Influenza vaccine coverage: Health care workers and pregnant women

Immunization Update

Routine influenza vaccination of health care workers (HCWs) and pregnant women is critically important. Among HCWs, annual vaccination can help protect HCWs and their patients from the potentially dire consequences of influenza-related illness. For pregnant women, vaccination means increased protection for both mother and infant.

In the September 27 Morbidity and Mortality Weekly Report, based on the results of Internet panel surveys conducted among HCWs and pregnant women, CDC reported coverage rates and other characteristics of influenza vaccination among the two populations for the 2012–13 flu season.

Health care workers

The Advisory Committee on Immunization Practices (ACIP) recommends yearly vaccination against influenza for all HCWs. Overall for the 2012–13 flu season, 72.0% of HCWs reported getting the influenza vaccine—an increase from 66.9% during the 2011–12 season.

According to occupation type, influenza vaccine coverage was highest among physicians (92.3%), followed by pharmacists (89.1%), nurse practitioners/physician assistants (88.5%), and nurses (84.8%).

By occupational setting, hospital-based HCWs had the highest (83.1%) vaccination coverage, while HCWs working in long-term care facilities (LTCFs) had the lowest. Because influenza vaccine effectiveness generally is lowest in the elderly, CDC noted the importance of improving vaccination rates of HCWs in LTCFs. HCWs in occupational settings offering vaccination onsite at no cost for one (75.7%) or multiple (86.2%) days had higher coverage compared with HCWs in occupational settings not offering onsite vaccination at no cost (55.3%).

CDC expressed a need for implementing widespread, comprehensive strategies to improve access to influenza vaccination services among HCWs. The agency noted three ways in which coverage could be increased: (1) providing HCWs with information on vaccination benefits and risks for themselves and their patients, (2) offering workplace-based vaccinations at convenient times and locations, and (3) providing vaccinations at no cost.

Pregnant women

ACIP and the American College of Obstetricians and Gynecologists recommend vaccination against influenza for all women who are or will be pregnant during the influenza season, regardless of trimester. Pregnant women and infants younger than 6 months are at increased risk for severe influenza-related illness and hospitalization.

Among the 1,702 respondents to the CDC survey (who were pregnant at any time during the 4-month period of October 2012 through January 2013), 50.5% reported receiving influenza vaccination before (14.6%) or during (35.9%; 15.7% first trimester, 10.6% second trimester, 8.1% third trimester, and 1.5% unknown trimester) their pregnancy.

The percent of vaccine coverage was higher among women who reported both a health care provider recommendation and an offer of influenza vaccination (70.5%) than among women who received a recommendation but no offer of vaccination (46.3%) and women who did not receive any recommendation (16.1%).

Women reporting the following characteristics had lower influenza vaccination coverage than other women within each comparison stratum: age 18 to 24 years, non-Hispanic black race/ethnicity, education less than a college degree, not married, reporting no health insurance, not working for wages, living below poverty level, having no high-risk conditions associated with increased complications for influenza, and having fewer than six health care provider visits since July 2012.

Women with a positive attitude toward the efficacy (64.2%) and safety (65.6%) of the flu vaccine had much greater vaccination coverage than those with negative attitude toward the vaccine’s efficacy (9.8%) and safety (13.0%).

Protecting their infant from influenza (33.2%), protecting themselves from influenza (20.0%), and presence of health care provider recommendation (15.7%) were the top three reasons women reported for getting vaccinated. Concerns regarding safety risk to the infant (20.5%), that the vaccination would give pregnant women influenza (13.6%), and that vaccination was not effective in preventing influenza (10.6%) were the top three reasons women reported for not getting vaccinated.

CDC advocated potential ways in which vaccination coverage of pregnant women could be improved: through (1) community-based interventions that include enhanced access to low-cost vaccination services, (2) provider recommendations and offers of influenza vaccination, and (3) education about influenza vaccination safety and efficacy during pregnancy.