Vaccinating Front-Line Healthcare Workers: Results of a Pre-Pandemic Cross-Sectional Study from North-Eastern Italy on First Responders

Abstract

First responders are front-line healthcare workers who are potentially exposed to different infectious agents. Characterizing their knowledge, attitudes, and practices (KAP) towards immunization, therefore, has the potential to significantly improve occupational health and safety. A cross-sectional study was performed in October 2018 using a sample of 161 first responders from the Parma Province (mean age 45.1 ± 14.1 years; seniority 10.8 ± 8.6 years). The participants were questioned on three recommended vaccinations (i.e., the seasonal influenza, measles, and pertussis vaccines) and on meningococcal vaccines (not officially recommended for first responders). The participant's knowledge status and risk perception were assessed as percentage values through a specifically designed questionnaire. Adjusted odds ratios (aOR) for factors associated with vaccination status were calculated by means of a binary logistic regression analysis. The internal consistency result, calculated using a general knowledge test, was good (Cronbach's alpha = 0.894), but the corresponding score was unsatisfying (46.5% ± 32.4), evidencing uncertainties surrounding the recommendations for measles and meningococcal vaccines (39.1% and 34.2% incorrect answers, respectively). While the large majority of respondents were favorable towards the meningococcal (89.4%), measles (87.5%), and pertussis vaccines (83.0%), 55.3% exhibited a favorable attitude toward the seasonal influenza vaccine, the uptake of which in 2018, was reported by 28.0% of respondents, compared to the self-reported lifetime status for meningitis (26.1%), measles (42.2%), and pertussis (34.8%). Not coincidentally, all assessed infections were associated with a low-risk perception score, particularly influenza (33.9% ± 18.4). Interestingly enough, neither knowledge status nor risk perception were associated with vaccination rates. More precisely, the main predictor for being vaccinated against seasonal influenza in 2018 was a seniority of ≥10 years (aOR 3.26, 95% confidence interval [95% CI] 1.35-7.91), while both pertussis and measles were positively associated with higher educational achievement (aOR 3.27, 95%CI 1.29-8.30; and aOR 2.69, 95%CI 1.09-6.65, respectively). The reasons for vaccination gaps among the sampled first responders, apparently, did not find their roots in inappropriate knowledge status and risk perception alone. However, the very low rates of sampled immunization lead us to recommend stronger and more appropriate information campaigns.

Keywords: attitudes; first responders; healthcare workers; immunizations; knowledge; practices; vaccines.

Figure A1

Risk perception score for: (a) seasonal influenza vaccine (SIV), (c) pertussis vaccine (PA), (e) measles vaccine (MeV), (g) meningitis from N meningitidis (MEN), and corresponding natural infections: seasonal influenza (b), pertussis (d), measles (f), infections from N meningitidis (h), all of them broken down by having or having not been vaccinated (SIV: 2018; PA, MeV, MEN = lifetime).

Figure A1

Risk perception score for: (a) seasonal influenza vaccine (SIV), (c) pertussis vaccine (PA), (e) measles vaccine (MeV), (g) meningitis from N meningitidis (MEN), and corresponding natural infections: seasonal influenza (b), pertussis (d), measles (f), infections from N meningitidis (h), all of them broken down by having or having not been vaccinated (SIV: 2018; PA, MeV, MEN = lifetime).

Figure 1

Flow chart of sampled participants.

Figure 2

Density plots for knowledge scores, calculated for general knowledge on vaccinations (average: 46.5% ± 32.4, range 0–100; median 46.2%) (a) and on the understanding of the National Immunization Prevention Plan 2017–2019 (PNPV) (average: 54.1% ± 11.8, range 28.6–85.7; median 50.0%) (b). Dotted lines report the respective median values.

Figure 3

Risk perception component for 161 first responders from the Province of Parma (2018) participating in our survey. Participants were questioned on four vaccine-preventable disorders (i.e., seasonal influenza, pertussis, measles, meningococcal meningitis), focusing on the perceived frequency and severity of both vaccine side effects and natural infection. Respective risk perception scores for natural infection and vaccine side effects were calculated as the product of the perceived frequency and severity of the events (Note: SIV = Seasonal Influenza Vaccine, aP = Pertussis vaccine, M = measles vaccine, Men = meningitis vaccine; Subfigures: (a) = perceived frequency of vaccine side effects; (b) = perceived severity of vaccine side effects; (c) = risk perception score for vaccinations; (d) = perceived frequency of natural infections; (e) = perceived severity of natural infections; (f) = risk perception score of natural infections).