Vaccine 30 (2012) 4648–4654 Contents lists available at SciVerse ScienceDirect Vaccine j ourna l ho me pag e: www.elsevier.com/locate/vaccine Vaccination coverage of health care personnel working in health care facilities in France: Results of a national survey, 2009 Jean-Paul Guthmann a,* , Laure Fonteneau a , Céline Ciotti b , Elisabeth Bouvet b , Gérard Pellissier b , Daniel Lévy-Bruhl a , Dominique Abiteboul b a InVS Institut de Veille Sanitaire (French Institute for Public Health Surveillance), 12 rue du Val d’Osne, 94415 Saint-Maurice Cedex, France b GERES Groupe d’étude sur le risque d’exposition des soignants aux agents infectieux, Paris, France a r t i c l e i n f o Article history: Received 26 December 2011 Received in revised form 24 April 2012 Accepted 26 April 2012 Available online 10 May 2012 Keywords: Vaccination coverage Health care personnel France a b s t r a c t We conducted a national cross-sectional survey to investigate vaccination coverage (VC) in health care personnel (HCP) working in clinics and hospitals in France. We used a two-stage stratified random sam- pling design to select 1127 persons from 35 health care settings. Data were collected by face-to-face interviews and completed using information gathered from the occupational health doctor. A total of 183 physicians, 110 nurses, 58 nurse-assistants and 101 midwives were included. VC for compulsory vac- cinations was 91.7% for hepatitis B, 95.5% for the booster dose of diphtheria–tetanus–polio (DTP), 94.9% for BCG. For non-compulsory vaccinations, coverage was 11.4% for the 10 year booster of the DTP pertussis containing vaccine, 49.7% for at least one dose of measles, 29.9% for varicella and 25.6% for influenza. Hepatitis B VC did not differ neither between HCP working in surgery and HCP in other sectors, nor in surgeons and anaesthesiologists compared to physicians working in medicine. Young HCP were better vaccinated for pertussis and measles (p < 0.01), and those working in an obstetric or a paediatric ward were better vaccinated for influenza and pertussis (p < 0.01). HCP are overall well covered by compul- sory vaccinations, whereas VC for non-compulsory vaccinations is very insufficient. The vaccination policy regarding these latter vaccinations should be reinforced in France. © 2012 Elsevier Ltd. All rights reserved. 1. Introduction Health care personnel (HCP) are offered vaccinations which aim to protect them against an occupational risk by providing individ- ual protection. Additionally, they prevent transmission from a HCP both to another HCP and to patients they are taking care of, and therefore have a crucial role in preventing nosocomial infections. In France, vaccination guidelines targeted to HCP distinguish two types of recommendations (Table 1) [1]. On the one hand, com- pulsory vaccinations, which are mandatory by law (public health code) to anyone entering a medical or a nursing training school or working in a health care facility. It is the employer’s responsi- bility (who delegates this responsibility to the occupational health physician) to ensure that the person has received, before employ- ment, the mandatory vaccines required. These vaccinations were * Corresponding author. Tel.: +33 01 41 79 69 07; fax: +33 01 41 79 68 72. E-mail addresses: jp.guthmann@invs.sante.fr (J.-P. Guthmann), l.fonteneau@invs.sante.fr (L. Fonteneau), celine.ciotti@geres.org (C. Ciotti), elisabeth.bouvet@bch.aphp.fr (E. Bouvet), gerard.pellissier@geres.org (G. Pellissier), d.levybruhl@invs.sante.fr (D. Lévy-Bruhl), dominique.abiteboul@bch.aphp.fr (D. Abiteboul). introduced in the French immunization schedule several decades ago for BCG and diphtheria, tetanus and polio vaccines (1950s) and more recently for the hepatitis B vaccine (HepB), which became compulsory for HCP in 1991. On the other hand, non-compulsory vaccinations, which may be rejected by the HCP, were introduced in the French vaccination schedule only in recent years: 2000 for influenza, 2004 for pertussis and varicella, and 2005 for measles. These vaccinations are regulated by the labour code, which stip- ulates that an employer, on the occupational health physicians’ advice, may recommend a vaccination to prevent a specific occu- pational risk. This recommendation may be followed or not by the future employee, without any consequence on his/her employ- ment. Despite these regulations, infections covered by these vaccines are still responsible for an important number of cases in France, both among HCP and in hospitalized patients, including cases of measles [2–4], pertussis [5,6] and influenza [7,8]. Nosocomial trans- mission of hepatitis B from caregivers to patients has also been described [9,10]. This morbidity suggests that vaccination recom- mendations are insufficiently implemented, which is confirmed by the available data on vaccination coverage (VC). The relevance of these coverage figures for guiding national policy is however lim- ited as these data are scarce, usually rather old, they concern only 0264-410X/$ – see front matter © 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.vaccine.2012.04.098