# 4738
One of the ongoing debates among infection control professionals is how to increase the uptake of seasonal (and pandemic) influenza vaccines by Health Care Workers (HCWs).
For years, the percentage of HCWs who voluntarily get the seasonal flu vaccine has languished in Canada and the United States between 30% and 40%.
Attempts to mandate vaccination have elicited numerous objections from HCWs, although many infection control organizations (IDSA, APIC, SHEA) support the idea.
Last week, the IDSA published an open letter to Thomas Frieden, Director of the CDC, in support of such a mandate.
Yesterday a study appeared in the CMAJ that took a retrospective look at programs used to promote the voluntary update of seasonal flu vaccines by HCWs.
First the press release, then the abstract and a link to the entire study.
Canadian Medical Association Journal
Seasonal influenza immunization rates among health-care workers
Campaigns to increase seasonal influenza vaccination rates amongst health care workers in Canada that include a combination of interventions had the greatest effect on increasing vaccine coverage, according to a study published in CMAJ (Canadian Medical Association Journal)
Seasonal influenza immunization rates among health care workers in Canada remain below 50%, yet it is recommended that all health care workers (at least 90%) should be immunized to protect against the flu virus.
Combined education/promotion and improved access to vaccines resulted in higher increases in vaccination rates amongst long-term care home workers. In one hospital campaign in which staff completed a mandatory electronic form to decline vaccination, immunization coverage increased to 55% compared to the previous nine years where rates ranged from 21% to 38%. When unvaccinated personnel were required to wear masks, rates increased to 52% from 33%.
"This review revealed gaps in the literature about the appropriate components to use to increase influenza immunization among health care personnel," writes Dr. Larry Chambers, Elisabeth Bruyére Research Institute, Ottawa, with coauthors.
The study, a systematic review of 12 studies, did not look at pandemic influenza programs.
The authors conclude that more studies with multiple campaign components are needed to assess the most appropriate influenza vaccination programs.
The abstract follows:
Seasonal influenza vaccination campaigns for health care personnel: systematic review
Po-Po Lam, Larry W. Chambers , Donna M. Pierrynowski MacDougall , Anne E. McCarthy
Background: In Canada, vaccination coverage for seasonal influenza among health care personnel remains below 50%. The objective of this review was to determine which seasonal influenza vaccination campaign or campaign components in health care settings were significantly associated with increases in influenza vaccination among staff.
Methods: We identified articles in eight electronic databases and included randomized controlled trials, controlled before-and-after studies and studies with interrupted time series designs in our review. Two reviewers independently abstracted the data and assessed the risk of biases. We calculated risk ratios and 95% confidence intervals for randomized controlled trials and controlled before-and-after studies and described interrupted time series studies.
Results: We identified 99 studies evaluating influenza vaccination campaigns for health care workers, but only 12 of the studies were eligible for review. In nonhospital health care settings, including long-term care facilities, campaigns with a greater variety of components (including education or promotion, better access to vaccines, legislation or regulation and/or role models) were associated with higher risk ratios (i.e, favouring the intervention group). Within hospital settings, the results reported for various types of campaigns were mixed. Many of the criteria for assessing risk of bias were not reported.
Interpretation: Campaigns involving only education or promotion resulted in minimal changes in vaccination rates. Further studies are needed to determine the appropriate components and combinations of components in influenza vaccination campaigns for health care personnel.
The link to the entire study is here.
The bottom line is that campaigns utilizing only educational and promotional incentives resulted in minimal improvements in vaccination rates among health care workers.
Certainly nowhere near the compliance goal of 90%.
