Seasonal influenza vaccine uptake among healthcare workers in tertiary care hospitals, Bangladesh: Study protocol for influenza vaccine supply and awareness intervention

Md Zakiul Hassan, Tahmina Shirin, Mahbubur Rahman, A S M Alamgir, Nusrat Jahan, Md Abdullah Al Jubayer Biswas, Sazzad Hossain Khan, Md Ahmed Khairul Basher, Md Ariful Islam, Kamal Hussain, Md Nazrul Islam, Md Arif Rabbany, Md Azizul Haque, Shishir Ranjan Chakraborty, Syeda Rukhshana Parvin, Mahmudur Rahman, Fahmida Chowdhury, Md Zakiul Hassan, Tahmina Shirin, Mahbubur Rahman, A S M Alamgir, Nusrat Jahan, Md Abdullah Al Jubayer Biswas, Sazzad Hossain Khan, Md Ahmed Khairul Basher, Md Ariful Islam, Kamal Hussain, Md Nazrul Islam, Md Arif Rabbany, Md Azizul Haque, Shishir Ranjan Chakraborty, Syeda Rukhshana Parvin, Mahmudur Rahman, Fahmida Chowdhury

Abstract

Background: Healthcare workers (HCWs), such as doctors, nurses, and support staffs involved in direct or indirect patient care, are at increased risk of influenza virus infections due to occupational exposures. Vaccination is the most effective way to prevent influenza. Despite the World Health Organization (WHO) recommendations, Bangladesh lacks a seasonal influenza vaccination policy for HCWs, and thus vaccination rates remain low. The current project aims to investigate the effect of interventions on influenza vaccine awareness and availability of vaccine supply, explore HCWs' knowledge and perceptions about influenza vaccination, understand the barriers and motivators for influenza vaccine uptake, and understand policymakers' views on the practicality of influenza vaccination among HCWs.

Method: We will conduct the study at four tertiary care teaching hospitals in Bangladesh, using a cluster randomized controlled trial approach, with the hospital as the unit of randomization and intervention. The study population will include all types of HCWs.The four different types of intervention will be randomly allocated and implemented in four study hospitals separately. The four interventions will be: i) ensuring the availability of influenza vaccine supply; ii) developing influenza vaccine awareness; iii) both ensuring influenza vaccine supply and developing influenza vaccine awareness and iv) control arm with no intervention. Both quantitative and qualitative approaches will be applied to assess the intervention effect. We will estimate the Difference in Differences (DID) with 95% CI of the proportion of vaccine uptake between each intervention and control (non-intervention) arm, adjusting for the clustering effect. The qualitative data will be summarised using a framework matrix method.

Discussion: The results of this study will inform the development and implementation of a context-specific strategy to enhance influenza vaccination rates among Bangladeshi HCWs.

Trial registration: Clinicaltrials.gov NCT05521763. Version 2.0 was registered in September 2022, and the first participant enrolled in March 2022. Retrospectively registered.

Keywords: Barriers and motivators; Healthcare worker; Influenza vaccination; Influenza vaccine awareness; Knowledge and perceptions; Policymakers' views.

Conflict of interest statement

The institutional review board (IRB) of icddr,b reviewed and approved the study protocol (PR-21150). The Institutional Review Board at the Centers for Disease Control and Prevention (Atlanta, GA, USA) relied on icddr,b's approval. We will obtain written informed consent from all study participants. The study team will provide detailed oral and written information in the local language (Bangla) on research aims, objectives, risks and benefits of participation, maintaining confidentiality, the right not to participate and/or withdraw conflicts of interest, and compensation. After being reminded that their participation is entirely voluntary and that any information they provide will be kept strictly confidential, participants will be asked to sign the consent form. Informed consent will also be sought for audio recordings of interviews.

All the authors report no conflicts of interest.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Location of the study sites. Source: Authors generated the map using QGIS version 3.2.1
Fig. 2
Fig. 2
Schematic diagram of study method
Fig. 3
Fig. 3
HCWs information delivery mechanism on influenza vaccination

References

    1. Guillari A, Polito F, Pucciarelli G, Serra N, Gargiulo G, Esposito MR, Botti S, Rea T, Simeone S: Influenza vaccination and healthcare workers: barriers and predisposing factors. A literature review. Acta Bio Medica: Atenei Parmensis 2021, 92(Suppl 2).
    1. Organization WH: Global influenza strategy 2019–2030. 2019.
    1. Iuliano AD, Roguski KM, Chang HH, Muscatello DJ, Palekar R, Tempia S, Cohen C, Gran JM, Schanzer D, Cowling BJ. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. The Lancet. 2018;391(10127):1285–1300. doi: 10.1016/S0140-6736(17)33293-2.
    1. Tokars JI, Olsen SJ, Reed C. Seasonal incidence of symptomatic influenza in the United States. Clin Infect Dis. 2018;66(10):1511–1518. doi: 10.1093/cid/cix1060.
    1. Yassi A, McGill M, Holton D, Nicolle L. Morbidity, cost and role of health care worker transmission in an influenza outbreak in a tertiary care hospital. Can J Infect Dis. 1993;4(1):52–56.
    1. Huttunen R, Syrjänen J. Healthcare workers as vectors of infectious diseases. Eur J Clin Microbiol Infect Dis. 2014;33(9):1477–1488. doi: 10.1007/s10096-014-2119-6.
    1. Lietz J, Westermann C, Nienhaus A, Schablon A. The occupational risk of influenza A (H1N1) infection among healthcare personnel during the 2009 pandemic: a systematic review and meta-analysis of observational studies. PLoS ONE. 2016;11(8):e0162061. doi: 10.1371/journal.pone.0162061.
    1. Kuster SP, Shah PS, Coleman BL, Lam P-P, Tong A, Wormsbecker A, McGeer A. Incidence of influenza in healthy adults and healthcare workers: a systematic review and meta-analysis. PLoS ONE. 2011;6(10):e26239. doi: 10.1371/journal.pone.0026239.
    1. Apisarnthanarak A, Puthavathana P, Kitphati R, Auewarakul P, Mundy LM. Outbreaks of influenza A among nonvaccinated healthcare workers: implications for resource-limited settings. Infect Control Hosp Epidemiol. 2008;29(8):777–780. doi: 10.1086/588162.
    1. Somes MP, Turner RM, Dwyer LJ, Newall AT. Estimating the annual attack rate of seasonal influenza among unvaccinated individuals: a systematic review and meta-analysis. Vaccine. 2018;36(23):3199–3207. doi: 10.1016/j.vaccine.2018.04.063.
    1. Turnberg W, Daniell W, Duchin J. Influenza vaccination and sick leave practices and perceptions reported by health care workers in ambulatory care settings. Am J Infect Control. 2010;38(6):486–488. doi: 10.1016/j.ajic.2009.12.006.
    1. Barberis I, Myles P, Ault S, Bragazzi N, Martini M. History and evolution of influenza control through vaccination: from the first monovalent vaccine to universal vaccines. J Prev Med Hyg. 2016;57(3):E115.
    1. Gasparini R, Amicizia D, Lai PL, Bragazzi NL, Panatto D. Compounds with anti-influenza activity: present and future of strategies for the optimal treatment and management of influenza Part II: Future compounds against influenza virus. J Prev Med Hyg. 2014;55(4):109.
    1. Frenzel E, Chemaly RF, Ariza-Heredia E, Jiang Y, Shah DP, Thomas G, Graviss L, Raad I. Association of increased influenza vaccination in health care workers with a reduction in nosocomial influenza infections in cancer patients. Am J Infect Control. 2016;44(9):1016–1021. doi: 10.1016/j.ajic.2016.03.024.
    1. Amodio E, Restivo V, Firenze A, Mammina C, Tramuto F, Vitale F. Can influenza vaccination coverage among healthcare workers influence the risk of nosocomial influenza-like illness in hospitalized patients? J Hosp Infect. 2014;86(3):182–187. doi: 10.1016/j.jhin.2014.01.005.
    1. Bénet T, Régis C, Voirin N, Robert O, Lina B, Cronenberger S, Comte B, Coppéré B, Vanhems P. Influenza vaccination of healthcare workers in acute-care hospitals: a case-control study of its effect on hospital-acquired influenza among patients. BMC Infect Dis. 2012;12(1):1–6. doi: 10.1186/1471-2334-12-30.
    1. Organization WH: Vaccines against influenza WHO position paper—November 2012. Weekly Epidemiological Record= Relevé épidémiologique hebdomadaire 2012, 87(47):461–476.
    1. mondiale de la Santé O, Organization WH: WHO seasonal influenza vaccination recommendations during the COVID-19 pandemic–Recommandations du SAGE de l’OMS pour la vaccination contre la grippe saisonnière pendant la pandémie de COVID-19. Weekly Epidemiological Record= Relevé épidémiologique hebdomadaire 2019, 95(45):539–543.
    1. mondiale de la Santé O, Organization WH: Vaccines against influenza: WHO position paper–May 2022–Vaccins antigrippaux: note de synthèse de l’OMS–mai 2022. Weekly Epidemiological Record= Relevé épidémiologique hebdomadaire 2022, 97(19):185–208.
    1. Al Awaidy S, Althaqafi A, Dbaibo G, East M, Network NAIS. A snapshot of influenza surveillance, vaccine recommendations, and vaccine access, drivers, and barriers in selected Middle Eastern and North African Countries. Oman Med J. 2018;33(4):283. doi: 10.5001/omj.2018.54.
    1. Hirve S, Organization WH: Seasonal influenza vaccine use in low and middle income countries in the tropics and subtropics: a systematic review: World Health Organization; 2015.
    1. Eaton JL, Mohr DC, McPhaul KM, Kaslow RA, Martinello RA: Access, education and policy awareness: predictors of influenza vaccine acceptance among VHA healthcare workers. infection control & hospital epidemiology 2017, 38(8):970–975.
    1. Abu-Gharbieh E, Fahmy S, Rasool BA, Khan S. Influenza vaccination: healthcare workers attitude in three Middle East countries. Int J Med Sci. 2010;7(5):319. doi: 10.7150/ijms.7.319.
    1. Rashid H, Yin JK, Ward K, King C, Seale H, Booy R. Assessing interventions to improve influenza vaccine uptake among health care workers. Health Aff. 2016;35(2):284–292. doi: 10.1377/hlthaff.2015.1087.
    1. Looijmans-Van Den Akker I, Van Delden J, Verheij TJ, van der Sande M, Van Essen G, Riphagen-Dalhuisen J, Hulscher M, Hak E: Effects of a multi-faceted program to increase influenza vaccine uptake among health care workers in nursing homes: A cluster randomised controlled trial. Vaccine 2010, 28(31):5086–5092.
    1. Dini G, Toletone A, Sticchi L, Orsi A, Bragazzi NL, Durando P. Influenza vaccination in healthcare workers: A comprehensive critical appraisal of the literature. Hum Vaccin Immunother. 2018;14(3):772–789. doi: 10.1080/21645515.2017.1348442.
    1. Gurley ES, Zaman RU, Sultana R, Bell M, Fry AM, Srinivasan A, Rahman M, Rahman MW, Hossain MJ, Luby SP. Rates of hospital-acquired respiratory illness in Bangladeshi tertiary care hospitals: results from a low-cost pilot surveillance strategy. Clin Infect Dis. 2010;50(8):1084–1090. doi: 10.1086/651265.
    1. Hassan MZ, Sturm-Ramirez K, Rahman MZ, Hossain K, Aleem MA, Bhuiyan MU, Islam MM, Rahman M, Gurley ES. Contamination of hospital surfaces with respiratory pathogens in Bangladesh. PLoS ONE. 2019;14(10):e0224065. doi: 10.1371/journal.pone.0224065.
    1. Ip DK, Lau EH, Tam YH, So HC, Cowling BJ, Kwok HK. Increases in absenteeism among health care workers in Hong Kong during influenza epidemics, 2004–2009. BMC Infect Dis. 2015;15(1):1–9. doi: 10.1186/s12879-015-1316-y.
    1. Hirve S, Lambach P, Paget J, Vandemaele K, Fitzner J, Zhang W. Seasonal influenza vaccine policy, use and effectiveness in the tropics and subtropics–a systematic literature review. Influenza Other Respir Viruses. 2016;10(4):254–267. doi: 10.1111/irv.12374.
    1. Saudi Arabia makes vaccine mandatory for hajj pilgrims. The Daily Star. . Accessed March 22 2022
    1. List of Primary, 2ndary & Tertiary Level Hospital. Hospital & Clinic Section, Director General of Health Service, Ministry ofHealth and Social Welfare, Bangaldesh. . Accessed March 22 2022. In.
    1. mondiale de la Santé O, Organization WH: Recommended composition of influenza virus vaccines for use in the 2022–2023 northern hemisphere influenza season–Composition recommandée des vaccins antigrippaux pour la saison grippale 2022–2023 dans l’hémisphère Nord. Weekly Epidemiological Record= Relevé épidémiologique hebdomadaire 2022, 97(12):109–119.
    1. Zaman RU, Alamgir A, Rahman M, Azziz-Baumgartner E, Gurley ES, Sharker MAY, Brooks WA, Azim T, Fry AM, Lindstrom S. Influenza in outpatient ILI case-patients in national hospital-based surveillance, Bangladesh, 2007–2008. PLoS ONE. 2009;4(12):e8452. doi: 10.1371/journal.pone.0008452.
    1. Cox N: Influenza seasonality: timing and formulation of vaccines. In., vol. 92: SciELO Public Health; 2014: 311–311.
    1. Akhtar Z, Chowdhury F, Rahman M, Ghosh PK, Ahmmed MK, Islam MA, Mott JA, Davis W. Seasonal influenza during the COVID-19 pandemic in Bangladesh. PLoS ONE. 2021;16(8):e0255646. doi: 10.1371/journal.pone.0255646.
    1. Seasonal Influenza Vaccination Resources for Health Professionals. CDC .. Accessed March 23 2022.
    1. Information for Health Professionals. CDC .. Accessed March 23 2022.
    1. Organization WH: How to implement seasonal influenza vaccination of health workers: an introduction manual for national immunization programme managers and policy makers: pilot version 2019. 2019.
    1. Madewell ZJ, Chacón-Fuentes R, Jara J, Mejía-Santos H, Molina I-B, Alvis-Estrada JP, Ortiz M-R, Coello-Licona R, Montejo B. Knowledge, attitudes, and practices of seasonal influenza vaccination in healthcare workers, Honduras. PLoS ONE. 2021;16(2):e0246379. doi: 10.1371/journal.pone.0246379.
    1. Hammour WA, Al-Saleh S. Knowledge, attitudes, and practice of healthcare workers toward influenza vaccination at Al Jalila Children's Specialty Hospital (AJCH), Dubai, UAE. International Journal of Pediatrics and Adolescent Medicine. 2019;6(1):16–20. doi: 10.1016/j.ijpam.2019.01.001.
    1. Alshammari TM, Yusuff KB, Aziz MM, Subaie GM. Healthcare professionals’ knowledge, attitude and acceptance of influenza vaccination in Saudi Arabia: a multicenter cross-sectional study. BMC Health Serv Res. 2019;19(1):1–10. doi: 10.1186/s12913-019-4054-9.
    1. Oguz MM: Improving influenza vaccination uptake among healthcare workers by on-site influenza vaccination campaign in a tertiary children hospital. Human vaccines & immunotherapeutics 2019.
    1. Cherif I, Kharroubi G, Bouabid L, Gharbi A, Boukthir A, Ben Alaya N, Ben Salah A, Bettaieb J. Knowledge, attitudes and uptake related to influenza vaccine among healthcare workers during the 2018–2019 influenza season in Tunisia. BMC Public Health. 2021;21(1):1–9. doi: 10.1186/s12889-021-10970-y.
    1. Schoonenboom J, Johnson RB. How to construct a mixed methods research design. KZfSS Kölner Zeitschrift für Soziologie und Sozialpsychologie. 2017;69(2):107–131. doi: 10.1007/s11577-017-0454-1.
    1. Naleway AL, Henkle EM, Ball S, Bozeman S, Gaglani MJ, Kennedy ED, Thompson MG. Barriers and facilitators to influenza vaccination and vaccine coverage in a cohort of health care personnel. Am J Infect Control. 2014;42(4):371–375. doi: 10.1016/j.ajic.2013.11.003.
    1. Petek D, Kamnik-Jug K. Motivators and barriers to vaccination of health professionals against seasonal influenza in primary healthcare. BMC Health Serv Res. 2018;18(1):1–7. doi: 10.1186/s12913-018-3659-8.
    1. Alame M, Kaddoura M, Kharroubi S, Ezzeddine F, Hassan G, Diab El-Harakeh M, Al Ariqi L, Abubaker A, Zaraket H. Uptake rates, knowledge, attitudes, and practices toward seasonal influenza vaccination among healthcare workers in Lebanon. Hum Vaccin Immunother. 2021;17(11):4623–4631. doi: 10.1080/21645515.2021.1948783.
    1. Costantino C, Restivo V, Gaglio V, Lanza G, Marotta C, Maida C, Mazzucco W, Casuccio A, Torregrossa M, Vitale F. Effectiveness of an educational intervention on seasonal influenza vaccination campaign adherence among healthcare workers of the Palermo University Hospital. Italy Ann Ig. 2019;31(1):35–44.

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