Flu and COVID-19 Vaccination Among Health Care Workers, 2022–23

Summary

Vaccinating health care personnel (HCP) protects them — they face high exposure to influenza and SARS-CoV-2 at work — and their patients, since vaccinated staff are less likely to pass infections on. The Advisory Committee on Immunization Practices recommends an annual flu vaccine for HCP and that everyone 6 months and older stay up to date on COVID-19 vaccination. The Centers for Medicare & Medicaid Services (CMS) requires hospitals and nursing homes to report staff vaccination to CDC's National Healthcare Safety Network (NHSN).

Coverage in the 2022–23 flu season (October 1, 2022–March 31, 2023):

"Up to date" meant a bivalent mRNA dose, or finishing a primary series within the previous 2 months.

Coverage by state: influenza (top) and up-to-date COVID-19 (bottom), in nursing homes (left) and acute care hospitals (right). CDC.

The details

Influenza — hospitals

• Lowest among nonemployee licensed practitioners (67.2%); higher among employees (83.1%) and students and volunteers (85.2%).
• Highest in the Midwest (84.7%), lowest in the Pacific region (74.4%).

Influenza — nursing homes

• Lowest among employees (46.1%); higher among licensed practitioners (55.3%) and students and volunteers (57.7%).
• Highest in the Pacific region (61.1%), lowest in the South (39.7%).
• Nursing homes in only 6 states reached 75% coverage, versus hospitals in 40 states.

Flu coverage was similar across facility size, urban or rural location and social vulnerability.

COVID-19 — hospitals: highest in the Pacific (28.9%), lowest in the Mountain region (9.1%); no big differences by staff type or urbanicity.

COVID-19 — nursing homes

• Highest among licensed practitioners (28.2%), lowest among employees (22.4%).
• Highest in the Pacific (40.7%), lowest in the South (17.5%).
• Higher in urban (24.2%) than rural (17.5%) nursing homes.
• 30 states' nursing homes reached 20%, but only 16 states' hospitals did.

Why coverage is low

• Coverage has fallen during the pandemic: hospital staff flu coverage was 88.6% and 90.0% in the 2017–18 and 2018–19 seasons.
• A CMS requirement (November 2021–June 2023) pushed COVID-19 primary series coverage to 94.3% in nursing homes and 91.2% in hospitals — but updated doses lagged. Vaccine fatigue and other factors may be at work.
• Nursing homes' higher COVID-19 coverage may reflect weekly public reporting required by CMS and CDC's help getting vaccines to residents and staff.
• Mandates have helped flu coverage but are hard to enforce for nonemployee staff. COVID-19 vaccines are newer, supply was more sporadic, and facilities had less experience running vaccination drives.

Limitations: flu and COVID-19 coverage used different staff counts, so they can't be compared directly; vaccinations received outside the facility may be undercounted; people recently infected may have delayed vaccination (by up to 3 months, as CDC allows); and facility-level data could not be broken down by age, race or ethnicity.

What can help

Keep monitoring coverage; study why it is low by region, facility type and job category; and use proven strategies such as making vaccines free and available at work, with campaigns tailored by region and focused on rural areas. Health care personnel should get the flu vaccine every year and stay up to date on COVID-19 vaccination.

Sources

Based on Jeneita Bell, Lu Meng et al., "Influenza and Up-to-Date COVID-19 Vaccination Coverage Among Health Care Personnel — National Healthcare Safety Network, United States, 2022–23 Influenza Season," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; published by CDC.