No abstract

The aim of this study was to identify factors that affect influenza vaccination in order to devise means to increase compliance. In February 2003, pediatricians attending a national medical conference and nurses in a university hospital in central Israel were asked to complete a questionnaire regarding occupational data, knowledge issues, and reasons for undergoing/not undergoing vaccination themselves. Physicians also reported their practice of recommending the vaccine. A total of 181 physicians and 217 nurses answered the questionnaires (compliance rate, 51%). Almost half (46.8%) had been vaccinated against influenza. There was a higher rate for physicians (60.8%) compared to nurses (35.2%), board-certified or board-eligible pediatricians (67.4%) compared to residents (44.7%), and for in-hospital physicians (67%) compared to community physicians (53%). Most frequent reason for vaccination was self-protection; and most frequent reason for non-vaccination was doubt about vaccine effectiveness. Physicians had better knowledge scores (68 ? 22 vs. 51 ? 23, p = 0.01). On multivariate regression analysis, the variables associated with getting influenza vaccine by physicians were knowledge concerning influenza vaccine (OR = 1.31), recommending the vaccine to patients (OR = 3.37), and specialist status (OR = 2.61). Increased knowledge concerning influenza vaccine is associated with increased vaccination rates among pediatric healthcare workers and their recommendation to vaccinate children.

The recent licensing of active hepatitis A vaccines raises the question of vaccine candidates. Although various groups of workers are at theoretical occupational risk of hepatitis A infection, no comprehensive quantitative data exist to determine which occupational groups should receive active vaccination. Therefore, the aims of this study were to identify occupations at risk for hepatitis A infection and to determine their relative risk. In this nationwide historical prospective study, the relative risk of hepatitis A among different occupations in Israel was determined according to the incidence of hepatitis A in different occupations during 1993 and 1994 compared with the incidence of hepatitis A in two standard populations. After age, gender, ethnicity, and time of immigration to Israel were controlled for, certain occupations showed a significant increased risk of hepatitis A: yeshiva students (standardized incidence ratio (SIR) = 9.98, 99% confidence interval: 7.55, 13.18), day care center and kindergarten staff (SIR = 5.47, 99% confidence interval: 3.50, 8.57), food industry workers (SIR = 5.41, 99% confidence interval: 1.92, 15.25), teachers (SIR = 4.02, 99% confidence interval: 2.92, 5.48), physicians and dentists (SIR = 3.77, 99% confidence interval: 1.78, 8.14), and therapists and medical technicians (SIR = 3.75, 99% confidence interval: 1.75, 8.14). Sewage workers and nurses did not show any significantly increased risk. The results were validated by comparison with an additional standard population. This first nationwide study identified occupations at risk of hepatitis A infection. It emerged that the authors' approach can provide a yardstick for measuring samples in both large and small countries that have a socioeconomic background similar to that of Israel.

HAV seropositivity was associated mainly with sociodemographic variables. Most children's hospital employees, especially pediatricians and other young (<40 years) employees, are seronegative and therefore susceptible to HAV. Vaccination of the high risk groups should be considered.