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A step ahead of the flu

National influenza immunization campaign – focus on health care

workers

Federal Centre for Health Education (BZgA) and

Robert Koch-Institute (RKI)

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Content of the presentation

• Background• Influenza vaccination of health care workers (HCW)

• Evaluation of German national influenza campaigns in 2006/07 and 2007/08• Preliminary results

• Next steps in 2008/09 influenza season• Special focus on HCW

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Recommendations for influenza vaccination in Germany - STIKO

• Persons 60 years and older• Persons with chronic medical conditions, e.g.

diabetes, COPD, CVD• Residents of long term care facilities• Persons at increased risk of infection

• Health care workers (HCW) • Persons in institutions with frequent interpersonal

contacts• Persons who could pose an infectious risk to

unimmunized contacts

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Influenza vaccination coverage, Germany, 2001 – 2008

TNS Healthcare, European Vaccine Manufacturers 2008

0

10

20

30

40

50

60

70

2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08

Season

%

generalpopulation

HCW

60 years andolder

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HCW immunization rates in 5 European countries

Blank et al. BMC Public Health 2008

23.7%

29.3%

25.2%

13.3%

22.2%

15.9%

23.2%

20.5%

22.6%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

Germany Italy France Spain UK

2003/04

2004/05

2005/06

2006/07

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Recommendation of ECDC

„Priority Risk Groups for Influenza vaccination“ (Aug. 2008):

„development of projects for stronger promotion of immunisation among health-care workers, both for their own benefit and for that of their patients“

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Influenza Campaign (2002 – 2004),RKI and Influenza working group (AGI)

Leitmeyer et al. Vaccine 2006

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Campaign strategy „A step ahead of the flu“

Season 2006/07

- Physicians in practice - Long Term Care Facilities- Public Health service

Season 2007/08

- Physicians in practice- Hospitals- Long Term Care Facilities- Public Health service

Season 2008/09

- Hospitals - Physicians in practice- Long Term Care Facilities - Public Health service

Evaluation I (2007)

Telefone interviews

• Physicians in practice (n=700)

• Hospitals (n=200)

• Long Term Care Facilities (n=500)

Evaluation II (2008)

Telefone interviews

• Physicians in practice (n=700)

• Hospitals (n=200)

• Long Term Care Facilities (n=500)

Evaluation III (2009)

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Evaluation of the campaign – Hospitals (I)

Evaluation: Forsa 2008

Vaccination coverage of HCW in Hospitals

* Difference not significant (α=0.05)

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Evaluation of the campaign – Hospitals (II)

„What do you think are the greatest barriers for immunization against influenza of health care workers?“

Evaluation: Forsa 2008

Critical opinion of flu vaccination

Lack of consciousness for protection of patients

Indifference of HCW

Lack of knowledge/misconceptions of risks and benefits of immunization

Immunization against influenza seen as low priority by leaders of the institution

Required time and organisation for workplace vaccination seen as barrier

Reimbursement of costs unclear

Fear of adverse events

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Strategy for influenza vaccination campaign in HCW

• Based on• Findings from scientific literature• Evaluation of previous national campaigns • Results of workshop with occupational physicians (2007)

• Message must be:• Strong („evidence should guide us“)• Convincing (no mandatory immunization) • Educative (knowledge works)• Understandable (tailored messages)• Emotional (personal concern)

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Key Message of the campaign – focusing on HCW

• By obtaining influenza vaccination, HCW show responsibility for protecting themselves, their families/friends, their patients and patient visitors

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Strategic focus on HCW in hospitals in season 2008/09

• Multifaceted approach to increase vaccination coverage of HCW:• No-cost vaccination• Extensive education• Incentives • Availability of immunization• Leadership involvement• Publicity

Sand et al. JAGS 2007

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Supporting the work of occupatioinal physicians by

• Posters and booklet designed for HCW• CD with flash animation on influenza • ppt – presentation for in-house education • Text modules for local media• „Good practice“ example

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Multiple level approach in season 2007/08

• For vaccinating hospitals• „Good practice“ contest • 1.000 € award for 3 most innovative hospitals

• For vaccinated HCW in hospitals:• Free cup with slogan of the campaign

„Wir kommen der Grippe zuvor.“ • Raffle with 100 book gift certificates valued at 25 €

each

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Perspectives of the campaign

• Innovative „good practice“ examples as communicable models of successful approaches

• Secure sustainability of the campaign(e.g. extension to HCW in long term care facilities)

• Intensify international exchange in prevention of influenza by immunization

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Different cultures of immunization – but sometimes closer than expected!

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Acknowledgements

BZgA• S. Wortberg• M. v.d. Knesebeck

RKI• FG 33

• W. Hellenbrand• S. Reiter

• FG 36• U. Buchholz• S. Buda• W. Haas

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Thank you very much for your attention

Material (German) can be ordered and downloaded from

www.bzga.de/:influenza

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Reasons for refusal of influenza vaccination by HCW

• Fear of adverse effects (8-54%)• Misconception that vaccination can cause influenza (10-45%) • Not at risk/ lack of concern (6-58%)• The time/location of vaccination were unsuitable (6-59%)• Doubt that influenza is a seriouse disease (2-32 %)• Belief that vaccine is ineffective (3-32%)• Fear of injections (4-26%)

Hofmann F. et al. Infection 2006