Vaccination Of Healthcare Workers Research Articles

P-1961. Epidemiologic analysis of an alpha variant COVID-19 nosocomial cluster that occurred after completed vaccination of healthcare workers

Abstract Background In a field where few reports have been made on the efficacy of SARS-CoV-2 vaccines in healthcare settings. We experienced an outbreak of an alpha variant in a medical institution cluster after healthcare workers were vaccinated, providing a novel perspective on the topic.Figure 1.Epidemic curve based on the day of positive SARS-CoV-2 PCR test (A) or on the symptom onset day (B) during this COVID-19 outbreak The index case was a patient admitted to the hospital on 24 May. The last positive case was detected ten days after the first detection, but 42 patients, including five asymptomatics and three healthcare workers, including an asymptomatic, were infected. Methods We conducted descriptive epidemiology from case detection in the cluster of medical institutions with the alpha variant in June 2021. We also compared the relationship between vaccination status and infection using the Fisher exact test for healthcare workers in the same period.Figure 2.Diagram of hospital room layouts for patients infected in the first wave (through June 1) We confirmed infected inpatients in a wide range of hospital rooms. Results We identified one healthcare worker as a first test-positive case on 4 Jun 2021, and 21 positive patients were identified by screening on the day of detection and the following day. Based on the descriptive epidemiological analysis, the index case was a patient admitted to the hospital on 24 May with pneumonia treated with NPPV in an independently air-conditioned negative pressure room from the third day of admission. The last positive case was detected 10 days after first detection, but 42 patients and three healthcare workers were infected (Figure 1). Forty-two of 88 hospitalized patients (53.7%) and 3 of 38 healthcare workers (7.9%) were infected. There were no cases of infection among the 30 healthcare workers who had completed the 2-dose vaccination, and the infection rate was significantly lower than that of the staff members who had not completed the vaccination (0% (0/30) vs. 37.5% (3/8), p=0.008). No hospitalized patients had completed the 2-dose vaccination, including infected and uninfected cases. Aerosol transmission from initial cases, the patient-to-patient droplet route, and the hospital ward contact route were considered factors in the spread of the disease (Figure 2 and Figure 3).Figure 3.Links within the cluster Aerosol transmission from initial cases, the patient-to-patient droplet route, and the hospital ward contact route were considered factors in the spread of the disease. Conclusion Our study not only underscores the importance of strict adherence to standard precautions, early detection of infected cases, and implementation of route-specific prophylaxis but also highlights the crucial role of vaccination in preventing the outbreak and spread of COVID-19 clusters in medical institutions. Disclosures All Authors: No reported disclosures

P-39. Trends in Pertussis Antibody Titers after DTaP Vaccination of Healthcare Workers at a Tertiary Children's Hospital in Japan

Abstract Background In Japan, diphtheria-tetanus-acellular pertussis (DTaP) is used for adults instead of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine. DTaP vaccinations for healthcare workers in obstetrics and pediatrics have been recommended since 2019 in Japan. However, data on the prevalence rate of pertussis antibodies among health care workers are limited. This study aims to evaluate pertussis antibody titers before and after DTaP vaccination to establish an optimal vaccination schedule for healthcare workers. Methods This study was a prospective observational study targeting staff members who received DTaP vaccination at our hospital after 2019. We investigated age, gender, history of pertussis, and history of vaccination with pertussis-containing vaccines at the time of participating in this study. Anti-PT-IgG antibodies (EIA method) were measured once a year in the remaining serum from staff health examinations. We defined 40 EU/mL as the antibody-positive threshold. Results There were 1454 subjects, with a median (IQR) age of 33 (26-44) years and 349 (24%) were male. Twenty-one (1.4%) had a history of pertussis, and the reason for diagnosis was antibody testing in 8, symptoms in 7, and unknown in 6. Thirty-one (2%) received a pertussis-containing vaccine within 10 years at the time of participating in this study. Antibody positivity rates were 16% (194/1222), 42% (383/928), 35.3% (226/639), and 25% (105/416) before, one year, two years, and three years after final DTaP vaccination, respectively. Within 1028 seronegative subjects before vaccination, 25% seroconverted after vaccination; during 108 subjects of which who could follow their titer continuously, 48% maintained the antibodies for up to three years. In one case, the person did not seroconvert but developed antibodies up to 100 IU/mL two years after vaccination. During the study period, no pertussis cases were diagnosed, and no outbreaks were observed in our hospital. Conclusion In this study, 84% of Japanese healthcare workers did not have sufficient pertussis antibodies before DTaP vaccination. Following a single dose of DTaP vaccination, 25% showed positive pertussis antibody titers, of which 45% maintained effective antibody levels for 3 years. Disclosures All Authors: No reported disclosures

Identifying emerging drivers and interventions to reduce vaccine hesitancy among long-term care facility nursing staff.

The study aimed to identify key drivers of vaccine hesitancy among healthcare workers (HCWs) employed at Long-term care facilities (LTCF) within selected states. It also sought to determine which interventions, policies, and programs effectively reduced HCW vaccine hesitancy for COVID-19 and influenza. The study employed a mixed methods approach, combining secondary analysis of the Behavioral Risk Factor Surveillance System (BRFSS) data, survey research, and focus groups. BRFSS data on influenza and COVID-19 rates informed the selection of states for qualitative sampling frames. HCWs from LTCFs (i.e., skilled nursing facilities and nursing homes) were recruited to complete a survey based on the sampling frame. Additionally, administration and nursing management from participating facilities were invited to participate in focus groups. Survey results (N = 199 from 23 facilities) showed vaccine hesitancy among HCWs in LTCFs is a complex issue influenced by several factors, such as lack of knowledge, misinformation, and doubts about vaccine safety, efficacy, risks, and benefits. Focus groups (N = 25 from 15 facilities) revealed a spectrum of vaccine hesitancy, ranging from acceptance to outright refusal. The survey and focus groups identified effective interventions to reduce HCW vaccine hesitancy, including educational campaigns, onsite vaccination, and vaccine recommendations from trusted nursing staff. This study provides important insights into addressing vaccine hesitancy among HCWs in LTCF. It highlights the moral and ethical responsibility for targeted interventions to improve vaccine uptake in the healthcare sector.

P-721. Risk Factors Associated with COVID-19 Among Fully Vaccinated Healthcare Workers in Lima, Peru

Abstract Background Healthcare workers (HCWs) are an important target group for COVID-19 vaccination. In February 2021, Peru launched a COVID-19 vaccination campaign among HCWs using a BBIBP-CorV inactivated whole-virus vaccine (Sinopharm). We aim to understand risk factors for SARS-CoV-2 infection after vaccination using a cohort of HCWs in two hospitals in Lima, Peru. Methods Between August 2021-June 2022, HCW who received at least two COVID-19 Sinopharm vaccine doses were enrolled in the cohort and followed for 6 months. Participants provided a self-collected nasal swab weekly for SARS-CoV-2 by reverse transcriptase polymerase chain reaction testing. SARS-CoV-2 infection was confirmed by a positive PCR test result at least 14 days after receiving the second vaccine dose. Adjusted hazard ratios (aHR) were used to identify associations with infection accounting for potential confounding. Person-time was calculated based on days between negative PCR results, capped at 10 days; in cases of infection, the time between positive and negative tests was halved, with half the days considered at risk. Results Of 670 vaccinated HCWs, 111 (16.6%) tested positive for SARS-CoV-2 during the follow-up period. In adjusted models, prior report of COVID-19 illness in the previous 12-months was associated with reduced risk of infection (aHR: 0.98 [95% CI:0.97‒0.99], p=0.026). Being beyond 6 months since the last vaccination was significantly associated with an increased risk of infection (aHR: 3.22 [95% CI:1.66‒6.23], p=0.0001) as well as working in an outpatient setting (aHR: 1.94 [95% CI:1.06‒3.53], p=0.031). Conclusion In this cohort of healthcare workers undergoing regular asymptomatic COVID testing, our findings suggest evidence of waning protection at 6 months post-vaccination BBIBP- CorV. Additionally, preliminary indications suggest that healthcare worker behaviors or specific occupational exposures may contribute to increased infection risk even following vaccination. In addition, these results support the inclusion of HCWs as a priority group for additional booster doses of COVID-19 vaccine at 6 months after the most recent dose. Disclosures All Authors: No reported disclosures

Vaccinating in Different Settings: Best Practices from Italian Regions.

The success of vaccination programs depends on a complex interplay of logistical, social, and structural factors. The objective of this study was to analyze the different approaches to vaccine administration implemented by several Italian regions since the onset of the SARS-CoV-2 pandemic. After careful qualitative review of information gathered from scientific articles, official reports (grey literature), contact with regional health authorities, and local health departments, five vaccination strategies across several Italian regions focusing on alternative vaccine providers and/or settings were identified. The innovative practices implemented by different actors covered specific topics and were then examined and described in detail. In Veneto, where prevention departments were the main actor, herpes zoster vaccination coverage for the 65-year-old cohort increased from 44.4% to 54.9%; in Tuscany, family pediatricians administered 64% of all childhood vaccines; in Liguria, pharmacies delivered 70.1% of COVID-19 vaccines, while vaccinating in schools in Taranto led to higher human papilloma virus vaccination rates compared to regional and national averages. Finally, in all the regions, hospitals focused on vaccinating healthcare workers and vulnerable populations. The positive outcomes of these five experiences may, in a context of limited resources, encourage other national and international entities to adopt innovative practices, which offer new perspectives beyond the traditional delivery methods (i.e., local health authority vaccination centers for childhood and adolescent immunizations, and family doctors for adults and the elderly). These strategies suggest the efficacy of specific local approaches favored by regional autonomy in optimizing vaccine distribution and coverage.

A Global Perspective on Infection Control Measures for Healthcare Workers: A Systematic Review

Infection control measures are essential to safeguarding healthcare workers (HCWs) and preventing healthcare-associated infections (HAIs) worldwide. This systematic review examines the global implementation of infection control strategies, their effectiveness, and the disparities between high-income countries and low- and middle-income countries (LMICs). A comprehensive search was conducted across multiple databases, focusing on studies published since 2016 that evaluated infection control practices, including hand hygiene, personal protective equipment (PPE), vaccination, environmental cleaning, and waste management. Findings reveal significant variation in compliance and outcomes, with LMICs facing challenges such as resource shortages, inadequate training, and organizational deficiencies. Conversely, high-income countries demonstrate better adherence to infection control protocols, supported by advanced technologies and robust policies. Despite these differences, common barriers such as HCW burnout and vaccine hesitancy persist globally. The review underscores the need for equitable access to resources, international collaboration, and the integration of innovative technologies to enhance infection prevention measures. Addressing these disparities is critical to protecting HCWs, improving patient safety, and achieving global health equity.

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.

Mandatory COVID-19 Vaccination in the Health Sector: a Comparative Approach Between the Greek and American Examples.

A few months after national vaccination campaigns were initiated around early 2021, the discussion regarding the mandatory vaccination of healthcare workers started gaining ground in most European states and also in the United States. The debate on whether healthcare workers should be required to be vaccinated has been fueled by three main reasons: the high transmissibility rate of the Delta variant, which posed a significant risk to national healthcare systems across Europe and the Americas, as well placing high pressure on intensive care units even in the summer months (a); states' inability to impose general lockdowns and social distancing measures during the 2022 winter due to financial hardship and fears of an ongoing recession (b); and governmental unwillingness to implement restrictive measures, having in mind their populations' tiredness from previous lockdowns (c). This paper will explore the legal and managerial implications of mandatory vaccination among healthcare workers and will argue that it has the capacity to be a successful part of effective national healthcare systems in the search for responsible professionals to staff them. It will argue that national vaccination strategies are dependent on states' national healthcare models. It will show how the major difference in healthcare models of the two states chosen as examples have affected their vaccination policies and their reception by healthcare personnel. Finally, it will prove that the advantages of mandatory vaccination for healthcare personnel outweigh prospected disadvantages, irrespective of ethical, or legal justification is applied. This research will go through the key points of the legislative provisions of the two states (a); it will delve into their legal (b) and managerial implications (c); and finally, it will go through the policy questions which arose (d). It will prove how selective mandatory vaccination policies may be applied to national healthcare systems with foundational differences in their conception. Thus, it will demonstrate that selective mandatory vaccination is a viable option both for models approaching health from a societal perspective, and from the liberal ones.

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.

Immune Response Against Influenza in a Cohort of Repeatedly Vaccinated Adults During the 2017/2018 and 2018/2019 Seasons.

The influenza vaccination of healthcare workers (HCWs) is recommended each autumn and winter season by the relevant authorities in EU/EEA countries. The objective of this study was to evaluate the impact of repeated trivalent influenza vaccine (TIV) uptake during the 2017/2018 and 2018/2019 seasons on vaccine-derived immunity against influenza. A cohort study of HCWs vaccinated with an annual TIV was conducted from October 2017 to June 2019. The protective antibodies against the influenza vaccine strains were assessed at three time points: prior to vaccination and at one and six months following vaccination for each season. Sera were tested by hemagglutination inhibition assay. Participants were grouped according to their history of TIV vaccination over four seasons (since 2015/16), with the groups designated as "frequently vaccinated" (≥3 vaccines) and "occasionally vaccinated" (≤2 vaccines). Seroprevalence, geometric mean titer (GMT) and seroconversion rate were compared between the frequently and occasionally vaccinated groups. A total of 97 healthcare workers (HCWs) were enrolled in the study; 49 HCWs participated in both seasons. Thirty-two (43.2%) and forty-three (59.7%) individuals had ≥3 vaccines since 2015/2016, at recruitment and during the 2017/2018 and 2018/2019 influenza seasons, respectively. One month following vaccination, HCWs who had received occasional vaccinations demonstrated a higher prevalence of protective antibodies and a greater GMT for both influenza A(H1N1)pdm09 and A(H3N2) viruses. For influenza B Victoria, the frequently vaccinated HCWs demonstrated a higher seroprevalence rate, seroconversion, and GMT. Previous vaccination can influence the immune response, although without substantially compromising the immunogenicity of annual influenza vaccination. HCW annual influenza vaccination is required to re-establish and maintain the antibody titers against influenza.

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.

Dynamics of Covid-19 Vaccine-Hesitancy among Primary Health Care Workers in an Urban City in India: An Exploratory Study.

The health-care workers (HCWs) were one of the vulnerable populations prioritized during the COVID-19 vaccination (COVISHIELD and COVAXIN) campaign. We aimed to estimate vaccine hesitancy and explore influencing factors among 238 HCWs in 21 Urban Primary Health Centres (UPHCs) across Hyderabad during June and July 2021. We used a semi-structured questionnaire and the SAGE determinants of vaccine hesitancy to determine factors underlying vaccine hesitancy and acceptance. A thematic framework was developed to unpack the factors that shaped the perceptions about the COVID-19 vaccine. We found a 17% hesitancy rate, primarily due to concerns about "vaccine-safety." HCWs were susceptible to misinformation, potentially shaping their views on COVID-19 vaccines. Despite regulatory approval, one in six HCWs in Hyderabad's UPHCs delayed or refused vaccinations, citing limited "vaccine-safety" information. This underscores the urgent need to address HCW vaccine hesitancy early, given its potential impact on general vaccine acceptance.

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.