Background: The European Council recommendation on seasonal influenza vaccination adopted in 2009 encourages European Union/ European Economic Area (EU/EEA) Member States (MS) (n=31, population of ~500 millions) to improve uptake of seasonal influenza vaccination among older age groups and individuals with chronic conditions to 75 % vaccination coverage. Increased vaccination rates among risk groups were expected to contribute to higher vaccination rates also in healthcare workers (HCWs). Following these recommendations data on reported national policy, payment schemes and measured/estimated uptake of seasonal influenza vaccine in HCWs were collected. Method: A standardized online survey questionnaire was developed and made available to all EU/EEA MS gatekeepers. Results: Of the 30/31 responding countries, 29 countries recommend seasonal influenza vaccine to HCWs. In Denmark no national recommendation is available, but most regions and municipalities offer HCWs influenza vaccination free of charge. Vaccination is recommended to all HCWs in 23 EU/EEA MS, while another 5 recommend vaccination to either front-line staff in close patient contact or staff caring for immuno-compromised patients only. In the UK vaccination is recommended for all HCWs in Northern Ireland and Scotland while England and Wales recommend front line HCWs only. No MS enforces mandatory vaccination of staff. Some health care settings in MS require unvaccinated staff to wear a mask during the influenza season. Payment schemes for vaccine/vaccination varied, with the employer, national or regional health services paying in 19 MS while 4 reported that at least some HCWs paid out of pocket. In the remaining seven countries a combination of several payment mechanisms exists (e.g. private insurance, out of pocket, employer or national insurance scheme). Uptake of seasonal influenza vaccine in HCWs was reported from fourteen EU/EEA MS and ranged between 5-55%. Information was collected by the administrative method (n= 13) or the survey method (n=1). Uptake in HCWs was often but not always lower than uptake in older populations, with a median uptake of ~25% among HCWs (n=14) compared to ~40% in older populations (n=23). Conclusion: There is a need for collection of uptake of seasonal influenza vaccine in HCWs in all EU/EEA MS and at least in those reporting there is room for substantial improvement in uptake of seasonal influenza vaccination.

1. .
J Mereckiene 1,9, S Cotter 1,9, K Johansen2, S Tsolova2, P Penttinen2, F D'Ancona3,9, D Levy-Bruhl 4,9, O Wichman7,9, L Demattè5,9, P Valentiner-Branth6,9, I Stankiewicz7,9, D O’Flanagan 1,9 on behalf of the VENICE project gatekeepers group10
Introduction
The European Council recommendation on seasonal
influenza vaccination adopted in 2009 encourages EU/EEA
Member States (MSs) to improve vaccination coverage
among healthcare workers (HCWs). Similarly, the WHO
SAGE in their recommendation from 2012 states that
HCWs are an important priority group.
In the context of these recommendations we assessed
reported policy, available payment schemes and
measured/estimated uptake of seasonal influenza vaccines
in health care workers in EU/EEA countries.
Methods
A standardized online survey questionnaire was developed
by the Vaccine European New Integrated Collaboration
Effort (VENICE III) network and made available in
December 2015 to all EU/EEA MS gatekeepers (n=31).
Descriptive analysis of data on vaccine policy and payment
schemes provided by each responding EU/EEA MS was
carried out. Vaccination coverage rates (VCR) were
calculated as proportions of the number of vaccinated
individuals (numerator) divided by the total number of
individuals in the population groups targeted for vaccination
(denominator) in each MS. VCR information was collected
either by the administrative method or the survey method.
Results
• Of 30 responding countries, 29 recommended seasonal
influenza vaccine to HCWs ahead of the 2014/2015
influenza season. In Denmark, no national
recommendation was available, but most regions and
municipalities offer vaccination free of charge.
• Vaccination was recommended to all HCWs in 24
EU/EEA MS, while another 4 recommend vaccination to
staff in close patient contact or staff caring for
immunocompromised patients only. In the UK,
vaccination was recommended for all HCWs in Northern
Ireland and Scotland, while England and Wales
recommended vaccination of front line HCWs only or
those HCWs who have direct contact with patients.
Policy recommendations, payment schemes and uptake of seasonal influenza vaccine in health care
workers in EU/EEA Member States assessed for the 2009/2010 to 2014/2015 influenza seasons
• No MS enforces mandatory vaccination of staff. Some
health care settings in MSs required unvaccinated staff
to wear a mask during the influenza season.
• Payment schemes for vaccine/vaccination varied, with
the employer, national or regional health services
covering the cost of in 19 MS while 4 reported that at
least some HCWs paid out of pocket. In the remaining
seven countries a combination of several payment
mechanisms exists (e.g. private insurance, out of pocket,
employer or national insurance scheme).
• Uptake of seasonal influenza vaccination in HCWs was
reported from fourteen EU/EEA MS and ranged between
5-55% in 2014-15. Information was collected by the
administrative method (n= 13) or the survey method
(n=1). Uptake in HCWs was often but not always lower
than uptake in older populations, with a median uptake
of ~25% among HCWs (n=17) compared to ~40% in
older populations (n=26).
Figure 2. Seasonal influenza vaccination coverage rates among HCWs in
EU/EEA MSs 2009-10 to 2014-15 influenza seasons
No recommendation
Recommended for all HCWs
Recommended for some* HCWs
* Health care workers in GPs practice/Outpatient health care settings
Conclusions
• Vaccine policy recommendations for HCWs to be
vaccinated against influenza exist in almost all
EU/EEA MSs
• Payment schemes vary but are available in all
EU/EEA MSs.
• Among those EU/EEA MSs reporting uptake there
is room for significant improvement in uptake of
seasonal influenza vaccination in HCWs
• There is a need for collection of uptake of seasonal
influenza vaccination in HCWs in all EU/EEA MSs
Affiliations: 1Health Protection Surveillance Centre, Dublin, Ireland , 2European Centre for Disease Prevention and Control, Stockholm, Sweden, 3Istituto Superiore di Sanità, Rome, Italy, 4Institut de Viellle Sanitaire, Saint-Maurice, France,5CINECA Consortium of Universities, Bologna, Italy, 6Statens Serum Institut, Copenhagen, Denmark,
7Robert Koch Institute, Berlin, Germany, 8National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland, 9Vaccine European New Integrated Collaboration Effort (VENICE) Project, 10The list of gatekeepers is available in the final report on VENICE website: http://venice.cineca.org
Acknowledgements: We are grateful to all VENICE gatekeepers/contact points in each EU/EEA MS that contributed data presented on this poster,
Figure 1. EU/EEA MSs recommending seasonal influenza vaccine for
health care workers.
*Some is defined as e.g. outpatient/inpatient/long term care facilities workers/ front line HCWs/ those
HCWs who have direct contact with patient.
0
10
20
30
40
50
60
70
80
90
100
Vaccinationcoverage(%)
2009-10 2010-11 2011-12 2012-13 2013-14 2014-15