Overview and Lessons Learned for Increasing Influenza Vaccination Coverage Among Healthcare Workers in the United States

Vaccinating healthcare workers (HCWs) annually against influenza is a key strategy for protecting HCWs, preventing nosocomial outbreaks and mortality (particularly among high-risk patient populations), and reducing work absenteeism during the influenza season (1-4). Vaccinated HCWs have also been shown to be more likely to recommend influenza vaccination to their patients (5-7). US CDC's official position has been recommending annual influenza vaccination to HCWs with direct patient contact since 1984 and for all HCWs since 1993 (8-10). In 2006, the CDC's recommendation for influenza vaccination defined HCW to include physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff not employed by the health-care facility, and persons (e.g., clerical, dietary, housekeeping, maintenance, and volunteers) not directly involved in patient care but potentially exposed to infectious agents (1). Since then, influenza vaccination coverage among HCWs in the United States increased from 10.0% in the 1987-1989 influenza season to 81.1% in the 2018-2019 influenza season, largely as a result of state and local government, professional society, and healthcare institutional policy and programmatic efforts to increase vaccination in this population Although influenza vaccination coverage among HCWs has improved substantially, differing implementation strategies have been needed to increase influenza vaccination in this population. This paper aims to describe the evolution of influenza vaccination policies for HCWs in the United States and to discuss lessons learned for increasing influenza coverage.