Monitoring influenza vaccination coverage and acceptance among health-care workers in German hospitals – results from three seasons

Figures & data

Table 1. Reasons not to get vaccinated, list of items assessed grouped according to vaccine hesitancy model (confidence, complacency, convenience)

Confidence	Complacency	Convenience/constraints
• I am afraid of side-effects.	• It is unlikely that I will get flu.	• I’ve always wanted to, but for organizational reasons, I’ve not made it.
• The vaccine is ineffective.	• I do not pose a risk to patients.
• If I weigh risk and benefits, the vaccine scores poorly.	• I am not aware that I should be vaccinated.	• At my workplace no flu vaccine is offered.
• I do not trust the official recommendations.		• I forgot about it/thought about it too late.
• The influenza vaccine can cause influenza.
• I was advised against the vaccination. • I am generally against vaccinations.

Table 2. Influenza vaccination coverage and study population stratified for different variables, results from the OKaPII study, data from 2017–2019

	Survey 2017		Survey 2018		Survey 2019
Hospitals	52		125		171
Participants	5 808		17 891		27 163
Repeated participation			5.3%		10.6%
	Rates in % (n =)	Vaccination coverage in %	Rates in % (n =)	Vaccination coverage in %	Rates in % (n =)	Vaccination coverage in %
Gender
Female	74.7 (4 127)	36.6	74.7 (12 893)	36.6	74.7 (19 666)	49.5
Male	25.3 (1 681)	48.1	25.3 (4 998)	47.2	25.3 (7 497)	60.6
Age group
18–24 years	5.7 (320)	21.5	5.6 (987)	21.0	6.7 (1 835)	35.3
25–34 years	24.2 (1 440)	28.6	23.1 (4 219)	31.9	23.5 (6 571)	43.0
35–44 years	23.0 (1 370)	39.7	23.9 (4 320)	38.1	22.2 (6 115)	52.0
45–54 years	30.7 (1 734)	45.3	28.4 (5 010)	42.4	26.6 (7 073)	55.7
≥ 55 years	16.5 (944)	51.0	19.0 (3 355)	50.6	21.0 (5 569)	64.1
Occupational group
Physicians	18.0 (1 074)	60.8	18.0 (3 476)	59.4	18.0 (5 109)	76.0
Nurses	36.7 (1 824)	32.7	36.7 (6 449)	31.1	36.7 (8 474)	46.0
Others	45.3 (2 910)	36.6	45.3 (7 966)	37.9	45.3 (13 580)	47.8
Work area
Ambulance	11.7 (665)	46.4	8.8 (1 612)	45.7	9.0 (2 471)	59.2
Functional diagnostics	No data	No data	8.8 (1 547)	43.9	6.1 (1 614)	59.0
Operation room	8.4 (468)	37.5	7.4 (1 339)	40.4	7.0 (1 826)	58.8
Intensive care unit	7.8 (421)	44.5	7.7 (1 432)	40.7	8.4 (2 188)	56.6
Laboratory/Logistics	6.7 (451)	49.2	4.7 (897)	49.7	4.8 (1 641)	55.8
Normal ward	26.4 (1 414)	38.3	29.2 (5 181)	36.1	29.2 (7 210)	50.7
Administration	26.8 (1 661)	34.4	24.1 (4 212)	35.1	24.0 (6 971)	45.7
Kitchen	No data	No data	0.3 (46)	33.5	0.4 (119)	41.2
Others	12.3 (728)	39.3	9.0 (1 625)	42.6	11.0 (3 123)	53.3
Chronic medical condition
Yes	24.3 (1 413)	45.2	24.9 (4 469)	45.2	27.0 (7 265)	56.3
No	75.7 (4 395)	37.7	75.1 (13 422)	37.4	73.0 (19 898)	50.8
Patient contact
Yes	67.9 (3 746)	41.1	72.5 (12 416)	39.8	67.8 (17 430)	54.7
No	32.1 (2 062)	36.2	27.5 (5 475)	35.6	32.3 (9 733)	47.2
Vaccination offered at workplace
Yes	89.4 (5 166)	42.1	90.8 (16 397)	42.6	93.9 (25 682)	54.3
No	1.5 (83)	26.2	2.0 (322)	21.1	1.2 (268)	30.8
Don’t know	9.1 (559)	16.9	7.2 (1 172)	15.5	4.8 (1 213)	19.4
Hospital size (number of beds)
<200	14.4 (601)	33.6	14.3 (1 271)	31.9	14.4 (1 467)	51.3
200–500	31.3 (1 145)	40.3	31.3 (5 098)	35.4	31.3 (6 502)	49.9
>500	54.4 (4 062)	40.7	54.4 (11 522)	43.6	54.4 (19 194)	54.0
Region
Eastern Germany	No data	No data	34.9 (6.650)	47.5	12.9 (3 360)	62.6
Western Germany	No data	No data	65.1 (11.241)	34.9	87.1 (23 803)	50.8

Weighted data (totals are not weighted).

Figure 1. Influenza vaccination coverage among German hospital staff in season 2016/17-2018/19. Note: others = all hospital staff that is not physicians or nurses including e.g. administration

Figure 2. Reasons for getting vaccinated against influenza among German hospital staff in season 2016/17-2018/19

Figure 3. Why hospital staff did not get vaccinated against influenza in season 2016/17-2018/19

We selected the four most frequent reasons for each physicians and nurses, also showing their respective distribution in the other group. In total, participants could choose from 13 items, see Table 1.

Figure 4. Previous vaccination behavior among unvaccinated hospital staff stratified for occupational group and types of reasons against vaccination (confidence vs. constraints) for 2019 data

Survey question: “How often did you get vaccinated in the last 5 years?”

Table 3. Factors associated with influenza vaccination status for both nurses and physicians (logistic regressions, 2019 data)

	Physicians’ influenza vaccination status	Nurses’ influenza vaccination status
Explanatory variables	Odds Ratios	Odds Ratios
(Intercept)	4.69 (3.12–7.12)	1.06 (0.81–1.38)
Age
18–34	Reference	Reference
35–44	1.10 (0.93–1.31)	1.63 (1.44–1.86)
45–54	1.26 (1.04–1.52)	2.24 (1.99–2.52)
>55	1.51 (1.21–1.89)	3.28 (2.87–3.76)
Gender
Male	Reference	Reference
Female	0.85 (0.74–0.98)	0.95 (0.85–1.06)
Region
East	Reference	Reference
West	0.84 (0.68–1.02)	0.48 (0.42–0.55)
Chronic disease
Yes	Reference	Reference
No	0.88 (0.73–1.04)	0.84 (0.76–0.92)
Patient contact
Yes	Reference	Reference
No	0.53 (0.39–0.73)	0.91 (0.75–1.12)
Work area
Normal ward	Reference	Reference
ITU	1.24 (0.97–1.60)	1.30 (1.14–1.48)
Operating room	0.70 (0.58–0.84)	1.13 (0.95–1.34)
Functional diagnostics	0.97 (0.75–1.27)	1.33 (1.06–1.66)
Laboratory/logistics	2.02 (1.21–3.49)	0.99 (0.39–2.41)
Ambulance/emergency	1.18 (0.96–1.46)	1.23 (1.05–1.43)
Administration	0.69 (0.44–1.10)	1.71 (1.35–2.19)
Others	1.11 (0.81–1.54)	1.34 (1.14–1.58)
Vaccine offered at work
Yes	Reference	Reference
No/don’t know	0.26 (0.20–0.35)	0.30 (0.23–0.39)
Hospital beds
<200	Reference	Reference
200–500	0.76 (0.54–1.06)	0.92 (0.75–1.12)
500–1000	0.94 (0.67–1.31)	0.80 (0.65–0.98)
>1000	1.21 (0.86–1.68)	1.07 (0.88–1.31)
Vaccinated against hepatitis B
Yes	Reference	Reference
No	0.36 (0.19–0.66)	0.69 (0.52–0.91)
Observations	5088	8334
R^Citation2 Tjur	0.047	0.083
AIC	5357.720	10820.770

Bold denotes significant at p <.05.

Janzen J, Tripatzis I, Wagner U, Schlieter M, ller-Dethard E and Wolters E. Epidemiology of hepatitis B surface antigen (HBsAg) and antibody to HBsAg in hospital personnel. J Infect Dis. 1978;3:261–65. doi:10.1093/infdis/137.3.261.

 Google Scholar