1 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)

2 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

3 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

4 Influenza vaccination coverage, Germany, 2001 – 2008 TNS Healthcare, European Vaccine Manufacturers 2008

5 HCW immunization rates in 5 European countries Blank et al. BMC Public Health 2008

6 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“

7 Influenza Campaign (2002 – 2004), RKI and Influenza working group (AGI) Leitmeyer et al. Vaccine 2006

8 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)

9 Evaluation of the campaign – Hospitals (I) Evaluation: Forsa 2008 Vaccination coverage of HCW in Hospitals * Difference not significant (α=0.05)

10 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

11 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)

12 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

13 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

14 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

15 Multiple level approach in season 2007/08 For vaccinating hospitals „Good practice“ contest € 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

16 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

17 Different cultures of immunization – but sometimes closer than expected!

18 Acknowledgements BZgA S. Wortberg M. v.d. Knesebeck RKI FG 33 W. Hellenbrand S. Reiter FG 36 U. Buchholz S. Buda W. Haas

19 Thank you very much for your attention Material (German) can be ordered and downloaded from

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21 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