Influenza and Up-to-Date COVID-19 Vaccination Coverage Among Health Care Personnel - National Healthcare Safety Network, United States, 2022-23 Influenza Season.

The Advisory Committee on Immunization Practices recommends that health care personnel (HCP) receive an annual influenza vaccine and that everyone aged ≥6 months stay up to date with recommended COVID-19 vaccination. Health care facilities report vaccination of HCP against influenza and COVID-19 to CDC's National Healthcare Safety Network (NHSN). During January-June 2023, NHSN defined up-to-date COVID-19 vaccination as receipt of a bivalent COVID-19 mRNA vaccine dose or completion of a primary series within the preceding 2 months. This analysis describes influenza and up-to-date COVID-19 vaccination coverage among HCP working in acute care hospitals and nursing homes during the 2022-23 influenza season (October 1, 2022-March 31, 2023). Influenza vaccination coverage was 81.0% among HCP at acute care hospitals and 47.1% among those working at nursing homes. Up-to-date COVID-19 vaccination coverage was 17.2% among HCP working at acute care hospitals and 22.8% among those working at nursing homes. There is a need to promote evidence-based strategies to improve vaccination coverage among HCP. Tailored strategies might also be useful to reach all HCP with recommended vaccines and protect them and their patients from vaccine-preventable respiratory diseases.

Disparities in COVID-19 Vaccination Coverage Among Health Care Personnel Working in Long-Term Care Facilities, by Job Category, National Healthcare Safety Network - United States, March 2021.

Residents of long-term care facilities (LTCFs) and health care personnel (HCP) working in these facilities are at high risk for COVID-19-associated mortality. As of March 2021, deaths among LTCF residents and HCP have accounted for almost one third (approximately 182,000) of COVID-19-associated deaths in the United States (1). Accordingly, LTCF residents and HCP were prioritized for early receipt of COVID-19 vaccination and were targeted for on-site vaccination through the federal Pharmacy Partnership for Long-Term Care Program (2). In December 2020, CDC's National Healthcare Safety Network (NHSN) launched COVID-19 vaccination modules, which allow U.S. LTCFs to voluntarily submit weekly facility-level COVID-19 vaccination data.* CDC analyzed data submitted during March 1-April 4, 2021, to describe COVID-19 vaccination coverage among a convenience sample of HCP working in LTCFs, by job category, and compare HCP vaccination coverage rates with social vulnerability metrics of the surrounding community using zip code tabulation area (zip code area) estimates. Through April 4, 2021, a total of 300 LTCFs nationwide, representing approximately 1.8% of LTCFs enrolled in NHSN, reported that 22,825 (56.8%) of 40,212 HCP completed COVID-19 vaccination.† Vaccination coverage was highest among physicians and advanced practice providers (75.1%) and lowest among nurses (56.7%) and aides (45.6%). Among aides (including certified nursing assistants, nurse aides, medication aides, and medication assistants), coverage was lower in facilities located in zip code areas with higher social vulnerability (social and structural factors associated with adverse health outcomes), corresponding to vaccination disparities present in the wider community (3). Additional efforts are needed to improve LTCF immunization policies and practices, build confidence in COVID-19 vaccines, and promote COVID-19 vaccination. CDC and partners have prepared education and training resources to help educate HCP and promote COVID-19 vaccination coverage among LTCF staff members.§.

Evaluation of the impact of the 2012 Rhode Island health care worker influenza vaccination regulations: implementation process and vaccination coverage.

CONTEXT: In October 2012, the Rhode Island Department of Health (HEALTH) amended its health care worker (HCW) vaccination regulations to require all HCWs to receive annual influenza vaccination or wear a surgical mask during direct patient contact when influenza is widespread. Unvaccinated HCWs failing to wear a mask are subject to a fine and disciplinary action. OBJECTIVE: To describe the implementation of the 2012 Rhode Island HCW influenza vaccination regulations and examine their impact on vaccination coverage. DESIGN: Two data sources were used: (1) a survey of all health care facilities subject to the HCW regulations and (2) HCW influenza vaccination coverage data reported to HEALTH by health care facilities. Descriptive statistics and paired t tests were performed using SAS Release 9.2. SETTING AND PARTICIPANTS: For the 2012-2013 influenza season, 271 inpatient and outpatient health care facilities in Rhode Island were subject to the HCW regulations. MAIN OUTCOME MEASURE: Increase in HCW influenza vaccination coverage. RESULTS: Of the 271 facilities, 117 facilities completed the survey (43.2%) and 160 facilities reported vaccination data to HEALTH (59.0%). Between the 2011-2012 and 2012-2013 influenza seasons, the proportion of facilities having a masking policy, as required by the revised regulations, increased from 9.4% to 94.0% (P < .001). However, the proportion of facilities implementing Advisory Committee on Immunization Practices-recommended strategies to promote HCW influenza vaccination did not increase. The majority of facilities perceived benefits to collecting HCW influenza vaccination data, including strengthening infection prevention efforts (83.2%) and improving patient and coworker safety (75.2%). Concurrent with the new regulations, influenza vaccination coverage among employee HCWs in Rhode Island increased from 69.7% in the 2011-2012 influenza season to 87.2% in the 2012-2013 season. CONCLUSION: Rhode Island's experience demonstrates that statewide HCW influenza vaccination requirements incorporating mask wearing and moderate penalties for noncompliance can be effective in improving influenza vaccination coverage among HCWs.

Influenza vaccination performance measurement among acute care hospital-based health care personnel--United States, 2013-14 influenza season.

Annual influenza vaccination is recommended for all health care personnel (HCP). In August 2011, the Centers for Medicare and Medicaid Services (CMS) published a final rule requiring acute care hospitals that participate in its Hospital Inpatient Quality Reporting Program to report HCP influenza vaccination data through the National Healthcare Safety Network (NHSN) beginning January 1, 2013. Data reported by 4,254 acute care hospitals, covering the period October 1, 2013, through March 31, 2014, were analyzed to collect estimates of the proportion of HCP vaccinated nationally and by state for three groups: (1) employees, (2) licensed independent practitioners (LIPs), and (3) adult students/trainees and volunteers. Overall in the United States, 81.8% of hospital-based HCP were reported vaccinated, with the highest proportion (86.1%) among employees and the lowest (61.9%) among LIPs. The proportion reported vaccinated varied widely by state, with ranges of 69.0%-97.6% for employees, 33.8%-93.6% for LIPs, and 50.3%-96.3% for adult students/trainees and volunteers. Public reporting of vaccination data has been shown to increase HCP influenza vaccination coverage. These new NHSN data provide a baseline for measuring changes in future hospital-based reporting of HCP influenza vaccination.

Coronavirus disease 2019 (COVID-19) vaccination rates and staffing shortages among healthcare personnel in nursing homes before, during, and after implementation of mandates for COVID-19 vaccination among 15 US jurisdictions, National Healthcare Safety Network, June 2021-January 2022.

OBJECTIVE: To examine temporal changes in coverage with a complete primary series of coronavirus disease 2019 (COVID-19) vaccination and staffing shortages among healthcare personnel (HCP) working in nursing homes in the United States before, during, and after the implementation of jurisdiction-based COVID-19 vaccination mandates for HCP. SAMPLE AND SETTING: HCP in nursing homes from 15 US jurisdictions. DESIGN: We analyzed weekly COVID-19 vaccination data reported to the Centers for Disease Control and Prevention's National Healthcare Safety Network from June 7, 2021, through January 2, 2022. We assessed 3 periods (preintervention, intervention, and postintervention) based on the announcement of vaccination mandates for HCP in 15 jurisdictions. We used interrupted time-series models to estimate the weekly percentage change in vaccination with complete primary series and the odds of reporting a staffing shortage for each period. RESULTS: Complete primary series vaccination among HCP increased from 66.7% at baseline to 94.3% at the end of the study period and increased at the fastest rate during the intervention period for 12 of 15 jurisdictions. The odds of reporting a staffing shortage were lowest after the intervention. CONCLUSIONS: These findings demonstrate that COVID-19 vaccination mandates may be an effective strategy for improving HCP vaccination coverage in nursing homes without exacerbating staffing shortages. These data suggest that mandates can be considered to improve COVID-19 coverage among HCP in nursing homes to protect both HCP and vulnerable nursing home residents.

Surveillance of COVID-19 Vaccination in Nursing Homes, United States, December 2020-July 2021.

Monitoring COVID-19 vaccination coverage among nursing home residents and staff is important to ensure high coverage rates and guide patient-safety policies. With the termination of the federal Pharmacy Partnership for Long-Term Care Program, another source of facility-based vaccination data is needed. We compared numbers of COVID-19 vaccinations administered to nursing home residents and staff reported by pharmacies participating in the temporary federal Pharmacy Partnership for Long-Term Care Program with the numbers of COVID-19 vaccinations reported by nursing homes participating in new COVID-19 vaccination modules of the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN). Pearson correlation coefficients comparing the number vaccinated between the 2 approaches were 0.89, 0.96, and 0.97 for residents and 0.74, 0.90, and 0.90 for staff, in the weeks ending January 3, 10, and 17, 2021, respectively. Based on subsequent NHSN reporting, vaccination coverage with ≥1 vaccine dose reached 73.7% for residents and 47.6% for staff the week ending January 31 and increased incrementally through July 2021. Continued monitoring of COVID-19 vaccination coverage is important as new nursing home residents are admitted, new staff are hired, and additional doses of vaccine are recommended.

Reduced sexual risk behaviors among people living with HIV: Results from the Healthy Relationships Outcome Monitoring Project.

In 2006, the Centers for Disease Control and Prevention funded seven community-based organizations (CBOs) to conduct outcome monitoring of Healthy Relationships. Healthy Relationships is an evidence-based behavioral intervention for people living with HIV. Demographic and sexual risk behaviors recalled by participants with a time referent of the past 90 days were collected over a 17-month project period using a repeated measures design. Data were collected at baseline, and at 3 and 6 months after the intervention. Generalized estimating equations were used to assess the changes in sexual risk behaviors after participation in Healthy Relationships. Our findings show that participants (n = 474) in the outcome monitoring project reported decreased sexual risk behaviors over time, such as fewer number of partners (RR = 0.55; 95% CI 0.41-0.73, P < 0.001) and any unprotected sex events (OR = 0.44; 95% CI 0.36-0.54, P < 0.001) at 6 months after the intervention. Additionally, this project demonstrates that CBOs can successfully collect and report longitudinal outcome monitoring data.

Association of State Laws With Influenza Vaccination of Hospital Personnel.

INTRODUCTION: Healthcare personnel influenza vaccination can reduce influenza illness and patient mortality. State laws are one tool promoting healthcare personnel influenza vaccination. METHODS: A 2016 legal assessment in 50 states and Washington DC identified (1) assessment laws: mandating hospitals assess healthcare personnel influenza vaccination status; (2) offer laws: mandating hospitals offer influenza vaccination to healthcare personnel; (3) ensure laws: mandating hospitals require healthcare personnel to demonstrate proof of influenza vaccination; and (4) surgical masking laws: mandating unvaccinated healthcare personnel to wear surgical masks during influenza season. Influenza vaccination was calculated using data reported in 2016 by short-stay acute care hospitals (n=4,370) to the National Healthcare Safety Network. Hierarchical linear modeling in 2018 examined associations between reported vaccination and assessment, offer, or ensure laws at the level of facilities nested within states, among employee and non-employee healthcare personnel and among employees only. RESULTS: Eighteen states had one or more healthcare personnel influenza vaccination-related laws. In the absence of any state laws, facility vaccination mandates were associated with an 11-12 percentage point increase in mean vaccination coverage (p<0.0001). Facility-level mandates were estimated to increase mean influenza vaccination coverage among all healthcare personnel by 4.2 percentage points in states with assessment laws, 6.6 percentage points in states with offer laws, and 3.1 percentage points in states with ensure laws. Results were similar in analyses restricted only to employees although percentage point increases were slightly larger. CONCLUSIONS: State laws moderate the effect of facility-level vaccination mandates and may help increase healthcare personnel influenza vaccination coverage in facilities with or without vaccination requirements.

Evaluation of the First Year of National Reporting on a New Healthcare Personnel Influenza Vaccination Performance Measure by US Hospitals.

One thousand hospitals were surveyed on a new measure of healthcare personnel influenza vaccination for the 2012-2013 influenza season. Facilities found it easier to collect data on employees than nonemployees; larger facilities reported more challenges than smaller facilities. Barriers may decrease over time as facilities become accustomed to the measure.

Influenza vaccination of health care personnel: Experiences with the first year of a national data collection effort.

BACKGROUND: The purpose of this project was to evaluate a standardized measure of health care personnel (HCP) influenza vaccination during the first year of implementation. The measure requires acute care hospitals to gather vaccination status data from employees, licensed independent practitioners (LIPs), and adult students/trainees and volunteers. The evaluation included a hospital sampling frame stratified by 4 United States Census Bureau Regions and hospital bed count. The hospitals were selected within strata using simple random sampling and the probability proportional to size method, without replacement. METHODS: Semi-structured telephone interviews were conducted. Two qualitative data analysts independently coded each interview, and data were synthesized using a thematic analysis. This evaluation took place at hospitals reporting HCP influenza vaccination data as part of the Centers for Medicare & Medicaid Services Hospital Inpatient Quality Reporting (IQR) Program. Participants included the staff at 46 hospitals who were knowledgeable about data collection to fulfill IQR program requirements. RESULTS: Facilitators of data collection included having a small number of HCP, having a data collection system already in place, and providing HCP with advance notice of data collection. Major challenges included the absence of an established tracking process and monitoring HCP not regularly working in the facility, particularly LIPs. More than half of the facilities noted the time- and/or resource-intensive nature of data collection. Most facilities used data collected to meet other reporting requirements beyond the IQR Program. CONCLUSIONS: Hospitals implemented a range of data collection methods to comply with reporting requirements. Lessons learned from the first year of measure implementation can be used to enhance data collection practices across HCP groups for future influenza seasons.

Qualitative evaluation of Rhode Island's healthcare worker influenza vaccination regulations.

OBJECTIVE: To evaluate Rhode Island's revised vaccination regulations requiring healthcare workers (HCWs) to receive annual influenza vaccination or wear a mask during patient care when influenza is widespread. DESIGN: Semi-structured telephone interviews conducted in a random sample of healthcare facilities. SETTING: Rhode Island healthcare facilities covered by the HCW regulations, including hospitals, nursing homes, community health centers, nursing service agencies, and home nursing care providers. Participants Staff responsible for collecting and/or reporting facility-level HCW influenza vaccination data to comply with Rhode Island HCW regulations. METHODS: Interviews were transcribed and individually coded by interviewers to identify themes; consensus on coding differences was reached through discussion. Common themes and illustrative quotes are presented. RESULTS: Many facilities perceived the revised regulations as extending their existing influenza vaccination policies and practices. Despite variations in implementation, nearly all facilities implemented policies that complied with the minimum requirements of the regulations. The primary barrier to implementing the HCW regulations was enforcement of masking among unvaccinated HCWs, which required timely tracking of vaccination status and additional time and effort by supervisors. Factors facilitating implementation included early and regular communication from the state health department and facilities' ability to adapt existing influenza vaccination programs to incorporate provisions of the revised regulations. CONCLUSIONS: Overall, facilities successfully implemented the revised HCW regulations during the 2012-2013 influenza season. Continued maintenance of the regulations is likely to reduce transmission of influenza and resulting morbidity and mortality in Rhode Island's healthcare facilities.

Retaining clients in an outcome monitoring evaluation study: HIV prevention efforts in community settings.

The Centers for Disease Control and Prevention (CDC), Division of HIV/AIDS Prevention (DHAP) conducted outcome monitoring studies on evidence-based interventions (EBIs) provided by CDC-funded community-based organizations (CBOs). Critical to the success of outcome monitoring was the ability of CBOs to recruit and retain clients in evaluation studies. Two EBIs, Video Opportunities for Innovative Condom Education and Safer Sex (VOICES/VOCES) and Healthy Relationships, were evaluated using repeated measure studies, which require robust follow-up retention rates to increase the validity and usefulness of the findings. The retention rates were high for both VOICES/VOCES CBOs (95.8% at 30 days and 91.1% at 120 days), and Healthy Relationships CBOs (89.5% at 90 days and 83.5% at 180 days). This paper presents an overview of the retention of clients, challenges to follow-up, and strategies developed by CBOs to achieve high retention rates. These strategies and rates are discussed within the context of the CBOs' target populations and communities.

Examining HIV infection among male sex workers in Bangkok, Thailand: a comparison of participants recruited at entertainment and street venues.

HIV prevalence and associated factors were examined among male sex workers (MSWs, N = 414) in Bangkok, Thailand. Cross-sectional venue-day-time sampling was used to collect data in entertainment and street venues. Chi-square and logistic regression were used to identify HIV risk factors. HIV prevalence was 18.8% overall, but differences were found between MSW recruited in entertainment and street venues. Significant relationships were found between several demographic, behavioral, exposure to HIV prevention, and other characteristics, and recruitment location. In multivariate analyses, being sexually attracted to men was significantly associated with HIV infection among both groups of sex workers. In addition, among street-based sex workers, not having had sex with a woman in the past 3 months, having ever had a sexually transmitted disease symptom, and not having a friend to talk to about personal problems were significantly associated with HIV infection.