Human Vaccines & Immunotherapeutics

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Comprehensive efforts to increase healthcare personnel immunization Samuel B Graitcer, David Kim & Megan Lindley To cite this article: Samuel B Graitcer, David Kim & Megan Lindley (2014) Comprehensive efforts to increase healthcare personnel immunization, Human Vaccines & Immunotherapeutics, 10:9, 2625-2626, DOI: 10.4161/hv.36090 To link to this article: http://dx.doi.org/10.4161/hv.36090

Accepted author version posted online: 01 Nov 2014. Published online: 13 Nov 2014. Submit your article to this journal

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Date: 05 November 2015, At: 20:28

COMMENTARY Human Vaccines & Immunotherapeutics 10:9, 2625--2626; September 2014

Comprehensive efforts to increase healthcare personnel immunization Samuel B Graitcer*, David Kim, and Megan Lindley Immunization Services Division; National Center for Immunization and Respiratory Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA

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accination of healthcare personnel (HCP) is an important component of worker and patient safety, yet vaccination rates are lagging. The findings from Taddei et al.’s study of healthcare personnel immunization attitudes and practices in Florence, Italy provides further data of the importance of routine assessment of and recommendations for vaccines for HCP in order to improve coverage.

Keywords: healthcare personnel, immunization practices, vaccination requirements, influenza, Tdap, MMR Abbreviations: ACIP, Advisory Committee on Immunization Practices; CDC, Centers for Disease Control and Prevention; CMS, Centers for Medicaid and Medicare; HCP, healthcare personnel; Tdap, Tetanus, diphtheria, acellular pertussis; VPD, vaccine-preventable disease. This article not subject to US copyright law. *Correspondence to: Samuel B Graitcer; Email: [email protected] Submitted: 07/31/2014 Accepted: 08/15/2014 http://dx.doi.org/10.4161/hv.36090 Taddei C, Ceccherini V, Niccolai G, Porchia BR, Boccalini S, Levi M, Tiscione E, Santini MG, Baretti S, Bonanni P, et al. Attitude toward immunization and risk perception of measles, rubella, mumps, varicella, and pertussis in health care workers working in 6 hospitals of Florence, Italy 2011. Hum Vaccin Immunother 2014; 10: In press; PMID:24964049; http://dx.doi.org/10.4161/ hv.29398.

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Comprehensive systems to assess vaccination needs and support vaccination of healthcare personnel (HCP) could substantially reduce the number of HCP susceptible to vaccine preventable diseases (VPD) and reduce the potential for transmitting VPD from HCP to patients and other HCP.1 Taddei et al. describe results from their cross-sectional evaluation of immunization knowledge, attitudes, and practices (KAP) among healthcare personnel (HCP) working at six hospitals in Florence, Italy after attending a one day mandatory training on the epidemiology and prevention of measles, mumps, rubella, varicella, and pertussis, followed by a one day, on-site vaccination campaign. Following the training and the one-day vaccination campaign, physicians, nurses, nursing assistants, and midwives were anonymously surveyed regarding their vaccination history and their susceptibility to infection. In addition, surveyed HCP were also questioned regarding their perceived risk of infection from these pathogens, their opinion on the benefits of these vaccines, and their willingness to be vaccinated. Interestingly, despite the relatively low vaccination coverage, roughly 85% of surveyed HCPs reported generally positive opinions about the usefulness for some or all of these vaccines in preventing disease. Human Vaccines & Immunotherapeutics

One of the most striking findings from Taddei et al. is that for the unvaccinated HCP, the primary reason reported for not being vaccinated was a “lack of active offer for vaccination.” Lack of an active offer for vaccination could have been interpreted by respondents in several ways. In the United States, HCP influenza vaccination coverage is higher among HCP who reported being offered vaccination through methods which could be interpreted as more “active,” such as through sustained vaccine promotional campaigns offered on multiple days, at no cost, and during multiple shifts.2 The Task Force on Community Preventive Services outlines evidence-based interventions associated with increased seasonal influenza vaccination coverage for HCP, based on a systematic review of existing studies and evaluations.2 This review included studies by Cooper et al., who observed a 40.7% point increase in HCP influenza vaccination coverage, and by Nace et al., who observed a 29.6% point increase in HCP influenza vaccination coverage, when strategies which could be described as “active vaccination offering” were implemented, such as offering vaccination for free, on-site, with various employee incentives; using reminders; and/or requiring formal vaccination declinations for HCP not wishing to be vaccinated.3,4 Not surprisingly, employer vaccination requirements are also strongly associated with higher vaccination coverage among HCP in the US. Among HCP who were required to receive annual influenza vaccination as a condition of employment, influenza vaccination coverage was 96.5% for the 2012¡13 US influenza season compared with 76.9% among HCP who worked in a facility which recommended vaccination but had no vaccination requirement, and 50.4% among HCP who 2625

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worked in a facility with neither a recommendation nor a requirement for influenza vaccination.5 Increased tetanus, diphtheria, and acellular (Tdap) coverage among HCP in the US may also be associated with the implementation of HCP employment policies for compulsory Tdap vaccination. A recent analysis of Tdap coverage among US. HCP by Lu et al. found that increased Tdap coverage was independently associated with living in the Western US, where it has been reported that a higher proportion (47.4%) of hospitals have Tdap vaccination requirements for HCP, compared with other US regions (22.5% in the Midwest, 27.8% in the Northeast, and 30.1% in the South).6,7 The Community Preventive Services Task Force recommends assessment and feedback to providers regarding vaccination coverage, an evidence-based strategy which has been shown to increase vaccination coverage.8 For example, a voluntary public reporting program among hospitals in Iowa demonstrated a 20% point increase in influenza vaccination coverage among hospital employees over four years.10 A relatively recent requirement by US. Center for Medicare and Medicaid Services (CMS) for acute care hospitals to report their healthcare facilities’ HCP influenza vaccine coverage rates may also

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increase influenza immunization coverage among hospital-based HCP.9 Following US HCP influenza vaccine coverage will be important to monitor the potential impact of this CMS reporting requirement. In summary, the HCP vaccination experience in the US validates that an “active offer of vaccination,” beyond education alone, improves immunization uptake by HCP along with other strategies, such as having influenza vaccination a condition of employment and publically reporting of HCP vaccination coverage. At a minimum, broader implementation of one or more of these strategies and other recommendations of the Community Preventive Services Task Force could help improve HCP immunization coverage in Italy and elsewhere.

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Disclosure of Potential Conflicts of Interest

No conflicts of interest were disclosed. References 1. Advisory Committee on Immunization Practices; Centers for Disease Control and Prevention (CDC). Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011; 60(RR-7):1-45; PMID:22108587 2. Community Guide to Preventive Services: Interventions to Promote Seasonal Influenza Vaccinations among Healthcare Workers. Community Guide to Preventive Services

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2008 2008; Available from: http://www. thecommunityguide.org/worksite/flu-hcw.html Cooper E, O’Reilly M. A novel staff vaccination strategy. Infect Control Hosp Epidemiol 2002; 23:232-3; PMID:12026143; http://dx.doi.org/10.1086/503459 Nace DA, Hoffman EL, Resnick NM, Handler SM. Achieving and sustaining high rates of influenza immunization among long-term care staff. J Am Med Dir Assoc 2007; 8:128-33; PMID:17289544; http://dx.doi. org/10.1016/j.jamda.2006.09.014 Centers for Disease Control and Prevention (CDC). Influenza vaccination coverage among health-care personnel–United States, 2012-13 influenza season. MMWR Morb Mortal Wkly Rep 2013; 62:781-6; PMID:24067582 Lu PJ, Graitcer SB, O’Halloran A, Liang JL. Tetanus, diphtheria and acellular pertussis (Tdap) vaccination among healthcare personnel-United States, 2011. Vaccine 2014; 32:572-8; PMID:24308960; http://dx.doi. org/10.1016/j.vaccine.2013.11.077 Miller BL, Ahmed F, Lindley MC, Wortley PM. US hospital requirements for pertussis vaccination of healthcare personnel, 2011. Infect Control Hosp Epidemiol 2011; 32:1209-12; PMID:22080660; http://dx. doi.org/10.1086/662711 Community Guide to Preventive Services. 2008; Available from: http://www.thecommunityguide.org/vaccines/ providerassessment.html US Department of Health and Human Services. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and FY2012 rates; hospitals’ FTE resident caps for graduate medical education payment; final rules. 2011: Federal Register p. 51631-3. Helms C, Polgreen P, Polgreen L, Evans T, Roberts LL, Clabaugh G, Quinlisk P. Voluntary reporting of employee influenza vaccination rates by acute care hospitals in Iowa: the impact of a four year provider-based statewide performance improvement project. Vaccine 2011; 29:3483-8; PMID:21439317; http://dx.doi.org/ 10.1016/j.vaccine.2011.02.056

Volume 10 Issue 9

Comprehensive efforts to increase healthcare personnel immunization.

Vaccination of healthcare personnel (HCP) is an important component of worker and patient safety, yet vaccination rates are lagging. The findings from...
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