Original Article Influenza Vaccination Acceptance and Refusal Rates Among Health Care Personnel Vaughn S. Millner, PhD, Bernard H. Eichold, II, MD, Ronald D. Franks, MD, and G. David Johnson, PhD Objectives: The primary aim of this study was to determine reasons why health care personnel (HCP) in a public health department chose or refused free influenza vaccinations offered at the worksite. Methods: In an internal review board-approved study, we offered, through a health nurse at the site, self-administered surveys designed to evaluate HCPs’ reasons for choosing or refusing influenza vac- cination, HCP knowledge of vaccination recommendations, and other items such as demographic information. We tested for differ- ences between the vaccinated and non-vaccinated cohorts, and con- ducted multiple logistic regression analysis to identify likely predic- tors of future vaccine acceptance. Results: Predictors of vaccine noncompliance were fear of needles (P  0.042), fear of getting sick from the vaccine (P  0.000), disbelief that the vaccine is effective (P  0.000), ignoring vaccination as a healthy behavior (P  0.000), and younger age (P  0.026). Nonva- ccinated HCP were less likely than vaccinated HCP to report. Vaccines are encouraged because of (a) minimizing sick days and loss of pro- ductivity (P  0.000); (b) sick patients are exposed to influenza by HCP (P  0.000); or (c) note any reason (P  0.006). Conclusion: The non-vaccinated group refused the vaccine primar- ily for reasons related to misconceptions regarding the effectiveness and health risks of the vaccine, as well as a belief that the vaccine is unnecessary. Conversely, the vaccinated cohort chose the vaccine for the primary reasons that the vaccine is effective, a vaccine is demonstrative of healthy behavior choices, and influenza is trans- mitted both to and from sick patients. Key Words: healthcare workers, vaccination, influenza vaccination, H1N1 A global pandemic, the first of the 21st century, was an- nounced by the World Health Organization on June 11, 2009 as a result of the spread of oseltamivir-resistant influ- enza A (H1N1) viruses. 1 The H1N1 pandemic spread to more than 213 countries worldwide, and 49 of the 50 United States throughout the summer and fall 0f 2009. 2,3 Health care personnel (HCP) were among the five targeted groups recommended for vaccine use against H1N1 by the Cen- ters for Disease Control and Prevention’s (CDC) Advisory Com- mittee on Immunization Practices (ACIP). 4 The other four groups included pregnant women, persons who are in contact with chil- dren younger than 6 months of age, those between the ages of 6 months through 24 years of age, and those from ages 25 through 64 years with chronic health conditions or compromised im- mune systems. Influenza vaccination recommendations for HCP also came from the World Health Organization and the National Foundation for Infectious Diseases. 5–7 The recommendations recognize the importance of vac- cinations as the most effective means of preventing influenza and the serious illnesses and death associated with it. 5,8 –10 Annual seasonal influenza vaccination is recommended for 90% of institutionalized adults and adults aged 65 years, and also recommended for 60% of institutionalized, high-risk people aged 18 – 64. 11 However, data derived from the Be- havioral Risk Factor Surveillance System revealed United States influenza vaccination coverage is much lower than the recommended levels, with 35.1% among those aged 18 – 49 From the School of Continuing Education and Special Programs, University of South Alabama; and Mobile County Health Department and Health Sciences, Academic Affairs, University of South Alabama, Mobile, AL. Reprint requests to Vaughn S. Millner, PhD, School of Continuing Education and Special Programs, University of South Alabama, AHE 101, Mobile, AL 36688-0002. Email: vmillner@usouthal.edu The authors have no financial disclosures to declare and no conflicts of interest to report. Accepted March 10, 2010. Copyright © 2010 by The Southern Medical Association 0038-4348/0-2000/10300-0993 Key Points • The majority of United States health care personnel (HCP) refuse influenza vaccination. • Vaccination of HCP is the primary prevention method for nosocomial infections and prevention of deaths from influenza. • The influenza A (H1N1) pandemic places immuniza- tion from vaccination as a key public health issue. • There are a variety of reasons why HCP in a public health department refuse and choose vaccination, which can be addressed in educational interventions. Southern Medical Journal • Volume 103, Number 10, October 2010 993