Skip to main content Accessibility help
×
×
Home

Factors Associated with Healthcare Worker Acceptance of Vaccination: A Systematic Review and Meta-analysis

  • Marija Vasilevska (a1), Jennifer Ku (a2) and David N. Fisman (a1)
Abstract
Background and objective.

Healthcare workers experience occupational risk of infection and may transmit infections to patients. Vaccination provides an efficient means of protecting workers and patients, but uptake may be low. We sought to identify factors influencing vaccine acceptance by healthcare workers in order to obtain insights leading to more effective vaccination programs in this population.

Design.

Systematic review and meta-analysis.

Methods.

We searched Medline, Embase, and CINAHL databases to identify studies published up to May 2012. Factors influencing vaccination acceptance were devised a priori. Random-effects meta-analysis was performed to generate summary estimates of effect. Heterogeneity and publication bias were explored using statistical tools.

Results.

Thirty-seven studies evaluating a variety of vaccines (against influenza, pertussis, smallpox, anthrax, and hepatitis B) were included. Homogeneous effects on vaccine acceptance were identified with desire for self-protection (odds ratio [OR], 3.42 [95% confidence interval (CI), 2.42–4.82]) and desire to protect family and friends (OR, 3.28 [95% CI, 1.10–9.75]). Concern that vaccine transmits the illness it was meant to prevent decreased acceptance (OR, 0.42 [95% CI, 0.30–0.58]). Differences in physician and nurse acceptance of immunization were seen between Asian and non-Asian studies.

Conclusions.

Consideration of self-protection (rather than absolute disease risk or protection of patients) appears the strongest and most consistent driver of healthcare workers’ decisions to accept vaccination, though other factors may also be impactful, and reasons for between-study divergence in effects is an important area for future research. This finding has important implications for the design of programs to enhance healthcare worker vaccine uptake.

Infect Control Hosp Epidemiol 2014;35(6):699–708

Copyright
Corresponding author
Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 547, Toronto, Ontario M5T 3M7, Canada (david.fisman@utoronto.ca).
References
Hide All
1. Halasa, NB, Williams, JV, Wilson, GJ, Walsh, WF, Schaffner, W, Wright, PF. Medical and economic impact of a respiratory syncytial virus outbreak in a neonatal intensive care unit. Pediatr Infect Dis J 2005;24(12):10401044.
2. Salgado, CD, Giannetta, ET, Hayden, FG, Farr, BM. Preventing nosocomial influenza by improving the vaccine acceptance rate of clinicians. Infect Control Hosp Epidemiol 2004;25(11):923928.
3. Outbreaks of pertussis associated with hospitals–Kentucky, Pennsylvania, and Oregon, 2003. MMWR Morb Mortal Wkly Rep 2005;54(3):6771.
4. Hyde, TB, Gilbert, M, Schwartz, SB, et al. Azithromycin prophylaxis during a hospital outbreak of Mycoplasma pneumoniae pneumonia. J Infect Dis 2001;183(6):907912.
5. Ofner-Agostini, M, Gravel, D, McDonald, LC, et al. Cluster of cases of severe acute respiratory syndrome among Toronto healthcare workers after implementation of infection control precautions: a case series. Infect Control Hosp Epidemiol 2006;27(5):473478.
6. Maltezou, HC. Nosocomial influenza: new concepts and practice. Curr Opin Infect Dis 2008;21(4):337343.
7. Carman, WF, Elder, AG, Wallace, LA, et al. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet 2000;355 (9198):9397.
8. Wilde, JA, McMillan, JA, Serwint, J, Butta, J, O’Riordan, MA, Steinhoff, MC. Effectiveness of influenza vaccine in health care professionals: a randomized trial. JAMA 1999;281(10):908913.
9. Rea, E, Upshur, R. Semmelweis revisited: the ethics of infection prevention among health care workers. CMAJ 2001;164(10):14471448.
10. Hofmann, F, Ferracin, C, Marsh, G, Dumas, R. Influenza vaccination of healthcare workers: a literature review of attitudes and beliefs. Infection 2006;34(3):142147.
11. Hollmeyer, H, Hayden, F, Poland, G, Buchholz, U. Influenza vaccination of health care workers in hospitals: a review of studies on attitudes and predictors. Vaccine 2009;27:39353944.
12. Riphagen-Dalhuisen, J, Gefenaite, G, Hak, E. Predictors of seasonal influenza vaccination among healthcare workers in hospitals: a descriptive meta-analysis. Occup Environ Med 2012;69(4):230235.
13. Diodati, C. Mandatory vaccination of health care workers. CMAJ 2002;166(3):301302.
14. Abramson, ZH. What, in fact, is the evidence that vaccinating healthcare workers against seasonal influenza protects their patients? a critical review. Int J Family Med 2012;2012:205464.
15. Yassi, A, Lockhart, K, Buxton, JA, McDonald, I. Vaccination of health care workers for influenza: promote safety culture, not coercion. Can J Public Health 2010;101(suppl 1):S41S45.
16. Downs, SH, Black, N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998;52(6):377384.
17. Becker, MH, Maiman, LA. Sociobehavioral determinants of compliance with health and medical care recommendations. Med Care 1975;13(1):1024.
18. Deeks, JJ, Altman, DG. Effect measures for meta-analysis of trials with binary outcomes. In: Egger, M, Smith, GD, Altman, DG, eds. Systematic Reviews in Health Care. London: sBMJ, 2008:313335.
19. Deeks, JJ, Altman, DG, Bradburn, MJ. Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger, M, Smith, GD, Altman, DG, eds. Systematic Reviews in Health Care. London: BMJ, 2008:285312.
20. Smith, GD, Egger, M. Going beyond the grand mean: subgroup analysis in meta-analysis of randomised trials. In: Egger, M, Smith, GD, Altman, DG, eds. Systematic Reviews in Health Care. London: BMJ, 2008:143156.
21. Sterne, JAC, Egger, M, Smith, GD. Investigating and dealing with publication and other biases in meta-analysis. BMJ 2001;323(7304):101105.
22. Pareek, M, Clark, T, Dillon, H, Kumar, R, Stephenson, I. Willingness of healthcare workers to accept voluntary stockpiled H5N1 vaccine in advance of pandemic activity. Vaccine 2009;27(8):12421247.
23. Beguin, C, Boland, B, Ninane, J. Health care workers: vectors of influenza virus? low vaccination rate among hospital health care workers. Am J Med Qual 1998;13(4):223227.
24. Qureshi, AM, Hughes, NJM, Murphy, E, Primrose, WR. Factors influencing uptake of influenza vaccination among hospital-based health care workers. Occup Med 2004;54(3):197201.
25. Chor, JSY, Pada, SK, Stephenson, I, et al. Seasonal influenza vaccination predicts pandemic H1N1 vaccination uptake among healthcare workers in three countries. Vaccine 2011;29(43):73647369.
26. Al-Tawfiq, JA, Antony, A, Abed, MS. Attitudes towards influenza vaccination of multi-nationality health-care workers in Saudi Arabia. Vaccine 2009;27(40):55385541.
27. Lam, P, Chambers, L, MacDougall, D, McCarthy, A. Seasonal influenza vaccination campaigns for health care personnel: systematic review. CMAJ 2010;182(12):E542–E548.
28. Arda, B, Durusoy, R, Yamazhan, T, et al. Did the pandemic have an impact on influenza vaccination attitude? a survey among health care workers. BMC Infect Dis 2011;11(1):87.
29. Barrière, J, Vanjak, D, Kriegel, I, et al. Acceptance of the 2009 A(H1N1) influenza vaccine among hospital workers in two French cancer centers. Vaccine 2010;28(43):70307034.
30. Bautista, D, Vila, B, Usó, R, Téllez, M, Zanón, V. Predisposing, reinforcing, and enabling factors influencing influenza vaccination acceptance among healthcare workers. Infect Control Hosp Epidemiol 2006;27(1):7377.
31. Briggs, MJ, Thomas, J. Obstacles to hepatitis B vaccine uptake by health care staff. Public Health 1994;108(2):137148.
32. Christini, AB, Shutt, KA, Byers, KE. Influenza vaccination rates and motivators among healthcare worker groups. Infect Control Hosp Epidemiol 2007;28(2):171177.
33. Doebbeling, BN, Edmond, MB, Davis, CS, Woodin, JR, Zeitler, RR. Influenza vaccination of health care workers: evaluation of factors that are important in acceptance. Prev Med 1997;26(1):6877.
34. Everett, WW, Zaoutis, TL, Halpern, SD, Strom, BL, Coffin, SE. Preevent vaccination against smallpox: a survey of pediatric emergency health care providers. Pediatr Infect Dis J 2004;23(4):332337.
35. Fowler, GL, Baggs, JM, Weintraub, ES, Martin, SW, McNeil, MM, Gust, DA. Factors influencing laboratory workers’ decisions to accept or decline anthrax vaccine adsorbed (AVA): results of a decision-making study in CDC’s anthrax vaccination program. Pharmacoepidemiol Drug Saf 2006;15(12):880888.
36. Goins, WP, Schaffner, W, Edwards, KM, Talbot, TR. Healthcare workers’ knowledge and attitudes about pertussis and pertussis vaccination. Infect Control Hosp Epidemiol 2007;28(11):12841289.
37. Heimberger, T, Chang H-G, Shaikh, M, Crotty, L, Morse, D, Birkhead, G. Knowledge and attitudes of healthcare workers about influenza: why are they not getting vaccinated? Infect Control Hosp Epidemiol 1995;16(7):412415.
38.LaVela, SL, Smith, B, Weaver, FM, Legro, MW, Goldstein, B, Nichol, K. Attitudes and practices regarding influenza vaccination among healthcare workers providing services to individuals with spinal cord injuries and disorders. Infect Control Hosp Epidemiol 2004;25(11):933940.
39. Lee, DJ, Carrillo, L, Fleming, L. Epidemiology of hepatitis B vaccine acceptance among urban paramedics and emergency medical technicians. Am J Infect Control 1997;25(5):421423.
40. Lester, RT, McGeer, A, Tomlinson, G, Detsky, AS. Use of, effectiveness of, and attitudes regarding influenza vaccine among house staff. Infect Control Hosp Epidemiol 2003;24(11):839844.
41. Manuel, DG, Henry, B, Hockin, J, Naus, M. Health behavior associated with influenza vaccination among healthcare workers in long-term-care facilities. Infect Control Hosp Epidemiol 2002;23(10):609614.
42. Martinello, R, Jones, L, Topal, J. Correlation between healthcare workers’ knowledge of influenza vaccine and vaccine receipt. Infect Control Hosp Epidemiol 2003;24:845847.
43. Nichol, KL, Hauge, M. Influenza vaccination of healthcare workers. Infect Control Hosp Epidemiol 1997;18(3):189194.
44. Norton, SP, Scheifele, DW, Bettinger, JA, West, RM. Influenza vaccination in paediatric nurses: cross-sectional study of coverage, refusal, and factors in acceptance. Vaccine 2008;26(23):29422948.
45. Nowalk, M, Lin, C, Zimmerman, R, et al. Self-reported influenza vaccination rates among health care workers in a large health system. Am J Infect Control 2008;36(8):574581.
46. O’Reilly, FW, Cran, GW, Stevens, AB. Factors affecting influenza vaccine uptake among health care workers. Occup Med 2005;55(6):474479.
47. Panhotra, BR, Saxena, AK, Al-Hamrani, HA, Al-Mulhim, A. Compliance to hepatitis B vaccination and subsequent development of seroprotection among health care workers of a tertiary care center of Saudi Arabia. Am J Infect Control 2005;33(3):144150.
48. Piccirillo, B, Gaeta, T. Survey on use of and attitudes toward influenza vaccination among emergency department staff in a New York metropolitan hospital. Infect Control Hosp Epidemiol 2006;27(6):618622.
49. Rubin, GJ, Potts, HWW, Michie, S. Likely uptake of swine and seasonal flu vaccines among healthcare workers: a cross-sectional analysis of UK telephone survey data. Vaccine 2011;29(13):24212428.
50. Saluja, I, Theakston, KD, Kaczorowski, J. Influenza vaccination rate among emergency department personnel: a survey of four teaching hospitals. Can J Emerg Med 2005;7(1):1721.
51. Seale, H, Kaur, R, Wang, Q, et al. Acceptance of a vaccine against pandemic influenza A (H1N1) virus amongst healthcare workers in Beijing, China. Vaccine 2011;29(8):16051610.
52. Song, JY, Park, CW, Jeong, HW, Cheong, HJ, Kim, WJ, Kim, SR. Effect of a hospital campaign for influenza vaccination of healthcare workers. Infect Control Hosp Epidemiol 2006;27(6):612617.
53. Steiner, MP, Vermeulen, LCRMS, Mullahy, JP, Hayney, MSSP. Factors influencing decisions regarding influenza vaccination and treatment: a survey of healthcare workers. Infect Control Hosp Epidemiol 2002;23(10):625627.
54. Takayanagi, IJ, Cardoso, MRA, Costa, SF, Araya, MES, Machado, CM. Attitudes of health care workers to influenza vaccination: why are they not vaccinated? Am J Infect Control 2007;35(1):5661.
55. Topuridze, M, Butsashvili, M, Kamkamidze, G, Kajaia, M, Morse, D, McNutt, LA. Barriers to Hepatitis B vaccine coverage among healthcare workers in the Republic of Georgia: an international perspective. Infect Control Hosp Epidemiol 2010;31(2):158164.
56. Trivalle, C, Okenge, E, Hamon, B, Taillandier, J, Falissard, B. Factors that influence influenza vaccination among healthcare workers in a French geriatric hospital. Infect Control Hosp Epidemiol 2006;27(11):12781280.
57. Walker, FJ, Singleton, JA, Lu, P, Wooten, KG, Strikas, RA. Influenza vaccination of healthcare workers in the United States, 1989–2002. Infect Control Hosp Epidemiol 2006;27(3):257265.
58. Weingarten, S, Riedinger, M, Bolton, LB, Miles, P, Ault, M. Barriers to influenza vaccine acceptance: a survey of physicians and nurses. Am J Infect Control 1989;17(4):202207.
59. Yanturali, S, Suner, S, Aksay, E, Cevik, AA, Sonmez, Y. To be vaccinated or not? a survey of Turkish emergency physicians regarding smallpox. J Emerg Med 2005;28(2):139145.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed