Influenza and hepatitis B vaccination coverage among healthcare workers in Croatian hospitals: a series of cross-sectional surveys, 2006–2011

BMC Infectious Diseases

Josip Car¹  Ilija Kuzman⁴  Smilja Kalenic⁵  Valerija Stamenic²  Neven Papic³  Rok Civljak⁴ 

[1] School of Public Health, Imperial College London, Reynolds building, London, UK;Department for Projects and Programs, Directorate for Medical Affairs, Ministry of Health, Ksaver 200a, 10 000 Zagreb, Croatia;Dr. Fran Mihaljevic University Hospital for Infectious Diseases, Mirogojska 8, 10000 Zagreb, Croatia;Department of Infectious Diseases, Medical School, University of Zagreb, Šalata 3, 10 000 Zagreb, Croatia;Department of Bacteriology, Virology and Parasitology, Medical School, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia

关键词: Vaccination;    Healthcare workers;    Hepatitis B;    Influenza;   

Others  :  1145549
DOI  :  10.1186/1471-2334-13-520

 received in 2013-07-30, accepted in 2013-10-30,  发布年份 2013

【 摘 要 】

Background

Healthcare workers (HCWs) are at an increased risk of exposure to and transmission of infectious diseases. Vaccination lowers morbidity and mortality of HCWs and their patients. To assess vaccination coverage for influenza and hepatitis B virus (HBV) among HCWs in Croatian hospitals, we conducted yearly nationwide surveys.

Methods

From 2006 to 2011, all 66 Croatian public hospitals, representing 43–60% of all the HCWs in Croatia, were included. Statistical analysis was performed using the Kruskal–Wallis analysis of variance, Dunn’s multiple comparison analysis and the chi-square test, as appropriate.

Results

The median seasonal influenza vaccination coverage rates in pre-pandemic (2006–2008) seasons were 36%, 25% and 29%, respectively. By occupation, influenza vaccination rates among physicians were 33 ± 21%, 33 ± 22% among graduate nurses, 30±34% among other HCWs, 26 ± 21% among housekeeping and the lowest, 23 ± 17%, among practical nurses (p < 0.01). In 2009–2010 season, seasonal influenza vaccination coverage was 30%, while overall vaccination coverage against pandemic influenza was fewer than 5%. Median vaccination coverage in the post-pandemic seasons of 2010–2011 and 2011–2012 decreased to 15% and 14%, respectively (reduction of 24% and 35%, respectively, p < 0.0001). Meanwhile, the median mandatory HBV vaccination coverage was 98%, albeit with considerable differences according to work setting (range 19–100%) and occupation (range 4–100%).

Conclusions

We found substantial year-on-year variations in seasonal influenza vaccination rates, with reduction in post pandemic influenza seasons. HBV vaccination is satisfactory compared to seasonal influenza vaccination coverage, although substantial variations by occupation and work setting were observed. These findings highlight the need for national strategies that optimize vaccination coverage among HCWs in Croatian hospitals. Further studies are needed to establish the potential role of mandatory vaccination for seasonal influenza.

【 授权许可】

   
2013 Civljak et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Haagsma JA, Tariq L, Heederik DJ, Havelaar AH: Infectious disease risks associated with occupational exposure: a systematic review of the literature. Occup Environ Med 2012, 69:140-146.
• [2]Centers for Disease Control and Prevention: Updated U.S. Public health service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for post exposure prophylaxis. MMWR Recomm Rep 2001, 50(RR-11):1-52.
• [3]Civljak R, Begovac J: Occupational exposure to blood-borne infections in health care workers. Infektoloski Glasnik 2003, 23:183-188.
• [4]Civljak R, Papes D: Exposure of emergency medical personnel to infective disease agents. Lijec Vjesn 2009, 131(Suppl 4):65-69.
• [5]Centers for Disease Control and Prevention: Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Recomm Rep 2010, 59(RR-8):1-62.
• [6]Poljicanin T, Benjak T: Croatian health service yearbook 2012. 2013. http://hzjz.hr/?cat=20 webcite
• [7]Mandatory immunization schedule in Croatia in 2013. 2013. http://hzjz.hr/?p=677 webcite
• [8]Tesovic G: Childhood vaccinations in Croatia. Period Biol 2012, 114:149-166.
• [9]The Croatian Parliament: The Protection of the Population from Communicable Diseases Act of 1992, Pub. L. No. PA4-71/1-92, Stat 78 (October 1, 1992). Official Gazette 60/92
• [10]The Ministry of Health: Ordinance on the manner of carrying out immunization, seroprophylaxis and chemoprophylaxis against communicable diseases, and on the persons subject to this obligation 1994, Pub. L. No. 534-02-22/94-0001, Stat 61 (March 25, 1994). Official Gazette 23/94
• [11]US Department of Labor, Occupational Safety and Health Administration: Occupational exposure to bloodborne pathogens; final rule. Fed Regist 1991, 56:64003-64182.
• [12]Civljak R, Begovac J: Recommendations for prevention of occupational exposure to blood-borne infections in health care workers. Infektoloski Glasnik 2004, 24:33-41.
• [13]Centers for Disease Control and Prevention: Recommendation of the Immunization Practices Advisory Committee (ACIP). Prevention and Control of Influenza. MMWR Morb Mortal Wkly Rep 1984, 33:253-260.
• [14]Wilde JA, McMillan JA, Serwint J, Butta J, O’Riordan MA, Steinhoff MC: Effectiveness of influenza vaccine in health care professionals: a randomized trial. JAMA 1999, 281:908-913.
• [15]Potter J, Stott DJ, Roberts MA, Elder AG, O’Donnell B, Knight PV, Carman WF: Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients. J Infect Dis 1997, 175:1-6.
• [16]Burls A, Jordan R, Barton P, Olowokure B, Wake B, Albon E, Hawker J: 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, 24:4212-4221.
• [17]Hayward AC, Harling R, Wetten S, Johnson AM, Munro S, Smedley J, Murad S, Watson JM: Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ 2006, 333:1241.
• [18]Carman WF, Elder AG, Wallace LA, McAulay K, Walker A, Murray GD, Stott DJ: Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet 2000, 355:93-97.
• [19]Hofmann F, Ferracin C, Marsh G, Dumas R: Influenza vaccination of healthcare workers: a literature review of attitudes and beliefs. Infection 2006, 34:142-147.
• [20]Mereckiene J, Cotter S, Nicoll A, Levy-Bruhl D, Ferro A, Tridente G, Zanoni G, Berra P, Salmaso S, O’Flanagan D, VENICE Project Gatekeepers Group: National seasonal influenza vaccination survey in Europe, 2008. Euro Surveill 2008, 13:19017.
• [21]Mereckiene J, Cotter S, D’Ancona F, Giambi C, Nicoll A, Levy-Bruhl D, Lopalco PL, Weber JT, Johansen K, Dematte L, Salmaso S, Stefanoff P, Greco D, Dorleans F, Polkowska A, O’Flanagan D, VENICE project gatekeepers group: Differences in national influenza vaccination policies across the European Union, Norway and Iceland 2008–2009. Euro Surveill 2010, 15:19700.
• [22]Bernstein HH, Starke JR, American Academy of Pediatrics. Committee on Infectious Diseases: Policy statement—recommendation for mandatory influenza immunization of all health care personnel. Pediatrics 2010, 126:809-815.
• [23]Kuehn BM: Mandatory influenza vaccination urged for clinicians, other health workers. JAMA 2010, 304:1545.
• [24]Stewart AM: Mandatory vaccination of health care workers. N Engl J Med 2009, 361:2015-2017.
• [25]Council Recommendation of 22 December 2009 on seasonal influenza vaccination. http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2009:348:0071:0072:EN:PDF webcite
• [26]Chapman GB, Li M, Colby H, Yoon H: Opting in vs opting out of influenza vaccination. JAMA 2010, 304:43-44.
• [27]Rakita RM, Hagar BA, Crome P, Lammert JK: Mandatory influenza vaccination of healthcare workers: a 5-year study. Infect Control Hosp Epidemiol 2010, 31:881-888.
• [28]Babcock HM, Gemeinhart N, Jones M, Dunagan WC, Woeltje KF: Mandatory influenza vaccination of health care workers: translating policy to practice. Clin Infect Dis 2010, 50:459-464.
• [29]Huynh S, Poduska P, Mallozzi T, Culler F: Mandatory influenza vaccination of health care workers: A first-year success implementation by a community health care system. Am J Infect Control 2012, 40:771-773.
• [30]Influenza vaccination in 2013-2014 season. 2013. http://hzjz.hr/wp-content/uploads/2013/11/cijepljenje_protiv_gripe_sezona_2013_2014.pdf webcite
• [31]Centers for Disease Control and Prevention: Immunization of Health-Care Personnel. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011, 60(RR- 7):1-45.
• [32]Register of Occupational Diseases of the Croatian Institute for Health Protection and Safety at Work. http://www.hzzzsr.hr/?what=content&ID=70&cat=68 webcite
• [33]Music T: Protecting patients, protecting healthcare workers: a review of the role of influenza vaccination. Int Nurs Rev 2012, 59:161-167.
• [34]Gripa.hr. http://www.gripa.hr webcite
• [35]Christini AB, Shutt KA, Byers KE: Influenza vaccination rates and motivators among healthcare worker groups. Infect Control Hosp Epidemiol 2007, 28:171-177.
• [36]Blasi F, Palange P, Rohde G, Severin T, Cornaglia G, Finch R: Healthcare workers and influenza vaccination: an ERS-ESCMID Web-based survey. Clin Microbiol Infect 2011, 17:1223-1225.
• [37]Blasi F, Aliberti S, Mantero M, Centanni S: Compliance with anti-H1N1 vaccine among healthcare workers and general population. Clin Microbiol Infect 2012, 18(Suppl 5):37-41.
• [38]Gajski L: Cijepljenje – spas od zaraznih bolesti ili nepotreban rizik. Lijecnicke novine 2011, 15:51-55.
• [39]Prematunge C, Corace K, McCarthy A, Nair RC, Pugsley R, Garber G: Factors influencing pandemic influenza vaccination of healthcare workers—a systematic review. Vaccine 2012, 30:4733-4743.
• [40]Aguilar-Diaz Fdel C, Jimenez-Corona ME, Ponce-de-Leon-Rosales S: Influenza vaccine and healthcare workers. Arch Med Res 2011, 42:652-657.
• [41]van Delden JJ, Ashcroft R, Dawson A, Marckmann G, Upshur R, Verweij MF: The ethics of mandatory vaccination against influenza for health care workers. Vaccine 2008, 26:5562-5566.
• [42]IDSA Policy on Mandatory Immunization of Health Care Workers Against Seasonal and Pandemic Influenza. http://www.idsociety.org/uploadedFiles/IDSA/Policy_and_Advocacy/Current_Topics_and_Issues/Influenza_and_Bio-Threats/Seasonal_and_Pandemic_Influenza/IDSA_Policy_on_Mandatory_Immunization_Revision_Aug_2010_Final.pdf webcite
• [43]Kwong JC, Stukel TA, Lim J, McGeer AJ, Upshur RE, Johansen H, Sambell C, Thompson WW, Thiruchelvam D, Marra F, Svenson LW, Manuel DG: The effect of universal influenza immunization on mortality and health care use. PLoS Med 2008, 5:e211.