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Ann Thorac Med. 2010 Oct-Dec; 5(4): 250–251.
PMCID: PMC2954388

Authors’ reply


We thank Dr. Wiwanitkit[1] for his interest in our recently published article about our experience in improving rates of influenza vaccination coverage among healthcare workers (HCWs) at our tertiary care facility in Riyadh, Saudi Arabia.[2] In this article, training advocate nurses together with engaging nursing service in the efforts to enhance the vaccination coverage may have contributed to about 2.5 folds increase of vaccination coverage (from 29 to 77%). We believe we still have a room for further improvement especially after the slight drop happened last year concomitant with the recent H1N1 influenza pandemic (April 2009).

Dr. Wiwanitkit raised important questions about the best techniques to improve influenza vaccination coverage among HCWs.[1] We believe such improvement requires enhancement at all levels of any successful influenza vaccination program including education, training, engagement, motivation, accessibility, and mandate.[3,4] Although we carried out huge efforts at all these levels, careful evaluation of 2009–2010 influenza vaccination campaign revealed more to be done to achieve our goal of more than 90% coverage. In addition to the overlapping educational and advertising materials used, we are planning to start 2010–2011 campaign by adding online learning module for all HCWs and online quiz for advocate nurses to improve influenza vaccination education and training. These new materials will challenge the myths that were linked to H1N1 vaccine and negatively impacted the last influenza vaccination campaign. We are planning to continue the fruitful partnership with nursing service that was shown to be successful in our facility and elsewhere.[2,5] Free-vaccine accessibility will be further improved by adding weekend sessions at the employee health clinic.

Although we mandated influenza vaccination in 2009–2010 campaign in response to the recent H1N1 influenza pandemic, we did not get better rates of influenza vaccination coverage. We are planning a new modification in implementing the vaccination mandate in order to achieve the coverage goal. The signed waiver that was used inappropriately by some HCWs to report health-related reasons for decline needs to be replaced by an infection control “granted” waiver after reviewing a standard waiver application and supporting medical documentations. In case of waiver denial by the infection control staff, the HCW will have to get the vaccine or wear surgical mask while at work throughout the flu season, to maintain a fitness-for-duty requirement to continue working. Such approach was recently shown to be extremely successful in sustaining influenza vaccination coverage at 98% for many years.[6] In conclusion, no single technique is able to achieve high influenza vaccination coverage in HCWs, rather, a multipronged approach is required to achieve and sustain such a goal. Needless to say, without a strong support and commitment of the facility leadership, such approach would be difficult to implement.


1. Wiwanitkit V. Influenza vaccination program for medical workers. Ann Thorac Med. 2010;5:250. [PMC free article] [PubMed]
2. Al-Otaibi BM, El-Saed A, Balkhy HH. Influenza vaccination among healthcare workers at a tertiary care hospital in Saudi Arabia: Facing challenges. Ann Thorac Med. 2010;5:120–1. [PMC free article] [PubMed]
3. Talbot TR, Dellit TH, Hebden J, Sama D, Cuny J. Factors associated with increased healthcare worker influenza vaccination rates: Results from a national survey of university hospitals and medical centers. Infect Control Hosp Epidemiol. 2010;31:456–62. [PubMed]
4. Talbot TR. Improving rates of influenza vaccination among healthcare workers: Educate; motivate; mandate? Infect Control Hosp Epidemiol. 2008;29:107–10. [PubMed]
5. Nicholson MR, Hayes DM, Bennett AM. Partnering with nursing service improves health care worker influenza vaccination rates. Am J Infect Control. 2009;37:484–9. [PubMed]
6. Rakita RM, Hagar BA, Crome P, Lammert JK. Mandatory Influenza Vaccination of Healthcare Workers: A 5-Year Study. Infect Control Hosp Epidemiol. 2010;31:881–8. [PubMed]

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