Abstract
Annual influenza epidemics continue to cause worldwide morbidity, mortality and societal disruption, especially among the aged residents of residential care homes for the elderly (RCHEs). Vaccination remains the most effective measure to prevent influenza and its associated complications. The seasonal influenza vaccine uptake rates among RCHE staff were much lower than that among residents. In order to increase uptake of influenza vaccination among RCHE staff in Hong Kong, this study developed and evaluated amultimodal vaccine promotion program (VPP) based on identified factors affecting vaccination acceptance or refusal within the Hong Kong Chinese context. Vaccine acceptance was found to be significantly associated with belief in vaccine efficacy, duration of service, staff group and providing direct care to residents. The focus group study revealed that RCHE staff's belief in the efficacy and safety of the vaccine played a major role in vaccine acceptance. VPP effectiveness was evaluated with a cluster randomised controlled trial among RCHEs with staff vaccination rates below 50%. Compared with 2008/09, the 2009/10 mean staff vaccination rates increased significantly in both the intervention (39.4% to 59.6% (P < 0.001)) and control groups (36.3% to 47.6% (P = 0.008)). RCHE staff in the intervention group had a higher vaccination rate than in the control group (59.6% versus 47.6%, P = 0.072). This program reinforces the importance of a comprehensive and culturally sensitive approach to promote influenza vaccination for RCHE staff.
References
- 1.Influenza Fact Sheet WHO. 211. Geneva, Switzerland: World Health Organization; 2003.
- 2.Scientific Committee on Vaccine Preventable Diseases . Centre for Health Protection; Hong Kong: 2008. Recommendation on influenza vaccine for the 2008/2009 season. [Google Scholar]
- 3.Leung J. Effectiveness of influenza vaccination among elderly home residents in Hong Kong: a retrospective cohort study. HK Pract. 2007;29(4):123–133. [Google Scholar]
- 4.Talbot T.R., Dellit T.H., Hebden J., Sama D., Cuny J. Factors associated with increased healthcare worker influenza vaccination rates: results from a national survey of university hospitals and medical centers. Infect Control Hosp Epidemiol. 2010;31(5):456–462. doi: 10.1086/651666. doi:10.1086/651666. [DOI] [PubMed] [Google Scholar]
- 5.Fiore A., Shay D., Broder K., Iskander J.K., Uyeki T.M., Mootrey G. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recomm Rep. 2009;58:1–52. [PubMed] [Google Scholar]
- 6.Demicheli V., Jefferson T., Rivetti D., Deeks J. Prevention and early treatment of influenza in healthy adults. Vaccine. 2000;18(11–12):957–1030. doi: 10.1016/s0264-410x(99)00332-1. doi:10.1016/S0264-410X(99)00332-1. [DOI] [PubMed] [Google Scholar]
- 7.Wilde J.A., McMillan J.A., Serwint J., Butta J., O’Riordan M.A., Steinhoff M.C. Effectiveness of influenza vaccine in health care professionals: a randomized trial. J Am Med Assoc. 1999;281(10):908–913. doi: 10.1001/jama.281.10.908. [DOI] [PubMed] [Google Scholar]
- 8.Potter J., Stott D.J., Roberts M.A., Elder A.G., O’Donnell B., Knight P.V. Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients. J Infect Dis. 1997;175(1):1–6. doi: 10.1093/infdis/175.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Thomas R.E., Jefferson T., Lasserson T.J. Influenza vaccination for healthcare workers who work with the elderly. Cochrane Db Syst Rev. 2010;(issue 2.):CD005187. doi: 10.1002/14651858.CD005187.pub3. [DOI] [PubMed] [Google Scholar]
- 10.Hofmann F., Ferracin C., Marsh G., Dumas R. Influenza vaccination of healthcare workers: a literature review of attitudes and beliefs. Infection. 2006;34(3):142–147. doi: 10.1007/s15010-006-5109-5. doi:10.1007/s15010-006-5109-5. [DOI] [PubMed] [Google Scholar]
- 11.Ehrenstein B.P., Hanses F., Blaas S., Mandraka F., Audebert F., Salzberger B. Perceived risks of adverse effects and influenza vaccination: a survey of hospital employees. Eur J Public Health. 2010;2010:ckp227. doi: 10.1093/eurpub/ckp227. [DOI] [PubMed] [Google Scholar]
- 12.Bautista D., Vila B., Uso R., Tellez M., Zanon V. Predisposing, reinforcing, and enabling factors influencing influenza vaccination acceptance among healthcare workers. Infect Control Hosp Epidemiol. 2006;27(1):73–77. doi: 10.1086/499148. doi:10.1086/499148. [DOI] [PubMed] [Google Scholar]
- 13.Burls A., Jordan R., Barton P., Olowokure B., Wake B., Albon E. Vaccinating healthcare workers against influenza to protect the vulnerable–Is it a good use of healthcare resources?.: a systematic review of the evidence and an economic evaluation. Vaccine. 2006;24(19):4212–4221. doi: 10.1016/j.vaccine.2005.12.043. doi:10.1016/j.vaccine.2005.12.043. [DOI] [PubMed] [Google Scholar]
- 14.Daley M.F., Crane L.A., Chandramouli V., Beaty B.L., Barrow J., Allred N. Influenza among healthy young children: changes in parental attitudes and predictors of immunization during the 2003 to 2004 influenza season. Pediatrics. 2006;117(2):e268–e277. doi: 10.1542/peds.2005-1752. [DOI] [PubMed] [Google Scholar]
- 15.O’Reilly F.W., Cran G.W., Stevens A.B. Factors affecting influenza vaccine uptake among health care workers. Occup Med (Lond) 2005;55(6):474–479. doi: 10.1093/occmed/kqi099. [DOI] [PubMed] [Google Scholar]
- 16.Doebbeling B.N., Edmond M.B., Davis C.S., Woodin J.R., Zeitler R.R. Influenza vaccination of health care workers: evaluation of factors that are important in acceptance. Prev Med. 1997;26(1):68–77. doi: 10.1006/pmed.1996.9991. doi:10.1006/pmed.1996.9991. [DOI] [PubMed] [Google Scholar]
- 17.Toy W.C., Janosky J.E., Laird S.B. Influenza immunization of medical residents: knowledge, attitudes, and behaviors. Am J Infect Control. 2005;33(8):473–475. doi: 10.1016/j.ajic.2005.06.003. doi:10.1016/j.ajic.2005.06.003. [DOI] [PubMed] [Google Scholar]
- 18.Takayanagi I.J., Cardoso M.R.A., Costa S.F., Araya M.E.S., Machado C.M. Attitudes of health care workers to influenza vaccination: why are they not vaccinated? Am J Infect Control. 2007;35(1):56–61. doi: 10.1016/j.ajic.2006.06.002. doi:10.1016/j.ajic.2006.06.002. [DOI] [PubMed] [Google Scholar]
- 19.Smedley J., Poole J., Waclawski E., Stevens A., Harrison J., Watson J. Influenza immunisation: attitudes and beliefs of UK healthcare workers. Occup Environ Med. 2007;64(4):223–227. doi: 10.1136/oem.2005.023564. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Canning H.S., Phillips J., Allsup M.S. Health care worker beliefs about influenza vaccine and reasons for non-vaccination; a cross-sectional survey. J Clin Nurs. 2005;14(8):922–925. doi: 10.1111/j.1365-2702.2005.01190.x. doi:10.1111/j.1365-2702.2005.01190.x. [DOI] [PubMed] [Google Scholar]
- 21.Mah M.W., Hagen N.A., Pauling-Shepard K., Hawthorne J.S., Mysak M., Lye T. Understanding influenza vaccination attitudes at a Canadian cancer center. Am J Infect Control. 2005;33(4):243–250. doi: 10.1016/j.ajic.2004.12.006. doi:10.1016/j.ajic.2004.12.006. [DOI] [PubMed] [Google Scholar]
- 22.Wicker S., Rabenau H., Doerr H., Allwinn R. Influenza vaccination compliance among health care workers in a German university hospital. Infection. 2009;37(3):197–202. doi: 10.1007/s15010-008-8200-2. [DOI] [PubMed] [Google Scholar]
- 23.Qureshi A.M., Hughes N.J.M., Murphy E., Primrose W.R. Factors influencing uptake of influenza vaccination among hospital-based health care workers. Occup Med (Lond) 2004;54(3):197–201. doi: 10.1093/occmed/kqg087. [DOI] [PubMed] [Google Scholar]
- 24.Tam D.K.P., Lee S.S., Lee S. Impact of severe acute respiratory syndrome and the perceived avian influenza epidemic on the increased rate of influenza vaccination among nurses in Hong Kong. Infect Control Hosp Epidemiol. 2008;29(3):256–261. doi: 10.1086/527507. doi:10.1086/527507. [DOI] [PubMed] [Google Scholar]
- 25.Capolongo M.J., Di Bonaventura M.D., Chapman G.B. Physician vaccinate thyself: why influenza vaccination rates are higher among clinicians than among nonclinicians. Ann Behav Med. 2006;31(3):288–296. doi: 10.1207/s15324796abm3103_11. doi:10.1207/s15324796abm3103_11. [DOI] [PubMed] [Google Scholar]
- 26.King W., Woolhandler S., Brown A., Jiang L.H., Kevorkian K., Himmelstein D. Brief report: influenza vaccination and health care workers in the United States. J Gen Intern Med. 2006;21(2):181–184. doi: 10.1111/j.1525-1497.2006.00325.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Willis B.C., Wortley P. Nurses’ attitudes and beliefs about influenza and the influenza vaccine: a summary of focus groups in Alabama and Michigan. Am J Infect Control. 2007;35(1):20–24. doi: 10.1016/j.ajic.2006.07.009. doi:10.1016/j.ajic.2006.07.009. [DOI] [PubMed] [Google Scholar]