Influenza vaccination and healthcare workers: barriers and predisposing factors.: A literature review.

Assunta Guillari; Francesco  Polito; Gianluca Pucciarelli; Nicola Serra; Gianpaolo Gargiulo; Maria Rosaria Esposito; Stefano Botti; Teresa Rea; Silvio Simeone

doi:10.23750/abm.v92iS2.11106

Influenza vaccination and healthcare workers: barriers and predisposing factors.

A literature review.

Authors

Assunta Guillari Department of Hygiene, University of Naples Federico II, Naples (Italy)
Francesco Polito Department of Hygiene, University of Naples Federico II, Naples (Italy)
Gianluca Pucciarelli Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome (Italy)
Nicola Serra Department of Hygiene, University of Naples Federico II, Naples (Italy)
Gianpaolo Gargiulo Department of Hematology, AOU Federico II, Naples (Italy)
Maria Rosaria Esposito National Cancer Institute Foundation “G. Pascale” Naples (Italy)
Stefano Botti AUSL-IRCCS Reggio Emilia
Teresa Rea Department of Hygiene, University of Naples Federico II, Naples (Italy)
Silvio Simeone Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome (Italy)

DOI: https://doi.org/10.23750/abm.v92iS2.11106

Keywords:

influenza, vaccination, healthcare workers, adherence, barriers

Abstract

Background and aim of the work. Influenza is a disease that affects a large part of the world's population annually, with major health, social and economic impacts. Active immunisation practices have always been recommended to counter influenza, especially for people at risk. The recommendations of major health agencies strongly advise influenza vaccination for all healthcare workers, mostly for those in contact with at-risk or immunocompromised individuals. Yet, the influenza vaccination coverage among healthcare workers remains rather low worldwide. This review explore barriers and the facilitators of health care professional toward influenza's vaccination.

Methods. Narrative review consulting the databases: PubMed, CINAHL by combining keywords health care worker, flu, influenza, vaccination, barrier, resistence, hesitangy, between November 2019 and February 2020

Results. From the 1031 records initially, twenty-two primary studies were included in this narrative review. Our results show that the identified facilitators are: desire for self-protection, protection for loved ones and community. Instead, the barriers to vaccination identified are: fear of contracting influenza from the vaccination itself; not considering themselves at risk; to believing believe that their immune system is capable of managing a trivial disease; disease considered trivial, laziness; false beliefs.

Discussion and conclusion. Adherence rate on influenza vaccination among health professionals is quite low. The interventions that make it “complex and traceable” flu vaccination refusal increase adherence to this type of vaccination. The results show that current vaccination campaigns do not increase the rate of adherence by healthcare workers. Identifying the predisposing factors and barriers to such vaccination can help to create, develop and test targeted educational programmes.

References

Alfonsi V, Montano C, Rota MC, Declich S. HProImmune - Promotion of Immunization for Health Professionals in Europe. State of the art report. Overview of helath-care workers immunization status in Europe. 2012. Available at: http://hproimmune.eu/index.php/hproimmune/report . Accessed on August 20, 2020.

Centers for Disease Control and Prevention (CDC), National Center for Immunization and Respiratory Diseases (NCIRD). Influenza Vaccination Information for Health Care Workers. 2016. Available at: https://www.cdc.gov/flu/professionals/healthcareworkers.htm . Accessed on August 8, 2020.

Rabensteiner A, Buja A, Regele D, Fischer M, Baldo V. Healthcare worker's attitude to seasonal influenza vaccination in the South Tyrolean province of Italy: barriers and facilitators. Vaccine 2018, 36(4):535-44.

Hulo S, Nuvoli A, Sobaszek A, Salembier-Trichard A. Knowledge and attitudes towards influenza vaccination of health care workers in emergency services. Vaccine 2017, 35(2):205-7.

Barker WH. Excess pneumonia and influenza associated hospitalization during influenza epidemics in the United States, 1970-78. Am J Public Health 1986, 76(7):761-5.

Chang YC, Tung HJ, Huang YT, Lu CT, Ernawaty E, Wu SY. Effect of Influenza Vaccination on Mortality and Risk of Hospitalization in Elderly Individuals with and without Disabilities: A Nationwide, Population-Based Cohort Study. Vaccines (Basel) 2020, 8(1).

Simonsen L, Fukuda K, Schonberger LB, Cox NJ. The impact of influenza epidemics on hospitalizations. J Infect Dis 2000, 181(3):831-7.

Rao S, Yanni E, Moss A, Lamb MM, Schuind A, Bekkat-Berkani R, Innis BL, Cotter J, Mistry RD, Asturias EJ. Evaluation of a New Clinical Endpoint for Moderate to Severe Influenza Disease in Children: A Prospective Cohort Study. J Pediatric Infect Dis Soc 2020, 9(4):460-7.

Coffin SE, Zaoutis TE, Rosenquist AB, Heydon K, Herrera G, Bridges CB, Watson B, Localio R, Hodinka RL, Keren R. Incidence, complications, and risk factors for prolonged stay in children hospitalized with community-acquired influenza. Pediatrics 2007, 119(4):740-8.

Izurieta HS, Thompson WW, Kramarz P, Shay DK, Davis RL, De Stefano F, Black S, Shinefield H, Fukuda K. Influenza and the rates of hospitalization for respiratory disease among infants and young children. N Engl J Med 2000, 342(4):232-9.

Poehling KA, Edwards KM, Griffin MR, Szilagyi PG, Staat MA, Iwane MK, Snively BM, Suerken CK, Hall CB, Weinberg GA, Chaves SS, Zhu Y, McNeal MM, Bridges CB. The burden of influenza in young children, 2004-2009. Pediatrics 2013, 131(2):207-16.

Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, Fukuda K. Mortality associated with influenza and respiratory syncytial virus in the United States. Jama 2003, 289(2):179-86.

Barker WH, Mullooly JP. Impact of epidemic type A influenza in a defined adult population. Am J Epidemiol 1980, 112(6):798-811.

Grohskopf LA, Alyanak E, Broder KR, Walter EB, Fry AM, Jernigan DB. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2019-20 Influenza Season. MMWR Recomm Rep 2019, 68(3):1-21.

Cox NJ, Subbarao K. Influenza. Lancet 1999, 354(9186):1277-82.

Garten RJ, Davis CT, Russell CA, Shu B, Lindstrom S, Balish A, Sessions WM, Xu X, Skepner E, Deyde V, Okomo-Adhiambo M, Gubareva L, Barnes J, Smith CB, Emery SL, Hillman MJ, Rivailler P, Smagala J, de Graaf M, Burke DF, Fouchier RA, Pappas C, Alpuche-Aranda CM, López-Gatell H, Olivera H, López I, Myers CA, Faix D, Blair PJ, Yu C, Keene KM, Dotson PD Jr, Boxrud D, Sambol AR, Abid SH, St George K, Bannerman T, Moore AL, Stringer DJ, Blevins P, Demmler-Harrison GJ, Ginsberg M, Kriner P, Waterman S, Smole S, Guevara HF, Belongia EA, Clark PA, Beatrice ST, Donis R, Katz J, Finelli L, Bridges CB, Shaw M, Jernigan DB, Uyeki TM, Smith DJ, Klimov AI, Cox NJ. Antigenic and genetic characteristics of swine-origin 2009 A(H1N1) influenza viruses circulating in humans. Science 2009, 325(5937):197-201.

van de Sandt CE, Bodewes R, Rimmelzwaan GF, de Vries RD. Influenza B viruses: not to be discounted. Future Microbiol 2015, 10(9):1447-65.

Russell CA, Jones TC, Barr IG, Cox NJ, Garten RJ, Gregory V, Gust ID, Hampson AW, Hay AJ, Hurt AC, de Jong JC, Kelso A, Klimov AI, Kageyama T, Komadina N, Lapedes AS, Lin YP, Mosterin A, Obuchi M, Odagiri T, Osterhaus AD, Rimmelzwaan GF, Shaw MW, Skepner E, Stohr K, Tashiro M, Fouchier RA, Smith DJ. The global circulation of seasonal influenza A (H3N2) viruses. Science 2008, 320(5874):340-6.

Ishiguro T, Takayanagi N, Yamaguchi S, Yamakawa H, Nakamoto K, Takaku Y, Miyahara Y, Kagiyama N, Kurashima K, Yanagisawa T, Sugita Y. Etiology and factors contributing to the severity and mortality of community-acquired pneumonia. Intern Med 2013, 52(3):317-24.

Washio M, Kondo K, Fujisawa N, Harada E, Tashiro H, Mizokami T, Nogami H, Iwanaga T, Nakanishi Y, Suzuki K, Ohfuji S, Fukushima W, Hirota Y; Kyushu Task Force for CAP Risk in the Elderly. Hypoalbuminemia, influenza vaccination and other factors related to the development of pneumonia acquired outside hospitals in southern Japan: A case-control study. Geriatr Gerontol Int 2016, 16(2):223-9.

Cowan AE, Winston CA, Davis MM, Wortley PM, Clark SJ. Influenza vaccination status and influenza-related perspectives and practices among US physicians. Am J Infect Control 2006, 34(4):164-9.

Ding H, Black CL, Ball S, Donahue S, Fink RV, Williams WW, Kennedy ED, Bridges CB, Lu PJ, Kahn KE, Dean AK, Grohskopf LA, Ahluwalia IB, Devlin R, DiSogra C, Walker DK, Greby SM. Influenza vaccination coverage among pregnant women—United States, 2014–15 influenza season. MMWR Recomm Rep 2015, 64(36):1000-5.

Salgado CD, Farr BM, Hall KK, Hayden FG. Influenza in the acute hospital setting. Lancet Infect Dis. 2002;2(3):145-55.

Pearson ML, Bridges CB, Harper SA; Healthcare Infection Control Practices Advisory Committee (HICPAC); Advisory Committee on Immunization Practices (ACIP). Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2006, 55(RR-2):1-16.

European Union. Directive 2000/54/EC of the European Parliament and of the Council of 18 September 2000 on the protection of workers from risks related to exposure to biological agents at work. OJ L 262, 17.10.2000, p. 21–45 (ES, DA, DE, EL, EN, FR, IT, NL, PT, FI, SV).

Barchitta M, Basile G, Lopalco PL, Agodi A. Vaccine-preventable diseases and vaccination among Italian healthcare workers: a review of current literature. Future Microbiol. 2019 Jun;14:15-9.

Black CL, Yue X, Ball SW, Donahue SM, Izrael D, de Perio MA, Laney AS, Williams WW, Lindley MC, Graitcer SB, Lu PJ, Bridges CB, DiSogra C, Sokolowski J, Walker DK, Greby SM. Influenza vaccination coverage among health care personnel—United States, 2014–15 influenza season. MMWR Morb Mortal Wkly Rep 2015, 64(36):993-9.

Blank PR, Schwenkglenks M, Szucs TD. Vaccination coverage rates in eleven European countries during two consecutive influenza seasons. J Infect 2009;58(6):446-58.

Haviari S, Benet T, Saadatian-Elahi M, Andre P, Loulergue P, Vanhems P. Vaccination of healthcare workers: A review. Hum Vaccin Immunother 2015, 11(11):2522-37.

Genovese C, Picerno IAM, Trimarchi G, Cannavo G, Egitto G, Cosenza B, Merlina V, Icardi G, Panatto D, Amicizia D, Orsi A, Colosio C, Marsili C, Lari C, Palamara MAR, Vitale F, Casuccio A, Costantino C, Azara A, Castiglia P, Bianco A, Currà A, Gabutti G, Stefanati A, Sandri F, Florescu C, Marranzano M, Giorgianni G, Fiore V, Platania A, Torre I, Cappuccio A, Guillari A, Fabiani L, Giuliani AR, Appetiti A, Fauci V, Squeri A, Ragusa R, Squeri R. Vaccination coverage in healthcare workers: a multicenter cross-sectional study in Italy. J Prev Med Hyg 2019, 60(1):E12-E7.

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. 2014 Jan;58(1):50-7.

Dixon-Woods M, Martin GP. Does quality improvement improve quality? Future Hosp J 2016, 3(3):191.

Cozza V, Alfonsi V, Rota MC, Paolini V, Degli Atti MLC. Promotion of influenza vaccination among health care workers: findings from a tertiary care children’s hospital in Italy. BMC Public Health. 2015, 15(1):697.

Riccò M, Cattani S, Casagranda F, Gualerzi G, Signorelli C. Knowledge, attitudes, beliefs and practices of occupational physicians towards vaccinations of health care workers: A cross sectional pilot study in North-Eastern Italy. Int J Occup Med Environ Health 2017, 30(5):775.

Albano L, Matuozzo A, Marinelli P, Di Giuseppe G. Knowledge, attitudes and behaviour of hospital health-care workers regarding influenza A/H1N1: a cross sectional survey. BMC Infect Dis 2014, 14(1):208.

Durando P, Alicino C, Dini G, Barberis I, Bagnasco A, Iudici R, Zanini M, Martini M, Toletone A, Paganino C, Massa E, Orsi A, Sasso L. Determinants of adherence to seasonal influenza vaccination among healthcare workers from an Italian region: results from a cross-sectional study. BMJ Open 2016, 6(5):e010779.

Karafillakis E, Dinca I, Apfel F, Cecconi S, Wűrz A, Takacs J, Suk J, Celentano LP, Kramarz P, Larson HJ. Vaccine hesitancy among healthcare workers in Europe: A qualitative study. Vaccine 2016, 34(41):5013-20.

Little K, Goodridge S, Lewis H, Lingard S, Din S, Tidley M, Roberts RJ, Williams NS, Hayes S. Occupational vaccination of health care workers: uptake, attitudes and potential solutions. Public Health 2015, 129(6):755-62.

Boey L, Bral C, Roelants M, De Schryver A, Godderis L, Hoppenbrouwers K, Vandermeulen C. Attitudes, believes, determinants and organisational barriers behind the low seasonal influenza vaccination uptake in healthcare workers–a cross-sectional survey. Vaccine 2018, 36(23):3351-8.

Edeghere O, Fowler T, Wilson F, Caspa R, Raichand S, Kara E, Janmohamed Rampling S, Olowokure B. Knowledge, attitudes, experience and behaviour of frontline health care workers during the early phase of 2009 influenza A(H1N1) pandemic, Birmingham, UK. J Health Serv Res Policy 2015, 20(1):26-30.

Petek D, Kamnik-Jug K. Motivators and barriers to vaccination of health professionals against seasonal influenza in primary healthcare. BMC Health Serv Res 2018, 18(1):853.

Pless A, McLennan SR, Nicca D, Shaw DM, Elger BS. Reasons why nurses decline influenza vaccination: a qualitative study. BMC Nursing 2017, 16(1):20.

Fernández‐Villa T, Molina AJ, Torner N, Castilla J, Astray J, García-Gutiérrez S, Mayoral JM, Tamames S, Domínguez Á, Martín V; CIBERESP Working Group for the Survey on Influenza Vaccination in Primary Health Care Workers. Factors associated with acceptance of pandemic flu vaccine by healthcare professionals in Spain, 2009–2010. Res Nurs Health 2017, 40(5):435-43.

Prematunge C, Corace K, McCarthy A, Nair RC, Roth V, Suh KN, Garber G. Qualitative motivators and barriers to pandemic vs. seasonal influenza vaccination among healthcare workers: a content analysis. Vaccine 2014, 32(52):7128-34.

Hussain H, McGeer A, McNeil S, Katz K, Loeb M, Simor A, Powis J, Langley J, Muller M; Canadian Health Care Worker Study Group, Coleman BL. Factors associated with influenza vaccination among healthcare workers in acute care hospitals in Canada. Influenza Other Respir Viruses 2018, 12(3):319-25.

Bazán M, Villacorta E, Barbagelatta G, Jimenez MM, Goya C, Bartolini RM, Penny ME. Health workers’ attitudes, perceptions and knowledge of influenza immunization in Lima, Peru: A mixed methods study. Vaccine 2017, 35(22):2930-6.

Tuckerman JL, Shrestha L, Collins JE, Marshall HS. Understanding motivators and barriers of hospital-based obstetric and pediatric health care worker influenza vaccination programs in Australia. Hum Vaccin Immunother 2016, 12(7):1749-56.

Sundaram N, Duckett K, Yung CF, Thoon KC, Sidharta S, Venkatachalam I, Chow A, Yoong J. “I wouldn’t really believe statistics”–challenges with influenza vaccine acceptance among healthcare workers in Singapore. Vaccine 2018, 36(15):1996-2004.

Alabbad AA, Alsaad AK, Al Shaalan MA, Alola S, Albanyan EA. Prevalence of influenza vaccine hesitancy at a tertiary care hospital in Riyadh, Saudi Arabia. J Infect Public Health 2018, 11(4):491-9.

Haridi H, Salman K, Basaif E, Al-Skaibi D. Influenza vaccine uptake, determinants, motivators, and barriers of the vaccine receipt among healthcare workers in a tertiary care hospital in Saudi Arabia. J Hosp Infect 2017, 96(3):268-75.

Nouri Shadkam M, Nasiriani K, Dehghani H. Factors influencing influenza vaccination among nurses in teaching hospitals of Yazd University of Medical Sciences in 2011. Journal of Nursing and Midwifery Sciences 2015, 2(1):27-33.

Betsch C. Overcoming healthcare workers’ vaccine refusal–competition between egoism and altruism. Euro Surveill 2014, 19(48):20979.