Seasonal influenza vaccination coverage and barriers among healthcare workers in an Egyptian Province

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Amani Waheed
Youssef Waheeb
Adel Hassan
Ayman Fahim


Seasonal Influenza vaccination; healthcare workers; Barriers


Background: Influenza vaccination uptake by Egyptian healthcare workers remains sub-optimal despite local initiatives and infection control programs to increase it. The aim was to assess vaccination coverage and investigate health care workers’ barriers and motivators toward seasonal influenza vaccination. Methods: An interview questionnaire survey and focus group sessions were conducted to measure uptake and assess barriers to seasonal influenza vaccination among HCWs in main hospitals and primary care centers in Ismailia. Results: There were 980 participants, of whom 131 (13.4%) reported having received influenza vaccination in last season 2018/2019. Females were 76.8% of participants, and nurses were the main occupational category of study sample (80.4%). The most commonly reported reason (97.7%) was "protecting myself and my family" among the vaccinated participants. And most important barriers among the non-vaccinated HCWs; was "not instructed to receive the vaccine" (73.2%). Predictors of non-vaccination included; the perception that the vaccine itself my induce influenza (OR: 1.9 p<0.05, CI, 1.3-2.8) and the belief that vaccination is ineffective (OR: 2.7 p<0.05, CI, 1.5-5.2), and lack of awareness about the vaccinations recommended (OR: 1.8 p<0.05, CI, 1.2-2.8). The top barriers ranked by their Relative Importance Index (RII), included lack of instruction by supervisors RII=0.82, lack of awareness about vaccine benefits RII= 0.79 and lack of awareness from where to get the vaccine RII=0.71. Conclusion: Addressing specific barriers to influenza vaccination uptake among healthcare workers may improve rate.


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1. Factsheet about seasonal influenza. 2017.

2. Kuster SP, Shah PS, Coleman BL, Lam P, Tong A, Wormsbecker B, et al. Incidence of influenza in healthy adults and health professionals: a systematic review and meta-analysis. PLoS One. 2011;6:e26239
3. Maltezou HC, Poland GA. Vaccination policies for health care workers in Europe. Vaccine. 2014;32:4876–80.
4. Talbot TR, Babcock H, Caplan AL, Cotton D, Maragakis LL, Poland GA, et al. Revised SHEA position paper: influenza vaccination of healthcare personnel. Infect Control Hosp Epidemiol. (2010) 31:987–95
5. Ciancio BC, Rezza G. Costs and benefits of influenza vaccination: more evidence, same challenges. BMC Public Health (2014) 14:818.
6. Mallari J, Goad J, Joanne W, Johnson K, Forman T, Neinstein L. Knowledge, attitudes, and practices regarding influenza vaccination among health professional students. J Am Pharm Assoc. (2007) 47:498–502
7. Carman WF, Elder AG, Wallace LA, McAulay K, Walker A, Murray GD, et al. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet (2000) 355:93–7
8. Abu-Gharbieh E, Fahmy S, Rasool BA, Khan S. Influenza Vaccination: Healthcare workers attitude in three Middle East countries. Int J Med Sci. 2010;7:319–25
9. Hollmeyer HG, Hayden F, Poland G, Buchholz U. Influenza vaccination of health care workers in hospitals-a review of studies on attitudes and predictors. Vaccine. 2009;27:3935–44.
10. Nowalk MP, Lin CJ, Raymund M, Bialor J, Zimmerman RK. Impact of hospital policies on health care workers' influenza vaccination rates. Am J Infect Control. 2013;41:697–701.
11. To KW, Lai A, Lee KC, et al. Increasing the coverage of influenza vaccination in healthcare workers: review of challenges and solutions. J Hosp Infect 2016;94 (2):133–42.
12. Qureshi AM, Hughes NJ, Murphy E, Primrose WR. Factors influencing uptake of influenza vaccination among hospital-based health care workers. Occupational Medicine. 2004, 54(3): 197–201.

13. Hwang SW, Hwee HB,. Barriers and Motivators of Influenza Vaccination Uptake among Primary Healthcare Workers in Singapore. Proceedings of Singapore Healthcare Volume 23 Number 2 2014
14. Willis B, Wortley P. Nurses; attitudes and beliefs about influenza and the influenza vaccine: a summary of focus groups in Alabama and Michigan. American Journal of Infection Control. 2007; 35(1):20-4.
15. Kometa ST, Olomolaiye PO, Harris FC. Attributes of UK construction clients influencing project consultants' performance. Const Manag Econ. (1994) 12:433–43.
16. Sambasivan M, Soon YW. Causes and effects of delays in Malaysian construction industry. Int J Project Manag. (2007) 25:517–26.
17. Cheung S, Tam C, Ndekugri I, Harris F. Factors affecting clients' project dispute resolution satisfaction in Hong Kong. Const Manag Econ. (2000) 18:281–94
18. Lim EC, Alum J. Construction productivity: issues encountered by contractors in Singapore. Int J Project Manag. (1995) 13:51–8.
19. Salgado D, Farr B, Hall K, Hayden F. Influenza in the acute hospital setting. Lancet Infect Dis. 2002, 2(3): 145-155.
20. Abramson ZH, Avni O, Levi O. Randomized trial of a program to increase staff influenza vaccination in primary care clinics. Ann Fam Med. 2010, 8(4): 293-298
21. Pless A, Shaw D, McLennan S, Elger BS. Nurses’ attitudes towards enforced measures to increase influenza vaccination: A qualitative study. Influenza Other Respir Viruses 2017; 11(3):247-253.
22. Mytton O, O’Moore E, Sparkes T, Baxi R, Abid M. Knowledge, attitudes and beliefs of healthcare workers towards influenza vaccination. Occup Med 2013; 63(3):189-195.
23. Shrikrishna D, Williams S, Restrick, L, Hopkinson, NS. Influenza vaccination for NHS staff: attitudes and uptake. BMJ Open Resp Res 2015; 2: e000079. https://doi:10.1136/bmjresp-2015-000079

24. Schmid P, Rauber D, Betsch C, Lidolt G, Denker ML. Barriers of influenza vaccination intention and behaviour – A systematic review of influenza vaccine hesitancy, 2005-2016. PLOS One 2017; 12(1):e0170550;