The COVID States Project #62: COVID-19 vaccine attitudes among healthcare workers

The vaccination status of healthcare workers is of particular importance, for two key reasons:First, healthcare workers have been a harbinger of trends among the broader population through the entire vaccination campaign, as they were among the first to gain access to vaccines. The early inequalities in terms of access among healthcare workers were predictive of inequalities within the broader population. The divides in terms of vaccine skepticism presaged those of the broader population; and, as we will see below, the plateauing of vaccination rates anticipated the slowdown in vaccinations within the broader population.Second, the vaccine decisions of healthcare workers have particular ramifications with respect to the spread of COVID-19, and, especially, with respect to morbidity and mortality resulting from COVID-19. In particular, unvaccinated healthcare workers are potentially a vector of infection of the elderly and the vulnerable, who have been vastly more likely to die of the disease.A recent outbreak in a nursing home in Kentucky is illustrative. Despite the fact that over 90% of the residents had been fully vaccinated, only 53% of the healthcare workers had been. In a subsequent outbreak, 31% of residents were infected (more than two third of whom had been vaccinated); and 33% of healthcare workers (20% of whom had been vaccinated). Two residents died as a result. In short, the low vaccination rate of the healthcare workers supplied the kindling for the outbreak. The question going forward is to what extent might this occur in other healthcare settings around the country.Healthcare institutions thus face critical decisions regarding the vaccination of their employees. In late July, the Department of Veterans Affairs issued a vaccine mandate for all its frontline health care workers. A joint statement by nearly 60 major medical organizations called for mandatory vaccination of healthcare workers. Brown University's School of Public Health built a Hospital Vaccine Mandate Tracker to gather and list hospital systems that require their staff to be vaccinated. Many more institutions have announced that they will issue mandates once vaccines are formally approved by the U.S. FDA.

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Promotion of the influenza vaccination to hospital staff during pre-employment health check: a prospective, randomised, controlled trial

Journal of Occupational Medicine and Toxicology ◽

10.1186/s12995-020-00285-w ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Michael Currat ◽

Catherine Lazor-Blanchet ◽

Giorgio Zanetti

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Healthcare Workers ◽

Vaccination Campaign ◽

Intervention Group ◽

Vaccination Rate ◽

Health Check ◽

Control Group ◽

Vaccination Rates ◽

Newly Hired

Abstract Background Vaccination is the most effective prevention of seasonal influenza. Despite its recommendation and active promotion, vaccination coverage remains low among healthcare staff. The goal of the study was to test if a pre-employment health check is a good opportunity to promote future vaccination against influenza among healthcare workers newly hired by a university hospital. Methods All new hospital employees active at the bedside who underwent a pre-employment health check between the end of 2016’s influenza epidemic and the start of the next influenza vaccination campaign were randomly allocated to a control group or an intervention group. The intervention consisted of a semi-structured dialog and the release of an information leaflet about influenza and influenza vaccination during the check-up, and the shipment of a postcard reminder 2 weeks before the next vaccination campaign. Vaccination rates during the campaign were compared among the two groups. Results Three hundred fifty-seven employees were included. Vaccination rates were similar in both groups: 79/172 (46%) in the control and 92/185 (50%) in the intervention group. A significantly higher rate of vaccination was noted among physicians (70/117, 60%) than among other employees (101/240, 42%, p = 0.001). In a pre-defined exploratory analysis among physicians, the vaccination rate was higher in the intervention group (36/51, 71%) than in the control group (34/65, 52%, p = 0.046). Conclusions Promotion of the influenza vaccine during pre-employment health check did not improve the vaccination rate of newly hired hospital healthcare workers overall during the next influenza vaccination campaign. Results suggest a favourable impact on the vaccination rate of physicians. Thus, there may be an interest in using communication strategies tailored to the different categories of healthcare workers to promote the influenza vaccine during pre-employment health check. Trial registration ClinicalTrials, NCT02758145. Registered 26 April 2016.

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Effect of A Hospital Campaign for Influenza Vaccination of Healthcare Workers

Infection Control and Hospital Epidemiology ◽

10.1086/504503 ◽

2006 ◽

Vol 27 (6) ◽

pp. 612-617 ◽

Cited By ~ 53

Author(s):

Joon Young Song ◽

Cheong Won Park ◽

Hye Won Jeong ◽

Hee Jin Cheong ◽

Woo Joo Kim ◽

...

Keyword(s):

Influenza Vaccination ◽

Healthcare Workers ◽

Vaccination Campaign ◽

Intervention Strategy ◽

Vaccination Rate ◽

Demographic Characteristics ◽

Tailored Intervention ◽

Vaccination Rates ◽

Knowledge And Attitudes ◽

Item Questionnaire

Objective.To identify the factors that inhibit or motivate influenza vaccination among healthcare workers (HCWs).Methods.In March 2000, we prepared 34-item questionnaire for both vaccine recipients and nonrecipients regarding demographic characteristics, factors motivating and inhibiting vaccination, and knowledge and attitudes about influenza vaccination. On the basis of the results of our survey, an aggressive hospital vaccination campaign was undertaken. In April 2004, after the 4-year campaign, the same questionnaire was again administered to HCWs.Results.In both 2000 and 2004, the main motives for undergoing influenza vaccination were “hospital campaign” and “recommendation by colleagues”; the percentage of respondents who were motivated by the hospital campaign had remarkably increased from 27% in 2000 to 52% in 2004 (P<.001), whereas the percentage who were motivated by recommendation by colleagues had not changed significantly (21% vs 14%). Qverall, the 4 reasons most frequently cited by HCWs for noncompliance with vaccination were insufficient available time, confidence in their health, doubt about vaccine efficacy, and fear of injection. In 2000, vaccination rates were below 30%, irrespective of occupation. After an aggressive vaccination campaign, the increase in the vaccination rate was highest among the nursing staff, increasing from 21% in 2000 to 92% in 2004, whereas the vaccination rate among the physicians was still below 60%.Conclusion.We conclude that a hospital campaign can markedly improve influenza vaccination rates among HCWs. Both a mobile cart system and free vaccine supply contributed to improving the vaccination rates in our study. In addition, a specifically tailored intervention strategy was required.

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A Time Off Incentive Was Not Associated with Influenza Vaccination Acceptance among Healthcare Workers

Influenza Research and Treatment ◽

10.1155/2013/209491 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4

Author(s):

Saima Cheema ◽

Christopher Vinnard ◽

Sarah Foster-Chang ◽

Darren R. Linkin

Keyword(s):

Influenza Vaccination ◽

Healthcare Workers ◽

Medical Center ◽

Vaccination Rate ◽

Web Based ◽

Vaccination Rates ◽

Vaccination Acceptance ◽

Survey Responses ◽

Mandatory Vaccination ◽

Relationship Of

Objectives. The national influenza vaccination rate among healthcare workers (HCWs) remains low despite clear benefits to patients, coworkers, and families. We sought to evaluate formally the effect of a one-hour time off incentive on attitudes towards influenza vaccination during the 2011-2012 influenza season. Methods. All HCWs at the Philadelphia Veterans Affairs (VA) Medical Center were invited to complete an anonymous web-based survey. We described respondents’ characteristics and attitudes toward influenza vaccination and determined the relationship of specific attitudes with respondents’ acceptance of influenza vaccination, using a 5-point Likert scale. Results. We analyzed survey responses from 154 HCWs employed at the Philadelphia VA Medical Center, with a response rate of 8%. Among 121 respondents who reported receiving influenza vaccination, 34 (28%, 95% CI 20–37%) reported agreement with the statement that the time off incentive made a difference in their decision to accept influenza vaccination. Conclusions. Our study provides evidence that modest incentives such as one-hour paid time off will be unlikely to promote influenza vaccination rates within medical facilities. More potent interventions that include mandatory vaccination combined with penalties for noncompliance will likely provide the only means to achieve near-universal influenza vaccination among HCWs.

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Correlates of Improved Influenza Vaccination of Healthcare Personnel: A Survey of Hospitals in Louisiana

Infection Control and Hospital Epidemiology ◽

10.1086/670992 ◽

2013 ◽

Vol 34 (7) ◽

pp. 723-729 ◽

Cited By ~ 6

Author(s):

Kayla L. Fricke ◽

Mariella M. Gastañaduy ◽

Renee Klos ◽

Rodolfo E. Bégué

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Influenza Vaccination ◽

Vaccination Campaign ◽

Vaccination Rate ◽

Healthcare Personnel ◽

Patient Contact ◽

Hospital Type ◽

Vaccination Rates ◽

Item Questionnaire

Objective.To describe practices for influenza vaccination of healthcare personnel (HCP) with emphasis on correlates of increased vaccination rates.Design.Survey.Participants.Volunteer sample of hospitals in Louisiana.Methods.All hospitals in Louisiana were invited to participate. A 17-item questionnaire inquired about the hospital type, patients served, characteristics of the vaccination campaign, and the resulting vaccination rate.Results.Of 254 hospitals, 153 (60%) participated and were included in the 124 responses that were received. Most programs (64%) required that HCP either receive the vaccine or sign a declination form, and the rest were exclusively voluntary (36%); no program made vaccination a condition of employment. The median vaccination rate was 67%, and the vaccination rate was higher among hospitals that were accredited by the Joint Commission; provided acute care; served children, pregnant women, oncology patients, or intensive care unit patients; required a signed declination form; or imposed consequences for unvaccinated HCP (the most common of which was to require that a mask be worn on patient contact). Hospitals that provided free vaccine, made vaccine widely available, advertised the program extensively, required a declination form, and imposed consequences had the highest vaccination rates (median, 86%; range, 81%–91%).Conclusions.The rate of influenza vaccination of HCP remains low among the hospitals surveyed. Recommended practices may not be enough to reach 90% vaccination rates unless a signed declination requirement and consequences are implemented. Wearing a mask is a strong consequence. Demanding influenza vaccination as a condition of employment was not reported as a practice by the participating hospitals.

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Description of an Influenza Vaccination Campaign and Use of a Randomized Survey to Determine Participation Rates

Infection Control and Hospital Epidemiology ◽

10.1086/649798 ◽

2010 ◽

Vol 31 (2) ◽

pp. 151-157 ◽

Cited By ~ 7

Author(s):

Xuguang (Grant) Tao ◽

Janine Giampino ◽

Deborah A. Dooley ◽

Frances E. Humphrey ◽

David M. Baron ◽

...

Keyword(s):

Confidence Interval ◽

Healthcare Workers ◽

Vaccination Campaign ◽

Vaccination Rate ◽

Patient Contact ◽

Participation Rates ◽

Immunization Program ◽

Influenza Immunization ◽

Direct Patient Contact ◽

Johns Hopkins University

Objectives.To describe the procedures used during an influenza immunization program and the use of a randomized survey to quantify the vaccination rate among healthcare workers with and without patient contact.Design.Influenza immunization vaccination program and a randomized survey.Setting.Johns Hopkins University and Health System.Methods.The 2008/2009 Johns Hopkins Influenza Immunization Program was administered to 40,000 employees, including 10,763 healthcare workers. A 10% randomized sample (1,084) of individuals were interviewed to evaluate the vaccination rate among healthcare workers with direct patient contact.Results.Between September 23, 2008, and April 30, 2009, a total of 16,079 vaccinations were administered. Ninety-four percent (94.5%) of persons who were vaccinated received the vaccine in the first 7 weeks of the campaign. The randomized survey demonstrated an overall vaccination rate of 71.3% (95% confidence interval, 68.6%-74.0%) and a vaccination rate for employees with direct patient contact of 82.8% (95% confidence interval, 80.1%-85.5%). The main reason (25.3%) for declining the program vaccine was because the employee had received documented vaccination elsewhere.Conclusions.The methods used to increase participation in the recent immunization program were successful, and a randomized survey to assess participation was found to be an efficient means of evaluating the workforce's level of potential immunity to the influenza virus.

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Voluntary to Mandatory: Evolution of Strategies and Attitudes toward Influenza Vaccination of Healthcare Personnel

Infection Control and Hospital Epidemiology ◽

10.1086/663210 ◽

2012 ◽

Vol 33 (1) ◽

pp. 63-70 ◽

Cited By ~ 46

Author(s):

Kathleen Quan ◽

David M. Tehrani ◽

Linda Dickey ◽

Eugene Spiritus ◽

Denise Hizon ◽

...

Keyword(s):

Influenza Vaccination ◽

Vaccination Campaign ◽

Vaccine Uptake ◽

Healthcare Personnel ◽

Vaccination Policy ◽

Vaccination Rates ◽

Hospital Policies ◽

Mandatory Vaccination ◽

Vaccination Campaigns ◽

The Impact

Background.Assessing the relative success of serial strategies for increasing healthcare personnel (HCP) influenza vaccination rates is important to guide hospital policies to increase vaccine uptake.Objective.To evaluate serial campaigns that include a mandatory HCP vaccination policy and to describe HCP attitudes toward vaccination and reasons for declination.Design.Retrospective cohort study.Methods.We assessed the impact of serial vaccination campaigns on the proportions of HCP who received influenza vaccination during die 2006–2011 influenza seasons. In addition, declination data over these 5 seasons and a 2007 survey of HCP attitudes toward vaccination were collected.Results.HCP influenza vaccination rates increased from 44.0% (2,863 of 6,510 HCP) to 62.9% (4,037 of 6,414 HCP) after institution of mobile carts, mandatory declination, and peer-to-peer vaccination efforts. Despite maximal attempts to improve accessibility and convenience, 27.2% (66 of 243) of die surveyed HCP were unwilling to wait more than 10 minutes for a free influenza vaccination, and 23.3% (55 of 236) would be indifferent if they were unable to be vaccinated. In this context, institution of a mandatory vaccination campaign requiring unvaccinated HCP to mask during the influenza season increased rates of compliance to over 90% and markedly reduced the proportion of HCP who declined vaccination as a result of preference.Conclusions.A mandatory influenza vaccination program for HCP was essential to achieving high vaccination rates, despite years of intensive vaccination campaigns focused on increasing accessibility and convenience. Mandatory vaccination policies appear to successfully capture a large portion of HCP who are not opposed to receipt of die vaccine but who have not made vaccination a priority.Infect Control Hosp Epidemiol 2012;33(1):63-70

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Mandatory Influenza Vaccination for Healthcare Workers: Do Nurses Agree?

10.28971/532013nm89 ◽

2013 ◽

Author(s):

Meghan Nightingale

Keyword(s):

Influenza Vaccination ◽

Rhode Island ◽

Healthcare Workers ◽

High Risk Group ◽

Hospital Policy ◽

Care Workers ◽

Healthcare Work ◽

Area Of Concern ◽

Mandatory Vaccination ◽

Study Participants

Influenza is a significant cause of morbidity and mortality among hospitalized patients. Health care workers are considered a high-risk group for influenza, and annual vaccination is the most effective way to prevent getting influenza. Increasing concern about inadequate levels of healthcare work vaccination has led many groups to recommend mandatory vaccination for healthcare workers. The state of Rhode Island was considering mandatory vaccination in 2012 for all healthcare workers, with only medical exemption, but this movement was halted. Research focused on the perception of nursing personnel toward mandatory influenza vaccination is lacking, and considering that registered nurses are one of the largest healthcare groups that would be affected, this is an area of concern. The purpose of this research study was to examine the perception of nursing staff toward mandated vaccination at a hospital in Rhode Island. The survey used a mixed methods design, including forced choice questions and an open-ended question, developed for purposes of this research. The study participants included RNs employed in inpatient units. Most of the nurses disagreed that healthcare workers should be mandated to get immunization and disagreed that a vaccine policy requiring mandatory vaccination was fair. They also disagreed that hospital policy requiring influenza vaccination keeps them from getting influenza or keeps their patients from getting influenza. In one of the first states considering mandatory vaccination statewide, these results are an important consideration before implementation of this potential measure.

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Prevention of Nosocomial Influenza

Infection Control and Hospital Epidemiology ◽

10.1017/s0195941700002927 ◽

1996 ◽

Vol 17 (10) ◽

pp. 641-648 ◽

Cited By ~ 3

Author(s):

Karim A. Adal ◽

Richard H. Flowers ◽

Anne M. Anglim ◽

Frederick G. Hayden ◽

Maureen G. Titus ◽

...

Keyword(s):

Healthcare Workers ◽

Influenza A ◽

Vaccination Rate ◽

Employee Health ◽

University Hospital ◽

Vaccination Program ◽

Preventive Strategies ◽

Hospital Epidemiology ◽

Vaccination Rates ◽

Health Hospital

AbstractObjective:To study compliance with preventive strategies at a university hospital during an outbreak of nosocomial influenza A during the winter of 1988, and the rates of vaccination of healthcare workers and of nosocomial influenza following changes in vaccine practices after the outbreak.Design:Retrospective review of employee health, hospital epidemiology, hospital computing, and clinical microbiology records.Setting:A university hospital.Interventions:Unvaccinated personnel with exposure within the previous 72 hours to an unisolated case of influenza were offered influenza vaccine and 14 days of amantadine hydrochloride prophylaxis. Personnel with exposure more than 72 hours before evaluation were offered vaccine. A mobile cart was introduced for vaccinating personnel after the 1988 outbreak.Results:An outbreak of influenza with 10 nosocomial cases occurred in 1988. Only 4% of exposed employees had been vaccinated previously and 23% of exposed, unvaccinated employees agreed to take vaccine, amantadine, or both. A mobile-cart vaccination program was instituted, and annual vaccination rates steadily increased from 26.3% in 1989 to 1990 to 38% in 1993 to 1994 (P<.0001). The relative frequency of documented cases of influenza in employees with symptoms of influenza decreased significantly during this period (P=.025), but nosocomial influenza rates among patients did not change significantly.Conclusion:A mobile-cart influenza vaccination program was associated with a significant increase in compliance among healthcare workers, but a majority still remained unvaccinated. The rate of nosocomial influenza among patients was not reduced by the modest increase in the vaccination rate, but influenza rates remained acceptably low, perhaps due to respiratory isolation of patients and furlough of employees with influenza.

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The Impact of Healthcare Worker Influenza Vaccination on Nosocomial Influenza in a Tertiary Hospital: An Ecological Study

10.21203/rs.2.13528/v2 ◽

2020 ◽

Author(s):

Wycliffe Enli Wei ◽

Stephanie Fook-Chong ◽

Wen Kai Chen ◽

Maciej Piotr Chlebicki ◽

Wee Hoe Gan

Keyword(s):

Protective Effect ◽

Influenza Vaccination ◽

Healthcare Worker ◽

Healthcare Workers ◽

Ecological Study ◽

Tertiary Hospital ◽

Vaccination Rate ◽

Incidence Rates ◽

Vaccination Rates ◽

The Impact

Abstract Background: To protect hospitalized patients who are more susceptible to complications of influenza, seasonal influenza vaccination of healthcare workers (HCW) has been recommended internationally. However, its effectiveness is still being debated. To assess the effectiveness of HCW influenza vaccination, we performed an ecological study to evaluate the association between healthcare worker influenza vaccination and the incidence of nosocomial influenza in a tertiary hospital within Singapore between 2013-2018. Methods: Nosocomial influenza was defined by influenza among inpatients diagnosed 7 days or more post-admission by laboratory testing, while healthcare worker influenza vaccination rate was defined as the proportion of healthcare workers that was vaccinated at the end of each annual seasonal vaccination exercise. A modified Poisson regression was performed to assess the association between the HCW vaccination rates and monthly nosocomial influenza incidence rates. Results: Nosocomial influenza incidence rates followed the trend of non-nosocomial influenza, showing a predominant mid-year peak. Across 2,480,010 patient-days, there were 256 nosocomial influenza cases (1.03 per 10,000 patient-days). Controlling for background influenza activity and the number of influenza tests performed, no statistically significant association was observed between vaccination coverage and nosocomial influenza incidence rate although a protective effect was suggested (IRR 0.89, 95%CI:0.69-1.15, p =0.37). Conclusion: No significant association was observed between influenza vaccination rates and nosocomial influenza incidence rates, although a protective effect was suggested. Aligning local HCW vaccine timing and formulation to that of the Southern Hemisphere may improve effectiveness. HCW vaccination remains important but demonstrating its effectiveness in preventing nosocomial influenza is challenging.

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Mobility network reveals the impact of geographic vaccination heterogeneity on COVID-19

10.1101/2021.10.26.21265488 ◽

2021 ◽

Author(s):

Yuan Yuan ◽

Eaman Jahani ◽

Shengjia Zhao ◽

Yong-Yeol Ahn ◽

Alex Pentland

Keyword(s):

Computational Models ◽

Negative Impact ◽

Vaccination Campaign ◽

Vaccination Rate ◽

Control Measures ◽

Vaccine Uptake ◽

Vaccination Rates ◽

The Impact ◽

Hub Effect ◽

The U.S

ABSTRACTMassive vaccination is one of the most effective epidemic control measures. Because one’s vaccination decision is shaped by social processes (e.g., socioeconomic sorting and social contagion), the pattern of vaccine uptake tends to show strong social and geographical heterogeneity, such as urban-rural divide and clustering. Yet, little is known to what extent and how the vaccination heterogeneity affects the course of outbreaks. Here, leveraging the unprecedented availability of data and computational models produced during the COVID-19 pandemic, we investigate two network effects—the “hub effect” (hubs in the mobility network usually have higher vaccination rates) and the “homophily effect” (neighboring places tend to have similar vaccination rates). Applying Bayesian deep learning and fine-grained simulations for the U.S., we show that stronger homophily leads to more infections while a stronger hub effect results in fewer cases. Our simulation estimates that these effects have a combined net negative impact on the outcome, increasing the total cases by approximately 10% in the U.S. Inspired by these results, we propose a vaccination campaign strategy that targets a small number of regions to further improve the vaccination rate, which can reduce the number of cases by 20% by only vaccinating an additional 1% of the population according to our simulations. Our results suggest that we must examine the interplay between vaccination patterns and mobility networks beyond the overall vaccination rate, and that the government may need to shift policy focus from overall vaccination rates to geographical vaccination heterogeneity.

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