ABSTRACT
The influenza vaccine is the most effective measure to prevent influenza. The aim of this study was to evaluate the impact of measures taken by the hospital on the influenza vaccination coverage of medical staff after implementation. We collected and compared the influenza vaccination of staff in key departments from 2018 to 2022. As the results, in 2018 and 2019, the influenza vaccination rates of staff in key departments in our hospital were generally as low as 10.3% and 11.6%, respectively. After the policy of free vaccination for staff in key departments was adopted in 2020 and other incentive measures, the overall influenza vaccination rates of key departments from 2020 to 2022 were 77.2%, 71.4%, and 81.3%, respectively, which were significantly higher than the pre-2020 vaccination rates in our hospital and healthcare workers in most regions of China. In conclusion, with the implementation of several measures to promote influenza vaccination, the rate of influenza vaccination among medical staff has significantly increased.
Introduction
Influenza is an acute respiratory infection caused by the influenza virus, which is widespread, highly contagious and has a high incidence, with an estimated one billion influenza cases, three to five million severe cases and 290,000 to 650,000 deaths worldwide each year.Citation1 A pandemic of influenza, in the opinion of many experts, poses the greatest danger to global public health.Citation1,Citation2 The influenza vaccine is the most effective measure to prevent influenza, and the World Health Organization recommends influenza vaccination for high-risk groups such as children, the elderly and medical personnel.Citation1
Medical personnel are more exposed to influenza viruses due to their work environment, especially those in high-risk departments such as outpatient and emergency departments. Influenza infection in medical staff can have many undesirable outcomes: impact on productivity, transmission from medical staff to patients, and increased probability of nosocomial infections.Citation3 Numerous studies in the literature have confirmed that influenza vaccination can reduce the incidence of influenza among medical staff and reduce the risk of medical staff working with illness, which is important for ensuring medical safety.Citation4 However, the current influenza vaccination rate for staff in medical institutions in China is relatively low. The results of a cross-sectional study from 10 provinces in China showed that the overall influenza vaccination rate of 1159 public health workers and general practitioners was 25.3%.Citation5 A survey on influenza vaccination among health care workers during the 2019–2020 influenza season in China showed that there could be a short-term increase in influenza vaccination rates among health care workers to 67% under a policy of free vaccination and workplace vaccination requirements.Citation6 After the COVID-19 outbreak in early 2020, China raised its focus on influenza vaccination, recommending that the use of influenza vaccine during the COVID-19 pandemic should be prioritized for the protection of medical staff.Citation7 Children’s Hospital Affiliated to Zhengzhou University has also begun to implement a policy of free influenza vaccination for key department staff.
Influenza virus poses a serious risk to children. Many studies have indicated that children have a much greater rate of influenza than adults, as well as a higher risk of serious illness following infection.Citation8 At the same time, school-age children play an important role in the spread of influenza in schools, homes and communities.Citation9 Children’s hospitals, as medical institutions dedicated to serving children, have higher influenza exposure among medical staff than general hospitals. It is therefore all the more crucial for pediatricians to step up influenza vaccination.
Methods
Henan Children’s Hospital is the largest tertiary children’s hospital in China, with four branches: East Hospital, South Hospital, West Hospital and Central Hospital. Each campus has an emergency medicine department. Henan Children’s Hospital has implemented a policy of free influenza vaccination in key departments since 2020. The key departments include the emergency departments of several hospital districts, mainly because doctors in China’s emergency departments are often confronted with a variety of febrile children and are the frontline doctors most likely to come into contact with children with influenza. Our hospital’s vaccination clinic can provide free influenza vaccinations to personnel in these key departments. To evaluate the impact of this policy on the influenza vaccination coverage of medical staff after implementation, we collected the influenza vaccination of staff in key departments from 2018 to 2022. We obtained a list of key departmental staff who administer the free flu vaccination each year from our hospital’s vaccination clinic. Data on personnel in each department were obtained from the departmental administrators. In addition, verbal interviews were conducted with those who did not receive the influenza vaccine through face-to-face and telephone conversations to find out why they did not get vaccinated.
Results
There are 224 frontline personnel in key departments. In 2018 and 2019, our hospital did not adopt a policy of free influenza vaccination in key departments, and the vaccination rates were generally as low as 10.3% and 11.6%, respectively. After the policy of free vaccination for staff in key departments was adopted in 2020, the vaccination rate of staff in key departments was significantly improved. The overall influenza vaccination rates of key departments from 2020 to 2022 were 77.2%, 71.4%, and 81.3%, respectively, which were significantly higher than the pre-2020 vaccination rates. And the vaccination rates of our hospital were higher than the influenza vaccination rates of medical personnel in most regions of China.Citation10 We also found a large variation in influenza vaccination rates among different departments, with a minimum of 45.2% and a maximum of 96.8%. ()
Table 1. Influenza vaccination coverage of staff in key departments from 2020 to 2021.
Discussion
Our results suggest a significant increase in influenza vaccination rates among medical staff in key departments in our hospital during COVID-19 through a variety of measures to promote influenza vaccination. The study by Ma L et al., however, found that there was a downward trend in influenza vaccination rates among healthcare workers in China during COVID-19.Citation10 The difference between the two results may be largely due to the various measures we have taken after 2020. Through surveys and interviews with medical staff in different departments, we found that the reasons for not administering influenza vaccination in the case of free influenza vaccination are as follows: too busy to work and no time; not considered necessary to be vaccinated; not convinced of the safety of influenza vaccine; and allergic to influenza vaccine components. Given the above situation, through discussions among the departmental staff and review of relevant literature,Citation11,Citation12 we summarized several measures that could improve the influenza vaccination rate of medical staff: 1. adopt incentive-type measures to reward by increasing bonuses those who receive influenza vaccination; 2. the vaccination department shall cooperate with key departments to carry out inoculation at the location of key departments within the agreed time; 3. through meetings and online communication, the department emphasized the necessity and importance of influenza vaccination for medical staff, as well as vaccine safety; 4. for those vaccinated as required, a half-day holiday will be given on the day of vaccination; 5. those who have not been vaccinated are required to report their valid reasons for not being vaccinated. However, our analysis was limited to medical staff in several critical areas at our hospital, and the effectiveness of these procedures needs to be confirmed by more medical institutions.
The Hospital Infection Control Branch of the Chinese Preventive Medicine Association jointly developed the “Guideline on influenza vaccination for staff in Chinese medical institutions” in China in August 2023 in the post-COVID-19 era to strengthen the influenza vaccination of staff in Chinese medical institutions and recommends that medical institutions in each region adopt a diversified approach to promoting influenza vaccination for medical staff according to the actual situation.Citation5 Relevant measures such as free vaccination, enhanced publicity and incentive mechanisms adopted by our hospitals in key departments have been proven to significantly increase the influenza vaccination rate. The future extension of these measures to healthcare institutions in other districts where the current influenza vaccination rate of medical staff is low is expected to significantly increase the influenza vaccination rate of the entire voluntary workforce, which is of great significance to the prevention and control of influenza.
With the implementation of several measures to promote influenza vaccination, the rate of influenza vaccination among medical staff has significantly increased, so we recommend that other medical institutions adopt similar measures to promote influenza vaccination.
This study has several limitations as well. This was a single-center retrospective study with a small sample size, and we need a larger sample size, multi-center investigation to corroborate our findings.
Conclusion
With the implementation of several measures to promote influenza vaccination, the rate of influenza vaccination among medical staff has significantly increased. These measures can be extended to other health care facilities in the future to increase influenza vaccination rates.
Authors’ contributions
WyJ collected and analyzed the data and was a major contributor in writing the manuscript. XZ and RyS collected and analyzed the data. PL and DbW reviewed and edited the manuscript. ClS offered cceptualization and reviewed and edited the manuscript. All authors read and approved the final manuscript.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Data availability statement
All data generated or analyzed during this study are included in this published article.
Additional information
Funding
References
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