Studies have shown that influenza among healthcare personnel (HCP) increases absenteeism and the potential to spread the infection to patients as well as family and friends. Additional research indicates that influenza vaccination of HCP reduces morbidity and mortality among nursing home patients, a population shown to be highly vulnerable to influenza. To reduce influenza-related morbidity, mortality, and absenteeism among HCP and their patients, the Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccination for all HCP. The CDC conducted an opt-in internet panel survey of nearly 2,000 HCP to estimate adherence with the ACIP recommendation for the 2014-2015 influenza season.
“We conducted an internet panel survey to obtain data on influenza coverage quickly following the end of an influenza season,” explains Carla L. Black, PhD, lead author of the study. “These data can then be used to enhance communication, messaging, and planning for the next influenza season.”
Dr. Black notes that HCP are a relatively rare segment of the population, and performing a population-based survey would be time-consuming and expensive. “The Internet panel survey estimates might be inexact measures of influenza vaccination coverage, but we’ve conducted the same survey for several years and are able to look at trends in coverage,” she says. “We were also interested in vaccination-related attitudes, practices, and knowledge among HCP, which are hard to obtain with current larger, population-based surveys.”
According to survey participant reports received for the 2014-2015 influenza season, overall HCP vaccination coverage was 77%, a rate that was similar to that of the 2013-2014 season but higher than what was seen during the 2010-2011 season (Figure). Coverage was highest among HCP who worked in a hospital (90%) and lowest among those working in long-term care (LTC) settings (64%).
By occupation, influenza coverage was highest among pharmacists (95%) and lowest among assistants and aides (64%). HCP who were required by their employer to be vaccinated reported the highest coverage rate (96%). The number of HCP required to be vaccinated against influenza nearly doubled since the 2011-2012 season, rising up to 40%. Among HCP without an employer requirement for vaccination, coverage rates were 74% and 84% for those working where vaccination was offered on-site at no cost for 1 day and multiple days, respectively. By comparison, those working where influenza vaccination was not required, promoted, or offered on-site had a coverage rate of just 44%. Overall, coverage increased between the 2013-2014 season and the 2014-2015 season for pharmacists, assistants and aides, and non-clinical personnel, whereas coverage among clinical personnel other than physicians, nurse practitioners, physician assistants, and nurses decreased during this period.
While coverage rates were lowest among assistants and aides, Dr. Black notes that occupation and work setting were closely related in this regard. “Most of the assistants and aides in our study who had the lowest coverage also worked at LTC facilities,” she says. “These facilities were least likely among all sites to promote influenza vaccination. About 30% of LTC employees reported that their employers did not have any promotions regarding vaccination. In contrast, less than 3% of HCP working in hospitals reported that their employers neither required, provided, nor promoted vaccination. Although not measured in this study, assistants and aides are also more likely to have factors that are associated with lower vaccination coverage among non-HCP, including lower incomes, less health insurance coverage, and a lower likelihood of having a regular physician. These factors could be mitigated by providing vaccination onsite at the workplace at no charge to the HCP.”
Room for Improvement
Although influenza vaccination coverage was high among physicians when compared with other HCP, Dr. Black says there is still room for improvement. “Physicians are in a position of authority in many healthcare settings,” she says. “They can set an example by getting vaccinated.” She adds that physicians can push for the promotion of vaccination among all HCP at their place of work.
The high rates of vaccination coverage and vaccination requirements and promotion in hospitals—when compared with other settings—may in part be a result of CMS requirements, which have been in place since January 2013. CMS requires hospitals to report HCP influenza vaccination levels as part of hospital quality reporting programs, according to the study authors. Vaccination coverage in non-hospital settings may improve in the future as more institutions are held accountable with quality reporting programs.
“Overall, influenza vaccination coverage among HCP is still suboptimal,” says Dr. Black. “However, there are several ways to improve coverage. Offering vaccination on site to employees at no cost in conveniently located places is associated with a large increase in coverage. On-site vaccination, along with other promotional activities like sending reminders to be vaccinated, educating HCP about the influenza vaccine, and identifying vaccinated or un-vaccinated personnel can increase coverage even further. Efforts to increase vaccination should also target assistants, aides, and non-clinical support staff.”
Readings & Resources (click to view)
Black C, Yue X, Ball S, et al. Influenza vaccination coverage among health care personnel—United States, 2014–15 influenza season. MMWR Morb Mortal Wkly Rep. 2015;64:993-999. Available at www.cdc.gov/mmwr/preview/mmwrhtml/mm6436a1.htm.
Hayward A, Harling R, Wetten S, et al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ. 2006;333:1241.
Black C, Yue X, Ball S, et al. Influenza vaccination coverage among health care personnel—United States, 2013–14 influenza season. MMWR Morb Mortal Wkly Rep. 2014;63:805-811.
Hollmeyer H, Hayden F, Mounts A, Buchholz U. Review: interventions to increase influenza vaccination among healthcare workers in hospitals. Influenza Other Respir Viruses. 2013;7:604-621.