Flu Vaccination Rates Among Eligible Health Care Workers Drop 26%

Posted on February 23, 2023

All health care categories saw declines steady since 2019-2020 season, but ambulatory surgery centers had highest rate during 2021-2022

PORTLAND, Ore.—The influenza vaccination rate among Oregon health care workers dropped 26% between the 2019-2020 and 2021-2022 influenza seasons, new data show, worrying state officials trying to prevent the virus’s spread to people most at risk of severe illness and death.

Following a steady increase in flu vaccinations among health care workers at all health care facility types between the 2016-2017 and 2019-2020 flu seasons – when rates rose 9%, from 78% to 85% of eligible workers — the rate fell to just 63% during the 2021-2022 season, according to the Healthcare-Associated Infections (HAI) Program’s Healthcare Worker Influenza Vaccination data dashboard. That’s well below the Healthy People 2020 goal of 90% health care worker flu vaccination rate.

“People receiving care in hospitals and other medical settings are at high risk of infection and severe outcomes – including death – from the flu,” said Rebecca Pierce, Ph.D., manager of the HAI Program at the Oregon Health Authority’s (OHA) Public Health Division. “That’s why it’s very important that health care workers are vaccinated against the virus. When they are, they are helping protect themselves and their vulnerable patients.”

Pierce said one reason for the low flu vaccination levels among health workers is that “people have been knee-deep in COVID-19.”

“They were coming off very quiet flu activity during the pandemic, so motivation to get vaccinated may have waned as they were prioritizing getting their COVID-19 shots,” she explained. “What we are doing now is reminding these workers – particularly as we are seeing a late-season increase in influenza B activity – is that it’s still not too late to get your flu shot.”

Dialysis facility workers in Oregon once had the highest flu vaccination rates among health facility types – during the 2018-2019 season, they exceeded the 2020 Healthy People goal with a 91% vaccination rate. That rate has since dropped to 27%, a 70% drop, the most dramatic decline among all health facility types.

The least dramatic decline occurred among employees at ambulatory surgery centers. During both the 2018-2019 and 2019-2020 flu seasons, their vaccination rates were 81%, then dropped to 75% — a 7.4% decline – by the 2021-2022 season.

Other big declines in flu vaccination rates have been seen among health care workers of hospitals (88% in 2019-2020 to 66% in 2021-2022, a 25% drop); inpatient psychiatric facilities (80% in 2019-2020 to 46% in 2021-2022, down 43%); and nursing facilities (67% in 2019-2020 and 2020-2021 to 51% in 2021-2022, an almost 24% decrease).

The plummeting flu vaccination rates among health care workers is partially driven by an increase in the rate of workers who declined the flu shot or whose vaccination status is unknown. The rate of those declining the shot rose from 8% in the 2019-2020 season to 11% during 2021-2022, a 37.5% increase, while unknown vaccination rates were 8% in the 2019-2020 season and rose to 26% for the 2021-2022 season, an 18% increase.

“We know, in particular, that the high unknown vaccination rate contributes to lower vaccination rates seen in dialysis facilities,” Pierce said. “It is likely that pandemic response activities challenged the ability to track flu vaccination uptake. Now that flu is back to pre-pandemic levels of circulation, it is so important that facilities track vaccination status of health care personnel as it’s the first step to improving vaccine uptake.”

In addition to providing flu vaccination rates for health care workers by health facility type, the dashboard provides rates by county, worker classification and facility name.

The U.S. Department of Health and Human Services developed the Healthy People program with 10-year objectives for improving the health of all Americans. Healthy People 2030 does not include a goal focused on increasing flu vaccinations among health care workers as Healthy People 2020 did, so Oregon is continuing to use the Healthy People 2020 health worker vaccination goal as a way to direct public health action and show where additional support and education is needed.

To achieve 90% vaccination coverage, there are important steps health care facilities can take. Among public health recommendations are encouraging health care workers, including those not employed by the facility—such as contractors and volunteers—to get vaccinated at the beginning of every influenza season. Facilities can also host promotional activities, such as holding mass vaccination fairs, providing vaccines at no cost to employees, starting incentive programs, and documenting all employees’ vaccination status and requiring a declination form for staff members who forgo vaccination.

OHA has developed a toolkit for health care employers and workers – particularly those at long-term care facilities – to help them improve employee flu vaccinations rates at their facilities to protect patients, themselves and their families.

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