1020
Table 1. Percentage of Healthcare Personnel (HCP) Who Expressed Agreement With the Statement, “Healthcare Workers Should Be Required To Be Vaccinated For Flu” in an Internet Panel Survey Conducted in the United States During the 2016–2017 Influenza Season
Variable Overall
Healthcare settingb Hospital
Ambulatory care Long-term care Other settingc
Occupation Physician
Nurse practitioner/Physician assistant Nurse
Pharmacist Assistant/aide
Other clinical HCPd Nonclinical HCPe
Influenza vaccination receipt Received influenza vaccination
Did not receive influenza vaccination
Workplace vaccination promotion Employer vaccination requirementf Onsite vaccinationg
Other vaccination promotionh
No requirement, onsite vaccination, or promotion
No. Who Expressed Agreement (Weighted %a
1,810 (72.9)
925 (77.2) 718 (70.9) 549 (71.0) 604 (73.4)
251 (85.7) 154 (81.0) 167 (73.7) 307 (80.6) 641 (69.9) 572 (67.4) 315 (75.7)
1,989 (83.5) 449 (33.9)
983 (81.6) 795 (70.1) 206 (78.6) 454 (56.4)
aWeights were calculated based on each occupation type, by age, sex, race/ethnicity,
healthcare setting, and US census region to represent the US HCP population. bRespondents could choose >1 setting. cDentist office or dental clinic, pharmacy, laboratory, public health setting, emergency medical services setting, or other setting where clinical care or related services was pro-
vided to patients. dAllied health professional, technician, or technologist. eAdministrative support staff members or manager and nonclinical support staff members including food service workers, laundry workers, janitors, and members of the house-
keeping and maintenance staff. fIncludes all respondents who indicated that their employer required them to be vaccinated
for influenza. gEmployer made influenza vaccination available on-site for at least 1 day during the influenza season at no cost to employees. Restricted to respondents without an employer
requirement for vaccination. hInfluenza 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, publicizing the number or percentage of employees receiving vaccination, or making vaccination available at special events organized on site. Restricted to respondents without an employer requirement for vaccination or on-site vaccination.
pharmacists, and nurse practitioners/physician assistants had the highest agreement with employer vaccination requirements (all >80%), and other clinical HCP (67.4%) and assistants/aides (69.9%) had the lowest agreement.
)
Marie A. de Perio et al Nearly one-third of HCP not vaccinated agreed with the
employer influenza vaccination requirement statement. Also, 56.4% of HCP work in settings without vaccination requirement, onsite vaccination, or promotion efforts in combination with vaccination requirements. These findings suggest that employer vaccination requirements, particularly in long-term care settings, could increase influenza vaccination coverage. Notably, the survey question lacked details on what “required” vaccination entails. However, vaccine requirement is generally defined as any institutional policy that requires HCP to receive influenza vaccine or decline to receive one, with or without consequences for vaccine refusal.10 Examples of consequences include termination, mask wearing, and restriction from patient care duties. Exploring the consequences was outside the scope of this study. Most HCP from all occupational groups and healthcare
settings agreed with vaccination requirements, including 33.9% of those not vaccinated. Wider adoption of employer vaccina- tion requirements in all healthcare settings has support, can increase HCP influenza vaccination, and may reduce influenza transmission in healthcare settings. Interventions known to improve coverage, such as educating workers and offering vaccine on site, at no cost, and during work hours should be implemented.
Acknowledgments. We acknowledge the staff of Abt Associates for their contributions to data collection. The findings and conclusions in this manu- script are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.
Financial support. No financial support was provided relevant to this article.
Potential conflicts of interest. All authors report no conflicts of interest relevant to this article.
References
1. CDC. Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recom Rep 2011;60(No. RR-07.
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3. Pitts SI, Maruthur NM, Millar KR, Perl TM, Segal J. A systematic review of mandatory influenza vaccination in healthcare personnel. Am J Prev Med 2014;47:330–340.
4. Maurer J, Harris KM, Black CL, Euler GL. Support for seasonal influenza vaccination requirements among US healthcare personnel. Infect Control Hosp Epidemiol 2012;33:213–221.
5. Stewart AM, Caplan A, Cox MA, Chang KHM, Miller JE. Mandatory vaccination of health-care personnel: good policy, law, and outcomes. Jurimetrics 2013;53:341–359.
6. Quan K, Tehrani DM, Dickey L, et al. Voluntary to mandatory: evolution of strategies and attitudes toward influenza vaccination of healthcare personnel. Infect Control Hosp Epidemiol 2012;33:63–70.
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