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ABSTRACT
Influenza vaccination is recommended for healthcare workers (HCWs), but coverage is often low. We reviewed studies evaluating interventions to increase seasonal influenza vaccination coverage in HCWs, including a meta-regression analysis to quantify the effect of each component. Fourty-six eligible studies were identified. Domains conferring a high risk of bias were identified in most studies. Mandatory vaccination was the most effective intervention component (Risk Ratio of being unvaccinated [RRunvacc] = 0.18, 95% CI: 0.08–0.45), followed by “soft” mandates such as declination statements (RRunvacc = 0.64, 95% CI: 0.45–0.92), increased awareness (RRunvacc = 0.83, 95% CI: 0.71–0.97) and increased access (RRunvacc = 0.88, 95% CI: 0.78–1.00). For incentives the difference was not significant, while for education no effect was observed. Heterogeneity was substantial (τ2 = 0.083). These results indicate that effective alternatives to mandatory HCWs influenza vaccination do exist, and need to be further explored in future studies.
Disclosure of potential conflicts of interest
The authors declare that they have no conflicts of interest.
Authors' contributions
TL conceived the idea for this review and designed the search strategy, inclusion criteria and analysis protocol. TL, FK, EM and DP searched the literature and selected the studies. TL and SB extracted and analyzed the data, interpreted the findings and drafted the initial version of the manuscript. All authors participated in the further development of the manuscript and approved the final version for publication.