infection control and hospital epidemiology october 2014, vol. 35, no. 10 concise communication Parental Perceptions about Required Influenza Immunization of Pediatric Healthcare Personnel W. Matthew Linam, MD, MS; 1,2 Craig H. Gilliam, BSMT, CIC; 2 Michele Honeycutt, RN, BSN, CIC; 2 Christy Wisdom, RN, BSN, CIC; 2 Christopher J. Swearingen, PhD; 3 Jose ´ R. Romero, MD 1 Annual influenza vaccination is recommended for all healthcare per- sonnel (HCP). During 2010–2011, a cross-sectional design was used to survey 372 parents of hospitalized children regarding their influ- enza vaccination perceptions. Independent of their feelings regarding vaccine safety and efficacy, 76% of parents felt that annual influenza vaccination should be required for HCP. Infect Control Hosp Epidemiol 2014;35(10):1301-1303 Influenza transmission between healthcare personnel (HCP) and patients is well documented. 1 Influenza vaccination is the most effective way to prevent influenza infection in healthcare settings. The Advisory Committee on Immunization Practices (ACIP) recommends that all HCP receive influenza vacci- nation annually. 1 Despite this recommendation, annual HCP vaccination rates before 2008 were below 45%. 1,2 Strategies to improve HCP vaccination rates have included educational campaigns, increasing vaccine availability, prioritizing influ- enza vaccination within organizations, and use of mandatory declination forms. 2 As a result, vaccination coverage of HCP has gradually increased to 72% during 2012–2013. 3 To consistently reach high rates of HCP influenza vacci- nation, many hospitals now require annual influenza vacci- nation of their staff. Hospitals implementing mandatory HCP vaccination have achieved over 95% vaccination coverage, 3,4 whereas hospitals that have not implemented such policies have achieved only 78% coverage. 3 At Arkansas Children’s Hospital (ACH), HCP influenza vaccination coverage between 2007 and 2010 ranged from 65% to 85%. In 2011, ACH proposed an annual HCP influ- enza vaccination requirement. There are no data regarding parental perception concerning the importance of HCP in- fluenza vaccination or whether parental perceptions regarding the safety and efficacy of influenza vaccines influence their perception about HCP vaccination. This study investigates parent perceptions regarding the importance, safety, and ef- ficacy of influenza vaccination as they relate to the need for annual HCP influenza vaccination. methods This institutional review board–approved study was per- formed at ACH, a 370-bed freestanding children’s hospital. A cross-sectional survey of parents and guardians of children hospitalized at ACH was performed over three 4-week periods from Fall 2010 through Summer 2011. An internally devel- oped 16-question, self-administered paper questionnaire as- sessed the perceived importance of influenza vaccination for parents, children, and HCP; the perceived safety and efficacy of influenza vaccines (defined as yes, no, or unsure); and parent demographic information. Additional data collected included study population disposition and patient demo- graphic data and clinical features. Surveys were administered during business hours each weekday during the following 3 time periods: Fall 2010 (be- fore the influenza season), Winter 2011 (during the influenza season), and Summer 2011 (after the influenza season). Each weekday morning, all new inpatients from the preceding 24 hours (or the preceding 72 hours on Mondays) were iden- tified from the admissions database. If the patient had been discharged from the hospital, no attempts were made to con- tact them. Survey administrators made reasonable attempts to enroll 1 parent or guardian for each patient in the 24 hours after admission. Parents and guardians between 18 and 65 years of age were included. If the patient was critically ill and enrollment seemed inappropriate, the survey administrator could exclude the parent or guardian from the study. If a parent or guardian was unavailable, no attempts to contact a parent or guardian were made on subsequent days of hospitalization. Demographic and survey responses were summarized by study time period; categorical data were summarized by fre- quency and percentage, whereas continuous data were sum- marized as median and range (minimum and maximum). Similarity between the cohort’s demographic and admittance data and the hospital data for the same time period was estimated using equivalence tests that assumed a 20% mar- gin. 5 Differences between time periods were investigated using x 2 test (Fisher exact test if assumptions failed) for categorical data and Kruskal Wallis test for continuous and ordinal data. Firth-conditional as well as logistic regression models esti- mated any association between outcomes (HCP vaccination importance and requirement) and parent perception of vac- cine importance for themselves or their children (“yes” vs “no” and “unsure” responses) while adjusting for vaccine safety, vaccine efficacy, insurance status, race, intensive care unit (ICU) admission, and parent’s education level. results A total of 372 parents were enrolled and completed ques- tionnaires (Fall 2010: 132; Winter 2011: 125; Summer 2011: 115). This represented 11% of all admitted patients during the study time periods. Of the parents and guardians not enrolled, 50.5% were not approached, 14% had been dis-