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Landelle C, Birgand G, Price JR, Mutters NT, Morgan DJ, Lucet JC, Kerneis S, Zingg W. Considerations for de-escalating universal masking in healthcare centers. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e128. [PMID: 37592969 PMCID: PMC10428150 DOI: 10.1017/ash.2023.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 08/19/2023]
Abstract
Three years after the beginning of the COVID-19 pandemic, better knowledge on the transmission of respiratory viral infections (RVI) including the contribution of asymptomatic infections encouraged most healthcare centers to implement universal masking. The evolution of the SARS-CoV-2 epidemiology and improved immunization of the population call for the infection and prevention control community to revisit the masking strategy in healthcare. In this narrative review, we consider factors for de-escalating universal masking in healthcare centers, addressing compliance with the mask policy, local epidemiology, the level of protection provided by medical face masks, the consequences of absenteeism and presenteeism, as well as logistics, costs, and ecological impact. Most current national and international guidelines for mask use are based on the level of community transmission of SARS-CoV-2. Actions are now required to refine future recommendations, such as establishing a list of the most relevant RVI to consider, implement reliable local RVI surveillance, and define thresholds for activating masking strategies. Considering the epidemiological context (measured via sentinel networks or wastewater analysis), and, if not available, considering a time period (winter season) may guide to three gradual levels of masking: (i) standard and transmission-based precautions and respiratory etiquette, (ii) systematic face mask wearing when in direct contact with patients, and (iii) universal masking. Cost-effectiveness analysis of the different strategies is warranted in the coming years. Masking is just one element to be considered along with other preventive measures such as staff and patient immunization, and efficient ventilation.
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Affiliation(s)
- Caroline Landelle
- University of Grenoble Alpes, CNRS, UMR 5525, Grenoble INP, CHU Grenoble Alpes, Infection Prevention and Control Unit, 38000 Grenoble, France
| | - Gabriel Birgand
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
- Regional Center for Infection Prevention and Control Pays de la Loire, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | | | - Nico T. Mutters
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Daniel J. Morgan
- University of Maryland School of Medicine, Baltimore, MD, USA
- VA Maryland Healthcare System, Baltimore, MD, USA
| | - Jean-Christophe Lucet
- Infection Control Unit, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Solen Kerneis
- Infection Control Unit, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Walter Zingg
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Zurich, Switzerland
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Giubilini A, Savulescu J, Pugh J, Wilkinson D. Vaccine mandates for healthcare workers beyond COVID-19. JOURNAL OF MEDICAL ETHICS 2023; 49:211-220. [PMID: 35636917 PMCID: PMC9985724 DOI: 10.1136/medethics-2022-108229] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/12/2022] [Indexed: 05/06/2023]
Abstract
We provide ethical criteria to establish when vaccine mandates for healthcare workers are ethically justifiable. The relevant criteria are the utility of the vaccine for healthcare workers, the utility for patients (both in terms of prevention of transmission of infection and reduction in staff shortage), and the existence of less restrictive alternatives that can achieve comparable benefits. Healthcare workers have professional obligations to promote the interests of patients that entail exposure to greater risks or infringement of autonomy than ordinary members of the public. Thus, we argue that when vaccine mandates are justified on the basis of these criteria, they are not unfairly discriminatory and the level of coercion they involve is ethically acceptable-and indeed comparable to that already accepted in healthcare employment contracts. Such mandates might be justified even when general population mandates are not. Our conclusion is that, given current evidence, those ethical criteria justify mandates for influenza vaccination, but not COVID-19 vaccination, for healthcare workers. We extend our arguments to other vaccines.
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Affiliation(s)
- Alberto Giubilini
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jonathan Pugh
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Newborn Care, John Radcliffe Hospital, Oxford, UK
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Ratti M, Concina D, Rinaldi M, Salinelli E, Di Brisco AM, Ferrante D, Volpe A, Panella M. Vaccination Strategies against Seasonal Influenza in Long Term Care Setting: Lessons from a Mathematical Modelling Study. Vaccines (Basel) 2022; 11:vaccines11010032. [PMID: 36679877 PMCID: PMC9861048 DOI: 10.3390/vaccines11010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND seasonal influenza in nursing homes is a major public health concern, since in EU 43,000 long term care (LTC) facilities host an estimated 2.9 million elderly residents. Despite specific vaccination campaigns, many outbreaks in such institutions are occasionally reported. We explored the dynamics of seasonal influenza starting from real data collected from a nursing home located in Italy and a mathematical model. Our aim was to identify the best vaccination strategy to minimize cases (and subsequent complications) among the guests. MATERIALS AND METHODS after producing the contact matrices with surveys of both the health care workers (HCW) and the guests, we developed a mathematical model of the disease. The model consists of a classical SEIR part describing the spreading of the influenza in the general population and a stochastic agent based model that formalizes the dynamics of the disease inside the institution. After a model fit of a baseline scenario, we explored the impact of varying the HCW and guests parameters (vaccine uptake and vaccine efficacy) on the guest attack rates (AR) of the nursing home. RESULTS the aggregate AR of influenza like illness in the nursing home was 36.4% (ward1 = 56%, ward2 = 33.3%, ward3 = 31.7%, ward4 = 34.5%). The model fit to data returned a probability of infection of the causal contact of 0.3 and of the shift change contact of 0.2. We noticed no decreasing or increasing AR trend when varying the HCW vaccine uptake and efficacy parameters, whereas the increase in both guests vaccine efficacy and uptake parameter was accompanied by a slight decrease in AR of all the wards of the LTC facility. CONCLUSION from our findings we can conclude that a nursing home is still an environment at high risk of influenza transmission but the shift change room and the handover situation carry no higher relative risk. Therefore, additional preventive measures in this circumstance may be unnecessary. In a closed environment such as a LTC facility, the vaccination of guests, rather than HCWs, may still represent the cornerstone of an effective preventive strategy. Finally, we think that the extensive inclusion of real life data into mathematical models is promising and may represent a starting point for further applications of this methodology.
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Affiliation(s)
- Matteo Ratti
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy
- Correspondence:
| | - Diego Concina
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Maurizio Rinaldi
- Department of Pharmaceutical Science (DSF), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Ernesto Salinelli
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Agnese Maria Di Brisco
- Department of Studies for Economics and Business (DiSEI), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Daniela Ferrante
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Alessandro Volpe
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Massimiliano Panella
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy
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Effect of influenza vaccination among healthcare workers on hospital-acquired influenza in short-stay hospitalized patients: A multicenter pilot study in France. Infect Control Hosp Epidemiol 2022; 43:1828-1832. [PMID: 35382916 DOI: 10.1017/ice.2022.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Exposure to infected healthcare workers (HCWs) is a source of hospital-acquired (HA) influenza. We estimated the risk of HA influenza for hospitalized patients by rate of influenza vaccine coverage (IVC) of HCWs. METHODS A case-case negative control study nested in a prospective cohort was conducted in 2 French university hospitals during 2 influenza seasons. Each inpatient with influenza-like illness (ILI) provided a nasal swab sample that was systematically analyzed for influenza virus by polymerase chain reaction (PCR) testing. An HA influenza case was a patient with a virological confirmation of influenza with onset of symptoms ≥72 hours after admission to the ward. The IVC rate of HCWs in each participating ward was calculated from the data provided by the occupational health departments. A mixed-effect logistic regression was performed with adjustments on patient sex, age, the presence of a potential source of influenza on the ward in the 5 days prior to the start of the ILI, type of ward and influenza season. RESULTS The overall HA influenza attack rate was 1.9 per 1,000 hospitalized patients. In total, 24 confirmed HA influenza cases and 141 controls were included. The crude odds ratio (OR) of HA influenza decreased from 0.52 (95% confidence interval [CI], 0.21-1.29) to 0.14 (95% CI, 0.03-0.63) when the IVC of HCWs increased from 20% to 40%. After adjustment, IVC ≥40% was associated with a risk reduction of HA influenza (aOR, 0.07; 95% CI, 0.01-0.78). CONCLUSIONS Considering a limited sample size, influenza vaccination of HCWs is highly suggestive of HA flu prevention among hospitalized patients.Trial Registration: clinicaltrials.gov identifier: NCT02198638.
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Sansone M, Holmstrom P, Hallberg S, Nordén R, Andersson LM, Westin J. System dynamic modelling of healthcare associated influenza -a tool for infection control. BMC Health Serv Res 2022; 22:709. [PMID: 35624510 PMCID: PMC9136787 DOI: 10.1186/s12913-022-07959-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 04/12/2022] [Indexed: 12/02/2022] Open
Abstract
Background The transmission dynamics of influenza virus within healthcare settings are not fully understood. Capturing the interplay between host, viral and environmental factors is difficult using conventional research methods. Instead, system dynamic modelling may be used to illustrate the complex scenarios including non-linear relationships and multiple interactions which occur within hospitals during a seasonal influenza epidemic. We developed such a model intended as a support for health-care providers in identifying potentially effective control strategies to prevent influenza transmission. Methods By using computer simulation software, we constructed a system dynamic model to illustrate transmission dynamics within a large acute-care hospital. We used local real-world clinical and epidemiological data collected during the season 2016/17, as well as data from the national surveillance programs and relevant publications to form the basic structure of the model. Multiple stepwise simulations were performed to identify the relative effectiveness of various control strategies and to produce estimates of the accumulated number of healthcare-associated influenza cases per season. Results Scenarios regarding the number of patients exposed for influenza virus by shared room and the extent of antiviral prophylaxis and treatment were investigated in relation to estimations of influenza vaccine coverage, vaccine effectiveness and inflow of patients with influenza. In total, 680 simulations were performed, of which each one resulted in an estimated number per season. The most effective preventive measure identified by our model was administration of antiviral prophylaxis to exposed patients followed by reducing the number of patients receiving care in shared rooms. Conclusions This study presents an system dynamic model that can be used to capture the complex dynamics of in-hospital transmission of viral infections and identify potentially effective interventions to prevent healthcare-associated influenza infections. Our simulations identified antiviral prophylaxis as the most effective way to control in-hospital influenza transmission. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07959-7.
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Affiliation(s)
- Martina Sansone
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10B, 413 46, Gothenburg, Sweden. .,Department of Infectious Diseases, Region Vastra Gotaland, Sahlgrenska University Hospital, Journalvagen 10, 416 50, Gothenburg, Sweden.
| | - Paul Holmstrom
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University Medicinaregatan 3, 413 45, Gothenburg, Sweden
| | - Stefan Hallberg
- Regional Cancer Centre West, Western Sweden Healthcare Region, 413 45, Gothenburg, Sweden
| | - Rickard Nordén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10B, 413 46, Gothenburg, Sweden.,Department of Clinical Microbiology, Region Vastra Gotaland, Sahlgrenska University Hospital, Guldhedsgatan 10A, 402 34, Gothenburg, Sweden
| | - Lars-Magnus Andersson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10B, 413 46, Gothenburg, Sweden.,Department of Infectious Diseases, Region Vastra Gotaland, Sahlgrenska University Hospital, Journalvagen 10, 416 50, Gothenburg, Sweden
| | - Johan Westin
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10B, 413 46, Gothenburg, Sweden.,Department of Infectious Diseases, Region Vastra Gotaland, Sahlgrenska University Hospital, Journalvagen 10, 416 50, Gothenburg, Sweden.,Regional Cancer Centre West, Western Sweden Healthcare Region, 413 45, Gothenburg, Sweden
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Vora A, Shaikh A. Awareness, Attitude, and Current Practices Toward Influenza Vaccination Among Physicians in India: A Multicenter, Cross-Sectional Study. Front Public Health 2021; 9:642636. [PMID: 34497789 PMCID: PMC8419342 DOI: 10.3389/fpubh.2021.642636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 08/02/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Although annual influenza vaccination is recommended for healthcare providers (HCPs), vaccination rate among HCPs in India is generally low. This cross-sectional survey was conducted to evaluate physicians' awareness, attitude, and current practices toward influenza vaccination in high-risk groups in India. Methods: The survey was performed in June–July 2020, wherein consulting physicians, pulmonologists, diabetologists, obstetricians/gynecologists, or cardiologists across 14 cities completed a 39-item questionnaire consisting of 3 sections, one each on awareness, attitude, and practice patterns. Descriptive statistics were used to summarize the study results. Statistical analysis was performed for comparison of subgroups by physician specialty, city of practice (metro/non-metro), and zone of practice (north/south/east/west). Level of statistical significance was set at p < 0.05. Results: In all, 780 physicians completed the survey. Of these, 3.97, 53.08, and 42.95% had high, medium, and low level of awareness about influenza/influenza vaccination, respectively. Statistically significant (p < 0.05) between-group differences were found by physician specialty and zone of practice. In terms of attitude toward vaccination of high-risk group subjects, only 0.9% physicians were “extremely concerned,” while the majority (92.56%) were “quite concerned” and 6.54% were a “little concerned,” with no reported significant differences between different subgroups. With regard to practice patterns, 82.82% of physicians offered influenza vaccines to their patients, 32.69% vaccinated 10–25% of patients per month, and 38.85% required and offered the vaccine to their office staff. Physicians' reasons for not prescribing influenza vaccines to patients included fear of side effects (16.54%), cost (15.64%), lack of awareness about availability (15.38%), absence of belief that it is beneficial (14.36%), history of side effects (13.46%), and patients' fear of needles (11.28%). Conclusion: These findings suggest the need to implement educational strategies among physicians to enhance their awareness about influenza vaccination and improve their attitudes and current practices toward influenza vaccination especially in high-risk groups in India.
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Currat M, Lazor-Blanchet C, Zanetti G. Promotion of the influenza vaccination to hospital staff during pre-employment health check: a prospective, randomised, controlled trial. J Occup Med Toxicol 2020; 15:34. [PMID: 33292400 PMCID: PMC7672907 DOI: 10.1186/s12995-020-00285-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/10/2020] [Indexed: 12/03/2022] Open
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. Supplementary Information The online version contains supplementary material available at 10.1186/s12995-020-00285-w.
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Affiliation(s)
- Michael Currat
- Service of Hospital Preventive Medicine, Lausanne University Hospital, Occupational Medicine Unit BH-08, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
| | - Catherine Lazor-Blanchet
- Service of Hospital Preventive Medicine, Lausanne University Hospital, Occupational Medicine Unit BH-08, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Giorgio Zanetti
- Service of Hospital Preventive Medicine, Lausanne University Hospital, Occupational Medicine Unit BH-08, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, CH-1015, Lausanne, Switzerland
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Minimum healthcare worker influenza immunization rates required to decrease influenza transmission in two acute-care hospitals. Infect Control Hosp Epidemiol 2020; 42:109-110. [PMID: 33109283 DOI: 10.1017/ice.2020.1252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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9
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Grech V, Gauci C, Agius S. Withdrawn: Vaccine hesitancy among Maltese Healthcare workers toward influenza and novel COVID-19 vaccination. Early Hum Dev 2020:105213. [PMID: 33032879 PMCID: PMC7528734 DOI: 10.1016/j.earlhumdev.2020.105213] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Grech V, Borg M, Gauci C, Barbara C, Montalto SA, Agius S, Falzon C. WITHDRAWN: Needed: less influenza vaccine hesitancy and less presenteeism among health care workers in the COVID-19 era. Early Hum Dev 2020:105215. [PMID: 33032876 PMCID: PMC7528837 DOI: 10.1016/j.earlhumdev.2020.105215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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11
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Maltezou HC, Poland GA. Immunization of healthcare personnel in Europe: Time to move forward with a common program. Vaccine 2020; 38:3187-3190. [PMID: 32173093 DOI: 10.1016/j.vaccine.2020.02.090] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/17/2020] [Accepted: 02/29/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Helena C Maltezou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, 3-5 Agrafon Street, Athens, 15123 Greece.
| | - Gregory A Poland
- Mayo Vaccine Research Group, Mayo Clinic and Foundation, 200 First Street, Rochester, MN 55905, United States
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Jenkin DC, Mahgoub H, Morales KF, Lambach P, Nguyen-Van-Tam JS. A rapid evidence appraisal of influenza vaccination in health workers: An important policy in an area of imperfect evidence. Vaccine X 2019; 2:100036. [PMID: 31384750 PMCID: PMC6668237 DOI: 10.1016/j.jvacx.2019.100036] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The World Health Organization recommends vaccination of health workers (HWs) against influenza, but low uptake is intransigent.We conducted a Rapid Evidence Appraisal on: the risk of influenza in HWs, transmission risk from HWs to patients, the benefit of HW vaccination, and strategies for improving uptake. We aimed to capture a 'whole-of-system' perspective to consider possible benefits for HWs, employers and patients. METHODS We executed a comprehensive search of the available literature published from 2006 to 2018 in the English language. We developed search terms for seven separate questions following the PICO framework (population, intervention, comparators, outcomes) and queried nine databases. RESULTS Of 3784 publications identified, 52 met inclusion criteria. Seven addressed HW influenza risk, of which four found increased risk; 15 addressed influenza vaccine benefit to HWs or their employers, of which 10 found benefit; 11 addressed influenza transmission from HWs to patients, of which 6 found evidence for transmission; 12 unique studies addressed whether vaccinating HWs produced patient benefit, of which 9 concluded benefits accrued. Regarding the number of HWs needed to vaccinate (NNV) to deliver patient benefit, NNV estimates ranged from 3 to 36,000 but were in significant disagreement. Fourteen studies provided insights on strategies to improve uptake; the strongest evidence was for mandatory vaccination. CONCLUSIONS The evidence on most questions related to influenza vaccination in HWs is mixed and often of low-quality. Substantial heterogeneity exists in terms of study designs and settings, making comparison between studies difficult. Notwithstanding these limitations, a majority of studies suggests that influenza vaccination benefit HWs and their employers; and HWs are implicated in transmission events. The effects of vaccinating HWs on patient morbidity and mortality may include reductions in all-cause mortality and influenza-like illness (ILI). Taken together, the evidence suggests that HW vaccination is an important policy for HWs themselves, their employers, and their patients.
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Key Words
- GAVI, the global alliance for vaccines and immunization
- HW, health workers
- Health worker
- Healthcare
- ILI, influenza like illness
- Influenza
- LTCF, long-term care facility(ies)
- NNV, number needed to vaccinate
- OR, odds ratio
- Policy
- RCTs, randomised controlled trials
- RR, relative risk
- Transmission
- Vaccine
- WHO, World Health organization
- cRCTs, clustered randomised controlled trials
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Affiliation(s)
- Dawn C. Jenkin
- Health Protection and Influenza Research Group (WHO Collaborating Centre), University of Nottingham School of Medicine, United Kingdom
| | - Hamid Mahgoub
- East of England Health Protection Team, Public Health England, United Kingdom
| | | | | | - Jonathan S. Nguyen-Van-Tam
- Health Protection and Influenza Research Group (WHO Collaborating Centre), University of Nottingham School of Medicine, United Kingdom
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Perl TM, Talbot TR. Universal Influenza Vaccination Among Healthcare Personnel: Yes We Should. Open Forum Infect Dis 2019; 6:ofz096. [PMID: 31012441 PMCID: PMC6468130 DOI: 10.1093/ofid/ofz096] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/22/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Trish M Perl
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Thomas R Talbot
- Departments of Medicine and Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
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14
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Meijboom MJ, Riphagen-Dalhuisen J, Hak E. The potential economic value of influenza vaccination for healthcare workers in The Netherlands. Influenza Other Respir Viruses 2018; 12:457-464. [PMID: 29624882 PMCID: PMC6005606 DOI: 10.1111/irv.12558] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2018] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
- Marjan J Meijboom
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Josien Riphagen-Dalhuisen
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
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Mathematical models of infection transmission in healthcare settings: recent advances from the use of network structured data. Curr Opin Infect Dis 2018; 30:410-418. [PMID: 28570284 DOI: 10.1097/qco.0000000000000390] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Mathematical modeling approaches have brought important contributions to the study of pathogen spread in healthcare settings over the last 20 years. Here, we conduct a comprehensive systematic review of mathematical models of disease transmission in healthcare settings and assess the application of contact and patient transfer network data over time and their impact on our understanding of transmission dynamics of infections. RECENT FINDINGS Recently, with the increasing availability of data on the structure of interindividual and interinstitution networks, models incorporating this type of information have been proposed, with the aim of providing more realistic predictions of disease transmission in healthcare settings. Models incorporating realistic data on individual or facility networks often remain limited to a few settings and a few pathogens (mostly methicillin-resistant Staphylococcus aureus). SUMMARY To respond to the objectives of creating improved infection prevention and control measures and better understanding of healthcare-associated infections transmission dynamics, further innovations in data collection and parameter estimation in modeling is required.
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Jiang L, Ng IHL, Hou Y, Li D, Tan LWL, Ho HJA, Chen MIC. Infectious disease transmission: survey of contacts between hospital-based healthcare workers and working adults from the general population. J Hosp Infect 2017; 98:404-411. [PMID: 29097147 PMCID: PMC7114670 DOI: 10.1016/j.jhin.2017.10.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/25/2017] [Indexed: 10/29/2022]
Abstract
BACKGROUND Healthcare workers (HCWs) may be the inadvertent interface between the healthcare setting and the community for infectious diseases transmission. AIM To investigate HCWs' contacts during a work day and compare these against working adults from the general population. METHODS Prospective survey of contacts through 24 h self-reported diary in three public sector tertiary care hospitals and community-based working adults in Singapore. Participants were HCWs and working adults from the community. FINDINGS In all, 211 HCWs and 1028 working adults reported a total of 4066 and 9206 contacts. HCWs reported more work-related contacts than community-based working adults (median of 13 versus 4), and more contacts that were neither household nor work-related (1 versus 0) but fewer household contacts (2 versus 3). HCWs reported more work-related contacts involving physical contacts, and more new contacts particularly with short duration (≤15 min) compared to community-based working adults. Among different HCW types, doctors reported the highest whereas ward-based nurses reported the lowest total work-related contacts. Around half of ward-based and clinic-based nurses' contacts involved physical touch. Work-related contacts reported by clinic-based nurses, doctors, and assorted HCWs were shorter than in ward-based nurses, with a substantial number effectively occurring with new contacts. Institutional effects significant on univariate analyses were much reduced and non-significant after adjusting for confounding by HCW type. CONCLUSION HCWs' contacts differ substantially from those of community-based working adults. HCWs may thus be at higher risk of acquiring and spreading contact-transmissible and respiratory infections due to the nature of their work. Whereas total number of contacts was fairly similar between HCW types, the characteristics of their contacts differed substantively.
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Affiliation(s)
- Lili Jiang
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore, Singapore
| | | | - Yan'an Hou
- Infectious Diseases - Epidemiology Unit, National University Hospital, Singapore, Singapore
| | - Dunli Li
- Department of Infection Control, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Linda Wei Lin Tan
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore, Singapore
| | - Hanley Jian An Ho
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Mark I-Cheng Chen
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore, Singapore; Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore.
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Lansbury LE, Brown CS, Nguyen‐Van‐Tam JS. Influenza in long-term care facilities. Influenza Other Respir Viruses 2017; 11:356-366. [PMID: 28691237 PMCID: PMC5596516 DOI: 10.1111/irv.12464] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 01/13/2023] Open
Abstract
Long-term care facility environments and the vulnerability of their residents provide a setting conducive to the rapid spread of influenza virus and other respiratory pathogens. Infections may be introduced by staff, visitors or new or transferred residents, and outbreaks of influenza in such settings can have devastating consequences for individuals, as well as placing extra strain on health services. As the population ages over the coming decades, increased provision of such facilities seems likely. The need for robust infection prevention and control practices will therefore remain of paramount importance if the impact of outbreaks is to be minimised. In this review, we discuss the nature of the problem of influenza in long-term care facilities, and approaches to preventive and control measures, including vaccination of residents and staff, and the use of antiviral drugs for treatment and prophylaxis, based on currently available evidence.
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Affiliation(s)
- Louise E. Lansbury
- Health Protection and Influenza Research GroupDivision of Epidemiology and Public HealthCity HospitalUniversity of NottinghamNottinghamUK
| | - Caroline S. Brown
- Influenza & Other Respiratory Pathogens ProgrammeDivision of Communicable Diseases and Health SecurityWHO Regional Office for EuropeUN CityCopenhagenDenmark
| | - Jonathan S. Nguyen‐Van‐Tam
- Health Protection and Influenza Research GroupDivision of Epidemiology and Public HealthCity HospitalUniversity of NottinghamNottinghamUK
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De Serres G, Skowronski DM, Ward BJ, Gardam M, Lemieux C, Yassi A, Patrick DM, Krajden M, Loeb M, Collignon P, Carrat F. Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement. PLoS One 2017; 12:e0163586. [PMID: 28129360 PMCID: PMC5271324 DOI: 10.1371/journal.pone.0163586] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 08/27/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Four cluster randomized controlled trials (cRCTs) conducted in long-term care facilities (LTCFs) have reported reductions in patient risk through increased healthcare worker (HCW) influenza vaccination. This evidence has led to expansive policies of enforcement that include all staff of acute care hospitals and other healthcare settings beyond LTCFs. We critique and quantify the cRCT evidence for indirect patient benefit underpinning policies of mandatory HCW influenza vaccination. METHODS Plausibility of the four cRCT findings attributing indirect patient benefits to HCW influenza vaccination was assessed by comparing percentage reductions in patient risk reported by the cRCTs to predicted values. Plausibly predicted values were derived according to the basic mathematical principle of dilution, taking into account HCW influenza vaccine coverage and the specificity of patient outcomes for influenza. Accordingly, predicted values were calculated as a function of relevant compound probabilities including vaccine efficacy (ranging 40-60% in HCWs and favourably assuming the same indirect protection conferred through them to patients) × change in proportionate HCW influenza vaccine coverage (as reported by each cRCT) × percentage of a given patient outcome (e.g. influenza-like illness (ILI) or all-cause mortality) plausibly due to influenza virus. The number needed to vaccinate (NNV) for HCWs to indirectly prevent patient death was recalibrated based on real patient data of hospital-acquired influenza, with adjustment for potential under-detection (5.2-fold), and using favourable assumptions of HCW-attributable risk (ranging 60-80%). RESULTS In attributing patient benefit to increased HCW influenza vaccine coverage, each cRCT was found to violate the basic mathematical principle of dilution by reporting greater percentage reductions with less influenza-specific patient outcomes (i.e., all-cause mortality > ILI > laboratory-confirmed influenza) and/or patient mortality reductions exceeding even favourably-derived predicted values by at least 6- to 15-fold. If extrapolated to all LTCF and hospital staff in the United States, the prior cRCT-claimed NNV of 8 would implausibly mean >200,000 and >675,000 patient deaths, respectively, could be prevented annually by HCW influenza vaccination, inconceivably exceeding total US population mortality estimates due to seasonal influenza each year, or during the 1918 pandemic, respectively. More realistic recalibration based on actual patient data instead shows that at least 6000 to 32,000 hospital workers would need to be vaccinated before a single patient death could potentially be averted. CONCLUSIONS The four cRCTs underpinning policies of enforced HCW influenza vaccination attribute implausibly large reductions in patient risk to HCW vaccination, casting serious doubts on their validity. The impression that unvaccinated HCWs place their patients at great influenza peril is exaggerated. Instead, the HCW-attributable risk and vaccine-preventable fraction both remain unknown and the NNV to achieve patient benefit still requires better understanding. Although current scientific data are inadequate to support the ethical implementation of enforced HCW influenza vaccination, they do not refute approaches to support voluntary vaccination or other more broadly protective practices, such as staying home or masking when acutely ill.
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Affiliation(s)
- Gaston De Serres
- Institut national de santé publique du Québec, Quebec City, Quebec, Canada
- Laval University, Quebec City, Quebec, Canada
| | - Danuta M. Skowronski
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian J. Ward
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael Gardam
- University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Camille Lemieux
- University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Annalee Yassi
- University of British Columbia, Vancouver, British Columbia, Canada
| | - David M. Patrick
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Loeb
- McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Peter Collignon
- Australian National University, Acton, Australia
- Canberra Hospital, Garran, ACT, Australia
| | - Fabrice Carrat
- Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Sorbonne Universités, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Unité de Santé Publique, Paris, France
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Ling MH, Wong SY, Tsui KL. Efficient heterogeneous sampling for stochastic simulation with an illustration in health care applications. COMMUN STAT-SIMUL C 2017. [DOI: 10.1080/03610918.2014.977914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M. H. Ling
- Department of Mathematics and Information Technology, The Education University of Hong Kong, Tai Po, Hong Kong SAR, China
| | - S. Y. Wong
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon Tong, Hong Kong SAR, China
- Center for Clinical Epidemiology, Graduate School of Public Health Planning Office, St. Luke's International University, Tokyo, Japan
| | - K. L. Tsui
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon Tong, Hong Kong SAR, China
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Potential Ceiling Effect of Healthcare Worker Influenza Vaccination on the Incidence of Nosocomial Influenza Infection. Infect Control Hosp Epidemiol 2016; 37:840-4. [PMID: 27098758 DOI: 10.1017/ice.2016.77] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the effect of healthcare worker (HCW) influenza vaccination on the incidence of nosocomial influenza DESIGN Retrospective cross-sectional study SETTING A 550-bed tertiary-care academic medical center METHODS All admitted patients with a direct fluorescent antibody (DFA) or polymerase chain reaction (PCR) assay positive for influenza ordered between October 1 and May 31 from 2010 to 2015 were eligible for inclusion. Nosocomial influenza was defined as a positive influenza test collected ≥48 hours after admission in patients without influenza-like illness present within 24 hours of admission. Relative nosocomial influenza frequency was calculated by dividing the number of nosocomial cases by the total number of admitted patients with influenza for each season. A univariate logistic regression was used to determine the association between HCW influenza vaccination coverage and nosocomial influenza. RESULTS Over 5 seasons, 533 patients had positive influenza tests during their hospitalization; 29 of these patients (5.4%) acquired influenza during their hospitalization. HCW vaccination coverage increased over the 5 seasons from 47% to 90% (P<.001). Despite an initial decrease in relative nosocomial influenza frequency during the first year (9% to 4.9%), subsequent seasons failed to show an additional decrease in nosocomial infections (4.3%, 5.2%, and 4.8%, respectively); the overall decrease in nosocomial influenza from the first season to the final season was not significant (P=.282). No association was detected between HCW vaccination coverage and nosocomial influenza (odds ratio [OR], 0.990; 95% confidence interval [CI], 0.970-1.011). CONCLUSION HCW vaccination >50% may not have a significant effect on nosocomial influenza. Infect Control Hosp Epidemiol 2016;37:840-844.
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Hill JN, Smith BM, Evans CT, Anaya H, Goldstein B, LaVela SL. Implementing a declination form programme to improve influenza vaccine uptake by staff in Department of Veterans Affairs spinal cord injury centres: a pilot study. J Hosp Infect 2015; 91:158-65. [PMID: 26255219 DOI: 10.1016/j.jhin.2015.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/27/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Individuals with spinal cord injuries and disorders are at high risk for respiratory and influenza-related complications after developing influenza. These individuals often have frequent contact with the healthcare system. Vaccination rates in healthcare workers at Department of Veterans Affairs (VA) spinal cord injury (SCI) centres have been approximately 50% for several years. Efforts are needed to increase vaccination uptake among SCI HCWs. Declination form programmes (DFPs) in combination with other strategies have resulted in significant increases in influenza vaccination uptake in HCWs. AIM Use of external and internal facilitation including local teams and consensus processes to pilot a DFP in two VA SCI centres and evaluate factors influencing implementation. METHODS Implementation meetings and a consensus-building process with leadership and implementation team members were conducted, along with semi-structured post-implementation interviews with members of each implementation team (N = 7). FINDINGS The DFP was well accepted and easy to use. Leadership was a key facilitator for DFP implementation. Barriers included difficulty communicating with HCWs working during early/late shifts. Participation was 100% at Site 1 and 48% at Site 2. CONCLUSION Use of local teams and consensus to identify strategies to implement a DFP is feasible and effective for achieving moderate-to-high levels of participation in the programme.
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Affiliation(s)
- J N Hill
- Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr VA Hospital, Hines, IL, USA; Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA.
| | - B M Smith
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - C T Evans
- Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr VA Hospital, Hines, IL, USA; Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA; Department of Preventive Medicine, Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - H Anaya
- Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr VA Hospital, Hines, IL, USA; Human Immunodeficiency Virus/Hepatitis Quality Enhancement Research Initiative, Los Angeles, CA, USA; University of California - Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - B Goldstein
- National Spinal Cord Injury/Disorders Services, Clinical Operations, Veterans Affairs Central Office, Seattle, WA, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - S L LaVela
- Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr VA Hospital, Hines, IL, USA; Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA; Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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A new approach to improving healthcare personnel influenza immunization programs: a randomized controlled trial. PLoS One 2015; 10:e0118368. [PMID: 25781888 PMCID: PMC4363667 DOI: 10.1371/journal.pone.0118368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 01/11/2015] [Indexed: 11/19/2022] Open
Abstract
Background Healthcare personnel influenza immunization rates remain sub-optimal. Following multiple studies and expert consultations, the “Successful Influenza Immunization Programs for Healthcare Personnel: A Guide for Program Planners” was produced. This trial assessed the impact of the Guide with facilitation in improving healthcare personnel influenza immunization rates in Canadian healthcare organizations. Methods A sample of 26 healthcare organizations across six Canadian provinces (ON, MB, NS, BC, SK, NL) was randomized to Intervention (n=13) or Control groups (n=13). Baseline influenza immunization rates were obtained for 2008–2009; the study groups were followed over two subsequent influenza seasons. The Intervention group received the Guide, facilitation support through workshops for managers and ongoing support. The Control groups conducted programs as usual. The Groups were compared using their reported influenza healthcare personnel influenza immunization rates and scores from a program assessment questionnaire. Findings Twenty-six organizations agreed to participate. 35% (9/26) of sites were acute care hospitals, 19% (5/26) continuing care, long-term care organizations or nursing homes, and 46% (12/26) were mixed acute care hospitals and long-term care or regional health authorities. The median rate of influenza immunization among healthcare personnel for the Intervention group was 43%, 44%, and 51% at three points in time respectively, and in the Control group: 62%, 57%, and 55% respectively. No significant differences were observed between the groups at the three points in time. However, there was a 7% increase in the median rates between the Baseline Year and Year Two in the Intervention group, and a 6% decrease in the Control group over the same time period, which was statistically significant (0.071 versus -0.058, p < 0.001). Interpretation This pragmatic randomized trial of the Guide with facilitation of its implementation improved healthcare personnel immunization rates, but these rates continued to be sub-optimal and below rates achievable in programs requiring personnel to be immunized. Trial Registration ClinicalTrials.gov NCT01207518
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Gray M, Mayo P, Miyata M. Should influenza immunization be mandatory for all health care providers? Can J Hosp Pharm 2015; 68:60-3. [PMID: 25762822 DOI: 10.4212/cjhp.v68i1.1427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Talbot TR, Babcock H, Caplan AL, Cotton D, Maragakis LL, Poland GA, Septimus EJ, Tapper ML, Weber DJ. Revised SHEA Position Paper: Influenza Vaccination of Healthcare Personnel. Infect Control Hosp Epidemiol 2015; 31:987-95. [PMID: 20807037 DOI: 10.1086/656558] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Executive SummaryThis document serves as an update and companion piece to the 2005 Society for Healthcare Epidemiology of America (SHEA) Position Paper entitled “Influenza Vaccination of Healthcare Workers and Vaccine Allocation for Healthcare Workers During Vaccine Shortages.” In large part, the discussion about the rationale for influenza vaccination of healthcare personnel (HCP), the strategies designed to improve influenza vaccination rates in this population, and the recommendations made in the 2005 paper still stand. This position paper notes new evidence released since publication of the 2005 paper and strengthens SHEA's position on the importance of influenza vaccination of HCP. This document does not discuss vaccine allocation during times of vaccine shortage, because the 2005 SHEA Position Paper still serves as the Society's official statement on that issue.
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Affiliation(s)
- Thomas R Talbot
- Departments of Medicine and Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
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Cadena J, Prigmore T, Bowling J, Ayala BA, Kirkman L, Parekh A, Scepanski T, Patterson JE. Improving Influenza Vaccination of Healthcare Workers by Means of Quality Improvement Tools. Infect Control Hosp Epidemiol 2015; 32:616-8. [DOI: 10.1086/660198] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
For a healthcare worker seasonal influenza vaccination quality improvement project, interventions included support of leadership, distribution of vaccine kits, grand rounds, an influenza website, a Screensaver, e-mails, phone messages, and audit feedback. Vaccination rates increased from 58.8% to 76.6% (P < .01). Quality improvement increased the voluntary vaccination rate but did not achieve a rate more than 80%.
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Feng L, Yang P, Zhang T, Yang J, Fu C, Qin Y, Zhang Y, Ma C, Liu Z, Wang Q, Zhao G, Yu H. Technical guidelines for the application of seasonal influenza vaccine in China (2014-2015). Hum Vaccin Immunother 2015; 11:2077-101. [PMID: 26042462 PMCID: PMC4635867 DOI: 10.1080/21645515.2015.1027470] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022] Open
Abstract
Influenza, caused by the influenza virus, is a respiratory infectious disease that can severely affect human health. Influenza viruses undergo frequent antigenic changes, thus could spread quickly. Influenza causes seasonal epidemics and outbreaks in public gatherings such as schools, kindergartens, and nursing homes. Certain populations are at risk for severe illness from influenza, including pregnant women, young children, the elderly, and people in any ages with certain chronic diseases.
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Affiliation(s)
- Luzhao Feng
- Key Laboratory of Surveillance and Early-warning on Infectious Disease; Division of Infectious Disease; Chinese Center for Disease Control and Prevention; Beijing, China
| | - Peng Yang
- Beijing Center for Disease Control and Prevention; Beijing, China
| | - Tao Zhang
- School of Public Health; Fudan University; Shanghai, China
| | - Juan Yang
- Key Laboratory of Surveillance and Early-warning on Infectious Disease; Division of Infectious Disease; Chinese Center for Disease Control and Prevention; Beijing, China
| | - Chuanxi Fu
- Guangzhou Center for Disease Control and Prevention; Guangzhou, China
| | - Ying Qin
- Key Laboratory of Surveillance and Early-warning on Infectious Disease; Division of Infectious Disease; Chinese Center for Disease Control and Prevention; Beijing, China
| | - Yi Zhang
- Beijing Center for Disease Control and Prevention; Beijing, China
| | - Chunna Ma
- Beijing Center for Disease Control and Prevention; Beijing, China
| | - Zhaoqiu Liu
- Hua Xin Hospital; First Hospital of Tsinghua University; Beijing, China
| | - Quanyi Wang
- Beijing Center for Disease Control and Prevention; Beijing, China
| | - Genming Zhao
- School of Public Health; Fudan University; Shanghai, China
| | - Hongjie Yu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease; Division of Infectious Disease; Chinese Center for Disease Control and Prevention; Beijing, China
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Sociocognitive predictors of the intention of healthcare workers to receive the influenza vaccine in Belgian, Dutch and German hospital settings. J Hosp Infect 2014; 89:202-9. [PMID: 25586987 DOI: 10.1016/j.jhin.2014.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 11/18/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Influenza vaccination of healthcare workers (HCWs) is recommended to prevent the transmission of influenza to vulnerable patients. Nevertheless, vaccination coverage rates of HCWs in European countries have been low. AIM To investigate the relative and combined strength of sociocognitive variables, from past research, theory and a qualitative study, in explaining the motivation of HCWs to receive the influenza vaccine. METHODS An anonymous, online questionnaire was distributed among HCWs in hospital settings in Belgium, Germany and the Netherlands between February and April 2013. FINDINGS Attitude and past vaccination uptake explained a considerable amount of variance in the intention of HCWs to receive the influenza vaccine. Moreover, low perceived social norms, omission bias, low moral norms, being older, having no patient contact, and being Belgian or Dutch (compared with German) increased the probability of having no intention to receive the influenza vaccine compared with being undecided about vaccination. High intention to receive the influenza vaccine was shown to be more likely than being undecided about vaccination when HCWs had high perceived susceptibility of contracting influenza, low naturalistic views, and lower motivation to receive the vaccine solely for self-protection. CONCLUSION Country-specific interventions and a focus on different sociocognitive variables depending on the intention/lack of intention of HCWs to receive the influenza vaccine may be beneficial to promote vaccination uptake.
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Cortes-Penfield N. Mandatory influenza vaccination for health care workers as the new standard of care: a matter of patient safety and nonmaleficent practice. Am J Public Health 2014; 104:2060-5. [PMID: 24328628 PMCID: PMC4202972 DOI: 10.2105/ajph.2013.301514] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2013] [Indexed: 11/04/2022]
Abstract
A growing body of literature defends the efficacy of seasonal influenza vaccination for health care workers in reducing the mortality of hospitalized patients. I review the evidence concerning influenza vaccination, concluding that universal vaccination of health care workers against influenza should be considered standard patient care and that nonvaccination represents maleficent care. I further argue that the ethical responsibility to ensure universal vaccination of staff against seasonal influenza lies not only with individual health care providers but with each individual health care institution.
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Wicker S, Marckmann G. Vaccination of health care workers against influenza: Is it time to think about a mandatory policy in Europe? Vaccine 2014; 32:4844-8. [DOI: 10.1016/j.vaccine.2013.09.062] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 08/25/2013] [Accepted: 09/26/2013] [Indexed: 01/05/2023]
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Ksienski DS. Mandatory seasonal influenza vaccination or masking of British Columbia health care workers: Year 1. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2014; 105:e312-6. [PMID: 25166135 PMCID: PMC6972449 DOI: 10.17269/cjph.105.4346] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 07/23/2014] [Accepted: 05/25/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The Influenza Prevention Policy ("the Policy") aims to increase seasonal influenza vaccination coverage among British Columbia (BC) health care workers (HCWs). PARTICIPANTS HCWs who work in publicly funded facilities and attend patient care areas. SETTING The Policy was announced in August 2012 and took effect province-wide during the 2012/13 flu season. INTERVENTION BC HCWs are required to receive seasonal influenza vaccination by the start of the flu season (December 1) or wear a mask while at work until the flu season ends (March 30). Vaccinated HCWs need to wear a green dot on their identification tag. HCWs are expected to report noncompliant coworkers. As initially proposed, continued noncompliance with the Policy could result in termination of employment (ultimately this component was put in abeyance). OUTCOME For the 2012/13 flu season, 74% of HCWs (35,889/48,818) at acute care facilities received influenza vaccination compared with 40% (23,375/58,212) in 2011/12 (difference in proportion=0.33, 95% confidence interval [CI]: 0.33-0.34, p<0.001). Similarly, staff vaccination rates at residential care facilities increased from 57% (21,535/37,700) for the 2011/12 flu season to 75% (27,617/36,620) in 2012/13 (difference in proportion=0.18, 95% CI: 0.18-0.19, p<0.001). Health care unions claimed that the Policy was coercive, and they launched an unsuccessful grievance with the BC Labour Relations Board. CONCLUSION Implementation of the Policy was associated with increased HCW vaccination; the Policy was upheld by an independent arbitrator. Further research is required to correlate HCW vaccination coverage rates with changes in influenza incidence and its complications. Continued stakeholder engagement is vital to achieve a collaborative decision-making process.
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Can influenza vaccination coverage among healthcare workers influence the risk of nosocomial influenza-like illness in hospitalized patients? J Hosp Infect 2014; 86:182-7. [DOI: 10.1016/j.jhin.2014.01.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 01/13/2014] [Indexed: 11/15/2022]
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Vaccination policies for healthcare workers in Europe. Vaccine 2013; 32:4876-80. [PMID: 24161573 DOI: 10.1016/j.vaccine.2013.10.046] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 10/04/2013] [Accepted: 10/08/2013] [Indexed: 01/05/2023]
Abstract
Health-care workers (HCWs) are at increased risk for acquisition of vaccine-preventable diseases (VPDs) and vaccination is justified in order to protect them from occupational exposure and to prevent the spread of VPDs that pose a threat to susceptible patients. Review of European vaccination policies for HCWs revealed significant differences between countries in terms of recommended vaccines, implementation frame (mandatory or recommendation), target HCW groups and health-care settings. Further, the few published studies available identified indicate significant immunity gaps among HCWs against VPDs in Europe. In order to achieve higher vaccination coverage against VPDs stronger recommendations are needed. The issue of mandatory vaccination should be considered for diseases that can be transmitted to susceptible patients (influenza, measles, mumps, rubella, hepatitis B, pertussis, varicella). The acceptance of vaccinations and of mandatory vaccinations by HCWs is a challenge and appears to be VPD-specific.
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Ahmed F, Lindley MC, Allred N, Weinbaum CM, Grohskopf L. Effect of influenza vaccination of healthcare personnel on morbidity and mortality among patients: systematic review and grading of evidence. Clin Infect Dis 2013; 58:50-7. [PMID: 24046301 DOI: 10.1093/cid/cit580] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Influenza vaccination of healthcare personnel (HCP) is recommended in >40 countries. However, there is controversy surrounding the evidence that HCP vaccination reduces morbidity and mortality among patients. Key factors for developing evidence-based recommendations include quality of evidence, balance of benefits and harms, and values and preferences. METHODS We conducted a systematic review of randomized trials, cohort studies, and case-control studies published through June 2012 to evaluate the effect of HCP influenza vaccination on mortality, hospitalization, and influenza cases in patients of healthcare facilities. We pooled trial results using meta-analysis and assessed evidence quality using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS We identified 4 cluster randomized trials and 4 observational studies conducted in long-term care or hospital settings. Pooled risk ratios across trials for all-cause mortality and influenza-like illness were 0.71 (95% confidence interval [CI], .59-.85) and 0.58 (95% CI, .46-.73), respectively; pooled estimates for all-cause hospitalization and laboratory-confirmed influenza were not statistically significant. The cohort and case-control studies indicated significant protective associations for influenza-like illness and laboratory-confirmed influenza. No studies reported harms to patients. Using GRADE, the quality of the evidence for the effect of HCP vaccination on mortality and influenza cases in patients was moderate and low, respectively. The evidence quality for the effect of HCP vaccination on patient hospitalization was low. The overall evidence quality was moderate. CONCLUSIONS The quality of evidence is higher for mortality than for other outcomes. HCP influenza vaccination can enhance patient safety.
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Affiliation(s)
- Faruque Ahmed
- Immunization Services Division, National Center for Immunization and Respiratory Diseases
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van Kleef E, Robotham JV, Jit M, Deeny SR, Edmunds WJ. Modelling the transmission of healthcare associated infections: a systematic review. BMC Infect Dis 2013; 13:294. [PMID: 23809195 PMCID: PMC3701468 DOI: 10.1186/1471-2334-13-294] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 06/21/2013] [Indexed: 11/22/2022] Open
Abstract
Background Dynamic transmission models are increasingly being used to improve our understanding of the epidemiology of healthcare-associated infections (HCAI). However, there has been no recent comprehensive review of this emerging field. This paper summarises how mathematical models have informed the field of HCAI and how methods have developed over time. Methods MEDLINE, EMBASE, Scopus, CINAHL plus and Global Health databases were systematically searched for dynamic mathematical models of HCAI transmission and/or the dynamics of antimicrobial resistance in healthcare settings. Results In total, 96 papers met the eligibility criteria. The main research themes considered were evaluation of infection control effectiveness (64%), variability in transmission routes (7%), the impact of movement patterns between healthcare institutes (5%), the development of antimicrobial resistance (3%), and strain competitiveness or co-colonisation with different strains (3%). Methicillin-resistant Staphylococcus aureus was the most commonly modelled HCAI (34%), followed by vancomycin resistant enterococci (16%). Other common HCAIs, e.g. Clostridum difficile, were rarely investigated (3%). Very few models have been published on HCAI from low or middle-income countries. The first HCAI model has looked at antimicrobial resistance in hospital settings using compartmental deterministic approaches. Stochastic models (which include the role of chance in the transmission process) are becoming increasingly common. Model calibration (inference of unknown parameters by fitting models to data) and sensitivity analysis are comparatively uncommon, occurring in 35% and 36% of studies respectively, but their application is increasing. Only 5% of models compared their predictions to external data. Conclusions Transmission models have been used to understand complex systems and to predict the impact of control policies. Methods have generally improved, with an increased use of stochastic models, and more advanced methods for formal model fitting and sensitivity analyses. Insights gained from these models could be broadened to a wider range of pathogens and settings. Improvements in the availability of data and statistical methods could enhance the predictive ability of models.
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Affiliation(s)
- Esther van Kleef
- Infectious Disease Epidemiology Department, Faculty of Epidemiology and Population Health, Centre of Mathematical Modelling, London School of Hygiene and Tropical Medicine, London, UK.
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Riphagen-Dalhuisen J, Burgerhof JG, Frijstein G, van der Geest-Blankert AD, Danhof-Pont MB, de Jager HJ, Bos AA, Smeets EE, de Vries MJ, Gallee PM, Hak E. Hospital-based cluster randomised controlled trial to assess effects of a multi-faceted programme on influenza vaccine coverage among hospital healthcare workers and nosocomial influenza in the Netherlands, 2009 to 2011. ACTA ACUST UNITED AC 2013; 18:20512. [PMID: 23827527 DOI: 10.2807/1560-7917.es2013.18.26.20512] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nosocomial influenza is a large burden in hospitals. Despite recommendations from the World Health Organization to vaccinate healthcare workers against influenza, vaccine uptake remains low in most European countries. We performed a pragmatic cluster randomised controlled trial in order to assess the effects of implementing a multi-faceted influenza immunisation programme on vaccine coverage in hospital healthcare workers (HCWs) and on in-patient morbidity. We included hospital HCWs of three intervention and three control University Medical Centers (UMCs), and 3,367 patients. An implementation programme was offered to the intervention UMCs to assess the effects on both vaccine uptake among hospital staff and patient morbidity. In 2009/10, the coverage of seasonal, the first and second dose of pandemic influenza vaccine as well as seasonal vaccine in 2010/11 was higher in intervention UMCs than control UMCs (all p<0.05). At the internal medicine departments of the intervention group with higher vaccine coverage compared to the control group, nosocomial influenza and/or pneumonia was recorded in 3.9% and 9.7% of patients of intervention and control UMCs, respectively (p=0.015). Though potential bias could not be completely ruled out, an increase in vaccine coverage was associated with decreased patient in-hospital morbidity from influenza and/or pneumonia.
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Affiliation(s)
- J Riphagen-Dalhuisen
- Department of PharmacoEpidemiology & PharmacoEconomics, University Center of Pharmacy, University of Groningen, Groningen, the Netherlands.
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Can we achieve high uptakes of influenza vaccination of healthcare workers in hospitals? A cross-sectional survey of acute NHS trusts in England. Epidemiol Infect 2013; 142:438-47. [DOI: 10.1017/s095026881300112x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
SUMMARYIt is unknown which intervention strategies are used or effective to increase influenza vaccine uptake by healthcare workers (HCWs) in acute hospitals in England. We undertook a survey in acute hospitals, described strategies employed from 2008 to 2012 and used multivariable binomial regression to identify those effective. Eighty out of 166 trusts responded and reported 25 strategies. Every intervention showed increased use: peer vaccination from 3·8% to 38·8% (+921%); educational DVDs from 3·8% to 22·5% (+492%); Twitter from 2·5% to 12·5% (+400%) and Facebook from 1·3% to 6·3% (+384%). Peer vaccination increased uptake by 7·3% [95% confidence interval (CI) 1·1–13·6, P = 0·02] overall; educational DVDs by 9·7% overall (95% CI 1·8–17·6, P = 0·02), 11·9% in non-doctor, non-nurse HCWs (95% CI 0·9–22·8, P = 0·03). For doctors, using a champion doctor increased uptake by 17·8% (95% CI 7·6–28·0, P < 0·01). No intervention increased uptake by nurses. Increasing uptake requires multi-intervention strategies targeted at different HCW groups.
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Cusumano-Towner M, Li DY, Tuo S, Krishnan G, Maslove DM. A social network of hospital acquired infection built from electronic medical record data. J Am Med Inform Assoc 2013; 20:427-34. [PMID: 23467473 DOI: 10.1136/amiajnl-2012-001401] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Social networks have been used in the study of outbreaks of infectious diseases, including in small group settings such as individual hospitals. Collecting the data needed to create such networks, however, can be time consuming, costly, and error prone. We sought to create a social network of hospital inpatients using electronic medical record (EMR) data already collected for other purposes, for use in simulating outbreaks of nosocomial infections. MATERIALS AND METHODS We used the EMR data warehouse of a tertiary academic hospital to model contact among inpatients. Patient-to-patient contact due to shared rooms was inferred from admission-discharge-transfer data, and contact with healthcare workers was inferred from clinical documents. Contacts were used to generate a social network, which was then used to conduct probabilistic simulations of nosocomial outbreaks of methicillin-resistant Staphylococcus aureus and influenza. RESULTS Simulations of infection transmission across the network reflected the staffing and patient flow practices of the hospital. Simulations modeling patient isolation, increased hand hygiene, and staff vaccination showed a decrease in the spread of infection. DISCUSSION We developed a method of generating a social network of hospital inpatients from EMR data. This method allows the derivation of networks that reflect the local hospital environment, obviate the need for simulated or manually collected data, and can be updated in near real time. CONCLUSIONS Inpatient social networks represent a novel secondary use of EMR data, and can be used to simulate nosocomial infections. Future work should focus on prospective validation of the simulations, and adapting such networks to other tasks.
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Randall LH, Curran EA, Omer SB. Legal considerations surrounding mandatory influenza vaccination for healthcare workers in the United States. Vaccine 2013; 31:1771-6. [PMID: 23415931 DOI: 10.1016/j.vaccine.2013.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 01/23/2013] [Accepted: 02/01/2013] [Indexed: 11/17/2022]
Abstract
Recent years have brought increased focus on the desirability of vaccinating more healthcare workers against influenza. The concern that novel 2009 H1N1 influenza A would spark a particularly severe influenza season in 2009-2010 spurred several institutions and one state to institute mandatory vaccination policies for healthcare workers, and several new mandates have been introduced since then. Some healthcare workers, however, have voiced objections in the media and in legal proceedings. This paper reviews the characteristics of influenza and how it is transmitted in the healthcare setting; surveys possible constitutional, administrative, and common law arguments against mandates; assesses the viability of those arguments; and identifies potential new legal strategies to support influenza vaccine mandates. It is intended to assist those involved in the regulation and administration of public and private healthcare institutions who may be considering approaches to mandates but have concerns about legal challenges.
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Bélisle Pipon JC, Frenette M. Mandatory influenza vaccination: how far to go and whom to target without evidence? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2013; 13:48-50. [PMID: 23952836 DOI: 10.1080/15265161.2013.813607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Jean-Christophe Bélisle Pipon
- Bioethics Programme, Department of Social and Preventive Medicine, Université de Montréal, Montréal, Québec, Canada.
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Antommaria AHM. An ethical analysis of mandatory influenza vaccination of health care personnel: implementing fairly and balancing benefits and burdens. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2013; 13:30-37. [PMID: 23952830 DOI: 10.1080/15265161.2013.814731] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Health care institutions have paid increasing attention to preventing nosocomial transmission of influenza through vaccination of health care personnel. While multifaceted voluntary interventions have increased vaccination rates, proponents of mandatory programs contend the rates remain unacceptably low. Conventional bioethical analyses of mandatory programs are inadequate; they fail to account for the obligations of nonprofessional personnel or to justify the weights assigned to different ethical principles. Using an ethics framework for public health permits a fuller analysis. The framework's focus on fairness accentuates the potential differences between the risk of transmitting infection and employment status, and the need to equitably evaluate exemptions. The framework's emphasis on balancing benefits and burdens highlights the need to justify a specific goal and questions the need to exclude all nonmedical exemptions. While mandatory vaccination programs are justifiable, greater attention should be paid to their implementation.
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Dolan GP, Harris RC, Clarkson M, Sokal R, Morgan G, Mukaigawara M, Horiuchi H, Hale R, Stormont L, Béchard-Evans L, Chao YS, Eremin S, Martins S, Tam JS, Peñalver J, Zanuzdana A, Zanuzadana A, Nguyen-Van-Tam JS. Vaccination of health care workers to protect patients at increased risk for acute respiratory disease. Emerg Infect Dis 2012; 18:1225-34. [PMID: 22840895 PMCID: PMC3414018 DOI: 10.3201/eid1808.111355] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Health care workers (HCWs) may transmit respiratory infection to patients. We assessed evidence for the effectiveness of vaccinating HCWs to provide indirect protection for patients at risk for severe or complicated disease after acute respiratory infection. We searched electronic health care databases and sources of gray literature by using a predefined strategy. Risk for bias was assessed by using validated tools, and results were synthesized by using a narrative approach. Seventeen of the 12,352 identified citations met the full inclusion criteria, and 3 additional articles were identified from reference or citation tracking. All considered influenza vaccination of HCWs, and most were conducted in long-term residential care settings. Consistency in the direction of effect was observed across several different outcome measures, suggesting a likely protective effect for patients in residential care settings. However, evidence was insufficient for us to confidently extrapolate this to other at-risk patient groups.
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Street JM, Delany TN. Guidelines in disrepute: a case study of influenza vaccination of healthcare workers. Aust N Z J Public Health 2012. [DOI: 10.1111/j.1753-6405.2012.00896.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Andrawis MA, Rehm SJ. Health-system pharmacists' role in improving immunization rates. Am J Health Syst Pharm 2012; 69:74-6. [PMID: 22180557 DOI: 10.2146/ajhp110257] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Mary A Andrawis
- Centers for Medicare and Medicaid Services, Baltimore, MD 21244, USA.
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Bénet T, Régis C, Voirin N, Robert O, Lina B, Cronenberger S, Comte B, Coppéré B, Vanhems P. Influenza vaccination of healthcare workers in acute-care hospitals: a case-control study of its effect on hospital-acquired influenza among patients. BMC Infect Dis 2012; 12:30. [PMID: 22292886 PMCID: PMC3293022 DOI: 10.1186/1471-2334-12-30] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 02/01/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In acute-care hospitals, no evidence of a protective effect of healthcare worker (HCW) vaccination on hospital-acquired influenza (HAI) in patients has been documented. Our study objective was to ascertain the effectiveness of influenza vaccination of HCW on HAI among patients. METHODS A nested case-control investigation was implemented in a prospective surveillance study of influenza-like illness (ILI) in a tertiary acute-care university hospital. Cases were patients with virologically-confirmed influenza occurring ≥ 72 h after admission, and controls were patients with ILI presenting during hospitalisation with negative influenza results after nasal swab testing. Four controls per case, matched per influenza season (2004-05, 2005-06 and 2006-07), were randomly selected. Univariate and multivariate conditional logistic regression models were fitted to assess factors associated with HAI among patients. RESULTS In total, among 55 patients analysed, 11 (20%) had laboratory-confirmed HAI. The median HCW vaccination rate in the units was 36%. The median proportion of vaccinated HCW in these units was 11.5% for cases vs. 36.1% for the controls (P = 0.11); 2 (20%) cases and 21 (48%) controls were vaccinated against influenza in the current season (P = 0.16). The proportion of ≥ 35% vaccinated HCW in short-stay units appeared to protect against HAI among patients (odds ratio = 0.07; 95% confidence interval 0.005-0.98), independently of patient age, influenza season and potential influenza source in the units. CONCLUSIONS Our observational study indicates a shielding effect of more than 35% of vaccinated HCW on HAI among patients in acute-care units. Investigations, such as controlled clinical trials, are needed to validate the benefits of HCW vaccination on HAI incidence in patients.
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Affiliation(s)
- Thomas Bénet
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hygiène, Epidémiologie et Prévention, Lyon, France.
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Bryce E, Embree J, Evans G, Johnston L, Katz K, McGeer A, Moore D, Roth V, Simor A, Suh K, Vearncombe M. AMMI Canada position paper: 2012 Mandatory influenza immunization of health care workers. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2012; 23:e93-5. [PMID: 24294284 PMCID: PMC3597405 DOI: 10.1155/2012/756824] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Elizabeth Bryce
- Infection Prevention and Control, Vancouver Coastal Health, Vancouver, British Columbia
| | - Joanne Embree
- Department of Medical Microbiology and Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| | - Gerald Evans
- Infection Prevention & Control Kingston General Hospital/Hotel Dieu Hospital, and Departments of Medicine, Biomedical & Molecular Sciences and Pathology & Molecular Medicine, Queen’s University, Kingston, Ontario
| | - Lynn Johnston
- Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia
| | - Kevin Katz
- Infection Prevention and Control Program, North York General Hospital, Toronto, Ontario
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario
| | - Allison McGeer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario
- Infection Control, Mount Sinai Hospital, Toronto, Ontario
| | - Dorothy Moore
- Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec
| | - Virginia Roth
- Infection Prevention and Control Program, Division of Infectious Diseases, The Ottawa Hospital, and the Department of Medicine, University of Ottawa, Ottawa, Ontario
| | - Andrew Simor
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario
- Department of Microbiology, Sunnybrook Health Sciences Centre, Toronto, Ontario
- Infection Prevention and Control, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Kathryn Suh
- Infection Prevention and Control Program, Division of Infectious Diseases, The Ottawa Hospital, and the Department of Medicine, University of Ottawa, Ottawa, Ontario
| | - Mary Vearncombe
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario
- Department of Microbiology, Sunnybrook Health Sciences Centre, Toronto, Ontario
- Infection Prevention and Control, Sunnybrook Health Sciences Centre, Toronto, Ontario
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Groenewold M, Baron S, Tak S, Allred N. Influenza vaccination coverage among US nursing home nursing assistants: the role of working conditions. J Am Med Dir Assoc 2011; 13:85.e17-23. [PMID: 22208764 DOI: 10.1016/j.jamda.2011.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 02/16/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To estimate influenza vaccination coverage among nursing assistants (NAs) working in US nursing homes, and to identify demographic and occupational predictors of vaccination status among NAs. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis of data on 2873 NAs from the 2004 National Nursing Assistant Survey. Multivariable-adjusted vaccination coverage (prevalence) ratios for demographic and occupational characteristics were calculated using Poisson regression. MEASUREMENTS Outcome variable was NAs' influenza vaccination status, yes or no, based on the question, "During the past 12 months, did you receive a flu shot?" RESULTS Coverage for all NAs working in US nursing homes was estimated to be 37.1%. NAs 45 or older were more likely to be vaccinated than younger NAs (prevalence ratio [PR] = 1.23, 95% confidence interval [CI]: 1.07-1.41). Significant negative associations with vaccination status were found for NAs who were non-Hispanic blacks (PR = 0.82, 95% CI: 0.70-0.97), disagreed that they were respected/rewarded for their work (PR = 0.85, 95% CI: 0.71-1.00), worked at for-profit facilities (PR = 0.83, 95% CI: 0.72-0.95), and reported receiving fewer than 7 of 15 nonwage job benefits (PR = 0.77, 95% CI: 0.67-0.90). CONCLUSION Influenza coverage among nursing home NAs appears to be similar to nationally reported coverage estimates among health care providers in the United States in general. In addition to individual characteristics, occupational characteristics reflective of working conditions are associated with vaccination status among NAs, suggesting that further research into these types of associations may be useful in identifying which institutions may benefit from outreach efforts and types of interventions to increase vaccination coverage.
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Affiliation(s)
- Matthew Groenewold
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Alice Hamilton Laboratory, Cincinnati, OH 45226, USA.
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Polgreen PM, Tassier TL, Pemmaraju SV, Segre AM. Prioritizing healthcare worker vaccinations on the basis of social network analysis. Infect Control Hosp Epidemiol 2010; 31:893-900. [PMID: 20649412 DOI: 10.1086/655466] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To use social network analysis to design more effective strategies for vaccinating healthcare workers against influenza. DESIGN An agent-based simulation. SETTING A simulation based on a 700-bed hospital. METHODS We first observed human contacts (defined as approach within approximately 0.9 m) performed by 15 categories of healthcare workers (eg, floor nurses, intensive care unit nurses, staff physicians, phlebotomists, and respiratory therapists). We then constructed a series of contact graphs to represent the social network of the hospital and used these graphs to run agent-based simulations to model the spread of influenza. A targeted vaccination strategy that preferentially vaccinated more "connected" healthcare workers was compared with other vaccination strategies during simulations with various base vaccination rates, vaccine effectiveness, probability of transmission, duration of infection, and patient length of stay. RESULTS We recorded 6,654 contacts by 148 workers during 606 hours of observations from January through December 2006. Unit clerks, X-ray technicians, residents and fellows, transporters, and physical and occupational therapists had the most contacts. When repeated contacts with the same individual were excluded, transporters, unit clerks, X-ray technicians, physical and occupational therapists, and social workers had the most contacts. Preferentially vaccinating healthcare workers in more connected job categories yielded a substantially lower attack rate and fewer infections than a random vaccination strategy for all simulation parameters. CONCLUSIONS Social network models can be used to derive more effective vaccination policies, which are crucial during vaccine shortages or in facilities with low vaccination rates. Local vaccination priorities can be determined in any healthcare facility with only a modest investment in collection of observational data on different types of healthcare workers. Our findings and methods (ie, social network analysis and computational simulation) have implications for the design of effective interventions to control a broad range of healthcare-associated infections.
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Affiliation(s)
- Philip M Polgreen
- Department of Internal Medicine, The University of Iowa, Iowa City, Iowa 52242, USA
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Nazarko L. Staff flu vaccination: A patient safety necessity? Br J Community Nurs 2010; 15:525. [PMID: 21079555 DOI: 10.12968/bjcn.2010.15.11.79619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The nights are drawing in, winter is fast approaching, and occupational health departments are already beginning staff flu immunization programmes. Vaccinated staff protect both vaccinated and unvaccinated patients from flu (van den Dool et al, 2008; 2009), and improve staff health, reduce sick leave, as well as set the public a good example.
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Attitudes towards vaccination against seasonal influenza of health-care workers in primary health-care settings in Greece. Vaccine 2010; 28:5931-3. [DOI: 10.1016/j.vaccine.2010.06.108] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 06/07/2010] [Accepted: 06/30/2010] [Indexed: 11/30/2022]
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Brown LH, Aitken P, Leggat PA, Speare R. Self-reported anticipated compliance with physician advice to stay home during pandemic (H1N1) 2009: results from the 2009 Queensland Social Survey. BMC Public Health 2010; 10:138. [PMID: 20233450 PMCID: PMC2847980 DOI: 10.1186/1471-2458-10-138] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 03/16/2010] [Indexed: 12/24/2022] Open
Abstract
Background One strategy available to public health officials during a pandemic is physician recommendations for isolation of infected individuals. This study was undertaken during the height of the Australian pandemic (H1N1) 2009 outbreak to measure self-reported willingness to comply with physician recommendations to stay home for seven days, and to compare responses for the current strain of pandemic influenza, avian influenza, seasonal influenza, and the common cold. Methods Data were collected as part of the Queensland Social Survey (QSS) 2009, which consisted of a standardized introduction, 37 demographic questions, and research questions incorporated through a cost-sharing arrangement. Four questions related to respondents' anticipated compliance with a physician's advice to stay home if they had a common cold, seasonal influenza, pandemic (H1N1) 2009 influenza or avian influenza were incorporated into QSS 2009, with responses recorded using a balanced Likert scale ranging from "very unlikely" to "very likely." Discordance between responses for different diseases was analysed using McNemar's test. Associations between demographic variables and anticipated compliance were analysed using Pearson's chi-square or chi-square for linear-by-linear association, and confirmed using multivariate logistic regression; p < 0.05 was used to establish statistical significance. Results Self-reported anticipated compliance increased from 59.9% for the common cold to 71.3% for seasonal influenza (p < .001), and to 95.0% for pandemic (H1N1) 2009 influenza and 94.7% for avian influenza (p < 0.001 for both versus seasonal influenza). Anticipated compliance did not differ for pandemic (H1N1) 2009 and avian influenza (p = 0.815). Age and sex were both associated with anticipated compliance in the setting of seasonal influenza and the common cold. Notably, 27.1% of health and community service workers would not comply with physician advice to stay home for seasonal influenza. Conclusions Ninety-five percent of people report they would comply with a physicians' advice to stay home for seven days if they are diagnosed with pandemic (H1N1) 2009 or avian influenza, but only 71% can be expected to comply in the setting of seasonal influenza and fewer still can be expected to comply if they are diagnosed with a common cold. Sub-populations that might be worthwhile targets for public health messages aimed at increasing the rate of self-imposed isolation for seasonal influenza include males, younger people, and healthcare workers.
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Affiliation(s)
- Lawrence H Brown
- Anton Breinl Centre, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia.
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