New Employer-Sponsored Program Effective at Increasing Influenza Vaccination

A study presented at the American Public Health Association annual meeting in San Francisco and recently published in the Journal of Occupational and Environmental Medicine found that influenza-like illness took a significant toll on employee health and productivity during a recent influenza season. A new employer-sponsored influenza immunization program that was developed for this study was effective at engaging both employees and families.

The prospective, multi-site study was designed by Ofstead & Associates, Inc. and conducted in collaboration with a major U.S. manufacturer that is an active member of the Employers Health Coalition. Study sites included factories in three Midwestern towns, with a study population of 13,520 covered employees and dependents.

During the 2010-2011 influenza season, only 35 percent of working-age adults were vaccinated against influenza even though the annual vaccine is recommended for everyone in the United States and vaccination is a covered health benefit for many workers. This is far short of the Healthy People 2020 objective of 80 percent coverage and indicates the need for innovative approaches to achieving higher immunization rates.

"Influenza immunization rates for working adults remain abysmally low," says co-investigator Gregory A. Poland, MD, professor of medicine and infectious diseases at Mayo Clinic in Rochester, Minn. "Education efforts and healthcare systems are failing to reach them. However, this 'hard-to-reach' adult population can be largely found at work. Strategies for increasing vaccination rates should include expanded access to vaccine at the worksite, and consideration should be given to offering influenza vaccination at the same time as other preventive health services, such as annual health screenings."

A baseline survey found that 45 percent of employees experienced influenza-like illness, with high rates of associated absenteeism (>25 percent), presenteeism (>80 percent), and healthcare utilization (30 percent). The economic toll on employees totaled more than $600,000 in lost wages and out-of-pocket costs at each factory. Many employees had concerns and misconceptions about influenza and vaccination, and multiple barriers to receiving vaccine were identified. Employees commonly perceived that immunization was expensive, inconvenient, and unnecessary for healthy adults. The survey findings were used to design multifaceted interventions that provided educational information and addressed barriers to vaccination during the 2010-2011 influenza season.

According to the co-principal investigators, Cori L. Ofstead, MSPH and Bruce W. Sherman, MD, vaccine uptake significantly increased at the two intervention sites, whereas it decreased at the control site, reflecting a national trend toward lower vaccination rates among working adults.  A follow-up survey and claims data analysis revealed that convenient access to free vaccine was the primary driver of immunization. One half of vaccinated employees indicated they would not have received vaccine were it not offered free through the corporation's program.

A strong association was found between employee and family vaccination status. When the employee was vaccinated, nearly all spouses (94 percent) were vaccinated; when the employee was unvaccinated, few spouses (10 percent) were vaccinated. In addition, households with vaccinated employees were significantly more likely to have vaccinated all of their children than households with unvaccinated employees.

Evidence showed that customized, evidence-based education successfully served as an important cue to action, but did not result in significant changes in employee knowledge or beliefs. Employees were motivated to receive vaccine primarily due to economic reasons, including convenient access to free vaccine and a desire to avoid missing work due to illness, rather than fear of catching influenza or transmitting it to others.

"The results from this study demonstrate that convenient access to free employer-sponsored influenza vaccine is the most valued and impactful component of worker immunization," says Sherman. "Employers, particularly those that are self-insured for health benefits, should pursue new approaches to make vaccine available to employees and their family members. As one of the few health interventions that can actually be cost-saving, employer-sponsored influenza vaccination can help to lower healthcare costs and also reduce employee absence and presenteeism."