Rate of Influenza Vaccination and Its Adverse Reactions Seen in
(Received June 13, 2008. Accepted September 5, 2008)
redness in 18.1%, myalgia in 17.7%, fatigue in 17%, and febrile sensation in 15.2%. After vaccination, such
HCP provide care to patients at high risk for complications
avoidance of medications, and fear of needles (1,9-14).
National University Hospital, Jeonju, Korea, a 1,050-bed
Health Care Personnel in a Single Tertiary Hospital in Korea
SUMMARY: To determine the vaccination rate and its adverse reactions after influenza vaccination, we admin-
for 1-3 days, but 11% persisted more than 4 days. Serious adverse reactions were not noted; the reported adverse
transmission of influenza in health-care settings, staff illness
of HCP influenza vaccination on patients’ outcomes and HCP
after vaccination in a single tertiary university hospital.
Chang-Seop Lee1,2, Kang-Hyu Lee1, Min-Hee Jung3 and Heung-Bum Lee1,2*
2008. In total, the rate of influenza vaccination was 82.3% in health-care personnel. Dividing the subjects into
participation was the lowest. We believe that influenza vaccination is safe and that physicians should be more
tality among persons at increased risk for severe influenza
Reported barriers to HCP acceptance of influenza vaccination
MATERIALS AND METHODS
1Department of Internal Medicine, Chonbuk National University Medical School;
four groups by work category, the vaccine coverage rates were as follows: physicians 67.9%; nurses and nursing
concerned with influenza vaccination and its impact on the health-care community.
illness (1-5). Also, HCP can play a role as infectious media-
include fear of side effects, insufficient time or inconvenience,
2Research Institute of Clinical Medicine, Chonbuk National University; and
assistants 91.2%; technicians, pharmacists, therapists, and administrative personnel 80.2%; and other personnel
3Department of Infection Control, Chonbuk National University Hospital, Jeonju, Republic of Korea
not directly involved in patient care but having the potential of being exposed to infectious agents 89%. The
istered an anonymous questionnaire survey during the last three influenza seasons from 2005-2006 to 2007-
reactions were relatively minor and transient. Surprisingly, among those who were vaccinated, the physicians’
and absenteeism, and influenza-related morbidity and mor-
absenteeism, vaccination coverage remains low (<50%) (1,8).
most frequent adverse reaction after vaccination was soreness at the injection site in 33.4%, followed by skin
adverse reactions began within 24 h in 70.6% of subjects. Eighty-nine percent of those adverse reactions persisted
Vaccination of health-care personnel (HCP) reduces the
expanding vaccine use (1). Despite the documented benefits
and the incidence of adverse reactions and their duration
Jpn. J. Infect. Dis., 61, 457-460, 2008
*Corresponding author: Mailing address: Department of Internal
Medicine, Chonbuk National University Medical School, 634-
18, Keumamdong, Jeonju, 561-712, South Korea. Tel: +82-63-
250-1685, Fax: +82-63-254-1609, E-mail: firstname.lastname@example.org.
tors by acquiring influenza from patients and/or transmitting
perceived ineffectiveness of the vaccine, medical contra-
This study was conducted during three consecutive influ-
influenza to patients and other staff (2,6,7). Furthermore, since
indication, perceived low likelihood of contracting influenza,
enza seasons from 2005-2006 to 2007-2008 at Chonbuk
of influenza, HCP should be considered a high priority in
In this study, we investigated the vaccination rates in HCP
tertiary care university hospital. The influenza vaccine was
given to full-time and part-time HCP who were employees at
of being exposed to infectious agents that can be transmitted
and B/Malaysia/2506/2002 (SK chemical, Seoul, Korea)
adverse reactions that occurred in the first 10 days after receiv-
the hospital. To assess the frequency and nature of adverse
to and from HCP (1).
for the 2007-2008 season. The vaccine was given intra-
ing the vaccine was distributed to HCP.
reactions, we divided HCP into four groups based on their
The trivalent inactivated split influenza vaccine contain-
muscularly in a 0.5-ml dose, during the last 2 weeks of Octo-
The questionnaire form was to be used to record any signs
work: Group I was physicians, Group II was nurses and nurse
ing A/New Caledonia/20/99 (H1N1), A/Hiroshima/52/2005
ber by the same nurse to all HCP working in the hospital.
and symptoms, including fever and other adverse reactions,
assistants, Group III was technicians, therapists, emergency
(H3N2), and B/Malaysia/2506/2004 (Dongsin, Seoul, Korea)
The infection control nurse using mobile vaccination carts
local or systemic, observed in the 10 days after vaccination,
paramedical service personnel, laboratory personnel, phar-
was prepared for the 2005-2006 season; A/New Caledonia/
visited all inpatient wards and clinic areas to facilitate the
regardless of the symptom’s severity.
macists, and administrative workers, and Group IV was other
20/99 (H1N1), A/Wisconsin/67/2005 (H3N2), and B/Malay-
vaccination of HCP. The vaccine was given free of charge,
employees in general areas (clerical, dietary, and maintenance)
sia/2503/2004 (Dongsin) for the 2006-2007 season; and A/
and it was not compulsory.
not directly involved in patient care but having the potential
New Caledonia/20/99 (H1N1), A/Wisconsin/67/2005 (H3N2),
At the time of vaccination, a questionnaire regarding
Vaccination rates and questionnaire return rates: Table
1 shows the rate of influenza vaccination for three seasons.
Three hundred and thirty physicians (72.2%) received the
influenza vaccine in 2005-2006, 321 (68.4%) in 2006-2007,
and 285 (62.9%) in 2007-2008, for a 3-year total of 936
(67.9%). The vaccination rate in physicians was the lowest
of the groups vaccinated. The total vaccination rate of Group
II was 1,764 (91.2%) out of 1,935, which was the highest
221 (17.7%), fatigue in 212 (17%), and febrile sensation in
Duration of adverse effects: A total of 42.8% of those
among HCP; the rate of Group III was 1,462 (80.2%) and
190 (15.2%). Other less common symptoms were chills (106,
who presented adverse symptoms reported that their symp-
that of Group IV was 887 (89%).
8.5%), rhinorrhea (93, 7.5%), headache (87, 7%), sore throat
toms subsided within 24 h, 31.3% experienced their symp-
Local and systemic reactions after influenza vaccina-
(81, 6.5%), dizziness (60, 4.8%), cough (48, 3.8%), abdomi-
toms for 2 days, 15% experienced them for 3 days, and
tion: The number of questionnaires returned was 293 (43.1%)
nal pain (10, 0.8%), and diarrhea (7, 0.6%) (Table 3).
approximately 10% complained of symptoms for more than
in 2005, 490 (70%) in 2006, and 464 (62%) in 2007 (Table
The time of the symptoms presented: A total of 70.6%
4 days. In total, 89% of the people who had vaccine-relating
2). The most frequent side effect of vaccination was pain at
of side effects began on the day HCP received the vaccine,
adverse symptoms improved within 3 days (Figure 2).
the injection site, which was seen in 416 (33.4%), followed
followed by 22.7% on the 2nd day, 5.7% on the 3rd day, and
by redness at the injection site in 226 (18.1%), myalgia in
1% after the 4th day (Figure 1).
Table 1. Demographic data of influenza vaccination for the 3-year-study
*: Total number of health-care personnel (HCP).
No. of vaccine recipient
No. of vaccine recipient
No. of vaccine recipient
No. of vaccine recipient
personnel, pharmacists, and administrative workers, and Group IV was other personnel (clerical, dietary, and maintenance) not directly involved in a patient
457330 (72.2) 469 321 (68.4)453 285 (62.9)1,379936 (67.9)
care but having the potential of being exposed to infectious agents that can be transmitted to and from HCP.
564542 (96.1)671581 (86.6) 700 641 (91.6)1,9351,764 (91.2)
Group III676481 (71.2)518 478 (92.3)629 503 (80.0)1,8231,462 (80.2)
Table 2. Returning rates of questionnaire after influenza vaccination
315292 (92.7)300 (85.0)329
Table 3. Adverse effects seen after influenza vaccination in
295 (89.7)997 887 (89.0)
Group I was physicians, Group II was nurses and nurse assistants, Group III was technicians, therapists, emergency paramedical service personnel, laboratory
Fig. 1. Time of the symptoms presented. Adverse reactions after influ-
enza vaccination began within 3 days in more than 99%. Only 1%
began after the 4th day.
Fig. 2. Duration of adverse effect. Adverse effects after influenza vacci-
nation subsided within 3 days in more than 89%. However, it lasted
more than 4 days in 11%.
(n = 293)
(n = 490)
(n = 464)
(n = 1,247)
*: At injection site.
Sent (no.)Return (no.) Return rate (%)
2007-2008 748 46462.0
Transmission and outbreaks of influenza in hospitals are
on influenza immunization rate and incidence of its side
visited all of the inpatient wards and clinic areas to facilitate
cination rates of HCP.
their role as transmission mediators. We feel physicians should
cough, abdominal pain, and diarrhea. These reactions were
than 89% of recipients, though it lasted more than 4 days in
well documented (1,6,7). By acquiring influenza from pa-
effects in HCP attempted in Korea.
vaccination of HCP. Interestingly, 33% of HCP reported that
Influenza remains a major cause of illness, suffering, and
be more concerned with their position as transmission sources
very similar to those noted in previously reported studies
approximately 10% of HCP. Since this study was carried out
tients and/or transmitting it to patients, HCP can be media-
Surprisingly, the vaccine coverage rate in this study was
they would refuse influenza vaccination if they were required
death for the elderly and other high-risk patients cared for by
and make an effort to achieve high vaccination coverage lev-
(2,18-21), and they were relatively well tolerated. Several
using returned questionnaires only, results may differ depend-
tors in hospital influenza transmission. Furthermore, HCP
much higher than that reported in previous global studies (1,8).
to pay for the vaccine (15). Besides fear of the vaccine’s side
physicians (16,17). Physicians should receive the vaccine as
previous papers reported that vaccination-related adverse
ing on the response rate, and answers were subjective. That
influenza vaccination has an impact on patients’ outcome and
The reasons for the higher vaccination rate in the present study
effects, lack of time or inconvenience, perceived low likeli-
a top priority, because they can be a major source of infec-
According to this study, the most frequent local reactions
reactions typically began at 6-12 h after vaccination and
is, personal biases could have influenced the results with
HCP absenteeism, and on reducing influenza infection among
may be that the hospital provided the vaccine to HCP with-
hood of contracting influenza, avoidance of medications, and
tion for these vulnerable patients (1). However, physicians
to vaccination were pain and redness at the injection site, and
persisted for 1-2 days (1,18,22-24). These findings were simi-
respect to the rate of adverse reaction and duration of symp-
hospital staff members (1,3-5). Several studies in foreign
out charge and that the hospital ran a vigorous promotional
fear of needles, the cost was one of the major hindrances to
among HCP showed the lowest vaccinated rate in this study.
the major systemic reactions were myalgia, fatigue, and
lar to this study, in which HCP reported adverse reactions
toms. However, there were no severe adverse reactions such
countries demonstrate that the rate of vaccination coverage
campaign and made accessibility of the vaccine to HCP easy.
HCP accepting the influenza vaccination. Therefore, healthcare
This may be related to their self-confidence or over-credulity
febrile sensation. The less common other adverse reactions
that began within 2 days in more than 93% of vaccine recipi-
as immunologic hypersensitivity to certain vaccine compo-
remains below 50% (1,8). This report details the first study
The infection control nurse using mobile vaccination carts
institutions should consider multiple ways to maximize vac-
regarding their health and their being somewhat casual about
were chills, rhinorrhea, headache, sore throat, dizziness,
ents, and the symptoms subsided within 3 days in more
nents or Guillain-Barré syndrome.
In conclusion, though the presence of some biases in the
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