihood of vaccination against seasonal influenza among HCWs. Results: Overall, 60% of HCWs were vaccinated in the 2018/2019 season; vaccine uptake among nurses was 52% and uptake was higher among women. Self-protection and protection of the community were the most cited reasons for vaccine acceptance, with side effects being the main reason for hesitancy. Vaccinated respondents had a higher mean knowledge score (7.18; standard deviation SD: 2.14) than unvaccinated respondents (6.30; SD: 2.2). Odds of vaccination were highest among respondents who believed influenza vaccine should be mandatory for HCWs (Odds ratio (OR): 2.04 [1.30–3.18]), those working in the general medicine, emergency medicine, or intensive care units (OR: 1.92 [1.20–3.10]), nurses and doctors (OR: 1.75 [1.09–2.79]) and those who believe that HCWs should receive an influenza vaccine (OR: 1.35 [1.07–2.77]). Conclusions: The study provides valuable insights into the enablers and barriers of influenza vaccination practices among HCWs and may inform interventions to increase acceptance of vaccination.

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An Internet-Based Survey of Influenza Vaccination Coverage in Healthcare Workers in China, 2018/2019 Season

Vaccines ◽

10.3390/vaccines8010006 ◽

2019 ◽

Vol 8 (1) ◽

pp. 6 ◽

Cited By ~ 4

Author(s):

Haitao Liu ◽

Yayun Tan ◽

Muli Zhang ◽

Zhibin Peng ◽

Jiandong Zheng ◽

...

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Vaccination Coverage ◽

Healthcare Workers ◽

Online Survey ◽

Vaccine Coverage ◽

National Level ◽

Influence Factors ◽

Multivariate Logistic Regression Analysis ◽

Vaccine Uptake

Influenza vaccination coverage was low among healthcare workers (HCWs) in China. In October 2018, the National Health Commission of China began to require all hospitals to provide free influenza vaccination for HCWs to increase vaccine uptake, and no study on vaccine coverage among HCWs at the national level after the announcement of new policy. This evaluation aims to investigate self-reported influenza vaccination coverage among HCWs and factors that may affect vaccine receipt during the 2018/2019 influenza season. We delivered an opt-in internet panel survey among registered HCWs of DXY forum (the biggest online forum for HCWs in China). The survey was self-administered using a standard questionnaire to collect information on demographics, occupational characteristics, policy implementation, influenza vaccination and influence factors. We conducted multivariate logistic regression analysis to assess factors associated with receipt of influenza vaccine. The response rate of this online survey was 3.6%. The seasonal influenza vaccine coverage reported among HCWs surveyed during the 2018/2019 season was 11.6% (472/4078). Only 19.0% (774/4078) of HCWs surveyed reported free policy in their workplace. Combing free policy and workplace requirement proved to be effective to improve influenza vaccination coverage in HCWs (PR = 6.90, 95% CI: 6.03–7.65). The influenza vaccination coverage among surveyed HCWs in China was low during the 2018/2019 season. To increase future vaccination uptake, we recommend a multi-faceted strategy that include free policy, workplace requirement and promotion, on-site vaccination, and monitoring.

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Vaccination against influenza in pregnant women.

Acta Biochimica Polonica ◽

10.18388/abp.2014_1880 ◽

2014 ◽

Vol 61 (3) ◽

Cited By ~ 3

Author(s):

Lidia Bernadeta Brydak ◽

Aneta Nitsch-Osuch

Keyword(s):

Pregnant Women ◽

Healthcare Workers ◽

Vaccine Coverage ◽

Influenza Infection ◽

Cost Effective ◽

Educational Programme ◽

Care Providers ◽

Increased Risk ◽

Prenatal Care Providers ◽

Serious Disease

Pregnancy places otherwise healthy women at an increased risk of complications arising from an influenza infection. It is suggested that physiological changes such as immunological changes, increased cardiac output and oxygen consumption, as well as lung tidal volume might increase the susceptibility to influenza complications if infection occurs during pregnancy. Immunization of pregnant women against influenza is currently recommended in many countries and has been proven to be safe and effective in reducing rates and severity of the disease in vaccinated mothers and their children. Influenza vaccination is also cost-effective. Nevertheless, influenza vaccine coverage remains low in pregnant women. This might stem from the lack of healthcare workers' education, a feeling among the general public that influenza is not a serious disease and a failure of prenatal care providers to offer the vaccine. In order to protect pregnant women and infants from influenza related morbidity and mortality an educational programme targeting healthcare workers in charge of pregnant women should be implemented.

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Assessment of COVID-19 vaccine acceptance among healthcare workers in Los Angeles

10.1101/2020.11.18.20234468 ◽

2020 ◽

Cited By ~ 1

Author(s):

Adva Gadoth ◽

Megan Halbrook ◽

Rachel Martin-Blais ◽

Ashley Gray ◽

Nicole H. Tobin ◽

...

Keyword(s):

Los Angeles ◽

Healthcare Workers ◽

Vaccine Safety ◽

Vaccine Uptake ◽

Phase Iii ◽

Vaccine Hesitancy ◽

Patient Contact ◽

Political Climate ◽

Increased Risk ◽

Novel Coronavirus

AbstractImportanceHealthcare workers (HCW) are slated to be early recipients of SARS-CoV-2 vaccines due to increased risk of exposure to patients with COVID-19, and will be tasked with administering approved vaccines to the general population. As lynchpins of the vaccination effort, HCWs’ opinions of a vaccine’s safety and efficacy may affect both public perception and uptake of the vaccine. Therefore, it is crucial to understand and address potential hesitancy prior to vaccine administration.ObjectiveTo understand healthcare workers’ attitudes about vaccine safety, efficacy, and acceptability in the context of the COVID-19 pandemic, including acceptance of a novel coronavirus vaccine.Design, Setting, ParticipantsA cross-sectional survey was distributed to participants enrolled in a longitudinal cohort study surveilling SARS-CoV-2 infection among 1,093 volunteer sampled University of California, Los Angeles (UCLA) Health System employees. Surveys were completed online between September 24 and October 16, 2020. In total, 609 participants completed this supplemental survey.ResultsWe averaged a 9-statement Likert scale matrix scored from 1 (“strongly disagree”) to 5 (“strongly agree”) and found respondents overwhelmingly confident about vaccine safety (4.47); effectiveness (4.44); importance, self-protection, and community health (4.67). Notably, 47.3% of respondents reported unwillingness to participate in a coronavirus vaccine trial, and most (66.5%) intend to delay vaccination. The odds of reporting intent to delay coronavirus vaccine uptake were 4.15 times higher among nurses, 2.45 times higher among other personnel with patient contact roles, and 2.15 times higher among those without patient contact compared to doctors. Evolving SARS-CoV-2 science (76.0%), current political climate (57.6%), and fast-tracked vaccine development timeline (83.4%) were cited as primary variables impacting HCW decisions to undergo vaccination. Of note, these results were obtained prior to release of Phase III data from companies manufacturing vaccines in the U.S.Conclusions and RelevanceDespite overall confidence in vaccines, a majority of HCW expressed concerns over a novel coronavirus vaccine. A large proportion plan to delay vaccine uptake due to concerns about expedited development, emerging scientific discoveries, and the political climate. Forthcoming vaccination campaigns must address these unique points of coronavirus vaccine hesitancy in order to achieve adequate vaccine coverage.

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Factors Affecting HBV Vaccination in a Medical Training College in Kenya: A Mixed Methods Study

10.21203/rs.2.15470/v1 ◽

2019 ◽

Author(s):

Anne Maina ◽

Leah Bii

Keyword(s):

Mixed Methods ◽

Hepatitis B ◽

Healthcare Workers ◽

Medical Training ◽

Mixed Methods Study ◽

Vaccine Uptake ◽

Sub Saharan Africa ◽

Hbv Vaccine ◽

Vaccination Recommendations ◽

Increased Risk

Abstract Background: Hepatitis B Virus (HBV) is highly endemic in Sub-Saharan Africa with 70 to 90% of the population becoming infected before the age of 40 years. Healthcare workers (HCWs) including healthcare students (HCSs) are at an increased risk of contracting HBV due to occupational exposure. HCS are especially at a high risk because of their inexperience with infection control procedures and insufficient knowledge about the level of risk when dealing with patients. Despite the availability of an effective vaccine, and its recommendation by Kenya’s Ministry of Health, few HCW and students are vaccinated. The aim of this study was to evaluate the influence of awareness, attitude, practices, and access factors on hepatitis B vaccination uptake by HCS at Kenya Medical Training College (KMTC). Methods: This was a concurrent mixed methods study. For the qualitative arm, a structured questionnaire was used to assess the awareness, knowledge, attitudes and practices towards HBV disease and vaccination. Accessibility of the HBV vaccine in the participating campuses was also assessed. Two FGDs were carried out: one comprised of members of the participating campuses while the second comprised members of staff. Quantitative data was analysed using STATA (version 15) while NVIVO (version 11) was used for qualitative data. Results: Out of 634 students invited to participate in the study, 487 participated (response rate 76.81%). HBV vaccine uptake rate was 76.18% while the non-vaccination rate was 19.10%. Full vaccination was reported by only 21.78% of respondents. The major reason for not receiving the recommended doses was that the vaccine was not available when the students went for it. The qualitative study revealed challenges in the implementation of the vaccination program at KMTC. Conclusions: A clear policy on mandatory vaccination of students and staff is required. In addition, the HBV vaccine should be readily available, affordable and accessible at all times. Regular review of the curricula in medical colleges to include current vaccination recommendations could aid in improving the vaccination status of healthcare workers in particular and the larger community in general.

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Infection control, occupational and public health measures including mRNA-based vaccination against SARS-CoV-2 infections to protect healthcare workers from variants of concern: A 14-month observational study using surveillance data

PLoS ONE ◽

10.1371/journal.pone.0254920 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254920

Author(s):

Annalee Yassi ◽

Jennifer M. Grant ◽

Karen Lockhart ◽

Stephen Barker ◽

Stacy Sprague ◽

...

Keyword(s):

Public Health ◽

Infection Control ◽

Healthcare Workers ◽

Cox Regression ◽

Vaccine Coverage ◽

Severe Disease ◽

Surveillance Data ◽

Control Measures ◽

Vaccine Uptake ◽

Occupational Infection

Background We evaluated measures to protect healthcare workers (HCWs) in Vancouver, Canada, where variants of concern (VOC) went from <1% VOC in February 2021 to >92% in mid-May. Canada has amongst the longest periods between vaccine doses worldwide, despite Vancouver having the highest P.1 variant rate outside Brazil. Methods With surveillance data since the pandemic began, we tracked laboratory-confirmed SARS-CoV-2 infections, positivity rates, and vaccine uptake in all 25,558 HCWs in Vancouver Coastal Health, by occupation and subsector, and compared to the general population. Cox regression modelling adjusted for age and calendar-time calculated vaccine effectiveness (VE) against SARS-CoV-2 in fully vaccinated (≥ 7 days post-second dose), partially vaccinated infection (after 14 days) and unvaccinated HCWs; we also compared with unvaccinated community members of the same age-range. Findings Only 3.3% of our HCWs became infected, mirroring community rates, with peak positivity of 9.1%, compared to 11.8% in the community. As vaccine coverage increased, SARS-CoV-2 infections declined significantly in HCWs, despite a surge with predominantly VOC; unvaccinated HCWs had an infection rate of 1.3/10,000 person-days compared to 0.89 for HCWs post first dose, and 0.30 for fully vaccinated HCWs. VE compared to unvaccinated HCWs was 37.2% (95% CI: 16.6–52.7%) 14 days post-first dose, 79.2% (CI: 64.6–87.8%) 7 days post-second dose; one dose provided significant protection against infection until at least day 42. Compared with community infection rates, VE after one dose was 54.7% (CI: 44.8–62.9%); and 84.8% (CI: 75.2–90.7%) when fully vaccinated. Interpretation Rigorous droplet-contact precautions with N95s for aerosol-generating procedures are effective in preventing occupational infection in HCWs, with one dose of mRNA vaccination further reducing infection risk despite VOC and transmissibility concerns. Delaying second doses to allow more widespread vaccination against severe disease, with strict public health, occupational health and infection control measures, has been effective in protecting the healthcare workforce.

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Infection control, occupational and public health measures including mRNA-based vaccination against SARS-CoV-2 infections to protect healthcare workers from variants of concern: a 14-month observational study using surveillance data

10.1101/2021.05.21.21257600 ◽

2021 ◽

Author(s):

Annalee Yassi ◽

Jennifer M. Grant ◽

Karen Lockhart ◽

Stephen Barker ◽

Stacy Sprague ◽

...

Keyword(s):

Public Health ◽

Infection Control ◽

Healthcare Workers ◽

Cox Regression ◽

Vaccine Coverage ◽

Severe Disease ◽

Surveillance Data ◽

Control Measures ◽

Vaccine Uptake ◽

Occupational Infection

Background: We evaluated measures to protect healthcare workers (HCWs) in Vancouver, Canada, where variants of concern (VOC) went from <1% in February 2021 to >92% in mid-May. Canada has amongst the longest periods between vaccine doses worldwide, despite Vancouver having the highest P.1 variant rate outside Brazil. Methods: With surveillance data since the pandemic began, we tracked laboratory-confirmed SARS-CoV-2 infections, positivity rates, and vaccine uptake in all 25,558 HCWs in Vancouver Coastal Health, by occupation and subsector, and compared to the general population. We employed Cox regression modelling adjusted for age and calendar-time to calculate vaccine effectiveness (VE) against SARS-CoV-2 in fully vaccinated (≥ 7 days post-second dose), partially vaccinated (14 days post vaccine) and unvaccinated HCWs; we also compared with unvaccinated community members of the same age-range. Findings: Only 3.3% of our HCWs became infected, mirroring community rates, with peak positivity of 9.1%, compared to 11.8% in the community. As vaccine coverage increased, SARS-CoV-2 infections declined significantly in HCWs, despite a surge with predominantly VOC; unvaccinated HCWs had an infection rate of 1.3/10,000 person-days compared to 0.89 for HCWs post first dose, and 0.30 for fully vaccinated HCWs. VE compared to unvaccinated HCWs was 37.2% (95% CI: 16.6-52.7%) 14 days post-first dose, 79.2% (CI: 64.6-87.8%) 7 days post-second dose; one dose provided significant protection against infection until at least day 42. Compared with community infection rates, VE after one dose was 54.7% (CI: 44.8-62.9%); and 84.8% (CI: 75.2-90.7%) when fully vaccinated. Interpretation: Predominantly droplet-contact precautions, with N95s required for aerosol generating medical procedures and available as needed according to point-of-care risk assessment, has been a highly effective approach to preventing occupational infection in HCWs, with one dose of mRNA vaccination further reducing infection risk despite VOC and transmissibility concerns. Delaying second doses to allow more widespread vaccination against severe disease, with strict public health, occupational health and infection control measures, has been effective in protecting the healthcare workforce.

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Seasonal influenza vaccination: from hesitancy to social norm

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20210900 ◽

2021 ◽

Vol 9 (3) ◽

pp. 902

Author(s):

Asif Parvez Malik ◽

Sanjeewa Sumathipala

Keyword(s):

High Risk ◽

Influenza Vaccination ◽

Healthcare Workers ◽

Seasonal Influenza ◽

Social Norm ◽

Disease Risk ◽

Vaccine Coverage ◽

Risk Groups ◽

Vaccine Uptake ◽

World Health

Seasonal influenza is of the most globally burdening vaccine-preventable diseases, infecting 3-5 billion people annually and according to the World Health Organisation (WHO) resulting in 250,000 to 500,000 deaths worldwide. Vaccination against influenza and all respiratory infections carries greater emphasis in the light of the COVID-19 pandemic. With added pressure on healthcare systems due to the coronavirus, Qatar is one country that is keen to emphasise the importance of influenza vaccination to prevent potential co-infection causing severe disease especially in high-risk groups. Currently seasonal influenza vaccines protect against 3 or 4 strains with revised data from the WHO twice yearly due to the changing natures of strains helping to maximise efficacy of the vaccines. It is recommended for specific high-risk groups to be prioritised for vaccination, including pregnant women, the elderly, children above 6 months of age, patients with chronic conditions as well as front line healthcare workers with risk of exposure. However, uptake of the vaccine remains low and contributes significantly to the burden of the disease. Barriers to vaccine uptake can be physical, such as unhealthy lifestyles, psychological, such as perception of disease as low-risk, contextual, such as lack of access to vaccinations, or sociodemographic, such as living alone. Vaccine coverage can be increased by knowledge of these barriers and how to address them. The physical barriers highlight the need to support behavioural change in lifestyle in order to increase vaccine uptake. Psychological barriers, usually due to misconceptions, can be addressed with education through public health campaigns and interactions between health professionals and patients. This education is not just a need for patients but also healthcare workers. It is up to healthcare providers and contractors to find ways of addressing contextual and sociodemographic barriers by increasing access to vaccination whether through transport, or home–care etc. A key barrier of those mentioned to vaccination is a lack of knowledge which needs to be addressed though positive discussions about the health benefits of immunisation as well as the traditional idea of disease-risk prevention. Addressing the above barriers will help to increase vaccine uptake, and produce health-conscientious societies where vaccination becomes a social norm.

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Influenza vaccination coverage in a population-based cohort of Australian-born Aboriginal and non-Indigenous older adults

Communicable Diseases Intelligence ◽

10.33321/cdi.2019.43.30 ◽

2019 ◽

Vol 43 ◽

Author(s):

Amalie Dyda ◽

Surendra Karki ◽

Marlene Kong ◽

Heather F Gidding ◽

John M Kaldor ◽

...

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Vaccination Coverage ◽

Torres Strait Islander ◽

Vaccine Coverage ◽

Vaccine Uptake ◽

P Value ◽

Healthy Weight ◽

Medical Risk ◽

Torres Strait

Background: There is limited information on vaccination coverage and characteristics associated with vaccine uptake in Aboriginal and/or Torres Strait Islander adults. We aimed to provide more current estimates of influenza vaccination coverage in Aboriginal adults. Methods: Self-reported vaccination status (n=559 Aboriginal and/or Torres Strait Islander participants, n=80,655 non-Indigenous participants) from the 45 and Up Study, a large cohort of adults aged 45 years or older, was used to compare influenza vaccination coverage in Aboriginal and/or Torres Strait Islander adults with coverage in non-Indigenous adults. Results: Of Aboriginal and non-Indigenous respondents aged 49 to <65 years, age-standardised influenza coverage was respectively 45.2% (95% CI 39.5–50.9%) and 38.5%, (37.9–39.0%), p-value for heterogeneity=0.02. Coverage for Aboriginal and non-Indigenous respondents aged ≥65 years was respectively 67.3% (59.9–74.7%) and 72.6% (72.2–73.0%), p-heterogeneity=0.16. Among Aboriginal adults, coverage was higher in obese than in healthy weight participants (adjusted odds ratio (aOR)=2.38, 95%CI 1.44–3.94); in those aged <65 years with a medical risk factor than in those without medical risk factors (aOR=2.13, 1.37–3.30); and in those who rated their health as fair/poor compared to those who rated it excellent (aOR=2.57, 1.26–5.20). Similar associations were found among non-Indigenous adults. Conclusions: In this sample of adults ≥65 years, self-reported influenza vaccine coverage was not significantly different between Aboriginal and non-Indigenous adults whereas in those <65 years, coverage was higher among Aboriginal adults. Overall, coverage in the whole cohort was suboptimal. If these findings are replicated in other samples and in the Australian Immunisation Register, it suggests that measures to improve uptake, such as communication about the importance of influenza vaccine and more effective reminder systems, are needed among adults.

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