Vaccine 24 (2006) 7003–7008 Influenza vaccination in German health care workers: Effects and findings after two rounds of a nationwide awareness campaign Katrin Leitmeyer a , Udo Buchholz a,∗ , Michael Kramer b , Karl Schenkel a , Heike Stahlhut c , Michael K ¨ ollstadt c , Walter Haas a , Christiane Meyer a a Robert Koch-Institut, Seestrasse 10, 13353 Berlin, Germany b Ministry of Health, Bonn, Germany c Deutsches Gr¨ unes Kreuz, Marburg, Germany Received 10 August 2005; received in revised form 30 March 2006; accepted 10 April 2006 Available online 11 May 2006 Abstract In Germany, despite longstanding recommendations for influenza vaccination, uptake among health care workers (HCW) is poor. We conducted and evaluated a 2-year nationwide campaign to increase influenza vaccination rates among German HCW. The campaign was tailored to the results of a baseline survey and included the distribution of information material to all German hospitals (n ∼ 2000) and engagement of stakeholders, such as professional HCW associations. Human and financial resources consisted of one full-time public health scientist (2 months) and approximately USD 45,000 to produce and distribute materials. We evaluated the intervention in a survey among a systematic sample of HCW in a sample of selected 20 hospitals. HCW were stratified by profession and asked to self-administer a questionnaire inquiring about self-perceived risk for influenza, belief of effectiveness of the vaccine, and influenza vaccination before the starting season (2003/2004) as well as the previous two seasons (2001/2002, 2002/2003). Three hundred and ninety-six of 800 (50%) HCW who were addressed in the evaluated hospitals participated in the evaluation survey. The overall influenza vaccination rate among respondents increased from 21% (2001/2002) to 26% (2003/2004), which was mostly due to a significant increase among physicians (2001/2002: 21%; 2003/2004: 31%; nurses: 20% and 22%, respectively). Significantly more physicians than nurses felt at increased risk for influenza and believed that the vaccine is very effective. Increased uptake among physicians (compared to nurses) was likely due to physicians’ higher awareness of their risk and trust in the vaccine. In the future it may be necessary to address nurses differently than physicians. We conclude that a national campaign with very limited resources is feasible and capable of achieving measurable results in a short time frame. © 2006 Elsevier Ltd. All rights reserved. Keywords: Influenza vaccination; Health care workers; Vaccination campaign; Vaccination rates; German hospitals 1. Introduction In Germany, average influenza seasons are associated with an estimated 7000–14,000 excess deaths [1]. Over 90% of these deaths occur in the elderly. Due to demographic changes, the proportion of the German population above 60 years is increasing and so is the proportion among patients admitted to hospitals. Although influenza vaccination is rec- ommended for the elderly as well as for persons with chronic ∗ Corresponding author. Tel.: +49 30 4547 3486; fax: +49 30 4547 3533. E-mail address: buchholzu@rki.de (U. Buchholz). diseases, in the season 2003/2004 more than 50% of these risk groups were not vaccinated against influenza [2]. Even if vaccinated the protection conferred is not as good as for young, healthy adults. In order to reduce the risk for nosoco- mial influenza infections [3], it is therefore crucial that health care workers (HCW) get vaccinated against influenza. A ran- domized controlled trial in long-term elderly-care hospitals in the United Kingdom has shown that influenza vaccination of HCW can significantly reduce mortality among inpatients [4]. To protect patients and HCW from influenza, the Ger- man Standing Committee for Vaccination Recommendations 0264-410X/$ – see front matter © 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.vaccine.2006.04.040