Occupational Medicine 2014;64:348–351 Advance Access publication 9 April 2014 doi:10.1093/occmed/kqu048
Healthcare workers’ attitude towards influenza vaccination after the 2009 pandemic P. Lewthwaite1, K. Campion2, B. Blackburn3, E. Kemp4, D. Major4 and K. Sarangi5 Department of Occupational Health and Wellbeing Services, Luton and Dunstable University Hospital, Luton, UK, Department of Occupational Health and Wellbeing, Buckinghamshire Healthcare NHS Trust, Amersham, UK, 3Department of Occupational Health, Royal Berkshire NHS Foundation Trust, Reading, UK, 4Centre for Occupational Health and Wellbeing, Oxford University Hospitals NHS Trust, Oxford, UK, 5Department of Occupational Health Service, Milton Keynes Hospital NHS Foundation Trust, Bucks, UK. 1 2
Background Previous studies have demonstrated the variability of healthcare workers’ (HCWs) willingness to consider seasonal influenza vaccination, possibly to the detriment of their patients. Aims
To ascertain HCW uptake of H1N1 and seasonal influenza vaccination and the reasons why one or both might have been declined following the pandemic of 2009.
An online, anonymous survey of HCWs across five, acute National Health Service trusts was undertaken in 2010.
A total of 765 responses were obtained, of which the two main groups of participants were doctors of all grades (42%) and qualified nurses (40%). The willingness to be vaccinated increased with age. Senior doctors were the occupational group most likely to have had both vaccinations, but where they did decline they mainly did so because they perceived influenza to be a minor illness. Females were more likely to decline vaccination due to a fear of side effects, whereas males, particularly younger ones, viewed influenza as a minor illness. Junior doctors cited lack of availability of immunization sessions as one of the main reasons why they may not have had vaccination.
Conclusions Future influenza vaccination campaigns should consider using different approaches depending on the gender and occupational mix of the target population, rather than adopting a ‘one-size’ fits all approach. Key words
Influenza; NHS workforce; vaccination.
In 2009, the World Health Organization declared a H1N1 (swine flu) pandemic  and healthcare workers (HCWs) in the UK, especially those in ‘front-line’ posts , were recommended to have both H1N1 and seasonal influenza vaccination. HCWs, in many countries, have been reluctant to have seasonal influenza vaccine in the past for a variety of reasons including fear of side effects or having felt unwell after a previous influenza vaccination [3–9]. The aim of this study was to explore attitudes to influenza vaccination across a range of HCWs from five, acute National Health Service trusts in South-East England and to suggest ways to improve future uptake.
In August 2010, HCWs from five, acute hospital trusts were invited to participate in an anonymous, online survey (18 August–30 September 2010) about their uptake of and attitude towards seasonal and H1N1 influenza vaccination. Each author sent out a standardized, invitation e-mail with a link to the survey (Survey monkey) via their hospital’s employee e-mail lists. Two weeks later, a reminder was sent. Participants were asked for their occupation, gender and age range together with questions about influenza vaccination. Free text comments were invited. Senior doctors were defined as those at consultant or staff grade level and juniors at any level below. Nurses were defined as those who were qualified
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Correspondence to: P. Lewthwaite, Department of Occupational Health and Wellbeing Services, Luton and Dunstable University Hospital, Lewsey Road, Luton LU4 0DZ, UK. Tel: +44 (0)15 8249 7226; fax: +44 (0)15 8249 7396; e-mail: [email protected]
P. LEWTHWAITE ET AL.: INFLUENZA VACCINATION AFTER THE 2009 PANDEMIC 349
and professions allied to medicine (PAM) included physiotherapists, occupational therapists and so forth. Healthcare assistants (HCAs) were considered to be unqualified nurses. Each trust had different e-mail arrangements and it proved impossible to obtain accurate denominators for occupational groups. Using amalgamated data, chi-squared values were calculated and P values were determined. Ethical approval was not sought as no personal identifiable information was obtained and the aim was to enhance service delivery.
Discussion This study found that in 2009/10 senior doctors were the group most willing or able to accept both seasonal and H1N1 flu vaccinations. This finding could partially be explained by age as previous studies have suggested an age related increase in vaccine uptake . Lack of opportunity to attend vaccination sessions was one of the main, but potentially remediable, reasons why junior doctors did not have seasonal influenza vaccination. One of the main limitations of this study was that respondents were those who had e-mail access at work, and thus were not necessarily representative of their respective populations. It proved impossible to calculate an overall response rate and potential bias could not be excluded, e.g. respondents with polarized views about vaccinations. It was feasible that respondents could have completed the survey more than once.
Table 1. The effect of gender, age and occupation on vaccination uptake, n (%)
Male Female 18–35 36–45 46–55 >55 Senior doctors Junior doctors Qualified nurses and HCAs PAMs
90 (48) 234 (41) 65 (31) 80 (38) 116 (49) 63 (62) 109 (58) 46 (34) 123 (37) 46 (42)
47 (25) 104 (18) 56 (26) 48 (23) 35 (15) 12 (12) 42 (23) 39 (29) 53 (16) 17 (16)
15 (8) 66 (11) 18 (9) 21 (10) 32 (13) 10 (10) 15 (8) 9 (7) 44 (13) 13 (12)
37 (20) 172 (30) 73 (34) 64 (30) 56 (23) 16 (16) 21 (11) 43 (31) 111 (34) 34 (31)
189 576 212 213 239 101 187 137 331 110