Internet panel surveys monitor association of influenza vaccination mandate and occupation type among health care personnel, United States, 2011-12 influenza season

Background: Despite long-standing recommendations for annual influenza vaccination of health care personnel (HCP), coverage remains below 65%. To monitor annual influenza vaccination during the influenza season (September–April), CDC uses rapid web surveys of vaccination among a national sample of HCP. We conducted surveys in November 2011 and again in April 2012 among HCP recruited from two large internet panels. Purpose: We measured the impact of requirements (a policy requiring influenza vaccination, with consequences for noncompliance, and exemptions only if medically contraindicated or for reasons of religious doctrine) on influenza vaccination coverage among HCP employed in hospitals, long-term and residential care facilities, and outpatient/ambulatory care settings in six occupational categories: physicians/dentist, nurse practitioner/physician assistants(NP/PA); nurses; allied health professionals; technicians; and administrative/non-clinical support staff. Methods: We recruited health care professionals and technical professionals from an internet portal and clinical content provider with >2.5 million U.S. members (Medscape). We recruited clinical and nonclinical support personnel from a general population panel that includes >1 million U.S. households (Survey Spot). Participants were recruited by email invitation, pop-up ads, and a panel survey requirements page. We used occupational data from the Bureau of Labor Statistics for the control population for post-stratification weights. All analyses utilized weighted data. We examined relationships between vaccination coverage and vaccination requirements using logistic regression. Results: Of 2,528 HCP completing the survey screening questions, 2,449 (96.9%) completed the questionnaire. Vaccination status was reported by 2,442 (99.7%). Of these, 68.5% reported influenza vaccination since July 2011. An additional 7.3% reported “definite” intent to be vaccinated before March 2012. Weighted coverage estimates by occupation type were 77.6% (95%CI: 73.7-81.5)-- physician/dentist,76.8% (95%CI: 69.5-84.1) -- NP/PA, 75.7% (95%CI: 71.1-80.4)—nurse, 82.5% (95%CI: 77.6-87.3) -- allied health professional, 56.9% (95%CI: 52.4-61.5)- technician/assistant, and 56.1% (95%CI: 50.4-61.7)-- administrative/non-clinical support staff. Among 2,433 HCP reporting requirement status, coverage was 89.0% among those with requirements compared with 50.0% for those without. Coverage varied by occupation type with a range of 81.4% (technician/assistant/aide) to 97.9% (administrative/non-clinical support staff) among those with, compared with 51.3% (administrative/non-clinical support) to 80.8% (allied health professionals) among those without, an administrative requirement. Coverage differences between those with requirements and those without were greatest for administrative/non-clinical support staff (46.6%) and technician/assistant/aides (28.3%). Conclusions: Employer requirements are associated with increased annual influenza vaccination among all HCP occupation types with the greatest impact seen among administrative/non-clinical support and technician/assistant/aide occupational categories.