Elsevier

Public Health

Volume 137, August 2016, Pages 196-199
Public Health

Short Communication
Pertussis vaccination for healthcare workers: staff attitudes and perceptions associated with high coverage vaccination programmes in England

https://doi.org/10.1016/j.puhe.2016.02.033Get rights and content

Highlights

  • Two hospitals implemented booster vaccination programmes in response to suspected staff exposure to pertussis.

  • Perceived vulnerability of patients was the single most important reason for healthcare workers accepting vaccination.

  • Pertussis vaccine uptake was high among those who had not received influenza vaccination the previous year.

  • Self-reported adverse effect profile following vaccination was reassuring.

  • Fourteen percent of staff reported a recent illness compatible with pertussis but had not notified occupational health.

Introduction

Pertussis poses a significant risk to vulnerable infants and immune-suppressed adults in hospital settings, and nosocomial outbreaks involving patients and healthcare workers are well recognized.1, 2 Booster vaccination of healthcare workers is recommended during suspected nosocomial outbreaks or following unprotected exposure of staff to infectious cases.3 How often such reactive vaccination programmes are undertaken in hospitals, and whether such programmes achieve a high uptake is unknown. Furthermore, in order to design and implement programmes that can achieve the high uptake required for effectiveness in outbreak situations, it is important to understand staff attitudes and perceptions in such vaccination campaigns. In this report, we present the key aspects of highly successful booster vaccination programmes for healthcare workers implemented in two hospitals and the findings of a post-vaccination questionnaire study to understand staff experiences and factors influencing uptake.

During the national outbreak of pertussis in the UK in 2012, two hospitals undertook booster vaccination programmes of frontline healthcare workers to reinforce standard infection control measures. Hospital A is a 700 bedded acute NHS hospital with 45 general paediatric beds. Between June and August 2012, all frontline paediatric staff were offered a single dose of Revaxis © (low dose diphtheria, tetanus, acellular pertussis) in response to a suspected outbreak among paediatric clinical staff. A line listing of eligible staff was maintained and updated through the campaign. A number of ‘drop-in’ and ward-based vaccination sessions were held with extended hours to cover staff working various shifts. Staff awareness was raised using promotional materials and posters, along with ad-hoc face to face conversations in the clinical areas by infection control and occupational health staff. Posters in a simple layout and easy to understand language were displayed in the targeted clinical areas with information on pertussis symptoms, infection control measures and vaccination clinic times. Non-vaccinated staff were actively followed up and were strongly encouraged to have vaccination unless they had a genuine contraindication. Hospital A achieved a vaccination uptake of 86% (210/243). Hospital B, a 800-bedded acute NHS hospital, implemented the booster vaccination programme for frontline midwifery and paediatric staff between August and November 2012 in light of repeated episodes of exposure of healthcare workers to patients admitted with infectious pertussis. The vaccination campaign employed a similar methodology as Hospital A. In addition, staff were advised that non-vaccinated staff could be redeployed to less risky clinical areas and/or might be required to wear a mask in the event of a nosocomial outbreak. The estimated vaccine uptake in Hospital B was over 95% and 179 staff were vaccinated. It was difficult to accurately measure uptake because new-starters and other staff eligible for vaccination were identified and vaccinated over a 3-month period.

Following the vaccination campaign, all staff who were offered booster vaccination were invited to complete an anonymised, self-administered online survey questionnaire. The questionnaire contained 20 questions and covered demographics, pertussis and flu vaccination status, reasons for accepting or declining the offer of booster vaccination and the presence or absence of symptoms suggestive of pertussis. The survey invitation and a single reminder were sent by group email method to all eligible staff, with advice that completion of the survey questionnaire was entirely voluntary. It was not possible to identify survey respondents or non-respondents as no identifiable details were collected in the survey questionnaire. The response rate for the survey questionnaire was estimated at 34% (131/389). Median age was 40 years (range 21–63 years). Females constituted 95% of the survey respondents. The proportion of female to male staff was estimated as 80:20 for the booster vaccine programme.

Section snippets

Reasons for accepting vaccination

Among survey respondents, self-reported pertussis vaccination uptake was 82% (42/51) in hospital A, 99% (79/80) in hospital B and 92% overall (121/131; P = 0.001). Among those who accepted vaccination, the ‘single most critical factor’ in the decision to get vaccinated was their intention to protect the patients they were caring for (35%), followed by intention to protect self and their family (16%) and perceived higher risks of acquiring and spreading pertussis due to their clinical role

Adverse effects following vaccination

Almost half of the respondents (47%; 56/120) reported no adverse effects following vaccination. Among the rest, 41% (49/120) reported local side-effects such as arm pain, swelling and redness and 10% (12/120) reported systemic side-effects (e.g. fever) that did not limit normal activities. Three staff members (2.5%) reported major local or systemic side-effects that required one or more days off work or restriction of routine activities.

Reasons for non-vaccination

Among survey respondents, ten reported not receiving pertussis booster vaccination. Self-reported reasons for non-acceptance included having had pertussis infection or vaccination in childhood, fear of adverse effects, being pregnant or a lack of national policy/colleague recommendation. Better information on the risks and benefits of vaccination and a direct recommendation from line manager/colleague were suggested by non-vaccinated staff as interventions for improving uptake.

Flu vaccination status

Self-reported flu vaccination uptake in the previous season among respondents was 71% overall. Pertussis vaccine uptake was high among those who had not received influenza vaccination the previous year. Flu vaccination status in the previous season did not significantly predict pertussis vaccination – among those who did and did not receive flu vaccination in the previous season, 96.5% and 88.5% (P = 0.08) accepted pertussis vaccination respectively. However, flu vaccination status in the

Symptoms suggestive of pertussis

Seventeen staff (14%) reported having had a cough illness lasting more than three weeks duration in the previous 12 months, of which 15 had not reported their illness to the occupational health. Among these, seven stated that their illness was likely due to pertussis.

Discussion

The striking finding of this study is the high uptake (over 85%) achieved in the booster vaccination programme in both hospitals. The high coverage achieved in the pertussis booster campaign contrasts starkly with ∼58% coverage for flu vaccination among healthcare workers in the corresponding flu season in both hospitals. In particular, staff who had not received influenza vaccine in the past year and stated their intention to not have this vaccine in the forthcoming season accepted pertussis

Acknowledgements

The authors would like to gratefully acknowledge the support of infection control and occupational health staff at Oxford University Hospitals NHS Foundation Trust and Northampton General Hospitals NHS Trust. We would also like to thank all staff who volunteered their time to complete the study questionnaire.

Ethical approval

Not required.

Funding source

None required.

Competing interest

None.

Contributors

KP and NM provided specialist advice and support on the strategy and rationale for pertussis vaccination programme for healthcare workers in Hospitals A and

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