While hospital rates remain high, flu immunization rates of healthcare workers overall have leveled off and remain particularly low in long-term care, the CDC reports.1

A CDC internet survey found that during the 2016–17 influenza season, 79% of healthcare workers overall were vaccinated. That is similar to coverage during the 2015–16 season, and the last few seasons before that. Vaccination coverage remained high among hospital workers (92%), and considerably lower among workers in ambulatory care (76%) and long-term care (68%).

“As in previous seasons, coverage was highest among healthcare personnel (HCP) who were required by their employer to be vaccinated (97%) and lowest among HCP working in settings where vaccination was not required, promoted, or offered onsite (46%),” the CDC reported.

The overall trend is a plateau effect, as immunization rates remain stalled at the same level over several seasons.

“While we don’t know for sure why vaccination coverage among healthcare workers has plateaued over the past four influenza seasons, we do know that workplace efforts to promote vaccination — which are associated with [higher] vaccination coverage — have also plateaued,” says Carla Black, MD, lead author of the CDC paper. “By the 2016-17 season, almost all healthcare workers working in hospital settings reported either being required to be vaccinated or being offered flu vaccine at their workplace free of charge. However, healthcare settings other than hospitals have not followed suit in increasing their efforts to promote vaccination in the workplace.”

The CDC’s Healthy People 2020 goal is to achieve 90% flu vaccination coverage among healthcare workers. Specific occupational groups must be targeted if this goal is to be met.

“Fewer than 70% of assistants and aides were vaccinated, while coverage was over 90% for physicians, PAs [physician assistants], nurses, nurse practitioners, and pharmacists,” she says.

When employers held onsite vaccination clinics for more than one day, four out of five healthcare personnel took advantage, even in the absence of a vaccination requirement, she adds. There have been some court decisions favoring workers who took religious exemptions to getting the seasonal flu shot. However, the CDC cites findings in the literature showing that immunizing healthcare workers against flu protects patients.2,3

Given the number of influenza outbreaks in long-term care facilities, it is clear that nonimmunized workers may pose a risk to residents as well.

“We do not have [national] facility-level data on how many long-term facilities mandate vaccination, but we know from our survey that 26.2% of respondents who worked in long-term care reported that their employer required them to be vaccinated,” Black says. “We know that comprehensive work site intervention strategies that include education, promotion, and easy access to vaccination at no cost for multiple days can increase healthcare worker vaccination coverage.”

There also are lingering issues with workers declining flu shots due to myths and misconceptions about vaccine safety.

“Approximately 30% of unvaccinated respondents in this year’s survey reported that fear of side effects or some other safety concern was the main reason that they were not vaccinated,” Black says. “Flu vaccines are among the safest medical products in use. Hundreds of millions of Americans have safely received flu vaccines over the past 50 years, and there has been extensive research supporting the safety of flu vaccines.”

REFERENCES

1. CDC. Black CL, Yue X, Ball SW, et al. Influenza Vaccination Coverage Among Health Care Personnel — United States, 2016–17 Influenza Season. MMWR 2017;66:1009–1015.

2. Ahmed F, Lindley M, Allred N, et al. Effect of Influenza Vaccination of Health Care Personnel on Morbidity and Mortality Among Patients: Systematic Review and Grading of Evidence. Clin Infect Dis 2014;58:(1):50-57.

3. Griffin MR. Influenza Vaccination of Health Care Workers: Making the Grade for Action. Clin Infect Dis 2014;58:(1):58-60.