Coverage and side effects of influenza A(H1N1) 2009 monovalent vaccine among primary health care workers
Introduction
In late April 2009, the World Health Organization (WHO) announced the emergence of a novel influenza A virus. This particular H1N1 strain has not been circulated previously in humans and required WHO to raise the pandemic alert to phase 5 less than 1 week after declaring phase 3. On 11 June 2009, WHO declared a phase 6 influenza pandemic alert, which is the maximum alert level [1].
Health care workers (HCWs) are a strategic target for pandemic influenza A(H1N1) prevention such as vaccination and frequent hand-washing, since they are at higher risk themselves of contracting influenza, can place their patients at risk and are critical for a functioning health care system [2]. In the United States, influenza A(H1N1) vaccine was made mandatory for hospital employees [3]. Recent survey on Italian HCWs showed that a high percentage of them did not realise that vaccination against influenza A(H1N1) virus is a fundamental means of prevention [4].
The overall vaccination coverage by seasonal flu vaccination in a survey in Spanish university hospital varied between 16 and 40% along three consecutive campaigns [5]. The vaccination of HCWs plays an important part in prevention programs aimed at reducing influenza-related morbidity and mortality among high-risk patients [6].
The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices [6], [7] (ACIP) has recommended influenza A(H1N1) vaccine for health care workers and considered HCWs among initial target groups for vaccination.
The objectives of our study were identifying the uptake of influenza A(H1N1) 2009 monovalent vaccine by primary health care workers in the southern part of Cordoba and exploring the correlation between H1N1 vaccine uptake and seasonal flu vaccination. Also this study aimed at reporting of the adverse events occurred after vaccination by those who complied to the vaccine uptake.
Section snippets
Methodology
All HCWs of 12 primary health care (PHC) centres in South Cordoba Health District were invited to participate in the study. South Cordoba Health District offers PHC to the population residing in the Southern Area of the Province of Cordoba (Andalusia, Spain). This PHC District has 45 villages and could serve over 300,000 persons.
Of 327 HCWs of the 12 PHC centres, 240 accepted to participate in the study, with participation rate of 73.4%. The data were collected from HCWs 3 weeks after starting
Statistical methods
First, the following descriptive analysis was done: frequency, percent, mean, standard deviation. The statistical tests used in this paper were chi-square and chi-square for trend, odds ratios and confidence intervals were also calculated. A logistic regression model was done to investigate the independent factors relating to the uptake of the H1N1 vaccine. Level of significance was set at P < 0.05. All data variables were encoded and computerized. Data entry and statistical analysis were
Results
This study included 240 HCWs working in 12 primary health care centres at Southern Cordoba Health District. The mean age of the studied health care workers was 46.8 ± 7.8 years (range 25–65 years). Females constituted 56.7% of the studied sample. The coverage by seasonal flu vaccine was 43.3%, 43.8% and 44.2% in the years 2007, 2008 and 2009 respectively. These coverage rates were higher compared to the coverage by H1N1 vaccine in response to the pandemic alert which was 49 cases only (20.5%).
The
Compliance and adverse events
The total number of subjects who complied with three doses of seasonal flu vaccine and H1N1 vaccine was 34 HCWs (14.1%). Among those complaint subjects 13 subjects (38.2%) reported the occurrence of adverse events. The reporting of adverse events among compliant subjects to three doses of seasonal flu vaccine was higher in males compared to females and the difference is significant statistically.
A logistic regression model to see the effect of age, gender (male gender) and vaccination with
Discussion
Health care workers are at the frontline for caring of patients with pandemic influenza. Among the recommendations of WHO in good practice and preparedness of HCW to pandemic flu is the adherence of health care workers to vaccination [8]. However several studies have reported resistance of intake of H1N1 vaccine in health care workers.
In a university hospital in Madrid, Spain (12 de Octubre) the coverage rate for seasonal flu vaccine in health care workers was 49.7% which is comparable to our
References (12)
- et al.
(H1N1) 2009 influenza vaccination coverage and attitudes among health-care workers in a Spanish University Hospital
Vaccine
(2010) - 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) - et al.
Vaccination against pandemic influenza A/H1N1 among healthcare workers and reasons for refusing vaccination in Istanbul in last pandemic alert phase
Vaccine
(2010) - et al.
Positive attitudes of French general practitioners towards A/H1N1 influenza-pandemic vaccination: a missed opportunity to increase vaccination uptakes in the general public?
Vaccine
(2010) Global influenza surveillance network: laboratory surveillance and response to pandemic H1N1 2009
Wkly Epidemiol Rec
(2009)H1N1 vaccine urged for health workers, but some resist getting on board
JAMA
(2009)
Cited by (15)
Interventions for preventing or controlling health care–associated infection among health care workers or patients within primary care facilities: A scoping review
2024, American Journal of Infection ControlCharacteristics of patients with hospital-acquired influenza A (H1N1)pdm09 virus admitted to the intensive care unit
2017, Journal of Hospital InfectionCitation Excerpt :Precautions include exclusion of visitors and staff with suspected influenza and the use of masks and good hand hygiene. Immunization of healthcare personnel against influenza is a key component of such strategies, but unfortunately campaigns to improve the uptake of vaccination have often had limited success.31–34 We believe that our data, underlining the severity of hospital-acquired influenza A (H1N1)pdm09 infection, will provide useful support to campaigns to prevent transmission of influenza in hospitals.
Visualizing knowledge and attitude factors related to influenza vaccination of physicians
2015, VaccineCitation Excerpt :The United States Centers for Disease Control and Prevention recommend influenza vaccination of all hospital and outpatient HCW as a core strategy to prevent influenza transmission in healthcare centers [14]. In Spain, influenza vaccination is recommended and offered voluntarily and free-of-charge to all HCW, although coverages rarely reach 50% [15–18]. Primary healthcare physicians play a crucial role in influenza prevention as they attend the vast majority of patients with influenza and have a very important role in vaccinating patients [19,20].
What do we learn from outbreaks of vaccine-preventable diseases?
2013, Gaceta Sanitaria