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Practices, beliefs and attitudes associated with support for mandatory influenza vaccination among Spanish medical students
Vaccine 32 (2014) 207–208
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Letter to the Editor Practices, beliefs and attitudes associated with support for mandatory influenza vaccination among Spanish medical students Keywords: Influenza vaccines Medical students Mandatory vaccination
Sir, Influenza vaccination of healthcare workers (HCWs) and persons in training for health-care professions is a key question in healthcare-associated infections prevention programs, since it is one of the most effective measures to avoid nosocomial outbreaks. In Spain, although vaccination of HCWs and students who have contact with patients is recommended by health authorities (such as the Health Regional Ministry of Castilla y León), and evidence-based strategies have been implemented, coverages are low (ranging from 7.2% among medical students [1] to 38.1% among HCWs [2]); because of that, mandatory vaccination has been suggested [2]. In this study, we examined the practices, beliefs and attitudes associated with support for mandatory HCWs influenza vaccination among Spanish medical students. During March 2013, a cross-sectional survey was conducted among second-year and sixth-year medical students at the University of Salamanca, Salamanca, Castilla y León, Spain. They were asked to complete a self-administered questionnaire, a technique selected based on existing literature [3]. The questionnaire assessed vaccination status, support for mandatory HCWs vaccination (unless medical contraindication recognized is documented), and 7 attitudes/beliefs: (a) the flu and its complications can be serious; (b) perceived risk of occupational influenza infection; (c) medical students can give the flu to patients, if they do their practices sick with the flu; (d) the vaccination effectively prevents disease; (e, f) there are no serious risks associated with the vaccination; and (g) vaccination of medical students that accomplish their practices in health settings protects patients from influenza infection. Support for mandatory vaccination and attitudes/beliefs were examined on a 7-point Likert scale (strongly disagree = 1 point, neutral = 4 points, and strongly agree = 7 points). For analysis, responses ≥ 5 were coded as agree, ≤4 as do not agree. A chi-square test was used to identify associations between attitudes/beliefs and support for mandatory vaccination, with P < 05 being considered statistically significant. Of 360 enrolled second and sixth-year students, 216 (60%) responded to our survey. Of the 216 students who responded, 9 (4.2%) were vaccinated during the 2012–2013 season. There was a non-significant difference in vaccination rate between clinical and preclinical students (3.3% [3 of 92] vs 4.8% [6 of 124]; P = .736). Mandatory HCWs influenza vaccination was supported by 0264-410X/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.vaccine.2013.10.073
70.8% (77.2% of clinical students and 66.1% of preclinical students, respectively, P = .078). Beliefs/attitudes associated with supporting mandatory influenza vaccination were: (a) vaccine efficacy for selfprotection (OR, 3.37 [95% CI, 1.69–6.75]; P = .000); (b) protection of their patients (OR, 4.92 [95% CI, 2.61–9.28]; P = .000); and (c) not fearing long-term side effects of the vaccine (OR, 0.45 [95% CI, 0.20–0.99]; P = .046). Vaccination status was not associated with supporting mandatory influenza vaccination (P = .290). Approval of mandatory HCWs influenza vaccine policies was similar [4] or higher [5] than other countries’ one; however, our students’ vaccination coverage was lower [6]. In any case, a future research is required to identify the reasons of the difference between vaccination rate and support for mandatory vaccination. Moreover, educational programs should be carried out at universities to improve the medical students’ knowledge regarding side effects and importance of influenza vaccination to protect themselves and their patients. It might help to improve the acceptance of mandatory influenza vaccination policies among the future HCWs and, thus, to contribute to generate a social demand for such policies in Spain, whose implementation would allow to reach the best vaccination coverages.
1. Conflict of interest None to report.
References [1] Hernández-García I, Domínguez B, González R. Influenza vaccination rates and determinants among Spanish medical students. Vaccine 2012;31(1): 1–2. ˜ [2] Sánchez-Payá J, Hernández-García I, Barrenengoa Sanudo J, Rolando Martínez H, Camargo Ángeles R, Cartagena Llopis L, et al. Determinants of influenza vaccination in health staff: 2009–2010 season. Gac Sanit 2011;25(1): 29–34. [3] Banach DB, Zhang C, Factor SH, Calfee DP. Support for mandatory health care worker influenza vaccination among allied health professionals, technical staff, and medical students. Am J Infect Control 2013;41(4):354–6. [4] Douville LE, Myers A, Jackson MA, Lantos JD. Health care worker knowledge, attitudes, and beliefs regarding mandatory influenza vaccination. Arch Pediatr Adolesc Med 2010;164(1):33–7. [5] Maltezou HC, Gargalianos P, Nikolaidis P, Katerelos P, Tedoma N, Maltezos E, et al. Attitudes towards mandatory vaccination and vaccination coverage against vaccine-preventable diseases among health-care workers in tertiary-care hospitals. J Infect 2012;64(3):319–24. [6] Loulergue P, Fonteneau L, Armengaud JB, Momcilovic S, Levy-Brühl D, Launay O, et al. Studyvax survey group. Vaccine coverage of healthcare students in hospitals of the Paris region in 2009: the Studyvax survey. Vaccine 2013;31(26):2835–8.
Ignacio Hernández-García ∗ Preventive Medicine Service, Infanta Leonor University Hospital – Virgen de la Torre Hospital, Street Gran Vía del Este, 80, 28031 Madrid, Spain Luis-Félix Valero 1
208
Letter to the Editor / Vaccine 32 (2014) 207–208
Preventive Medicine Department, Faculty of Medicine, University of Salamanca, Campus Miguel de Unamuno, Street Alfonso X El Sabio s/n, 37007 Salamanca, Spain
1
Tel.: +34 923 294 541; fax: +34 923 294 541. 18 September 2013 20 October 2013
∗ Corresponding
author. Tel.: +34 911 918 000. E-mail address: [email protected] (I. Hernández-García)
23 October 2013 Available online 1 November 2013
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Letter to the Editor Practices, beliefs and attitudes associated with support for mandatory influenza vaccination among Spanish medical students Keywords: Influenza vaccines Medical students Mandatory vaccination
Sir, Influenza vaccination of healthcare workers (HCWs) and persons in training for health-care professions is a key question in healthcare-associated infections prevention programs, since it is one of the most effective measures to avoid nosocomial outbreaks. In Spain, although vaccination of HCWs and students who have contact with patients is recommended by health authorities (such as the Health Regional Ministry of Castilla y León), and evidence-based strategies have been implemented, coverages are low (ranging from 7.2% among medical students [1] to 38.1% among HCWs [2]); because of that, mandatory vaccination has been suggested [2]. In this study, we examined the practices, beliefs and attitudes associated with support for mandatory HCWs influenza vaccination among Spanish medical students. During March 2013, a cross-sectional survey was conducted among second-year and sixth-year medical students at the University of Salamanca, Salamanca, Castilla y León, Spain. They were asked to complete a self-administered questionnaire, a technique selected based on existing literature [3]. The questionnaire assessed vaccination status, support for mandatory HCWs vaccination (unless medical contraindication recognized is documented), and 7 attitudes/beliefs: (a) the flu and its complications can be serious; (b) perceived risk of occupational influenza infection; (c) medical students can give the flu to patients, if they do their practices sick with the flu; (d) the vaccination effectively prevents disease; (e, f) there are no serious risks associated with the vaccination; and (g) vaccination of medical students that accomplish their practices in health settings protects patients from influenza infection. Support for mandatory vaccination and attitudes/beliefs were examined on a 7-point Likert scale (strongly disagree = 1 point, neutral = 4 points, and strongly agree = 7 points). For analysis, responses ≥ 5 were coded as agree, ≤4 as do not agree. A chi-square test was used to identify associations between attitudes/beliefs and support for mandatory vaccination, with P < 05 being considered statistically significant. Of 360 enrolled second and sixth-year students, 216 (60%) responded to our survey. Of the 216 students who responded, 9 (4.2%) were vaccinated during the 2012–2013 season. There was a non-significant difference in vaccination rate between clinical and preclinical students (3.3% [3 of 92] vs 4.8% [6 of 124]; P = .736). Mandatory HCWs influenza vaccination was supported by 0264-410X/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.vaccine.2013.10.073
70.8% (77.2% of clinical students and 66.1% of preclinical students, respectively, P = .078). Beliefs/attitudes associated with supporting mandatory influenza vaccination were: (a) vaccine efficacy for selfprotection (OR, 3.37 [95% CI, 1.69–6.75]; P = .000); (b) protection of their patients (OR, 4.92 [95% CI, 2.61–9.28]; P = .000); and (c) not fearing long-term side effects of the vaccine (OR, 0.45 [95% CI, 0.20–0.99]; P = .046). Vaccination status was not associated with supporting mandatory influenza vaccination (P = .290). Approval of mandatory HCWs influenza vaccine policies was similar [4] or higher [5] than other countries’ one; however, our students’ vaccination coverage was lower [6]. In any case, a future research is required to identify the reasons of the difference between vaccination rate and support for mandatory vaccination. Moreover, educational programs should be carried out at universities to improve the medical students’ knowledge regarding side effects and importance of influenza vaccination to protect themselves and their patients. It might help to improve the acceptance of mandatory influenza vaccination policies among the future HCWs and, thus, to contribute to generate a social demand for such policies in Spain, whose implementation would allow to reach the best vaccination coverages.
1. Conflict of interest None to report.
References [1] Hernández-García I, Domínguez B, González R. Influenza vaccination rates and determinants among Spanish medical students. Vaccine 2012;31(1): 1–2. ˜ [2] Sánchez-Payá J, Hernández-García I, Barrenengoa Sanudo J, Rolando Martínez H, Camargo Ángeles R, Cartagena Llopis L, et al. Determinants of influenza vaccination in health staff: 2009–2010 season. Gac Sanit 2011;25(1): 29–34. [3] Banach DB, Zhang C, Factor SH, Calfee DP. Support for mandatory health care worker influenza vaccination among allied health professionals, technical staff, and medical students. Am J Infect Control 2013;41(4):354–6. [4] Douville LE, Myers A, Jackson MA, Lantos JD. Health care worker knowledge, attitudes, and beliefs regarding mandatory influenza vaccination. Arch Pediatr Adolesc Med 2010;164(1):33–7. [5] Maltezou HC, Gargalianos P, Nikolaidis P, Katerelos P, Tedoma N, Maltezos E, et al. Attitudes towards mandatory vaccination and vaccination coverage against vaccine-preventable diseases among health-care workers in tertiary-care hospitals. J Infect 2012;64(3):319–24. [6] Loulergue P, Fonteneau L, Armengaud JB, Momcilovic S, Levy-Brühl D, Launay O, et al. Studyvax survey group. Vaccine coverage of healthcare students in hospitals of the Paris region in 2009: the Studyvax survey. Vaccine 2013;31(26):2835–8.
Ignacio Hernández-García ∗ Preventive Medicine Service, Infanta Leonor University Hospital – Virgen de la Torre Hospital, Street Gran Vía del Este, 80, 28031 Madrid, Spain Luis-Félix Valero 1
208
Letter to the Editor / Vaccine 32 (2014) 207–208
Preventive Medicine Department, Faculty of Medicine, University of Salamanca, Campus Miguel de Unamuno, Street Alfonso X El Sabio s/n, 37007 Salamanca, Spain
1
Tel.: +34 923 294 541; fax: +34 923 294 541. 18 September 2013 20 October 2013
∗ Corresponding
author. Tel.: +34 911 918 000. E-mail address: [email protected] (I. Hernández-García)
23 October 2013 Available online 1 November 2013