Influenza and COVID-19 Vaccination Coverage Among Health Care Personnel – United States, 2023-24 Influenza Season

Overall, 75.4% of HCP reported having received an influenza vaccination during the 2023-2024 season, similar to the 75.9% reported in the 2022–2023 season (Table 1). Among all HCP, influenza vaccination coverage over the previous ten seasons ranged from 77.3%-81.1%, steadily increased from the 2014–2015 season through the 2018–2019 seasons, and then decreased between the 2019–2020 and 2020–2021 seasons and between the 2021–2022 and 2023–2024 seasons after an apparent increase in 2021–2022 (Figure 1). Similar patterns were seen for HCP working in ambulatory care and other clinical settings. While coverage among HCP working in hospitals declined from a high of 95.2% in 2018–2019 to 85.7% in 2022–23 and 89.1% in 2023-2024, coverage among HCP working in LTC settings has remained stable from 2015–2016 (69.2%) through 2023–2024 (65.2%) (Figure 1). As in previous seasons, influenza vaccination coverage in 2023–2024 was highest among HCP working in hospitals (89.1%) and lowest among HCP working in LTC and home health care settings (65.2%) (Table 1, Figure 1). Influenza vaccination coverage was highest among pharmacists (93.9%), physicians (93.0%), nurses (87.6%), and nurse practitioners and physician assistants (85.7%) and lower among other clinical personnel (81.8%), non-clinical personnel (69.5%), and assistants/aides (63.2%); similar patterns were seen in previous seasons (Table 1, Figure 2). Estimates and 95% CIs for influenza seasons 2014–2015 through 2023–2024 are reported in the supplemental Table S1.

During the 2023–2024 season, significantly higher influenza vaccination coverage was reported among Asian, non-Hispanic HCP (89.2%) than White, non-Hispanic HCP (75.9%); HCP with either a master's, professional, or doctoral degree (83.7%) than among those with some college education or less (59.5%); and among HCP who were male (84.8%) than female (72.5%). Influenza vaccination coverage was also highest among HCP who were aged ≥60 years (80.7%), HCP who reported working in a non-rural area (76.1%), and the Midwest region (80.4%). No statistically significant changes in influenza vaccination coverage compared with the 2022–2023 season were observed in any HCP group.

Table 1. Receipt of influenza vaccination during 2022-2023 and 2023-2024 influenza seasons among health care personnel, by selected characteristics — Internet panel surveys^*, United States, April 2024

^{Abbreviation: CI = confidence interval; Ref = referent group.}

^{* Respondents were recruited from two preexisting national opt-in Internet sources: Medscape (https://www.medscape.com), a medical website managed by WebMD Health Professional Network, and general population Internet panels operated by Dynata (Dynata_Panel_Book.pdf).† Modified Clopper-Pearson 95% CI according to the approach of Korn and Graubard (https://www150.statcan.gc.ca/n1/en/pub/12-001-x/1998002/article/4356-eng.pdf?st = nQVSWv1i).}

^{§ Statistically significant (p<0.05) when compared with ref in the same season.}

^{¶ Race and ethnicity were self-reported. Respondents identified as Hispanic might be of any race. The "Other" race category included persons who identified as American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and persons who selected multiple races.}

^{** Estimates do not meet the National Center for Health Statistics' standards of reliability. https://www.cdc.gov/nchs/data/series/sr_02/sr02_175.pdf.}

^{†† Excludes students.}

^{§§ Includes dentists, allied health professionals, technicians and technologists, emergency technicians, emergency medical technicians, and paramedics.}

^{¶¶ Includes administrative support staff members and managers, and non-clinical support staff members.}

^{*** Respondents could select more than one work setting. Each work setting is represented by a separate variable with two values (yes and no, where reference value is no).}

^{††† Nursing home, assisted living facility, other long-term care facility, home health agency, or home health care.}

^{§§§ Includes dentist office or dental clinic, pharmacy, emergency medical services, and other settings where clinical care or related services were provided to patients.}

^{¶¶¶ Rurality was defined using zip codes in which >50% of the population resides in a nonmetropolitan county, a rural U.S. Census Bureau tract, or both, according to the Health Resources and Services Administration's definition of rural population. https://www.hrsa.gov/rural-health/about-us/what-is-rural.}

^{**** https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf.}

^{†††† Excludes those with employer influenza vaccination requirement.}

Figure 1. Percentage of health care personnel who received influenza vaccination, by work setting^* — Internet panel surveys^†, United States, 2014-2015 through 2023-2024 influenza seasons^§

View LargerDownload

^{*Respondents could select more than one work setting. The other clinical setting category includes dentist office or dental clinic, pharmacy, emergency medical services, and other settings where clinical care or related services were provided to patients.}

^{†Respondents were recruited from two preexisting national opt-in Internet sources: Medscape (https://www.medscape.com), a medical website managed by WebMD Health Professional Network, and general population Internet panels operated by Dynata (Dynata_Panel_Book.pdf).}

^{§During the 2020-2021 influenza season, a weighting methodological change was implemented. Prior to the 2020-2021 influenza season, weights were calculated to population control totals controlling for the main effects (occupation, age group, race and ethnicity, gender, work setting, and Census region); From the 2020-2021 influenza season and onward, interaction terms between occupation and the other main effects were added in the weighting model. Influenza Vaccination Coverage Among Health Care Personnel — United States, 2020–21 Influenza Season | FluVaxView | Seasonal Influenza (Flu) | CDC}

Figure 2. Percentage of health care personnel who received influenza vaccination, by occupation* — Internet panel surveys^†, United States, 2014-2015 through 2023-2024 influenza seasons^§

View LargerDownload

^{*Other clinical personnel include dentists, allied health professionals, technicians and technologists, emergency medical technicians, and paramedics. Non-clinical personnel includes administrative support staff members and managers, and non-clinical support staff members.}

^{†Respondents were recruited from two preexisting national opt-in Internet sources: Medscape (https://www.medscape.com), a medical website managed by WebMD Health Professional Network, and general population Internet panels operated by Dynata (Dynata_Panel_Book.pdf).}

^{§During the 2020-2021 influenza season, a major weighting methodological change was implemented. Prior to the 2020-2021 influenza season, weights were calculated to population control totals controlling for the main effects (occupation, age group, race and ethnicity, gender, work setting, and Census region); From the 2020-2021 influenza season and onward, interaction terms between occupation and the other main effects were added in the weighting model. Influenza Vaccination Coverage Among Health Care Personnel — United States, 2020–21 Influenza Season | FluVaxView | Seasonal Influenza (Flu) | CDC.}

Overall, 31.3% of HCP reported having received the updated 2023–24 COVID-19 vaccine (Table 2), compared with 38.6% who reported having received a COVID-19 bivalent vaccine during the 2022–2023 survey7. Receipt of the 2023–24 updated COVID-19 vaccine was highest among Asian, non-Hispanic HCP (53.4%), physicians (52.7%), HCP aged ≥60 years (45.0%), and those who reported receiving an influenza vaccine in 2023-2024 (39.2%). Receipt of the updated 2023–24 COVID-19 vaccine was lowest among HCP who were aged 30-44 years (28.5%), Hispanic (28.7%), had some college education or less (25.4%), were assistants/aides (27.7%), and working in ambulatory care (26.1%) (Table 2).

Table 2. Receipt of updated 2023-24 COVID-19 vaccine^* among health care personnel, by selected characteristics — Internet panel surveys^†, United States, April 2024

^{Abbreviations: CI = confidence interval; Ref = referent group.}

^{* Respondents were considered to have received an updated 2023-24 COVID-19 vaccine if they responded "Yes" to the question, "An updated COVID-19 vaccine (2023-2024 formula) became available in September 2023. Have you received an updated 2023-24 COVID-19 vaccine?"}

^{† Respondents were recruited from two preexisting national opt-in Internet sources: Medscape (https://www.medscape.com), a medical website managed by WebMD Health Professional Network, and general population Internet panels operated by Dynata (Dynata_Panel_Book.pdf).}

^{§ Modified Clopper-Pearson 95% CI according to the approach of Korn and Graubard (https://www150.statcan.gc.ca/n1/en/pub/12-001-x/1998002/article/4356-eng.pdf?st = nQVSWv1i).}

^{¶ Statistically significant (p<0.05) when compared with Ref.}

^{** Race and ethnicity were self-reported. Respondents who identified as Hispanic might be of any race. The "Other" race category included persons who identified as American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and persons who selected multiple races.}

^{†† Estimate does not meet CDC's National Center for Health Statistics' standards of reliability (https://www.cdc.gov/nchs/data/series/sr_02/sr02_175.pdf).}

^{§§ Excludes students (N=31).}

^{¶¶ Includes dentists, allied health professionals, technicians and technologists, emergency technicians, emergency medical technicians, and paramedics.}

^{*** Includes administrative support staff members and managers, and nonclinical support staff members.}

^{††† Respondents could select more than one work setting. Each work setting is represented by a separate variable with two values (yes and no, where reference value is no).}

^{§§§ Nursing home, assisted living facility, other long-term care facility, home health agency, or home health care.}

^{¶¶¶ Includes dentist office or dental clinic, pharmacy, emergency medical services, and other settings where clinical care or related services were provided to patients.}

^{**** Rurality was defined using zip codes in which >50% of the population resides in a nonmetropolitan county, a rural U.S. Census Bureau tract, or both, according to the Health Resources and Services Administration's definition of rural population. https://www.hrsa.gov/rural-health/about-us/what-is-rural.}

^{†††† https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf.}

^{§§§§ Excludes those with employer updated COVID-19 vaccination requirement.}

Employer requirements for receipt of influenza and updated 2023–24 COVID-19 vaccination were reported by 39.2% and 12.5% of HCP overall, respectively (Figure 3A). HCP working in LTC settings were less likely to report requirements for influenza vaccine (25.6%) compared with HCP working in ambulatory care settings (33.4%) and hospitals (62.1%). For the updated 2023–24 COVID-19 vaccine, HCP working in ambulatory care settings were less likely to report requirements for receipt of vaccine (10.2%) compared with HCP working in hospital (14.8%) or LTC (13.5%) settings.

Influenza vaccination coverage was highest among HCP who reported an employer requirement for influenza vaccination (97.5%) compared with those who reported an employer recommendation for vaccination without a requirement (74.1%) or no recommendation or requirement for vaccination (38.8%). Updated 2023–24 COVID-19 vaccination coverage was also higher among HCP who reported an employer requirement for updated COVID-19 vaccination (55.6%) than among those who reported an employer recommendation without a requirement (38.1%), or no recommendation or requirement (15.7%) (Figure 3B). Additionally, among HCP who were not required by their employer to be vaccinated, 74.2% were vaccinated for influenza and 40.8% were vaccinated with the updated 2023–24 COVID-19 vaccine when their employers offered these vaccines onsite at the workplace, compared with 45.5% and 23.3%, respectively, among those whose employers did not offer these vaccines onsite (Table 1 and 2).

Figure 3. Prevalence of employer requirement or recommendation for influenza and updated 2023-24 COVID-19 vaccination^† (A) and vaccination coverage, by employer requirement status (B) among health care personnel, by work setting – Internet panel surveys^§, United States, April 2024

View LargerDownload

*^{Estimates do not meet the National Center for Health Statistics' standards of reliability and should be interpreted with caution.}

^{†Respondents were considered to have received an updated 2023-24 COVID-19 vaccine if they responded "Yes" to the question, "An updated COVID-19 vaccine (2023-2024 formula) became available in September 2023. Have you received an updated 2023-24 COVID-19 vaccine?"}

^{§Respondents were recruited from two preexisting national opt-in Internet sources: Medscape (https://www.medscape.com), a medical website managed by WebMD Health Professional Network, and general population Internet panels operated by Dynata (Dynata_Panel_Book.pdf).}

When asked about their attitudes towards influenza and COVID-19 and influenza and COVID-19 vaccinations, most HCP agreed that they are at risk for getting influenza (71.3%) and COVID-19 (71.0%). The majority of the HCP surveyed also agreed that people around them were at risk of getting influenza (79.9%) and COVID-19 (79.3%). When asked if the influenza vaccination or COVID-19 vaccination can protect them from getting influenza or COVID-19, 78.4% agreed that influenza vaccination can protect them, whereas only 59.6% agreed that COVID-19 vaccinations can protect them from getting COVID-19. Furthermore, 84.6% of HCP agreed that the influenza vaccination was safe, compared with 63.3% of HCP who agreed that the COVID-19 vaccination was safe. When asked about requirements for vaccination, 58.8% agreed that HCP should be required to be vaccinated against influenza, but only 43.7% agreed that HCP should be required to be vaccinated against COVID-19 (Figure 4).

Figure 4. Attitudes toward influenza and COVID-19 and influenza and COVID-19 vaccinations^* among health care personnel – Internet panel surveys^†, United States 2024

View LargerDownload

*^{Percent of health care personnel who agreed with each attitude statement among respondents. Weighted percentages are shown.}

^{†Respondents were recruited from two preexisting national opt-in Internet sources: Medscape (https://www.medscape.com), a medical website managed by WebMD Health Professional Network, and general population Internet panels operated by Dynata (Dynata_Panel_Book.pdf).}

*^{Respondents were recruited from two preexisting national opt-in Internet sources: Medscape (https://www.medscape.com), a medical website managed by WebMD Health Professional Network, and general population Internet panels operated by Dynata (Dynata_Panel_Book.pdf).†During 2020-21 influenza season, a weighting methodological change was implemented. Prior to 2020-21 influenza season, weights were calculated to population control totals controlling for the main effects (occupation, age group, race and ethnicity, gender, work setting, and Census region); 2020-21 influenza season and onward, interaction terms between occupation and the other main effects were added in the weighting model. Influenza Vaccination Coverage Among Health Care Personnel — United States, 2020–21 Influenza Season | FluVaxView | Seasonal Influenza (Flu) | CDC.}

^{§Modified Clopper-Pearson 95% CI according to the approach of Korn and Graubard (https://www150.statcan.gc.ca/n1/en/pub/12-001-x/1998002/article/4356-eng.pdf?st = nQVSWv1i).}

^{¶Excludes students.}

**^{Includes dentists, allied health professionals, technicians and technologists, emergency technicians, emergency medical technicians, and paramedics.}

^{††Includes administrative support staff members and managers, and non-clinical support staff members.}

^{§§Respondents could select more than one work setting. Each work setting is represented by a separate variable with two values (yes and no, where reference value is no).}

^{¶¶Nursing home, assisted living facility, other long-term care facility, home health agency, or home health care.}

***^{Includes dentist office or dental clinic, pharmacy, emergency medical services, and other settings where clinical care or related services were provided to patients.}