Failure to Vaccinate Health Care Personnel Against Influenza

The CDC’s Advisory Committee on Immunization Practices recommends that all health care personnel (HCP) be vaccinated annually against influenza. Vaccination of HCP can reduce influenza-related morbidity and mortality among both HCP and their patients. To estimate influenza vaccination coverage among HCP during the 2013–2014 season, the CDC analyzed results of an opt-in Internet panel survey of 1,882 HCP conducted during April 1–16, 2014. Overall, 75.2% of participating HCP reported receiving an influenza vaccination during the 2013–2014 season, similar to the 72.0% coverage among participating HCP reported in the 2012–2013 season.


Coverage was highest among HCP working in hospitals (89.6%) and lowest among HCP working in long-term care (LTC) settings (63.0%). By occupation, coverage was highest among physicians (92.2%), nurses (90.5%), nurse practitioners and physician assistants (89.6%), pharmacists (85.7%), and "other clinical personnel" (87.4%) compared with assistants and aides (57.7%) and nonclinical personnel (e.g., administrators, clerical support workers, janitors, and food service workers) (68.6%). HCP working in settings where vaccination was required had higher coverage (97.8%) compared with HCP working in settings where influenza vaccination was not required but promoted (72.4%) or settings where there was no requirement or promotion of vaccination (47.9%). Among unvaccinated HCP, the most common reasons given for not being vaccinated were "I might get sick from the vaccine" (20.1%), "I don't think that flu vaccines work" (16.3%), and "I don't need it" (16.0%).


Among HCP without an employer requirement for vaccination, coverage was higher for HCP working in settings where vaccination was offered on-site at no cost for one day (61.6%) or multiple days (80.4%) compared with HCP working in settings not offering free on-site vaccination (49.0%). Comprehensive vaccination strategies that include making vaccine available at no cost at the workplace along with active promotion of vaccination might be needed to increase vaccination coverage among HCP and minimize the risk for influenza to HCP and their patients.


Just over one quarter of states reached the Healthy People 2020 target of 90% influenza vaccination among HCP in their hospitals. The overall HCP influenza vaccination coverage estimate for the 2013–2014 season was 75.2%, similar to the estimate of 72.0% from the previous influenza season, but higher than the estimates of 63.5% and 66.9% observed for the 2010–2011 and 2011–2012 seasons, respectively. As in the 2012–2013 season, coverage during the 2013–2014 season was >90% for two groups of HCP: physicians, regardless of the settings in which they worked, and HCP with an employer requirement to be vaccinated, regardless of work setting.


The results of this survey showed that higher vaccination coverage among HCP was associated with employer vaccination requirements, vaccination promotion, and access to vaccination at the workplace at no cost for more than one day. Vaccination at the worksite, the most common place of vaccination reported by HCP in this survey, has been associated with higher seasonal vaccination coverage among HCP. This study found that coverage of 80.4% was achieved in the absence of a vaccination requirement among HCP working in facilities where free on-site vaccination was available for more than one day. However, 49.3% of HCP, without a requirement to be vaccinated, worked in locations that either did not offer vaccination on-site, or if offered, did not make vaccination available at no cost. These results indicate that a comprehensive strategy that includes promotion of vaccination along with easy access to vaccination at no cost on multiple days might increase HCP vaccination coverage.


HCP working in LTC settings also were most likely to report that their employer neither required nor promoted vaccination, and were least likely to report that their employer made vaccination available at no cost for multiple days. Influenza vaccination of HCP in LTC settings is important given that influenza vaccine effectiveness is generally lowest in the elderly, making vaccination of close contacts even more critical. In addition, multiple studies have demonstrated that vaccination of HCP in LTC settings confers a health benefit to patients, including reduced risk for mortality.


Public reporting of HCP vaccination data is an important strategy to increase influenza vaccination coverage. A voluntary public reporting program among Iowa hospitals resulted in an increase of 20 percentage points in median employee influenza vaccination coverage over four years. The CDC’s Guide to Community Preventive Services recommends assessment and feedback on vaccination rates as an evidence-based approach to increase vaccination coverage. Facility-level reports of HCP influenza vaccination will be published by the Centers for Medicare and Medicaid Services (CMS) on its Hospital Compare website in 2014.


The CMS Hospital Inpatient Quality Reporting program comprises a list of performance measures, including HCP influenza vaccination, which acute care hospitals must report annually to CMS. Hospitals failing to report all required measures can be subject to a decrease in their annual payment update from CMS. This provides a financial incentive for acute care hospitals to report HCP influenza vaccination data to the National Healthcare Safety Network (NHSN), a web based surveillance system managed by the CDC, contributing to completeness of reporting. Data in this report provide a baseline for measuring changes in hospital-based HCP vaccination reporting in future influenza seasons. States and hospitals can use these data to evaluate the effectiveness of efforts to increase HCP influenza vaccination in pursuit of the HP2020 target of 90% vaccination.


See the CDC Report on Vaccination for Health Care Personnel


Also see the CDC Report on Vaccination for Acute Care Hospital-Based Health Care Personnel


See also Medical Law Perspectives, January 2012 Report: Hospital-Acquired Infections: Who Is Liable and Why?


See also Medical Law Perspectives, January 2013 Report: Vaccines: An Ounce of Prevention May Lead to a Pound of Injury