1. Julius Center.nl Julius Center.nl Health Sciences and Primary Care Seasonal vaccination of health care workers Ted van Essen, general practitioner Julius Center for Health Sciences and Primary Care University Medical Center Utrecht,The Netherlands Vilamoura, September 15th, 2008 Julius Center.nl Julius Center.nl Health Sciences and Primary Care

2. Influenza vaccination in 71 countries, 2002-2005 MIVSG 2007

3. Julius Center.nl Julius Center.nl Health Sciences and Primary Care Vaccination rate (%) at-risk groups by age in the Netherlands, 2006 % Tacken MAJB et al. 2006

4. Julius Center.nl Julius Center.nl Health Sciences and Primary Care Vaccination rate (%) at-risk groups by age in the Netherlands, 2006 ; HCW 2007 %

5. Julius Center.nl Julius Center.nl Health Sciences and Primary Care Vaccination rate Dutch GPs 2007 (N=698) Response questionnaire 96% Vaccination rate 36% Adj RR for not being vaccinated: -<40 year: 1,2 (95%CI 1,05-1,37) -female: 1,2 (95%CI 1,07-1,34)

6. Julius Center.nl Julius Center.nl Health Sciences and Primary Care Vaccination rate (%) HCWs in different studies %

7. Julius Center.nl Julius Center.nl Health Sciences and Primary Care F. Hofmann et al, Infection 2006

8. Julius Center.nl Julius Center.nl Health Sciences and Primary Care Motives for Dutch GPs to be vaccinated or not 2007 Not vaccinated - I do not belong to an at-risk group52% -I am protected by contacts with my patients28% -I doubt the effectiveness16% -I just forgot14% -I fear the side effects 6% Vaccinated -It reduces my risk for influenza74% -It reduces the risk of transmission36% -I belong to an at-risk group17% -There were left-overs 7%

9. Julius Center.nl Julius Center.nl Health Sciences and Primary Care Seasonal Influenza vaccination for HCWs Rachel Jordan, UK What is the evidence on effectiveness of HCWs vaccination? What is the evidence in implementation programs? Hans van Delden, The Netherlands What are the ethical considerations? Should influenza vaccination be mandatory for HCW? Dietmar Walter, Germany Was the German program successful? Do we need more evidence on implementation programs? Discussion based on position statements

10. Julius Center.nl Julius Center.nl Health Sciences and Primary Care Discussion 1 HCWs attitudes are blocking progress towards higher vaccination rates.

11. Julius Center.nl Julius Center.nl Health Sciences and Primary Care Discussion 2 HCWs indifference towards the benefits of vaccination is a threat to public health.

12. Julius Center.nl Julius Center.nl Health Sciences and Primary Care Discussion 3 The annual vaccination of healthcare professionals reduces morbidity of their patients.

13. Julius Center.nl Julius Center.nl Health Sciences and Primary Care Discussion 4 Better implementation programs are needed to increase HCWs vaccination.

14. Julius Center.nl Julius Center.nl Health Sciences and Primary Care Discussion 5 Voluntary vaccination of HCWs will not work.

15. Julius Center.nl Julius Center.nl Health Sciences and Primary Care Discussion 6 Mandatory influenza vaccination of HCWs is an ethically acceptable means to increase vaccination rates.