title: Healthcare workers and H1N1 vaccination: does having a chronic disease make a difference?
abstract: BACKGROUND
  A novel H1N1 vaccine was manufactured in response to the pandemic in 2009. This study describes the willingness to be vaccinated for H1N1 among healthcare workers (HCWs) in primary healthcare clinics with and without chronic medical conditions, their reasons for refusing vaccination and whether they sought additional information to make an informed decision for the vaccination.
  
  
  METHODS
  An anonymous survey was conducted in November 2009 among all medical, nursing, allied health and operations HCWs in nine primary care clinics in Singapore. Participants were asked if they had any chronic medical conditions associated with influenza-related complications (example: asthma, stroke, heart disease, cancer, diabetes mellitus, renal disease), their perception towards vaccination for H1N1 and against seasonal influenza within the preceding 2 years.
  
  
  RESULTS
  The initial response rate was 80%, of which 711 (54.7%) of the completed surveys were analysed. Among the 711 respondents, 16.6% reported having at least 1 chronic disease. Asthma (10.8%), hypertension (10.4%) and dyslipidaemia (9.8%) were the main chronic conditions. Only 39.4% of respondents were willing to be vaccinated against H1N1. Males were 2.07 (95% CI 1.19-3.62) times more likely than females to receive the H1N1 vaccination; the 45-54 and 55+ years old were 2.12 (95% CI 1.06-4.24) and 2.44 (95% CI 1.13-5.27) times more willing than those below 25 years old; and those who considered accepting the seasonal influenza vaccine were 7.0 times more likely than those who did not (95%CI 4.48-10.92). The 2 principal barriers were "fear of side effects" and "unsure of vaccine's effectiveness". Although 78% attended some H1N1-related talks, only 7% of all HCWs felt that they had sufficient information. Most wanted more information about the vaccine's safety profile and contraindications.
  
  
  CONCLUSIONS
  Fewer than 40% of HCWs expressed willingness to receive the H1N1 vaccination, lower than past rates of influenza vaccine. HCWs in primary care clinics who had a chronic condition did not perceive themselves to be at higher risk of developing H1N1-related complications and were not more willing than the rest of the HCWs to accept H1N1 vaccination. Vaccine's side effects and effectiveness were the main concerns. Uptake of H1N1 vaccine may improve with targeted health information covering the vaccine's safety profile.
authors.affiliation: Information Management, Corporate Development, National Healthcare Group, 6 Commonwealth Lane, #04-01/02 GMTI Building, Singapore 149547. matthias_toh@nhg.com.sg
authors.forename: Matthias Paul Han Sim
authors.initials: MP
authors.lastname: Toh
authors.forename: Predeebha
authors.initials: P
authors.lastname: Kannan
authors.forename: Yongchang
authors.initials: Y
authors.lastname: Chen
authors.forename: Florence Liong Cheu
authors.initials: FL
authors.lastname: Chng
authors.forename: Wern Ee
authors.initials: WE
authors.lastname: Tang
mesh_terms: D000328:Adult; D002908:Chronic Disease / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology*; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000276:immunology*; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D012846:Singapore; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines