摘要：Objectives. We examined barriers to influenza vaccination among long-term care facility (LTCF) health care workers in Southern California and developed simple, effective interventions to improve influenza vaccine coverage of these workers. Methods. In 2002, health care workers at LTCFs were surveyed regarding their knowledge and attitudes about influenza and the influenza vaccine. Results were used to develop 2 interventions, an educational campaign and Vaccine Day (a well-publicized day for free influenza vaccination of all employees at the worksite). Seventy facilities were recruited to participate in an intervention trial and randomly assigned to 4 study groups. Results. The combination of Vaccine Day and an educational campaign was most effective in increasing vaccine coverage (53% coverage; prevalence ratio [PR]=1.45; 95% confidence interval [CI]=1.24, 1.71, compared with 27% coverage in the control group). Vaccine Day alone was also effective (46% coverage; PR= 1.41; 95% CI=1.17, 1.71). The educational campaign alone was not effective in improving coverage levels (34% coverage; PR=1.18; 95% CI=0.93, 1.50). Conclusion. Influenza vaccine coverage of LTCF health care workers can be improved by providing free vaccinations at the worksite with a well-publicized Vaccine Day. During annual influenza epidemics, persons aged 65 years and older are most likely to suffer severe influenza-related complications and death. 1 Residents of long-term care facilities (LTCFs) are at particularly high risk of influenza infection because they often have multiple underlying medical problems, reside in proximity to each other, and are in contact with a wide range of caregivers in a closed setting. 2 – 5 Outbreaks of influenza in LTCFs can result in considerable resident morbidity and mortality. 6 – 8 Because of their susceptibility to influenza-related complications, LTCF residents are considered by the Advisory Committee on Immunization Practices to be a high-priority group for annual vaccination. 1 LTCF residents should receive the influenza vaccination annually; however, in contrast to healthy adults, the elderly have suboptimal immunologic response to the influenza vaccine. 9 , 10 Although the vaccine efficacy is estimated to be 80% in preventing death and 50% to 60% in preventing hospitalizations and pneumonia among LTCF residents, the vaccine is only 30% to 40% effective in preventing influenza infection. 11 – 15 Thus, despite generally high vaccination rates among residents, influenza outbreaks still occur in LTCFs, sometimes triggered by illness among unvaccinated health care workers. 16 – 19 Health care worker vaccination has been shown to reduce morbidity and mortality among the elderly in long-term care settings. 20 , 21 Preventing influenza among LTCF residents through vaccination of health care workers is therefore critical in protecting this vulnerable population. Vaccination of these LTCF personnel also lowers costs for LTCFs because it prevents worker illness and reduces absenteeism. 22 – 24 National organizations, including the Advisory Committee on Immunization Practices, American Medical Association, and Association for Professionals in Infection Control and Epidemiology, Inc, strongly promote influenza vaccination of health care workers as an important public health goal. 25 , 26 Nonetheless, health care worker vaccination rates are estimated to be less than 40% in LTCFs in the United States, far below the national health objective for 2010 to achieve health care worker coverage of 60%. 1 , 27 We conducted a 2-year study in community-based LTCFs to ascertain the reasons for the low influenza vaccine coverage of health care workers and used this information to design and test interventions to improve their vaccination rates.
