Sustained low influenza vaccination in health care workers after H1N1 pandemic: a cross sectional study in an Italian health care setting for at-risk patients.
BACKGROUND
Despite consistent recommendations by all Public Health Authorities in support of annual influenza vaccination for at-risk categories, there is still a low uptake of influenza vaccine in these groups including health care workers (HCWs). Aim of this observational two-phase study was to estimate the immunization rates for influenza in four subsequent seasons and for pandemic H1N1 influenza in HCWs of a University Hospital, and to investigate its distribution pattern and the main determinants of immunization. Phase 1 data collection was performed in 2009-2010, during the peak of H1N1 pandemic. Phase 2 data collection, aimed to investigate seasonal influenza vaccination coverage in the three seasons after pandemic, was performed in 2012-2013.


METHODS
The overall H1N1 vaccination rate was derived by the Hospital immunization registry. In 2010, the personnel of three Departments (Infectious Diseases, Pediatrics and Gynecology/Obstetrics) completed a survey on influenza. A second-phase analysis was performed in 2012 to investigate influenza vaccination coverage in three consecutive seasons.


RESULTS
The first-phase survey showed a low coverage for influenza in all categories (17 %), with the lowest rate in nurses (8.1 %). A total of 37 % of health care workers received H1N1 vaccine, with the highest rate among physicians and the lowest in nurses. H1N1 vaccination was closely related to the Department, being higher in the Department of Infectious Diseases (53.7 %) and Pediatrics (42.4 %) than in Gynecology/Obstetrics (8.3 %). The second-phase survey showed the lowest rate of influenza vaccination in 2012/13 season. The main reasons for not being vaccinated were "Unsure of the efficacy of vaccine" and "Feel not at-risk of getting influenza or its complications". Despite recommendations, influenza vaccine uptake remains poor.


CONCLUSIONS
Immunization is largely perceived as a personal protection rather than a measure needed to prevent disease spreading to at-risk patients. Compulsory vaccination against influenza should be considered as a possible strategy, at least in health institutions where at-risk patients are admitted.
Medicine and Health Sciences Department, University of Molise, Campobasso, Italy. antogianna@libero.it.|Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Via S. Pansini, Naples, 80100, Italy. antogianna@libero.it.
Antonietta
A
Giannattasio
Medicine and Health Sciences Department, University of Molise, Campobasso, Italy. miriam_86@hotmail.it.
Miriam
M
Mariano
Medicine and Health Sciences Department, University of Molise, Campobasso, Italy. berto.ro@live.it.
Roberto
R
Romano
Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Via S. Pansini, Naples, 80100, Italy. fabriziachiatto@gmail.com.
Fabrizia
F
Chiatto
Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Via S. Pansini, Naples, 80100, Italy. ilarialiguoro@gmail.com.
Ilaria
I
Liguoro
Clinical Medicine and Surgery Department, University of Naples Federico II, Naples, Italy. borgia@unina.it.
Guglielmo
G
Borgia
Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Via S. Pansini, Naples, 80100, Italy. alfguari@unina.it.
Alfredo
A
Guarino
Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Via S. Pansini, Naples, 80100, Italy. andrealovecchio@gmail.com.
Andrea
A
Lo Vecchio
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology*; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012042:Registries; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
D007252:Influenza Vaccines