1. Unwillingness to Obtain the Influenza Vaccine among Chicago Department of Public Health Sexually Transmitted Infection (STI) Clinic Health Care Workers Lindsay Pluff, MPH Public Health Associate Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention PHAP Summer Seminar May 13, 2016 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

2. 1.Hollmeyer, H.G., Hayden, F., Poland, G., & Bucholz, U. (2009). Influenza vaccination of health care workers in hospitals – A review of studies on attitudes and predictors. Vaccine, 27, 3935-3944. 2.Centers for Disease Control and Prevention (25 Nov 2011).Immunization of Health-Care Personnel Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, 60(7). 3.Office of Disease Prevention and Health Promotion (2Mar2016). Healthy People 2020: Immunization and Infectious Diseases. https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases. https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases  The influenza vaccine is very important for health care workers (HCW)  Protects patients & coworkers  Reduces absenteeism & presenteeism  Recommendations & Goals  American Committee on Immunization Practices (ACIP)  Healthy People 2020 Public Health Significance

3. Motivations for the study  Health Departments should be a model for the community  Large-scale studies rarely focus on Health Department staff  Objectives:  Describe staff knowledge and perceptions of influenza vaccine  Determine the impact of knowledge and perceptions on unwillingness to receive a vaccination

4. Chicago Department of Public Health  No records of employee vaccination rates  Influenza vaccination encouraged  Free vaccination drives offered throughout influenza season  Educational materials displayed  Division of HIV/STI  Offer free testing and comprehensive treatment for gonorrhea, chlamydia, syphilis & HIV  Staff includes Disease Intervention Specialists (DIS) and clinical personnel  Staff has frequent interactions with immune suppressed clients

5. Methods  Influenza Survey  Adapted from the 2012 National Flu Survey  Anonymous, self-administered  Administered during a staff meeting in fall 2015  Inclusion criteria  Staff of STI clinic Clinical staff Partner service staff  Statistical methods  Logistic regression analysis 1.Centers for Disease Control and Prevention (Mar 2012). National Flu Survey.

6. Variable N= 50 Fall 2015 survey Age 25-49 50-64 65+ Not answered 19(38%) 23(46%) 3(6%) 5(10%) Sex Male Female Other Not answered Ethnicity Hispanic Non- Hispanic Not answered 11(21%) 36(72%) 1(2%) 2(5%) 13(26%) 30(60%) 7(14%) Variable N= 50 Fall 2015 survey Race White Black American Indian Asian Other/Mixed Not answered 16(32%) 19(38%) 1(2%) 5(10%) 4(8%) Position Clinician CMA/Lab Admin/Clerical DIS Management Other Not answered 7(14%) 6(12%) 5(10%) 12(24%) 7(14%) 9(18%) 4(8%) Results

7. 68% (n=34) willing to obtain the vaccine 24% (n=12) were unwilling to obtain the vaccine 2% (n=3) reported that not knowing 1% (n= 1) did not answer the question Willingness to obtain the flu shot

8. Perceptions: Effectiveness  Unwillingness was associated with uncertainty of vaccine effectiveness  OR: 6.21  CI: 1.31±85.86  p: 0.03

9. Perceptions: Safety  Unwillingness was associated with uncertainty of vaccine safety  OR: 17.4  CI: 3.72±217.1  p: 0.003

10. Perception: Risk of Influenza  Unwillingness was associated with a low perceived risk of influenza OR: 10.5 CI: 2.4±106.71 p: 0.001

11. Knowledge: Familiarity with Recommendations  Unwillingness was associated with lack of awareness of recommendation OR: 6.4 CI: 0.8±616.9 p: 0.00003

12. Conclusions  24% (n=12) were unwilling to obtain the influenza vaccine  Consistent with current trends but well below national goal  26% (n=13) lacked awareness of recommendation  Unwillingness was associated with:  uncertainty of safety and effectiveness  low perceived risk of influenza  lack of awareness of recommendations 1.Centers for Disease Control and Prevention. (2015). Influenza Vaccination Information for Health Care Workers. http://www.cdc.gov/flu/healthcareworkers.htm http://www.cdc.gov/flu/healthcareworkers.htm

13. Limitations  Data from one time point  Follow up surveys to be completed in spring 2016  Addresses willingness, rather than receipt  Small sample size  N= 50  Biases:  Self-reported survey  Response bias  Time and place of administration

14. Implications for Future Work  Interventions targeting safety, effectiveness, risk of influenza and vaccine recommendations  Posters  Presentations  Trainings  Follow up surveys  Pre- and post-influenza season surveys  Measures impact of interventions  Establishes baseline  Follow trends over time

15. Acknowledgements  Ramona Bhatia, MD, MS  Dawn Broussard, MPH  Irina Tabidze, MD, MPH  Chicago Department of Public Health HIV/STI Division  Centers for Disease Control and Prevention

16. For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support 4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: OSTLTSfeedback@cdc.govWeb: http://www.cdc.gov/stltpublichealthOSTLTSfeedback@cdc.govhttp://www.cdc.gov/stltpublichealth The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Lindsay Pluff, MPH kzt1@cdc.gov Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support