A 'nice to have' or a 'non-negotiable': South African healthcare workers' knowledge, attitudes, practices and perceptions of vaccination

Background: Non-immune healthcare workers (HCWs) are at high risk of contracting and transmitting vaccine-preventable diseases. Data on the knowledge, attitudes and practices (KAP) of African HCWs regarding the World Health Organization (WHO)-recommended vaccinations is limited. Objectives: We aimed to describe the KAP of HCWs regarding the WHO-recommended vaccinations, namely, those against hepatitis B, polio, diphtheria, measles, rubella, meningococcus, influenza, varicella and pertussis, and to assess the facilitators of, and barriers to, HCW vaccine uptake. Methods: This was a cross-sectional study. A self-administered KAP survey was completed by 300 clinical (nurses, doctors, allied health) and non-clinical (laboratory, pharmacy, administrative, household staff and porters) HCWs at Tygerberg Hospital, Cape Town, from June to October 2018. Data were analysed using Stata Statistical Software version 13.0 IC to generate mean scores for KAP. Individual question scores were compared across job categories (clinical vs non-clinical) using Pearson's chi-square test. Results: Most of the study participants were female (n = 228, 76.0%), aged 18­40 years (n = 190, 63.3%) and employed as clinical staff (n = 252, 84.0%). The overall mean KAP scores were 57.1%, 68.4% and 39.9%, respectively; clinical HCWs scored significantly higher than non-clinical HCWs in all three topics (p < 0.001). HCWs believed vaccines to be effective (n = 254, 84.7%) and safe with few side effects (n = 219, 73.0%). Vaccine uptake was highest for hepatitis B (n = 247, 82.3%), followed by measles (n = 159, 53.0%) and diphtheria/tetanus (n = 101, 33.7%), and lowest for influenza (n = 68, 22.7%). Common reasons for vaccination included HCWs wanting to protect themselves, their families and their patients. Fear of side effects and lack of workplace access were common reasons for not vaccinating. Conclusion: Clinical HCWs had better KAP regarding vaccination than non-clinical HCWs. Strategies to improve HCW vaccine uptake should focus on vaccination education and facilitation of workplace access to vaccination.