Major article Influenza vaccination rates and beliefs about vaccination among nursing home employees Jill D. Daugherty MPH, PhD a, *, Sarah C. Blake MA, PhD a , Jessica M. Grosholz MA, PhD a , Saad B. Omer MBBS, MPH, PhD b , LuMarie Polivka-West MS c , David H. Howard PhD a a Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA b Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA c Florida Health Care Association, Tallahassee, FL Key Words: Influenza Vaccination Long-term care facilities Background: Recent studies have suggested that vaccination of nursing home staff members may reduce the incidence of influenza among nursing home residents. Current national estimates of employee vaccination rates (around 50%) indicate that residents may be at an unnecessarily high risk of contracting influenza. This article reports on the influenza vaccination rates and attitudes toward the vaccine among employees in 37 nursing homes in 3 states. Methods: Nursing home employees were surveyed at nursing homes in Florida, Georgia, and Wisconsin in 2011-2012. Completed surveys were received from a total of 1,965 employees. Results: Approximately 54% of the employees surveyed received the vaccination during the 2010-2011 and 2011-2012 influenza seasons. Nursing homeelevel staff vaccination rates varied widely, from 15%-97%. Black and younger employees were less likely to receive the vaccine. Employee vaccination rates in nursing homes that used incentives were 12 percentage points higher than those that did not use incentives (P ¼ .08). Conclusion: Low vaccination rates among nursing home workers may put residents at increased risk for influenza-related morbidity and mortality. The Centers for Medicare and Medicaid Services may consider employee vaccination rates as a quality indicator in addition to resident vaccination rates. Our findings support the use of a trial to test the use of incentives to increase employee vaccination rates. Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. Influenza in nursing home residents is responsible for 7,300 deaths annually and over $173 million in inpatient Medicare spending. 1 Although approximately three-quarters (72%) of nursing home resi- dents receive the seasonal influenza vaccine annually, 2 the vaccine offers limited protection in older and immunocompromised pa- tients. 3,4 Case reports of outbreaks of influenza-like illnesses in health care facilities suggest that workers transmit the virus to patients. 5,6 Observational studies also support the theory that vaccinating workers can reduce the transmission of influenza to nursing home residents. A survey of New Mexico nursing homes found that the likelihood of an influenza outbreak was inversely related to the staff vaccination rate but unrelated to resident vaccination rates. 7 Shu- garman et al 8 assessed the impact of staff and resident vaccination rates, as reported by facility administrators, on influenza-like illness outbreaks at 301 nursing homes in a for-profit chain. They found that staff and resident vaccination rates did not independently predicted the occurrence of outbreaks, but nursing homes with higher com- bined staff and resident vaccination rates had lower rates of out- breaks. Studies of facilities that have experienced a serious influenza-like outbreak note that staff vaccination should be a tar- geted area for intervention. 4 For this reason, the Advisory Commit- tee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services state that “vaccination of all health care personnel who have no contraindications is recommended.” 9,10 Newly released recommendations from the National Vaccine Advisory Committee suggest that facilities integrate influenza vaccination programs into their existing infection prevention programs or occupational health programs. It is also recommended that the facilities that continue to struggle to meet vaccination goals should implement a vaccination requirement for employees. 9 * Address correspondence to Jill D. Daugherty, MPH, PhD, Emory University Rollins School of Public Health,1518 Clifton Road NE, Atlanta, GA 30322. E-mail address: Jill.d.daugherty@gmail.com (J.D. Daugherty). Funding/support: The study was supported by the Centers for Disease Control and Prevention cooperative agreement 1U01IP000411-01. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Conflicts of interest: None to report. Contents lists available at ScienceDirect American Journal of Infection Control journal homepage: www.ajicjournal.org American Journal of Infection Control 0196-6553/$36.00 - Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2014.08.021 American Journal of Infection Control 43 (2015) 100-6