Posted on

Influenza immunization coverage for healthcare workers in a community hospital in Qatar (2011—2012 and 2012—2013 seasons)

Dr. Humberto Guanche Garcell

By Dr. Humberto Guanche Garcell

Dr. Humberto Guanche Garcell MD MPH Hospital Epidemiologist. Hospital ¨Joaquín Albarrán¨. Assistance Professor by the Cuban Medical University and Assistance Researcher by the Cuban Academy of Sciences. La Habana, Cuba

Garcell, H. G., & Ramirez, E. C. (2014). Influenza immunization coverage for healthcare workers in a community hospital in Qatar (2011–2012 and 2012–2013 seasons). Journal of infection and public health, 7(1), 70-72.


Influenza vaccination is recommended for all healthcare workers (HCW) to prevent transmission within healthcare facilities. We conducted a descriptive study on influenza vaccination coverage during 2011—2012 and 2012—2013 campaigns in a community hospital in Qatar. 61.7% of the HCW were immunized in the first campaign, with an increase of up to 71.1% (p < 0.05) in the second one, which was mainly due to better compliance of doctors (46.9% and 69.2%, respectively). Our results show proper coverage rates according US standards and highlight the need to implement additional strategies to improve health workers adherence of influenza, vaccination.


Influenza immunization for healthcare workers (HCWs) is recommended to reduce transmission in healthcare facilities, particularly transmission to patients with chronic conditions and other risk factors that can otherwise increase the probability of influenza-related illness, other complications, and death. Additionally, immunization can decrease staff illness, absenteeism, and transmission to family members [1,2].

Despite strong scientific evidence regarding the benefits of influenza vaccination and institutional policies that promote immunization, coverage rates remain low according to reports from Brazil [3] (43.2%), Australia [4] (16.3—58.7%), and eleven European countries including Spain [2] (maximum 26.3%). In the United States, the coverage rate in the 2011—2012 season was 66.9% [1]. An evaluation of the coverage among employees of the Hamad Medical Corporation (HMC), the largest healthcare provider in Qatar, indicated that 19.4% of HCWs as well as 17.2% of medical staff (6.3% of physicians and 16.7% of nurses) were immunized during the 2006—2007 season [5].

Immunization rates are not systematically evaluated in healthcare facilities, although they are a useful indicator of the adherence to vaccination programs and the need to implement improvement strategies. We conducted an observational study to determine the immunization coverage during the 2011—2012 and 2012—2013 influenza seasons in a community hospital in Qatar.


The study was conducted in The Cuban Hospital, a 75-bed community hospital that is a member of the Hamad Medical Corporation.

Every year during November, the HMC invites all HCWs to be vaccinated (free  of  charge) as part of a national influenza immunization campaign. Using the vaccination records of the Infection Control Department for the 2011—2012 and 2012—2013 seasons, we collected data on the demographics (age and sex) and professions (doc- tors, nurses, technicians) of the vaccinees. During the 2011—2012 and 2012—2013 campaigns, 209 and 325 hospital medical staff, respectively, were included.

Statistical analyses

Data were entered into an excel spreadsheet, and statistical analyses were performed using JMP version 5.1 ( The vaccination coverage was calculated as the number of HCWs vaccinated during the season divided by the total number of HCWs targeted by the program (per  100 HCWs). A descriptive analysis was generated.

Categorical variables were analyzed using the chi-square test when appropriate. The percentages of immunization coverage were compared using the Z test. A p-value < 0.05 was considered statistically significant.


During the 2011—2012 season, 129 (61.9%) HCWs were vaccinated with a higher coverage rate among nurses (69.3%) than doctors and technicians (p < 0.05). Older age was associated with high immunization coverage. No differences were identified according to sex. During the 2012—2013 season, 231 (71.1%) HCWs were vaccinated, and no significant differences were observed regarding age, sex, or professional category (Table 1).

Table 1 Influenza vaccination coverage (per 100 HCWs) according age, sex and professional category in a community hospital, Qatar, 2011—2012/2012—2013 season.


2011—2012 Season vaccination


2012—2013 Season vaccination







Age (means ± SD)


42 (8.5)



42.1 (7.0)

41.5 (8.5)



44 (37.3)

74 (62.7)



144 (70.9)



36 (39.6)

55 (60.4)


35 (28.7)

87 (71.3)

Professional categoryª


31 (30.7)

70 (69.3)*


46 (26.1)

130 (73.9)



34 (53.1)

30 (46.9)


24 (30.8)

54 (69.2)*



15 (34.1)

29 (65.9)


24 (33.8)

47 (66.2)



80 (38.3)

129 (61.7)


94 (28.9)

231 (71.1)*

The comparison of coverage between seasons demonstrated a significant increase (p < 0.05) during the 2012—2013 season due to increased compliance among doctors (46.9—69.2%) (p < 0.05).


The ideal vaccination rate among HCWs is 100%, although 80% is sufficient to reduce transmission to a safe level within healthcare facilities [2]. The US Department of Health and Human Services set a goal to reach an influenza vaccination rate of 60% among HCWs by 2010, with a future target of 90% by 2020 [6]. Vaccine coverage among our workers was higher than previously reported rates and complied with the US target [5].

The influenza pandemic was associated with an improvement of vaccination coverage during the 2009—2010 season among the general population and HCWs without a clear tendency to increase in subsequent years [1,7]. We wish to emphasize the increase in coverage in the 2012—2013 season compared with the previous season, which was primarily due to improved adherence among physicians. This can be explained by corporate strategies and the institutional promotion of vaccination through educational programs and providing free vaccines to all HCWs. At the institutional and corporate levels, HCWs receive regular information on national and international epidemiological conditions regarding influenza and other acute respiratory diseases. These programs include the monthly dissemination of bulletins, newsletters, and epidemiological alerts.

Measures to promote vaccination have been developed and include essential educational and promotional campaigns, measures to facilitate immunization (free vaccines, email and pager reminders, after hours vaccination, decentralized distribution, mobile carts, and peer to peer vaccination), and mandatory policies (requirement for all healthcare personnel to either be vaccinated or wear a mask on medical center grounds during the entire flu season), among others (mandatory declination, incentives, real-time noncompliance tracking, and surveillance of coverage). Non-mandatory campaigns have been shown to successfully increase vaccination coverage; nevertheless, only the implementation of a mandatory policy has increased coverage to greater than 90%.


Our results highlight the need to implement reinforce strategies to improve HCW adherence to influenza vaccination.



  1. Influenza vaccination coverage among healthcare person- nel — 2011—2012 Influenza seasons, United MMWR 2012;61(38):753—7.
  2. Picazo JJ, Alonso MM, Aristegui J, Bayas JM, Sanz J, del Amo P, et Consenso sobre la vacunación frente a la gripe en el personal sanitario. Rev Esp Quimioter 2012;25(3):226—339.
  3. De Souza Cavalcante R, Zambonatto Jorge AM, Bastelo Branco Fortaleza Predictors of adherence to influenza vaccination for healthcare workers from a teaching hospi- tal: a study in the prepandemic era. Rev Soc Bras Med Trop 2010;43(6):611—4.
  4. Seale H, Macintyre   Seasonal  influenza  vaccination  in Australian hospital healthcare workers: a review. MJA 2011;19:363—438.
  5. Shahbic HE, Said Flu vaccine among health workers in Qatar. Saudi Med J 2010;31(10):1157—60.
  6. Quan K, Tehrani DM, Dickey L, Spiritus E, Hizon D, et Voluntary mandatory evolution of strategies and attitudes toward influenza vaccination of healthcare personnel. Infect Control Hosp Epidemiol 2012;33(1):63—70.
  7. Honda H, Padival S, Shimamura Y, Babcock Changes in influenza vaccination rates among healthcare workers fol- lowing a pandemic influenza year at a Japanese tertiary care centre. J Hosp Infect 2012;80:316—20.