Influenza vaccination of health care workers in hospitals--a review of studies on attitudes and predictors.

INTRODUCTION: Immunization guidelines from many countries recommend influenza vaccination of health care workers (HCW). However, influenza vaccination rates among HCW are universally low. To aid in designing effective immunization programs we reviewed the literature for studies reporting on (1) self-reported reasons of HCW regarding vaccination against influenza and (2) predictive factors for influenza vaccination in HCW.
METHODS: We searched PUBMED for relevant publications from 1980 to 2008 with predetermined search strategies and applied pre-defined criteria for inclusion or exclusion. To be included in the review as a predictor study, a multivariate analysis must have been conducted.
RESULTS: We included 25 studies relevant to self-reported reasons for rejecting or accepting vaccination. These studies identified two major reasons for lack of vaccine uptake by HCW: firstly, a wide range of misconceptions or lack of knowledge about influenza infection; and secondly, a lack of convenient access to vaccine. In contrast, among studies reporting on reasons for vaccination acceptance, all but two found that HCW stated self-protection was the most important reason. In the area of "predictive factors for influenza vaccination", we included 13 studies. At least five of them identified the following three factors: previous receipt of influenza vaccine, belief in the vaccine's effectiveness, and older age.
CONCLUSION: Our findings indicate that if HCW get immunized against influenza, they do so primarily for their own benefit and not for the benefit to their patients. Misconceptions about influenza and influenza vaccine could be improved by education, and organizational barriers could be bridged with sustainable, structural changes to allow flexible and workplace vaccine delivery.