In findings that further underscore the “presenteeism” phenomenon, investigators found that more than 40% of healthcare workers with influenza-like illness reported to work, putting patients and co-workers at risk of infection, an officer in the CDC Epidemic Intelligence Service (EIS) recently reported at the annual EIS meeting in Atlanta.

“Our results are consistent with studies that I have read in the literature based on certain occupation groups: physicians and nurse practitioners,” says Sophia K. Chiu, MD, an EIS officer at the CDC.

Healthcare settings, where an estimated 14.6 million influenza cases received medical attention in 2013–14, are known sites for influenza transmission.1 Healthcare workers with influenza-like illness (ILI) who continue working despite CDC’s recommendation not to work until being afebrile for ≥24 hours, contribute to influenza transmission. Of course, not everyone who reports ILI has the actual flu, but the CDC recommendation is that ILI is defined as fever and cough or sore throat. “So the recommendations are not based on whether the person tests positive for influenza,” she says.

Chiu and colleagues used a national internet survey of 1,914 healthcare workers during the 2014–15 influenza season to calculate the frequency of working with self-reported ILI. Of 414 (21.6% overall) healthcare workers reporting ILI during the 2014–15 season, 183 (41.4%) reported working with ILI (median: 3 days). Pharmacists (67.2%) and physicians (63.2%) had the highest frequency of working with ILI. By setting, hospital-based workers had the highest frequency of working with ILI (49.3%). The most common reasons for working while ill included the following

• still being able to perform job duties,

• not feeling bad enough to miss work,

• having a professional obligation to co-workers, and

• difficult to find coverage.

“We think these [reasons] are amenable to education and training of healthcare personnel with the goal of changing social or cultural norms; for example, about how sick one has to be to take sick leave and also reminding HCWs about how and when influenza can be transmitted,” Chiu tells HEH. “Hospitals and other institutions can make arrangements so there is a pool of healthcare personnel that is scheduled to be on standby to fill in for ill colleagues. This can alleviate that feeling of burdening colleagues. There are some systems like this in place for some physicians and nurses, but it could be extended for all personnel.”

Among respondents working in long-term care facilities, the main reason for working ill was more disturbing, as most said they were not able to afford lost pay.

“However, that doesn’t necessarily mean they don’t have paid sick leave,” she says. “It could be they used all of it up. We don’t exactly know what the paid sick leave structure is to all the people that responded to the survey. We didn’t directly ask about that, but it is an incentive to stay home while you’re sick [if you have sick leave]. We asked institutions to consider implementing paid sick leave policies.”


  1. Chiu SK, Black C, Yue X, et al. Health Care Personnel Working While Having Influenza-Like Illness — United States, 2014–15 Influenza Season. Epidemic Intelligence Service Conference. Atlanta: May 2-5 2016.