Influenza vaccination coverage of professionals working in nursing homes in France and associated determinants, 2018-2019 season: a cross-sectional survey | BMC Public Health

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We found low flu vaccination coverage during the 2018-2019 season among healthcare workers (doctors, nurses, nursing assistants and other paramedical staff) and non-medical professionals working in NH in France. Adoption varied by occupational category. Consistent with the results of other French and European studies, coverage was highest among physicians (75%). [11,12,13], followed by nurses, other paramedical staff, non-medical professionals and nursing auxiliaries. These results showed that professionals in close contact with NH residents, and in particular caregivers, are insufficiently vaccinated. The coverage target of 75% is only achieved for doctors.

Coverage data for the 2018-2019 season in mainland France was compared to that of the 2008-2009 season (overseas data for the latter period was not available) [11]. Over the 10-year interim period, physician coverage increased (2008-2009: 60.4% [CI95%: 54.9–65.8] vs. 2018-2019: 75.5% [69.3–81.7]), remained stable among nurses (45.2% [42.8–47.5] against 43.1% [39.6–46.7]), decreased among caregivers (33.7 [31.8–35.6] against 26.9 [24.6–29.2]), and tends to decrease among non-medical professionals (34.2 [32.0–36.3] against 28.8 [25.2–32.3]). No data was collected for other paramedical personnel in 2008-2009. Therefore, a like-for-like comparison of healthcare coverage cannot be made. Given these missing data, coverage for all health workers combined remained relatively stable and low (33.6% [31.9–35.4] against 31.9% [29.7–34.1]. Differences in coverage by occupation have increased over time. This is a particularly worrying observation, especially for nursing auxiliaries, because they provide direct and local care to residents. In addition, this observation highlights the difficulty of reaching these populations, and underlines the importance of creating prevention messages adapted for professionals working in NH.

This trend could also be explained by the controversy in France around vaccination against influenza in the context of the H1N1 pandemic in 2010, where a very large number of vaccine doses were purchased while final consumption was low. This has contributed to a growing reluctance of the French population towards vaccines in general, leading to a multi-year decrease in coverage and possibly a decrease in consumption among certain categories of NH professionals. [14]. Other perceived or real health scandals in recent decades may also have contributed to undermining public confidence in vaccination.

Our study highlighted several key findings useful to policy makers to improve uptake of influenza vaccination among healthcare workers working in NH. We discuss these results below.

Accessibility to vaccines

Free on-site flu vaccination for professionals working in NH has significantly improved vaccination coverage. In our study, nearly 98% of NHs have already implemented this measure.

Internal information sessions

The organization of information sessions for NH staff was associated with higher vaccination coverage whether these sessions were collective or individual.

While providing information about influenza vaccines was associated with higher health worker coverage, this was not the case for providing information about influenza or information about the individual or community benefits of vaccination. This result suggests that professionals expect reliable information on influenza vaccines before deciding whether or not to get vaccinated. Studies elsewhere have shown that believing the vaccine is effective and unlikely to cause side effects correlates with higher uptake. [15, 16].

Influenza vaccine information sessions and information on vaccination would most likely lead to significant improvements, as we found that less than 70% of NS in France held such sessions for staff during the 2018- 2019 or gave information on influenza vaccines.

The media to transmit information

Although more than 90% of the NHs included hung posters to promote influenza vaccination among caregivers, this media had no influence on vaccination in this population. In contrast, the use of videos or games was associated with higher use among healthcare workers (over 40%). The success of these media could certainly be linked to the fact that they better attract the attention of professionals because of their originality and because they promote interactive exchanges. It is important to emphasize that these tools were only used in 10% of the NHs.

Human contact

Having a point of contact in NH who provided accurate vaccination information was associated with higher usage among healthcare workers (70%). However, only 33% of all NHs included report having such a person.

The points discussed above highlight that any information disseminated during a vaccination campaign must take into account the following elements: i) provide information on influenza vaccines, ii) use attractive media, and iii) be conveyed by a vaccinator contact point who can provide reliable information. vaccination information. Previous studies have shown that healthcare workers may be reluctant to seek information published by national public health institutes due to time constraints. [17]. In addition, innovative and original information tools, accessible and usable directly in NH, as well as train-the-trainer programs for vaccination contact points should be explored. The combination of these measures should make it possible to increase vaccination coverage.

In our study, coverage was also higher in NH where a care coordinator was present, and when the director, care coordinator or nurse coordinator supported and was involved in the vaccination campaign.

Higher vaccination rates were observed in private NHs (vs. public NHs). This observation had already been observed for the 2007-2008 season in France [11]. Private retirement homes can encourage the vaccination of their staff more than public retirement homes. Additionally, coverage was higher in smaller NHs (i.e. less than 100 beds), reflecting earlier findings in France [11]. This can be explained by the fact that the management teams of small NHs are more concerned about the health of their staff: falling ill can lead to absenteeism of health workers; compensating an absent colleague can be more difficult in small structures.

Studies of vaccine hesitancy have concluded that while knowledge of efficacy and safety are key, societal approval, support from colleagues, and the belief that most colleagues have been vaccinated are also important. [17, 18].

Finally, vaccination coverage against influenza is much lower in the four overseas territories included than in mainland France. Although the flu is also circulating in South America and the Caribbean islands, it is possible that health care workers in these territories felt less at risk or were more reluctant to get vaccinated against this disease. Specific studies are needed to characterize reluctance to influenza vaccination and set up appropriate vaccination campaigns in overseas territories. It is possible that appropriation was underestimated for Reunion Island due to the study period, this territory being located in the southern hemisphere.

Annual influenza vaccination is recommended for healthcare workers worldwide, but uptake remains low in the majority of countries [19, 20]. Mandatory flu vaccination programs for healthcare workers have led to coverage levels of over 95% [21,22,23]. Currently, no country has made influenza vaccination mandatory for healthcare workers at the national level.

Our study has limitations. First, we only collected aggregate data; individual data such as demographic characteristics, vaccine hesitancy, and influenza vaccine knowledge were not collected. Despite a high response rate (certainly due in part to the short, easy-to-complete questionnaire used), NHs that did not respond to the survey may have been those where caregiver vaccination initiatives were least developed and had therefore potentially lower coverage rates. Second, the questionnaire was self-administered by NH directors, medical or nursing coordinators, and the quality of the data cannot be verified. Finally, a recall bias cannot be excluded, although it can be assumed that it was limited given the relatively short time interval between the vaccination period and the study. The influenza vaccination coverage estimates obtained in this study were close to those observed in surveillance of acute respiratory clusters that occurred in nursing homes during the 2018-2019 season (influenza vaccination coverage of health care workers : 33%) [3]. Finally, due to the low number of NHs in the overseas territories (heterogeneous islands), these data must be interpreted with caution.

The flu vaccination rate among NH residents was not investigated in this study as it has been reported as high for many years in France [11]and was confirmed by surveillance data for the 2018-2019 season (87% uptake in NH reported ARI clusters) [3].

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