Vaccination Of Healthcare Workers Research Articles

Prevalence of hepatitis B surface antibody among previously vaccinated healthcare workers in Tashkent, Uzbekistan

ABSTRACT Healthcare workers (HCW) have high occupational risk for hepatitis B and Uzbekistan held two HCW vaccination campaigns in 2015 and 2022. Hepatitis B antibody testing (anti-HBs) after Hepatitis B (HepB) vaccination is recommended by the U.S. CDC and WHO for HCW, but Uzbekistan does not have such a policy. In 2023, we randomly selected HCW from the campaign registries. Participants who agreed were interviewed at their workplaces. Vaccination doses were self-reported. Testing for hepatitis B surface antigen (HBsAg), Total hepatitis B core antibody (anti-HBc), and anti-HBs were concurrently performed. We used multivariable Poisson regression to assess factors associated with anti-HBs ≥10 mIU/mL. Of 334 participants, 205 were vaccinated in 2015 and 129 in 2022. Median age was 40 years (interquartile range 35–49 years), and 87% were female. Most (71%) reported having completed the three doses, 21% two doses and 7% one dose. Testing revealed that 5% had an active HBV infection, 4% had a resolved infection, and 91% had detectable vaccine-derived antibodies. Among those (n = 303), 71% had anti-HBs ≥10 mIU/mL. For those who reported receiving 1, 2, and 3 doses, protective titers were 59%, 70%, and 72%, respectively. Protective titers were lower for HCW that worked in clinics versus hospitals (aPR = 0.92, CI: 0.87–0.98, p = .01) adjusting for age, dose number and presence of chronic conditions. Strategies to improve completion of the 3-dose series and policies for post-vaccination immunity testing 1–2 months after completion of the 3-dose HepB series could help identify workers who may require revaccination or are currently infected.

Randomized trial of BCG in healthcare workers to reduce absenteeism during the COVID-19 pandemic in sub-Saharan Africa.

We tested whether providing BCG vaccine to healthcare workers (HCWs) could reduce non-planned absenteeism and thereby reduce the potential impact of the COVID-19 pandemic on healthcare systems in Africa. We conducted a multicenter, single-blinded, placebo-controlled randomized trial in Guinea-Bissau and Mozambique between December 2020 and June 2022. Participants were randomized 1:1 to BCG vaccine or placebo (saline) and followed by biweekly telephone calls for 6mo. The incidence of unplanned absenteeism due to illness was analyzed using Bayesian negative binomial regression yielding relative RRs. Secondary outcomes included infectious disease episodes, COVID-19 infection and all-cause hospitalizations. We enrolled 668 HCWs (Guinea-Bissau, n=503; Mozambique, n=165). The RR for absenteeism of BCG vs placebo was 1.29 (0.81 to 1.94) with comparable effects by country. No protection against infectious disease episodes (HR=1.18 [0.97 to 1.45]) or COVID-19 infection (HR=1.19 [0.80 to 1.75]) was observed. Two trial deaths (1 BCG, 1 control) were registered and nine admissions (3 BCG, 6 control), the all-cause admission HR being 0.51 (0.13 to 2.03). With 64% of the planned sample size and unplanned absenteeism rates lower than expected, BCG did not reduce self-reported absenteeism due to illness. Rather, BCG tended to increase the risk of self-reported absenteeism, infectious disease episodes and COVID-19 infections. This was a randomized control trial assessing non-specific effects of BCG vaccination in healthcare workers. There was no beneficial effect on self-reported absenteeism due to illness within 6mo of follow-up during the COVID-19 pandemic, but a trend towards fewer all-cause hospital admissions.

Antibody Response After a Fifth Dose (Third Booster) of BNT162b2 mRNA COVID-19 Vaccine in Healthcare Workers.

Although a fourth dose of SARS-CoV-2 vaccine was shown to be effective, the immunogenicity of a fifth dose in immunocompetent individuals had not been well described. This was a prospective observational cohort study of previously vaccinated healthcare workers at a single tertiary hospital in Israel. Individuals were administered up to three booster doses of the BNT162b2 mRNA vaccine (i.e., up to five overall doses), during the period between July 2021 and January 2023. Immunogenicity was assessed using the SARS-CoV-2 IgG (sCOVG) semi-quantitative assay, performed at several time points. The cohort consisted of 162 individuals (median age 69 years, 62% female). Of these, 104 (64%) received four doses and 58 (36%) received five doses. Anti-SARS-CoV-2 antibody levels increased in all cases, regardless of the baseline levels. The fold-change increase in the mean sCOVG index was 29.2 (SD 2.6) after the third vaccine, 3.8 (SD 2.4) after the fourth vaccine, and 3.6 (SD 3.0) after the fifth vaccine. A waning effect over time was seen in 78% and 43% of participants for the third and fourth doses, respectively. Adverse events following the fifth dose were limited and mild. Similar to previous booster vaccines, a fifth dose of BNT162b2 is immunogenic and safe in healthy individuals, although the clinical implications remain unclear.

Protective Impact of Influenza Vaccination on Healthcare Workers.

Influenza vaccine uptake among healthcare workers is crucial for preventing influenza infections, yet its effectiveness needs further investigation. This prospective observational study aimed to assess the protective effect of influenza vaccination among healthcare workers in Shenzhen. We enrolled 100 participants, with 50 receiving the 2023-2024 quadrivalent influenza vaccine (QIV) and 50 serving as unvaccinated controls. Epidemiological data were collected when the participants presented influenza-like illness. Serum samples were collected at three time points (pre-vaccination and 28 and 180 days after vaccination). Hemagglutination inhibition (HI) assay was performed against the strains included in the 2023-2024 QIV (H1N1, H3N2, BV and BY strains) to assess antibody protection levels. Demographics comparisons revealed no significant differences between the vaccinated and control groups (p > 0.05), ensuring group comparability. The incidence of influenza-like illness was significantly lower in the vaccinated (18%) compared to the control group (36%; p = 0.046; OR = 0.39; 95% CI: 0.15 to 0.98). The vaccinated group also exhibited a higher rate of consecutive two-year vaccinations (48% vs. 24% in the control group, p < 0.05). Additionally, the vaccinated healthcare workers were more inclined to recommend vaccination to their families (80% vs. 48%, p < 0.05). HI titers against H1N1 (p < 0.01), H3N2 (p < 0.01), BV (p < 0.001) and BY (p < 0.01) significantly increased in the vaccinated group at 28 days post-vaccination. Moreover, a marked and sustained increase in HI titers against the H3N2 strain (p < 0.001) was observed at 180 days post-vaccination, highlighting the vaccine's enduring impact on the immune response. The fold change in the HI titers, indicative of the magnitude of the immune response, was significantly higher for H1N1 (p < 0.01), H3N2 (p < 0.001), BV (p < 0.01) and BY (p < 0.05) among the vaccinated individuals compared to the control group, underscoring the vaccine's efficacy in eliciting a robust and sustained antibody response. Influenza vaccination significantly reduces the incidence of influenza-like illness among healthcare workers and promotes a sustained immune response. The study supports the importance of annual vaccination for this group to enhance personal and public health.

The intention of Egyptian healthcare workers to take the monkeypox vaccine: is urgent action required?

BackgroundIn light of the ongoing monkeypox (MPOX) epidemic, healthcare workers (HCWs) have been in contact with various diseases. Therefore, they should take appropriate preventive and control measures to maintain their health. This study assessed Egyptian HCWs’ intentions to take MPOX vaccines.MethodsA cross-sectional survey was conducted using social media platforms between September 27 and November 4, 2022. An anonymous online survey using the 5C scale was conducted using convenience and snowball sampling methods to assess the five psychological antecedents of vaccination (i.e., confidence, constraints, complacency, calculation, and collective responsibility).ResultsA total of 399 HCWs with a mean age of 32.6 ± 5.7 participated in this study. Of them, 89.7% were female. The five C psychological antecedents of vaccination were as follows: 55.9% were confident about vaccination, 50.6% were complacent, 56.6% experienced constraints, 60.7% calculated the risk and benefit, and 58.4% had collective responsibility. Multivariate analysis showed that high income level and having information about MPOX were significant predictors of confidence in the MPOX vaccines (adjusted odds ratio ((AOR) = 4.19, 95% CI (1.12– 15.59), P = 0.032). Participants aged 31–45 years and 19–30 years showed significant association (AOR = 2.46, 95% CI (0.85–7.15), P = 0.096) and (AOR = 4.19, 95% CI (1.39–12.64), P = 0.011), respectively. Having an idea about the MPOX vaccines significantly predicted the complacency domain (AOR = 3.77, 95%CI (1.47–9.65, P = 0.006). Moreover, precollege/undergraduate education and having an idea about MPOX vaccination were significant predictors of the constraint domain (AOR = 1.81.95% CI (1.09–2.99, P = 0.020), (AOR = 2.70, 95% CI (1.05–6.95, P = 0.038), respectively). Female sex, having a diploma, postgraduate studies, and having an idea about MPOX vaccine significantly predicted calculation domain (AOR = 2.06, 95% CI (1.05–4.04, P = 0.035), (AOR = 3.98,95% CI (1.33–11.87, P = 0.013), (AOR = 2.02, 95% CI (1.25–3.26, P = 0.004) & (AOR = 2.75. 95% CI (1.05–7.18, P = 0.039), respectively. The only significant predictor of collective responsibility was having a diploma and postgraduate studies (AOR = 3.44, 95% CI (1.21–9.78, P = 0.020), (AOR = 1.90,95% CI (1.17–3.09, P = 0.009).ConclusionsEfforts to control MPOX should focus on promoting protective measures such as the vaccination of HCWs as well as raising their awareness about the updated information regarding the virus and the approved vaccines.

Newspaper Representation of Mandatory Vaccination Against COVID-19 for Healthcare Workers in England: A Qualitative Framing Analysis

In 2021, vaccination against COVID-19 became mandatory for healthcare workers in England. The media coverage of the mandate was extensive and became an issue of public interest. This study aimed to understand the United Kingdom (UK) debate on mandatory COVID-19 vaccination through a framing analysis of UK media coverage. Articles written between November 2021 and April 2022 were identified from UK national newspapers: The Daily (and Sunday) Telegraph, the Times (and Sunday Times), the Guardian (and the Observer), the Independent, the Daily Mail (and Mail on Sunday), the Daily Mirror, the Daily Express, and the Sun. Articles were selected using eligibility criteria before framing analysis was undertaken. The sample included 204 articles. Safe Staffing, Treatment of Staff, Change in Covid Context, and Protect Patient Safety were identified as frames used to stimulate debate on the mandatory vaccination policy. Such frames established three broader concepts in the media: civil liberty theory, duty-based ethics, and social-vulnerability theory. This study analyzed how mandatory COVID-19 vaccination for healthcare workers in England was framed in the UK national media. The broader concepts built in the media heightened debate on the policy, creating a voluminous amount of coverage and criticism that may have played a role in the mandate’s reversal.

COVID-19 Vaccination Acceptance and Hesitancy in Healthcare Workers and the General Population: A Systematic Review and Policy Recommendations.

The COVID-19 pandemic challenged the scientific community to find and develop a vaccine to fight the disease. However, problems with achieving high vaccine coverage have emerged, even among high-risk groups such as healthcare workers (HCWs). The objective of this study is to examine factors that influence HCW's and the general population's adherence to COVID-19 vaccination and national policies to vaccinate HCWs and other target groups. This study implemented a systematic review. The eligibility criterion for inclusion was being a HCW, target population for COVID-19 vaccination, or general population. Vaccination was the target intervention, and the COVID-19 pandemic was the context. We selected publications published between 1 January 2020 and 31 March 2022. Qualitative synthesis used a meta-aggregation approach. Nineteen articles were included in the review, with study samples varying from 48 to 5708 participants. Most of the evidence came from cross-sectional and qualitative studies. The main findings were related to vaccine hesitancy rather than acceptance. Factors associated with HCW vaccine hesitancy included subjective feelings such as safety concerns, rapid vaccine development, and insufficient testing. Countries have adopted few public policies to address this problem, and the main concern is whether to enforce vaccination and the extent to which measures are legal. The quality of the evidence base remains weak. Skepticism, mistrust, and hesitancy toward vaccination are global issues that can jeopardize vaccination coverage.

BCG vaccination of healthcare workers for protection against COVID-19: 12-month outcomes from an international randomised controlled trial

ObjectivesBacille Calmette-Guérin (BCG) vaccine has immunomodulatory effects that may provide protection against unrelated infectious diseases. We aimed to determine whether BCG vaccination protects adults against COVID-19. DesignPhase III double blind randomised controlled trial. SettingHealthcare centres in Australia, Brazil, the Netherlands, Spain, and the United Kingdom during the COVID-19 pandemic. Participants3988 healthcare workers with no prior COVID-19 and no contraindication to BCG. InterventionRandomised 1:1 using a web-based procedure to receive a single 0.1mL intradermal dose of BCG-Denmark (BCG group, n=1999) or saline (placebo group, n=1989). Main outcome measuresDifference in incidence of (i) symptomatic and (ii) severe COVID-19 during the 12-months following randomisation in the modified intention to treat (mITT) population (confirmed SARS-CoV-2 naïve at inclusion). ResultsOf the 3988 participants randomised, 3386 had a negative baseline SARS-CoV-2 test and were included in the mITT population. The 12-month adjusted estimated risk of symptomatic COVID-19 was higher in the BCG group (22.6%; 95% confidence interval [CI] 20.6% to 24.5%) compared with the placebo group (19.6%; 95%CI 17.6% to 21.5%); adjusted difference +3.0 percentage points (95%CI 0.2% to 5.8%; p=0.04). The 12-month adjusted estimated risk of severe COVID-19 (mainly comprising those reporting being unable to work for ≥3 consecutive days) was 11.0% in the BCG group (95%CI 9.5% to 12.4%) compared with 9.6% in the placebo group (95%CI 8.3% to 11.1%); adjusted difference +1.3 percentage points (95%CI -0.7% to 3.3%, p=0.2). Breakthrough COVID-19 (post COVID-19 vaccination), and asymptomatic SARS-CoV-2 infections were similar in the two groups. There were 18 hospitalisations due to COVID-19 (11 in BCG group, 7 in placebo group; adjusted hazard ratio 1.56, 95%CI 0.60 to 4.02, p=0.4) and two deaths due to COVID-19, both in the placebo group. ConclusionsCompared to placebo, vaccination with BCG-Denmark increased the risk of symptomatic COVID-19 over 12 months among health care workers and did not decrease the risk of severe COVID-19 or post-vaccination breakthrough COVID-19. Trial registrationClinicalTrials.gov NCT04327206.

Effectiveness of annual influenza campaigns and vaccination in reducing influenza burden in nursing homes of Canton Vaud in Switzerland

BackgroundInfluenza infections pose significant risks for nursing home (NH) residents. Our aim was to evaluate the impact of the cantonal influenza campaign, and influenza vaccination coverage of residents and healthcare workers (HCWs) on influenza burden in NHs in a context of enhanced infection prevention and control measures (IPC) during the SARS-CoV-2 pandemic.MethodsWe extracted data from epidemic reports provided by our unit to NHs over two consecutive winter seasons (2021-22 and 2022-23) and used linear regression to assess the impact of resident and HCW vaccination coverage, and participation in the campaign, on residents’ cumulative influenza incidence and mortality.ResultsThirty-six NHs reported 155 influenza cases and 21 deaths during the two winter seasons corresponding to 6.2% of infected residents and a case fatality ratio of 13.5%. Median vaccination coverage was 83% for residents, 25.8% for HCWs, while 87% of NHs participated in the campaign. Resident vaccination was significantly associated with a decrease in odds of death (odds ratio (OR) 0.96, 95% confidence interval (CI): 0.93–0.99). There was no significant effect of HCW vaccination coverage on resident infections and deaths. Campaign participation was associated with decreased odds of infection and death among residents (OR: 0.17, 95% CI: 0.06–0.47 and OR: 0.06, 95% CI: 0.02–0.17 respectively).ConclusionOur analysis suggests that in a context of reinforced IPC measures, influenza still represents a significant burden for NH residents. The most effective measures in decreasing resident influenza burden in NHs was participation in the cantonal influenza vaccination campaign and resident vaccination.

Evaluating the Status of Hepatitis B Vaccination in Healthcare Workers at a Central Laboratory in a Tertiary Care Hospital and Research Centre.

Introduction Hepatitis B virusis a significant occupational hazard for healthcare workers worldwide. Long-term protection against hepatitis B infection is conferred by the vaccineand the protective immune response is indicated by anti-hepatitis B surface antigen (HBsAg) titre. It is crucial to monitor anti-HBsAg titres as their levels decrease over time. The study aims to evaluate thestatus of hepatitis B vaccination among personnel working in the Central Laboratory of Shri B.M. Patil Medical College Hospital and Research Centre. The focus is on understanding the immunization practices and protection levels against HBV within this high-risk group. Materials and methods A cross-sectional analysis was conducted, including collecting demographic data, determining HBsAgstatus, evaluating anti-HBsAg titre value, and getting vaccination details of the laboratory personnel. The study participants included doctors, lab technicians, and attendants who were assessed for both vaccination coverage and immunity levels. After obtaining their written consent, 4 ml of blood was collected in sterile blood collection tubes. All the samples were tested for HBsAg. The negative samples were tested for anti-hepatitis B surface antigen antibody (HBsAg-Ab (IgG)) titre. The enzyme-linked immunosorbent assay (ELISA) method was used to evaluate the obtained samples for HBsAg and anti-HBsAg titre. Results A total of 99 healthcare workerswere included in the study. Most of the laboratory healthcare workers were in the age range of 20-30 years.In 84.8% of the subjects, protective antibody levels (>10 IU/ml) were found. The highest protection was seen among doctors (94.5%), followed by lab technicians (82.9%) and attendants (66.6%). However, 15.2% exhibited inadequate immunity, predominantly among the attendants (33.3%). The highest vaccination coverage was among doctors (91.8%), followed by lab technicians (78.7%) and attendants (53.3%). Most doctors had completed the full vaccination schedule (70.2%) or received a booster dose (24.3%) compared to lab technicians (57.4%)and attendants (46.6%). Conclusion The study highlights effective preventive measures against HBV among laboratory healthcare workers, as indicated by the absence of active infections. But it also emphasizes the necessity of focused initiatives to raise vaccination rates, particularly among attendants, in order to guarantee complete protection against HBV for all levels of laboratory workers.

Healthcare workers’ perspectives on mandatory influenza vaccination: a scoping review

Background: Vaccination is efficacious at preventing influenza disease transmission, morbidity and mortality. Benefits of influenza vaccination for healthcare workers (HCW) are emphasized, yet vaccine uptake among HCW remains suboptimal. Mandatory vaccination programs may increase influenza vaccine uptake, however, attitudes and beliefs of HCW towards these mandates are not well known. Aims: This scoping review examined the attitudes and beliefs of HCW to ascertain the barriers and enablers to the implementation and acceptance of mandatory vaccination programs in healthcare settings. Design: Scoping review, guided by the PRISMA Extension for Scoping Reviews. Methods: Literature published between 2019 and 2023 was reviewed from five electronic databases, between June and October 2023. Data sources: Quantitative, qualitative and mixed-methods studies were obtained. Studies were limited to full-text English articles, published within peer-reviewed journals over the last five years. Data were extracted by both authors and documented using a modified version of the JBI’s scoping review data extraction instrument, and analyzed thematically. Results: The original search yielded 319 articles. Forty-two articles were screened, with 10 studies included. Most HCW had negative views towards mandatory influenza vaccination, influenced by geographical location, age and discipline. The protection of patients and affordability/accessibility of vaccination were described as enablers to the acceptance of mandatory measures. The belief that mandatory vaccination was a violation of autonomy and misconceptions concerning influenza transmission, vaccine mechanism of action, side effects and effectiveness, were described as common barriers. Conclusions: Health services must carefully consider the context in which mandatory vaccination programs are implemented and employ strategies that incorporate education and promote vaccine accessibility, affordability and HCW autonomy. The quality of evidence retrieved was moderate to poor, with high heterogeneity between studies. Minimal Australian research was evident, limiting the generalisability of findings. These results should be interpreted with caution and further high-quality research is recommended.

Active offer of Tdap vaccination in a cohort of healthcare workers of Maternal and Neonatal Department: Data from a large hospital in Southern Italy

Pertussis is a vaccine-preventable respiratory disease. Pertussis vaccination is currently mandatory for all children in Italy, and is administered in three doses at the beginning of the third, fifth, and twelfth month of life, respectively. Booster doses are also recommended at five-six years, at eleven-twelve years, and then once every ten years. Healthcare workers (HCWs) are a high-risk population for pertussis. Strategies to increase HCWs’ compliance to this vaccination have not been investigated in depth. Our study investigates the determinants of acceptance of a “soft nudge” vaccination campaign in a large hospital in Apulia (Southern Italy).HCWs from the Gynaecology and Neonatology Units of Bari’s Policlinico General Hospital were screened in June 2023 for pertussis vaccination. Non-vaccinated subjects were offered a vaccination appointment. Vaccination determinants were studied, and a logistic regression model was built to identify determinants that significantly influence vaccination acceptance.At the time of screening, only 31.34% of target HCWs (68/217) had already been vaccinated. After the active call intervention, vaccine coverage rose to 70.00% (152/217). Significantly higher coverage was found in the Neonatology Unit (30/43, 69.77%) than in the Gynaecology unit (54/106, 50.94%) (Chi2: 4.41; p-value: 0.036). A logistic regression model confirmed a higher compliance to vaccination in HCWs staffed in the Neonatology Unit (Chi2: 2.08; 95%CI: 1.04 – 4.73; p-value: 0.038).Our intervention increased vaccination coverage in a high-risk cohort. The solicitation was effective, as communication with a trained specialist might have improved the subjects’ perception of vaccination and individual risk of contagion and transmission to others. A synergistic approach, mixing active call with a vaccination mandate, might have greater effectiveness.

Vaccinating the Frontlines: A Qualitative Exploration of Hospital Healthcare Worker Perspectives on Influenza and COVID-19 Immunization.

Although they face higher occupational risk of contracting viral respiratory infections, hospital healthcare worker vaccine hesitancy persists. While most studies have used survey methods to quantify the prevalence of and reasons for healthcare worker vaccine hesitancy, this study employs a qualitative approach to understand their attitudes and beliefs associated with influenza and COVID-19 vaccination. To understand frontline healthcare worker experiences and perspectives on influenza and COVID-19 vaccination, 30 semi-structured interviews were conducted in summer/fall 2022 with staff recruited from two Johns Hopkins hospitals in Maryland. An in-depth, key informant interview was conducted with an expert in public health audience engagement. Interviews were audio recorded and transcribed for thematic and Framework analysis using NVivo software (QSR International, Melbourne, Australia). Healthcare workers engaged in little influenza vaccine information seeking due to their familiarity with the disease and low perceived disease severity. Approximately half (n=16) of healthcare workers reported no vaccine hesitancy towards influenza or COVID-19 vaccines. No physicians or physician assistants expressed any vaccine hesitancy, while most nurses expressed some (n=10). More than half of the women (n=14) expressed COVID-19 vaccine hesitancy compared to none of the men. Structural factors including hospital tier, unit assignment, and professional role influenced perceived risk of disease exposure and subsequent healthcare worker vaccination decisions. Institutional policies, including mandates and a pro-vaccine environment encouraged vaccination uptake. Healthcare workers reported being more receptive to vaccine messaging that focused on protection from disease, scientific and public health data and their heightened occupational exposure to pathogens. Despite their medical knowledge, healthcare workers are susceptible to vaccine hesitancy. Strategies to address specific concerns are needed and can be informed by our findings. A flexible and multi-pronged approach that considers individual anxieties, workplace structures, and the need for open communication with tailored messaging is necessary to promote vaccine acceptance in healthcare settings. What is already known on this topic: Healthcare worker vaccine hesitancy has been associated with many factors including race, gender, age and concerns about vaccine safety.What this study adds: Much of the research on healthcare worker vaccine hesitancy has used surveys and questionnaires giving a broad description of the prevalence and patterns of vaccine hesitancy in the healthcare workforce. This qualitative study examines vaccine behavior (rather than merely intent) through a cross comparison of healthcare workers' experiences and attitudes towards influenza and COVID-19 vaccination.How this study might affect research, practice or policy: Study findings can be used to help tailor vaccine messaging to hospital healthcare workers which could offset concerns regarding vaccine efficacy and risk, to promote vaccine uptake.

Intent to receive flu vaccine and influenza vaccination coverage among health professionals during 2019, 2020 and 2021 campaigns in Côte d’Ivoire

Vaccination of healthcare workers against influenza is a crucial strategy to reduce transmission amongst vulnerable populations, facilitate patient uptake of vaccination, and bolster pandemic preparedness. Globally, vaccination coverage of health workers varied from 10 % to 88 %. Understanding health workers’ knowledge and acceptance of the influenza vaccine, particularly among physicians, is crucial for the fine-tuning and continued success of influenza vaccination campaigns.We conducted a cross-sectional survey of 472 health workers in Abidjan, Côte d'Ivoire, to inform subsequent subnational and national introductions of influenza vaccine and subsequent campaigns targeting health workers in 2019 (14302), 2020 (14872), and 2021 (24473). Using a purposive sample of university hospitals, general hospitals, rural, and urban health facilities, we interviewed a convenience sample of health workers aged 18 years and older. Physicians had the lowest intention to receive the influenza vaccine (58 %), while nurses (78 %) and midwives (76 %) were the most willing. Across all occupations, intention to receive vaccination increased if the vaccine was offered for free or if recommended by the Ministry of Health. 76 % of respondents believed that the influenza vaccine could prevent illness in health workers.Communication strategies, including about the benefits of influenza vaccination, could raise awareness and acceptance among health workers prior to vaccination campaigns. Influenza vaccination coverage rates between 2019 and 2021 were on par with rates of intention to receive vaccination in the 2018 survey; in 2019, 2020, and 2021, coverage among physicians was 73 %, 73 %, and 52 % and coverage among nurses and midwives was 86 %, 86 %, and 74 % respectively.Improving health workers’ knowledge and acceptance of the influenza vaccine, particularly among physicians, is crucial for the continued success of influenza vaccination campaigns.

Sex and gender differences in adverse events following influenza and COVID-19 vaccination

IntroductionActive and passive surveillance studies have found that a greater proportion of females report adverse events (AE) following receipt of either the COVID-19 or seasonal influenza vaccine compared to males. In a predominately young adult female population of healthcare workers, we sought to determine the intersection of biological sex and sociocultural gender differences in prospective active reporting of vaccine outcomes, which remains poorly characterized.MethodsThis cohort study enrolled Johns Hopkins Health System healthcare workers (HCWs) who were recruited from the mandatory annual fall 2019–2022 influenza vaccine and the fall 2022 COVID-19 bivalent vaccine campaigns. Vaccine recipients were enrolled the day of vaccination and AE surveys were administered two days post-vaccination for bivalent COVID-19 and influenza vaccine recipients. Data were collected regarding the presence of a series of solicited local and systemic AEs. Open-ended answers about participants’ experiences with AEs also were collected for the COVID-19 vaccine recipients.ResultsFemales were more likely to report local AEs after either influenza (OR = 2.28, p = 0.001) or COVID-19 (OR = 2.57, p = 0.008) vaccination compared to males, regardless of age or race. Males and females had comparable probabilities of reporting systemic AEs after either influenza (OR = 1.18, p = 0.552) or COVID-19 (OR = 0.96, p = 0.907) vaccination. Hormonal birth control use did not impact the rates of reported AEs following influenza vaccination among reproductive-aged female HCWs. Women reported more interruptions in their daily routine following COVID-19 vaccination than men and were more likely to seek out self-treatment. More women than men scheduled their COVID-19 vaccination before their days off in anticipation of AEs.ConclusionsOur findings highlight the need for sex- and gender-inclusive policies to inform more effective mandatory occupational health vaccination strategies. Further research is needed to evaluate the potential disruption of AEs on occupational responsibilities following mandated vaccination for healthcare workers, a predominately female population, and to more fully characterize the post-vaccination behavioral differences between men and women.

Flu vaccine hesitancy of French nurses and nurse aides: A fresh light on freedom-restoring strategies of reactance to pro-vaccine communication

Despite numerous campaigns, influenza vaccination of healthcare workers remains insufficient in France. The highly cognitive approach of persuasion models in healthcare poorly explains this non-vaccination. A survey of 794 French nurses and nurse aides in 2018 highlights the role of psychological reactance. The greater their perceived threat to freedom due to vaccination pressure, the more it generates situational reactance and strategies for restoring their threatened freedom: denial or minimization of the health threat (low perceptions of severity and vulnerability to influenza) and diminished attractiveness or denigration of the recommended option or its source (low perceptions of efficacy and benefits of vaccination), leading to rejection of the recommended behavior (flu vaccination). This original modeling of variables traditionally seen as antecedents to reactance explains persuasive failure and is contextualized and discussed through objective characteristics (age, profession). Managerial recommendations and avenues of research follow.

Accelerated Bacille Calmette-Guérin reactions: More than meets the eye

An accelerated local injection site reaction following Bacille Calmette-Guérin (BCG) vaccination has been associated with underlying active tuberculosis (TB) in high TB-prevalence settings. The clinical significance of this accelerated BCG reaction in individuals without TB symptoms, particularly in low TB-prevalence countries, is unclear.Using safety surveillance data and baseline interferon-gamma release assays (IGRA) within an international randomised trial of BCG vaccination in healthcare workers (the BRACE trial), we aimed to determine the incidence, and investigate for clinical implications, of an accelerated BCG reaction in asymptomatic adults in low and high TB-prevalence settings.An accelerated BCG reaction occurred in 755/1984 (38 %) of BCG-vaccinees. Although more frequently painful, tender, erythematous and/or swollen within the first fourteen days of vaccination, compared with non-accelerated reactions, the majority of injection site reactions were mild and did not meet criteria for an adverse event.Prior mycobacterial exposure, through prior BCG vaccination (OR 2.46, 95%CI 1.93–3.13, p < 0.001) or latent TB infection (OR 4.17, 95%CI 1.16–14.93, p = 0.03), and female sex (OR 1.27, 95%CI 1.03–1.57, p = 0.02), were key determinants for the occurrence of an accelerated BCG reaction.The development of an accelerated local reaction to BCG vaccination in an individual without prior history of BCG vaccination, should prompt consideration of further investigations for potential underlying TB infection.

Influenza Vaccination of Romanian Medical Students during COVID-19 Times: From Knowledge to Behavior.

In Romania, influenza vaccination uptake among healthcare workers decreased over time despite access to the vaccine being constantly improved. The aim of this paper is to provide a comparative analysis of the knowledge and attitudes of Dental Medicine and Medicine students towards recommended vaccinations for healthcare workers, focusing on influenza vaccination. A cross-sectional study was conducted during the entire 2021-2022 academic year. Data were collected using 2 electronic questionnaires which were applied to the students from the Faculty of Medicine (n = 883) and, respectively, the Faculty of Dental Medicine of the Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. The questionnaires were offered to 1187 students and completed by 911 students (response rate = 77%). Out of these, 85% (n = 778) identified the influenza vaccine as recommended; 35% (n = 321) reported getting an annual influenza vaccination; and 37% (333) reported getting an influenza vaccination in the previous season. Overall, 45% (n = 222) of the respondents who completed the questionnaires from October 2021 to February 2022 reported that they intend to get vaccinated against influenza in the 2021-2022 season and approximately 8% (n = 39) reported that they had already been vaccinated. The multivariable analysis showed that the habit of getting annually vaccinated against influenza as well as the knowledge that influenza vaccine is recommended for all healthcare workers were associated with a higher probability of intending to get vaccinated. The current study emphasizes the need to raise awareness among medical students regarding influenza vaccination and to involve medical education institutions, public health authorities, and healthcare facilities in promoting this vaccination among students since the influenza vaccine uptake rate among medical students included in this study was suboptimal.

Acquired Immunity and Effects of SARS-CoV-2 Vaccination in Healthcare Work-ers and Nursing Students. Post-Booster Follow-Up

Introduction: Discussions on COVID-19 vaccine efficacy and the duration of immunity are relevant to health policy intervention. Aims: To assess adherence to SARS-CoV-2 vaccination in healthcare workers (HCWs) and nursing students (NS). To determine IgG levels after booster doses and to identify effects of vaccination. Methods: Observational followup study on the impact of COVID-19 and vaccine efficacy in 2021 and 2022. The study population comprised HCWs and NS from Albacete (Spain). The sample size was 179 HCWs and 120 NS. Data was gathered using a self-administered questionnaire and venous blood samples 6 months after full vaccination and 6 months after the booster dose, in which IgG levels against SARS-CoV2 were measured. Univariate statistical analyses and bivariate analyses were performed using SPSS (28.0). The project was ap-proved by the Ethics and Clinical Research Committee of Albacete. Results: A total of 229 individuals completed the questionnaires and participated in the initial analyses (148 HCWs and 81 NSs). Adherence to the SARS-CoV-2 vaccination regimen was high (100% in NS and 97% in HCWs). Booster doses were received by 94% of the sample. Homologous vaccines were received by 29% and het-erologous vaccines by 71%. IgG levels: 6 months after full vaccination, seropositivity was 100% and mean IgG levels were 3,017.2 AU/ml in HCWs and 2,484.62 AU/ml in NS (p&lt;0.001). At 6 months after the booster dose the mean IgG levels were 25,789.34 AU/ml in PS and 17,155.07 AU/ml in NS (p&lt;0.001). Adverse effects of the vaccines were mild and local, with some present in a high proportion of those vaccinated. Conclusions: After vaccination, antibody levels were positive at 6 months and increase considerably after the booster dose, remaining high 6 months later. No serious side effects were reported, but a high incidence of mild effects, both general and local, was observed.

The impact of COVID-19 vaccination on the risk of hospitalization in Fayoum healthcare workers

Background: Healthcare workers (HCWs) face several challenges including treating COVID-19 patients. The immunization of the population through vaccination is recognized as a public health priority. The aim of the study is to assess the impact of vaccination on the risk of hospitalization and mortality in HCWs due to COVID-19 infection. Methods: This study was conducted in Egypt in El Fayoum governorate on the HCWs from April 2021 to the end of the year 2021. A cohort retrospective approach was carried out using (the national electronic disease surveillance system) NEDSS and COVID-19 vaccine registration system. Hospitalization is determined by assessment of the cases according to the protocol of COVID-19 management of MOHP November 2020. Results: There was no association between hospitalization and both sex and residence (p=0.1, and 0.06 respectively). There was no statistical significant association between hospitalization and vaccination (time, status, or type). The p=0.2, 0.6, and 0.07 respectively. Age and the presence of comorbidities were statistically significant predictors with p=0.004 and 0.04, respectively, as increasing age and the presence of comorbidities will increase the likelihood of hospitalization by 1.04 and 1.9 folds, respectively. Conclusions: This study shows no significant association between vaccination and hospitalization of HCWs.