Flu and COVID-19 Vaccination Among Health Care Workers, 2023–24

Health care workers are exposed to respiratory viruses on the job, and vaccinating them helps keep the workforce healthy and reduces staffing shortages. The Advisory Committee on Immunization Practices (ACIP) recommends a flu vaccine every year for health care personnel, and in September 2023 it recommended the 2023–2024 COVID-19 vaccine for everyone 6 months and older.

The Centers for Medicare & Medicaid Services requires hospitals and nursing homes to report staff vaccination to CDC's National Healthcare Safety Network (NHSN). This report covers the 2023–24 respiratory virus season, October 1, 2023, to March 31, 2024.

Flu and 2023–2024 COVID-19 vaccination coverage among health care personnel, by facility type and state. Credit: Centers for Disease Control and Prevention.

The headline numbers

Fewer than one in six health care workers at hospitals and nursing homes got the updated COVID-19 vaccine, and fewer than half of nursing home workers got a flu shot.

Who was vaccinated

Hospitals. Employees had the highest flu coverage (83.6%) and licensed independent practitioners the lowest (65.7%). They were also least covered for COVID-19 (12.7%, compared with 15.9% of employees), pointing to ongoing trouble vaccinating nonemployees and recording shots they get elsewhere. Flu coverage ranged from 84.5% in the Mountain region to 74.3% in the Pacific.

Nursing homes. For flu, students, trainees and volunteers had the highest coverage (58.1%) and employees the lowest (44.5%); the Northeast led (58.6%) and the South trailed (38.1%). Only five states' nursing homes reached 75% flu coverage. For COVID-19, licensed independent practitioners were highest (18.8%) and employees lowest (10.0%); coverage was highest in the Pacific (14.2%) and lowest in the South (8.6%), and only two states' nursing homes reached 20%.

In general, coverage was higher in urban than rural facilities and lower in the South.

Going the wrong way

Hospital flu coverage held steady but remains well below the 91% reached in the 2019–20 season, before the pandemic.

Why the COVID-19 drop in nursing homes? CMS's requirement to vaccinate staff against COVID-19 expired in June 2023, and in fall 2023 the vaccines were commercialized — changes that may have disrupted on-site vaccination and raised costs for facilities and workers. A recent survey found health care workers see COVID-19 as a serious threat but have little confidence in the vaccine's effectiveness, safety and benefit. In one study, workers who felt well informed about the vaccine were 10 times as likely to get it and four times as likely to recommend it. Multifaceted campaigns with on-site vaccination have been shown to work.

Limitations

• Flu and COVID-19 coverage were reported separately with different staff counts, so the two can't be directly compared, and it's unknown how many workers had both.
• Facilities report on staff's behalf, which may miss vaccinations received elsewhere.
• Some workers may have delayed COVID-19 vaccination after a recent infection, as CDC guidance allows.
• Data are aggregated by facility, so coverage can't be broken down by age, race and ethnicity or job.

Why it still matters

The COVID-19 public health emergency is over, but thousands of COVID-19 hospitalizations and hundreds of deaths still occur each week. The authors call for research into strategies that work when vaccine confidence is low, and for education on vaccine safety and effectiveness — which can also reduce staffing shortages.

Sources

Based on Bell J, Meng L, Barbre K, et al., "Influenza and COVID-19 Vaccination Coverage Among Health Care Personnel — National Healthcare Safety Network, United States, 2023–24 Respiratory Virus Season," Morbidity and Mortality Weekly Report 73(43), Centers for Disease Control and Prevention; a work of the United States government in the public domain. Original report.