Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-13T00:49:20.415Z Has data issue: false hasContentIssue false
  • English
  • Français

Influence of critically appraising exemption requests from healthcare personnel along a spectrum of influenza vaccine hesitancy

Published online by Cambridge University Press:  18 February 2022

Joshua C. Eby Open the ORCID record for Joshua C. Eby [Opens in a new window] ,
Morgan M. Richey Open the ORCID record for Morgan M. Richey [Opens in a new window] ,
Costi D. Sifri Open the ORCID record for Costi D. Sifri [Opens in a new window]  and
Jonathon Z. Schuch
Joshua C. Eby*
Affiliation:
Employee Health, UVA Health, Charlottesville, Virginia Infectious Diseases and International Health, UVA Health, Charlottesville, Virginia
Morgan M. Richey
Affiliation:
Duke Department of Population Health Sciences, Duke University, Durham, North Carolina
Costi D. Sifri
Affiliation:
Infectious Diseases and International Health, UVA Health, Charlottesville, Virginia Office of Hospital Epidemiology/Infection Prevention and Control, UVA Health, Charlottesville, Virginia
Jonathon Z. Schuch
Affiliation:
Employee Health, UVA Health, Charlottesville, Virginia
*
Corresponding author: Joshua C Eby, E-mail: jce4u@virginia.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

This study was performed to assess whether an intervention for critically appraising influenza vaccine exemption requests from healthcare personnel (HCP) affected (1) the overall rate of influenza vaccine exemption within a healthcare institution and/or (2) the rates of postintervention vaccine acceptance among those who inconsistently request exemption from annual vaccination and those who consistently request exemption from vaccination.

Design:

Retrospective, before-and-after intervention study.

Setting:

We conducted the study at a single academic medical center.

Participants:

This study included 29,663 HCP.

Methods:

Between 2010 and 2019, HCP were permitted to request an exemption from influenza vaccination without critical appraisal of exemption requests. After January 2019, medical center policy required critical appraisal of exemption requests. Of those employed 3 or more years who requested an exemption at least once during the preintervention period (n = 1,177), those with unchanging exemption reasons annually were termed “consistent exempters.” Those who changed reasons or accepted vaccination n ≥ 1 times were termed “inconsistent exempters.”

Results:

The overall exemption rate from influenza vaccine decreased from 3.8% to 1.2% (P < .001; N = 29,663) after the intervention. Of those requesting exemption at least once before the intervention, 329 (28.0%) of 1,177 were consistent exempters and 878 (72.0%) were inconsistent exempters. Of inconsistent exempters employed after the intervention, 442 (88.9%) of 497 accepted vaccine postintervention compared with 118 (59.6%) of 198 consistent exempters (P < .001). Of all exempters who changed from exemption to acceptance after the intervention, 442 (78.9%) of 560 were inconsistent exempters.

Conclusions:

Critical appraisal of HCP exemption requests promotes influenza vaccine acceptance, and acceptance by inconsistent exempters drives the effect of the intervention. Analysis of changes in annual exemption requests represents a novel objective method for describing those on the spectrum of vaccine hesitancy.

Keywords

Influenzavaccinehesitancyexemptionhealthcare personnel
Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 11 , November 2022 , pp. 1672 - 1678
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a

Authors of equal contribution.

References

Salgado, CD, Farr, BM, Hall, KK, Hayden, FG. Influenza in the acute hospital setting. Lancet Infect Dis 2002;2:145–155.CrossRefGoogle ScholarPubMed
Wilde, JA, McMillan, JA, Serwint, J, Butta, J, O’Riordan, MA, Steinhoff, MC. Effectiveness of influenza vaccine in healthcare professionals: a randomized trial. JAMA 1999;281:908–913.CrossRefGoogle ScholarPubMed
Bridges, CB, Thompson, WW, Meltzer, MI, et al. Effectiveness and cost-benefit of influenza vaccination of healthy working adults: a randomized controlled trial. JAMA 2000;284:1655–1663.Google ScholarPubMed
Ahmed, F, Lindley, MC, Allred, N, Weinbaum, CM, Grohskopf, L. Effect of influenza vaccination of healthcare personnel on morbidity and mortality among patients: systematic review and grading of evidence. Clin Infect Dis 2014;58:50–57.CrossRefGoogle ScholarPubMed
Talbot, TR, Babcock, H, Caplan, AL, et al. Revised SHEA position paper: influenza vaccination of healthcare personnel. Infect Control Hosp Epidemiol 2010;31:987–995.CrossRefGoogle ScholarPubMed
Fiore, AE, Uyeki, TM, Broder, K, et al. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. Morb Mortal Wkly Rep Recomm Rep 2010;59(RR-8):1–62.Google ScholarPubMed
Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention (CDC). Immunization of healthcare personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). Morb Mortal Wkly Rep Recomm Rep 2011;60(RR-7):1–45.Google Scholar
Healthcare worker immunization. Infectious Diseases Society of America website. https://www.idsociety.org/globalassets/idsa/policy--advocacy/current_topics_and_issues/immunizations_and_vaccines/health_care_worker_immunization/statements/idsa-policy-statement-on-mandatory-immunization-of-health-care-personnel-pdf. Published online December 10, 2013. Accessed July 28, 2021.Google Scholar
MacDonald, NE, SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: definition, scope and determinants. Vaccine 2015;33:4161–4164.CrossRefGoogle ScholarPubMed
Hakim, H, Gaur, AH, McCullers, JA. Motivating factors for high rates of influenza vaccination among healthcare workers. Vaccine 2011;29:5963–5969.CrossRefGoogle ScholarPubMed
Bautista, D, Vila, B, Uso, R, Tellez, M, Zanon, V. Predisposing, reinforcing, and enabling factors influencing influenza vaccination acceptance among healthcare workers. Infect Control Hosp Epidemiol 2006;27:73–77.CrossRefGoogle ScholarPubMed
Black, CL, Yue, X, Ball, SW, et al. Influenza vaccination coverage among health care personnel—United States, 2017–2018 influenza season. Morb Mortal Wkly Rep 2018;67:1050–1054.CrossRefGoogle Scholar
Rakita, RM, Hagar, BA, Crome, P, Lammert, JK. Mandatory influenza vaccination of healthcare workers: a 5-year study. Infect Control Hosp Epidemiol 2010;31:881–888.CrossRefGoogle ScholarPubMed
Babcock, HM, Gemeinhart, N, Jones, M, Dunagan, WC, Woeltje, KF. Mandatory influenza vaccination of healthcare workers: translating policy to practice. Clin Infect Dis 2010;50:459–464.CrossRefGoogle ScholarPubMed
Rebmann, T, Wright, KS, Anthony, J, Knaup, RC, Peters, EB. Seasonal influenza vaccine compliance among hospital-based and nonhospital-based healthcare workers. Infect Control Hosp Epidemiol 2012;33:243–249.CrossRefGoogle ScholarPubMed
Wiwanitkit, V. Influenza vaccination for cancer patients: tertiary prevention of mortality. Asian Pac J Cancer Prev 2009;10:717–718.Google ScholarPubMed
Lugo, NR. Will carrots or sticks raise influenza immunization rates of health care personnel? Am J Infect Control 2007;35:1–6.CrossRefGoogle ScholarPubMed
Dreger, M. Seasonal influenza prevention in health care workers. J Occup Environ Med 2009;51:386–389.Google ScholarPubMed
Edmond, MB. Mandatory flu vaccine for healthcare workers: not worthwhile. Open Forum Infect Dis 2019;6(4):ofy214.CrossRefGoogle ScholarPubMed
Ribner, BS, Hall, C, Steinberg, JP, et al. Use of a mandatory declination form in a program for influenza vaccination of healthcare workers. Infect Control Hosp Epidemiol 2008;29:302–308.CrossRefGoogle Scholar
Polgreen, PM, Septimus, EJ, Parry, MF, et al. Relationship of influenza vaccination declination statements and influenza vaccination rates for healthcare workers in 22 US hospitals. Infect Control Hosp Epidemiol 2008;29:675–677.CrossRefGoogle ScholarPubMed
Ajenjo, MC, Woeltje, KF, Babcock, HM, Gemeinhart, N, Jones, M, Fraser, VJ. Influenza vaccination among healthcare workers: ten-year experience of a large healthcare organization. Infect Control Hosp Epidemiol 2010;31:233–240.CrossRefGoogle ScholarPubMed
Boone, BC, Johnson, RT, Rolando, LA, Talbot, TR. Use of a comprehensive program to review religious and personal seasonal influenza vaccination exemption requests by healthcare personnel. Infect Control Hosp Epidemiol 2021;42:507–512.CrossRefGoogle ScholarPubMed
Prevention strategies for seasonal influenza in healthcare settings. Centers for Disease Control and Prevention website. https://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm. Published May 13, 2021. Accessed July 28, 2021.Google Scholar
The Lancet Child Adolescent Health null. Vaccine hesitancy: a generation at risk. Lancet Child Adolesc Health 2019;3:281.CrossRefGoogle Scholar
Thomson, A, Robinson, K, Vallée-Tourangeau, G. The 5As: a practical taxonomy for the determinants of vaccine uptake. Vaccine 2016;34:1018–1024.CrossRefGoogle ScholarPubMed
Oduwole, EO, Pienaar, ED, Mahomed, H, Wiysonge, CS. Current tools available for investigating vaccine hesitancy: a scoping review protocol. BMJ Open 2019;9:e033245.CrossRefGoogle ScholarPubMed
Dyda, A, King, C, Dey, A, Leask, J, Dunn, AG. A systematic review of studies that measure parental vaccine attitudes and beliefs in childhood vaccination. BMC Public Health 2020;20:1253.CrossRefGoogle ScholarPubMed
Mello, MM, Silverman, RD, Omer, SB. Ensuring uptake of vaccines against SARS-CoV-2. N Engl J Med 2020;383:1296–1299.CrossRefGoogle ScholarPubMed
Omer, SB, Salmon, DA, Orenstein, WA, deHart, MP, Halsey, N. Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. N Engl J Med 2009;360:1981–1988.CrossRefGoogle ScholarPubMed
Offit, PA. The Cutter incident, 50 years later. N Engl J Med 2005;352:1411–1412.CrossRefGoogle ScholarPubMed
Sencer, DJ, Millar, JD. Reflections on the 1976 swine flu vaccination program. Emerg Infect Dis 2006;12:29–33.CrossRefGoogle ScholarPubMed
Trogen, B, Oshinsky, D, Caplan, A. Adverse consequences of rushing a SARS-CoV-2 vaccine: implications for public trust. JAMA 2020;323:2460–2461.CrossRefGoogle Scholar
Gerber, JS, Offit, PA. Vaccines and autism: a tale of shifting hypotheses. Clin Infect Dis 2009;48:456–461.CrossRefGoogle ScholarPubMed
Omer, SB, Pan, WKY, Halsey, NA, et al. Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence. JAMA 2006;296:1757–1763.Google ScholarPubMed
Mohanty, S, Buttenheim, AM, Joyce, CM, Howa, AC, Salmon, D, Omer, SB. Experiences with medical exemptions after a change in vaccine exemption policy in California. Pediatrics 2018;142:e20181051.CrossRefGoogle ScholarPubMed
Delamater, PL, Leslie, TF, Yang, YT. Change in medical exemptions from immunization in California after elimination of personal belief exemptions. JAMA 2017;318:863–864.CrossRefGoogle ScholarPubMed