Infection Control & Hospital Epidemiology
Agreement with employer influenza vaccination requirements among US healthcare personnel during the 2016–2017 season
Marie A. de Perio MD1, Xin Yue MPS, MS2, A. Scott Laney MPH, PhD3, Stacie M. Greby DVM, MPH4 and
Carla L. Black PhD4 1Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, 2Leidos, Inc, Reston, Virginia, 3Respiratory Health Division, National Institute of Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia and 4Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
To the Editor—Annual vaccination of healthcare personnel (HCP) is a high priority for reducing influenza-associated morbidity in healthcare settings.1 Although the percentage of HCP nationwide who reported receiving influenza vaccination was 78.6% in the 2016– 2017 season, coverage remains incomplete, placing HCP and patients at risk of influenza.1,2 Employer influenza vaccination requirements are associated with higher coverage rates, and though controversial, mandatory influenza vaccination is supported by multiple healthcare professional societies.3,4 We explored agreement with employer influenza vaccination requirements among HCP nationwide.
Methods
We used data from the opt-in Internet panel survey of HCP for the 2016–2017 influenza season conducted from March 28 to April 19, 2017. Similar surveys have been conducted using 2 national opt-in Internet sources since the 2010–2011 influenza season to provide estimates of influenza vaccination coverage among HCP.2 In addition to questions about influenza vaccination coverage, occupation type, and healthcare setting, the survey included the statement, “Healthcare workers should be required to be vacci- nated for flu.” Respondents were asked to rate their agreement with the statement using a 4-point scale. Responses of strongly agree and agree were combined and categorized as expressed agreement. Responses of strongly disagree and disagree were combined and categorized as expressed disagreement. We weighted responses to the US HCP population by age, sex, race/ethnicity, work setting, and census region based on Bureau of Labor Statistics and US Census Bureau data. We calculated the number and weighted percentage of HCP who expressed agree- ment or disagreement with the vaccination requirement state- ment by occupation type, healthcare setting, vaccination status, and employer promotion efforts. Additional statistical analyses were not performed because this survey included an opt-in sample and a nonrandom sample.
Results
Overall, 72.9% of 2,438 respondents expressed agreement with the vaccination requirement statement. In total, 78.6% of respondents
Author for correspondence: Marie A. de Perio, MD, National Institute for Occu-
pational Safety and Health, Centers for Disease Control and Prevention, 1090 Tusculum Ave, R-9, Cincinnati, OH 45226. E-mail:
mdeperio@cdc.gov
Cite this article: de Perio MA, et al. (2018). Agreement With Employer Influenza
Vaccination Requirements Among US Healthcare Personnel During the 2016–2017 Season. Infection Control & Hospital Epidemiology 2018, 39, 1019–1020. doi: 10.1017/ ice.2018.111
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
reported receiving an influenza vaccination during the 2016–2017 season, and 42.3% of respondents reported working in a setting with employer influenza vaccination requirements.2 Table 1 shows the weighted percentage of respondents who expressed agreement with the statement by occupation type, healthcare setting, vaccination status, and employer promotion efforts. By healthcare setting, the weighted percentage of respondents who expressed agreement ranged from 70.9% (ambulatory care settings) to 77.2% (hospitals). By occupation, the weighted per- centage of respondents who expressed agreement ranged from 67.4% (other clinical HCP) to 85.7% (physicians). By influenza vaccination status, the weighted percentage of
respondents who expressed agreement with the vaccination requirement statement was 83.5% for those who received the vac- cine and 33.9% for those who did not. Of those who agreed with the vaccination requirement statement yet did not receive it, the most common reasons given for not getting it were “I haven’t gotten around to it (18.0%),”“Ijust don’t want the vaccine (15.7%),” and “My employer didn’t require me to have a vaccination (14.1%).” By workplace vaccination promotion, the weighted percentage of respondents who expressed agreement ranged from 56.4% for those with no employer requirement, onsite vaccination, or promotion to 81.6% for those with an employer vaccination requirement.
Discussion
Mandatory influenza vaccination is increasingly common in healthcare settings, and multiple states have established influenza vaccination requirements for hospital HCP.5 However, concerns have been raised related to the variable effectiveness of the vaccine and the ethical and legal impact of these policies.5,6 The duty of a HCP to protect the health of individual patients and the public competes with their right to personal autonomy. Mandates also invoke legal issues, including the applicability of state and federal constitutional laws and statutes.5,7 Nevertheless, in our study, most HCP (72.9%) from all occupa-
tional groups and healthcare settings agreed with employer vaccina- tion requirements. These findings suggest an increase when compared with a 2010 online research panel of HCP nationwide, showing that 57.4% of HCP agreed with influenza vaccination requirements.4 Implementation of employer vaccination requirements is becoming more common (11.1% of respondents in 2010 compared with 42.3% in our study).4 This finding is similar to those of other nationally representative samples among hospitals (43%–44%).8,9 In our study, employees in hospitals, ambulatory care, and
long-term care settings had similar agreement with employer vaccination requirements (70.9%–77.2%). However, physicians,
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