Emergency Department influenza vaccination campaign allows increasing influenza vaccination coverage without disrupting time interval quality indicators
To evaluate the impact of an influenza vaccination (IV) coverage (IVC) in a vaccination campaign of an Emergency Department (EDVC) and its impact on ED time interval quality indicators. We conducted a 4 year observational study, with an intervention during the 4th year. IVC was calculated during pre-and early-epidemic periods. During the final period, a 12 weeks EDVC was implemented. Physicians and nurses were trained and sensitized in the importance of vaccination, and their role in the prevention of severe forms of influenza was reinforced. The vaccine was proposed by physicians and nurses, and delivered by them. Repeated measures ANOVA is a validated method for related not independent groups (https://statistics.laerd.com/statistical-guides/repeated-measures-anova-statistical-guide.php). Overall, IVC was 987/3191 (30.9%) with an increasing trend from 28.8 to 33.2%. In the fourth period, out of 868 patients identified with IV indication, 288 had already been vaccinated (IVC 33.2%). After excluding patients presenting criteria of exclusion, IV was proposed to 475 patients: 317 (66.7%) accepted. The vaccination rate after patient’s acceptance was 89.6% (288/317). At the end of the EDVC, influenza vaccination coverage was 572 (284 + 288)/868 (65.9%). The delay between arrival at the ED and seeing the triage nurse and physician as well as the overall ED length of stay were not modified during the study period and before and during EDVC. EDVC effectively doubled the influenza vaccination coverage, without modifying ED time interval quality indicators.
KeywordsInfluenza Seasonal epidemic Vaccination Coverage Evaluation Interventional study
We would like to thank Jeffrey Arsham for having reviewed the English language text.
ED-Study Group on Respiratory Viruses: Julien Bernard, MD; Anne Casaubieilh, Nurse Practitioner; Abigael Debit, MD; Elise Dupeyrat, MD; Yoan Gil, MD; Madline Gillo, Nurse Practitioner; Suzanne Goncalves, Nurse Practitioner; Neila Laurent, Head Staff Nurse; Michèle Macaux, Head Staff Nurse; Jeanne Pigeau, Head Staff Nurse; Ranaivoson Michel, MD; Sabrina Rouleau, Head Staff Nurse; Lydia Roux, Head Staff Nurse.
EC, AG, DB, SA, PhK CC and LP conceived the study and designed the trial. EC, AG, DB, SA, PhK CC and LP supervised the conduct of the trial and data collection. EC, AG, DB, SA, PhK CC and LP undertook recruitment of patients and managed the data, including quality control. EC, AG, DB and SA provided statistical advice on study design and analysed the data. EC, AG, DB and PhK drafted the manuscript, and all authors contributed substantially to its revision. EC takes responsibility for the paper as a whole.
Compliance with ethical standards
Conflict of interest
Statements on human and animal rights
The protocol was conducted in agreement with the Helsinki declaration. This dataset was completely anonymous and did not contain any identifiable personal health information. This study was approved by the ED (Assistance Publique-Hôpitaux de Paris) committees on ethics, research and informatics.
Patient informed consent was obtained before study inclusion.
- 2.Rosselli R, Martini M, Fluad Effect Working Group, Bragazzi NL, Watad A (2017) The public health impact of the so-called “Fluad effect” on the 2014/2015 influenza vaccination campaign in Italy: ethical implications for health-care workers and health communication practitioners. Adv Exp Med Biol 973:125–134CrossRefPubMedGoogle Scholar
- 4.US Department of Health and Human Services (2016) Immunization and infectious diseases. https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases/objectives. Accessed 11 July 2017
- 5.Direction Générale de la Santé (2012) Comité technique des vaccinations. Guide des vaccinations. http://solidarites-sante.gouv.fr/IMG/pdf/Guide_des_vaccinations_edition_2012.pdf. Accessed 14 Nov 2017
- 6.European Centre for Disease Prevention and Control (2016) Influenza. http://ecdc.europa.eu/en/healthtopics/influenza/Pages/home.aspx. Accessed 02 July 2017
- 7.Centers for Disease Control and Prevention (2016) Flu vaccination coverage. United States, 2014–15 influenza season. http://www.cdc.gov/flu/fluvaxview/coverage-1415estimates.htm. Accessed 11 July 2017
- 9.Dexter LJ, Teare MD, Dexter M, Siriwardena AN, Read RC (2012) Strategies to increase influenza vaccination rates: outcomes of a nationwide cross-sectional survey of UK general practice. BMJ Open 11:2Google Scholar
- 10.Bechini A, Bonanni P, Lauri S, Tiscione E, Levi M, Prato R et al (2017) Strategies and actions of multi-purpose health communication on vaccine preventable infectious diseases in order to increase vaccination coverage in the population: the ESCULAPIO project. Hum Vaccines Immunother 13:369–375CrossRefGoogle Scholar
- 18.Assurance Maladie (2016) Grippe saisonnière. La campagne nationale de vaccination contre la grippe saisonnière se déroule du 6 octobre 2016 au 31 janvier 2017. Le point sur la campagne, le dispositif mis en place et les modalités pratiques. http://www.ameli.fr/professionnels-de-sante/infirmiers/exercer-au-quotidien/vaccination-contre-la-grippe-saisonniere/la-campagne-de-vaccination-2016-2017.php. Accessed 16 Nov 2017
- 19.Centers for Disease Control and Prevention (2016) Flu vaccination coverage. United States, 2014–15 influenza season. http://www.cdc.gov/flu/fluvaxview/coverage-1415estimates.htm. Accessed 12 Jul 2017
- 21.Nicand E (2015) Couverture vaccinale en France en 2014: un bilan contrasté. https://www.mesvaccins.net/web/news/6140-couverture-vaccinale-en-france-en-2014-un-bilan-contraste. Accessed 01 July 2017
- 23.Jiménez-García R, Rodríguez-Rieiro C, Hernandez-Barrera V, Carrasco Garrido P, López de Andres A, Esteban-Vasallo MD et al (2014) Negative trends from 2008/9 to 2011/12 seasons in influenza vaccination coverages among high risk subjects and health care workers in Spain. Vaccine 32:350–354CrossRefPubMedGoogle Scholar