Tailoring Seasonal Influenza Immunization Programmes for Health Care Workers

Transcription

1 Tailoring Seasonal Influenza Immunization Programmes for Health Care Workers Pernille Jorgensen Influenza and other Respiratory Pathogens High-level hearing on seasonal influenza vaccination Luxembourg 30 April 2015

2 Background Low influenza vaccination uptake among key target groups in many countries Reasons for non-vaccination are complex and multiple Influenza vaccination HPV vaccination Females years

3 Addressing low influenza vaccination uptake in the WHO European Region

4 First phase: Health care workers Higher infection rates than other adults Transmission to patients/nursing home residents Continue to work while sick Subclinical infections Lost work days, postponed surgery Vaccinated HCWs more likely to offer vaccine to their patients Photo: Cassandra Butu, WHO, Romania

5 Influenza vaccination uptake (%) in HCWs, WHO European Region Vaccination coverage is generally low Monitoring of vaccination uptake lacking (or not being reported) Vaccination coverage from 2011/2012 or 2012/2013 season, depending on latest available data Source: VENICE collaboration, ECDC, and WHO/Europe

6 Tailoring Immunization Programmes (TIP) to increase influenza vaccination Step-by-step tool grounded in behavioural science and social marketing theories Use qualitative and quantitative research

7 Key steps in TIP Identify and prioritize target groups Diagnose demand- and supply-side barriers and motivators to vaccination Design evidence-informed interventions to assist decision-makers in tailoring services to close immunity gaps

8 Application of TIP in Montenegro Results from quantitative and qualitative research

9 Montenegro, quick facts Population: , of which live in Podgorica Healthcare system predominantly public sector TIP implemented in the Primary Health Care Centre of Podgorica (~400 HCWs, serves 1/3 of the population)

10 Identify and prioritize target groups 1 in 5 HCWs vaccinated against seasonal influenza Generally, low levels of vaccination among both doctors and nurses Similar across departments, gender, seniority, education etc..

11 Diagnose situation SWOT Strengths Well-working child immunization program SIV guidelines, with defined risk groups Well-functioning procurement and distribution system for SIV Well-respected Public Health Institute Vaccination free of cost Opportunities No strong barriers to SIV among HCWs Quality improvement and patient safety strategic priorities for MoH; opportunity to promote vaccination among HCWs Decisive role of HCWs in SIV in risk groups Weaknesses Low SIV uptake among HCWs Low perception of SIV benefits Lack of clarification on effectiveness and safety Need for greater political and managerial commitment to HCW vaccination at facility level Low motivation of medical staff to get SIV as part of their routine professional practice Threats Nosocomial outbreaks in health care settings Anti-vaccine sentiment in media and distrust after 2009 pandemic (general public, parents, HCWs) No institutional platform to address vaccination concerns and hesitancy on digital media platforms Low sense of importance of HCWs role in transmitting seasonal influenza

12 Diagnose barriers and motivators I am afraid of needles It s my duty as manager to get vaccinated Influenza is not severe My colleagues don t get vaccinated Immunity through infection is better than the vaccine Vaccines are unsafe Where do I get the flu shot? I am way too busy I suffer from diabetes

13 Barriers I have been working for almost 30 years. So far, I have not caught influenza. I think my immune system is good (nurse, not vaccinated, age 44) Time/access Vaccine not effective Other reasons Vaccine side effects Natural infection better immunity Acquire immunity through work Not serious/no risk Because I think I am in good shape, in good health (doctor, not vaccinated, age 40) 0% 10% 20% 30% 40% 50% 60% Results from quantitative (survey questionnaire, N=300) and qualitative (semi-structured interviews, N=25) studies

14 Motivators (facilitators) 100% 80% 36% yrs vaccinated 8% yrs vaccinated 60% 40% 20% I suffered from flu, that s the first reason why I get vaccinated. I work with infected patients and am exposed to the risk every day. Also I ve heart problems and influenza could deteriorate my health (nurse, vaccinated, age unknown) 0% Protect self Protect family Protect patients Afraid of flu Flu in the past Serious disease Other Encouraged by media Encouraged by family Rec by employer Rec by colleague Results from quantitative (survey questionnaire, N=300) and qualitative (semi-structured interviews, N=25) studies

15 Categorize facilitators and barriers Environmental Social/community Personal

16 Conceptual map Facilitates identification of factors that courage or discourage vaccination in a given context Helps identify how and what the programme should focus on to trigger positive behaviour change

17 Design and implement interventions (mix of strategies) Set objective Design evidenceinformed strategies Monitor & evaluate

18 Current and future activities Publication of TIP FLU for HCWs and Montenegro case study Development of TIP FLU for pregnant women Annual Influenza Awareness Campaigns in collaboration with Member States

19 Acknowledgements HProImmune Agoritsa Baka, Pania Karnaki, Greece TIP FLU expert working group, Montenegro Mensud Grbovic, Ministry of Health Nebojsa Kavaric, Primary Health Care Centre Podgorica Natasa Terzic, Institute of Public Health HCWs at Institute of Public Health; Primary Health Care Centre Podgorica; Adult Infectious Disease, Pediatrics, and Gynecologists and Obstetricians clinics at the Clinical Centre of Montenegro; Duga Long-term Care Facility, and national nurses associations and networks. TIP FLU for HCWs guide Nathalie Likhite, independent consultant Photo: Cassandra Butu, WHO