title: Occupational vaccination of health care workers: uptake, attitudes and potential solutions.
abstract: OBJECTIVE
  Occupational vaccination of health care workers is strongly recommended to prevent health care associated transmission but coverage in general remains suboptimal. The aim of this survey was to: 1. Estimate levels vaccination coverage for annual flu and MMR vaccines among hospital-based health care workers; 2. Explore the reasons behind low vaccination rates; and 3. Identify potential practical and policy solutions.
  
  
  METHODS
  A cross-sectional study.
  
  
  METHODS
  An opportunistic survey was used to estimate MMR and flu vaccination coverage, and review attitudes and explore solutions. Staff from eight randomly selected wards, stratified by ward-level patient susceptibility, were invited to participate.
  
  
  RESULTS
  In total 133 staff responded, an approximate response rate of 68%. Seventy one percent had ever received an MMR and 42% had received the most recent flu vaccination. Actively declining vaccination was more common for flu than MMR (29% and 7% respectively). Side-effects, insufficient knowledge and vaccine ineffectiveness were popular justifications for declining flu vaccination but not MMR. Not seeing vaccination as a professional responsibility was associated with declining flu vaccination (P < 0.001). Improving vaccination coverage with booster vaccines for new staff and immunity testing received strong support from staff working with vulnerable groups (82% and 74% respectively); 70% of this staff group also supported compulsory vaccination.
  
  
  CONCLUSIONS
  Improving staff education may increase coverage. Clarification of the benefits of vaccination in specific staff groups may also improve uptake. Routine booster vaccinations and immunity testing were generally acceptable and compulsory vaccination of certain staff groups warrants further investigation.
authors.affiliation: Public Health Wales, Swansea, Wales, United Kingdom. Electronic address: kirsty.little@wales.nhs.uk.
authors.forename: K E
authors.initials: KE
authors.lastname: Little
authors.affiliation: Public Health Wales, Swansea, Wales, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Goodridge
authors.affiliation: Public Health Wales, Swansea, Wales, United Kingdom.
authors.forename: H
authors.initials: H
authors.lastname: Lewis
authors.affiliation: Public Health Wales, Swansea, Wales, United Kingdom.
authors.forename: S W
authors.initials: SW
authors.lastname: Lingard
authors.affiliation: Abertawe Bro Morgannwg University Health Board, Princess of Wales Hospital, Bridgend, Wales, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Din
authors.affiliation: Abertawe Bro Morgannwg University Health Board, Princess of Wales Hospital, Bridgend, Wales, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Tidley
authors.affiliation: Public Health Wales, Temple of Peace and Health, Cardiff, Wales, United Kingdom.
authors.forename: R J
authors.initials: RJ
authors.lastname: Roberts
authors.affiliation: Public Health Wales, Swansea, Wales, United Kingdom.
authors.forename: N S
authors.initials: NS
authors.lastname: Williams
authors.affiliation: Abertawe Bro Morgannwg University Health Board, Port Talbot, Wales, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Hayes
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D008297:Male; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage*; D008505:Medical Staff, Hospital / Q000523:psychology* / Q000706:statistics & numerical data; D008875:Middle Aged; D018570:Risk Assessment; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines; D022542:Measles-Mumps-Rubella Vaccine
keywords: Influenza; MMR; Occupational health; Policies; Vaccination