title: Interventions to increase seasonal influenza vaccine coverage in healthcare workers: A systematic review and meta-regression analysis.
abstract: Influenza vaccination is recommended for healthcare workers (HCWs), but coverage is often low. We reviewed studies evaluating interventions to increase seasonal influenza vaccination coverage in HCWs, including a meta-regression analysis to quantify the effect of each component. Fourty-six eligible studies were identified. Domains conferring a high risk of bias were identified in most studies. Mandatory vaccination was the most effective intervention component (Risk Ratio of being unvaccinated [RRunvacc] = 0.18, 95% CI: 0.08-0.45), followed by "soft" mandates such as declination statements (RRunvacc = 0.64, 95% CI: 0.45-0.92), increased awareness (RRunvacc = 0.83, 95% CI: 0.71-0.97) and increased access (RRunvacc = 0.88, 95% CI: 0.78-1.00). For incentives the difference was not significant, while for education no effect was observed. Heterogeneity was substantial (τ(2) = 0.083). These results indicate that effective alternatives to mandatory HCWs influenza vaccination do exist, and need to be further explored in future studies.
authors.affiliation: a Department of Epidemiological Surveillance and Intervention , Hellenic Centre for Disease Control and Prevention , Athens , Greece.|b Centre for Research in Environmental Epidemiology (CREAL) , Barcelona , Spain.|c Department of Experimental and Health Sciences , Universitat Pompeu Fabra (UPF) , Barcelona , Spain.
authors.forename: Theodore
authors.initials: T
authors.lastname: Lytras
authors.affiliation: d Department of Occupational and Industrial Hygiene , National School of Public Health , Athens , Greece.
authors.forename: Frixos
authors.initials: F
authors.lastname: Kopsachilis
authors.affiliation: a Department of Epidemiological Surveillance and Intervention , Hellenic Centre for Disease Control and Prevention , Athens , Greece.
authors.forename: Elisavet
authors.initials: E
authors.lastname: Mouratidou
authors.affiliation: e Department of Child Health , National School of Public Health , Athens , Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Papamichail
authors.affiliation: f Humanitas Clinical and Research Center , Rozzano , Milan , Italy.
authors.forename: Stefanos
authors.initials: S
authors.lastname: Bonovas
mesh_terms: D001521:Behavior Therapy / Q000379:methods*; D006282:Health Personnel; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000276:immunology; D007251:Influenza, Human / Q000517:prevention & control*; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines
keywords: epidemiology; healthcare; healthcare workers; influenza; influenza vaccine; meta-analysis; meta-regression; systematic review; vaccination; vaccine coverage