Influenza Vaccination Coverage Among School Employees: Assessing Knowledge, Attitudes, and Behaviors

Each year in the United States, more than 200,000 people are hospitalized for influenza-related illnesses.1 The Centers for Disease Control and Prevention (CDC) estimates that from 1976 to 2007, influenza-associated deaths ranged from a low of about 3000 to a high of about 49,000 people per year in the United States.2 Influenza has been estimated to cause more than 70 million lost working days and $6.2 billion in lost productivity in the United States every year.3,4 Vaccination is the most effective method to prevent influenza and to prevent serious illness and death from influenza infection.5,6 Since 2010, the Advisory Committee on Immunization Practices (ACIP) has recommended annual influenza vaccination for all persons aged ≥6 months in the United States.7,8 Over 7.3 million people in the United States are employed in and over 62 million students are enrolled in approximately 130,000 public and private schools.9 Schools have the potential to become centers of influenza outbreaks because of their large population, high levels of close social contact, and interaction with the community.10 School settings place teachers, administrators, other school employees, and students at risk for influenza infection and subsequent transmission to others outside the school environment. Vaccinating these groups could help protect one fifth of the country’s population from influenza.11 In January 2013, the National Institute for Occupational Safety and Health (NIOSH) at the CDC received a health hazard evaluation request from a suburban school district in Ohio. The district requested assistance in determining 2012–2013 influenza vaccination coverage among employees in the school district, assessing employees’ knowledge and attitudes toward vaccination, and determining factors associated with acceptance and refusal of the vaccine.