Characteristics of Health Care Workers That Decline Influenza Vaccination for Varying Reasons

Abstract

Background. Annual vaccination of healthcare workers (HCW) is an important means to reduce transmission of influenza in the healthcare setting. Institutions have taken a variety of approaches to promoting uptake of the annual influenza vaccine by employees. At our institution, leadership required annual influenza vaccination starting in 2010, but exemptions due to medical indications or religious/personal beliefs were permitted. With a long-term goal of increasing vaccination compliance, we have characterized those who were exempted from vaccination since 2010. Methods. 20,861 employee records at a single institution from January 1, 2010 to January 1, 2017 were retrospectively reviewed for vaccination, employment and demographic information. During this period, declination of influenza vaccination was permitted for the following reasons: allergy to a component of the vaccine, Guillain-Barre syndrome following prior vaccination, another medical condition supported by a physician note, or self-declared religious/personal beliefs. Flip-flopping was defined as a pattern of declination consisting of at least 2 changes in reasons given for declination (minimum of 3 declinations) including at least one religious/personal belief exemption. Inclusion criteria therefore included only employees with durations of employment of at least 3 years to allow for identification of the exemption pattern. Results. Over the review period, 1,020 (4.9 %) of employees declined influenza vaccination. Of these, 556 (54.5%) reported the same reason for declination each time or had a maximum of 1 change, but 464 (45.5%) met our criteria for varying declination characterized as flip-flopping. Within the flip-flopping group, 73.8% were female, 60.8% were in positions involving direct patient contact, mean age at initial exemption was 43.1 years old, and mean duration of employment was 6.2 years. Conclusion. We have identified and characterized HCW that exhibit varying reasons for influenza vaccine exemption despite a pro-vaccination campaign by institutional leadership. The findings of this study will help to direct vaccination-related quality improvement efforts.