Introduction

The World Health Organization (WHO) recommends vaccination of health workers against influenza, but uptake in low-resource settings remains low. To complement routine global data collection efforts we conducted a detailed survey on influenza vaccination policies for health workers in low-income and middle-income countries (LMICs) in early 2020.

Methods

Health worker vaccination policy data were collected via a web-based survey tool sent to Expanded Programme on Immunization managers or equivalent managers of all eligible countries. High-income countries and countries with active civil war were excluded from the participation. The survey was sent by email to 109 LMICs in all WHO Regions to invite participation. Data were analyzed by World Bank income category and WHO Region. Statistical methods were applied to assess mean vaccination rates across countries.

Results

Sixty-eight (62%) out of 109 invited LMICs were studied. Thirty-five (51.5%) reported to have a policy for influenza vaccination of health workers. Vaccinations were voluntary in 23 countries (66%), mandatory in 4 (11%), while in 8 countries (23%) mixed vaccination policies existed. A mechanism to estimate vaccine uptake existed in 26 countries (74%). Low-income and African Region countries were less likely to have influenza vaccination policies for health workers (p-values < 0.001 and 0.009, respectively). The most common reason for not having a vaccination policy for health workers was influenza not being a priority (48.5%).

Conclusions

Despite policies being in place in more than half LMICs studied, gaps remain in translating vaccination policies to action, particularly in low-income and African Region countries. To optimize the operationalization of policies, further research is needed within countries, to enable evidence-based introduction decisions, categorization of health workers for vaccination, identification of factors impacting effective service delivery, strengthening monitoring and estimation of vaccination uptake rates and ensure sustainability of funding.

中文翻译：

---

低收入和中等收入国家卫生工作者的流感疫苗接种政策：横断面调查，2020年1月至3月

介绍

世界卫生组织（世卫组织）建议为卫生工作者接种预防流感的疫苗，但在资源贫乏地区的吸收率仍然很低。为了补充常规的全球数据收集工作，我们于2020年初对低收入和中等收入国家（LMIC）的卫生工作者进行了流感疫苗接种政策的详细调查。

方法

卫生工作者的疫苗接种政策数据是通过基于网络的调查工具收集的，该调查工具发送给所有合格国家的免疫管理人员或等效管理人员扩展计划。高收入国家和内战活跃的国家被排除在外。该调查通过电子邮件发送给世卫组织所有区域的109个中低收入国家，以邀请其参加。数据按世界银行收入类别和世卫组织区域进行了分析。采用统计方法评估各国的平均疫苗接种率。

结果

在109个受邀的LMIC中，有68个（62％）被研究。据报告，有三十五（51.5％）制定了针对卫生工作者进行流感疫苗接种的政策。有23个国家（占66％）自愿接种疫苗，有4个国家（占11％）强制接种疫苗，而在8个国家（占23％）存在混合疫苗接种政策。26个国家（74％）存在估算疫苗摄入量的机制。低收入国家和非洲地区国家不太可能针对卫生工作者制定流感疫苗接种政策（p值分别小于0.001和0.009）。没有为卫生工作者制定疫苗接种政策的最常见原因是流感没有成为优先重点（48.5％）。

结论

尽管有一半以上的中低收入国家制定了政策，但在将疫苗接种政策转化为行动方面仍然存在差距，尤其是在低收入和非洲地区国家。为了优化政策的实施，需要在各国内部进行进一步研究，以制定循证引进决策，对卫生工作者进行疫苗分类，确定影响有效服务提供的因素，加强对疫苗接种率的监测和估计并确保资金的可持续性。