Exposed Family Members Research Articles

Limited role of children in transmission of SARS‐CoV‐2 virus in households—Immunological analysis of 26 familial clusters

The impact of children on the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains uncertain. This study provides an insight into distinct patterns of SARS-CoV-2 household transmission in case of pediatric and adult index cases as well as age-dependent susceptibility to SARS-CoV-2 infection. Immune analysis, medical interviewing, and contact tracing of 26 families with confirmed SARS-CoV-2 infection cases have been conducted. Blood samples were analyzed serologically with the use of a SARS-CoV-2-specific IgG assay and virus neutralization test (VNT). Uni- and multivariable linear regression and mixed effect logistic regression models were used to describe potential risk factors for higher contagiousness and susceptibility to SARS-CoV-2 infection. SARS-CoV-2 infection could be confirmed in 67 of 124 family members. Fourteen children and 11 adults could be defined as index cases in their households. Forty of 82 exposed family members were defined as secondarily infected. The mean secondary attack rate in households was 0.48 and was significantly higher in households with adult than with pediatric index cases (0.85 vs 0.19; p< 0.0001). The age (grouped into child and adult) of index case, severity of disease, and occurrence of lower respiratory symptoms in index cases were significantly associated with secondary transmission rates in households. Children seem to be equally susceptible to acquire a SARS-CoV-2 infection as adults, but they suffer milder courses of the disease or remain asymptomatic. SARS-CoV-2 transmission from infected children to other household members occurred rarely in the first wave of the pandemic, despite close physical contact and the lack of hygienic measures.

Out-of-pocket expenditures associated with congenital zika syndrome in Brazil: an analysis of household health spending

Objective: The study aims to estimate catastrophic health expenditures associated with the diagnosis and follow-up treatment of Congenital Zika Syndrome (CZS) in children affected during the 2015-2016 epidemic in Brazil. Catastrophic health expenditures are defined as health spending that exceeds a predefined proportion of the household’s total expenditures, exposing family members to financial vulnerability. Methods: Ninety-six interviews were held in the cities of Fortaleza and Rio de Janeiro in a convenience sample, using a questionnaire on sociodemographic characteristics and private household expenditures associated with the syndrome, which also allowed estimating catastrophic expenditures resulting from care for CZS. Results: Most of the mothers interviewed in the study were brown, under 34 years of age, unemployed, and reported a monthly family income of two minimum wages or less. Spending on medicines accounted for 77.6% of the medical expenditures, while transportation and food were the main components of nonmedical expenditures, accounting for 79% of this total. The affected households were largely low-income and suffered catastrophic expenditures due to the disease. Considering the family income metric, in 41.7% of the households, expenses with the child’s disease exceeded 10% of the household income. Conclusion: Public policies should consider the financial and healthcare needs of these families to ensure adequate support for individuals affected by CZS.

Perceptions of Risk, Work, and Lifestyle Changes on Mental Health of Healthcare Workers Amidst the COVID-19 Pandemic.

The COVID-19 outbreak is significantly affecting the mental health of healthcare workers worldwide. This study aims to investigate the mental health outcomes of healthcare workers in a health system located in southeastern US during the first peak of the pandemic and examine the association of specific factors on the mental well-being of healthcare workers. A cross-sectional survey of 388 healthcare workers was conducted. Data were collected using a 79-item questionnaire, which included the Patient Health Questionnaire (PHQ-9) instrument, the 7-item Generalized Anxiety Disorder (GAD-7) instrument, and the 22-item Impact of Event Scale-Revised (IES-R), to assess symptoms of depression, anxiety, and general distress, respectively. Data were analyzed using descriptive, bivariate, and multivariate statistics. Accordingly, 30.1%, 28.7%, and 39.4% of respondents reported depression, anxiety, and distress symptoms, respectively. Younger workers and females reported higher mental symptomologies. We identified significant, nontraditional factors associated with depression and anxiety symptoms among healthcare workers: healthcare procedure change, concern of exposing family to COVID-19, number of missed shifts, and access to psychological resources/services. These findings emphasize the importance of providing the proper training to reduce concerns of exposing family members and psychological interventions to promote mental health well-being for healthcare workers during the stressful COVID-19 pandemic.

Addressing Health Concerns Interrupted by the COVID-19 Pandemic

Addressing Health Concerns Interrupted by the COVID-19 Pandemic

SECONDARY INFECTIONS IN THE FAMILY FROM PRIMARY CASES OF COVID-19 BREAKTHROUGH INFECTIONS IN FULLY VACCINATED OR NOT FULLY VACCINATED PEOPLE. TWO DOSES MODESTLY REDUCE FAMILY TRANSMISSION BUT DOES NOT ELIMINATE IT.

Background It is unclear whether vaccination of individuals against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) protects members of their households.&#x0D; Objective Epidemiological evaluation of SARS-CoV-2 transmissibility from fully and incompletely vaccinated index cases with COVID-19 breakthrough infection to initially uninfected family members (secondary attack rate)&#x0D; Methodology An observational, longitudinal, and prospective study of all families with a primary case of COVID-19 breakthrough infection in fully vaccinated or not fully vaccinated people and at least one COVID-19 secondary case in family members was conducted from February to November 2021 in a general medicine office in Toledo, Spain. Clinical and epidemiological variables were compared between secondary cases of primary cases of COVID-19 breakthrough infection in fully vaccinated people versus secondary cases of primary cases of COVID-19 breakthrough infection in not fully vaccinated people.&#x0D; Results Twenty-five index cases (25 families; 84 people) were included, 13 fully vaccinated, which gave rise to 20 secondary cases, and 12 not fully vaccinated, which gave rise to 21 secondary cases. The secondary attack rate of exposed family members to fully vaccinated primary cases were 61% (20/33), and the secondary attack rate of exposed family members to not fully vaccinated primaries was 81% (21/33). &#x0D; Conclusions In the context of general medicine in Toledo (Spain), from February to November 2021 (before omicron), two doses of COVID-19 vaccine vs. only one modestly reduce family transmission but do not eliminate it.&#x0D;

Case Report: Severe COVID-19 in a Kidney Transplant Recipient Without Humoral Response to SARS-CoV-2 mRNA Vaccine Series.

Supplemental Digital Content is available in the text.

Home Hospice Versus Other Places of Death and Caregiver Stresses

As of 2017, more individuals in the U.S. die at home than in any other location. Hospice care was designed to provide support for people who are dying and their families. However, dying persons may have rapidly emerging needs that home hospice does not immediately meet, thereby, exposing family members to be “first responders.” Thus, home death may result in distress and burden for dying individuals’ family members, even when hospice is involved. This study uses multivariable regression analysis to explore the relationship between place of death and stressful end-of-life experiences in a sample of 185 patients with advanced cancer. We also analyze which end-of-life experiences are associated with death location. Compared to home hospice death, we found dying in a hospital was associated with fewer caregiver exposures to, and reports of fearfulness and helplessness in response to, stressful end-of-life events. Compared to home hospice death, hospital death was associated with decreased frequency of choking, falls, confusion/delirium, and feeling the patient has had enough. It was also associated with less fearfulness about choking and falls and less hopelessness about falls, the patient having enough, and thinking the patient was dead. Our results suggest home death with hospice care, often involves undesirable experiences that result in more caregiver fear and helplessness than dying in a hospital without hospice care. Research is needed to understand how to best support family members through stressful end-of-life experiences even when supported by home hospice services.

Successful Response to a Measles Exposure in a Pediatric Clinic Utilizing Measles, Mumps, and Rubella (MMR) Vaccine Prophylaxis

Background: To be effective, postexposure prophylaxis (PEP) must be administered promptly after measles exposure. MMR vaccine is recommended within 72 hours of exposure. Immunoglobulin (IG) is recommended for infants aged &lt;6–12 months, susceptible individuals, and severely immunocompromised people within 6 days of exposure. MMR vaccine is readily available, less expensive, and more easily administered than IG, and it provides long-term immunity. However, due to delays in diagnosis of measles cases, it is often not possible to administer MMR PEP to contacts within 72 hours. We describe an unvaccinated infant with fever and rash after recent international travel who presented to a pediatric outpatient clinic. Measles was promptly suspected, and specimens were collected for measles polymerase chain reaction (PCR) testing at the California Department of Public Health (CDPH) laboratory. PCR results confirming measles were obtained within 24 hours of the patient visit. Methods: A multidisciplinary team of medical, employee health, nursing, pharmacy and infection prevention staff was assembled. Electronic health records (EHRs) were used to identify exposed patients based on registration times, as well as to determine their MMR vaccination status and to identify any immunocompromising conditions. Exposed patients were notified either by e-mail or phone. Adult caretakers were interviewed to determine who accompanied the child to the clinic. Caretakers were questioned regarding their MMR vaccination status and the high risk to accompanying persons. The use of EHRs with data integration from other healthcare system helped validate and supplement vaccine statuses and medical histories of exposed family members. Results: In total, 128 persons were exposed; 31 staff (24%), 46 patients (36%) and 51 family members (40$). All 128 patients (100%) and family members were notified within 24 hours of case confirmation, and 44 of 128 (34%) required PEP. All staff had documentation of measles immune status. However, 1 of 31 staff (3%) needed PEP due to immunosuppression. MMR vaccine was given to 35 of 36 eligible persons (97%), except for 1 sibling who received IG due to delay in exposure identification. An additional 8 of 44 persons (18%) required IG due to age or immunosuppression. There were no secondary cases. Conclusions: MMR vaccine was used as primary PEP due to prompt suspicion for measles, early laboratory confirmation, and swift coordinated response using a multidisciplinary team. Leveraging EHRs helped rapidly identify exposed persons, validate measles immunity status and risk factors, order prophylaxis, and track outcomes.Funding: NoneDisclosures: None

Robust T Cell Immunity in Convalescent Individuals with Asymptomatic or Mild COVID-19

SARS-CoV-2-specific memory T cells will likely prove critical for long-term immune protection against COVID-19. Here, we systematically mapped the functional and phenotypic landscape of SARS-CoV-2-specific T cell responses in unexposed individuals, exposed family members, and individuals with acute or convalescent COVID-19. Acute-phase SARS-CoV-2-specific T cells displayed a highly activated cytotoxic phenotype that correlated with various clinical markers of disease severity, whereas convalescent-phase SARS-CoV-2-specific T cells were polyfunctional and displayed a stem-like memory phenotype. Importantly, SARS-CoV-2-specific T cells were detectable in antibody-seronegative exposed family members and convalescent individuals with a history of asymptomatic and mild COVID-19. Our collective dataset shows that SARS-CoV-2 elicits broadly directed and functionally replete memory T cell responses, suggesting that natural exposure or infection may prevent recurrent episodes of severe COVID-19.

Coronavirus Disease 2019 Pandemic Measures: Reports From a National Survey of 9,120 ICU Clinicians.

Importance:Recent reports identify that among hospitalized coronavirus disease 2019 patients, 30% require ICU care. Understanding ICU resource needs remains an essential component of meeting current and projected needs of critically ill coronavirus disease 2019 patients.Objectives:This study queried U.S. ICU clinician perspectives on challenging aspects of care in managing coronavirus disease 2019 patients, current and anticipated resource demands, and personal stress.Design, Setting, and Participants:Using a descriptive survey methodology, an anonymous web-based survey was administered from April 7, 2020, to April 22, 2020 (email and newsletter) to query members of U.S. national critical care organizations.Measurements and Main Results:Through a 16-item descriptive questionnaire, ICU clinician perceptions were assessed regarding current and emerging critical ICU needs in managing the severe acute respiratory syndrome coronavirus 2 infected patients, resource levels, concerns about being exposed to severe acute respiratory syndrome coronavirus 2, and perceived level of personal stress. A total of 9,120 ICU clinicians responded to the survey, representing all 50 U.S. states, with 4,106 (56.9%) working in states with 20,000 or more coronavirus disease 2019 cases. The 7,317 respondents who indicated their profession included ICU nurses (n = 6,731, 91.3%), advanced practice providers (nurse practitioners and physician assistants; n = 334, 4.5%), physicians (n = 212, 2.9%), respiratory therapists (n = 31, 0.4%), and pharmacists (n = 30, 0.4%). A majority (n = 6,510, 88%) reported having cared for a patient with presumed or confirmed coronavirus disease 2019. The most critical ICU needs identified were personal protective equipment, specifically N95 respirator availability, and ICU staffing. Minimizing healthcare worker virus exposure during care was believed to be the most challenging aspect of coronavirus disease 2019 patient care (n = 2,323, 30.9%). Nurses report a high level of concern about exposing family members to severe acute respiratory syndrome coronavirus 2 (median score of 10 on 0–10 scale). Similarly, the level of concern reached the maximum score of 10 in ICU clinicians who had provided care to coronavirus disease 2019 patients.Conclusions:This national ICU clinician survey identifies continued concerns regarding personal protective equipment supplies with the chief issue being N95 respirator availability. As the pandemic continues, ICU clinicians anticipate a number of limited resources that may impact ICU care including personnel, capacity, and surge potential, as well as staff and subsequent family members exposure to severe acute respiratory syndrome coronavirus 2. These persistent concerns greatly magnify personal stress, offering a therapeutic target for professional organization and facility intervention efforts.

Estimation of External Dose Rates to Hotel Workers from bed linens Contaminated by 131I Patients.

Iodine-131 is commonly used in medical diagnosis and therapy for patients with hyperthyroidism or differentiated thyroid cancer. Following treatment, patients may recuperate in a hotel room to avoid exposing family members. The main purpose of this study was to estimate external effective dose rate coefficients to a hotel worker who handles potentially contaminated bed linens due to secretions from I patients as sweat or urine. The external dose rate estimates were derived using Monte Carlo radiation transport code and the phantom with movable arms and legs to model a housekeeper standing in an upright position holding a pile of bed linens. Simulations further integrated the body burden of time-dependent biokinetic metabolism of I in the patient's body, differentiating between biokinetic excretion models of hyperthyroid vs. cancer patients. Organ absorbed dose rate and effective dose rate coefficients were calculated for three scenarios of bed linen contamination and estimated out to 5 d postadministration and compared to past I patient contamination measurements.

Provider Burnout and Fatigue During the COVID-19 Pandemic: Lessons Learned From a High-Volume Intensive Care Unit.

Provider Burnout and Fatigue During the COVID-19 Pandemic: Lessons Learned From a High-Volume Intensive Care Unit.

Cold Weather Viruses.

1. Asif Noor, MD* 2. Theresa Fiorito, MD* 3. Leonard R. Krilov, MD*,† 1. *Department of Pediatrics, Children's Medical Center, NYU Winthrop Hospital, Mineola, NY 2. †Department of Pediatrics, State University of New York, Stony Brook School of Medicine, Stony Brook, NY * Abbreviations: AAP: : American Academy of Pediatrics Adv: : adenovirus CDC: : Centers for Disease Control and Prevention FDA: : Food and Drug Administration hMPV: : human metapneumovirus PCR: : polymerase chain reaction PIV: : parainfluenza virus RSV: : respiratory syncytial virus RV: : rhinovirus Clinicians must learn to identify viral infections in children during the winter months and must practice caution with the use of unnecessary medications in such cases. Recognition of the clinical pattern of viral infection (eg, bronchiolitis) in conjunction with judicious use of viral tests (either office-based immunoassays or newer molecular tests) may assist in epidemiological monitoring, cohorting patients in the hospital, withholding unnecessary therapies, and providing a definitive diagnosis. After completing this article, readers should be able to: 1. Review the epidemiological aspects and clinical signs and symptoms of common cold weather viruses. 2. Recognize situations in which viral testing is indicated. 3. Recognize situations in which treatment is indicated. In early November you are evaluating a 9-month-old boy born at 33 weeks of gestation. The infant presents with 2 days of fevers (101°F–102°F [38.3°C–38.8°C]), copious rhinorrhea, and 1 day of coughing with difficulty breathing. He is otherwise feeding well and has had adequate urination. His 4-year-older sister has an upper respiratory tract infection. On physical examination, the infant has a respiratory rate of 45 breaths/min without chest wall retractions. On auscultation there is good air entry with scattered rhonchi bilaterally. What is the most appropriate next step in management? 1. Obtain respiratory syncytial virus (RSV) and influenza antigen testing. 2. Obtain a chest radiograph to look for focal infiltrate. 3. Provide supportive care with nasal …

Pet-associated Campylobacteriosis: A persisting public health concern.

Campylobacter is regarded as a leading cause of human bacterial gastroenteritis in the United States. We report on a case of laboratory-confirmed Campylobacter jejuni infection in the Commonwealth of Pennsylvania among members of a household living with a laboratory-confirmed but non-speciated Campylobacter-infected puppy. We describe an outbreak of likely dog-associated campylobacteriosis, the risk factors, potential routes of exposure and the clinical features in the exposed family members, which began shortly after exposure to the recently purchased dog. We also provide public health recommendations to prevent Campylobacter infections in veterinary care providers, pet owners and those planning to adopt pets in the future. Finally, this report underscores the importance of the One Health approach when public health responders, human and animal healthcare providers and clinical diagnostic laboratories are tasked with developing effective strategies when investigating, detecting and responding to zoonoses (diseases shared between animals and humans).

Pesticide Knowledge, Attitudes, and Clothing Practices of Turkish Farmers

The purpose of this study was to assess Turkish farmers’ knowledge, attitudes, and clothing practices during pesticide activities. Seventy male farmers from seven districts of the Aegean region of Turkey were interviewed. Farmers indicated a high level of knowledge of adverse health effects associated with pesticides. In contrast to their level of knowledge, over 50% of the farmers had the attitude that pesticides would not be harmful to them. The type of clothing most often worn further supported the farmers’ attitudes: T-shirts or long-sleeve shirts, denim pants, leather shoes, or sandals, all of which provide little protection. Therefore, farmers’ knowledge on the harmful effects of pesticides did not correlate with their clothing practices. Additionally, farmers’ attitudes and clothing practices were inconsistent with each other. A weak but significant correlation between attitudes and clothing practices with a negative direction also supported this. Furthermore, participant farmers indicated bringing contaminated clothing inside the home and laundering contaminated work clothes with regular family clothes, potentially exposing family members by take-home contamination. These findings suggest that the development of training programs to reduce pesticide exposure would benefit Turkish farmers.

Community Health Seeking Behavior for Suspected Human and Animal Rabies Cases, Gomma District, Southwest Ethiopia.

BackgroundTimely presentation to appropriate health service provider of sick animals/humans from zoonotic diseases like rabies is important for early case/outbreak detection and management. However, data on community’s health seeking practice for rabies in Ethiopia is limited. Therefore the objective of this study was to determine community’s health seeking behavior on rabies, Southwest Ethiopia.MethodsA cross-sectional survey was conducted from January 16-February 14, 2015 to collect data from 808 respondents where the respondents were selected using multistage sampling technique. Data were collected using interviewer administered structured questionnaire by trained epidemiology graduate level students. Data were entered to Epidata version 3.1 and analyzed using SPSS version 20 for windows.ResultEight hundred three (99.4%) respondents participated in the study. Out of 28 respondents who reported their family members’ exposure to rabies, 8 of them replied that the exposed family members sought treatment from traditional healers. More than nine in ten respondents perceived that humans and domestic animals with rabies exposure should seek help of which 85% of them suggested modern health care facilities as the preferred management option for the sick humans and domestic animals. However, among those who reported sick domestic animals, near to 72% of them had either slaughtered for human consumption, sold immediately, visited traditional healer, given home care or did nothing for the sick domestic animals.ConclusionMajority of the respondents had favorable perception of seeking treatment from modern health care facilities for rabies. However, significant number of them had managed inappropriately for the sick domestic animals from rabies. Hence, raising awareness of the community about management of sick domestic animals from rabies and the need for reporting to both human and animal health service providers is needed.

Health issues among MIC exposed population 30 years post MIC disaster at Bhopal

Bhopal the capital city of Madhya Pradesh suffered an accidental toxic gas disaster 30 years back. The gases released included mainly Methyl Iso Cyanate (MIC), Hydrogen Cyanide (HCN) and Carbon Mono Oxide (CO). The left over stockpile and products of reactions posed threat to environmental contamination and gases lead to heavy toll on human and animal lives and injured people with long term consequences. People believed that the toxicants could cause irreversible damage to human health. Present review article is based on extensive review of the large number of research publications and reports appeared over last 29 years following MIC gas leak at Bhopal. The results of extensive review of literature reveal that fear of carcinogenesis, immune compromise status was unfounded and congenital malformations was not proved epidemiologically as well as experimentally. And as on today, thirty years' post disaster only three health problems as Reactive Airways Disease Syndrome, Pulmonary Fibrosis and Post Traumatic Stress Disorder need further attention, that too for their management. The result of present review also indicates that by and large no research need seems to emerge. However, to be sure, author recommend that a cohort of gas exposed people who were given Thiosulphate injection (N = 18000) and their exposed family members may be assembled and their health status be examined through a cross sectional study to come to final conclusion.

A practical guideline for the release of patients treated by I-131 based on Monte Carlo dose calculations for family members

We recently published effective doses per time-integrated activity (mSv MBq−1 s−1) for paediatric and adult family members exposed to an adult patient released from hospital following I-131 therapy. In the present study, we intend to provide medical physicists with a methodology to estimate family member effective dose in daily clinical practice because the duration of post-radiation precautions for the patient–family member exposure scenario has not been explicitly delineated based on the effective dose. Four different exposure scenarios are considered in this study including (1) a patient and a family member standing face to face, (2) a patient and a family member lying side by side, (3) an adult female patient holding a newborn child to her chest and (4) a one-year-old child standing on the lap of an adult female patient following her I-131 therapy. The results of this study suggest that an adult female hyperthyroidism (HT) patient who was administered with 740 MBq should keep a distance of 100 cm from a 15-year-old child for six days and the same distance from other adults for seven days. The HT female patient should avoid holding a newborn against her chest for at least 16 days following hospital discharge, and a female patient treated with 5550 MBq for differentiated thyroid cancer should not hold her newborn child for at least 15 days following hospital discharge. This study also gives dose coefficients allowing one to predict age-specific effective doses to family members given the measured dose rate (mSv h−1) of the patient. In conclusion, effective dose-based patient release criteria with a modified NRC two-component model provide a site medical physicist with less restrictive and age-specific radiation precaution guidance as they fully consider a patient’s iodine biokinetics and photon attenuation within both the patient and the exposed family members.

Pandemic (H1N1) 2009 Influenza in Australia: Absenteeism and redeployment of emergency medicine and nursing staff

The aim of the present study was to examine the impact of Pandemic (H(1)N(1)) 2009 Influenza on the Australian emergency nursing and medicine workforce, specifically absenteeism and deployment. Data were collected using an online survey of 618 members of the three professional emergency medicine or emergency nursing colleges. Despite significant increases in emergency demand during the Pandemic (H(1)N(1)) 2009 Influenza, 56.6% of emergency nursing and medicine staff reported absenteeism of at least 1 day and only 8.5% of staff were redeployed. Staff illness with influenza-like illness was reported by 37% of respondents, and 87% of respondents who became ill were not tested for the Pandemic (H(1)N(1)) 2009 Influenza. Of the respondents who became ill, 43% (n= 79) reported missing no days of work and only 8% of respondents (n= 14) reported being absent for more than 5 days. The mean number of days away from work was 3.73 (standard deviation = 3.63). Factors anecdotally associated with staff absenteeism (caregiver responsibilities, concern about personal illness, concern about exposing family members to illness, school closures, risk of quarantine, stress and increased workload) appeared to be of little or no relevance. Redeployment was reported by 8% of respondents and the majority of redeployment was for operational reasons. Future research related to absenteeism, redeployment during actual pandemic events is urgently needed. Workforce data collection should be an integral part of organizational pandemic planning.

Influenza Vaccination among Emergency Medical Services and Emergency Department Personnel

Objectives. Influenza vaccination has long been recommended for health care workers, but vaccination rates among this group have been low. Data on emergency medical services (EMS) personnel's vaccination status have not been published. This study compared self-reported vaccination rates and barriers among EMS and emergency department (ED) personnel. Methods. We conducted a cross-sectional survey of full-time EMS providers servicing metropolitan Rochester, New York, and a convenience sample of ED personnel in an academic medical center in Rochester, New York. Surveys, completed during July and August 2006, focused on influenza vaccination status for the 2005–2006 season and opinions regarding the vaccination. Immunization rates of EMS providers and ED personnel were compared using the chi-square calculation. Results. Surveys were completed by 128 EMS providers (100% of eligible) and 128 ED personnel (100% of approached). Among EMS providers, 27 of 128 (21%; 95% confidence interval [CI] 14%–29%), and among ED personnel, 83 of 128 (65%; 95% CI 56%–73%) reported receiving an influenza vaccination in the preceding year (p < 0.001). Among interventions that could lead to an increase in influenza vaccination, the most commonly chosen by EMS providers and ED personnel alike were “no waiting” vaccination at work (71% and 62%, respectively) and free vaccination (59% and 50%, respectively). When asked about important factors in the decision whether to get an influenza vaccination the following season, the most common responses were frequency of exposure (71%, 69%) and concern about secondarily exposing family members (62%, 60%). Conclusion. EMS providers reported low influenza vaccination levels in 2005–2006, even as compared with ED personnel. This failure to receive vaccination poses potential risk to the workers themselves and their patients. Resolution of reported barriers could lead to higher vaccination rates.