Flu vaccination still a challenge for hospitals

Apr 9, 2008 (CIDRAP News) – Healthcare institutions still face significant hurdles in getting their staff members vaccinated against seasonal influenza, and fear of flu infection and caring for sick family will keep many staff home during an influenza pandemic, according to research released this week,

Four teams of researchers reported at the 18th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America, held in Orlando, Fla., that large proportions of hospital staff believe that flu vaccine causes influenza or triggers other side effects. Others believe that previous bouts of flu have made them immune to contracting the flu again.

On average, only 40% of healthcare workers receive flu shots each year, according to the Centers for Disease Control and Prevention.

At Emory University School of Medicine and Emory Healthcare of Atlanta, intensive campaigns have raised flu vaccination coverage from 43% to 67% of the staff, but pockets of resistance remain, according to a report by Sarah E. Smithson and colleagues. An anonymous online survey of the academic medical center's 9,700 employees, which garnered responses from 1,994 workers or 21% of the staff, found that 50% of those who did not take the flu shot believe vaccination is a "personal decision," 31% did not take it for fear of side effects, and 20% had confidence in their own "natural immunity."

Concern about vaccine side effects was also common at Our Lady of Mercy Medical Center in the Bronx, NY, where the 40% of staff were vaccinated in 2007—more than three times the number who accepted the shot in 2003, according to Rajitha Ambuti, MD, and colleagues. "Declination forms" filled out by staff who refused the shot revealed that 53% feared adverse effects, 10% believed the vaccine does not work, and 9.6% believed they were at no risk for flu.

At the University of California–Irvine, where staff who decline vaccination are required to report electronically, researchers reviewed 1,160 refusals and also polled a convenience sample of 300 healthcare workers waiting to be vaccinated. The report by Kathleen A. Quan, RN, and others revealed a complex mix of attitudes toward the flu shot. A high proportion of those who agreed to be vaccinated—47%—believed it would cause flu symptoms, whereas only 29% of those who refused the vaccine shared that belief. And though 84% of those waiting for the shot had taken it in earlier years, only 61% said they intended to take it the following year, and 2% said they would be relieved if the vaccine supply ran out before they reached the end of the line.

Finally, at the University of South Alabama in Mobile, 50% of the staff responded to an anonymous 10-question survey on seasonal and pandemic flu that was distributed to all hospital employees on all shifts, and 49.6% of those responding  revealed that they do not receive flu vaccine.

Staff in that hospital also said they would have difficulty coming to work in a flu pandemic, said the report by William K. Green, MD. Only 13.7% of employees expected to report as usual. Among those who said they would not come to work, 13.9% said they were afraid of becoming sick, 30% said they could not come to work if someone else in their household were sick, and 48.1% said they would not be able to report if schools and daycare centers were closed as a protective measure.

Despite educational efforts by the hospital, 15.7% of the staff said they did not know what pandemic influenza was.

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