Healthcare worker acceptance of pandemic (H1N1) 2009 vaccination, Morocco.
Article Type: Letter to the editor
Subject: Swine influenza (Research)
Swine influenza (Prevention)
Vaccination (Usage)
Medical personnel (Health aspects)
Authors: Tagajdid, Rida
Annaz, Hicham El
Doblali, Taoufik
Sefiani, Kawtar
Belfquih, Bouchra
Mrani, Saad
Pub Date: 10/01/2010
Publication: Name: Emerging Infectious Diseases Publisher: U.S. National Center for Infectious Diseases Audience: Academic; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 U.S. National Center for Infectious Diseases ISSN: 1080-6040
Issue: Date: Oct, 2010 Source Volume: 16 Source Issue: 10
Topic: Event Code: 310 Science & research
Product: Product Code: 8010000 Medical Personnel; 8000146 Vaccination & Immunization NAICS Code: 62 Health Care and Social Assistance; 621999 All Other Miscellaneous Ambulatory Health Care Services
Geographic: Geographic Scope: Morocco Geographic Code: 6MORO Morocco
Accession Number: 238895956
Full Text: To the Editor: In Morocco, the first case of pandemic (H1N1) 2009 was diagnosed on June 12, 2009 (1). Because a main determinant of public immunization success is healthcare workers' support and recommendations and because little is known about such with regard to pandemic (H1N1) 2009 vaccination in Morocco, our aim was to document healthcare workers' knowledge, attitudes, practices, and acceptance of pandemic (H1N1) 2009 vaccination in Morocco.

From January 15 through February 28, 2010, a structured, self-administered, anonymous questionnaire was distributed to a convenience sample of 1,332 healthcare workers in 5 public hospitals in Rabat, Morocco. Completed questionnaires were analyzed by using SPSS version 10.0 (SPSS, Chicago, IL, USA). The 1,002 responses gave a response rate of 75% ([approximately equal to]17% of the entire staff of the University Hospital of Rabat).

We found that the hospital staff had acquired basic knowledge about transmission and prevention of the pandemic (H1N1) 2009 virus. Responses indicated that 218 (22%) study participants had accepted vaccination (i.e., had been vaccinated) against this virus. Markedly more healthcare workers in Morocco were undervaccinated than were those in the United States; by mid-January 2010, estimated vaccination coverage among healthcare workers was 37.1% (2). Some evidence indicates that willingness of healthcare workers to be vaccinated with the new vaccine is poor: 48.0% in Hong Kong Special Administrative Region, People's Republic of China (3) and 22.3% in the United States (4). Vaccination coverage was significantly higher for those 20-30 years of age than for those in other age groups (p = 0.001). The analysis by occupational category showed significantly higher coverage for paramedical staff (26%) than for physicians and pharmacists (19%) (p<0.01). The main causes for this reluctance were fear of adverse effects, concerns about the new adjuvant used, the short duration of clinical trials, and influence of the media.

The low acceptance rate of vaccination for pandemic (H1N1) 2009 among healthcare workers in Morocco is alarming because they serve as an example for their patients and the public. Vaccination is needed to keep the healthcare system operating at maximum capacity during a pandemic. The following factors appear to play a major role in acceptance: accessibility of the vaccine within the service; free vaccine; and a display explaining vaccination's benefits, protective value, and risk for adverse effects (5,6). Policy makers could use our findings to improve the vaccination strategy for healthcare workers in future vaccination campaigns.

DOI: 10.3201/eid1610.100984

Rida Tagajdid, Hicham El Annaz, Taoufik Doblali, Kawtar Sefiani, Bouchra Belfquih, and Saad Mrani

Author affiliations: Mohammed V Military Teaching Hospital, Rabat, Morocco (R. Tagajdid, H. El Annaz, B. Belfquih, S. Mrani); and Mohammed V-Souissi University, Rabat (R. Tagajdid, H. El Annaz, T. Doblali, K. Sefiani, B. Belfquih, S. Mrani)


(1.) World Health Organization. World now at the start of 2009 influenza pandemic [cited 2009 Dec 7]. mediacentre/news/statements/2009/h1n1_ pandemic_phase6_20090611/en/index.html

(2.) Centers for Disease Control and Prevention. Interim results: influenza A (H1N1) 2009 monovalent and seasonal influenza vaccination coverage among health-care personnel--United States, August 2009 January 2010. MMWR Morb Mortal Wkly Rep. 2010;59:357-62.

(3.) Chor JS, Ngai KL, Wong MC, Wong SY, Lee N, Leung TF, et al. Willingness of Hong Kong healthcare workers to accept pre-pandemic influenza vaccination at different WHO alert levels: two questionnaire surveys. BMJ. 2009;339:b3391. DOI: 10.1136/bmj.b3391

(4.) Centers for Disease Control and Prevention. Use of influenza A (H1N1) 2009 monovalent vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recomm Rep. 2009:58:1-8.

(5.) Jordan R, Hayward A. Should healthcare workers have the swine flu vaccine? BMJ. 2009;339:b3398. DOI: 10.1136/bmj. b3398

(6.) Lautenbach E, Saint S, Henderson DK, Harris DA. Initial response of health care institutions to emergence of H1N1 influenza: experiences, obstacles, and perceived future needs. Clin Infect Dis. 2010;50:523-7. DOI: 10.1086/650169

Address for correspondence: Rida Tagajdid, Military Hospital of Rabat, Virology, Hay Riad, Rabat 10100, Morocco; email: reda.tagajdid@
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