BETHESDA, MD 15 January 2010—Forty-nine percent of health care workers reported being vaccinated against seasonal influenza by mid-November, and 12% more planned to be vaccinated, according to a survey conducted by the nonprofit RAND Corporation.
Those figures, if comparable to national surveillance data, are an improvement over federal estimates that approximately 40% of U.S. health care workers typically receive an influenza vaccination each year. The RAND data also suggest that the country may meet its Healthy People 2010 goal of achieving a 60% influenza vaccination rate among health care workers.
"It appears that health care workers responded very early and enthusiastically when seasonal influenza vaccine became available, more so than in previous years," said William Schaffner, chair of the Department of Preventive Medicine at the Vanderbilt University School of Medicine and president-elect of the National Foundation for Infectious Diseases (NFID).
"I am optimistic that this bodes well for the next influenza season. I hope we can build on this going forward," Schaffner said.
He said initial data from his university hospital suggest that it will attain a health care worker vaccination rate of about 65%, a figure he called "substantially higher" than in years past.
"While we would be pleased with that, we`re certainly not ecstatic," Schaffner said. "Ecstatic would be 93%, because we really think that this is a professional and ethical obligation of every health care worker to be vaccinated annually against influenza so we can protect our patients."
The Centers for Disease Control and Prevention (CDC) has recommended for nearly three decades that all health care workers without a contraindication for influenza vaccine receive it each flu season.
Influenza season in the United States begins in October, during the 40th week of the year, and continues through the 20th week of the following year, in May. With the emergence last spring of the 2009 H1N1 virus, Schaffner said, "the news has been nothing but influenza for almost a straight year."
Schaffner said public awareness of influenza-related news, along with educational campaigns that have long encouraged health care workers to get vaccinated, likely contributed to the apparent increase in the vaccination rate.
It is unknown whether the unvaccinated health care workers and others who still intend to get immunized against influenza this season will actually do so. CDC officials say that most of the trivalent vaccine doses produced for this season have already been distributed and administered.
In all, 38% of the RAND study participants said they want to get vaccinated but have not been able to locate a dose of influenza vaccine.
The RAND study was funded by a contract with GlaxoSmithKline and involved 7222 adults, including 1889 self-identified health care workers. Study participants received "small financial incentives or free Internet access," according to the survey report.
The unvaccinated. NFID and other private and public entities have attempted to dispel myths about influenza vaccination. These include the belief that healthy people are not at risk for influenza, that the vaccine does not prevent flu, and that the vaccine can cause influenza.
"It is remarkable...how tenacious some of these myths are, particularly the one that you can get flu from the flu vaccine," Schaffner said.
In general, according to NFID, health care workers often give similar reasons as other populations for declining influenza vaccination.
The RAND survey found that all target groups, including health care workers, shared the same top three reasons for not getting vaccinated: a belief that they personally do not need influenza vaccination; a general lack of faith in influenza vaccines; and a fear that the vaccine will cause illness or other adverse events.
In all, 60% of the survey participants cited one or more of those reasons for not getting vaccinated.
New pressures. The Joint Commission in 2007 began requiring accredited hospitals to offer influenza vaccine to staff and licensed independent practitioners.
Joint Commission Resources, a not-for-profit affiliate of the Joint Commission, launched the Flu Vaccination Challenge during the summer of 2008, asking participating hospitals to achieve a 43% or greater influenza vaccination rate among staff for the 2008–09 influenza season.
According to Joint Commission Resources, more than 1700 hospitals accepted the challenge and 94% met or exceeded the target vaccination rate. On average, the vaccination rate among participants was 63%.
Participants for this season`s challenge were asked to reach a target rate of 65, 75, or 90% by March 2010. A spokeswoman for Joint Commission Resources said in late December that vaccination was still ongoing in hospitals and the results from the challenge will not be available until after the data are analyzed this spring.
The H1N1 effect. Federal recommendations about who should be vaccinated against seasonal influenza have remained consistent since the start of the season. But the monovalent influenza H1N1 vaccine has been targeted toward different priority groups. Demand for the H1N1 vaccine greatly exceeded its supply this past fall, prompting some health officials to reserve the vaccine for those at greatest risk of complications from H1N1 infection.
Schaffner said infectious disease experts have debated whether the mixed messages on when to get the vaccines and their unpredictable availability will affect future vaccination rates.
"That`s a matter of discussion constantly at the CDC`s Advisory Committee on Immunization Practices," he said. "None of us are really sure whether the short-term messages [about] what to do this year influence long-term behavior. We`re reasonably sure, just on the basis of anecdotes, that it has some long-term impact."
He said groups that were told to stand aside to allow others to get vaccinated may carry that behavior to the next flu season.
"The answer to all of this, of course, is to have an abundant supply of influenza vaccine available everywhere early. Then we wouldn`t have to ever prioritize," Schaffner said.
