International Journal of Hygiene and Environmental Health
Attitudes of dental healthcare workers towards the influenza vaccination
Introduction
Dental healthcare workers (DHCWs) may be unaware of their risk of contracting occupational infections such as influenza. This is evidenced by low rates of use of personal protective equipment like oronasal masks and protective goggles (Molinari, 2010, Wicker and Rabenau, 2010). However, the intimate nature of the patient–dentist environment, the number of patients treated and the frequent creation of aerosols combine to make the dentist's workplace a hazardous site for occupational infections (Stewardson et al., 2002).
The influenza virus is primarily transmitted via large droplets which are generated when infected individuals cough or sneeze. Furthermore, aerosol transmission of influenza is an important mode of transmission and transmission can also occur through direct or indirect contact with respiratory secretions (Centers for Disease Control and Prevention (CDC), 2011, Blachere et al., 2009, Tellier, 2006, Palenik, 2004). Influenza viruses are highly infectious and cause annual epidemics and periodic pandemics. The most important prevention strategy is the annual immunization (Poland and Morse, 2010, Rueckmann et al., 2009).
Influenza immunization has long been recommended for healthcare workers (HCWs). However, acceptance of the influenza vaccination by medical personnel remains low (Hollmeyer et al., 2009, Looijmans-van den Akker et al., 2009, Wicker et al., 2009, Talbot et al., 2010, McLennan and Wicker, 2010). To the best of our knowledge data on DHCWs influenza vaccination status has not been published.
During the 2009–2010 influenza pandemic a good deal of the public expressed concern about the 2009 H1N1 vaccine's safety and refused receipt of said vaccine, fearing that it was a “new” vaccine, “untested”, and “rushed to market” (Poland, 2011). In Germany a significant number of the public and even HCWs were suspicious of the pandemic AS03-adjuvanted influenza vaccines (Brandt et al., 2011).
The purpose of the present study was to characterize the reasons of DHCWs for accepting or declining seasonal influenza vaccine and reasons for refusing to be immunized with the pandemic vaccine in 2009/2010. Furthermore, we evaluate attitudes towards the pandemic due to the emergence of the H1N1/2009.
Section snippets
Study population and questionnaire
At the University of Frankfurt dental hospital 174 DHCWs with direct patient contact or contact with material possibly contaminated with blood or saliva and 38 employees without patient contact (e.g. administrative personnel, maintenance) are employed (total staff: 212). There are approximately 570 dental students at the dental school, including 330 dental students who are in the clinical phase of their studies.
Since 2009, the dental hospital offers influenza vaccinations free of charge to
Results
From October 2010 to February 2011, overall, 31.6% of the DHCWs (67/212) and 31.5% of the dental students (104/330) were vaccinated against influenza and completed the anonymous questionnaire. Dentists were significantly more likely to have been vaccinated (36.8% – 28/76) than dental assistants and dental technicians (21.4% – 21/98) (p = 0.038).
Overall, 58% of the vaccinees were female, 42% male, in accordance with the gender distribution of employees and student body at the dental hospital and
Discussion
DHCWs are exposed to a variety of infectious pathogens in their work environments (Wicker and Rabenau, 2010, Palenik and Govoni, 2004). Ensuring that DHCWs are immune to vaccine-preventable diseases (e.g. influenza, hepatitis B) is an essential part of preventing occupational infections and transmissions to patients (Andrews, 2006, Miller and Palenik, 2010).
Studies on influenza vaccine acceptance in the healthcare setting had previously focused on hospital-based HCWs (Hopman et al., 2011,
Conclusion
In conclusion, compliance rates with the influenza vaccination among German DHCWs were low. However, our findings also suggest that the convenience of an on-site vaccination at the workplace can improve immunization rates. Nevertheless, many German DHCWs remained unconvinced of the safety of the adjuvanted influenza vaccine. Greater efforts at educating DHCWs about the influenza vaccine safety and the need to increase influenza vaccination rates to ensure occupational health and also patient
Contribution
SW drafted the manuscript. SW and WB conceived the study and the study design.
HFR performed the analysis and interpretation of the data and revised together with HCL the manuscript for important intellectual content.
All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors read and approved the final manuscript.
Conflict of interest
The views in this article are the personal views of the authors and do not necessarily represent the views of the professional organizations or institutions within which we are members.
Sabine Wicker is a member of the Standing Committee on Vaccination (STIKO) at the German Robert Koch Institute (RKI). She has been a member of an advisory board on nasal influenza vaccines for AstraZeneca Germany. She has received honoraria for non-product-related talks on influenza vaccination from
Financial support
No financial support was received.
Acknowledgements
The authors would like to thank the participants of the study for their time and effort in completing the questionnaire and their valuable suggestions regarding the vaccination campaign.
The authors extend special thanks to Ms. Christine Wobst (Dental Hospital) for her effort in promoting the project.
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