Cost-effectiveness of workplace vaccination against measles

Abstract

Measles is one of the most contagious infectious diseases. Measles vaccine, which has been introduced in Italy in 1979, is highly effective in preventing the disease (two-dose vaccine effectiveness is 99%). In 2017, Italy was the second country of EU for number of cases of measles. A study conducted in the same year showed that 22.3% of measles infection happened in hospital settings and 6.6% of cases occurred in HCWs. This risk group showed low rates of adhesion to the vaccination campaign. For this reason, we hypothesized that workplace vaccination could lead to better vaccination rates in HCWs. Moreover, we focused the vaccination campaign on a specific target group composed of HCWs not serologically immune and previously not vaccinated. We analyzed the clinical records of measles-specific IgG antibodies of 2,940 HCWs, that underwent occupational health surveillance between 1 January 2017 and 31 December 2017. 15.3% (450) was seronegative for measles, especially in the age group under 35 years. We compared the costs related to strategies with and without serological screening. Our study confirmed that immunization strategy with pre-vaccination screening was cost-effective compared to the vaccination without screening. In our sample, in fact, administration of two dose vaccine only susceptible HCWs determine a saving of 146,262 €. The vaccination of HCWs remains a topical issue in preventing the transmission of infectious disease in the hospital setting. Due to the cost-effectiveness evaluation, we recommend extending the pre-vaccination screening to identify the real susceptible workers.

Measles among healthcare workers in Italy: is it time to act?

“…56 On these grounds, the education and training of HCWs to allow them to promote and perform missing vaccinations after pre-vaccination screening could represent a cost-effective measure that would protect patients and HCWs, and would minimize the economic impact. 15,57 Regarding reporting of measles genotype, the results are consistent with the trends described by the Measles and Rubella National Reference Laboratory of the Italian NIH: B3 and D8 co-circulated from 2014 to 2018, while D4 disappeared after 2014. 58,59 Despite some improvements in the measles and rubella aggregate reporting forms, 60 a non-uniform degree of completeness of reporting was observed.…”

“… 56 On these grounds, the education and training of HCWs to allow them to promote and perform missing vaccinations after pre-vaccination screening could represent a cost-effective measure that would protect patients and HCWs, and would minimize the economic impact. 15 , 57 …”

Immunity to vaccine-preventable diseases among paediatric healthcare workers in Denmark, 2019

“…The best way to prevent such hospital-based outbreaks is to ensure that all HCW are fully immunised. Because the NPV of self-reported immunity was low, the most cost-effective and accurate immunisation strategy among HCW seems to be pre-vaccination IgG screening [ 29 , 30 ]. For such an initiative to succeed, HCW should be educated about the importance and limitations of vaccines and the severe manifestations of the VPD.…”

Intention to Be Vaccinated for COVID-19 among Italian Nurses during the Pandemic

“…The main factors contributing to hesitancy are a lack of confidence in vaccines (and fear of the potential hazards, including misconceptions about the risk of infection following vaccination), poor understanding of the need to vaccinate (e.g., underestimation of disease severity) or of the value of the vaccine, and difficulties accessing the vaccine [ 16 ]. Recent findings show that mandatory vaccination policies and strategies that improve vaccine accessibility are likely to be effective, whereas education policies are often ineffective [ 17 , 18 ].…”