Influenza Vaccination Coverage Among Health Care Personnel — United States, 2022–23 Influenza Season

Overall, 75.9% of HCP reported having received an influenza vaccination during the 2022-2023 season, lower than the 80.6% reported in the 2021-2022 season (p<0.05) (Table 1). Among all HCP, influenza vaccination coverage over the previous nine seasons steadily increased from the 2013-2014 season through the 2018-2019 seasons, and then decreased between the 2019-2020 and 2020-2021 seasons and between the 2021-2022 and 2022-2023 seasons after an apparent increase in 2021-2022. Similar patterns were seen for HCP working in ambulatory care and other clinical settings, while coverage among HCP working in hospitals declined from a high of 95.2% in 2018-2019 to 85.7% in 2022-23, and coverage among HCP working in LTC settings has remained stable from 2015-2016 through 2022-2023 (Figure 1). As in previous seasons, influenza vaccination coverage in 2022-2023 was highest among HCP working in hospitals (85.7%) and lowest among HCP working in LTC and home health care settings (68.3%) (Table 1, Figure 1). Influenza vaccination coverage was highest among physicians (94.5%), pharmacists (90.7%), nurse practitioners and physician assistants (91.0%) and nurses (88.1%), and lower among other clinical personnel (82.5%), non-clinical personnel (70.6%), and assistants/aides (62.8%); similar patterns were seen in previous seasons (Table 1, Figure 2). Estimates and 95% CIs for influenza seasons 2013-2014 through 2022-2023 are reported in the Supplementary Table S1.

Table 1. Receipt of influenza vaccination among health care personnel by selected characteristics — Internet Panel Surveys*, United States, April 2022 and April 2023

_{Abbreviation: Ref = referent group.}

_{*Respondents were recruited from two preexisting national opt-in Internet sources: Medscape, a medical website managed by WebMD Health Professional Network, and general population Internet panels operated by Dynata.}

_{†Estimates for the 2021-22 season in this report used updated weights, which are slightly different than the report published in October 2022.}

_{§Modified Clopper-Pearson 95% CI according to the approach of Korn and Graubard.}

_{¶Statistically significant (p<0.05) when compared across seasons.}

_{**Statistically significant (p<0.05) when compared with Ref in the same season.}

_{††Race and ethnicity were self-reported. Respondents who identified as Hispanic might be of any race. The “Other” race category included persons who identified as Asian, American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and persons who selected “Other” or “multiple races.”}

_{§Estimate does not meet CDC’s National Center for Health Statistics standards of reliability (https://www.cdc.gov/nchs/data/series/sr_02/sr02_175.pdf).}

_{¶¶Excludes students.}

_{***Includes dentists, allied health professionals, technicians and technologists, emergency technicians, emergency medical technicians, and paramedics.}

_{†††Includes administrative support staff members and managers, and non-clinical support staff members.}

_{§§Respondents could select more than one work setting. Each work setting is represented by a separate variable with two values (yes and no, where reference value is no).}

_{¶¶¶ Nursing home, assisted living facility, other long-term care facility, home health agency, or home health care.}

_{****Includes dentist office or dental clinic, pharmacy, emergency medical services, and other settings where clinical care or related services were provided to patients.}

_{††††Rurality was defined using zip codes in which >50% of the population resides in a nonmetropolitan county, a rural U.S. Census Bureau tract, or both, according to the Health Resources and Services Administration’s definition of rural population. https://www.hrsa.gov/rural-health/about-us/what-is-rural}

_{§§§https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf}

Figure 1. Percentage of health care personnel who received influenza vaccination, by work setting^* — Internet panel surveys^†, United States, 2013-2014 through 2022-2023 influenza seasons^§

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_{*Respondents could select more than one work setting. The other clinical setting category includes dentist office or dental clinic, pharmacy, emergency medical services, and other settings where clinical care or related services were provided to patients.}

_{†Respondents were recruited from two preexisting national opt-in Internet sources: Medscape, a medical website managed by WebMD Health Professional Network, and general population Internet panels operated by Dynata.}

_{§During the 2020-2021 influenza season, a weighting methodological change was implemented. Prior to the 2020-2021 influenza season, weights were calculated to population control totals controlling for the main effects (occupation, age group, race and ethnicity, gender, work setting, and Census region); From the 2020-2021 influenza season and onward, interaction terms between occupation and the other main effects were added in the weighting model. Influenza Vaccination Coverage Among Health Care Personnel — United States, 2020–21 Influenza Season}

Supplementary Table S1. Influenza vaccination coverage among health care personnel, by select characteristics — Internet panel surveys*, United States, 2013-2014 through 2022-2023 influenza seasons

_{Abbreviations: Ref = referent group.}

_{*Completion of primary series of COVID-19 vaccines was defined as the receipt of a 2-dose primary mRNA COVID-19 vaccine series for respondents who did not report being immunocompromised, or an additional dose after completion of a 2-dose mRNA COVID-19 vaccine series for respondents who reported being immunocompromised. For respondents whose initial vaccine was Janssen (Johnson & Johnson), completion of primary COVID-19 series was defined as the receipt of 1 dose for those who were not immunocompromised, or a second COVID-19 vaccine (either Janssen or mRNA) for those who were immunocompromised.}

_{†Respondents were considered to have received a COVID-19 bivalent booster vaccine if they responded "Yes" to the question, "Have you received a bivalent booster vaccine?" which was asked of respondents who reported receipt of at least one dose of a COVID-19 vaccine.}

_{§Respondents were recruited from two preexisting national opt-in Internet sources: Medscape, a medical website managed by WebMD Health Professional Network, and general population Internet panels operated by Dynata.}

_{¶Modified Clopper-Pearson 95% CI according to the approach of Korn and Graubard.}

_{**Statistically significant (p<0.05) when compared with Ref.}

_{††Race and ethnicity were self-reported. Respondents who identified as Hispanic might be of any race. The “Other” race category included persons who identified as Asian, American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and persons who selected “Other” or “multiple races.”}

_{§Estimate does not meet CDC’s National Center for Health Statistics standards of reliability (https://www.cdc.gov/nchs/data/series/sr_02/sr02_175.pdf).}

_{¶¶Excludes students (29).}

_{*** Includes dentists, allied health professionals, technicians and technologists, emergency technicians, emergency medical technicians, and paramedics.}

_{†††Includes administrative support staff members and managers, and nonclinical support staff members.}

_{§§Respondents could select more than one work setting. Each work setting is represented by a separate variable with two values (yes and no, where reference value is no).}

_{¶¶¶Nursing home, assisted living facility, other long-term care facility, home health agency, or home health care.}

_{****Includes dentist office or dental clinic, pharmacy, emergency medical services, and other settings where clinical care or related services were provided to patients.}

_{††††Rurality was defined using zip codes in which >50% of the population resides in a nonmetropolitan county, a rural U.S. Census Bureau tract, or both, according to the Health Resources and Services Administration’s definition of rural population. https://www.hrsa.gov/rural-health/about-us/what-is-rural.}

_{§§§https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf}

Figure 2. Percentage of health care personnel who received influenza vaccination, by occupation^* — Internet panel surveys^†, United States, 2013-2014 through 2022-2023 influenza seasons^§

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_{*Other clinical personnel includes dentists, allied health professionals, technicians and technologists, emergency medical technicians, and paramedics. Non-clinical personnel includes administrative support staff members and managers, and non-clinical support staff members.}

_{†Respondents were recruited from two preexisting national opt-in Internet sources: Medscape, a medical website managed by WebMD Health Professional Network, and general population Internet panels operated by Dynata.}

_{†During the 2020-2021 influenza season, a major weighting methodological change was implemented. Prior to the 2020-2021 influenza season, weights were calculated to population control totals controlling for the main effects (occupation, age group, race and ethnicity, gender, work setting, and Census region); From the 2020-2021 influenza season and onward, interaction terms between occupation and the other main effects were added in the weighting model. Influenza Vaccination Coverage Among Health Care Personnel — United States, 2020–21 Influenza Season.}

During the 2022-2023 season, higher influenza vaccination coverage was reported among HCP with either a master's, professional, or doctoral degree (82.8%) than among those with some college education or less (63.4%). Coverage was highest among HCP who reported an employer requirement for influenza vaccination (95.9%) than among those who reported an employer recommendation (70.2%) or no recommendation or requirement for vaccination (44.8%). Influenza vaccination coverage was also highest among HCP who were aged ≥60 years (85.3%), reported working in a non-rural area (77.7%), and HCP who reported receiving ≥1 dose of COVID-19 vaccine (83.8%). Compared with the 2021-2022 influenza season, statistically significant decreases in influenza vaccination coverage were observed among HCP aged 30-44 years (10.9 percentage points), male (10.5 percentage points), those with master's, professional, or doctoral degrees (8.8 percentage points), assistants/aides (6.3 percentage points), those who work in hospital (6.5 percentage points), ambulatory (6.0 percentage points), and other clinical settings (11.9 percentage points), those working in rural areas (11.6 percentage points), and those who worked in the Midwest (8.2 percentage points) and Northeast (7.4 percentage points) regions (Table 1).

Overall, 84.1% of HCP reported having completed the COVID-19 primary series vaccination and 38.6% reported having received a COVID-19 bivalent vaccine (Table 2). Completion of COVID-19 primary series vaccination was highest among those aged ≥60 years (91.0%), pharmacists (96.0%) and physicians (95.4%), HCP working in a hospital setting (91.2%), and those who reported ever having COVID-19 (85.0%). COVID-19 primary series vaccination coverage was also higher among HCP who reported an employer requirement for COVID-19 vaccination (92.2%) than among those who reported an employer recommendation (81.0%), or no recommendation or requirement (58.8%). Receipt of a COVID-19 bivalent vaccination among all HCP was highest among HCP aged ≥60 years (60.1%), physicians (54.9%), HCP working in hospital settings (41.1%), and those who reported an employer requirement for COVID-19 bivalent vaccine (67.7%). COVID-19 bivalent vaccination coverage was lowest among HCP aged 30-44 years (32.4%), non-Hispanic Black (29.4%), those with some college education or less (28.3%), assistants/aides (27.3%), HCP working in other clinical settings (34.2%), and HCP who reported ever having COVID-19 (35.7%) (Table 2).

Table 2. Completion of primary series* of a COVID-19 vaccine and receipt of a bivalent vaccine† among health care personnel, by selected characteristics — Internet panel surveys§, United States, April 2023

COVID-19 primary series (89.8%) and bivalent vaccination coverage (47.4%) was higher among HCP who reported that their employer offered COVID-19 vaccinations onsite at the workplace (Table 2). This remained true when restricted to HCP without an employer requirement for vaccination but who were offered COVID-19 vaccination onsite (vaccination coverage 85.2% and 43.4%, respectively)

The main reasons for not getting a COVID-19 bivalent vaccination among HCP who had completed a primary vaccination series were "I am concerned about possible safety risks or side effects if I got vaccinated" (12.5%), "I had a bad reaction after a previous COVID-19 vaccination" (10.2%), and "I don't think bivalent provides any more protection than initial vaccine" (8.7%) (Figure 3).

Figure 3. Main reasons^* for non-receipt of a bivalent vaccine^† of COVID-19 vaccine among health care personnel (n=1,627) – Internet panel surveys^§, United States, April 2023

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_{*Reasons selected by less than 5% of respondents are not presented.}

_{†Respondents were considered to have received a COVID-19 bivalent vaccine if they responded "Yes" to the question, "Have you received a bivalent vaccine?" which was asked of respondents who reported receipt of at least one dose of a COVID-19 vaccine.}

_{§Respondents were recruited from two preexisting national opt-in Internet sources: Medscape, a medical website managed by WebMD Health Professional Network, and general population Internet panels operated by Dynata.}