Trends in influenza vaccine coverage among primary healthcare workers in Spain, 2008–2011 Jesús Castilla a,b, ⁎, Iván Martínez-Baz a,b , Pere Godoy b,c , Diana Toledo b,d , Jenaro Astray e , Susana García f , José María Mayoral g , Vicente Martín b,h , Fernando González-Candelas b,i , Marcela Guevara a,b , José Diaz-Borrego g , Núria Torner b,d,k , Maretva Baricot b , Sonia Tamames j , Angela Domínguez b,k , the CIBERESP Working Group for the Survey on Influenza Vaccination in Primary Healthcare Professionals a Instituto de Salud Pública de Navarra, Pamplona, Spain b CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain c Agencia de Salud Pública de Cataluña, Barcelona, Spain d Servicio de Epidemiología, Agencia de Salud Pública de Barcelona, Spain e Área de Epidemiología, Comunidad de Madrid, Spain f Hospital Galdakao-Usansolo, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bizkaia, Spain g Servicio de Vigilancia de Andalucía, Sevilla, Spain h Instituto de Biomedicina, Universidad de León, Spain i Centro Superior de Investigación en Salud Pública, Universidad de Valencia, Spain j Dirección General de Salud Pública, Investigación, Desarrollo e Innovación, Junta de Castilla y León, Spain k Departamento de Salud Pública, Universidad de Barcelona, Spain abstract article info Available online 1 June 2013 Keywords: Influenza vaccination Primary health care Healthcare workers Vaccine coverage Pandemic influenza Objective. To evaluate trends in seasonal influenza vaccination coverage in primary healthcare workers (PHCWs) in Spain between 2008 and 2011. Methods. We made an anonymous web survey of PHCWs in 2012. Information on attitudes towards and knowledge of influenza vaccine, and immunization in previous seasons was collected. Self-reported vaccination coverage and factors related to vaccination continuity were analysed. Results. Of 5433 workers contacted, 2625 (48.3%) responded to the survey: 47.0% were general practitioners, 10.3% paediatricians and 42.7% nurses. Their reported vaccination rates from seasons 2008–2009 to 2011–2012 decreased over time: 58.4%, 57.4%, 53.2% and 49.3% (linear trend, p b 0.001). Among workers vaccinated in any previous season, 70.2% were vaccinated again in 2011–2012, compared with 5.2% among those not previously vaccinated (p b 0.001). Continuity of vaccination increased with age and with the worker or cohabitant having a major chronic condition. Vaccination was higher in workers who recognized vaccination as effective and those worried about being infected or infecting patients. Conclusion. Influenza vaccination coverage in PHCWs has declined, especially after the pandemic. Intensive interventions are needed to change this trend. Knowledge of vaccination should be reinforced by stressing the effectiveness of the vaccine and the risks of influenza for workers and patients. © 2013 Elsevier Inc. All rights reserved. Introduction Influenza affects a significant percentage of the population annually and is associated with excess hospitalization and mortality (Glezen, 1982). The main preventive measure is annual vaccination (Fifty-sixth World Health Assembly, 2003). Various reasons justify influenza vaccination in healthcare workers: firstly, to protect their health, as healthcare workers have a greater probability of infection; secondly, to avoid sick leave during periods of increased demand for health services; and thirdly, to avoid disease transmission and thereby reduce morbidity and mortality in patients (Carman et al., 2000; Castilla et al., 2013; Jordan and Hayward, 2009; Potter et al., 1997; Vanhems et al., 2011). Annual influenza vaccination is recommended for all healthcare workers who have no contraindications (Centers for Disease Control and Prevention, 2011; European Union, 2009). In Spain, influenza vaccination is recommended and offered voluntarily free-of-charge to all healthcare workers (Ministerio de Sanidad Servicios Sociales e Igualdad, 2012a). Every year a campaign publicizes vaccination sites and encourages workers to be vaccinated; despite it, coverage rarely Preventive Medicine 57 (2013) 206–211 ⁎ Corresponding author at: Instituto de Salud Pública de Navarra, Leyre 15. 31003 Pamplona, Navarra, Spain. Fax: +34 848423474. E-mail address: jcastilc@navarra.es (J. Castilla). 0091-7435/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ypmed.2013.05.021 Contents lists available at SciVerse ScienceDirect Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed