Influenza Vaccination Campaign during the COVID-19 Pandemic: The Experience of a Research and Teaching Hospital in Milan

Abstract

Background: During the COVID-19 pandemic, more than ever, optimal influenza vaccination coverage among healthcare workers (HCWs) is crucial to avoid absenteeism and disruption of health services, as well as in-hospital influenza outbreaks. The aim of this study is to analyze the 2020 influenza vaccination campaign, comparing it with the previous year’s in a research and teaching hospital in Northern Italy. Methods: adopting an approach based on combined strategies, three interventions were deployed: a promotional and educational campaign, vaccination delivery through both ad hoc and on-site ambulatories, and a gaming strategy. Personal data and professional categories were collected and analyzed using univariate logistic regression. Vaccinated HCWs were asked to fill in a questionnaire to describe their reasons for vaccination adherence. Results: the vaccination coverage rate (VCR) was 43.1%, compared to 21.5% in 2019. The highest increase was registered among administrative staff (308.3%), while physicians represent the most vaccinated category (n = 600). Moreover, residents (prevalence ratio (PR): 1.12; 95% CI 1.04–1.20), as well as intensive care (PR: 1.44; 95% CI: 1.24–1.69) and newborn workers (PR: 1.41; 95% CI: 1.20–1.65) were, respectively, the categories most frequently vaccinated for the first time. Conclusion: the significant increase in vaccination coverage rate confirms the suitability of the combined strategy of delivering the flu vaccination campaign and represents a first step towards reaching WHO recommended vaccination rates.

COVID-19 and Influenza Vaccination Campaign in a Research and University Hospital in Milan, Italy

“…Whilst physicians have long been considered one of the most adherent professional categories towards flu vaccination [ 47 ], even without reaching the optimal coverage target [ 48 ], results from residents and nurses might be considered more surprising. Particularly, despite a long tradition of vaccine hesitancy found in the scientific literature for nurses [ 11 , 49 ], this professional group nearly tripled among the vaccinated population in the 2020–2021 campaign [ 25 ]. Concerning residents, our study showed their leading role in the 2021–2022 campaign, as the number of those who received flu vaccination nearly doubled.…”

“…Given the encouraging results achieved in the 2020–2021 influenza vaccination campaign, two out of the three strategies adopted in that campaign, namely a promotional and educational campaign and a competition among the hospital departments (so-called gaming strategy), were still adopted for the 2021–2022 campaign [ 25 ].…”

“…Reasons were imported from a similar questionnaire administered to HCWs undergoing vaccination in the 2020–2021 flu campaign. Imported reasons were: “Vaccination is the most effective strategy of prevention”; “As HCW I am more exposed to the flu”; “I fear the complications of the flu”; “I suffer from diseases at risk of complications”; “I live with fragile patients”; and “As HCW it’s my duty to get vaccinated to protect my patients” [ 25 ]. As can be noticed, reasons explored different dimensions behind flu vaccine acceptance which have emerged in the scientific literature [ 9 , 21 ], e.g., the alignment to programmatic recommendations by major health authorities (“Vaccination is the most effective strategy of prevention”), more “egoistic” motivations (“As HCW I am more exposed to the flu”; “I fear the complications of the flu”), even related to a possible HCW’s fragile health status (“I suffer from diseases at risk of complications”), or more “altruistic” motivations, either towards one’s households (“I live with fragile patients”) or towards patients (“As HCW it’s my duty to get vaccinated to protect my patients”).…”

“…However, this single strategy failed to achieve the expected results, as a comprehensive VCR of 21.5% was reached [ 22 ]. Following the first wave of the SARS-CoV-2 pandemic, which by February 2020 overwhelmed Italian and worldwide health services [ 23 , 24 ], the 2020–2021 flu vaccination campaign implemented three combined strategy, namely a promotional and educational campaign, a gaming strategy, and a logistically improved on-site and ad hoc vaccine delivery [ 25 ]. The final VCR was 43.1% and relevant changes in HCWs attitude towards flu vaccination were registered, foremost a dramatic increase in the participation of HCWs aged 40–59 years [ 25 ].…”

Influenza Vaccination Strategies in Healthcare Workers: A Cohort Study (2018–2021) in an Italian University Hospital

“…Influenza vaccination among HCWs has been an intensely investigated topic in Italy in recent years, in particular with the aim to evaluate the campaigns’ effectiveness in increasing vaccination coverage [ 45 , 46 , 47 ]. During the COVID-19 pandemic, the effectiveness of these measures has become particularly important as the influenza vaccine is useful to distinguish between symptoms of influenza and those related to COVID-19 and enables the prevention of outbreaks in hospitals and disruption of health services due to HCWs requiring sick leave [ 48 , 49 , 50 ]. Furthermore, co-circulation of SARS-CoV-2 and influenza virus during the 2020–2021 season may have caused an increased perception of the importance of flu vaccination among health professionals, leading to greater adherence to vaccination.…”