Our study documents how occupation, age, and race/ethnicity affect the receipt of influenza vaccination of HCWs. We observed low vaccination rates among HCWs who were younger, black, or had the occupation of health aide. Health aides have a substantial amount of direct contact with patients and yet had the lowest rates of vaccination against influenza, placing them at a potentially high risk of propagating nosocomial influenza.
Although HCWs may have access to health care services through insurance or occupational health programs, younger, poorer, and black HCWs may not exhibit high utilization of preventive health care services such as immunization because of preconceptions about the lack of utility in being immunized, cultural barriers to health care, or competing priorities.16
Our results are consistent with prior studies that have shown low levels of influenza vaccination among blacks16
and disparities in access to care for poor black HCWs.17
Improving access to vaccination by incorporating culturally relevant and appropriately targeted educational interventions, improving outreach efforts, or increasing availability of preventive services may help to reduce this disparity.
There are potential limitations to this study. First, the receipt of influenza vaccination was determined by survey and is therefore subject to recall bias. Second, the NHIS categories of health-diagnosing and health-assessing occupations were not exclusively physicians or registered nurses, respectively. The Bureau of Labor and Statistics, which constructs the Standard Occupational Classifications, also conducts biennial employment occupation projections using a taxonomy that is consistent with the Standard Occupational and Industry Codes. In 1998, physicians were approximately 65% of the health-diagnosing professions and registered nurses were approximately 73% of the health-assessing and treatment professions category (T. Cosca, personal communication, January 3, 2005).18
Small differences among occupational categories such as dentists and physicians, nurses, or other health care providers may be obscured because of the broad occupational categories. However, if we assumed that only physicians and nurses were vaccinated within their respective occupational categories, at most 71% of physicians and 51% of nurses would have been vaccinated, rates that fall far short of optimal coverage. Finally, although the sample was restricted, with the exception of administrators, to workers likely to have direct patient contact, physicians, nurses, or other health care providers who do not have direct patient contact could have been included within the sample.
Low vaccination rates may occur either because HCWs do not believe in influenza vaccination efficacy, believe that their own immune system is sufficient, or are concerned about side effects such as Guillain–Barre and injection site pain.19
Misconceptions about influenza vaccinations have been correlated with HCW refusal of vaccinations in single institution studies.19
Information and policy regarding the benefits of influenza vaccination, including reduction of nosocomial infection, hospitalizations, and employee absenteeism, must be presented in a manner that is credible.
Active campaigns at the local level using occupational health programs or a vaccination team to provide education, distribute reminder notices, and schedule vaccination times could help increase vaccination rates.13, 20
Further work is needed to identify the best strategies for improving vaccination rates among all HCWs, but especially those who are young or black or work as health aides.
The overall influenza vaccination rate of HCWs in the U.S. is low, particularly among workers who are under 50, black, or health aides. Overcoming barriers to vaccination and improving targeted outreach to subgroups of HCWs, who have direct patient care and low vaccination rates, could reduce the high mortality rates because of influenza.