Primary care providers' (PCPs) compliance to self-immunization is important for their protection and the protection of their colleagues and patients and has been associated with the coverage of the general public. In this study, we aim to investigate the vaccination coverage of PCPs.
A questionnaire-based cross-sectional survey was conducted among physicians, nurses and pharmacists employed in public or private primary care settings in Greece. Demographic and occupational characteristics as well as vaccination coverage data for influenza, tetanus, pneumococcal pneumonia and herpes zoster were collected. Statistical significance was set at 0.05.
In total, 748 (61.7% response rate) PCPs participated. Vaccination rates were 66.4% (496/747) for influenza (2019/2020 flu season), 62.9% (469/746) for tetanus (10-year Td or Tdap booster dose), 70% (14/20) for pneumococcal pneumonia (≥ 1 dose of PPSV23 or PCV13) and 12.3% (10/81) for herpes zoster. Multiple logistic regression revealed that nurses had significantly lower probability of being vaccinated against influenza [odds ratio (OR) = 0.25; 95% confidence interval (CI) = 0.14–0.45] and pharmacists had significantly lower probability of being vaccinated against both influenza (OR = 0.44; 95% CI = 0.31–0.62) and influenza & tetanus (OR = 0.52; 95% CI = 0.37–0.73) compared to physicians. Older age (>40 years) was an independent risk factor for not receiving a tetanus vaccine (40–49 vs. 19–39; OR = 0.42; 95% CI = 0.28–0.63, over 50 years old vs. 19–39; OR = 0.54; 95% CI = 0.36–0.79).
The results revealed suboptimal vaccination rates among health providers who are in the frontline of adult immunization. Individualized and targeted measures to improve their vaccination coverage and indirectly the vaccination coverage of their patients, are therefore required.
Citation: Panagiota Kalatzi, Antonios K. Travlos, Nickos Geladas, Maria Iliadou, Chara Tzavara, Costas Chryssanthopoulos, Alexandros Mihopoulos, Styliani Tziaferi. Vaccination coverage of primary care providers against seasonal influenza, tetanus, pneumococcal pneumonia and herpes zoster: A cross-sectional study in Greece[J]. AIMS Public Health, 2023, 10(4): 952-963. doi: 10.3934/publichealth.2023061
Primary care providers' (PCPs) compliance to self-immunization is important for their protection and the protection of their colleagues and patients and has been associated with the coverage of the general public. In this study, we aim to investigate the vaccination coverage of PCPs.
A questionnaire-based cross-sectional survey was conducted among physicians, nurses and pharmacists employed in public or private primary care settings in Greece. Demographic and occupational characteristics as well as vaccination coverage data for influenza, tetanus, pneumococcal pneumonia and herpes zoster were collected. Statistical significance was set at 0.05.
In total, 748 (61.7% response rate) PCPs participated. Vaccination rates were 66.4% (496/747) for influenza (2019/2020 flu season), 62.9% (469/746) for tetanus (10-year Td or Tdap booster dose), 70% (14/20) for pneumococcal pneumonia (≥ 1 dose of PPSV23 or PCV13) and 12.3% (10/81) for herpes zoster. Multiple logistic regression revealed that nurses had significantly lower probability of being vaccinated against influenza [odds ratio (OR) = 0.25; 95% confidence interval (CI) = 0.14–0.45] and pharmacists had significantly lower probability of being vaccinated against both influenza (OR = 0.44; 95% CI = 0.31–0.62) and influenza & tetanus (OR = 0.52; 95% CI = 0.37–0.73) compared to physicians. Older age (>40 years) was an independent risk factor for not receiving a tetanus vaccine (40–49 vs. 19–39; OR = 0.42; 95% CI = 0.28–0.63, over 50 years old vs. 19–39; OR = 0.54; 95% CI = 0.36–0.79).
The results revealed suboptimal vaccination rates among health providers who are in the frontline of adult immunization. Individualized and targeted measures to improve their vaccination coverage and indirectly the vaccination coverage of their patients, are therefore required.
Confidence Interval
Coronavirus Disease 2019
European Union
Health Care Professionals
Hepatitis A
Hepatitis B
Haemophilus influenzae type b
Human Papillomavirus
Herpes Zoster
Measles, Mumps and Rubella
National Adult Immunization Schedule
Nomenclature of Territorial Units for Statistics
Odds Ratio
Primary Care Providers
Pneumococcal Conjugate Vaccine
Pneumococcal Polysaccharide Vaccine
Tetanus and Diphtheria
Tetanus, Diphtheria and Pertussis.
[1] | Maltezou HC, Poland GA (2016) Immunization of Health-Care Providers: Necessity and Public Health Policies. Healthcare (Basel) 4: 47. https://doi.org/10.3390/healthcare4030047 |
[2] | Fotiadis K, Dadouli K, Avakian I, et al. (2021) Factors associated with healthcare workers' (HCWs) acceptance of COVID-19 vaccinations and indications of a role model towards population vaccinations from a cross-sectional survey in Greece, May 2021. Int J Environ Res Public Health 18: 10558. https://doi.org/10.3390/ijerph181910558 |
[3] | Greek Ministry of HealthNational Vaccination Program of Greece, 2020–2021 (2020). Available from: https://www.moh.gov.gr/articles/health/dieythynsh-dhmosias-ygieinhs/emboliasmoi/ethniko-programma-emboliasmwn-epe-enhlikwn/7968-ethniko-programma-emboliasmwn-enhlikwn-2020-2021 |
[4] | Hellenic Republic GovernmentChild and Adult Immunization (2022). Available from: https://www.gov.gr/en/sdg/healthcare/public-preventive-healthcare-measures/general/child-and-adult-immunisation |
[5] | Wilkinson E, Jetty A, Petterson S, et al. (2021) Primary Care's historic role in vaccination and potential role in COVID-19 immunization programs. Ann Fam Med 19: 351-355. https://doi.org/10.1370/afm.2679 |
[6] | Song Y, Zhang T, Chen L, et al. (2017) Increasing seasonal influenza vaccination among high risk groups in China: Do community healthcare workers have a role to play?. Vaccine 35: 4060-4063. https://doi.org/10.1016/j.vaccine.2017.06.054 |
[7] | You Y, Li X, Jiang S, et al. (2023) Can primary care physician recommendation improve influenza vaccine uptake among older adults? A community health centre-based experimental study in China. BMC Prim Care 24: 16. https://doi.org/10.1186/s12875-023-01980-3 |
[8] | Godoy P, Castilla J, Mayoral JM, et al. (2015) Influenza vaccination of primary healthcare physicians may be associated with vaccination in their patients: A vaccination coverage study. BMC Fam Pract 16: 44. https://doi.org/10.1186/s12875-015-0259-0 |
[9] | Zhang J, While AE, Norman IJ (2010) Knowledge and attitudes regarding influenza vaccination among nurses: A research review. Vaccine 28: 7207-7214. https://doi.org/10.1016/j.vaccine.2010.08.065 |
[10] | Karlsson LC, Lewandowsky S, Antfolk J, et al. (2019) The association between vaccination confidence, vaccination behavior, and willingness to recommend vaccines among Finnish healthcare workers. PLoS One 14: e0224330. https://doi.org/10.1371/journal.pone.0224330 |
[11] | Kalemaki D, Karakonstantis S, Galanakis E, et al. (2020) Vaccination coverage of general practitioners: A cross-sectional study from Greece. Public Health 181: 110-113. https://doi.org/10.1016/j.puhe.2019.12.012 |
[12] | Vrachnaki O, Vergadi E, Ioannidou E, et al. (2020) Determinants of low uptake of vaccination against influenza, measles, and hepatitis B among healthcare professionals in Greece: A multicenter cross-sectional study. Hum Vaccin Immunother 16: 2663-2669. https://doi.org/10.1080/21645515.2020.1741311 |
[13] | Maltezou HC, Katerelos P, Poufta S, et al. (2013) Attitudes toward mandatory occupational vaccinations and vaccination coverage against vaccine-preventable diseases of health care workers in primary health care centers. Am J Infect Control 41: 66-70. https://doi.org/10.1016/j.ajic.2012.01.028 |
[14] | Maltezou HC, Katerelos P, Protopappa K, et al. (2019) Seasonal influenza vaccination in healthcare personnel in Greece: 3-year report. Future Microbiol 14: 55-58. https://doi.org/10.2217/fmb-2018-0266 |
[15] | Council of the European UnionCouncil recommendation of 22 December 2009 on Seasonal Influenza Vaccination (2009/1019/EU), 2009 (2009). Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A32009H1019 |
[16] | Maltezou HC, Tseroni M, Drositis I, et al. (2022) Vaccination coverage rates and attitudes towards mandatory vaccinations among healthcare personnel in tertiary-care hospitals in Greece. Expert Rev Vaccines 21: 853-859. https://doi.org/10.1080/14760584.2022.2063118 |
[17] | European Centre for Disease Prevention and Control (ECDC)Seasonal Influenza Vaccination and Antiviral Use in EU/EEA Member States, 2018 (2018). Available from: https://www.ecdc.europa.eu/en/publications-data/seasonal-influenza-vaccination-antiviral-use-eu-eea-member-states |
[18] | Marinos G, Lamprinos D, Georgakopoulos P, et al. (2022) Increased influenza vaccination coverage among members of the Athens Medical Association amidst COVID-19 pandemic. Vaccines (Basel) 10: 797. https://doi.org/10.3390/vaccines10050797 |
[19] | Kong G, Lim NA, Chin YH, et al. (2022) Effect of COVID-19 pandemic on influenza vaccination intention: A meta-analysis and systematic review. Vaccines (Basel) 10: 606. https://doi.org/10.3390/vaccines10040606 |
[20] | Maltezou HC, Botelho-Nevers E, Brantsæter AB, et al. (2019) Vaccination of healthcare personnel in Europe: Update to current policies. Vaccine 37: 7576-7584. https://doi.org/10.1016/j.vaccine.2019.09.061 |
[21] | Arnold JN, Gundlach N, Böckelmann I, et al. (2021) Vaccination coverage rates of military personnel worldwide: A systematic review of the literature. Int Arch Occup Environ Health 94: 1-8. https://doi.org/10.1007/s00420-020-01559-w |
[22] | Cunningham AL, McIntyre P, Subbarao K, et al. (2021) Vaccines for older adults. BMJ 372: n188. https://doi.org/10.1136/bmj.n188 |
[23] | U.S. Department of Health and Human ServicesHealthy People 2020 (2020). Available from: https://www.healthypeople.gov/2020/topics-objectives/topic/Immunization-and-Infectious-Diseases/objectives%234670 |
[24] | Papagiannis D, Rachiotis G, Mariolis A, et al. (2020) Vaccination coverage of the elderly in Greece: A cross-sectional nationwide study. Can J Infect Dis Med Microbiol 2020: 5459793. https://doi.org/10.1155/2020/5459793 |
[25] | UK GovernmentShingles Vaccine Coverage Report (adults eligible from April to December 2021 and vaccinated to the end of March 2022): England Quarter 3 of 2021 to 2022 (2021). Available from: https://tinyurl.com/23e2syb2 |
[26] | Neufeind J, Wenchel R, Boedeker B, et al. (2021) Monitoring influenza vaccination coverage and acceptance among health-care workers in German hospitals-results from three seasons. Hum Vaccin Immunother 17: 664-672. https://doi.org/10.1080/21645515.2020.1801072 |
[27] | Genovese C, Picerno IAM, Trimarchi G, et al. (2019) Vaccination coverage in healthcare workers: A multicenter cross-sectional study in Italy. J Prev Med Hyg 60: E12-E17. https://doi.org/10.15167/2421-4248/jpmh2019.60.1.1097 |
[28] | Dedoukou X, Nikolopoulos G, Maragos A, et al. (2010) Attitudes towards vaccination against seasonal influenza of health-care workers in primary health-care settings in Greece. Vaccine 28: 5931-5933. https://doi.org/10.1016/j.vaccine.2010.06.108 |
[29] | Durovic A, Widmer AF, Dangel M, et al. (2020) Low rates of influenza vaccination uptake among healthcare workers: Distinguishing barriers between occupational groups. Am J Infect Control 48: 1139-1143. https://doi.org/10.1016/j.ajic.2020.02.004 |
[30] | Schmid P, Rauber D, Betsch C, et al. (2017) Barriers of influenza vaccination intention and behavior-A systematic review of influenza vaccine hesitancy, 2005–2016. PLoS One 12: e0170550. https://doi.org/10.1371/journal.pone.0170550 |
[31] | Cataldi JR, Kerns ME, O'Leary ST (2020) Evidence-based strategies to increase vaccination uptake: A review. Curr Opin Pediatr 32: 151-159. https://doi.org/10.1097/MOP.0000000000000843 |
[32] | Maltezou HC, Maragos A, Raftopoulos V, et al. (2008) Strategies to increase influenza vaccine uptake among health care workers in Greece. Scand J Infect Dis 40: 266-268. https://doi.org/10.1080/00365540701642658 |
[33] | Hu S, Xiong C, Li Q, et al. (2022) COVID-19 vaccine hesitancy cannot fully explain disparities in vaccination coverage across the contiguous United States. Vaccine 40: 5471-5482. https://doi.org/10.1016/j.vaccine.2022.07.051 |
[34] | Sydnor E, Perl TM (2014) Healthcare providers as sources of vaccine-preventable diseases. Vaccine 32: 4814-4822. https://doi.org/10.1016/j.vaccine.2014.03.097 |
[35] | Collange F, Zaytseva A, Pulcini C, et al. (2019) Unexplained variations in general practitioners' perceptions and practices regarding vaccination in France. Eur J Public Health 29: 2-8. https://doi.org/10.1093/eurpub/cky146 |
[36] | European CommissionEmployment, social affairs & security- Greece. Publications Office of the European Union, 2023 (2023). Available from: https://ec.europa.eu/social/main.jsp?catId=1112&langId=en&intPageId=4567 |