Letter to the Editor

Nosocomial influenza: Need to vaccinate health-care workers

Los trabajadores sanitarios tienen riesgo de adquirir la gripe y actuar como vectores para la transmisión nosocomial. El objetivo del estudio fue la valoración de los conocimientos y actitudes de los profesionales sobre la vacunación antigripal, y determinar los factores asociados a ella por parte de profesionales de atención primaria en Cataluña.

Estudio transversal mediante una encuesta anónima vía web.

Profesionales sanitarios de atención primaria del Instituto Catalán de la Salud.

Se incluyó a 1.212 profesionales de atención primaria. Se excluyó a los profesionales con contraindicación para recibir la vacuna o indicación de vacunación por condición médica de riesgo y aquellos que hubieran participado en la red centinela de vigilancia de la gripe Pla d’Informació Diària d’Infeccions Respiratòries Agudes de Catalunya (PIDIRAC).

Se consideraron 423 respuestas válidas, con una cobertura vacunal global del 46,6%. Se vacunaron más los que tenían de 45 a 54 años, los pediatras, los vacunados en las 3 temporadas anteriores o en alguna de ellas y los que convivían con enfermos crónicos. Se observó asociación entre estar vacunado y considerar que la vacunación es la mejor medida preventiva, preocupación por contraer la gripe y considerar importante la vacunación del personal sanitario.

Las actividades dirigidas a aumentar la cobertura de vacunación en profesionales sanitarios deberían dirigirse fundamentalmente a corregir concepciones erróneas sobre la vacunación de la gripe en profesionales sanitarios.

Health personnel are at risk of acquiring influenza infection and of nosocomial influenza transmission. The objective of this study was to assess the relationship between the knowledge and attitudes of primary care health personnel in Catalonia as regards influenza vaccine and the factors related to the uptake of this vaccine.

A cross-sectional study using a web survey.

Primary care health personnel of the Catalan Health Institute.

A total of 1212 primary health care personnel were included in the survey. Those who had medical reasons for being or not being vaccinated were excluded.

A total of 423 replies were valid, with a 46.6% overall vaccination coverage. Vaccination rate was higher among 45 to 54 year-olds, paediatricians, those vaccinated in preceding seasons, and those living with chronic patients. There was an association between having received the vaccine and considering vaccination the best preventive action, advocating vaccination to at risk population, concern about acquiring influenza, and considering health personnel vaccination important.

Actions taken to increase vaccination rate among health personnel should aim at correcting lack of knowledge and misconceptions about influenza vaccination of health personnel.

Healthcare students are a specific subgroup of healthcare workers as they are often not identified by the occupational medicine systems in healthcare facilities, because of their shared time between hospital wards and universities. Nevertheless, they should comply with the same vaccination recommendations as employed healthcare workers because they are in close and repeated contact with patients. Occupational immunization recommendations may vary between countries, but always include vaccine-preventable diseases that might lead to nosocomial outbeaks and/or fatal outcomes for healthcare workers or patients. Studies conclude that vaccine coverage is too low in healthcare students, and that they are often not aware of their possibility to be vectors of infections to frail patients. Efforts should be made to educate medical and nursing students on vaccines, to convince them of the utility of immunization and to offer them an increased access to occupational vaccinations in hospitals and universities.

Policies that mandate immunization have always been controversial. The controversies take different forms in different contexts.

For routine childhood immunizations, many parents have fears about both short- and long-term side effects. Parental worries change as the rate of vaccination in the community changes. When most children are vaccinated, parents worry more about side effects than they do about disease. Because of these worries, immunization rates go down. As immunization rates go down, disease rates go up, and parents worry less about side effects of vaccination and more about the complications of the diseases. Immunization rates then go up.

For teenagers, controversies arise about the criteria that should guide policies that mandate, rather than merely recommend and encourage, certain immunizations. In particular, policy makers have questioned whether immunizations for human papillomavirus, or other diseases that are not contagious, should be required.

For healthcare workers, debates have focused on the strength of institutional mandates. For years, experts have recommended that all healthcare workers be immunized against influenza. Immunizations for other infections including pertussis, measles, mumps, and hepatitis are encouraged but few hospitals have mandated such immunizations—instead, they rely on incentives and education. Pandemics present a different set of problems as people demand vaccines that are in short supply.

These issues erupt into controversy on a regular basis. Physicians and policy makers must respond both in their individual practices and as advisory experts to national and state agencies. The articles in this volume will discuss the evolution of national immunization programs in these various settings. We will critically examine the role of vaccine mandates. We will discuss ways that practitioners and public health officials should deal with vaccine refusal. We will contrast responses of the population as a whole, within the healthcare setting, and in the setting of pandemic influenza.