Infection Control & Hospital Epidemiology

Original Articles

Voluntary to Mandatory: Evolution of Strategies and Attitudes toward Influenza Vaccination of Healthcare Personnel

Kathleen Quana1, David M. Tehrania2, Linda Dickeya1, Eugene Spiritusa3, Denise Hizona3, Kristie Hecka3, Pamela Samuelsona3, Elliott Kornhausera3, Raja Zeitanya3, Susan Manciaa3, Lauri Thruppa1, Susan M. Tisoa3 and Susan S. Huanga1a2 c1

a1 Department of Epidemiology and Infection Prevention, University of California Irvine Medical Center, Orange, California

a2 Division of Infectious Disease and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California

a3 University of California, Irvine Health, Irvine, California


Background. Assessing the relative success of serial strategies for increasing healthcare personnel (HCP) influenza vaccination rates is important to guide hospital policies to increase vaccine uptake.

Objective. To evaluate serial campaigns that include a mandatory HCP vaccination policy and to describe HCP attitudes toward vaccination and reasons for declination.

Design. Retrospective cohort study.

Methods. We assessed the impact of serial vaccination campaigns on the proportions of HCP who received influenza vaccination during die 2006–2011 influenza seasons. In addition, declination data over these 5 seasons and a 2007 survey of HCP attitudes toward vaccination were collected.

Results. HCP influenza vaccination rates increased from 44.0% (2,863 of 6,510 HCP) to 62.9% (4,037 of 6,414 HCP) after institution of mobile carts, mandatory declination, and peer-to-peer vaccination efforts. Despite maximal attempts to improve accessibility and convenience, 27.2% (66 of 243) of die surveyed HCP were unwilling to wait more than 10 minutes for a free influenza vaccination, and 23.3% (55 of 236) would be indifferent if they were unable to be vaccinated. In this context, institution of a mandatory vaccination campaign requiring unvaccinated HCP to mask during the influenza season increased rates of compliance to over 90% and markedly reduced the proportion of HCP who declined vaccination as a result of preference.

Conclusions. A mandatory influenza vaccination program for HCP was essential to achieving high vaccination rates, despite years of intensive vaccination campaigns focused on increasing accessibility and convenience. Mandatory vaccination policies appear to successfully capture a large portion of HCP who are not opposed to receipt of die vaccine but who have not made vaccination a priority.

Infect Control Hosp Epidemiol 2012;33(1):63-70

(Received July 12 2011)

(Accepted August 31 2011)


c1 University of California Irvine School of Medicine, Division of Infectious Diseases and Health Policy Research Institute, 101 The City Drive, City Tower, Suite 400, ZC 4081, Orange, CA 92868 (