1. RESEARCH POSTER PRESENTATION DESIGN © 2015
www.PosterPresentations.com
Background: Influenza can be a serious illness, not only in high risk patients, but also in previously
healthy individuals. Therefore, healthcare workers should be vaccinated against influenza not only
for their own protection, but to protect their patients as well.
Aim: The study aimed to examine the attitudes and opinions of healthcare workers at “Laikon”
General Hospital, Athens Greece, towards influenza vaccination.
Methods: The study was conducted at “Laikon” Hospital, a 565 bed teaching tertiary hospital. A
standardized anonymous questionnaire was distributed to nurses, physicians and medical
students. The questionnaire contained 3 sections of questions regarding demographics of the
responders, their opinions towards influenza vaccination and their sources of information about
influenza vaccination.
Results: 317 questionnaires were distributed and 293 healthcare workers responded (response
rate 92.4%). The responders were 35.5% physicians, 38.2% nurses, and 22.1% medical students.
Only 38.6% of the responders self-reported that they had ever been vaccinated against influenza
in the past.
The majority (62.8%) agreed that influenza vaccination was necessary, however only 55,3%
thought vaccination was safe and a minority (44.7%) believed it was effective.
Reported reasons for non-vaccination were: distrust against vaccinations in general (20.5%),
neglect (16%), vaccine side effects (15.4%) & vaccine lack of effectiveness (15.1%). 68.6% of the
responders had received information regarding influenza vaccination the last 5 years but only
42.3% believed it was adequate.
Only 35.5% of the responders intended to be vaccinated in the future. In multivariate analysis
predictors of future vaccination were previous vaccination (Odds Ratio = 8.7), belief that the
vaccine was necessary (OR = 8.2), and trust to the vaccine (OR = 5.6).
Conclusion: The low rate of influenza vaccination in healthcare workers is a fact and a problem
that needs to be addressed. However, the question still remains whether this specific vaccination
should become mandatory for healthcare infrastructures.
ABSTRACT
OBJECTIVES
RESULTS
Table 1:Reasons for refusing vaccination against seasonal influenza
• As far as the intention of a future vaccination against seasonal influenza was concerned, we
chose to further analyze the last question of the questionnaire “Are you going to receive the
influenza vaccination or not?”. Due to the fact that the possible answers were ‘Yes’, ’No’ and ‘I
do not know’, we chose to analyze the variables that appeared to be important with the linear
logistic regression model in three ways. The first way, as shown in table 2, was the worst case
scenario and treated the ‘I do not know’s as if they were not going to get vaccinated, the second
scenario simply ignored them (table 3), whereas the third treated them as if they were going to
get vaccinated (best case scenario, table 4). The results were mostly the same, especially those
that linked the intention of a future vaccination with the history of a previous influenza
vaccination, further indicating that those who had not been vaccinated in the past were more
prone to decline a future vaccination in the future.
Table 2: Yes vs No + I don’t know Table 3: Yes vs No (I don’t knows were not included)
Table 4: Yes + I don’t know vs No
The use of the questionnaire was based mainly to our need for quick yet reliable results. However,
this particular selection may have unwittingly allowed the appearance of certain bias, such as a
non- response bias concerning the non-responders and a selection bias, since a great portion of
the population was excluded. Despite the limitations, our hypothesis was confirmed: almost ⅔ of
the responders denied having received the influenza vaccination and only 11% of them actually
changed their mind after the completion of the questionnaire.
Finally, the realization of a previous vaccination plays a major role in the intention of a future
vaccination against seasonal influenza, which underlines once more the difficulty of achieving a
behavioral change and calls to the possibility of constituting a mandatory vaccination policy in
healthcare infrastructures.
REFERENCES
1.WHO. WHO | Influenza (Seasonal). Available at:
http://www.who.int/mediacentre/factsheets/fs211/en/.
2.Takayanagi, I., Cardoso, M., Costa, S. & Elke. Attitudes of health care workers to influenza
vaccination: why are they not vaccinated? Am J Infect Control 2007 Feb; 35(1):56-61
3.Dedoukou, X., Nikolopoulos, G., Maragos, A., Giannoulidou, S. & Maltezou, H. C. Attitudes
towards vaccination against seasonal influenza of health-care workers in primary health-care
settings in Greece. Vaccine 28, 5931–5933 (2010).
4.Maltezou, H. C. et al. Influenza vaccination acceptance among health-care workers: a
nationwide survey. Vaccine 26, 1408–1410 (2008).
Seasonal influenza is a major cause of acute respiratory illness.1 Annually, three to five million
people get infected and 250.000-500.000 eventually will die.1 Although seasonal influenza is
usually harmless, it constitutes a great danger for high risk groups.
According to the World Health Organization (WHO), the vaccination of healthcare workers against
seasonal influenza is widely recommended.1 After all, it is well known that the health care workers
that are not vaccinated against seasonal influenza pose a great risk not only to themselves but
also to the hospitalized patients. Still, the vaccination rate remains extremely low worldwide.2–4
Even though the vaccination has been recommended for the past three decades for healthcare
workers in Greece as well, the vaccination rate in this particular country still remains very
low.3Such low rates pose a serious threat to the safety of the hospitalized patients, that are thus
more prone to influenza complications and underline the need to enhance the vaccination uptake
as well as to improve the overall situation.
It is in that spirit that we chose to perform an additional study, referring to the vaccination attitudes
and opinions of healthcare workers in a tertiary Greek hospital in the hope that it would lead to a
better understanding of the situation and provide us with better insight into the problem and its
possible solution.
The main aim of the study was the recording of the influenza vaccination history of healthcare
workers in ″Laikon″ General Hospital of Athens and the confirmation that the vaccination rate still
remains low.
¹National and Kapodistrian University of Athens, 1st Department of Internal Medicine, ″Laikon″General Hospital, Athens, Greece
atsifi@hotmail.com ²National and Kapodistrian University of Athens, 1st Department of Internal Medicine, ″Laikon″General Hospital,
Athens, Greece ³Biopathology Department, Pedi ″Ilion″, Athens, Greece ⁴ Department of Medical Oncology , ″Metaxa″Special Cancer
Hospital, Piraeus, Greece ⁵1st Department of Internal Medicine, ″Pammakaristos″General Hospital, Athens, Greece ⁶National and
Kapodistrian University of Athens, 1st Department of Surgery, ″Laikon″General Hospital, Athens, Greece
Tsifi A.¹Samarkos M.²Theodoridis D.³Miltiadou K.⁴Solomos Z.⁵Rosenberg T.⁶Daikos G.²
ATTITUDES AND OPINIONS OF HEALTH CARE WORKERS TOWARDS
INFLUENZA VACCINATION IN A TERTIARY HOSPITAL IN ATHENS,
GREECE
Reason Rate (%)
Influenza is not a dangerous disease 11,9%
The vaccine is not safe 15%
The vaccine is not effective 16%
The vaccine has many side- effects 15,4%
I do not trust vaccinations 20,5%
It was not recommended to me 7,8%
I did not know I was supposed to get vaccinated 3,4%
I do not need it because I will not get sick 4,1%
I forgot it 16%
I am not sure it is in my interest to get vaccinated 14,3%
Other 10,9%
Variables in the Equation
B S.E. Wald df Sig. Exp(B)
95% C.I.for EXP(B)
Lower Upper
Step 1a Gender .038 .469 .007 1 .936 1.039 .414 2.604
Profession -.496 .314 2.499 1 .114 .609 .329 1.126
Working Experience .222 .256 .747 1 .387 1.248 .755 2.063
Previous Vaccination 2.167 .506 18.322 1 .000 8.729 3.237 23.542
Necessary 2.113 .890 5.638 1 .018 8.272 1.446 47.319
Safe -.393 .498 .624 1 .430 .675 .255 1.790
Effective -.289 .350 .681 1 .409 .749 .377 1.488
Important for patients -.360 .524 .472 1 .492 .698 .250 1.949
Important for family .836 .582 2.062 1 .151 2.306 .737 7.217
Important for them m .470 .454 1 .500 .728 .290 1.831
Dangerous -.076 .432 .031 1 .861 .927 .397 2.163
Mandatory .839 .500 2.813 1 .093 2.314 .868 6.169
Trustworthy 1.723 .598 8.306 1 .004 5.600 1.735 18.071
Source of Information -.418 .802 .271 1 .603 .658 .137 3.174
Valid information .779 .571 1.863 1 .172 2.179 .712 6.667
Further Information .589 .511 1.331 1 .249 1.803 .662 4.909
Constant -9.319 1.938 23.114 1 .000 .000
a. Variable(s) entered on step 1: GENDER, PROF, YEARS, VACC, NESS, SAFE, RESULT, IMPORTPA, IMPORTFA, IMPORTHE, DANGER, MANDA, TRUST,
INFORM, INFVAL, MOREINF.
Variables in the Equation
B S.E. Wald df Sig. Exp(B)
95% C.I.for EXP(B)
Lower Upper
Step 1a Gender .117 .553 .045 1 .832 1.124 .380 3.325
Profession -.469 .361 1.686 1 .194 .626 .308 1.270
Working Experience .577 .301 3.665 1 .056 1.781 .986 3.215
Previous Vaccination 2.100 .578 13.208 1 .000 8.164 2.631 25.333
Necessary 2.007 .938 4.574 1 .032 7.441 1.183 46.811
Safe -.318 .552 .331 1 .565 .728 .247 2.148
Effective -.662 .462 2.048 1 .152 .516 .209 1.277
Important for patients -.232 .588 .156 1 .693 .793 .250 2.511
Important for family 1.099 .673 2.671 1 .102 3.002 .803 11.218
Important for them -.068 .528 .017 1 .897 .934 .332 2.627
Dangerous -.092 .520 .031 1 .860 .912 .329 2.530
Mandatory .974 .570 2.922 1 .087 2.649 .867 8.095
Trustworthy 1.867 .696 7.186 1 .007 6.469 1.652 25.334
Source of Information -1.735 .993 3.057 1 .080 .176 .025 1.234
Valid information .972 .647 2.256 1 .133 2.644 .744 9.403
Further Information .707 .574 1.517 1 .218 2.028 .658 6.251
Constant -10.284 2.220 21.454 1 .000 .000
a. Variable(s) entered on step 1: GENDER, PROF, YEARS, VACC, NESS, SAFE, RESULT, IMPORTPA, IMPORTFA, IMPORTHE, DANGER, MANDA, TRUST, INFORM,
INFVAL, MOREINF.
Variables in the Equation
B S.E. Wald df Sig. Exp(B)
95% C.I.for EXP(B)
Lower Upper
Step 1a Gender -.391 .407 .922 1 .337 .676 .305 1.502
Profession -.106 .263 .162 1 .687 .900 .537 1.507
Working Experience .154 .217 .506 1 .477 1.167 .763 1.784
Previous Vaccination 1.199 .419 8.200 1 .004 3.315 1.460 7.530
Necessary .789 .490 2.591 1 .107 2.200 .842 5.748
Safe -.332 .342 .939 1 .333 .718 .367 1.404
Effective -.209 .287 .530 1 .467 .811 .462 1.424
Important for patients .227 .391 .338 1 .561 1.255 .583 2.704
Important for family .935 .438 4.564 1 .033 2.547 1.080 6.007
Important for them .147 .368 .159 1 .690 1.158 .563 2.381
Dangerous -.057 .351 .026 1 .871 .945 .475 1.879
Mandatory .334 .399 .700 1 .403 1.396 .639 3.049
Trustworthy .541 .352 2.356 1 .125 1.717 .861 3.425
Source of Information -1.313 .677 3.763 1 .052 .269 .071 1.014
Valid information .629 .419 2.258 1 .133 1.876 .826 4.264
Further Information .676 .429 2.481 1 .115 1.965 .848 4.556
Constant -5.533 1.510 13.430 1 .000 .004
a. Variable(s) entered on step 1: GENDER, PROF, YEARS, VACC, NESS, SAFE, RESULT, IMPORTPA, IMPORTFA, IMPORTHE, DANGER, MANDA, TRUST,
INFORM, INFVAL, MOREINF.
A total of 778 healthcare workers belonging to our target population were employed at the time in
″Laikon″ General Hospital. Since at least 260 filled questionnaires were required, 317 questionnaires
were distributed and 293 returned (response rate: 92,4%) from resident doctors (35,49%), nurses
(38,23%), medical students (4,10%) and other healthcare workers (4,10%).
• 38,57% of the participants were vaccinated against influenza as opposed to 59,04% of
unvaccinated responders
• 2,93% of the target population answered that they did not remember whether or not they had
received an influenza vaccination in the past
• Overall the majority of the participants (68,60%) claimed that they had received adequate
information over the past five years regarding the influenza vaccination, mostly from the university
or other health establishments
• 51,88% found the received information valid (as opposed to 40,61%) and 42,33% thought that it
was adequate (as opposed to 20,48% who found it to be inadequate and 37,20% who did not
have a formed opinion on the matter)
• More than ⅔ of the participants (67,92%) expressed their wish to further receive information
mostly from specialists and the Greek Center of Disease Control (KEELPNO).
• Regarding the reasons for adherence to the recommendations for influenza vaccination 72,70% of
the participants thought that the vaccine is recommended for the protection of the patients,
46,05% because the risk of getting sick is great and 39,59% because of the seriousness of the
influenza complications. The main reasons for refusing the vaccination, as depicted in table 1 are
the fact that the responders: do not trust the influenza vaccination (20,5%), they find the vaccine
ineffective (16%), with many side effects (15,4%), unsafe (15%) or are not sure that it is in their
interest to get vaccinated (14,3%)
CONCLUSIONS
The low rate of influenza vaccination in healthcare workers is a fact and a problem that needs to
be addressed. The results of our survey unfortunately demonstrated a tendency of healthcare
workers in our hospital not to receive the influenza vaccination , especially if they have not done so
in the past.
In Greece the choice of vaccination against seasonal influenza relies more on the healthcare
worker’s desire and less on his acknowledgement that he has a moral obligation to himself and to
others. Some claim that the benefits that derive from the vaccination both for the patients and for
the healthcare workers are more than enough in order to convert the existing policy into a
mandatory one. Others, however, claim that these methods threaten our freedom and our ability to
treat our bodies in an individual manner.3 Thus, the question still remains whether this specific
vaccination should become mandatory for healthcare infrastructures.
The improvement of the information provided can certainly change the misdirected opinions of
certain healthcare workers regarding the influenza vaccination. Stereotypes, such as the idea that
the vaccination will inevitably cause Guillain-Barré should cease to exist. After all, ignorance, fear
and panic are the three major causes that discourage healthcare workers from getting vaccinated
against seasonal influenza.