Pandemic influenza (A/H1N1) vaccine uptake among French private general practitioners: a cross sectional study in 2010.

BACKGROUND: In July, 2009, French health authorities, like those in many other countries, decided to embark on a mass vaccination campaign against the pandemic A(H1N1) influenza. Private general practitioners (GPs) were not involved in this campaign. We studied GPs' pandemic vaccine (pvaccine) uptake, quantified the relative contribution of its potential explanatory factors and studied whether their own vaccination choice was correlated with their recommendations to patients about pvaccination. METHODOLOGY/PRINCIPAL FINDINGS: In this cross-sectional telephone survey, professional investigators interviewed an existing panel of randomly selected private GPs (N = 1431; response rate at inclusion in the panel: 36.8%; participation rate in the survey: 100%). The main outcome variable was GPs' own pvaccine uptake. We used an averaging multi-model approach to quantify the relative contribution of factors associated with their vaccination. The pvaccine uptake rate was 61% (95%CI = 58.3-63.3). Four independent factors contributed the most to this rate (partial Nagelkerke's R(2)): history of previous vaccination against seasonal influenza (14.5%), perception of risks and efficacy of the pvaccine (10.8%), opinions regarding the organization of the vaccination campaign (7.1%), and perception of the pandemic's severity (5.2%). Overall, 71.3% (95%CI = 69.0-73.6) of the participants recommended pvaccination to young adults at risk and 40.1% (95%CI = 37.6-42.7) to other young adults. GPs' own pvaccination was strongly predictive of their recommendation to both young adults at risk (OR = 9.6; 95%CI = 7.2-12.6) and those not at risk (OR = 8.5; 95%CI = 6.4-11.4). CONCLUSIONS/SIGNIFICANCE: These results suggest that around 60% of French private GPs followed French authorities' recommendations about vaccination of health care professionals against the A(H1N1) influenza. They pinpoint priority levers for improving preparedness for future influenza pandemics. Besides encouraging GPs' own uptake of regular vaccination against seasonal influenza, providing GPs with clear information about the risks and efficacy of any new pvaccine and involving them in the organization of any future vaccine campaign may improve their pvaccine uptake

Opinions and attitudes of GPs according to their vaccination status for A/H1N1 flu (French nationwide panel of general practitioners, weighted data, N = 1431).

*<p>Weighted numbers;</p>†<p>Rao-Scott Chi² test;</p>‡<p>Ministry of Health service providing timely information to physicians during public health emergencies through e-mails.</p

Factors associated with personal vaccination of GPs against A/H1N1 flu (French nationwide panel of general practitioners, multi-model averaging, weighted data, N = 1429).^*

*<p>Model adjusted for gender, age, type of place of practice, 2008 workload, and solo or group practice (only the latter variable is significant);</p>†<p>Including 2009–2010;</p>‡<p>Significant dose-effect relation (p<0.001);</p>#<p>On infectious diseases and vaccination;</p>§<p>Ministry of Health service distributing timely information to physicians during public health emergencies through e-mails.</p

Relative contribution and importance of the explanatory factors associated with personal vaccination of GPs against A/H1N1 flu (French nationwide panel of general practitioners, weighted data, N = 1429: multi-model averaging).^*

*<p>Total Nagelkerke’s R² : 46,77%.</p>†<p>According to the value of the importance weights <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0041837#pone.0041837-Kass1" target="_blank">[28]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0041837#pone.0041837-Viallefont1" target="_blank">[29]</a>:</p><p>• [0–0.5[: no evidence.</p><p>• [0.5–0.75[: weak evidence.</p><p>• [0.75–0.90[: positive evidence.</p><p>• [0.95–0.99[: strong evidence.</p><p>• [0.99–1 [: very strong evidence.</p>‡<p>Based on importance weight.</p

Social, demographic, and professional characteristics of GPs according to their vaccination status for A/H1N1 flu (French nationwide panel of general practitioners, weighted data, N = 1431).

*<p>Weighted numbers;</p>†<p>Rao-Scott Chi² test;</p>‡<p>Number of half-day CME courses on infectious diseases and vaccination.</p