Health care worker beliefs about influenza vaccine and reasons for non-vaccination--a cross-sectional survey.

AIMS AND OBJECTIVES: To identify reasons for poor uptake of influenza vaccine in healthcare workers. BACKGROUND: When influenza is circulating in the community, influenza vaccination of healthcare workers may reduce morbidity and sick leave and may also reduce mortality in older hospitalized patients. Despite this, vaccine uptake in healthcare workers remains low. DESIGN: Cross-sectional survey. METHODS: Self-completed questionnaires were distributed to 144 nurses and healthcare assistants in two Liverpool hospitals. RESULTS: Vaccination uptake in this sample was 7.6%. The main reasons given for not being vaccinated were: did not think it was needed (29%), not aware of the vaccine (18%) and concerned about side-effects (11%). The main perceived benefits of vaccination were reducing sick leave (44%) and personal protection against influenza (28%). CONCLUSION: In this study, many healthcare workers demonstrated a lack of awareness and understanding of the vaccine, especially in relation to its benefits and side-effects. Relevance to clinical practice. Vaccinating healthcare workers against influenza can reduce staff sickness during times of winter pressure as well as reducing mortality in frail, older hospitalized patients. It is therefore important that hospitals maximize vaccine uptake by increasing awareness and promoting the benefits of influenza vaccine amongst healthcare workers as well as ensuring that all staff have the opportunity to receive the vaccine.

Is influenza vaccination cost effective for healthy people between ages 65 and 74 years? A randomised controlled trial.

The aim of this study was to determine the cost effectiveness of influenza vaccination for healthy people aged 65-74 years living in the UK. People without risk factors for influenza (chronic heart, lung or renal disease, diabetic, immunosuppressed or those living in an institution) were identified from 20 general practitioner (GP) practices in Liverpool in September 1999. 729/5875 (12.4%) eligible individuals were recruited and randomised to receive either influenza vaccine or placebo (ratio 3:1), with all participants receiving 23-valent-pneumococcal polysaccharide vaccine unless already administered. The primary analysis was the frequency of influenza as recorded by a GP diagnosis of pneumonia or influenza like illness. In 2000, the UK vaccination policy was changed with influenza vaccine becoming available for all people aged 65 years and over irrespective of risk. As a consequence of this policy change, the study had to be fundamentally restructured and only results obtained over a one rather than the originally planned two-year randomised controlled trial framework were used. Results from 1999/2000 demonstrated no significant difference between groups for the primary outcome (relative risk 0.8, 95% CI 0.16-4.1). In addition, there were no deaths or hospitalisations for influenza associated respiratory illness in either group. The subsequent analysis, using both national and local sources of evidence, estimated the following cost effectiveness indicators: (1) incremental NHS cost per GP consultation avoided = 2000 pound sterling; (2) incremental NHS cost per hospital admission avoided = 61,000 pound sterling; (3) incremental NHS cost per death avoided = 1,900,000 pound sterling and (4) incremental NHS cost per QALY gained = 304,000 pound sterling. The analysis suggested that influenza vaccination in this population would not be cost effective.

Can a short period of micronutrient supplementation in older institutionalized people improve response to influenza vaccine? A randomized, controlled trial.

OBJECTIVES: To test the hypothesis that a micronutrient supplement can improve seroconversion after influenza immunization in older institutionalized people. DESIGN: : Randomized, double-blind, placebo-controlled study. SETTING: Nursing and residential homes in Liverpool, United Kingdom. PARTICIPANTS: One hundred sixty-four residents aged 60 and older from 31 homes were initially randomized; of these, 119 (72.6%) completed the study. INTERVENTION: Participants were randomized to receive a micronutrient supplement providing the reference nutrient intake for all vitamins and trace elements or identical placebo. Tablets were taken over an 8-week period during September and October 2000; influenza vaccine was administered 4 weeks after their commencement. MEASUREMENTS: The hemagglutination-inhibiting antibody response as defined by a fourfold or greater titer rise over 4 weeks and assessed separately for each of the three antigens contained in the 2000/2001 influenza vaccine (A/New Caledonia/20/99 (H1N1), A/Moscow/10/99 (H3N2), B/Beijing/184/93 (B)). RESULTS: Despite a significant increase in serum concentrations of vitamins A, C, D3, E, folate, and selenium in the supplemented group, there was no significant difference between groups (supplemented vs placebo, respectively) in the proportion of participants seroconverting to H1N1 (41% vs 49%, P=.374), H3N2 (49% vs 58%, P=.343), or B (41% vs 40%, P=.944). CONCLUSION: A micronutrient supplement providing the reference nutrient intake administered over 8 weeks had no beneficial effect on antibody response to influenza vaccine in older people living in long-term care.

Difficulties of recruitment for a randomized controlled trial involving influenza vaccination in healthy older people.

BACKGROUND: In a randomized controlled trial to determine the cost benefits of influenza vaccination in fit healthy individuals aged 65-74 years, recruiting individuals to the study was more difficult than anticipated. OBJECTIVES: To investigate reasons for poor recruitment. MATERIALS AND METHODS: 6,058 people were initially identified as eligible for the study but only 729 (12%) were subsequently randomized. Individuals (n = 2,583) who returned cards indicating that they did not wish to participate were sent a postal questionnaire asking for reasons why they felt unable to consent for the study. RESULTS: 1,173/2,583 (45.4%) questionnaires were returned. A total of 2,621 reasons were given for nonparticipation, i.e. a mean of 2.2 reasons per questionnaire returned. Reasons given for noninvolvement were: reluctance to participate in a research project (53%); concerned about side effects (34%); self-perceived view of not requiring influenza vaccination (31.7%); preference for own doctor to give the vaccine (29.1%); objection to name "Geriatric Medicine" on the letter of invitation (25.2%); already been vaccinated (17.3%); illness requiring vaccination out of the study (13.8%); previous bad reaction to the vaccine (6.4%); unable to attend on day of vaccination (4.3%); unable to get to general practice surgery (4%); already involved in a clinical trial (2.5%); fear of needles/dislike of injections (1.6%); doubts about vaccine efficacy (0.3%); egg allergy (0.2%). CONCLUSION: Inaccurate beliefs about influenza vaccination persist across a wide section of the community. Efforts should be made by all health professionals to correct these false beliefs and ensure that those at risk can be easily recognized and targeted for vaccination.