Influenza Vaccination Coverage Among Health Care Personnel — United States, 2017–18 Influenza Season

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The Advisory Committee on Immunization Practices (ACIP) recommends that all health care personnel receive an annual influenza vaccination to reduce influenza-related morbidity and mortality among health care personnel and their patients and to reduce absenteeism among health care personnel (1–4). CDC conducted an opt-in Internet panel survey of 2,265 U.S. health care personnel to estimate influenza vaccination coverage among these persons during the 2017–18 influenza season. Overall, 78.4% of health care personnel reported receiving influenza vaccination during the 2017–18 season, similar to reported coverage in the previous four influenza seasons (5). As in previous seasons, coverage was highest among personnel who were required by their employer to be vaccinated (94.8%) and lowest among those working in settings where vaccination was not required, promoted, or offered on-site (47.6%). Health care personnel working in long-term care settings, the majority of whom work as assistants or aides, have lower influenza vaccination coverage than do health care personnel working in all other health care settings, which puts the elderly in long-term settings at increased risk for severe complications for influenza. Implementing workplace strategies shown to improve vaccination coverage among health care personnel, including vaccination requirements and active promotion of on-site vaccinations at no cost, can help ensure health care personnel and patients are protected against influenza (6). CDC’s long-term care web-based toolkit* provides resources, strategies, and educational materials for increasing influenza vaccination among health care personnel in long-term care settings.

An Internet panel survey of health care personnel was conducted for CDC during March 27–April 17, 2018, to provide estimates of influenza vaccination coverage among health care personnel during the 2017–18 influenza season. Similar surveys have been conducted since the 2010–11 influenza season, and survey methodology has been described previously (7). 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 Survey Sampling International (SSI).^§ Responses were weighted to the distribution of the U.S. population of health care personnel by occupation, age, sex, race/ethnicity, work setting, and Census region.^¶ Because the study sample was based on health care personnel from opt-in Internet panels rather than probability samples, statistical tests were not conducted.** A change was considered an increase or decrease when there was at least a 5 percentage-point difference between estimates; estimates with smaller differences were considered similar.

Among the 2,382 persons who started the survey from either source (Medscape or SSI) and had eligible responses to the screening questions, 2,310 (97.0%) completed the survey.^†† Forty-three respondents with completed surveys who reported working in “other health care settings” were excluded because examination of their other survey responses indicated that they were either unlikely to have contact with patients or unlikely to have worked in one of the health care settings of interest for this analysis; two additional respondents were excluded because their work locations were outside of the United States. The final analytic sample included 2,265 health care personnel.

Overall, 78.4% of health care personnel reported having received an influenza vaccination during the 2017–18 season, a 15 percentage-point increase since the 2010–11 season but similar to coverage in the previous four seasons (75.2%–78.6%) (Figure 1) (Figure 2). Vaccination coverage in the 2017–18 season was similar to that in the 2016–17 season among health care personnel in all work settings (Figure 1) and occupation groups (Figure 2). As in previous seasons, coverage in the 2017–18 season was highest among health care personnel working in hospital settings (91.9%) followed by those working in ambulatory care (75.1%), other clinical settings (74.9%), and long-term care settings (67.4%) (Figure 1). Overall, vaccination coverage in 2017–18 was higher among physicians (96.1%), pharmacists (92.2%), nurses (90.5%), and nurse practitioners and physician assistants (87.8%), and lower among other clinical health care personnel (80.9%), assistants and aides (71.1%), and nonclinical health care personnel (72.8%) (Figure 2).

Vaccination coverage was highest (94.8%) among health care personnel working in settings where vaccination was required (Table). Overall, 44.1% of health care personnel reported a requirement to be vaccinated; those working in hospitals were more likely to report a vaccination requirement (68.3%) than were those working in ambulatory care (39.2%), long-term care (29.6%), or other clinical settings (37.9%) (Table). Among health care personnel whose employers did not have a requirement for vaccination, coverage was higher among those who worked in locations where vaccination was offered at the worksite at no cost for 1 day only (70.4%) or >1 day (76.0%) or who worked in locations where their employer did not provide influenza vaccination on-site at no cost but actively promoted vaccination through other mechanisms^§§ (75.1%) compared with that among health care personnel working in locations where employers did not have any vaccination-related requirements or provisions (47.6%) (Table). Health care personnel working in hospital settings were less likely to report that their employer did not require, provide, or promote vaccination (2.1%) than were personnel working in ambulatory care, long-term care, and other clinical settings (23.2%, 23.5%, and 26.1%, respectively).

Corresponding author: Carla L. Black, cblack2@cdc.gov, 404-639-8436.

¹Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC; ²Leidos, Reston, Virginia; ³Abt Associates Inc., Cambridge, Massachusetts; ⁴Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC; ⁵Division of Respiratory Health, National Institute for Occupational Safety and Health, CDC.

References

1. CDC. Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011;60(No. RR-7).
2. Hayward AC, 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. CrossRef PubMed
3. Lemaitre M, Meret T, Rothan-Tondeur M, et al. Effect of influenza vaccination of nursing home staff on mortality of residents: a cluster-randomized trial. J Am Geriatr Soc 2009;57:1580–6. CrossRef PubMed
4. Saxén H, Virtanen M. Randomized, placebo-controlled double blind study on the efficacy of influenza immunization on absenteeism of health care workers. Pediatr Infect Dis J 1999;18:779–83. CrossRef PubMed
5. Black CL, Yue X, Ball SW, et al. Influenza vaccination coverage among health care personnel—United States, 2016–17 influenza season. MMWR Morb Mortal Wkly Rep 2017;66:1009–15. CrossRef PubMed
6. Community Preventive Services Task Force. The guide to community preventive services. Vaccination. Atlanta, GA: US Department of Health and Human Services, CDC, Community Preventive Services Task Force; 2008. https://www.thecommunityguide.org/topic/vaccination
7. Black CL, Yue X, Ball SW, et al. . Influenza vaccination coverage among health care personnel—United States, 2013–14 influenza season. MMWR Morb Mortal Wkly Rep 2014;63:805–11. PubMed
8. Garten R, Blanton L, Elal AIA, et al. Update: influenza activity in the United States during the 2017–18 season and composition of the 2018–19 influenza vaccine. MMWR Morb Mortal Wkly Rep 2018;67:634–42. CrossRef PubMed
9. CDC. Surveillance of influenza vaccination coverage—United States, 2007–08 through 2011–12 influenza seasons. MMWR Surveill Summ 2013;62(No. SS-04).
10. Hung MC, Williams WW, Lu PJ, et al. Vaccination coverage among adults in the United States, National Health Interview Survey, 2016. Atlanta, GA: US Department of Health and Human Services, CDC; 2018. https://www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/pubs-resources/NHIS-2016.html

FIGURE 1. Percentage of health care personnel who received influenza vaccination, by work setting* — Internet panel surveys,^† United States, 2010–11 through 2017–18 influenza seasons

* Respondents could select more than one work setting. The “ambulatory care/physician office” category includes physician’s office, medical clinic, and other ambulatory care settings. The “other clinical setting” category includes dentist office or dental clinic, pharmacy, laboratory, public health setting, emergency medical services setting, or other setting 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 Survey Sampling International.

FIGURE 2. Percentage of health care personnel (HCP) who received influenza vaccination, by occupation* — Internet panel surveys,^† United States, 2010–11 through 2017–18 influenza seasons

* In the 2010–11 season, dentists were included in the physician category. Before the 2012–13 season, separate data on pharmacists were not collected. Other clinical personnel category includes allied health professionals, technicians, and technologists. Nonclinical personnel category includes administrative support staff members or managers and nonclinical support staff members (e.g., food service workers, laundry workers, janitors, and other housekeeping and maintenance 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 Survey Sampling International.

* Persons who worked in a place where clinical care or related services were provided to patients, or whose work involved face-to-face contact with patients or who were ever in the same room as 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 Survey Sampling International.
^§ Weights were calculated based on each occupation type, by age, sex, race/ethnicity, work setting, and U.S. Census region to represent the U.S. population of health care personnel. Work setting and overall occupation are presented as weighted estimates of the total sample. Where the groups are stratified by work setting, the estimates are presented as weighted estimates of the occupation group subsample of each work setting subgroup.
^¶ Includes all respondents who indicated that their employer required them to be vaccinated for influenza.
** Ambulatory care (physician’s office, medical clinic, and other ambulatory care setting).
^†† Dentist office or dental clinic, pharmacy, laboratory, public health setting, health care education setting, emergency medical services setting, or other setting where clinical care or related services was provided to patients.
^§§ Employer made influenza vaccination available on-site for >1 day during the influenza season at no cost to employees. Restricted to respondents without an employer requirement for vaccination.
^¶¶ Employer made influenza vaccination available on-site for 1 day during the influenza season at no cost to employees. Restricted to respondents without an employer requirement for vaccination.
*** Influenza vaccination was promoted among employees through public identification of vaccinated persons, financial incentives, or rewards to individuals or groups of employees, competition between units or care areas, free or subsidized cost of vaccination, personal reminders to be vaccinated, or publicizing of the number or percentage of employees receiving vaccination. Restricted to respondents without an employer requirement for vaccination or on-site vaccination.
^††† Vaccination coverage estimate not reliable because the sample size was <30.