Vaccination policies for healthcare workers in Europe

doi:10.1016/j.vaccine.2013.10.046

Vaccine

Volume 32, Issue 38, 27 August 2014, Pages 4876-4880

https://doi.org/10.1016/j.vaccine.2013.10.046 Get rights and content

Highlights

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Country-to-country differences in terms of vaccinations for HCWs exist in Europe.
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Mandatory vaccination has been adopted by very few countries and for very limited indications.
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There are significant immunity gaps among HCWs against VPDs in Europe.
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Mandatory vaccination should be considered for HCWs in Europe.

Abstract

Health-care workers (HCWs) are at increased risk for acquisition of vaccine-preventable diseases (VPDs) and vaccination is justified in order to protect them from occupational exposure and to prevent the spread of VPDs that pose a threat to susceptible patients. Review of European vaccination policies for HCWs revealed significant differences between countries in terms of recommended vaccines, implementation frame (mandatory or recommendation), target HCW groups and health-care settings. Further, the few published studies available identified indicate significant immunity gaps among HCWs against VPDs in Europe. In order to achieve higher vaccination coverage against VPDs stronger recommendations are needed. The issue of mandatory vaccination should be considered for diseases that can be transmitted to susceptible patients (influenza, measles, mumps, rubella, hepatitis B, pertussis, varicella). The acceptance of vaccinations and of mandatory vaccinations by HCWs is a challenge and appears to be VPD-specific.

Introduction

Public health policies refer to decisions, plans, and actions that are implemented in order to protect or improve the health of entire populations. In this frame, the wide implementation of childhood vaccinations during the second half of the 20th century has been one of the most successful public health policies in history, leading to the control or elimination of multiple infectious diseases [1]. Nevertheless, large epidemics of vaccine-preventable diseases (VPDs) still occur even in countries with long term-established vaccination programs, like measles epidemics in Europe and pertussis in the United States [2], [3]. Not unexpectedly, health-care facilities also experience outbreaks due to VPDs, often in association with serious morbidity and even mortality among patients, disruption of health-care services, and high costs [4], [5], [6], [7], [8], [9], [10]. Susceptible health-care workers (HCWs) are at increased risk for acquisition of VPDs and at the same time may act as vehicles for the evolution of outbreaks in health-care facilities. In this context, vaccination of HCWs is justified not only by the need to protect them from occupational exposure, but also to protect their patients, who may not develop a satisfactory immune response after they get vaccinated (e.g. immunocompromised persons), may not be eligible for vaccination (e.g. influenza vaccines are not licensed for infants <6 months old), or may be unvaccinated because of missed opportunities or anti-vaccination opinions [11]. Herein we review current vaccination policies for HCWs in Europe, focusing on measles and influenza as prototype VPDs for discussion.

Section snippets

The measles paradigm

Almost four decades after the introduction of measles vaccine in childhood vaccination programs in Europe, Europe is experiencing a decade of large-scale measles epidemics in several countries [12], [13], [14], [15], [16], with more than 20,000 cases and 6 related deaths notified in 34 countries of the World Health Organization European Region during the first half of 2013 alone [2]. Cases mainly involve unvaccinated persons of various backgrounds, namely Roma, religious or anthroposophic

The influenza paradigm

Of all vaccines, influenza vaccines have two characteristics which render them far from ideal, namely their moderate effectiveness which may vary by influenza season [38] and the requirement for annual administration. Nevertheless, influenza vaccination is the only massively available and easily applied means for protection against a disease which is the leading cause of VPD-associated morbidity and death in developed countries; approximately 40,000 deaths are associated with influenza in the

Vaccination policies for HCWs in European countries

Table 1 shows the vaccination policies for HCWs in 30 European countries, including all (27) EU Member States, as of 2011. Significant country-to-country differences exist in terms of vaccines, implementation frame (mandatory or recommendation), target HCW groups and health-care settings [35]. Differences in childhood and adult vaccination programs and the costs of vaccines may partly account for these differentiations. However, vaccination policies for HCWs against influenza and hepatitis B

Toward an holistic approach of HCW vaccinations in Europe

During the past decade the issue of safety within health-care facilities in Europe was shaped by legislative acts and often was incorporated in pandemic preparedness and response plans. Although all European countries have established vaccination policies for HCWs, we identified several shortcomings, in terms of vaccines and indications. The fragmentation of vaccination policies for HCWs in Europe needs to be addressed at the EU level in order for vaccination policies for HCWs to be

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Cited by (111)

Vaccination coverage among laboratory personnel - health safety imperative for all
2023, Vacunas
The objective of the study was to evaluate disparities in vaccination coverage among laboratory personnel in health care facilities and to identify risk factors for nonvaccination.
A multicenter, quantitative, cross-sectional study was conducted between November 2020 and February 2021. The validated bilingual questionnaire was distributed online through professional association networks. Descriptive and inferential statistics were included in the analysis.
Of the 640 respondents, approximately one-third (30.9%) had received an annual influenza vaccination. Significantly higher vaccination coverage rates were reported for measles, tuberculosis, and hepatitis B (82.8%, 78.3%, and 72.5%, respectively). Influenza vaccination coverage was higher among LPs with higher education (p < 0.001), in microbiology laboratories (p = 0.009), in the private sector (p = 0.012), and twice as high in EU countries (p < 0.001). Measles vaccination coverage was lower among LPs older than 45 years (p < 0.001), had a college degree (p = 0.015), and were EU citizens (p = 0.002). Better tuberculosis vaccination coverage was found among LPs older than 45 years (p < 0.001), with higher educational degrees (p = 0.003), employed in microbiology laboratories (p = 0.004), and working in the private sector (p = 0.025). Hepatitis B vaccination coverage was higher among LPs under 45 years (p = 0.020), with higher levels of education (p = 0.003), and with respect to territorial affiliation (p < 0.001).
The present study showed that the vaccination coverage rate was satisfactory for most LPs against hepatitis B, tuberculosis, and measles, while the coverage rate against influenza was low.
El objetivo del estudio fue evaluar las disparidades en la cobertura de vacunación entre el personal de laboratorio (LPs) en los establecimientos de salud e identificar los factores de riesgo para la no vacunación.
Se realizó un estudio transversal cuantitativo multicéntrico entre noviembre de 2020 y febrero de 2021. El cuestionario bilingüe validado se distribuyó por Internet a través de redes de asociaciones profesionales. El análisis estadístico incluyó análisis descriptivos e inferenciales.
De los 640 encuestados, aproximadamente un tercio (30.9%) había recibido una vacuna antigripal anual. Se reportaron tasas de cobertura de vacunación significativamente más altas para el sarampión, la tuberculosis y la hepatitis B (82.8%, 78.3% y 72.5%, respectivamente). La cobertura de vacunación contra la influenza fue mayor entre el PL con educación superior (p < 0.001), en laboratorios de microbiología (p = 0.009), en el sector privado (p = 0.012) y el doble que en los países de la UE (p < 0.001). La cobertura de vacunación contra el sarampión fue menor entre el PL mayor de 45 años (p < 0.001), con título universitario (p = 0.015) y ciudadanos de la UE (p = 0.002). Se encontró mejor cobertura de vacunación contra la tuberculosis entre los mayores de 45 años (p < 0.001), con mayor grado de instrucción (p = 0.003), empleados en laboratorios de microbiología (p = 0.004) y trabajadores del sector privado (p = 0.025). La cobertura de vacunación contra la hepatitis B fue mayor entre el PL menor de 45 años (p = 0.020), con mayor nivel educativo (p = 0.003) y con respecto a la afiliación territorial (p < 0.001).
El presente estudio mostró que la tasa de cobertura de vacunación en el área de estudio fue satisfactoria para la mayoría de los LP contra la hepatitis B, la tuberculosis y el sarampión, mientras que la tasa de cobertura contra la influenza fue baja.
Vaccines for healthcare associated infections without vaccine prevention to date
2022, Vaccine: X
In spite of the widespread implementation of preventive strategies, the prevalence of healthcare-associated infections (HAIs) remains high. The prevalence of multidrug resistant organisms is high in HAIs. In 2019, the World Health Organization retained antimicrobial resistance as one of the ten issues for global health. The development of vaccines may contribute to the fight against antimicrobial resistance to reduce the burden of HAIs. Staphylococcus aureus, Gram negative bacteria and Clostridium difficile are the most frequent pathogens reported in HAIs. Consequently, the development of vaccines against these pathogens is crucial. At this stage, the goal of obtaining effective vaccines against S.aureus and Gram negative bacteria has not yet been achieved. However, we can expect in the near future availability of a vaccine against C. difficile. In addition, identifying populations who may benefit from these vaccines is complex, as at-risk patients are not great responders to vaccines, or as vaccination may occur too late, when they are already confronted to the risk. Vaccinating healthcare workers (HCWs) against these pathogens may have an impact only if HCWs play a role in the transmission and in the pathogens acquisition in patients, if the vaccine is effective to reduce pathogens carriage and if vaccine coverage is sufficient to protect patients. Acceptance of these potential vaccines should be evaluated and addressed in patients and in HCWs.
Analysis of the best strategies to promote flu vaccination coverage among healthcare professionals
2022, Vacunas
la gripe representa un importante problema de salud pública. La cobertura de vacunación antigripal entre profesionales sanitarios ha sido tradicionalmente inferior a la recomendada por las autoridades sanitarias nacionales, con heterogeneidad regional. El proyecto Gripetool pretende identificar las iniciativas más efectivas para fomentar la vacunación antigripal en España en este colectivo.
se recabó información a través de una encuesta online realizada a los socios de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN) entre julio y noviembre de 2020, previamente validada por un comité de expertos. Se realizó un análisis de regresión lineal múltiple para analizar la posible relación entre la vacunación contra la gripe de los profesionales sanitarios y las distintas medidas de fomento reportadas en la encuesta.
según los encuestados (n = 385), la publicación de recomendaciones de vacunación (18,6%), el uso de medios de comunicación y redes sociales (14,4%) y la captación activa a través de e-mail/cartas (10,6%) son las medidas más eficaces para aumentar la cobertura vacunal. Según el análisis estadístico, son 10 las medidas con impacto positivo en la tasa vacunal, siendo las más relevantes la distribución de carteles en los centros sanitarios (aumento de 17 puntos porcentuales [pp]), la publicación de recomendaciones de vacunación (14pp) y la elaboración de protocolos y guías (13pp).
las medidas más efectivas para aumentar la vacunación antigripal en los profesionales sanitarios pasarían por acciones a nivel macro, meso y micro para promover la vacunación y comunicar sus beneficios, explotando el potencial de las nuevas tecnologías.
The flu represents a major public health issue. The flu vaccination rate among healthcare professionals has traditionally been lower than recommended by national health authorities, and there is also regional heterogeneity. The objective of the Gripetool project was to identify the most effective initiatives to promote influenza vaccination in Spain among healthcare workers.
Information was obtained through an online survey conducted among members of the Spanish Society of Primary Care Physicians (SEMERGEN) between July and November 2020, which had been previously validated by a committee of experts. A multiple linear regression analysis was performed to analyse the possible relationship between the vaccination coverage of health professionals and the different promotion measures reported in the survey.
According to respondents (n = 385), the publication of vaccination recommendations (18.6%), the use of media and social networks (14.4%) and the active recruitment through email/letters (10.6%) are the most effective measures to increase vaccination rates. According to the statistical analysis there are ten measures that have a positive impact on the vaccination rate, the most relevant include the distribution of posters in health centres (17 percentage points increase, pp), the publication of vaccination recommendations (14pp) and the development of protocols and guidelines (13pp).
The most effective strategies to increase influenza vaccination comprehend actions at macro, meso and micro levels to promote vaccination and communicate its benefits, exploiting the potential of new technologies.
Attitudes of junior healthcare professionals towards mandatory vaccination
2022, Vaccine
Vaccination of healthcare professionals (HCPs) is a key measure to prevent infections in healthcare facilities, but uptake rates often remain low. Mandatory vaccination policies have been occasionally implemented to increase compliance among HCPs, but this remains an issue of controversy. The purpose of this survey was to assess the attitudes and beliefs of trainee HCPs towards mandatory occupational vaccination and further explore the factors that determine their decision. In this cross-sectional survey, trainees consisted of medical residents and medical and nursing students undergoing their clinical clerkship. An anonymous questionnaire was distributed following pilot testing. In total, 410 trainees participated (response rate: 90.1%), of whom 194 (47.3%) were residents, 154 (37.6%) medical and 62 (15.1%) nursing students. Most participants (320/410, 78%) supported mandatory occupational vaccination, stating that it should be applied to promote public welfare and benefit (294/320, 91.9%) or should be a prerequisite for employment (271/320, 84.7%). Only 22/410 (5.4%) of HCPs opposed to mandatory occupational vaccination. The primary reasons for a negative attitude were the belief that personal rights outweigh public benefit (10/22, 45.5%) and the fear of side effects (9/22, 40.9%). Univariate analysis revealed that HCPs that have been informed by vaccination campaigns or had higher knowledge scores, were more likely to support mandatory occupational vaccination (OR 1.7, 95% CI: 1.1–2.7, p 0.038 and OR 1.7, 95% CI: 1.02– 2.7. p 0.044, respectively). In conclusion, most medical and nursing trainees in this study supported mandatory vaccination for HCPs. Focusing on continuing professional education on vaccines is important to positively determine HCPs’ attitudes towards occupational vaccination and increase their vaccination uptake rates.
10-Year survey on serum antibody positivity rates and titers for measles and rubella in healthcare workers; an observational study at a Japanese university hospital
2021, Journal of Infection and Chemotherapy
We evaluated the effect of the two-dose vaccination strategy, which has been a widely adopted as childhood routine schedule worldwide to acquire herd immunity, on healthcare workers (HCWs) in Japan.
Between 2010 and 2019, antibody titers for measles and rubella were measured annually among newly employed HCWs at Osaka University Hospital, Japan, using Enzygnost® assays (Siemens Healthcare Diagnostics Co. Ltd., Marburg, Germany). The data were categorized by age to compare the antibody positivity rates and antibody titers among no-vaccine, single-dose, and two-dose groups.
Over the 10-year period, the annual antibody positivity rates for measles and rubella were 84.0%–95.3% and 90.0%–94.5%, respectively, without any particular trend. The antibody titers for measles (median [interquartile range]: 8.4 [3.9, 20] vs. 6.1 [3.5, 12]) and rubella (11 [5.5, 20] vs. 6 [3.7, 11]) were statistically lower (p < 0.001) in the two-dose generation than in the single-dose generation.
A shift from single-dose to two-dose vaccination did not yield an increase in antibody positivity rates for both measles and rubella among HCWs. Notably, antibody titers were significantly lower in the two-dose generation.
Despite several limitations, our data suggests a paradoxical vulnerability in young HCWs who received the two-dose vaccination in a view of sero-positivity rates.
Quantifying preferences around vaccination against frequent, mild disease with risk for vulnerable persons: A discrete choice experiment among French hospital health care workers
2021, Vaccine
The individual determinants of vaccine acceptance among health workers (HCWs) have been described in the literature, but there is little evidence regarding the impact of vaccine characteristics and contextual factors (e.g., incentives, communication) on vaccination intentions. We developed a single profile discrete choice experiment (DCE) to assess the impact of seven attributes on stated vaccination intention against an unnamed disease, described as frequent with rapid clinical evolution and epidemic potential (similar to influenza or pertussis). Attributes evaluated vaccine characteristics (effectiveness, security profile), inter-individual aspects (epidemic risk, controversy, potential for indirect protection, vaccine coverage) and incentives (e.g., badge, hierarchical injunction). A total of 1214 French hospital-based HCWs, recruited through professional organizations, completed the online DCE questionnaire. The relative impact of each attribute was estimated using random effects logit models on the whole sample and among specific subgroups. Overall, 52% of included HCWs were vaccinated against influenza during 2017–18 and the average vaccination acceptance rate across all scenarios was 58%. Aside from the management stance, all attributes’ levels had significant impact on vaccination decisions. Poor vaccine safety had the most detrimental impact on stated acceptance (OR 0.04 for the level controversy around vaccine safety). The most motivating factor was protection of family (OR 2.41) and contribution to disease control (OR 2.34). Other motivating factors included improved vaccine effectiveness (OR 2.22), high uptake among colleagues (OR 1.89) and epidemic risk declared by health authorities (OR 1.76). Social incentives (e.g., a badge I’m vaccinated) were dissuasive (OR 0.47). Compared to HCWs previously vaccinated against influenza, unvaccinated HCWs who were favorable to vaccination in general were most sensitive towards improved vaccine effectiveness. Our study suggests that vaccine safety considerations dominate vaccine decision-making among French HCWs, while adapted communication on indirect protection and social conformism can contribute to increase vaccination acceptance.

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Vaccination policies for healthcare workers in Europe

Highlights

Abstract

Introduction

Section snippets

The measles paradigm

The influenza paradigm

Vaccination policies for HCWs in European countries

Toward an holistic approach of HCW vaccinations in Europe

Am J Infect Control

Clin Liver Dis

J Hosp Infect

Am J Infect Control

J Infect

Enferm Infecc Microbiol Clin

J Hosp Infect

Arch Pediatr

Vaccine

Lancet

Vaccine

Med Mal Infect

Lancet Infect Dis

Vaccine

J Hosp Infect

J Infect

J Hosp Infect

Vaccine

Am J Infect Control

Public Health

Dig Liver Dis

Vaccine

Am J Infect Control

Vaccine

Vaccine

Vaccine

Mandating vaccination: what counts as a mandate in public health and when should be used?

Am J Bioethics

Regional uptake: ongoing measles and rubella outbreaks and environmental detection of wild poliovirus

Epidemic pertussis in 2012 – the resurgence of a vaccine-preventable disease

N Engl J Med

Measures to control an outbreak of pertussis in a neonatal intermediate care nursery after exposure to a healthcare worker

Infect Control Hosp Epidemiol

Two nosocomial pertussis outbreaks and their associated costs – King County, Washington, 2004

Infect Control Hosp Epidemiol

Health care-associated measles outbreak in the United States after an importation: challenges and economic impact

J Infect Dis

Nosocomial transmission of measles among healthcare workers, Bulgaria, 2010

Euro Surveill

The age-old struggle against the antivaccinationists

N Engl J Med