Knowledge, attitudes, and practices of seasonal influenza vaccination in healthcare workers, Honduras.

BACKGROUND: Seasonal influenza is a highly contagious vaccine-preventable disease that may cause high morbidity and mortality in susceptible populations. Healthcare workers are a priority group for seasonal influenza vaccination to protect them from contracting influenza and prevent nosocomial transmission to patients. This study aimed to evaluate knowledge, attitudes, and practices (KAP) of seasonal influenza vaccination among healthcare workers in Honduras. METHOD: From August 24 to October 21, 2018, we conducted a cross-sectional KAP survey regarding seasonal influenza vaccination to a random sample of healthcare workers who attended patients in hospitals of the Ministry of Health of Honduras (SESAL) and Honduran Social Security Institute (IHSS). We reported frequency distributions of demographics, vaccination KAP, sources of information, and reasons for non-vaccination. We used principal components factor analysis to create knowledge and attitude scores. We used linear regression to analyze associations between demographics and sources of information about the influenza vaccine, and knowledge and attitude scores. We used logistic regression to analyze associations between demographics, sources of information, knowledge scores, and attitude scores, and influenza vaccination. RESULT: We surveyed 947 healthcare workers who attended patients in 13 SESAL hospitals and two IHSS hospitals. Only 4.6% of participants knew the seasonal influenza vaccine was composed of inactivated viruses, 94.7% believed vaccination causes flu-like symptoms, and 52.0% were vaccinated for influenza in 2018. Knowledge scores were lower for nursing assistants and other healthcare professionals compared to doctors, and higher for healthcare workers who attended a healthcare facility training (P-values≤0.030). Attitude scores were higher for healthcare workers who attended ≥11 patients per day having ≤10 patients per day as reference, self-reported influenza vaccination in previous year, and cited trainings and informal information at the healthcare facility as sources of information for influenza vaccination (P-values≤0.030). Factors associated with self-reported vaccination were self-reported influenza vaccination in previous year (aOR: 7.61; 95% CI: 5.24-11.04), attitude score (aOR: 1.14; 95% CI: 1.07-1.21), and worked in a SESAL hospital (aOR: 1.73; 95% CI: 1.12-2.68) having IHSS as reference. CONCLUSION: Although influenza vaccination is required by law in Honduras and available for free in public health centers, coverage of healthcare workers in 2018 was half that reported in 2017. Lower coverage may be attributed to misconceptions of vaccination side effects.

Knowledge, attitudes, and practices of seasonal influenza vaccination among older adults in nursing homes and daycare centers, Honduras.

BACKGROUND: Older adults represent 70-90% of seasonal influenza-related deaths and 50-70% of influenza-related hospitalizations. Vaccination is the most efficient means of preventing influenza and reducing influenza-related illnesses. We aimed to describe knowledge, attitudes, and practices (KAP) of seasonal influenza vaccination among older adults in Honduras. METHODS: From August 29-October 26, 2018, we conducted a cross-sectional KAP survey regarding seasonal influenza vaccinations to samples of older adults 1) admitted to nursing homes and 2) attending daycare centers. We used the Minimental State Examination (MMSE) psychometric tool to assess the cognitive status of older adults and included participants with scores of ≥23 points in the survey. We reported frequency distributions for demographics, KAP of influenza virus and vaccination, and vaccination coverage. We used logistic regression to analyze associations between demographics and verified influenza vaccination. RESULTS: Of 511 MMSE participants, 341 completed the survey (95 adults in 12 nursing homes and 246 older adults in ten daycare centers). Almost all participants knew that influenza causes severe illness and may be transmitted from person to person, vaccination is safe and protects against disease, and older adults have greater risk of complications. Of 284 participants with verified vaccinations, 81.3% were vaccinated for influenza: 87.9% attending daycare centers and 61.4% in nursing homes. Among all participants, verified current influenza vaccination was associated with self-reported influenza vaccination in previous year (aOR: 14.05; 95% CI: 5.36-36.81); no formal education (aOR: 4.83; 95% CI: 1.63-14.37) or primary school education (aOR: 4.51; 95% CI: 1.79-11.37) having ≥secondary as reference; and indigenous (aOR: 4.55; 95% CI: 1.18-17.49) having Mestizo as reference. Reasons for vaccination were perceived self-benefits, protection against influenza complications, favorable vaccination hours, and healthcare provider recommendations. CONCLUSION: Four-fifths of older adults were vaccinated for seasonal influenza. Educational efforts provided in conjunction with vaccination campaigns resulted in high knowledge of influenza virus, transmission, and vaccination. Further outreach regarding disease risks and vaccine safety needs to be directed towards older adults in nursing homes who had lower knowledge and coverage than older adults in daycare centers.

Knowledge, attitudes, and practices of seasonal influenza vaccination in postpartum women, Honduras.

BACKGROUND: Influenza during pregnancy may cause serious neonatal outcomes including stillbirth, fetal distress, preterm birth, congenital abnormalities, and stunted growth. Pregnant women are the highest priority group for seasonal influenza vaccination, but low coverage has been repeatedly reported in this population. Understanding reasons for and for not receiving the seasonal influenza vaccine is needed to design communication strategies to increase vaccination coverage. This study aimed to describe knowledge, attitudes, and practices (KAP) of seasonal influenza vaccination among women giving birth in public maternity hospitals in Honduras. METHODS: From August 20-October 8, 2018, we conducted a cross-sectional KAP survey regarding seasonal influenza vaccinations to a sample of postpartum women who gave birth in maternity hospitals and clinics from the Ministry of Health of Honduras and Honduran Social Security Institute. We reported frequency distributions for demographics, KAP of influenza vaccine, and vaccination coverage. We used logistic regression to analyze unadjusted and adjusted associations between sociodemographic characteristics and influenza vaccination. RESULTS: We surveyed 842 postpartum women in 17 healthcare facilities. Of 534 postpartum women with term pregnancy and verified vaccinations, 417 (78.1%; 95% CI: 74.6-81.6%) were vaccinated for influenza. Factors associated with verified influenza vaccination included receipt of vaccination recommendations by a healthcare worker during prenatal check-ups (aOR: 16.46; 95% CI: 9.73-27.85), concurrent chronic disease (aOR: 5.00; 95% CI: 1.25-20.07), and influenza vaccination of other children in the household (aOR: 2.28; 95% CI: 1.19-4.39). The most cited reasons for vaccination were perceived benefits for both mother and infant and easy access. Reasons for non-vaccination were: vaccine was not offered and fear of side effects, harm to the infant, and needles or pain caused by injection. CONCLUSION: Influenza vaccination was well received among postpartum women in Honduras. Increasing clinician recommendations for vaccination and assuring the vaccine is readily available to women during prenatal visits may increase vaccination rates.

Pilot to evaluate the feasibility of measuring seasonal influenza vaccine effectiveness using surveillance platforms in Central-America, 2012.

BACKGROUND: Since 2004, the uptake of seasonal influenza vaccines in Latin America and the Caribbean has markedly increased. However, vaccine effectiveness (VE) is not routinely measured in the region. We assessed the feasibility of using routine surveillance data collected by sentinel hospitals to estimate influenza VE during 2012 against laboratory-confirmed influenza hospitalizations in Costa-Rica, El Salvador, Honduras and Panama. We explored the completeness of variables needed for VE estimation. METHODS: We conducted the pilot case-control study at 23 severe acute respiratory infections (SARI) surveillance hospitals. Participant inclusion criteria included children 6 months-11 years and adults ≥60 years targeted for vaccination and hospitalized for SARI during January-December 2012. We abstracted information needed to estimate target group specific VE (i.e., date of illness onset and specimen collection, preexisting medical conditions, 2012 and 2011 vaccination status and date, and pneumococcal vaccination status for children and adults) from SARI case-reports and for children ≤9 years, inquired about the number of annual vaccine doses given. A case was defined as an influenza virus positive by RT-PCR in a person with SARI, while controls were RT-PCR negative. We recruited 3 controls per case from the same age group and month of onset of symptoms. RESULTS: We identified 1,186 SARI case-patients (342 influenza cases; 849 influenza-negative controls), of which 994 (84 %) had all the information on key variables sought. In 893 (75 %) SARI case-patients, the vaccination status field was missing in the SARI case-report forms and had to be completed using national vaccination registers (36 %), vaccination cards (30 %), or other sources (34 %). After applying exclusion criteria for VE analyses, 541 (46 %) SARI case-patients with variables necessary for the group-specific VE analyses were selected (87 cases, 236 controls among children; 64 cases, 154 controls among older adults) and were insufficient to provide precise regional estimates (39 % for children and 25 % for adults of minimum sample size needed). CONCLUSIONS: Sentinel surveillance networks in middle income countries, such as some Latin American and Caribbean countries, could provide a simple and timely platform to estimate regional influenza VE annually provided SARI forms collect all necessary information.

Congenital rubella syndrome surveillance in Honduras.

INTRODUCTION: Congenital rubella syndrome (CRS) surveillance was established in Honduras to determine the scope of the problem and assess the impact of vaccination. METHODS: Implementation of the surveillance system required the drafting of national CRS epidemiological surveillance guidelines, the development of a laboratory diagnostic method, and training of physicians, nurses, and microbiologists in the Honduran hospital network and social security system on CRS surveillance guidelines. RESULTS: Honduras' experience with the surveillance of other vaccine-preventable diseases facilitated the implementation of hospital-based CRS surveillance. The surveillance system operates in 23 of the 25 public hospitals that offer services to children and at 2 social security hospitals; the private sector has not been integrated into this system. Clinical and technical staff, including representatives from various disciplines such as pediatrics, neonatology, general medicine, epidemiology, nursing, and microbiology, participate in the hospital network, as well as follow up on cases in accordance with the standardized guidelines, depending on their areas of expertise. CONCLUSIONS: Implementation of the CRS surveillance system requires technical guidelines, laboratory diagnostic capacity, and trained multidisciplinary human resources for its systematization and operation.

Burden of diarrhea among children in Honduras, 2000-2004: estimates of the role of rotavirus

OBJECTIVES: To estimate the annual burden of diarrhea and of diarrhea that is associated with rotavirus (RV) in children who are treated at public clinics and hospitals in Honduras. METHODS: Data were collected from computerized records of all children < 5 years old treated for diarrhea at clinics and hospitals operated by the Secretary of Health for the period of 2000 through 2004. A review of studies of RV in Honduras and neighboring countries provided estimates of detection rates of RV among children treated for acute diarrhea as outpatients or as inpatients. From these data, we estimated the annual number of cases of diarrhea and of rotavirus-related diarrhea in Honduras, the cumulative incidence of diarrhea and of rotavirus-related diarrhea for a child from birth to age 5 years, and the number of fatalities due to RV among children hospitalized for diarrhea. RESULTS: From 2000 through 2004, a mean of 222 000 clinic visits, 4 390 hospitalizations, and 162 in-hospital deaths due to diarrhea were recorded annually among children < 5 years of age in the public health facilities in Honduras. From our review of scientific literature on Honduras and neighboring countries, an estimated 30 percent of outpatients and 43 percent of inpatients who were treated for diarrhea would be expected to have RV. Consequently, we estimated that 66 600 outpatient visits, 1 888 hospitalizations, and 70 in-hospital deaths among children < 5 years in Honduras could be attributed to RV each year. Therefore, a child in the first five years of life has a respective risk for consultation, hospitalization, and in-hospital death of 1:1, 1:46, and 1:1 235 for diarrhea. For an episode associated with RV, the respective risks are 1:3, 1:106, and 1:2 857. These values likely underestimate the true burden of diarrhea in Honduras, since some 51 percent of children with acute diarrhea do not receive formal care for the illness, 70 percent do not receive oral rehydration...

OBJETIVOS: Estimar la carga anual por diarrea y por diarrea asociada con la infección por rotavirus (RV) en niños atendidos en clínicas y hospitales públicos de Honduras. MÉTODOS: Los datos se obtuvieron a partir de los registros computarizados de todos los niños menores de 5 años atendidos por diarrea en clínicas y hospitales operados por la Secretaría de Salud de Honduras durante el período 2000-2004. Una revisión de los estudios realizados sobre RV en Honduras y los países vecinos ofreció estimados de las tasas de detección de RV en niños tratados por diarrea aguda hospitalizados o de forma ambulatoria. Con estos datos se estimó el número anual de casos de diarrea y de diarrea asociada con la infección por RV en Honduras, la incidencia acumulativa de diarrea y de diarrea asociada con la infección por RV en niños menores de 5 años y el número de muertes debido a RV en niños hospitalizados por diarrea. RESULTADOS: Entre los años 2000 y 2004 se registraron medias anuales de 222 000 visitas médicas, 4 390 hospitalizaciones y 162 muertes hospitalarias por diarrea en niños menores de 5 años en instalaciones sanitarias públicas de Honduras. A partir de la revisión de la literatura científica relativa a Honduras y los países vecinos se estimó que 30 por ciento de los casos de diarrea atendidos ambulatoriamente y 43 por ciento de los hospitalizados podrían deberse a RV. En consecuencia, se estimó que 66 600 visitas médicas ambulatorias, 1 888 hospitalizaciones y 70 muertes hospitalarias de niños menores de 5 años pueden atribuirse a la infección por RV anualmente en Honduras. Por lo tanto, los riesgos de un niño en sus primeros 5 años de vida de asistir a una consulta, de ser hospitalizado y de morir en un hospital por diarrea son de 1:1, 1:46 y 1:1 235, respectivamente. Los riesgos asociados con la infección por RV son de 1:3, 1:106 y 1:2 857, respectivamente. Posiblemente, estos valores subestiman la carga real por diarrea en Honduras, ya...

Burden of diarrhea among children in Honduras, 2000-2004: estimates of the role of rotavirus.

OBJECTIVES: To estimate the annual burden of diarrhea and of diarrhea that is associated with rotavirus (RV) in children who are treated at public clinics and hospitals in Honduras. METHODS: Data were collected from computerized records of all children < 5 years old treated for diarrhea at clinics and hospitals operated by the Secretary of Health for the period of 2000 through 2004. A review of studies of RV in Honduras and neighboring countries provided estimates of detection rates of RV among children treated for acute diarrhea as outpatients or as inpatients. From these data, we estimated the annual number of cases of diarrhea and of rotavirus-related diarrhea in Honduras, the cumulative incidence of diarrhea and of rotavirus-related diarrhea for a child from birth to age 5 years, and the number of fatalities due to RV among children hospitalized for diarrhea. RESULTS: From 2000 through 2004, a mean of 222,000 clinic visits, 4,390 hospitalizations, and 162 in-hospital deaths due to diarrhea were recorded annually among children < 5 years of age in the public health facilities in Honduras. From our review of scientific literature on Honduras and neighboring countries, an estimated 30% of outpatients and 43% of inpatients who were treated for diarrhea would be expected to have RV. Consequently, we estimated that 66,600 outpatient visits, 1,888 hospitalizations, and 70 in-hospital deaths among children < 5 years in Honduras could be attributed to RV each year. Therefore, a child in the first five years of life has a respective risk for consultation, hospitalization, and in-hospital death of 1:1, 1:46, and 1:1,235 for diarrhea. For an episode associated with RV, the respective risks are 1:3, 1:106, and 1:2,857. These values likely underestimate the true burden of diarrhea in Honduras, since some 51% of children with acute diarrhea do not receive formal care for the illness, 70% do not receive oral rehydration solution, and 80% of diarrheal deaths occur outside of hospitals. CONCLUSIONS: Diarrhea is a major cause of illness among children < 5 years old in Honduras, and RV is likely the most common cause. Our preliminary estimates need to be refined so that health planners in Honduras can make decisions on the future use of rotavirus vaccines. A program of hospital-based surveillance for rotavirus in Honduras has been established to address this need.