Results

Validity of self-reported vaccination status among French healthcare studentsValidity of self-reported vaccination status among French healthcare students Pierre Loulergue¹, Céline Pulcini2,3,4, Sophie Massin4,5,6, Marion Bernhard4,5,6, Laure Fonteneau7, Daniel Levy-Brühl7,

Jean-Paul Guthmann7, Odile Launay¹1. CIC de Vaccinologie Cochin-Pasteur, Inserm CIC BT505, Groupe Hospitalier Cochin-Hôtel Dieu-Broca, Assistance Publique-Hôpitaux de Paris, Paris, France

2. CHU de Nice, Service d’Infectiologie, Nice, France; 3. Université Nice-Sophia Antipolis, Faculté de Médecine de Nice, Nice, France; 4. INSERM, UMR912 (SESSTIM), Marseille, France5. Aix Marseille Université, UMR_S912, IRD, Marseille, France; 6. ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France

7. Département des Maladies Infectieuses, Institut de Veille Sanitaire, Saint-Maurice, France

Patients & Methods

Purpose Discussion

Although healthcare students should comply with the same vaccination recommendations as healthcare professionals, since they are in close and repeated contacts with patients during their training, data on vaccination coverage in this population is scarce.

In France, those recommendations consist of compulsory vaccinations, for which a certificate is required before recruitment, including BCG, diphtheria, tetanus, polio-DTP- and hepatitis B; and recommended vaccinations including annual seasonal influenza, pertussis, varicella (for seronegative subjects) and measles vaccines.

We conducted a survey in 2009, which aimed at assessing the vaccination coverage of healthcare students in Paris teaching hospitals. The objective of this study was to evaluate the validity of self-reported vaccination status for the occupational vaccinations compared to personal immunization records.

Among the 483 eligible students, 432 (89%) were finally included between March and July 2009 (178 doctors, 147 nurses, 107 midwives).An immunization record was available for 381 (86%) students. Students with a proof of vaccination were not different from students without proof regarding age (p=0.93), gender (p=0.11), year of study (p=0.62) and type of healthcare school (p=0.22). Confirmed vaccination coverage data for all occupational vaccinations is presented in Table 1.

A cross-sectional survey was carried out on medical, nursing and midwifery students in 15 teaching hospitals in Paris, France. Students were selected by multi-stage random sampling. Data regarding self-reported vaccination status was collected by face-to-face interviews, whereas immunization records were checked, when available. The validity of the students’ self-reported data was compared to the written medical information, which was used as the gold standard, by calculation of the sensitivity, specificity, positive predictive value and negative predictive value.

Overall, the validity of self-reported vaccination status for occupational vaccines among healthcare students was quite poor.

Only two vaccines (BCG and hepatitis B-1st dose) showed a high (> 90%) positive predictive value and high sensitivity (98%) for the self-reported vaccination status.

Vaccines with regular boosters, like DTP and pertussis, showed a better level of specificity (> 70%) than the others (between 2 and 32% for hepatitis B, BCG and measles).

Regarding vaccines without boosters, such as BCG, hepatitis B and measles, the sensitivity rates were higher (> 70%) than for pertussis (18%) and DTP (46%). Of note, age, gender, year of study and type of school did not impact significantly on validity estimates.

Funding

Table. Validity of the students’ self-reported DTP, pertussis, hepatitis B, BCG and measles vaccination status, compared to immunization records (unadjusted weighted estimates) (N=381)

Results

The validity of self-reported information regarding DTP, pertussis, tuberculosis, hepatitis B and measles vaccination status was poor among French healthcare students compared to their immunization records, although they constitute a population aware of the importance of vaccines.

Checking vaccination history by immunization record review remains the preferable strategy for determining vaccination status.

Specificity was > 70% for DTP and pertussis vaccines, whereas sensitivity was > 70% for hepatitis B, tuberculosis and measles vaccines. Self-reported vaccination status for tuberculosis and the 1st dose of hepatitis B vaccines had a sensitivity > 95%. Estimates adjusted for the factors of interest (gender, age, year of study and type of school) showed little variations from the unadjusted estimates.

Vaccination coverage was excellent for mandatory vaccinations (> 90% for tuberculosis and hepatitis B vaccines), good for DTP (78% for the 16-18 years old dose), but quite poor for measles (45% for the 2nd dose) and pertussis vaccines (23%).

The study received funding from the Institut de Veille Sanitaire.All authors report no conflicts of interest relevant to this article.