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Background: Preventing seasonal influenza is a public health priority but, although the benefits of vaccinating healthcare workers (HCWs) are emphasised, seasonal influenza vaccine uptake rates remain low. Voluntary vaccination policies have been less successful in achieving high vaccine uptake when compared to mandatory policies and the persistently low vaccine uptake among HCWs has fuelled debate on whether mandatory vaccination programmes should be implemented in the interest of patient safety. Aim: This study explored nurses' views on mandatory vaccination policy for seasonal influenza. Methods: A self-selected sample (n=35) of qualified nurses working in two large hospital sites in Ireland participated in five focus groups. Data were analysed using Braun and Clarke's framework. Findings: Two themes were identified: (1) mixed views on mandatory vaccination and (2) leave nurses to make their own choice on vaccination. Conclusion: This study provides an understanding of nurses' views regarding mandatory vaccination policy for seasonal influenza and highlights that individual choice and autonomy are crucial for vaccine acceptance.

To identify the barriers and facilitators to seasonal influenza vaccination uptake among nurses.Seasonal influenza causes significant mortality and morbidity among older people and high-risk groups. Vaccinating nurses against influenza is an essential public health measure to reduce the burden of disease. Yet despite annual recommendations, nurses' influenza vaccine uptake rates remain low.An explanatory sequential mixed methods study design.Qualified nurses attending mandatory training in two large acute hospitals in Ireland.A paper-based questionnaire assessing nurses' knowledge, risk perception, health beliefs and influenza vaccination practices was distributed to a convenience sample of qualified nurses (N = 462) between September 2017 - February 2018. A self-selected sample of 35 nurses who completed the questionnaire participated in five focus groups to explore in depth the barriers and facilitating factors associated with their vaccination practices between September 2018 - October 2018. The questionnaire data were analysed statistically and thematic analysis was applied to the qualitative data. The quantitative and qualitative findings were integrated using the Pillar Integration Process.Seven themes emerged: (a) the influence of nurses' knowledge on vaccine uptake; (b) dissemination of information; (c) vaccine fears and concerns; (d) protection, risk and vulnerability: self and others; (e) influencers; (f) accessibility; and (g) organizational pressure.Achieving high vaccine uptake rates among nurses through voluntary vaccination programmes remains a challenge. Multi-faceted influenza campaigns based on the HBM should be prioritized to address dissemination of evidence-based knowledge, accessibility, and external cues to action.Low influenza vaccine uptake among nurses compromises patient safety and contributes to a significant burden on health services. This study identified factors associated with vaccine practices among nurses and will inform the development of specific tailored interventions for nurses.目的: 探讨护士接种季节性流感疫苗的助力及阻力因素。 背景信息: 季节性流感对于老年群体和高危群体具有极高的病死率和发病率。为护士接种流感疫苗是减轻疾病负担的重要公共卫生举措。然而,尽管这个意见年年被提及,但护士的流感疫苗接种率仍偏低。 设计: 解释性与顺序性的混合法研究设计。 数据来源: 在爱尔兰两所大型急症医院接受强制性培训的合格护士。 方法: 将调查护士医学知识、风险认知、健康信念和流感疫苗接种实践的纸质问卷分发给2017年9月至2018年2月间随机抽取的合格护士样本(N = 462)。在2018年9月至2018年10月期间,邀请35名完成问卷调查的自选护士样本参加五个焦点小组,深入探讨其疫苗接种实践相关的助力和阻力因素。然后对问卷数据进行统计分析,在这些定性数据中采用主题分析的方法。利用支柱一体化流程整合定量和定性研究结果。 结果: 提出七大主题:(a)护士的医学知识对疫苗接种的影响;(b)信息的传播;(c)对疫苗的恐惧和担忧;(d)保护、风险和脆弱性:自我和他人;(e)影响者;(f)可获取性;(g)组织压力。 结论: 通过自愿疫苗接种方案在护士中实现高疫苗接种率仍存在挑战。应优先考虑基于健康信念模式的多方面流感活动,以传播循证知识、可获取性和外部的行动线索。 影响: 护士偏低的流感疫苗接种率会危及患者的安全,并对医疗卫生服务造成严重的负担。本研究确定了与护士接种疫苗相关的各类因素,并将通报有关针对护士的具体介入治疗的进展。.

Background & Aim In the mid-1990s, a group of Rh negative women was diagnosed with hepatitis C virus (HCV) genotype 1b infection, following administration of contaminated anti-D immunoglobulin in 1977–79. We aimed to describe their disease history and estimate the effect of selected host and treatment factors on disease progression. Methods We conducted a cohort study on the women infected with HCV. Information was collected from records at seven HCV treatment centres on demographics, treatment and health outcomes up to the 31st December 2013. We calculated cumulative incidence, case fatality, and sub hazard ratios (SHR) for disease progression using competing risks regression. Results Six hundred and eighty-two patients were included in the study. Among the chronically infected patients (n=374), 35% completed interferon-based antiviral treatment; 42% of whom had a sustained virological response. At the end of 2013, 19%, 1.9%, and 4.9% of chronically infected patients had developed cirrhosis, hepatocellular carcinoma, and liver-related death, respectively, compared with 10%, 0.8%, and 2.4% at the end of 2008. At the end of 2013, 321 (86%) of the chronically infected patients remained alive, 247 (77%) of whom were still chronically infected. Factors associated with increased cirrhosis rates included high alcohol intake (aSHR=4.9 [2.5–9.5]) and diabetes mellitus (aSHR=5.0 [2.9–8.8]). Conclusions Development of liver-related outcomes accelerated with time, with the risk of cirrhosis, hepatocellular carcinoma, and liver-related death doubling in the last five years of follow-up, particularly in women with high alcohol consumption and diabetes mellitus. We recommend that patients with chronic HCV infection be advised of the additive harmful effect of alcohol, and that data be collected on this cohort after a further five years to analyse the effect of subsequent antiviral treatment during this rapidly evolving period in HCV treatment history. Lay summary In the mid-1990s, a group of women were diagnosed with chronic hepatitis C virus (HCV) infection following receipt of contaminated anti-D immunoglobulin between 1977 and 1979 in Ireland. Seventy-two (19%) developed cirrhosis and 18 had died from liver-related causes (5%) after 36years of infection. Disease progression accelerated in the last five years of follow-up, particularly in women with diabetes mellitus and high alcohol consumption. We recommend that patients with chronic HCV infection be advised of the additive harmful effect of high alcohol consumption.

Background Until recently, trivalent influenza vaccines (TIV) have contained one influenza B virus, recommended annually by the WHO vaccine selection committee. Quadrivalent Influenza Vaccines (QIV) add protection against a second B lineage; preventing the threat of a vaccine mismatched season, which often occurs in the Northern Hemisphere, leading to reduced vaccine effectiveness (VE) and increased influenza morbidity and mortality. Young children have one of the highest clinical burdens in Ireland, with the highest age-specific rate for influenza cases admitted to critical care units generally in children aged 0–4 years. Additionally, school-aged children are a major source of community transmission. Aim To assess the benefit of a QIV in the Irish paediatric population. Methods A literature review was conducted comparing QIV to TIV, focusing on VE and cost-effectiveness (CE). The VE of live-attenuated influenza vaccine (LAIV) compared to inactivated influenza vaccine (IIV) in children was also studied. The Cochrane database of systematic reviews, the Cochrane Central Register of Controlled Trials, PubMed, the Lancet, and publications from the European projects I-MOVE/I-MOVE+ and VENICE were searched for publications between 2009–2018. Results Recent influenza seasons suggest a higher VE of QIV compared to TIV. Studies have shown that QIV is as effective as TIV for the strains included in both; however QIV has superior immunogenicity for the additional B strain when there is a mismatch season. These results are also reflected in pre-licensing studies of the immunogenicity of QIVs that are now approved. LAIV has been recommended due to higher VE against influenza B strains and the ease and acceptability of the intranasal vaccination compared to the injectable IIV. QIV are more expensive than TIV, however CE analyses indicate that QIV delivers substantial savings in terms of preventing direct healthcare costs through reductions in infection numbers, hospitalisations and deaths; resulting in quality-adjusted life years gained. There are also substantial societal benefits through indirect savings in productivity (preventing employee/caregiver absences). Rolling out QIV to children was the most cost-effective vaccination strategy in the UK (aged 2–11 years) and in European countries (4–16 years) partaking in the I-MOVE+ project, with the exception of Portugal. Conclusion QIV would stabilise the VE across influenza seasons; eliminating the uncertainty of predicting the influenza B lineage, ultimately increasing public confidence in the vaccine, resulting in increased vaccine uptake. Broader protection in the paediatric population would directly reduce influenza transmission and indirectly protect vulnerable populations in the community.

Introduction Prior to the introduction of viral inactivation of factor concentrates and screening of blood, 225 people with haemophilia became infected with hepatitis C (HCV) in Ireland. Aim Our aim was to assess liver disease progression and mortality in this population after 30 years of infection. Methods Demographic and clinical data were collected from medical records in five hepatology units and one infectious disease unit retrospectively in 2005, and on four subsequent occasions. Results The participation rate was 73% (165/225). Eighty three percent of patients, who had been tested for RNA (n = 106/128), developed chronic HCV infection. Thirty four percent were co-infected with HIV. All-cause mortality, after approximately 30 years of infection with chronic HCV, was 44% in HIV positive patients and 29% in HIV negative patients. Liver-related mortality was 12.5% and did not vary significantly by HIV status. Thirty seven percent of patients had developed advanced liver disease, including 20% with cirrhosis and 9% with hepatocellular carcinoma. In the pre-interferon-free direct acting antivirals era, 57% (n = 60/106) of patients were treated for HCV, 65% of whom achieved a sustained virological response. Successfully treated patients had few adverse liver outcomes. Conclusion After 30 years of infection, 40% of the patients who had evidence of chronic HCV had developed advanced liver disease, such as cirrhosis and HCC, or had died from liver-related causes. This proportion is high relative to similar international cohorts despite good anti-HCV treatment uptake and responses.

Summary Introduction A cohort of people with iatrogenic HCV infection, current or resolved, in Ireland have access to primary and secondary health care services, including specified complementary and alternative medicine (CAM) services, free of charge. Objectives Information about their pattern of CAM usage and its association with various demographic and lifestyle factors, and current HCV status, was sought as part of a health and lifestyle survey, in order to provide information for health service planning. Design and methods The survey was carried out by self-administered postal questionnaire. The level of CAM usage was compared to an age- and sex-matched sample of the general population. Results The response was 48% (720/1485). Compared to the general population, the HCV population was significantly more likely to have attended a CAM practitioner (50.1% vs 23.9%, OR 3.2; 95% CI 2.7–3.9). Within the HCV population, multivariate analysis showed that females (OR 3.1; 95% CI 1.9–4.9), those who reported fibromyalgia (OR 2.7; 95% CI 1.8–3.9) and those who reported anxiety (OR 1.4; 95% CI 1.0–2.0) were significantly more likely to have used CAM, and smokers significantly less likely (OR 0.6; 95% CI 0.4–0.8). CAM attendance did not vary by current HCV status. Reflexology, acupuncture and massage were the most commonly used forms of CAM. Conclusions This study demonstrates that CAM services are used by a high proportion of people with iatrogenic chronic HCV. A more holistic approach to health care, using a biopsychosocial model framework, may better meet the physical and psychological health needs of this group.

The risk of communicable disease transmission during air travel is of public health concern and has received much attention over the years. We retrospectively reviewed information from nine flights (≥ 8 hours) associated with infectious tuberculosis (TB) cases in Ireland between September 2011 and November 2014 to investigate whether possible transmission had occurred. Twenty-four flights notified in Ireland associated with sputum smear-positive pulmonary TB cases with a history of air travel were reviewed. Nine were suitable for inclusion and analysed. Six cases of infectious TB travelled on nine flights. A total of 232 passengers were identified for contact tracing; 85.3% (n = 198) had sufficient information available for follow-up. In total, 12.1% (n = 24) were reported as screened for TB. The results revealed no active TB cases among passengers and 16.7% (n = 4) were diagnosed with latent TB infection (LTBI) all of whom had other risk factors. Despite the limited sample size, we found no evidence of M. tuberculosis transmission from infectious passengers. This study identified challenges in obtaining complete timely airline manifests, leading to inadequate passenger information for follow-up. Receipt of TB screening results from international colleagues was also problematic. The challenge of interpreting the tuberculin skin test results in determining recent vs earlier infection was encountered.

Between March 2010 and November 2013 eight laboratory-confirmed cases of serogroup B, invasive meningococcal disease (IMD) were identified in an extended Irish Traveller family across three Health Service Executive (HSE) areas of Ireland. Cases were aged between 5 and 46 months, and were either a cousin or sibling of another case. All eight cases survived. Chemoprophylaxis was given to relevant nuclear family members and close contacts on each occasion, but failed to prevent further cases. Neisseria meningitidis isolates from six cases were highly related, belonging to the ST-41/44 clonal complex, and shared the porA designation 7–2,4. In November 2013, the outbreak control team recommended that directly observed ciprofloxacin chemoprophylaxis be administered simultaneously to the extended family, and that the four component meningococcal B (4CMenB) vaccine be administered to family members aged 2 months to 23 years inclusive and relevant close contacts of the eighth case. Subsequently these recommendations were implemented at three regional clinics. Additionally pharyngeal swabs (n=112) were collected to assess carriage rates of N. meningitidis in this extended family. Pharyngeal carriage of N. meningitidis was detected in 15 (13%) family members. From the epidemiological investigation and carriage study overcrowding was the most likely risk factor identified in this outbreak. To date, the combination of directly observed ciprofloxacin chemoprophylaxis and use of 4CMenB vaccine have controlled the outbreak with no further cases diagnosed.