Seasonal influenza vaccination predicts pandemic H1N1 vaccination uptake among healthcare workers in three countries

doi:10.1016/j.vaccine.2011.07.079

Vaccine

Volume 29, Issue 43, 6 October 2011, Pages 7364-7369

https://doi.org/10.1016/j.vaccine.2011.07.079 Get rights and content

Abstract

The aim of this study was to identify the common barriers and facilitators for acceptance of pandemic influenza vaccination across different countries. This study utilized a standardized, anonymous, self-completed questionnaire-based survey recording the demographics and professional practice, previous experience and perceived risk and severity of influenza, infection control practices, information of H1N1 vaccination, acceptance of the H1N1 vaccination and reasons of their choices and opinions on mandatory vaccination. Hospital-based doctors, nurses and allied healthcare workers in Hong Kong (HK), Singapore (SG) and Leicester, United Kingdom (UK) were recruited. A total of 6318 (HK: 5743, SG: 300, UK: 275) questionnaires were distributed, with response rates of 27.1% (HK), 94.7% (SG) and 94.5% (UK). The uptake rates for monovalent 2009 pandemic H1N1 vaccine were 13.5% (HK), 36.2% (SG) and 41.3% (UK). The single common factor associated with vaccine acceptance across all sites was having seasonal influenza vaccination in 2009. In UK and HK, overestimation of side effect reduced vaccination acceptance; and fear of side effect was a significant barrier in all sites. In HK, healthcare workers with more patient contact were more reluctant to accept vaccination. Drivers for vaccination in UK and HK were concern about catching the infection and following advice from health authority. Only a small proportion of respondents agreed with mandatory pandemic influenza vaccination (HK: 25% and UK: 42%), except in Singapore where 75.3% were in agreement. Few respondents (<5%) chose scientific publications as their primary source of information, but this group was more likely to receive vaccination.

The acceptance of pandemic vaccine among healthcare workers was poor (13–41% of respondents). Breaking barriers to accept seasonal influenza vaccination should be part of the influenza pandemic preparedness plan. Mandatory vaccination even during pandemic is likely to arouse substantial discontent.

Highlights

► The uptake of 2009 pandemic influenza vaccine among healthcare workers is poor. ► Previous seasonal vaccination is a strong predictor for accepting pandemic vaccine. ► Overestimation of side effect is a key barrier to vaccination. ► Mass media rather than scientific publication is the primary of vaccine information. ► Only a small proportion of healthcare workers agree with mandatory vaccination.

Introduction

The World Health Organization (WHO) declared on 10 August 2010 that the 2009 H1N1 virus has moved into post-pandemic phase. However, the virus remains prominent globally, and will contribute to further mortality and morbidity. Therefore, the WHO strongly recommends that seasonal vaccines should contain an A/California/7/2009 (H1N1)-like strain.

Healthcare workers are regarded as a priority group for influenza vaccination because of an increased risk of exposure, and as a potential source of transmission of influenza to high-risk patients under their care. However, healthcare workers have reported a relatively low intention to be vaccinated against the pandemic influenza [1], [2]. Pandemic vaccination programmes implemented during the 2009 pandemic were criticized by some scientists and media reports that the infection was relatively mild, there were insufficient safety data of vaccines and that mass vaccination of the population was unwarranted, or even a large-scale experiment [3]. This may have deterred vaccine acceptance and uptake among eligible healthcare workers and people considered at high-risk.

The acceptance rates of 2009 pandemic H1N1 vaccine among healthcare workers may vary among countries on account of differences in their health system, health policy, provision of personal protective equipment to staff and availability of anti-viral agents. Cultural and societal beliefs and personal perceptions following national or localised information programmes regarding the benefits of vaccination may affect coverage as well. We hypothesized that these factors would contribute to differences in acceptance rates of pandemic influenza vaccination among healthcare workers in different countries. We utilized a standardized questionnaire to identify and compare the factors associated with the uptake of pandemic influenza vaccine among healthcare workers in three different countries: Hong Kong, Singapore and United Kingdom. These three countries have different health systems, but all had procured adequate pandemic vaccine supplies for healthcare workers, therefore vaccination was a personal choice of each healthcare worker. The results of this analysis can help inform vaccination promotion strategies in future influenza pandemic preparedness plans.

This study investigated the factors associated with pandemic H1N1 vaccination uptake among healthcare workers in three countries during the 2009/10 influenza pandemic.

Section snippets

Materials and methods

A standardized survey was conducted between 20 January 2010 and 12 April 2010, during which the WHO pandemic influenza alert level was at phase 6, and there was widespread availability of monovalent 2009 pandemic H1N1 vaccines at each participating site.

Results

A total of 6318 questionnaires were distributed with 2100 completed questionnaires received. The response rate was 27.1% (HK), 94.7% (SG) and 94.5% (UK). The 2009 pandemic H1N1 vaccination uptake rates among respondents from the three study sites were 13.5% (HK), 36.2% (SG) and 41.3% (UK), respectively.

The single common factor associated with vaccine acceptance across all sites after multivariate analysis was a history of seasonal influenza vaccination in 2009. The uptake rates of the seasonal

Discussion

This is the first study to assess factors associated with pandemic influenza vaccination uptake in healthcare workers across countries with different health systems and policies. Overall vaccination coverage was relatively poor, less than 50%, despite the WHO declaration of an influenza pandemic. The actual uptake was lower than the previously stated intentions to receive pandemic vaccine in studies conducted during the prepandemic period in similar populations [1], [4], [5]. The low uptake may

Conclusions

Our study has revealed that previous acceptance of seasonal vaccination is a strong predictor for accepting pandemic influenza vaccination across the three countries. A more vigorous promotion of seasonal influenza vaccination should therefore be part of the preparedness plans for future pandemics. In addition, information flow by various channels including impact of mass media and overestimation of severe side effects are barriers that should be addressed in future vaccination campaign.

Acknowledgements

The authors thank Dr. Jon Tilburt for his invaluable advice and efforts in constructing the questionnaires and generous support from the Chiefs of Service and health professionals in participating departments.

Funding sources: The study was sponsored by the Direct Grant for Research 2009/2010.

Conflict of interest statement: Nil.

Contributors: J.S.Y.C. and P.K.S.C. were responsible for the conception and design of the study. S.K.P., I.S., W.B.G. and S.G. were responsible for commenting the

References (11)

J. Maurer et al.
Perceived seriousness of seasonal and A(H1N1) influenzas, attitudes toward vaccination, and vaccine uptake among U.S adults: does the source of information matter?
Prev Med
(2010)
M. Pareek et al.
Willingness of healthcare workers to accept voluntary stockpiled H5N1 vaccine in advance of pandemic activity
Vaccine
(2009)
A. Dinh et al.
Expected and unexpected adverse effects H1N1 vaccination for health care workers in a university hospital
Vaccine
(2010)
J. Barrière et al.
Acceptance of the 2009 A(H1N1) influenza vaccine among hospital workers in two French cancer centers
Vaccine
(2010)
J.S.Y. Chor et al.
Willingness of Hong Kong healthcare workers to accept pre-pandemic influenza vaccination at different WHO alert levels: two questionnaire surveys
BMJ
(2009)

There are more references available in the full text version of this article.

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Seasonal influenza vaccination predicts pandemic H1N1 vaccination uptake among healthcare workers in three countries

Abstract

Highlights

Introduction

Section snippets

Materials and methods

Results

Discussion

Conclusions

Acknowledgements

Prev Med

Vaccine

Vaccine

Vaccine

Willingness of Hong Kong healthcare workers to accept pre-pandemic influenza vaccination at different WHO alert levels: two questionnaire surveys

BMJ