Background Vaccination adherence among healthcare workers (HCWs) is fundamental for the prevention of vaccine-preventable diseases (VPDs) in healthcare. This safeguards HCWs' well-being, prevents transmission of infections to vulnerable patients and contributes to public health. Aim This systematic review and meta-analysis aimed to describe interventions meant to increase HCWs’ adherence to vaccination and estimate the effectiveness of these interventions. Methods We searched literature in eight databases and performed manual searches in relevant journals and the reference lists of retrieved articles. The study population included any HCW with potential occupational exposure to VPDs. We included experimental and quasi-experimental studies presenting interventions aimed at increasing HCWs’ adherence to vaccination against VPDs. The post-intervention vaccination adherence rate was set as the main outcome. We included the effect of interventions in the random-effects and subgroup meta-analyses. Results The systematic review considered 48 studies on influenza and Tdap vaccination from database and manual searches, and 43 were meta-analysed. A statistically significant, positive effect was seen in multi-component interventions in randomised controlled trials (relative risk (RR) = 1.37; 95% CI: 1.13–1.66) and in observational studies (RR = 1.43; 95% CI: 1.29–1.58). Vaccination adherence rate was higher in community care facilities (RR = 1.58; 95% CI: 1.49–1.68) than in hospitals (RR = 1.24; 95% CI: 0.76-2.05). Conclusion Interventions aimed at increasing HCWs’ adherence to vaccination against VPDs are effective, especially multi-component ones. Future research should determine the most effective framework of interventions for each setting, using appropriate study design for their evaluation, and should compare intervention components to understand their contribution to the effectiveness.

ABSTRACT Healthcare workers (HCWs) are among the at-risk groups for whom influenza vaccination is strongly recommended. To assess the proportion of Italian HCWs with positive attitudes toward influenza vaccination, we conducted a systematic review of relevant literature and a meta-analysis. Our focus was on the influenza seasons from 2017/18 to 2021/22. The prevalence of favorable attitudes toward vaccination varied, ranging from 12% during the 2017/18 influenza season to 59% in the 2020/21 season. The significant increase in the 2020/21 season can be attributed to adaptations necessitated by the COVID-19 pandemic. During the 2021/22 influenza season, there was a decline in vaccination coverage (37%), likely due to the absence of a robust preventive culture. Various strategies have been employed to enhance HCWs’ attitudes to achieve higher vaccination rates, but none of them have demonstrated satisfactory results. Policymakers should consider implementing a policy of mandatory vaccination to ensure elevated vaccination coverage among HCWs.

Abstract Background Influenza affects approximately between 5 to 10% of general population every year, leading to 3 to 5 million cases of severe illness, and about 290 000 to 650 000 respiratory deaths. Healthcare Workers (HCWs) play a crucial role in spreading the infection to patients. Although the strong recommendations provided, influenza vaccination coverage rates among HCWs are globally well below the coverage target set by WHO. The aim of this study is to assess attitudes towards mandatory influenza vaccination programs among HCWs, in order to make a quantitative synthesis of the phenomenon. Methods The present study systematically reviewed published cross-sectional studies investigating attitudes towards compulsory influenza vaccination in Healthcare Workers. PubMed and Scopus scientific databases were searched and 4,198 results were returned. Of these, 23 met the inclusion criteria for the review and 13 were eligible for the meta-analyses. PRISMA statements were followed. Results Thirteen studies were conducted in North America, 4 were conducted in Europe, 3 in Asia, 2 were performed in Australia and one study collected data both from Europe and Asia. According to the assessed studies, the percentage of agreement ranged from 44% to 95% for different compulsory vaccination programs. A combined prevalence of 59.8% (95%CI 50.1-68.8) was found in the meta-analysis. Having been vaccinated against influenza in the previous year increases the likelihood (OR 4.1; 95%CI 2.8-6.1) of being in favour of mandatory vaccination policies. Conclusions Compulsory influenza vaccination programs are generally accepted by the majority of health professionals, especially by those who have already been vaccinated previously. These results could be important to improve European vaccination strategies, in order to increase influenza vaccination rates among Healthcare Workers. Key messages Mandatory influenza vaccination programs are accepted by the majority of Healthcare Workers. Having been previously vaccinated against influenza increases the likelihood of being in favor of a mandatory vaccination policy.

Background: Influenza vaccination is a commonly used intervention to prevent influenza infection in healthcare workers (HCWs) and onward transmission to other staff and patients. We undertook a systematic review to synthesize the latest evidence of the direct epidemiological and economic effectiveness of seasonal influenza vaccination among HCW. Methods: We conducted a systematic search of MEDLINE/PubMed, Scopus, and Cochrane Central Register of Controlled Trials from 1980 through January 2018. All studies comparing vaccinated and non-vaccinated (i.e. placebo or non-intervention) groups of HCW PLoS One PLoS ONE 440 plosone plos PLoS ONE 1932-6203 PLOS PMC5991711 PMC5991711.1 5991711 5991711 29879206 10.1371/journal.pone.0198685 PONE-D-17-37277 1 Research Article Medicine and Health Sciences Infectious Diseases Viral Diseases Influenza Medicine and Health Sciences Infectious Diseases Infectious Disease Control Vaccines Biology and Life Sciences Immunology Vaccination and Immunization Medicine and Health Sciences Immunology Vaccination and Immunization Medicine and Health Sciences Public and Occupational Health Preventive Medicine Vaccination and Immunization Research and Analysis Methods Research Design Observational Studies Social Sciences Economics Health Economics Medicine and Health Sciences Health Care Health Economics Research and Analysis Methods Research Assessment Systematic Reviews Social Sciences Economics Labor Economics Research and Analysis Methods Mathematical and Statistical Techniques Statistical Methods Meta-Analysis Physical Sciences Mathematics Statistics (Mathematics) Statistical Methods Meta-Analysis A systematic review and meta-analysis of the direct epidemiological and economic effects of seasonal influenza vaccination on healthcare workers Direct epidemiological and economic effects of seasonal influenza vaccination of healthcare workers http://orcid.org/0000-0002-0080-1487 Imai Chisato Data curation Formal analysis Investigation Methodology Project administration Visualization Writing – original draft Writing – review & editing 1 2 * Toizumi Michiko Data curation Investigation Writing – review & editing 2 Hall Lisa Supervision Writing – review & editing 3 4 Lambert Stephen Supervision Validation Writing – review & editing 5 Halton Kate Writing – review & editing 4 Merollini Katharina Funding acquisition Investigation Supervision Validation Writing – review & editing 6 1 Centre for Background Influenza vaccination is a commonly used intervention to prevent influenza infection in healthcare workers (HCWs) and onward transmission to other staff and patients. We undertook a systematic review to synthesize the latest evidence of the direct epidemiological and economic effectiveness of seasonal influenza vaccination among HCW. Methods We conducted a systematic search of MEDLINE/PubMed, Scopus, and Cochrane Central Register of Controlled Trials from 1980 through January 2018. All studies comparing vaccinated and non-vaccinated (i.e. placebo or non-intervention) groups of HCWs were included. Seasonal influenza vaccination of HCWs is a pivotal measure for prevention and control efforts in healthcare settings. International guidelines stress the significance of this approach with recommendations of organizational strategies to immunize HCW annually [ 7 , 8 ]. However, the challenge in maintaining high vaccination coverage of HCW has been marked by unfavorably low compliance rates [ 9 , 10 ], and limited improvement by voluntary motivations through incentives and provision of free vaccine [ 11 , 12 ]. The use of mandatory or regulatory policy has consequently gained popularity and has been implemented in organizations based on the premise of indirect patient benefits [ 13 , 14 ], while the evidence for this as a primary driver for HCW programs remains contentious [ 15 ]. Given the uncertainty in attributions of patient benefits to HCW vaccination, having strong evidence of the direct effectiveness of vaccination on healthcare workers and the cost-effectiveness of these campaigns in reducing the incidence of illness and absenteeism among HCW is important. HCW—our study population—were defined as employees in any healthcare facilities who could be exposed to patients directly or indirectly. This included both clinical staff (e.g. doctors, nurses, allied health professionals) and administrative officers. The intervention of interest was seasonal influenza vaccination, which is generally administered prior to the expected epidemic season. Vaccines, live attenuated or inactivated virus, by any route were considered. Studies that focused on non-seasonal influenza or specifically with monovalent A(H1N1)pdm09 vaccines that were produced as a response to the 2009 global influenza pandemic were excluded. The general cost analyses in the included studies estimated the expenses of influenza vaccination to hospital or healthcare organizations from the employers’ perspective. Consequently, no consideration was given to “out-of-pocket” costs for HCWs, such as costs of doctor visits and medicines to treat influenza or ILI symptoms. In all cost analyses, avoided hours of sick leave among vaccinated HCWs were considered as beneficial and cost-saving which overweighed the cost of program implementation. There was, however, variability in the type of cost input parameters included for analyses across reviewed studies, which makes comparisons difficult. The results of the cost evaluations in the reviewed articles were also not sufficient to determine whether HCW vaccination is indeed cost-effective in a given healthcare setting. In general, the inclusions of both cost and health outcomes are essential properties in performing a cost-effectiveness analysis. However, the reviewed studies did not consider all relevant monetary and non-monetary outcomes relevant to influenza vaccination; for instance, adverse effects related to vaccinations and costs of medical treatments for sick HCWs.

Bearman Affiliation: Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina * Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine , CB 7595, Chapel Hill, NC 27514 Article Metrics Article contents Abstract References Get access Share Cite Rights & Permissions [Opens in a new window] Abstract Objective: To determine the attitudes, policies, and barriers for requiring annual versus voluntary influenza vaccinations for the staff of healthcare institutions in North Carolina. Methods: Five different types of institutions serving at-risk elderly populations throughout North Carolina were chosen for study, including hospitals, home health agencies, nursing homes, dialysis centers, and assisted living facilities. Infection control managers completed a 45-question telephone survey on policies for annual influenza vaccinations for employees, incentives to encourage immunizations, support for mandatory influenza vaccinations for workers, barriers to employee vaccinations, and support for a state law to mandate influenza immunizations for employees with patient care contact. Results: Of 312 institutions, 268 (86%) participated in the study. Only 38% of institutions reported having formal written employee influenza vaccination policies, and only 2% actually mandated annual employee vaccinations. Reported barriers to increasing healthcare worker annual influenza vaccinations included “fear of side effects” and “perceived ineffectiveness of the flu vaccine.” Almost half of the respondents would support mandating influenza vaccinations for all healthcare workers with direct patient contact. Conclusion: A state-wide survey of the receptivity, policies, and implications of mandated employee influenza vaccinations among healthcare institutions serving the elderly in North Carolina found written policies uncommon and most of the mechanisms used to increase vaccinations voluntary. Efforts should be tailored to individuals, institutions, and healthcare systems to dramatically increase employee immunization rates. Information Type Original Articles Information Infection Control & Hospital Epidemiology , Volume 25 , Issue 11 , November 2004 , pp. 2006. Point: Mandatory Influenza Vaccination for All Heath Care Workers? Seven Reasons to Say "No" . Clinical Infectious Diseases, Vol. 42, Issue. 8, p. 1141. CrossRef Google Scholar Backer, H. 2006. Counterpoint: In Favor of Mandatory Influenza Vaccine for All Health Care Workers . Clinical Infectious Diseases, Vol. 42, Issue. 8, p. 1144. CrossRef Google Scholar Rothan-Tondeur, Monique de Wazieres, Benoit Lejeune, Benoist and Gavazzi, Gaëtan 2006. Influenza vaccine coverage for healthcare workers in geriatric settings in France . Aging Clinical and Experimental Research, Vol. 18, Issue. 6, p. 512. CrossRef Google Scholar Yang, Kok-Soong Fong, Yuke-Tien Koh, David and Lim, Meng-Kin 2007. High Coverage of Influenza Vaccination Among Healthcare Workers Can Be Achieved During Heightened Awareness of Impending Threat . Annals of the Academy of Medicine, Singapore, Vol. 36, Issue. 6, p. 384. CrossRef Google Scholar Mallari, Joycelyn Goad, Jeffery Joanne, W.U. Johnson, Kathleen Forman, Todd and Neinstein, Lawrence 2007. Knowledge, attitudes, and practices regarding influenza vaccination among health professional students . Journal of the American Pharmacists Association, Vol. 47, Issue. 4, p. 498. CrossRef Google Scholar Lorick, Suchita A. Wortley, Pascale M. Lindley, Megan C. Bardenheier, Barbara H. and Euler, Gary L. 2008. U.S. Healthcare Personnel and Influenza Vaccination During the 2004–2005 Vaccine Shortage . American Journal of Preventive Medicine, Vol. 34, Issue. 6, p. 455. CrossRef Google Scholar McLennan, Stuart Gillett, Grant and Celi, Leo Anthony 2008. Healer, heal thyself: Health care workers and the influenza vaccination . American Journal of Infection Control, Vol. 36, Issue. 1, p. 1. CrossRef Google Scholar Weber, David J. and Rutala, William A. 2008. Vaccines . p. 1453. CrossRef Google Scholar Strasser, Patricia B. Sullivan, Shannon M. Álvarez Villalba, M. and del Cura González, M.I. 2009. Motivos de los trabajadores sanitarios de atención primaria para no vacunarse contra la gripe . Vacunas, Vol. 10, Issue. 2, p. 37. CrossRef Google Scholar Moore, Brenda S. and Strasser, Patricia B. 2009. Why Health Care Workers Decline Influenza Vaccination . AAOHN Journal,

requiring vaccinations before attending child care and schools also does so. There is also evidence that mandatory vaccination policies for healthcare workers A vaccination policy is a health policy adopted in order to prevent the spread of infectious disease. These policies are generally put into place by state or local governments, but may also be set by private facilities, such as workplaces or schools. Many policies have been developed and implemented since vaccines were first made widely available. The main purpose of implementing a vaccination pol Vaccination is unique among de facto mandatory requirements in the modern era, requiring individuals to accept the injection of medicine or medicinal agent into their bodies, and it has provoked a spirited opposition. This opposition began with the first vaccinations, has not ceased, and probably never will.…